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PubMed2005

Headache as a side effect of combination estrogen-progestin oral contraceptives: a systematic review.

OBJECTIVE: We conducted a 2-part systematic review of published studies to examine the evidence that combination oral contraceptives can aggravate or cause headache. STUDY DESIGN: We used trials with a control group to assess headache risk that was attributable to oral contraceptive use and prospective cohort trials to answer important clinical questions about the natural history and treatment response of headache that occurs with oral contraceptive use. RESULTS: Because of differences in study populations, oral contraceptive formulations, trial end points and trial duration, it was not possible to pool data; but the evidence supports several conclusions. There is little indication that oral contraceptives have a clinically important effect on headache activity in most women. CONCLUSION: Headache that occurs during early cycles of oral contraceptive use tends to improve or disappear with continued use. No evidence supports the common clinical practice of switching oral contraceptives to treat headache; however, manipulating the extent or duration of estrogen withdrawal may provide benefit.

Contraceptives, Oral, Combined↗
PubMed2004

Impact of common contraceptive methods on quality of life and sexual function in Hong Kong Chinese women.

The combined oral contraceptive (COC) pills, injectables, intrauterine contraceptive device (IUCD) and female sterilization are the most common contraceptive methods used by women. Women's choice, compliance and satisfaction with specific contraceptive methods are influenced by any impact of the method on their quality of life and sexual function. Anxiety regarding possible adverse effects of the contraceptive methods on their quality of life and sexual function is one of the common concerns. The aim of this prospective observational study was to determine the impact of the abovementioned contraceptive methods on the quality of life and sexual function of the users. A sample of 361 Hong Kong Chinese women who were first-time users of the following contraceptive methods completed the study: COC pills (n=87), injectables (n=67), IUCD (n=96) and female sterilization (n=111). Quality of life and sexual function of the subjects were assessed before and 3-4 months after use of the method by a standardized questionnaire. The questions were adopted from the validated Chinese versions of the World Health Organization Quality of Life (WHOQOL) questionnaire and the Derogatis Sexual Functioning Inventory (DSFI). In the female sterilization group, we found a significantly higher score for sexual satisfaction (p=.004) and sexual drive (p=.003) 3-4 months after sterilization, as well as an improved WHOQOL social domain score (p=.009). However, the other DSFI subscale scores and WHOQOL domain scores were not significantly different (p>.05). No significant difference was demonstrated in all the WHOQOL domain scores and DSFI subscale scores after use of COC pills, injectables and IUCD (p>.05). We conclude that the COC pills, injectables, IUCD and female sterilization all do not have significant adverse impact on quality of life and sexual function. After female sterilization, there is a significant improvement in sexual satisfaction and sexual drive.

Adolescent↗
PubMed2005

Advance supply of emergency contraception: a randomized trial in adolescent mothers.

OBJECTIVE: To examine whether the advanced provision of emergency contraception (AEC) to parenting youth would increase emergency contraception (EC) utilization, and whether AEC would impact the rates of unprotected sex and contraception use. DESIGN: Subjects were randomized to receive either information about EC or information and an actual supply of AEC. Subjects were interviewed at baseline, 6 and 12-month follow-up. SETTING: Urban non-medical case management office. PARTICIPANTS: 160 adolescent mothers (ages 13 to 20) who were receiving case management services. INTERVENTION: Advance supply of emergency contraception. MAIN OUTCOME MEASURES: Emergency contraception use, sexual activity, unprotected intercourse, contraceptive methods and use. RESULTS: Parenting teens who received AEC were much more likely to have used it than the control group at the 6-month interview (83% vs. 11%) and the 12-month interview (64% vs. 17%). Teens in the AEC treatment group were more likely to have unprotected sex at the 12-month follow-up interview (69% vs. 45%). There was no difference in condom use between the groups at either the 6-month, or the 12-month follow-up interviews. CONCLUSION: Advance provision of emergency contraception in parenting teens increases the likelihood of its use, and does not affect the use of condoms, or hormonal methods of birth control. Parenting teens who receive AEC may be more likely to have unprotected sex.

Adolescent↗
PubMed1975

A clinical appraisal of patients following long-term contraception.

This study presents a clinical evaluation of private patients between the ages of 16 and 40 who have used contraceptive measures from January 1, 1961, through December 31, 1973. The clinical evaluation involves 3,746 private patients. The contraceptive methods of 641 patients (17 per cent) who have been bollowed for a total of 99,996 months (13 years each) are presented and analyzed. The patients are evaluated as to weight, blood pressure, pregnancy, pap smears. laboratory changes, pelvic surgery, breast surgery, incidence of cancer, contraceptive failures and changes in contraceptive practices over this span of time. This paper evaluates the role of such sociologic factors as education, religion, economic level, occupation, working status, changing marital status, age at the time of contraceptive choice, and the attitude of the husband with regard to long-term contraceptive therapy. Side effects have been well publicized. Safety has been questioned but essentially proved for the vast majority of the patients. Collected data enable some insight into the life style and motivation of the long-term contraceptive users.

Adolescent↗
PubMed2002

Does contraceptive method change the Pap smear finding?

The aim of the present study was to investigate the effect of various types of contraceptives on morphological finding of Pap smear results. Pap smear results of 7,753 fertile women who presented to 15 different family planning services in Fars Province (south of Iran) were analyzed according to their methods of contraception. The population consisted of 2241 women who used intrauterine device (IUD) as a contraceptive method (Group 1), 2521 women who were oral contraceptive (OCP) users (Group 2), and the control group, which consisted of women who used other methods of contraceptive. Comparison between the Pap smear results showed a higher number of benign cellular changes among Group 1 (22.4%) than Group 2 (19.3%), and the differences were statistically significant (p = 0.009). In addition, 80.6% women who used oral contraceptive pill (OCP) as contraceptive showed cellular changes within normal limits, while it were 77.6% for intrauterine device (IUD) users. Compared with Group 2, Group 1 had a significantly higher percentage of metaplastic cells in their Pap smear results (G1 7.4%, G2 5.8%, p < 0.05). No epithelial abnormalities were reported in Pap smears. Trichomonas vaginalis was higher in G1 than the other groups (p < 0.005), but the difference was not statistically significant for candidiasis. It may be concluded that in this population, IUD and OCP had no effect on morphological pattern of the Pap smears, but there was a significant increased rate of trichomonas infection in IUD users.

Adult↗
PubMed2003

Mechanisms of action of mifepristone when used for emergency contraception.

An emergency contraceptive method is used after coitus but before pregnancy occurs. The use of emergency contraception is largely underutilized worldwide. Recently, treatment with 10 mg mifepristone as a single dose has emerged as one of the most effective hormonal methods for emergency contraception, with very low side effects. However, the mechanism of action of mifepristone in humans when used for contraceptive purposes and especially for emergency contraception remains largely unknown. The objective of this review is to summarize available data on the effect of mifepristone on female reproductive functions relevant to emergency use of the compound. Taken together, available data from studies in humans indicate that the contraceptive effect of mifepristone used as a single low dose for emergency contraception is mainly due to impairment of ovarian function, either by blocking or postponing the luteinizing hormone surge, rather than to inhibiting of implantation.

Contraceptives, Oral↗
PubMed2001

Cost savings from emergency contraceptive pills in Canada.

OBJECTIVE: To estimate cost savings from emergency contraceptive pills in Canada. METHODS: We modeled cost savings when a single emergency contraceptive treatment was provided after unprotected intercourse and when women were provided emergency contraceptive pills in advance. RESULTS: Each dollar spent on a single treatment saved $1.19--$2.35 (in Canadian currency), depending on the regimen and on assumptions about savings from costs avoided by preventing mistimed births. The dedicated products Preven (Shire Canada, Inc., Oakville, Ontario) and Plan B (Paladin Labs, Inc., Montreal) were cost-saving even under the least favorable assumption that mistimed births prevented today occur 2 years later. Each dollar spent on advance provision of Preven saved $1.24--$12.23, depending on the regular contraception method, on how consistently emergency contraception was used when needed, and on whether mistimed births were averted forever or simply delayed. Plan B was almost always cost-saving, although less so. CONCLUSION: Emergency contraception was cost-saving whether provided when the emergency occurred or in advance to be used as needed. More extensive use of emergency contraception could save considerable medical costs by reducing unintended pregnancies.

Adolescent↗
PubMedDate not supplied

Contraceptive choice and patient compliance. The health care provider's challenge.

Contraceptive compliance is a multifaceted issue that is influenced by many factors. These factors can directly affect the level of patient compliance, thereby affecting contraceptive method efficacy rates. A review of the literature reveals many studies about contraceptive compliance but a dearth of studies addressing how to change noncompliant behaviors. This article describes the contraceptive methods currently available and their efficacy rates. Patient characteristics and the components of compliance are described as they affect contraceptive efficacy and patient care. Suggestions are made for the use of alternative terminology to include adherence to or continuance of a contraceptive method. Health care providers should realize the impact they can have on a patient's education, decision-making process, and ultimate compliance with a contraceptive method. It is the patient, however, who ultimately makes the decision, either actively or passively, to comply or not and whether to have an unplanned pregnancy.

Contraception↗
PubMed1982

Patterns of contraceptive use among female adolescents: method consistency in a clinic setting.

Major changes in contraceptive use among adolescents in the United States have been documented through surveys and analysis of family planning program service statistics. While we know of the changes in the adolescent population as a whole and those served by organized family planning programs, little is known about the patterns of contraceptive use by individuals. This study examines patterns of contraceptive use among 547 clients of a new contraceptive and counseling service for adolescents in New York City. The principal concern is consistency of contraceptive method use as determined from clinic statistics. Findings show generally high degrees of method consistency, with new and current users displaying more consistency than prior users. Among clients who switch methods, two major patterns emerged: switching among the more effective methods and from less effective to more effective methods. Younger new users were the most consistent subgroup suggesting that a service designed for adolescents may have a positive influence on teenagers without prior contraceptive experience. Prior users were the least consistent subgroup suggesting that programs incorporate screening procedures to identify prior users and to develop new approaches to understanding their past contraceptive use patterns to improve their future use.

Adolescent↗
PubMed2004

Contraceptive behaviour of teenagers requesting abortion.

OBJECTIVE: To examine the contraceptive use of teenage girls requesting abortion. STUDY DESIGN: A questionnaire survey was made concerning contraceptive use, awareness and the attitude toward contraceptives. The Mantel-Haenszel test was applied to compare contraceptive determinants between teenagers (<20 years old) and older women. RESULTS: The use of reliable contraceptive methods was significantly less frequent among the teenagers than among the older counterparts, but this difference was much more significant (P<0.001) between those who requested abortion (OR=0.44) than between the controls (OR=0.51). The knowledge about emergency contraceptive pills was similarly significantly poorer between the teenagers in the abortion group (P<0.001) relative to the older women (OR=0.07) and the teenagers in the control group (OR=0.10). Financial means was not a significant determinant in the choice of contraceptives. CONCLUSION: To prevent unwanted pregnancy among teenagers, the media, the family, the school and health-care providers should focus on sexual education and information.

Abortion Applicants↗
PubMed1999

Do young women have specific problems in contraceptive use and counselling?

OBJECTIVES: To find out if young women have specific problems with the use of contraception or contraceptive services. STUDY DESIGN: A national postal survey was conducted, RR 74%. Women aged 18-34 years (with experience of contraceptive use) were included in this report (n=1239). RESULTS: Weekly need for contraception was highest in the age group 18-24 years (61%), oral contraception being the most widely used method regardless of parity. Condoms were used by 35-37% in all age groups, either alone or combined with oral contraceptives (17% of young nulliparas). Women aged 18-24 years had mainly used public or subsidized services (79%). Of quality characteristics, only satisfaction with the kindness of the service provider varied significantly by age. The cost of contraception was highest in the youngest age group. CONCLUSIONS: The study did not point at any serious problems in family planning among young women, but it did produce several clues for the development of family planning services in general.

Adolescent↗
PubMed2006

[Acceptability of intrauterine levonorgestrel delivery system (Mirena 52mg) after estrogen-progesterone oral contraception: results of a prospective multicentric study of 211 patients aged 25-35 years].

INTRODUCTION: Use of an intrauterine levonorgestrel (SIU-LNG) delivery system (Mirena 52mg has become popular in recent years, particularly among younger women. Mirena is currently the contraceptive method of choice used as an alternative to classical copper-containing intrauterine devices after oral contraception. The purpose of this study was to evaluate patient satisfaction among young women during the first year of use of the intrauterine hormonal system. MATERIAL AND METHODS: This multicentric phase IV trial with a non-comparative methodology was conducted among 211 young women aged 25-35 years. The SIU-LNG was prescribed for women who wanted to change their contraception after oral estrogen progesterone taken for at least three months prior to inclusion in the study. A total of 211 patients were included and review was planned at one year: 197 patients (93.36%) were reviewed. RESULTS: Mean patient age was 31.48+/-3.25 years. The SIU-LNG was inserted successfully at the first attempt in 99.05% of women. The continuation rate ws 85.65% at one year. Evaluation of cycle characteristics showed less voluminous blood loss and fewer dysmenorrheal phenomena as well as, in 40%, the development of amenorrhea. At the last visit, 85% of women were satisfied or very satisfied with this method of contraception. CONCLUSION: As has been demonstrated in earlier studies, Mirena offers a contraception with a reliability equivalent to that of oral estrogen progesterone (IP: 0 - 0.2), with very few hormonal side effects due to the low plasma passage of levonorgestrel. Mirena is particularly well adapted for young women who desire a reliable long-term easty-to-use contraception after taking oral contraception.

Adult↗
PubMed2001

Contraceptive dispensing and selection in school-based health centers.

PURPOSE: To determine whether initiation of on-site dispensing of hormonal contraceptives (oral contraceptive pill, Depo-provera, and Norplant) in six urban school-based health centers reduced time to initial selection, and increased their consistent use among sexually active females. METHODS: Participants were sexually active females who received family planning care in a school year before (1994-1995 cohort) or after (1996-1997 cohort) the initiation of on-site dispensing. Data on contraception and sexual behavior were collected at each family planning visit. Cohorts were compared using Student's t-tests and Chi-square tests, analysis of covariance, and logistic regression. RESULTS: About 59% of the 1994-1995 cohort selected hormonal contraceptives at the first or second visit; this increased to 72% of the 1996-1997 cohort (chi(2) = 11.3; p <.001). After adjustment for cohort differences, the 1996-1997 cohort consistently selected hormonal contraceptives a longer period of time, although the difference did not reach statistical significance (adjusted means: 1994-1995 cohort = 73 days, 1996-1997 cohort = 81 days; t = 1.6, p <.10). CONCLUSION: Sexually active females receiving family planning care select methods of hormonal contraception sooner and somewhat more consistently when the clinics in their high schools can dispense contraceptives on-site.

Adolescent↗
PubMed1999

Red cell deformability in oral contraceptive pill users with sickle cell anaemia.

The use of the combined oral contraceptive pill (COCP) in women with sickle cell anaemia (SCA) is controversial, as contraceptive steroids are thought to adversely affect erythrocyte deformability. This observational study was performed to investigate whether hormonal contraception influenced erythrocyte deformability in women with SCA. 30 women with SCA using various contraceptive modalities: COCP (n = 10); progestogen only (PO) contraception (n = 10) and non-hormonal contraception (n = 10) were recruited. Erythrocyte deformability was assessed using the clogging rate (CR) and red cell transit time (RCTT). There was no statistical difference in the mean CR and RCTT between the three groups of women (one-way ANOVA). Current contraceptive steroids do not appear to impair red cell deformability in women with SCA.

Adult↗
PubMed2006

Attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland.

OBJECTIVES: To assess attitudes towards and perceptions about contraceptive use among married refugee women of Somali descent living in Finland. METHOD: A sample of 100 married refugee women of Somali descent (18-50 years of age) were invited to participate in a study on contraceptive use in Finland (30 women refused). Qualitative and quantitative methods were used to collect the data. Questionnaire of the first data set was written in the Somali language. Interviews were conducted in the Somali language. RESULTS: The attitudes and opinions of these women towards contraceptive use (73% did not use contraceptives, 27% did use them) were connected with religious beliefs and issues involving marital relations. Religious or gender issues did not seem to influence those who used contraception. CONCLUSIONS: The findings indicated that the majority of the married refugee women of Somali descent living in Finland did not use contraception. The process of starting the use of contraception was possible because of an access to good reproductive health care and family planning services, changes in life situations, and adaptations to Finnish social and cultural norms.

Adolescent↗
PubMed1975

Effect of oral contraceptive agents on nutrients: I. Minerals.

The epidemiological aspects of oral contraceptive agents on nutrient metabolism were studied in a large population of women. Incidence of clinical abnormalities, related to malnutrition, were more frequently observed in the lower (B) as compared to the higher (A) socioeconomic groups. In the A groups some clinical signs were more common in the nonsupplemented groups of subjects. In general, the intake of oral contraceptive agent subjects for calories, protein, calcium, magnesium, iron, copper and zinc did not differ from the controls. The intake of the above nutrients in group A subjects were higher than those of group B except for calories. The subjects who took supplements had higher intakes of calcium, iron, magnesium and copper. No effect of oral contraceptive agents was seen on hemoglobin, hematocrit and erythrocyte count. Serum iron was increased due to "Norinyl." Total iron binding capacity was increased as a result of oral contraceptive agent administration. Total iron binding capacity values were higher in group B as compared to group A and in the nonsupplemented as compared to the supplemented groups. Plasma copper was increased and plasma zinc was decreased as a result of oral contraceptive agent administration. An increase in erythrocyte zinc was observed due to "Norinyl." No effect of oral contraceptive agents on plasma calcium, magnesium and erythrocyte magnesium was observed. Although no effect of oral contraceptive agents on plasma total protein was found, serum albumin was decreased.

Adolescent↗
PubMed2005

Rates of suppression and recovery of human sperm output in testosterone-based hormonal contraceptive regimens.

BACKGROUND: Practical hormonal male contraceptive regimens are likely to have delayed onset and offset of reliable contraception dictated by the length of the spermatogenic cycle and clearance rate of pre-formed sperm from the ductular system. While delayed onset of contraceptive efficacy is an accepted feature of vasectomy, reliable time estimates for a hormonal male contraceptive of time to onset and offset of reliable contraception and of resumption of normal male fertility are required. METHODS AND RESULTS: We utilized the sperm output data from three male contraceptive efficacy studies to define quantitative estimates of suppression and recovery rates from an androgen alone (testosterone enanthate) and an androgen/progestin (testosterone/depot medroxyprogesterone acetate) study. Using nearly 14,000 semen samples from World Health Organization (WHO) studies #85921 and #89903 with identical protocols, the rate of suppression of sperm output was best modelled as a two-parameter, single exponential decay function with effective half-time to suppression of 5.5 weeks and times of 6.8 weeks to 10 x 10(6)/ml, 8.7 weeks to 5 x 10(6)/ml, 10.0 weeks to 3 x 10(6)/ml and 13.0 weeks to 1 x 10(6)/ml. The rate of recovery using absolute sperm concentration was best modelled as a three-parameter, sigmoidal curve with effective time to reach half of the recovery plateau of 10.5 weeks and times of 9.0 weeks to 3 x 10(6)/ml, 9.9 weeks to 5 x 10(6)/ml, 11.5 weeks to 10 x 10(6)/ml, and 13.6 weeks to 20 x 10(6)/ml. Using relative sperm output, defined as a percentage of the participants' own baseline, recovery approached an asymptotic plateau of approximately 85% of geometric mean pre-treatment sperm concentration. In the combination androgen/progestin study, suppression rate was significantly faster (effective time to reach half maximal suppression of 3.0 weeks) and recovery significantly slower (effective time to reach half of recovery plateau of 14.7 weeks) and less complete (asymptotic recovery plateau of 43% of baseline) than in the androgen-alone WHO studies. CONCLUSION: These findings therefore provide large sample estimates of the suppression and recovery rates from an androgen-alone hormonal male contraceptive regimen as a basis for comparison with other second-generation combination androgen/progestin regimens that are the most promising approach to developing practical male hormonal regimens.

Contraception↗
PubMed2004

Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception.

An emergency contraceptive method is used after coitus but before pregnancy occurs. The use of emergency contraception is largely under-utilized worldwide. One of the main barriers to widespread use is concern about the mechanism of action. Recently, treatment with either 10 mg mifepristone or 1.5 mg of levonorgestrel has emerged as the most effective hormonal method for emergency contraception with very low side-effects. However, the knowledge of the mechanism of action of mifepristone and levonorgestrel in humans, when used for contraceptive purposes and especially for emergency contraception, remains incomplete. The objective of this review is to summarize available data on the effects of mifepristone and levonorgestrel on female reproductive functions relevant to the emergency use of the compounds. When summarized, available data from studies in humans indicate that the contraceptive effects of both levonorgestrel and mifepristone, when used in single low doses for emergency contraception, involve either blockade or delay of ovulation, due to either prevention or delay of the LH surge, rather than to inhibition of implantation.

Contraception, Postcoital↗