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PubMed1984

Results of establishing medical guidelines for selecting oral contraceptive types in family planning agencies.

Family planning agencies are attempting to increase their efficiency and cost-effectiveness in delivering services, as federal funding is diminishing. We have examined the effects of establishing guidelines in a family planning agency, outlining the types of OCs to be routinely prescribed. We found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.

Contraceptives, Oral↗

PubMed1986

Contraception in hypertensive women using a vaginal ring delivering estradiol and levonorgestrel.

Contraception with a vaginal ring (CVR) that delivers estradiol and levonorgestrel was used during a mean of 15.6 menstrual cycles in 12 hypertensive women. Blood pressure (BP) was measured 5 times on each visit during 2 pretreatment control cycles; during the 1st, 2nd, 4th, 6th, and from the 9th to 12th cycles of CVR use; and again after a 1-month recovery period. No significant change in BP occurred during CVR use in any of the subjects. Plasma renin substrate and antithrombin III activity did not vary significantly, which suggests the utility of administering natural estradiol via the vagina, thus avoiding the first pass effect that occurs with oral contraceptives. Significant decreases in plasma sex hormone-binding globulin, cholesterol, high density lipoprotein cholesterol, phospholipids, and triglycerides occurred, indicating an androgenic effect of levonorgestrel. We conclude that the CVR is a method of contraception that does not elevate BP in hypertensive women.

Adolescent↗

PubMed1990

Risk factors for in situ cervical cancer: results from a case-control study.

A case-control study of 293 patients with in situ cervical cancer and 801 community controls was conducted between 1982 and 1984 in five geographic areas in the United States. Relative risk (RR) was elevated among women reporting multiple sexual partners (RR for greater than or equal to 5 partners = 5.0), a history of an abnormal Papanicolaou smear (RR = 5.0), interval since last Papanicolaou smear (RR for greater than or equal to 10-year interval versus 0- to 2-year interval = 4.1), use of oral contraceptives (RR for greater than or equal to 10 years use = 1.4), a history of nonspecific genital infection (RR = 2.6), and smoking (RR for current smokers = 1.9). Risk was low among diaphragm users (RR for greater than 2 years use = 0.5). Neither age at first coitus nor number of births was predictive of risk of in situ disease. Comparisons between this analysis and risk factors previously identified for invasive cervical cancer in this same study indicate that the risk factors were quite similar.

Adult↗

PubMed1992

Sources of information, experiences and opinions on sexuality, contraception and STD protection among young Swedish students.

The aim of the investigation was to study sources of information on sexuality, contraceptives and STDs among young people as well as their experiences of and opinions on the matter. A questionnaire was distributed to 192 high-school pupils in the Stockholm area. The mean age of the participants was 17.4 years. The majority stated that school teachers and individual reading are the best sources of information. Female students more often relied on friends and family members than male students. Among those who had had their sexual debut, many stated that condom use was hard to practice.

Adolescent↗

PubMed2005

Effectiveness of depot-holders introduced in urban areas: evidence from a pilot in Bangladesh.

Depot-holders are women from the community who promote good health practice and use of clinics. They keep a stock of contraceptives and oral rehydration salts to supply other women and are paid some incentives. In 2003, the NGO Service Delivery Program (NSDP) introduced depot-holders in three types of urban area in Bangladesh as a pilot. This evaluation study was carried out to: (a) establish a baseline for measuring the impact of activities of depot-holders on a comprehensive range of indicators in the long-term, (b) make a preliminary assessment of the impact on the use of selected services of the essen-tial services package (ESP) and other indicators at the end of the pilot phase, and (c) assess the cost of introducing depot-holders and running their activities for a year. Data from the baseline and end of pilot household surveys, together with service statistics from the intervention and comparison areas, were used for assessing the changes in clinic use and commodity distribution. The study found evidence that the depot-holders transferred knowledge to women in the community, provided services, and referred women to clinics run by non-governmental organizations (NGOs). There was a large increase in the number of client contacts at the NGO clinics and in the quantity of oral contraceptive pills and oral re-hydration salts distributed by the NGOs, mostly attributable to the activities of the depot-holders. The estimated cost per depot-holder per year was Tk 15,241 (U.S. dollars 262). Overall, the performance of the depot-holders in the pilot phase suggests that they can be introduced in different types of urban area and can be effective in their dual role as providers and promoters of services.

Adolescent↗

PubMed1990

Use of condoms as contraceptive and disease preventive measures among residents of Jos, northern Nigeria.

The effectiveness, acceptability and protective aspects of condoms as both contraceptive and disease control measures was evaluated in 168 male residents of Jos in Nigeria. They were aged between 15 and 40 years and were attending the Family Planning Clinic of the Jos University Teaching Hospital. The results showed that the majority (87.5%) of our patients were in the 21 to 30 years age group and most of the clients had used condoms for between 1 to 5 years. A good number of our clients (40.5%) used condom because it protects them against venereal disease while others felt it was safe and effective. The Family Planning Clinic was the main source of knowledge of the condom among our clients (42.9%), and the condom was rated as good or excellent by 137 (81.5%) clients. The only side effect of condom usage which featured prominently among our clients was reduced sexual excitement. The results were compared with studies carried out elsewhere. It was concluded that the condom could be an acceptable and effective form of contraception in this population. The users must, however, be highly motivated so as to use it during every act of coitus for optimal efficacy.

Adolescent↗

PubMed2006

Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study.

BACKGROUND: Menstrual pain can be alleviated after childbirth. The purpose of this observational study was to evaluate the natural progression of menstrual pain among nulliparous women at their reproductive age. METHODS: A questionnaire-based study of perimenopausal women with a history of primary dysmenorrhea was performed. The study subjects were recruited between July 1, 2001 and June 30, 2005. Severity of menstrual pain was graded using a multidimensional scoring system. RESULTS: A total of 247 nulliparous women with primary dysmenorrhea were enrolled, and of these, 218 patients were eligible for analysis. Patients who had more frequent intercourse (p = 0.016), fewer associated systemic symptoms (p = 0.028), and use of oral contraceptive pills (p = 0.039) tended to have a higher chance of an improvement in dysmenorrhea after age 40. Multidimensional scoring distribution over chronologic age revealed that patients had significantly improved menstrual pain after 40 years of age. CONCLUSION: For nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40. More studies are needed to explore this phenomenon from a biochemical or molecular basis.

Age Factors↗

PubMed1997

Clinical pharmacokinetics of mifepristone.

Mifepristone is a steroidal antiprogestin and antiglucocorticoid acting at the receptor level. The aromatic dimethylaminophenyl side chain in position 11 of the steroid structure is essential for the antagonistic properties of mifepristone. The pharmacokinetics of mifepristone are characterised by rapid absorption, a long half-life of 25 to 30 hours and micromolar serum concentrations following ingestion of doses currently in clinical use. The serum transport protein alpha 1-acid glycoprotein (AAG) regulates the serum kinetics of mifepristone. Binding to AAG limits the tissue availability of mifepristone, explaining the low metabolic clearance rate of 0.55 L/kg/day and the low volume of distribution of mifepristone. Also, similar serum concentrations of mifepristone following ingestion of single doses exceeding 100mg can be explained by saturation of the binding capacity of serum AAG. Following oral intake, mifepristone is extensively metabolised by demethylation and hydroxylation, the initial metabolic steps are catalysed by the cytochrome P450 (CYP) enzyme CYP3A4. The 3 most proximal metabolites, namely the monodemethylated, didemethylated and hydroxylated metabolites of mifepristone, all retain considerable affinity toward the human progesterone and glucocorticoid receptors; in addition, the serum concentrations of these 3 metabolites are in a similar range as those of the parent drug. Thus, the combined pool of mifepristone, as well as that of the metabolites, seems responsible for the biological actions of mifepristone. Combination therapy with mifepristone and low dose prostaglandin is currently in clinical use for termination of early pregnancy in China, France, Sweden and the UK. The combined regimen is well tolerated and highly efficacious with a 95% rate of complete pregnancy terminations. Recent clinical studies on pregnancy termination have focused on dose optimisation of mifepristone and evaluation of the orally active prostaglandin derivative misoprostol. In addition, several other indications for the clinical use of mifepristone, such as induction of labour, contraception, as well as treatment of various hormone dependent disorders, are emerging. The major obstacles currently inhibiting further evaluation and distribution of mifepristone are political rather than clinical. However, it is hoped that the eventual introduction of new antiprogesterone molecules by several manufacturers will enhance the availability of this important class of new drugs.

Abortifacient Agents, Steroidal↗

PubMed2000

Population attributable risk for ovarian cancer.

Parity, oral contraceptive (OC) use, age at menopause, a family history of the disease and selected aspects of diet have been related to the risk of ovarian cancer. The quantification of their impact on a population level may help focus and rank the importance of potential prevention strategies. Using data from a case-control study conducted in Italy between 1983 and 1991 on 971 ovarian cancer cases and 2758 control women we computed the multivariate relative risk estimates, and population attributable risks (PARs), i.e. the proportion of ovarian cancers that would have been avoided if a given exposure had not been present in the population. Overall, the PARs were 5% for nulliparity, 12% for never OC use and 4% for a family history of breast or ovarian cancer in first-degree relatives. Among women aged >/=50 years, later age at menopause accounted for 16% of all ovarian cancer cases. Low intake of green vegetables accounted for 24% of cases and a high fat score for 7%. All these factors together explained 51% of cases. In conclusion, even if the PAR estimates were based on several arbitrary assumptions, available knowledge could, in principle, explain over 50% of all ovarian cancer cases in this Italian population, thus indicating and quantifying the theoretical scope for prevention.

Adult↗

PubMed1987

Squamous and adenocarcinoma of the uterine cervix: a comparison using routine data.

We studied the clinical, demographic and survival characteristics of more than 5,000 women registered with either squamous or adenocarcinoma of the uterine cervix in South Thames Cancer Registry over the period 1968-81. There were similarities with respect to social class, smoking habit, oestrogen/oral contraceptive use and time trends in incidence but differences between the two cancers were found with respect to age distribution, parity, method of detection and survival. Some of the data are of limited value, having been obtained only from case notes, so the results need some caution in their interpretation. However the results are broadly consistent with those of studies performed in other countries on smaller samples. A methodological issue is also raised, viz. the appropriateness of a disease with well-known characteristics as a comparison group. From our results the likely size of various associations can be judged and used in the design of future studies to clarify the epidemiology of cervical adenocarcinoma.

Adenocarcinoma↗

PubMed2006

Mammographically detected breast arterial calcifications: indicators for arteriosclerotic diseases?

PURPOSE: To determine the prevalence of breast arterial calcifications (BAC) detected on mammography and search for conditions that may influence their existence. MATERIALS AND METHODS: The mammograms of 6156 consecutive patients were reevaluated for the presence of BAC. Four hundred eighty-five women having BAC were enrolled in the patient group. Additionally, randomly selected 500 women, without BAC constituted the control group. Hospital records of the participants were reviewed for parity, menopausal status, oral contraceptive agent (OCA) usage, hormone replacement therapy (HRT) usage, presence of diabetes, hypertension, hyperlipidemia, albuminuria and history of myocardial infarction (MI). RESULTS: Prevalence of BAC was 7.9% on mammograms. Ninety-four women were aged between 40 and 49 years, 165 were aged between 50 and 59 years and 226 were over 60 years among BAC positive 485 women. A significant relationship was found for the frequency of BAC versus age and HRT usage in all age groups (p<0.05). Similarly, significant relationships were also found for the frequency of BAC versus OCA usage, HRT usage, hyperlipidemia and diabetes in age group of 40-49 and in age group of 50-59, and for the frequency of BAC versus albuminuria in age group of 40-49, BAC versus history of myocardial infarction in age group of 59-59 and over 60 years (p<0.05). The correlations were not significant for the relationships of BAC with OCA usage, hyperlipidemia, diabetes and albuminuria in women over 60 years (p>0.05). CONCLUSION: Most benign findings like BAC are not routinely reported during mammographic evaluation. Our study showed that, presence of BAC on mammography was strongly related to advancing age. However, these findings may signify a systemic risk and can be used as precautious indicators for undocumented systemic diseases, especially in premenopausal women.

Adult↗

PubMed2006

A case series of young stroke in Rome.

In this hospital case series study we enrolled 394 consecutive ischemic stroke patients aged 14-47 years, all of whom were submitted to a diagnostic protocol. We evaluated the incidence of cerebral ischemia in young adults, as well as the risk factors and the etiopathogenesis of this pathology. Modified diagnostic criteria adopted from the TOAST and Baltimore-Washington Cooperative Young Stroke Study were used for the etiologic classification. The crude annual incidence rate was 8.8/100,000 (95% CI 7.7-9.9), which is in keeping with the rates reported in comparable registries. Risk factors were distributed as follows: smoking in 56% of patients, hypertension in 23%, dyslipidemia in 15%, migraine in 26%, and diabetes mellitus in 2%. Oral contraceptives were being taken by 38% of the women enrolled. The etiology of stroke in the patients was as follows: cardioembolism in 34%, atherothrombosis in 12%, non-atherosclerotic vasculopathies in 14% (including arterial dissection in 12%), other determined causes in 13%, lacunar stroke in 2.5%, migraine in 1%, and undetermined causes in 24%. Despite its biased sampling frame, this large hospital case series, in which risk factor distribution and etiopathogenesis were investigated, stresses the need for an adequate diagnostic approach in young ischemic patients.

Adolescent↗

PubMed2006

Recent advances in contraception.

The world population is expected to increase by 2.6 billion to 9.1 billion in 2050. This will occur, if fertility decreases from today's 2.6 children to about 2 children per woman. If fertility were to remain at the present level, 34 million persons would be added annually by mid-century and thus the world population would reach 10.6 billion by 2050. The most notable increase in the world population will occur in third world countries. Therefore immense investments are being made to develop safe, reliable and easily used contraceptive methods. It has not proven easy. Further, acceptance of the methods has been called into question. And even their distribution would be very difficult although Population Council and organizations like it have put a lot of effort into that matter also. In addition, the methods should preferably be such that they could to some extent prevent the rapid spread of sexually transmitted infections. So, the task is not easy, but every effort must be made on this question also at governmental and international political levels. It is noteworthy that this kind of approach has been given more currency since the beginning of this millennium.

Contraception↗

PubMed1995

Sixteen-year-old oral contraceptive users in Finland, 1981-1993.

While adolescent fertility and abortion rates continue to decline in Finland, regional variations in teenage pregnancies persist, particularly among 16-17-year-olds. We studied differences in the use of oral contraceptives (OCs) among 16-year-old girls according to sociodemographic variables between 1981 and 1993. Questionnaires were mailed to national samples (N = 462-1594) of 16-year-old girls biannually, giving response rates ranging from 86% to 91% (the Adolescent Health and Lifestyle Survey). The increasing trend in OC use levelled off in 1989 at around 17-19%. OC use was most frequent in the lower socioeconomic groups, least frequent in the rural areas, but did not vary significantly according to region of the country. The pace of adopting OCs did not vary across the socioeconomic groups or regions. The socioeconomic and regional distributions of OC use were consistent with previous studies on teenage sexual activity. The results suggest equal accessibility of family planning services; regional variation in pregnancy rates cannot be explained by unequal distribution of OC use.

Adolescent↗

PubMed1998

Combined oral contraceptives, smoking, and cardiovascular risk.

STUDY OBJECTIVE: To assess age specific incidence and mortality of stroke, acute myocardial infarction (AMI), and idiopathic venous thromboembolism (VTE) associated with use of modern low dose combined oral contraceptives (OCs) and the interaction with smoking. DESIGN: Hospital-based case-control study. SETTING: Hospitals in Oxford region in the United Kingdom, which covered a defined population, during the period 1989-1993. METHODS: Relative risk estimates from the WHO Collaborative Study and observed incidence rates from the Oxford region were used to estimate age specific incidence of each disease among women without cardiovascular risk factors and model total cardiovascular incidence and mortality. RESULTS: Among women who did not use OCs, smoke nor had any other cardiovascular risk factors, total incidence of stroke and AMI were less than 2 events per 100,000 woman years in those aged 20-24 years and rose exponentially with age to 8 events per 100,000 among women aged 40-44 years. Incidence of idiopathic VTE among women who did not use OCs rose linearly with age (from 3.3 per 100,000 at ages 20-24 years to 5.8 per 100,000 at ages 40-44 years). The increased risk of idiopathic VTE associated with OC use among non-smokers constituted over 90% of all cardiovascular events for women aged 20-24 years and more than 60% in those aged 40-44 years. Fatal cardiovascular events were dominated by haemorrhagic stroke and AMI, and among OC users who smoked these two diseases accounted for 80% of cardiovascular deaths among women aged 20-24 years, rising to 97% among those aged 40-44 years. Cardiovascular mortality associated with smoking was greater than that associated with OC use at all ages. Attributable risk associated with OC use was 1 death per 370,000 users annually among women aged 20-24 years, 1 per 170,000 at ages 30-34 years, and 1 per 37,000 at ages 40-44 years. Among smokers, the cardiovascular mortality attributable to OC use was estimated to be about 1 per 100,000 users annually among women aged less than 35 years, and about 1 per 10,000 users annually among those above the age of 35 years. CONCLUSION: The incidence of fatal cardiovascular events among women aged less than 35 years is low. The VTE risk associated with OC use is the largest contributor to OC induced adverse effects. The potentially avoidable excess VTE risk associated with the newer progestogens desogestrel and gestodene would account for a substantial proportion of total cardiovascular morbidity in this age group. For women over age 35 years the absolute risks associated with OC use and smoking are greater because of the steeply rising incidence of arterial diseases. The combination of smoking and OC use among such women is associated with particularly increased risks. Any potential reduction in AMI or stroke risk with use of third generation OCs would be a more important consideration among older compared with younger women, particularly if they smoke. However, the mortality associated with smoking is far greater than that associated with OC use (of any type) at all ages.

Adult↗

PubMed2002

Users' perspectives on implantable contraceptives for women.

Users of subdermal contraceptive implants report long duration of use, convenience, and high efficacy as liked features and bleeding irregularities, weight loss/gain, and headaches as disliked effects of these methods. Satisfied users tend to be women who do not experience side effects or women who value positive features and tolerate the side effects. Satisfaction of the users is also closely related to quality of services. Service delivery problems, such as lack of proper pre-insertion counseling, inadequacy in number and imbalance in the geographical distribution of providers who can insert and remove implants, and appropriately manage side effects have been observed in new programs. Insensitivity of some providers to side-effects, such as bleeding irregularities, and to requests for removal have caused user dissatisfaction and serious public concern. Care must be taken to provide implants in a context of high quality of care with adequate numbers and distribution of trained providers and a basic record-keeping and tracking system.

Contraceptive Agents, Female↗

PubMed1986

An assessment of burst strength distribution data for monitoring quality of condom stocks in developing countries.

Laboratory tests were conducted on condoms to examine the changes that occur over time in indicators of condom burst strength, and to determine the relationship between laboratory-assessed condom burst strength and breakage during use in a developing country setting. Three groups of unaged condoms purchased directly from the manufacturer were used: one group exposed to UV light for 10 hours; one group exposed for five hours; and one group unexposed. A sample of each of these groups was tested according to ISO condom air burst test protocols. The remaining condoms were individually packaged in coded polyethylene bags for shipment to the developing country study site. Also used in the study was a group of condoms that had been aged for over 40 months under field conditions in a tropical climate; a sample from this group was tested by the ISO air burst test protocol and the remainder distributed to the study site. One-hundred-thirty Indonesian urban males participated in the double-blind study. Volunteers were not relying on the condom for contraceptive purposes. Each volunteer was given one individually packaged untreated condom, one condom from each treatment group, and four condoms aged in the field. Study participants were instructed to return all used condoms. Each condom that was returned after use was examined for breakage, and the unbroken condoms were subjected to an air inflation test to determine volume and pressure at burst. A comparison of the air burst volume data for a sample of unused and used condoms from the same treatment group indicates that most of the condoms that broke during use had air burst volumes below 11 liters. Therefore, a significant downward shift in the burst strength distribution as measured in the laboratory is likely to result in an increased breakage rate during use. A Condom Deterioration Index calculated from regular periodic testing of stored condom stocks is a convenient and sensitive means of monitoring trends in the distribution and deterioration of condom strength.

Air↗

PubMed1989

Knowledge and attitudes towards premarital counselling and examination.

Premarital counselling and examination have begun to play a very important role in the management of many genetic disorders. 600 villager's knowledge and attitudes toward premarital counselling and examination in Menofia Governorate was studied in order to predict the community acceptance and behaviour toward utilization of such service. The result showed a big lack in knowledge even among educated respondents about the term. The main source of information was mass media followed by medical personnel who should participate more in this service. Most respondents, except unmarried males, have a favourable attitude toward either premarital counselling and examination or consanguinous marriage. This may be related to certain social changes in village life such as declining illiteracy, increased economic pressures, increase number of nuclear families and accordingly delay in beginning a family. It was unlikely that non-contraceptive users would resort to induced abortion rather to use contraceptive methods. Educational programs should be directed toward: (a) unmarried males so that their attitude toward premarital counselling and examination can be changed to correct direction, (b) unmarried females to make consanginous marriage more undesirable, and (c) non-contraceptive users to make them more intended to use safe contraceptive methods than induced abortion.

Adolescent↗