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Results for “Contraception Continuation”

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PubMed1982

[Effect of hormonal contraception on the course of lupus nephropathy].

Influence of oral contraceptive therapy on SLE activity was evaluated in 33 female patients with lupus nephropathy. Estroprogestative preparations containing either 50 micrograms (18 cases) or 30 micrograms (11 cases) of ethinylestradiol were used in 29 courses in 28 patients. Onset or exacerbation of clinical SLE activity occurred within 3 months after starting hormonal therapy in 13 cases, an overall incidence of lupus flare-up of 44 percent, involving major renal histological lesions in 5 cases. In contrast, of 16 patients receiving pure progestogen contraceptive therapy with either discontinuous normal dosage progestogens (9 cases) or continuous low-dose norsteroids (7 cases), only one developed clinical or immunological evidence of lupus exacerbation within 3 months of hormonal therapy. We conclude that oral contraceptive therapy using estrogens, even at low dosage, is associated with a high risk of SLE exacerbation. Pure progestogens, which have proven effective and devoid of such unfavorable effects, should be preferred in these patients when hormonal contraception is needed.

Contraceptives, Oral↗
PubMed2005

An assessment of the first 3 years' use of Implanon in Luton.

OBJECTIVES: Implanon was introduced in the UK in September 1999. We present here the results of our first 106 Implanon insertions, performed over a period of 18 months. The aims of the study were to study the clinical and demographic profile of Implanon users, to assess the continuation rates of Implanon in the local population, and to identify the reasons for removal. METHODS: This was a case note-based study in which the data were transferred to a standardised pre-tested proforma. RESULTS: The age range of the 106 Implanon users was 15-43 years. Eighty-six of these clients had their Implanon removed and the Implanon status of 20 clients is not known since they were lost to follow-up by our service. Of these 86 cases, 26 had completed the full 3-year period; therefore, the continuation rate at 3 years was 30.2%. The continuation rate at the end of 1 year was 69.8% and at 2 years was 44.1%. Of the 60 women who had their Implanon removed before the recommended 3-year period, the most common reason was for bleeding irregularity (24 cases, 40%). CONCLUSIONS: This is the first published study set in the UK within a real-life setting to follow up a cohort of Implanon users for the full 3-year period. No contraceptive failures were found, replicating previous clinical trials. The continuation rate in this real-life situation was quite low compared to clinical trials. This is frequently the case when comparing real-life situations with clinical trials and may be in part due to higher motivation on the part of clinical trial participants.

Adolescent↗
PubMed1998

The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania.

OBJECTIVES: To determine the risk factors for HIV seroconversion and assess the association between contraceptive use and HIV infection among women attending three large family planning clinics in Dar es Salaam, Tanzania. DESIGN: Prospective cohort study. METHODS: Between 1992 and 1995, 2471 HIV-negative women were followed prospectively. Information about sociodemographic characteristics, sexual behavior, contraceptive use and other risk factors was collected at recruitment and updated at follow-up visits. At the end of the study, specimens were collected for HIV testing and laboratory diagnosis of sexually transmitted diseases. RESULTS: The overall HIV incidence was 3.4 per 100 person-years [95% confidence interval (Cl), 2.6-4.1]. The risk of HIV seroconversion decreased with increasing age (P=0.04, test for trend). Women reporting three or more sex partners during the follow-up period had the highest risk of HIV [age-adjusted relative risk (RR), 4.89; 95% Cl, 2.61-9.17]. Having an uncircumcised husband was associated with a significantly increased risk of HIV (age-adjusted RR, 3.60; 95% Cl, 1.12-11.59). The risk of HIV was also significantly increased among women with gonorrhoea (age-adjusted RR, 3.51; 95% Cl, 1.60-7.71) and candidiasis at baseline (age-adjusted RR, 1.98; 95% Cl, 1.17-3.33) and among women reporting alcohol consumption during the follow-up period. After controlling for other risk factors, the risk of HIV infection amongst users of oral contraceptive, intrauterine device and injectable contraceptive was not significantly increased. Similarly, there was no significant trend associated with increasing duration of use of any of these contraceptive methods. CONCLUSION: These findings confirm that a large number of new HIV infections continue to occur in this population. Reassuringly, no significant association was observed between HIV and use of specific contraceptive methods. Interventions to reduce further spread of HIV are still urgently needed.

Adolescent↗
PubMed2005

The longue durée of contraceptive methods.

Medical history has so far paid hardly any attention to the longue durée, a history in which, according to Braudel, 'all change is slow'. It is therefore one of the challenges of the emerging field of the social history of medicine to work audaciously across time as well as across space. An interesting subject, for example, is the history of contraception. Throughout history, there has been almost nothing people have worried about more than having sex without fear of consequence. At first sight, the story of contraception seems to be one of progress, from the Ancient Egyptian crocodile-dung pessary to the modern-day condom and contraceptive pill. A closer look, however, shows a pattern of remarkable continuities in the reproductive behaviour of men and women over the last two thousand years. In this paper, I shall attempt to show why traditional male-dominated contraceptive methods still linger on despite the sexual revolution brought about by the invention of the 'pill' in the late 1950s.

Attitude to Health↗
PubMedDate not supplied

[Improving the quality of care after spontaneous abortions in rural Senegal].

OBJECTIVES: To evaluate the feasibility and impact on quality of decentralising care for spontaneous abortion (post-abortion care, PAC) in rural areas of Senegal. PATIENTS AND METHOD: This prospective study concerns all patients who had PAC services at 6 medical centres in the districts of Kaolack and Fatick. A preintervention baseline study was performed to evaluate the number of cases treated in these centres. We then introduced a new treatment protocol for PAC, which included manual vacuum aspiration (MVA) and quarterly visits for supervision in each centre from 1 August 2001 through 30 September 2002. An evaluation was performed at the end of the program and 6 months after that. Results were compared with the baseline data for the 14 months before the intervention period. We used the chi(2) test to compare proportions and set the threshold of significance at 5%. RESULTS: The new model for PAC made it possible to increase the number of patients treated for incomplete abortion by 22%. Their average age was 25 years, and 71% had first-trimester pregnancy losses. MVA was performed for 56%. Hospitalisation lasted a mean of 4 hours compared with the 48 hours at baseline, and the proportion of patients referred to the regional hospital for complications fell from 35% to 7%. The mean direct average cost fell by 3,500 F CFA. The number of patients with contraception in place before discharge rose from 0 to 20%, and 94% of the patients questioned were satisfied with the quality of the services they received. Six month after the program ended, the level of utilisation of PAC services continued to increase (by 11%) and the proportion leaving with contraception reached 33%. CONCLUSION: Decentralisation of PAC treatment in rural areas is possible without major expense, and it improves care for women with incomplete abortions.

Abortion, Spontaneous↗
PubMed1981

The relation between oral contraceptive use and subsequent development of hyperprolactinemia.

Serum prolactin levels were determined in 123 patients who presented with menstrual irregularities and/or infertility of more than 1 year's duration. Sixty-three patients had hyperprolactinemia with serum prolactin levels of 26 to 843 ng/ml (normal 5 to 22 ng/ml); 44.4% of this group of patients received oral contraceptive for a period of 2 months to 7 years. Sixty patients were normoprolactinemic, with serum prolactin levels of 3 to 22 ng/ml; 33.4% of this group received oral contraceptives for a period of 6 months to 7 years. The age of presentation, onset of symptoms, age at which they started on oral contraceptives, and duration of use were tabulated. The data were analyzed using chi 2 test corrected for continuity. There was no significant difference in age at the time of evaluation between oral contraceptive users and nonusers with hyperprolactinemia. The relative odds developing hyperprolactinemia were 2.64 times greater among women who has used oral contraceptives for more than 1 year and 6.25 times greater if this use started before the age of 25.

Adolescent↗
PubMed2001

Contraception in the adolescent: an update.

Contraception remains an important part of national efforts to reduce adolescent pregnancy in the United States. A number of safe and effective contraceptive methods are available for our youth, including abstinence, barrier methods, oral contraceptives, Depo-Provera, and Norplant. Research over the past few decades has resulted in a variety of oral contraceptives with reduced amounts of hormones and reduced side-effects. A number of methods have received approval by the Food and Drug Administration since the last review in 1980, including emergency contraceptives, depomedroxyprogesterone acetate, and the cervical cap. The use of condoms and vaginal spermicides continues to be recommended for all sexually active adolescents to reduce (not eliminate) the risk for acquiring sexually transmitted diseases. A polyurethane condom is now available, in addition to the latex condom and other barrier contraceptives, including the following: diaphragm, cervical cap, vaginal sponge, female condom and vaginal spermicides. Because of continuing concerns about pelvic inflammatory disease related to intrauterine devices, currently available intrauterine devices are not recommended for most adolescents. Abortion is not considered as a contraceptive method.

Adolescent↗
PubMed1992

Oral contraception affects osteocalcin serum profiles in young women.

The serum concentrations of osteocalcin (bone Gla protein) were followed by continuous blood sampling for 24 h in 9 healthy young women before and during treatment with oestrogen/progestogen combinations for oral contraception. There were marked fluctuations during the 24 h sampling period, values ranging from 0.5 to 10.0 ng/ml. Values displayed an apparent circadian rhythm. Daytime values were on average lower than nocturnal concentrations. During treatment with oral contraceptives there was a significant decrease in osteocalcin levels but fluctuations during the 24 h sampling period were still observed. Almost all individual values obtained at 30 min intervals were lower during treatment. For the whole group the mean osteocalcin concentration decreased by 1.4 ng/ml (p less than 0.01) during treatment. In postmenopausal women high serum levels of osteocalcin are supposed to reflect increased bone turnover secondary to enhanced bone resorption. Oestrogens are known to reduce osteocalcin levels and may reduce bone resorption. In healthy young women alternative mechanisms should be considered but the reduced osteocalcin serum levels in this short-term study indicate that oral contraceptive use may influence bone metabolism.

Adult↗
PubMed2005

Emergency contraception: an intervention on primary care providers.

OBJECTIVE: We studied whether a single educational intervention can change provider knowledge, attitudes and practice patterns with respect to emergency contraception (EC). MATERIALS AND METHODS: Primary care providers completed a preintervention survey prior to attending a lecture on EC, and again 6 months later. There were 50 physicians, 4 advanced practice nurses and 2 physician assistants in the final sample (internal medicine 48%, family medicine 34%, obstetrics-gynecology 9%, and pediatrics/adolescent medicine 9%). RESULTS: Following the intervention, providers were more likely to agree that advance prescriptions should be given, disagree that the number of times EC is dispensed should be restricted and disagree that repeated EC use poses health risks. The proportion of providers who had ever given an advance prescription increased from 18% to 41% (p = .007), and there was a trend toward a greater proportion of providers initiating counseling about EC from 36% to 54% (p = .057). CONCLUSIONS: A simple educational intervention was associated with a change in primary care provider attitudes and practice patterns regarding EC.

Adult↗
PubMed1978

Vitamin and trace mineral metabolism in medroxyprogesterone acetate users.

The effect of one year's continual use of medroxyprogesterone acetate as an injectable contraceptive (150 mg I.M. every 90 days) on vitamin (A, B-carotene, E, B-1, B-2, B-6, oral tryptophan load test, folate and B-12) and trace mineral metabolism (Na, K, Ca, Mg, Cu, Zn and phosphorus) were assessed before and at the 3rd week, 3rd, 6th, 9th and 12th months after initiation of daily treatment with a vitamin-mineral supplement, in 12 non-lactating helathy Thai women. Neither vitamin nor trace mineral metabolism changed significantly as a result of treatment when compared to the pre-treatment control, suggesting that this form of hormonal contraceptive did not interfere with any of the parameters studied.

Adolescent↗
PubMed1989

Noncompetitive antiestrogenic effect of RU 486 in blocking the estrogen-stimulated luteinizing hormone surge and the proliferative action of estradiol on endometrium in castrate monkeys.

The noncompetitive antiestrogenic effects of RU 486 were examined using estradiol (E2)-treated ovariectomized monkeys given RU 486, progesterone (P), or both. The E2-induced luteinizing-hormone (LH) surge of control animals was abrogated by P and/or RU 486. Secretory transformation by P was inhibited by RU 486 coadministration. RU 486 alone (1 mg/kg) induced endometrial secretory transformation, but higher doses (5 mg/kg) inhibited proliferation and secretory activity. Thus in the presence of P, RU 486 is antagonistic but, in absence of P, exhibits endometrial progestational effects at low doses and an antiproliferative (antiestrogenic) effect at higher doses. These data encourage continued evaluation of RU 486 as a potential contraceptive agent acting at the pituitary and/or endometrial level.

Animals↗
PubMed1976

Nurse specialist in family planning.

In an experimental clinic, run by nurse specialists in family planning, a total of 768 patients were seen in the first year. Oral contraception was dispensed for 377 patients and 187 intrauterine devices (IUCDs) were inserted; a further 204 IUCD patients attended only for follow-up visits. All side effects were adequately diagnosed by the nurse specialist.

Community Health Services↗
PubMedDate not supplied

Emergency services.

Explore the source record for details and available documents.

Adolescent↗
PubMedDate not supplied

[Inhibitors of acrosomal proteinase as antifertility agents. A problem of acrosomal membrane permeability (author's transl)].

In vitro studies were performed to investigate the accessibility of acrosin to various proteinase inhibitors inside the intact acrosome of testicular, ejaculated, and uterine human spermatozoa. As test system, the gelatin plate assay was used. For this assay, it was shown formerly that a correlation exists between the size of the digested lysis areas (halo formation) and acrosin activity estimated with synthetic substrates. In addition, saturation of the gelatin substrate membranes with acrosin inhibitors including highly specific ones before application of spermatozoa completely prevented halo formation indicating that the gelatinolytic activity of human spermatozoa is caused exclusively by acrosin. When human spermatozoa were incubated with various acrosin inhibitors (concentration: 1 mmol/1) prior to application to the gelatine membrane, reduction of halo formation could not be observed, however. This result indicates that most of the tested acrosin inhibitors (9 naturally occurring protein inhibitors, 2 microbial peptide inhibitors, 19 synthetic inhibitors) were unable to penetrate the acrosomal membranes of testicular, ejaculated, and uterine human spermatozoa. Only 2 inhibitors caused moderate to complete inhibition of the gelatinolytic activity of the spermatozoa if applied in concentrations between 1-10 mmol/l: the proteinase inhibitor aprotinin and the synthetic inhibitor NPGB (4-nitrophenyl 4-guanidinobenzoate). Obviously, human acrosomal membranes seem to be especially impenetrable to proteins, polypeptides, and synthetic agents. Those acrosin inhibitors penetrating the human sperm head membranes are either too toxic or the local concentration necessary for effective acrosin inhibition in vivo cannot be achieved within the male or female genital tract secretions. Therefore, acrosin inhitibors cannot be used for human contraception at present. Thus, it is mandatory to continue the search for suitable acrosin inhibitors with low toxicity easily penetrating into the intact sperm acrosome.

Biology↗