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PubMed2002

Fifteen years analysis of complications following minilaparotomy female sterilization in Jos Nigeria.

A retrospective analysis of complications following female sterilization via minilaparotomy performed in Jos University Teaching Hospital between January 1985 and December 1999 was undertaken to determine the incidence, the type of complications and identify ways of improving the service. 2986 clients had female surgical contraceptions. Major surgical complications occurred in 0.87% of the clients. Minor complications were seen in 4.15% with wound sepsis contributing 3.75% to the rate. The crude failure rate was 0.23%. Re-anastomosis was the reason for the failures not surgical misapplication of devices nor fistulous opening as found elsewhere. There was no death in the series. Clients seeking surgical contraception should be counseled about the minimal major surgical and minor complications that could occur during the procedures. Our center will need to focus on infection prevention in female surgical contraception in order for the services to enjoy continuous acceptance by the clients.

Adult↗
PubMed1996

Acceptability and discontinuation of Depo-Provera, IUCD and combined pill in Kenya.

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.

Adolescent↗
PubMed1998

Depressive symptoms and Depo-Provera.

Women enrolled in a multicenter prospective study were evaluated to identify any possible relationship between depressive symptoms and the use of contraceptives. Women choosing Depo-Provera (n = 495) were evaluated before starting these contraceptives and were reinterviewed 1 year later. Women who continued the method had lower depressive symptom scores at baseline than did the women who discontinued the method or who were lost to follow-up. Among the continuing Depo-Provera users, the depressive symptom scores improved slightly at 1 year (7.4 vs 6.7). Those subjects with the highest (i.e., worst) scores at enrollment demonstrated improved scores at follow-up.

Adolescent↗
PubMedDate not supplied

Teenage pregnancy in the United States.

One out of every 10 women aged 15-19 becomes pregnant each year in the United States. Of these pregnancies, five out of every six are unintended--92 percent of those conceived premaritally, and half of those conceived in marriage. The teenage pregnancy rate is high because only a minority (one in three) of sexually active young women always use contraceptives, and only one in two of these women rely on the most effective methods. The two most common reasons given by adolescents for not using contraceptives are believing that the risk of pregnancy is small, and failing to anticipate intercourse. Experience in other developed countries clearly shows that the incidence of adolescent pregnancy can be reduced if effective contraceptives are made widely available. Although high quality sex education programs that include information about contraception, reproductive biology and responsible sexual behavior can enhance the effectiveness of contraceptive delivery systems, they are not a substitute for the actual provision of services and supplies. However, there is formidable political opposition to the provision of such services by a vocal minority who believe that the crux of the problem is premarital sexual activity, and that lowering the cost of such behavior by reducing the risk of pregnancy will both legitimize adolescent sex and increase its prevalence. Consequently, there is a political impasse that guarantees a continuing large number of adolescent pregnancies. Further, even if contraceptives and sex education were readily available to all adolescents, there would still be a pool of teenagers who would see little benefit in postponing parenthood. This pool would be composed overwhelmingly of the poor and of blacks and Hispanics. Increasing the demand for pregnancy prevention among young women and men in this hard-core, high-risk group will be extremely hard to achieve without a fundamental restructuring of society.

Adolescent↗
PubMed1982

Continuous sonographic monitoring of IUD extraction during pregnancy: preliminary report.

The significance of the location of intrauterine contraceptive device in relation to the gestational sac on pregnancy outcome was studied in 13 pregnant women after extraction of the device. Of the seven women (group 1) who had the intrauterine contraceptive device removed after initial localization by sonography, two (28.5%) miscarried. In both cases the device was located cephalad or lateral to the gestational sac. In six women (group 2) continuous sonographic scanning was undertaken to visualize the extraction procedure. Traction on an intrauterine device located laterally (two cases) or cephalad (one case) to the gestational sac was followed by distortion of the sac configuration. Gentle intermittent traction on the contraceptive device resulted in successful extraction procedure. These preliminary observations suggest that pregnancies with an intrauterine contraceptive device located laterally or cephalad to the gestational sac are at greater risk during extraction of the device. Sonographic monitoring of the extraction procedure during pregnancy may minimize the hazards of intrauterine contraceptive device failure.

Abortion, Spontaneous↗
PubMed1999

Oral contraception: current use and attitudes.

Oral contraception (OC) has been available for almost four decades. During this time, changes in contraceptive use in general and OC in particular have occurred. Knowledge and attitudes about OC may not always reflect trends in use. Contraceptive use data from 1965-1995 show that OC continue to be the method chosen consistently by more than one-quarter of women contraceptors. Probably even more women would use the pill if they had more accurate information regarding the higher failure rates with barrier methods (especially the condom), if misperceptions about OC safety were put to rest, and if greater awareness of the noncontraceptive health benefits of OC could be achieved. Increased education and awareness of women as well as their healthcare providers has the potential to positively affect future contraceptive use.

Breast Neoplasms↗
PubMed2005

Nonhormonal drugs for contraception in men: a systematic review.

UNLABELLED: Nonhormonal drugs for contraception in men may have advantages over hormonal methods. The nonhormonal methods can have more rapid onset and less interference with androgen-dependent functions. This systematic review summarizes the clinical studies evaluating nonhormonal drugs administered to men for contraception. Relevant clinical results were found for gossypol, which is derived from the cotton plant, and for extracts of Tripterygium, a plant used in Chinese traditional medicine. Randomized, controlled trials were available on the efficacy of gossypol and on the effect of gossypol on potassium levels. Gossypol had problems with low efficacy and toxicity. For Tripterygium, 2 observational studies described men who were treated for rheumatoid arthritis. Although sperm density was lower among those taking Tripterygium, later reports indicated some toxicity. Nonclinical research continues on isolates of Tripterygium. No clinical studies for contraception in men were found for nonhormonal vaccines or neem, which is also a plant used for medicinal purposes. Clinical trials studied injecting styrene maleic anhydride into the vas deferens, but no comparative data were provided. At this time, no safe and effective nonhormonal drug is available for contraception in men. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to state that the number of studies concerning the use of nonhormonal drugs for male contraception are very limited, point out that the two nonhormonal drugs used to a small degree have varying results and serious side effects, and recall that there are limited clinical studies on use of vas deferens injections and vaccines in humans.

Contraceptive Agents, Male↗
PubMed1981

The copper-7 intrauterine contraceptive device: 5-year evaluation.

Over a 5-year period a family practitioner inserted copper-7 (Cu-7 intrauterine contraceptive devices (IUDs) in 134 women. The rates of continued use after 2 years, 53.0% for the women's first IUD and 63.9% for all their IUDs, and of accidental pregnancy, 2.4%, are comparable to those in the literature. However, in this series the rate of expulsion was 0.8%, much lower than that in the literature. Fertility did not appear to be reduced in women who planned to have pregnancies after the device was removed. A carefully scrutinized technique of insertion and conscientious follow-up make the Cu-7 IUD an acceptable form of contraception for many patients in a family practice.

Adolescent↗
PubMed1999

Barriers to uptake and use of modern methods of contraception in developing countries.

As the next millennium approaches, the current world population of 5.9 billion will continue to increase by 81 million per year -- 93% of which will come from the developing countries. Poor uptake and utilisation of various modern methods of contraception in the developing countries is mainly responsible. In this article, we identify various barriers responsible for the low prevalence of contraceptive uptake in these countries and suggest how these barriers may be eliminated. We conclude that by increasing contraceptive availability and utilisation, population explosion can be significantly controlled.

Contraception↗
PubMed1977

Injectable contraception (medroxyprogesterone acetate) in rural Bangladesh.

1601 women used the injectable contraceptive agent medroxyprogesterone acetate for up to 3 years. The programme was conducted by a rural health centre with detailed follow-up. While the continuation-rate, 56% after 1 year, compared favourably with that of other contraceptive methods in Bangladesh, at least half the women experienced troublesome menstrual side-effects and there were indications that milk yield was adversely affected in 147 out of the 1020 women who received the first injection while lactating.

Bangladesh↗
PubMed1993

The future of long-term and permanent contraceptive methods. Developments in technology.

The Association for Voluntary Surgical Contraception (AVSC) does not expect dramatic advances in female sterilization during the decade. Minilaparotomy and laparoscopy will endure as the standard surgical approaches, but programs will continue to shift toward the use of local anesthesia for these procedures because of greater safety and lower costs. No-scalpel vasectomy demonstrated by AVSC to be popular, effective, and safe holds greater potential for expanding the vast, and largely ignored, male market. The injection methods of vasectomy now being tested in China and elsewhere may make male sterilization even more acceptable. Markets for IUDs, implants, and injectables will continue to expand as more clients seek safe and effective long term contraception, and as national family planning programs (particularly in Asia) realize the ethical and programmatic importance of offering choices. Norplant is expensive and requires a skilled network of providers to both insert and remove the implants. For these reasons, AVSC expects Norplant to remain a niche method, mostly for urban clients who are not interested in sterilization or who are ill-suited for IUDs or injectables. Injectables, already popular in many parts of the world, will become increasingly available and used now that the US food and Drug Administration has approved Depo-Provera. New types of injectables, currently being developed, will be brought to market. The potential for IUDs is vast, particularly the low-cost, highly-effective Copper T 380A, which is expected to be approved as a 10-year method. However, poor quality service delivery and the high prevalence of sexually transmitted diseases could limit the potential of this method.

Contraception↗
PubMedDate not supplied

A prospective study of insulin sensitivity and glucose metabolism in women using a continuous subdermal levonorgestrel implant system.

OBJECTIVE: Decreased insulin sensitivity and deterioration in oral glucose tolerance curves have been reported with oral contraceptive use, particularly with those containing levonorgestrel. However, the subdermal levonorgestrel systems release a lower dosage of steroid and avoid the first pass through the liver that occurs with oral administration. We hypothesized, therefore, that continuous subdermal levonorgestrel has no significant effect on insulin sensitivity and other indices of glucose metabolism. METHODS: Nine women desiring a subdermal hormonal contraceptive system were recruited for this longitudinal prospective study. Each subject underwent a 3-hour frequently sampled intravenous glucose tolerance test immediately before insertion and after 6 months of continuous use. Insulin sensitivity and glucose effectiveness were determined using a mathematical minimal modeling approach. Glucose clearance and fasting and peak levels of glucose and insulin were examined as well. The matched-pair data were analyzed using paired t tests. RESULTS: There was no significant change in insulin sensitivity, glucose effectiveness, glucose clearance, or fasting or peak insulin levels. Fasting glucose levels remained within a normal range. CONCLUSIONS: Subdermal levonorgestrel appears to have no significant effect on tissue insulin sensitivity or glucose metabolism after 6 months of continuous use.

Adolescent↗
PubMedDate not supplied

Factor V Leiden and contraception.

Factor V Leiden is the most common genetic cause of primary and recurrent venous thromboembolism in women. It is an inherited thrombophilia that results from a genetic mutation. A college-aged woman who presented for care and had a positive family history of venous thrombosis tested positive for Factor V Leiden. Laboratory tests and plans for continuing care are discussed.

Adult↗