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PubMed2003

Bone mineral density in adolescent and young adult women on injectable or oral contraception.

PURPOSE OF REVIEW: This report critically reviews recent original research articles that pertain to bone mineral density in young adult women utilizing injectable depot medroxyprogesterone acetate or oral contraceptives. RECENT FINDINGS: Some evidence indicates that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives (containing 20 microg ethinyl estradiol) may interfere with the large increases normally observed in adolescence; however, the same degree of bone loss (or lack of bone gain) associated with these drugs is not so impressive in young adult women who would typically be experiencing small changes in bone mass. Data obtained from young adult women show that low dose (30-40 microg ethinyl estradiol) oral contraceptives seem to be more protective of bone than ultra-low dose oral contraceptives. The few extant data suggest that there may be substantial increases in bone mass after discontinuation of depot medroxyprogesterone acetate; no information is available regarding the response of bone after discontinuation of oral contraceptives. As the clinical risk for fracture is usually several decades later, several exogenous factors such as diet and exercise may exert overriding influences on later bone health. Moreover, without contraception, the clinical outcome may be unwanted pregnancy and its potential impact on bone health. SUMMARY: Recent findings suggest that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives may interfere with achieving optimal peak bone mass in very young women; however, there may be substantial recovery after cessation of these methods and overriding long-term influences on bone health imposed by a myriad of lifestyle factors.

Adolescent↗
PubMed2004

Contraceptive use in HIV-positive women.

The objective was to describe contraceptive use in women with HIV infection in France over the past decade. The study included 575 sexually active women of reproductive age, who knew the serologic status of their steady partners. It is part of a prospective observational study initiated in 1993 that was designed to investigate the gynecologic status of HIV-infected women. Women answered a standardized questionnaire about contraceptive use and sexual activity at each semiannual visit. Multivariate models were used to investigate parameters associated with the use of contraceptive methods. Contraceptive use was reported in 91% of the visits of women with an HIV-seronegative partner and 69% of women with an HIV-seropositive partner (P=0.0001). Consistent condom use was higher in serodiscordant couples than in seroconcordant couples (odds ratio [OR]=6.1, 95% CI=0.1-0.2, P<0.001). The use of oral contraception and intrauterine devices was higher in seroconcordant than in serodiscordant couples (OR=2.1, 95% CI=.5-2.9, P<0.001). Among women with an HIV-seronegative partner, the use of oral contraception and intrauterine devices decreased after the introduction of highly active antiretroviral therapy in 1998 (P=0.02) and was higher in couples with inconsistent condom use (OR=2.0, 95% CI=1.3-3.3). These data emphasize that contraception counseling should include a discussion on reproductive issues as well as transmission of HIV and other sexually transmitted infections, taking into account the partner's serostatus.

Adult↗
PubMed2006

The impact of sex and contraceptive therapy on the plasma and intracellular pharmacokinetics of zidovudine.

OBJECTIVES: Zidovudine remains part of combination antiretroviral therapy. Pharmacological studies rely on quantitation of active triphosphates in peripheral blood mononuclear cells. This study evaluated the impact of female sex and contraceptive therapy on zidovudine plasma and intracellular pharmacokinetics and the impact of contraceptive therapy on HIV viral load. METHODS: Serial plasma and intracellular zidovudine pharmacokinetics following oral and intravenous dosing were determined in 18 men and 20 women treated with zidovudine. Women could repeat pharmacokinetics assessment following 2 months oral or injectable contraceptive therapy. Zidovudine plasma and intracellular mono-, di- and triphosphate concentrations were determined by liquid chromatography tandem mass spectrometry. Plasma and cervical viral loads were determined preceding and following 2 months of contraceptive therapy in women. RESULTS: Men exhibited higher area under the concentration versus time curve for intracellular zidovudine and zidovudine-monophosphate following oral and intravenous dosing and higher zidovudine triphosphate following oral dosing. There was no difference between men and women in plasma zidovudine parameters. Furthermore, contraceptive therapy had no effect on zidovudine plasma or intracellular pharmacokinetics or on plasma or cervical HIV-1 RNA levels. CONCLUSIONS: Using an optimized pharmacokinetic design, this study indicated men exhibit significantly higher zidovudine-monophosphate and zidovudine-triphosphate exposure following zidovudine oral administration, having implications for drug toxicity and overall tolerance of zidovudine therapy. The lack of an effect of contraceptive therapy on zidovudine pharmacokinetics is surprising in light of previous pharmacokinetic studies for drugs eliminated primarily through glucuronidation. Contraceptive therapy had no effect on plasma or cervical viral load, results consistent with previous findings.

Administration, Oral↗
PubMed2003

Blood pressure, serum total cholesterol and contraceptive pill use in 17-year-old girls.

BACKGROUND: Many studies have analysed the relation between cardiovascular risk factors and oral contraceptive use in adult women, whereas information on the possible health effects of oral contraceptive use during adolescence is lacking. DESIGN: The effect of current contraceptive pill use on blood pressure and serum total cholesterol concentration was studied in a cross-sectional sample of 120 adolescent girls with a mean age of 17.4 years. METHODS: After the girls had rested for 5 minutes in the sitting position, trained study nurses measured blood pressure three times consecutively using a mercury sphygmomanometer. The nurses also administered a questionnaire gathering information on the use of oral contraceptives, smoking and parental social class. In the morning blood samples were taken for the measurement of serum total cholesterol. RESULTS: Mean age (+/-SD) was 17.4+/-0.8 years. Blood pressure averaged (+/-SD) 108.7+/-9.9 systolic and 68.0+/-8.2 mmHg diastolic. Serum total cholesterol was 4.5+/-0.7 mmol/l. Forty-nine girls (41%) were taking the contraceptive pill. Of these, 44 (90%) were on a combination of ethinyloestradiol (20-35 microg) and a progestogen, four (8%) on anti-androgens (35 microg) and one (2%) only on a progestogen. After adjustment for age, body mass index, smoking and alcohol status systolic blood pressure was 4.6 mmHg higher (95% CI 1.2-8.1; P<0.001) in current pill users than in girls not currently on the pill (111.4 versus 106.8 mmHg). Adjusted for the aforementioned covariates, diastolic blood pressure was not related to pill use (68.2 versus 67.8 mmHg; P=0.7). Serum total cholesterol was 0.43 mmol/l (95% CI 0.18-0.60; P=0.001) higher among girls using oral contraceptives (4.7 versus 4.3 mmol/l), irrespective of whether or not the model was adjusted for age, body mass index, smoking and alcohol status. CONCLUSIONS: In 17-year-old girls, the use of oral contraceptives was associated with a nearly 5 mmHg higher systolic blood pressure and a 0.4 mmol/l higher level of serum total cholesterol. The long-term prognostic implications of our findings remain to be elucidated.

Adolescent↗
PubMed2003

Dual contraceptive method use for pregnancy and disease prevention among HIV-infected and HIV-uninfected women: the importance of an event-level focus for promoting safer sexual behaviors.

BACKGROUND AND OBJECTIVES: Many women who report condom use also use other methods of birth control such as oral contraceptive pills. The use of 2 or more contraceptive methods often results in less consistent condom use. GOAL: This study sought to document the prevalence and patterns of such dual contraceptive use among HIV-seropositive and HIV-seronegative women, and to assess factors associated with condom-only versus dual contraceptive use. STUDY DESIGN: At 6 months postpartum, 361 sexually active women were interviewed regarding sexual behavior, male condom and other contraceptive use, and psychosocial factors. RESULTS: Dual contraceptive method use was reported by 39% of sexually active women; 30% reported using condoms only. Almost two thirds of dual method users (64%) reported always using these methods together (ie, simultaneously) during vaginal sex. Among dual users, those who used methods simultaneously were more likely to be HIV-seropositive (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.5), to believe that a pregnancy would be very upsetting should it occur in the next 6 months (OR, 2.4; 95% CI, 1.1-5.4), and to report no alcohol use (OR, 3.7; 95% CI, 1.5-9.2). CONCLUSION: Dual contraceptive users should be encouraged to use methods together at every episode of vaginal sex. Interventions promoting simultaneous use should include pregnancy attitudes and the role of alcohol use, as well as a consideration of HIV serostatus as it impacts on dual use.

Adult↗
PubMed2007

High uptake of postpartum hormonal contraception among HIV-1-seropositive women in Kenya.

OBJECTIVES: The objectives of this study were to determine patterns of contraceptive utilization among sexually active HIV-1-seropositive women postpartum and to identify correlates of hormonal contraception uptake. GOAL: The goal of this study was to improve delivery of family planning services to HIV-1-infected women in resource-limited settings. STUDY DESIGN: HIV-1-infected pregnant women were followed prospectively in a perinatal HIV-1 transmission study. Participants were referred to local clinics for contraceptive counseling and management. RESULTS: Among 319 HIV-1-infected women, median time to sexual activity postpartum was 2 months and 231 (72%) women used hormonal contraception for at least 2 months during follow-up, initiating use at approximately 3 months postpartum (range, 1-11 months). Overall, 101 (44%) used DMPA, 71 (31%) oral contraception, and 59 (25%) switched methods during follow-up. Partner notification, infant mortality, and condom use were similar between those using and not using contraception. CONCLUSIONS: Using existing the healthcare infrastructure, it is possible to achieve high levels of postpartum hormonal contraceptive utilization among HIV-1-seropositive women.

Adolescent↗
PubMed2006

Determinants of contraceptive availability at medical facilities in the Department of Veterans Affairs.

OBJECTIVE: To describe the variation in provision of hormonal and intrauterine contraception among Veterans Affairs (VA) facilities. DESIGN: Key informant, cross-sectional survey of 166 VA medical facilities. Data from public use data sets and VA administrative databases were linked to facility data to further characterize their contextual environments. PARTICIPANTS: All VA hospital-based and affiliated community-based outpatient clinics delivering services to at least 400 unique women during fiscal year 2000. MEASUREMENTS: Onsite availability of hormonal contraceptive prescription and intrauterine device (IUD) placement. RESULTS: Ninety-seven percent of facilities offered onsite prescription and management of hormonal contraception whereas 63% offered placement of IUDs. After adjusting for facility caseload of reproductive-aged women, 3 organizational factors were independently associated with onsite IUD placement: (1) onsite gynecologist (adjusted odds ratio [OR], 20.35; 95% confidence interval [CI], 7.02 to 58.74; P<.001); (2) hospital-based in contrast to community-based practice (adjusted OR, 5.49; 95% CI, 1.16 to 26.10; P=.03); and (3) availability of a clinician providing women's health training to other clinicians (adjusted OR, 3.40; 95% CI 1.19 to 9.76; P=.02). CONCLUSIONS: VA's provision of hormonal and intrauterine contraception is in accordance with community standards, although onsite availability is not universal. Although contraception is a crucial component of a woman's health maintenance, her ability to obtain certain contraceptives from the facility where she obtains her primary care is largely influenced by the availability of a gynecologist. Further research is needed to determine how fragmentation of women's care into reproductive and nonreproductive services impacts access to contraception and the incidence of unintended pregnancy.

Adult↗
PubMed1982

Influence of contraceptive pill and menstrual cycle on serum lipids and high-density lipoprotein cholesterol concentrations.

The fluctuations of serum lipid and lipoprotein concentrations within one cycle were studied both in women using and not using oral contraceptives. High-density lipoprotein cholesterol decreased significantly from 1.47 mmol/l (57 mg/100 ml) to 1.30 mmol/l (50 mg/100 ml) during one contraceptive cycle in eight women and rose again to the initial value during the pill-free days. The mean concentration of total cholesterol also fell significantly as a result of the decrease of high-density lipoprotein cholesterol and of a not significant decrease of low-density lipoprotein cholesterol. The mean serum triglyceride concentration did not change significantly. The fluctuations in the concentration of serum lipids and lipoproteins in 10 women not using oral contraceptives were smaller than in the women using oral contraceptives and no significant changes in the concentrations were found during one cycle. Thus, high-density lipoprotein cholesterol concentration decreases during each contraceptive cycle. The time of blood sampling during the cycle is, therefore, of vital importance in interpreting the effect of oral contraceptives on high-density lipoprotein cholesterol. In women not using oral contraceptives blood can be sampled on random days during the cycle.

Adult↗
PubMed2003

Contraception in the perimenopause.

The perimenopause is a stage of life when a woman has low fertility but still requires contraception. It is also a peak age for menstrual dysfunction and a time when menopausal symptoms may commence. All these factors impact on contraceptive choice. Combined oral contraception can be continued until the age of 50 years in women who are low risk and do not smoke. Progestogen-only methods have advantages for women who have risk factors for cardiovascular disease. An intrauterine device may exacerbate menstrual problems at this stage but the levonorgestrel releasing intrauterine system is highly effective in controlling perimenopausal menstrual dysfunction. Women should receive accurate individualised advice on how the risks and benefits of contraceptive methods relate to them and on when contraception can be safely discontinued. Hormone replacement therapy is not reliably contraceptive and women should be advised to continue with a contraceptive method until they have reached natural sterility.

Climacteric↗
PubMed2003

Contraceptive effect of proligestone on spotted seals and crossbreeds of spotted seals and harbor seals.

Spotted seals (Phoca largha) and related crossbreeds maintained at Kamogawa Sea World breed seasonally from the end of January to middle of March. For contraception in these animals, the effect of a single administration of a contraceptive synthetic luteal hormone for dogs, proligestone (PRG), was investigated. The animals tested were 10 seals aged 4-24 years old, and a total of 35 trials were performed over five years. PRG was administered in 23 trials during January, which was one month before the estimated estrus, and in 12 trials during December of the previous year, which was two months before the estimated estrus. The dose of PRG was 5 mg/kg in 32 trials and 10 mg/kg in 3 trials. The effect of the contraception was judged by the presence or absence of delivery. Among 23 animals treated in January, 2 animals treated with 5 mg/kg PRG became pregnant, but the contraception was successful in the other 21 animals. Contraception was successful in all 12 trials treated with 5 mg/kg PRG in December. Overall, contraception was successful in 94.3% (33/35). Therefore, a single administration of 5 mg/kg PRG in December may be an effective method of contraception for seals.

Animals↗
PubMed2005

Women on top: the relative influence of wives and husbands on contraceptive use in KwaZulu-Natal.

OBJECTIVES: The purpose of this paper is to examine the relative influence of husband and wife on contraceptive practice. METHODS: A cross-sectional survey was conducted among adult men and women in KwaZulu-Natal, South Africa. A matched file for 238 married or cohabiting couples was created. RESULTS: Knowledge of methods of contraception was virtually universal and attitudes to contraception were favorable both in men and women. A substantial proportion of men and women reported using a method of contraception. The wife's desire to stop childbearing was the most powerful predictor of contraceptive use among couples, after adjustment for possible confounders. The husband's approval (or not) of family planning and his preference for future childbearing were not significantly related to contraceptive use. CONCLUSION: Contraceptive use within marital and cohabiting unions is high and the wife's fertility preference was found to be a key determinant of use. This conclusion challenges conventional wisdom that men are the dominant decision-makers in fertility and family planning decisions.

Adult↗
PubMed2005

Emergency contraceptive pills: dispensing practices, knowledge and attitudes of South Dakota pharmacists.

CONTEXT: Despite a decision by the Food and Drug Administration to deny over-the-counter status to emergency contraceptive pills, pharmacists play a crucial role in a woman's access to this medication, especially in areas with large rural populations. Pharmacists' knowledge about and attitudes toward emergency contraceptive pills may affect whether pharmacies carry the medication and whether individual pharmacists dispense it. METHODS: In October 2003, all registered pharmacists living and working in South Dakota were mailed a survey to assess their dispensing practices for, knowledge about, and attitudes toward emergency contraceptive pills. Data for 501 respondents were analyzed through chi-square testing and multivariate logistic regression. RESULTS: Fifty-four percent of respondents worked in pharmacies that carried emergency contraceptive pills. Of these, 67% had dispensed the medication in 2003, and 24% were not comfortable providing customer counseling about the method. Thirty-seven percent of all pharmacists did not understand its mechanism of action; 43% and 21%, respectively, incorrectly answered questions about the medication's link to birth defects and health risks. Only 5% correctly answered all three questions. Eighty-four percent of surveyed pharmacists believed that the medication should not be made available over the counter. Multivariate analysis showed that knowledge of emergency contraception and support for over-the-counter status were relatively low among pharmacists working in small communities. CONCLUSIONS: The education of pharmacists about emergency contraceptive pills must be strengthened to ensure that women receive accurate medical information and access to all contraceptive services.

Attitude of Health Personnel↗
PubMed2003

Contraceptive treatment after biliopancreatic diversion needs consensus.

BACKGROUND: An important population of patients who undergo biliopancreatic diversion (BPD) are fertile women. A consensus is needed with regard to contraceptive therapy after BPD by evaluating the risks of pregnancy, the safety of oral contraception and the changes in fertility after this bariatric surgery. METHOD: From May 1997 until May 1998, 40 women who underwent a BPD were included in a prospective study evaluating the hormone status preoperatively and postoperatively after 2 and 7 days, 3 and 6 months and 1 year. An extensive questionnaire, with regard to fertility and obstetric history, was sent at least 2 years after inclusion. A literature search was performed to understand the complex physiology of hormone changes after excess weight loss, as well as absorption and metabolism of oral contraceptives. RESULTS: Our laboratory results are consistent with hormone changes found in the literature, which show that rising levels of serum sex-hormone-binding globulin, follicle stimulating hormone and luteinizing hormone and decreasing levels of testosterone and dehydroepiandrosterone sulphate result in an improved fertility status, regulated through complex interactions, in particular with the gonatotropin-releasing-hormone pulse generator. The questionnaire shows the use of different types of contraception. From the 9 patients who only used oral contraception, 2 patients developed an unforeseen pregnancy after BPD. Although miscarriages and neonatal complications were seen in other patients in our hospital, none of these problems were seen in our study. CONCLUSION: Pregnancy should be avoided for 12 to 18 months after BPD. Fertility increases after BPD. As oral contraception is most popular and less reliable, we strongly believe that large multi-centre, prospective, randomized studies are necessary to come to a consensus about the use of contraceptive therapy after BPD.

Adolescent↗
PubMed2004

Male hormonal contraception.

Although women have traditionally shouldered the responsibility of contraception, up to a third of couples worldwide employ a male form of contraception (e.g., condoms or vasectomy). Some women are unable to use hormonal contraception; vasectomy is best considered irreversible; and long-term use of condoms is associated with a relatively high failure rate (pregnancy). Thus, a need exists for a safe, effective, reversible, well-tolerated male hormonal contraceptive agent. Two large multi-centre, multi-national trials sponsored by the World Health Organization in the 1990s showed that high-dosage exogenous testosterone provided contraceptive efficacy similar to existing female oral contraceptives. However, the supraphysiological dosages of testosterone used resulted in androgen-related adverse effects such as weight gain and suppression of high-density lipoprotein cholesterol levels. Subsequent efforts have been directed at combining testosterone with other agents, such as progestogens or gonadotropin-releasing hormone analogues, to decrease the dosage of testosterone (and thus androgen-related side effects) while achieving uniform azoospermia. This review discusses the latest developments in male hormonal contraception.

Androgens↗
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↗
PubMed2001

Emergency contraception: Who are the users?

CONTEXT: Data collected from two community family planning services are used to discuss the characteristics of users of emergency contraception (EC). OBJECTIVE: To investigate the characteristics of women attending for emergency contraception. DESIGN: A descriptive survey design was used to collect data. Questionnaires were completed over a 4-week period. Data were analysed using SPSS. SETTING: Community family planning services in South West Surrey and Newham, East London. PARTICIPANTS: Consenting women aged 14-44 years attending for emergency contraception (n = 171). MAIN OUTCOME MEASURES: Description of the users, the current episode and contact with contraceptive services were analysed by age. RESULTS: The age range was 14-37 years (mean 20.2 years). A majority were smokers. Of the women, 97.7% attended the clinic within the 72-hour time frame for issuing oral EC, however only 4% came within 12 hours of intercourse; 55% said that they had used contraception. Condom breakage was the commonest reason for failure. Reasons for not using contraception included getting 'carried away' (35%), not having condoms available (22%) and having drunk alcohol (13%). Of the sample 55.6% were previous users of EC. DISCUSSION: The study demonstrates a high incidence of sexual risk taking and need for EC, especially amongst smokers and drinkers. The message that soonest is best still requires promotion. Providers of EC must co-ordinate their services to ensure access within the 12-hour time frame in a local area. CONCLUSION: Health professionals need to ensure that clients have appropriate information about EC and regular contraceptive methods and that user friendly provision is widely available.

Adolescent↗
PubMed2001

Knowledge and practice of contraception in United Arab Emirates women.

OBJECTIVE: To determine the knowledge and practice of contraception among United Arab Emirates (UAE) women. METHOD: Four hundred and fifty UAE women at risk of pregnancy were randomly selected from the community and primary health care centres and interviewed about knowledge and practice of contraception using a structured questionnaire. RESULTS: Four hundred women (89%) gave consent to participate in the study. One hundred and sixty-six participants (41.5%) were using contraception. All used natural methods backed with other methods. There were significant associations between using contraception and each of age, high level of education and low family income (p < 0.0001 for the three variables). Religious beliefs and low expectation of success of birth control were the reasons given for non-use. Eighty-five percent of subjects did not accept sterilisation without medical indications, nor using contraception before the first pregnancy. Of the women, 42.5% believed that contraceptive methods should not be used after the age of 40, and 78% were unaware that they could be used for treatment of gynaecological diseases. Disturbed bleeding patterns occurred in 48.7% of users, and these were most bothered by the inability to pray (100%) and to have sexual intercourse (97.5%). CONCLUSION: Contraception is not commonly used by UAE women because of sociocultural traditions, religious beliefs and poor knowledge.

Adult↗
PubMed2004

Peri-abortion contraception: a qualitative study of users' experiences.

BACKGROUND: Contraceptive counselling is an essential element of induced abortion services but concerns remain about its effectiveness. OBJECTIVE: The issues that influence peri-abortion contraception were explored as part of a study on the experiences of women undergoing induced abortion. METHOD: In-depth interviews with 21 women of varying ages, gestations and ethnicity, 3-9 weeks after termination of their pregnancy, with qualitative analysis of data. RESULTS: Contraceptive risk-taking was high both before and after abortion. After abortion, only a few women had changed either to using some method, or moving to more reliable methods. Health professionals had not explored the issues around contraception with sufficient clarity or detail to be effective. Discussion of contraception was often deferred to the post-abortion follow-up visit, which only 12 respondents had attended at the time of interview. CONCLUSIONS: The effectiveness of peri-abortion contraception counselling was disappointing. We suggest that a family planning-trained outreach nurse attached to abortion providers with specific responsibility for contraception could improve uptake post-abortion.

Abortion, Induced↗