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PubMed1994

The use of contraceptive methods among women seeking a legal abortion.

In a simple random sample study of 404 women 20 to 29 years of age, 201 applying for abortion and 203 continuing their pregnancies, all were interviewed personally and requested to complete a questionnaire. The aim of the study was to analyse the use and experience of contraceptives among the abortion applicants in this age group, and to compare their experience with that of women in a matched control group. The most important reasons given for desisting in the use of contraceptives were the experience of side effects, worry about the side effects, and the "human failure" factor involved even with methods of contraception such as pills, which generally are regarded as safe. This study demonstrates that women living alone without any permanent relationship, having a strained economy or having previously had an abortion, need particular and detailed contraceptive advice plus continued close follow-up. To improve the continuation rate, precise contraception counselling focusing on both positive and adverse effects to reduce worry seems essential.

Abortion Applicants↗
PubMed2002

Non-parametric confidence interval estimation for competing risks analysis: application to contraceptive data.

Non-parametric maximum likelihood estimation of the cause specific failure probability, and of its standard error, in the presence of competing risks is discussed with reference to some contraceptive use dynamics data from Bangladesh. The cause specific incidence function provides an intuitively appealing summary curve for failure rates and probabilities, such as probabilities of discontinuation of different kinds of contraception, based on right-censored data of the particular event. Dinse and Larson's formula can be utilized to calculate the standard error of the cause specific probability for the failure type of interest, and to construct pointwise confidence intervals. The accuracy of these intervals, as well as those based on the log(-log) transformation and the arcsine transformation, are compared by simulations. We find that Dinse and Larson's formula, used in conjuction with a log(-log) transform, yields reliable standard error estimates and accurate coverage in samples of small and large size, and can be recommended for use in this situation.

Adult↗
PubMed1986

Birth control failure.

Birth control failure usually results from the incorrect or inconsistent use of contraceptives. By providing anticipatory counseling, based on an understanding of the reasons for birth control failure, family physicians can help curtail the current epidemic of unwanted pregnancies.

Contraception Behavior↗
PubMed1981

Diaphragm failure.

Explore the source record for details and available documents.

Contraceptive Devices, Female↗
PubMed1993

Helping patients choose appropriate contraception.

Helping patients choose the proper contraceptive requires familiarity with the specific advantages and disadvantages, as well as failure rates, of available methods. Spermicides, condoms and contraceptive sponges are inexpensive and do not require physician prescription. Diaphragms and cervical caps help protect against sexually transmitted diseases but are more difficult to use effectively. Oral contraceptives are highly effective but have estrogen- and progesterone-related side effects. Norplant is ideally suited for less motivated users but requires an office surgical procedure. Depo-Provera provides another long-term option but may result in amenorrhea. Intrauterine devices provide long-term contraception without hormonal side effects but increase the risk of pelvic infection and may cause heavy menstrual bleeding. Tubal ligation and vasectomy are options for permanent contraception when childbearing is no longer desired.

Aftercare↗
PubMed1994

The contraceptive practices of women seeking termination of pregnancy in an Auckland clinic.

AIM: The aim of the study was to assess the contraceptive knowledge and practices of women attending the abortion service at Epsom day unit, Green Lane Hospital. METHODS: Women attending the unit in December 1992 and January 1993 were asked to take part in the study. A questionnaire was administered to consenting women to assess demographic details and previous contraceptive education. If a contraceptive method was used the reason for failure was explored and if no method was used the reason for non use was explored. RESULTS: Sixty-one percent of women were using a contraceptive method in the month of conception. The condom was used by 48% and the pill by 42%. Eight percent of women had never used contraception and 30% were not using a method in the month of conception. Forty-three percent had a household income of less than $22,000 and financial barriers were the reason for non use in 32% of those not using a method. Of women who did not use contraception, only 11% used emergency contraception, whereas 78% of those surveyed said they knew about emergency contraception. Sixty-three percent of women said they had received enough contraceptive education to select and use a method effectively. Pacific Island women were least likely to have received adequate contraceptive education or to have been using a method of contraception. CONCLUSIONS: A number of technical problems were identified with condom use. These problems need to be emphasised by sexuality education programmes and contraceptive prescribers. Omitting pills, diarrhoea, vomiting and drug interactions were important causes of pill failure. The seven day rule needs more emphasis when teaching women how to take the pill and when antibiotics are prescribed. Costs were an important barrier to the use of contraception for a significant proportion of women. Section 99 approval should be utilised more readily and the provision of free contraception, especially to low income groups, needs to be urgently explored.

Abortion, Legal↗
PubMed1998

Pill method failures in women seeking abortion: fourteen years experience.

AIMS: To document predisposing factors in 769 women who had inadvertently conceived while taking oral contraceptive pills reliably. METHODS: Over a 14-year period, 1981-1995, two questionnaires were administered, one for women using the combined oral contraceptive pill (COC) and one for women using the progestogen only pill (POP). RESULTS: More than one predisposing factor was usually present, the most common being diarrhoea and/or vomiting in 39.0%. Antibiotics had been prescribed in 20.5%. COC failure was associated with a high incidence of menstrual disturbance (37.1%). A history of a previous pill failure was obtained in 27.8%. Smoking was a risk factor for women on the COC. Only 6.0% became pregnant during the first month of pill use. As expected, POP users experienced a higher number of pill failures in proportion to the market share, but excess weight and time of taking did not appear to be risk factors. Most COCs failed according to the numbers expected from the market share. CONCLUSIONS: Many pill failures could be averted by better information about known or suspected risk factors, especially gastrointestinal upset and interacting medications. Pill failure is one more reason to discourage smoking in COC users.

Abortion, Induced↗
PubMed2001

Drug interactions between oral contraceptives and antibiotics.

OBJECTIVE: To evaluate the evidence on possible drug interactions between antibiotics and oral contraceptives (OCs) that may lead to OC failure. DATA SOURCES: MEDLINE and Lexis/Nexis Medical Library searches for 1966-1999 using the key word "oral contraceptives," cross-indexed with the terms "antibiotics," "adverse effects," and "pregnancy," and MEDLINE search using the additional MeSH term "drug interactions." No language restrictions were used. METHODS OF STUDY SELECTION: A total of 167 articles were retrieved for analysis. Another 32 articles were identified by review of the references cited in these publications. Articles were selected based on their ability to provide information on the relationship between antibiotic therapy and OC efficacy in otherwise compliant users (defined as women with unplanned pregnancies who reported compliance with their OC regimen). Additionally, studies that either directly measured the effects of antibiotics on the pharmacokinetics of OC components, or that analyzed the effects of antibiotics on measures of ovulation in OC users were accepted. TABULATION, INTEGRATION, AND RESULTS: At least 30 cases have been reported of pregnancies occurring in women taking OCs and antibiotics, particularly rifampin. Approximately 20% of pregnant women reporting to family planning or abortion clinics reported concomitant OC and antibiotic use. Information from adverse event reporting databases generally mirrors the types of information gleaned from these case reports and clinical surveys and accounts for approximately one-third of reported cases. Retrospective surveys, primarily from dermatology-based practices, also have reported 24 pregnancies in OC users who concomitantly received therapy with antibiotics, most commonly tetracyclines and penicillins. Apparent OC failure rates in clinical surveys were within the usual range expected for patterns of typical use. In pooled results obtained from relatively small populations, oral antibiotics, with the exception of rifampin, have not significantly affected the pharmacokinetics of ethinyl estradiol, levonorgestrel, and norethindrone or reduced the serum concentrations of gonadotropins. However, individual patients have been identified who experienced significant decreases in the plasma concentration of these components of OCs and who appeared to ovulate. CONCLUSION: Rifampin impairs the effectiveness of OCs. Pharmacokinetic studies of other antibiotics have not shown any systematic interaction between antibiotics and OC steroids. However, individual patients do show large decreases in the plasma concentrations of ethinyl estradiol when they take certain other antibiotics, notably tetracycline and penicillin derivatives. Because it is not possible to identify these women in advance, a cautious approach is advised.

Anti-Bacterial Agents↗
PubMed1989

Triphasic Randomized Clinical Trial: comparative frequency of intermenstrual bleeding.

Oral contraceptives have the highest theoretic efficacy of all reversible forms of contraception, yet in practice they have an actual failure rate equivalent to that of some barrier methods. The efficacy of oral contraceptives depends primarily on patient compliance. So-called "nuisance" side effects, such as intermenstrual bleeding (breakthrough bleeding or spotting), play a major role in their discontinuation. The Triphasic Randomized Clinical Trial compared the incidence of these side effects in three groups of subjects taking NET (A) (Ortho-Novum 7/7/7), LNG (Tri-Levlen), or NET (B) (Tri-Norinyl). Subjects taking NET (A) had the highest incidence of intermenstrual bleeding (63%) followed by NET (B) (44%) and LNG (33%). Only the difference between NET (A) and LNG attained statistical significance (p less than 0.030). Control subjects had no breakthrough bleeding and a 4% incidence of spotting. Further research is warranted to establish the cause of the disparity in the incidence of intermenstrual bleeding among patient groups assigned to the three oral triphasic contraceptives.

Contraceptives, Oral↗
PubMed1975

[Hemolytic-uremic syndrome in a young woman following the use of ovulation inhibitors].

After prolonged intake of oral contraceptives a 28-year-old woman developed a hemolytic uremic syndrome with microangiopathic hemolytic anemia, renal failure, malignant hypertension and blindness due to papillary congestion. Renal biopsy revealed widespread arteriolar alterations with massive intimal thickening, narrowing of the lumina and fibrinoid necrosis. During treatment with anticoagulation, antihypertensives and hemodialysis the hemolysis disappeared and vision improved, but the renal failure persisted. The possible relation between oral contraceptives and hemolytic uremic syndrome is mentioned and the literature is reviewed.

Adult↗
PubMed2001

A relative risk-based, disease-specific definition of sexual abstinence failure rates.

Sexual abstinence programs have the potential to reduce the incidence of unplanned pregnancies and sexually transmitted diseases (STDs) among adolescents. Effectiveness measures are needed to help researchers assess the impact of sexual abstinence promotion programs on STD and pregnancy rates and to enable comparisons of abstinence effectiveness with other contraception and STD prevention methods. Abstinence "failure rates" have been proposed as one measure of program effectiveness. However, the concept of abstinence failure rates has not been adequately operationalized. The present study examines a novel mathematical framework for estimating abstinence failure rates, both theoretically and empirically. Examples are provided, and the advantages and disadvantages associated with the mathematical model-based approach are discussed.

Adolescent↗
PubMed1975

Diagnostic error in breast disease.

Fifty-six breast biopsies, incorrectly assessed by preoperative clinical or mammographic examination, were reviewed to define the characteristics in the tumor or patient that caused the clinician and mammographer to be diagnostically inaccurate. The most important patient characteristic associated with error was the use of hormones. Failure to recognize that oral contraceptive use significantly reduces the incidience of benign breast disease contributed to the frequent misdiagnosis of lesions in those patients. Twelve of 16 masses in oral contraceptive users were malignant. In seven, their resemblance to cysts or fibroadenomas resulted in treatment delay of two weeks or 18 months. Because benign disease is uncommon in women who have used contraceptives two or more years, all new lesions in those women should be studied by biopsy promptly. Neither clinical nor mammographic evaluation of lesions in postmenopausal women who used estrogens was accurate. Twelve postmenopausal patients with carcinoma had used estrogens. Three of these lesions were considered benign clinically and four, by mammogram. In one, treatment was delayed four years. In women over 50 not using hormones, clinical diagnosis of malignancy was accurate. Ten carcinomas in those women were missed by mammogram. Eight had negative nodes; thus a negative mamogram when the clinical diagnosis is correct may be an effective guide in predicting the status of axillary nodes. Paget's disease was not recognized clinically in two of eight patients with that disease, and an additional two were not recognized on mammography. The initial examiner did not identify three of six inflammatory carcinomas. Ten percent of benign lesions were intraductal hyperplasia or papillomatosis with atypia and were the benign lesions most often misdiagnosed clinically and by mammogram. No microscopic lesions were noted on mammography without an associated palpable mass. Twenty-five per cent of the lesions in women aged 40-49 were incorrectly assessed by mammography or clinical examination. Four (15%) of the 27 carcinomas in this age group were not recognized by either modality. Mammography helped delineate the characteristics of masses in premenopausal women. With recognition that any mass that appears in a woman using oral contraceptives must be studied by biopsy, combined clinical and mammographic study in primenopausal women should minimize diagnostic error. Unfortunately, neither clinical nor mammographic evaluation of the women with irregular periods approaching menopause or within three years past menopause is accurate. It is in that age group that new diagnostic modalities are needed and when reported their efficacy in that age group should be stressed.

Adult↗
PubMed2001

Analysis of failure time hierarchical data in the presence of competing risks with application to oral contraceptive pill use in Egypt.

Problems of practical interest in the analysis of data on contraceptive use, from Demographic and Health Surveys (DHS), include the estimation of the cause-specific probability of discontinuation by time t (the cumulative incidence function), in the presence of other competing causes and the evaluation of the effect of covariates on the cause-specific hazards of discontinuation. Methods of analysis of failure time data with competing risks are by now fairly well developed in the case of a simple random sample. However, the data from the DHS are clustered by geographical areas and include multiple episodes per woman. For a marginal (population average) approach, we propose using methods developed for simple random samples with standard errors calculated using a double bootstrap to take account of the clustered hierarchical nature of the data. In the conditional approach, the cause-specific hazards are modelled as log-linear functions of the covariates conditional on random effects of clusters and women, using a three-level multinomial discrete-time logit model. The methods are applied to data from Egypt 1992 DHS on the oral contraceptive pill use.

Adolescent↗
PubMedDate not supplied

Condom breakage studied.

4 specific reasons why condoms--even those of high quality--break have been identified following a series of studies in 8 countries among 1700 people. According to the studies, breakage falls into 4 general categories: incorrect methods of putting on condoms, use of oil-based lubricants, reuse of condoms, and duration or intensity of coitus. The studies, conducted by Family Health International, a North Carolina based contraceptive research and AIDS prevention organization, was the 1st large scale effort to examine condom breakage. Used properly and consistently, condoms are considered to be highly reliable for prevention of pregnancy and sexually transmitted diseases. An estimated 40 million couples worldwide currently use condoms for pregnancy prevention. The studies found that human factors caused condoms to break at rates that ranged up to 13%, with a 4-5% average breakage rate reported at most sites. Preliminary research data indicate that the vast majority of condom users very seldom experienced condom failure. Past condom "failure," as defined by the number of accidental pregnancies among US couples who used condoms for contraception, was estimated at 12% (12 of 100 couples using condoms for 1 year will experience a pregnancy). But the 12% failure rate was attributable primarily to nonuse or inconsistent use of condoms, not breakage. "W now have some guideposts as to what types of behavior lead to breakage," said Dr. Nancy Williamson, director of Family Health International's program evaluation division, which directed the studies. "We need to inform condom users and providers about which errors users make." The studies provide an important cross-cultural data base on condom use. "The causes of condom breakage were usually associated with individual behavior, not with culturally based practices," said Dr. Williamson. the 8 countries where the studies were conducted are: Ghana, Kenya, Mali, Sri Lanka, the Dominican Republic, Jamaica and Mexico.

Behavior↗
PubMed1991

Contraception for women with diabetes: an update.

Today several effective contraceptive methods are available for women with IDDM. Contraceptive guidance as part of the pre-pregnancy counselling needs to be more widely implemented by general practitioners and in non-specialized obstetrical and gynaecological departments. Women with diabetes are generally well motivated, and thus the barrier methods may prove both acceptable and reliable contraceptive agents for some of these women. When, however, a high risk of user failure can be predicted, the IUD or hormonal contraception may be the only reversible alternative. According to our findings, IUDs can be recommended without reservation to women with IDDM. In women with previous GDM it seems that low dose oral contraceptive compounds may be administered without running the risk of inducing glucose intolerance, but long-term results are still unavailable. Natural oestrogens may be administered in combination with a progestogen for a limited period as an efficient and acceptable mode of contraception in women with IDDM without any concomitant adverse effects on diabetic control. From our investigations it also appears that short-term administration of combined low dose OCs containing the traditional progestogens (e.g. norethisterone or levonorgestrel) or the new gonane progestogens (e.g. gestodene) does not alter glycaemic control in women with IDDM. Similarly, these compounds do not cause any significant changes in lipid/lipoprotein levels during short-term treatment, although the intake of monophasic ethinyloestradiol/norethisterone preparations may result in higher triglyceride levels and tends to increase lipid levels more than triphasic ethinyloestradiol/levonorgestrel compounds. The results from our clinic have shown that OCs can be safely recommended at pre-conception counselling so that women with diabetes can obtain both optimal glycaemic control and efficient spacing of their pregnancies.

Contraception↗
PubMed1999

[A randomized, double-blind, multicentre study on comparing levonorgestrel and mifepristone for emergency contraception].

OBJECTIVE: To compare the efficacy, side effects and the effect on next menstruation of levonorgestrel(LNG) to low dose mifepristone in emergency contraception. METHODS: The study is a randomized double-blind multicenter comparative trial. The clients who have unprotected intercourse within 72 hours were allocated to one of the two study groups. In LNG group, 0.75 mg LNG was taken twice with 12 hours apart. In mifepristone (Mife-) group, single dose of 10 mg mifepristone was taken and a placebo 12 hours after. Follow-up visit was paid on the seventh day of the expected next menstruation to evaluate the contraceptive efficacy and to record side effects and menstruation. Contraceptive efficacy was calculated by Dixon's method. RESULTS: The total valid subjects in LNG and Mife- group were 643 and 633, respectively. There were 20 and 9 pregnancies occurred respectively in each group. The failure rate was 3.1% and 1.4%. Contraceptive efficacy rate of preventing pregnancy was 59.2% and 79.7%, the difference was statistically significant (P < 0.05). The incidence of various side effects was less than 10.0% which were mild. There was no statistically difference between the two groups. The percentage of subjects who had their next menstruation before or after their expected menstruation 3 days in LNG group and Mife- group was 77.7% and 78.5% respectively. The menstrual period less than 7 days was 95.0% and 93.3%. CONCLUSION: Use of levonorgestrel or low dose mifepristone for emergency contraception is effective and safe.

Adult↗
PubMed1985

Oral contraceptive drug interactions.

Approximately 50 million women use oral contraceptives (OC). Studies and case reports demonstrate that OC failure may be caused by rifampin, anticonvulsant drugs, and possibly some antibiotics. Contraceptive steroids may interfere with the metabolism of the benzodiazepines, theophylline, and the glucocorticoids. Future investigation will document the clinical significance of other OC interactions as well as give rise to new interactions.

Acetaminophen↗