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PubMed2003

Risk-benefit effects of implantable contraceptives in women.

Contraceptive implant technology has been used by millions of women throughout the world. The three marketed implant systems today are levonorgestrel-releasing implants: Norplant and Jadelle, and a single etonogestrel-releasing implant, Implanon. The main benefits common to these delivery systems are their safety, high effectiveness, ease of use, long duration of action (3 - 5 years) and reversibility. Bleeding disturbances are the main adverse events associated with implantable contraceptives. Other minor risks relate to the insertion and removal procedures, which require adequately trained providers as well as aseptic techniques. Furthermore, since initiation and discontinuation of use is provider-dependent and not controlled by the user, there may be a risk of coercion of use on the one hand or, on the other hand, difficulty in access to initiating use, if trained providers are not readily available. Although no single contraceptive method is perfect or appealing to all, contraceptive implants are safe and fulfil a very important need among fertility regulation methods.

Clinical Trials as Topic↗
PubMed1976

[Oral contraceptives (author's transl)].

A short review of the endocrinological basis of reproduction in the female is followed by a critical survey of the oral contraceptive methods in current use. The composition of the preparations, their use, their biological and use-effectiveness and mode of action are discussed.The importance is emphasized of complying with the basic principles of drug testing in the evaluation of effects of oral contraceptiveson health. Other effects than merely the contraceptive actions of these preparations are described in detail, including not only the undesirable, frequently neglected, yet very important beneficial effects on the drug-users, their children and families.

Abnormalities, Drug-Induced↗
PubMed1991

Contraception and sexuality in an area-specific group of Swedish women 15-34 years of age.

In a community-based study in a Swedish suburban/rural area, all women aged 15-34 years (n = 671) were invited to the local health centre to be examined for chlamydia infection and for an interview. The attenders were asked about contraceptive history, age at first intercourse, number of life-time sexual partners and socioeconomic background. The net attendance was 69%, and contraceptive information on an additional 20% could be gathered through medical records. The average age at first intercourse was around 16 years, and the average number of sexual partners in the age-groups 20-24, 25-30 and 31-34 years was 4.0, 5.6 and 6.1, respectively. Of all women, around 75% had used contraception at first intercourse, and there was no tendency to a changing pattern during the past 20 years studies through the interviews. Combined estrogen-progestagen pills were by far the most used contraceptive method, presently being used by 42% of the contracepting women, followed by condom (23%), IUD (19%) and other hormonal methods (10%). It is concluded that sexual life in Sweden starts earlier than it did 30 years ago, that the number of sexual partners is higher, that most women in the studied group were efficient contraceptors, and that hormonal contraception was by far the most common method.

Adolescent↗
PubMed1995

[Pharmacology of oral contraceptives].

Oral contraceptives include two types of steroids; ethinyl-estradiol as the main estrogenic component which dose vary from 20 to 50 micrograms per tablet (mostly 30 to 35 micrograms) and progestins essentially derivatives of 19 nortestosterone. Derivatives of 19 norprogesterone such as nomegestrol acetate or ST 1435 are not used as oral contraceptives but are being evaluated through parenteral administration, e.g. implants or transdermal systems. The assessment of the pharmacological properties of these progestins indicate a high antigonadotropic and a high antiestrogenic properties for levonorgestrel and for the newer gestagens as well. Therefore very low doses are being used in the current oral contraceptives. However, there is a lower margin of security with the low dose contraceptives than with previous standard combinations and especially when concomitant medications are ingested such as enzyme-inducing agents. Selection of contraceptive methods should be discussed when specific co-medications are necessary.

Contraceptives, Oral, Synthetic↗
PubMed2002

Future trends in contraceptive prevalence and method mix in the developing world.

This study reviews existing methodologies for projecting future trends in contraception, evaluates the validity of the assumptions underlying these projections, proposes methodological improvements, and assesses the prospects for new methods of contraception in the coming decade. Demand for contraception can be expected to continue to rise rapidly for the next few decades as populations continue to grow and fertility declines to approach replacement level. As a result of these trends, the number of contraceptive users in the developing world is expected to rise from 549 to 816 million during the next 25 years, according to the most recent UN projection. An examination of the projection methodology found it to be reasonable. Projecting the future distribution of specific contraceptive methods is more difficult. Method choice is affected by trends in several factors, including access to different methods, user characteristics, and technology. The procedure employed by the Futures Group to project method mix was found to be less than optimally designed, and a new methodology is, therefore, proposed.

Contraception↗
PubMedDate not supplied

Emergency contraception for midwifery practice.

Every year in the United States, there are an estimated 3.5 million unplanned pregnancies with nearly one third of these attributed to contraceptive failures. Despite the availability of effective contraceptive methods, far too many women still experience unwanted pregnancies. It has been estimated that emergency contraception, also referred to as postcoital contraception or "the morning after pill," can reduce the risk of pregnancy after unprotected intercourse by as much as 75%. When administered within 72 hours of unprotected intercourse, emergency contraception, inhibits implantation of a fertilized ovum. The most common method of emergency contraception, the administration of ethinyl estradiol and dL-norgestrel, was initially described by Yuzpe in 1977. In the past 20 years, multiple studies have demonstrated the effectiveness of commonly prescribed combination oral contraceptives containing ethinyl estradiol and levonorgestrel. For those women in whom estrogen is contraindicated, progestin-only pills or the synthetic androgen Danazol have been used with comparable effectiveness rates. For appropriately selected women, an intrauterine device such as the Paraguard T380A (Ortho Pharmaceuticals, Raritan, NJ) also may be inserted within 5-7 days after unprotected intercourse to reduce the risk of unintended pregnancy. Despite its success and safety, emergency contraception is underused by women and their health care providers. As providers of comprehensive health care, midwives should provide patients with accurate information concerning pregnancy prevention. For many women, obtaining emergency contraception is an entry into the health care system and provides them an opportunity to be educated about safer sex practices, contraception, and the importance of regular health screening. Regularly discussing emergency contraception with patients at routine health visits will enable them to participate fully in their health care decisions and diminish the physical, psychological, and societal stressors associated with unplanned pregnancy.

Contraceptives, Postcoital↗
PubMed1985

Cervical Chlamydia trachomatis infection in university women: relationship to history, contraception, ectopy, and cervicitis.

Endocervical Chlamydia trachomatis infection was found in 13 of 162 volunteer female university students (8%). Infection was correlated with younger age (p less than 0.05), less than or equal to 4 years of intercourse (p less than 0.05), a history of gonorrhea (p less than 0.01), and exposure to a partner with urethritis (p less than 0.01). Women who used intrauterine or barrier contraception had less infection (2%) than did women who used oral contraception (14.3%, p less than 0.05) or none at all (10.7%, p less than 0.05). Infection was strongly associated with a cervicitis score calculated from erythema, ectopy, discharge, and secretions that contained white blood cells (p less than 0.0001). By multivariate analysis, a proposed clinical approach was arrived at for testing for chlamydial organisms all women with cervicitis who were not using barrier contraception. The positive predictive value of this approach for chlamydial infection was 28%, and the negative predictive value 98.4%. Cervical ectopy was increased in women who used oral contraception (p less than 0.01), and infection was increased in women with ectopy, regardless of their contraceptive method (p less than 0.001). These results will aid in more rapid diagnosis of endocervical chlamydial infection and in the choice of contraception in young women and high-prevalence groups.

Adolescent↗
PubMed1996

Heterosexual experiences and partnerships of urban, low-income African-American and Hispanic youth.

We have used data from a probability sample of African-American and Hispanic youth living in low-income urban household to describe their heterosexual experiences and the influence of relationships with different kinds of sexual partners (married/lived with, well known, casual) on types of intercourse (oral, anal, vaginal), condom use, and use of other birth control methods. The Generalized Estimating Equation method for data sets with multiple observations on the same subject was used to examine whether an individual's behavior differs with different kinds of partners and how behavior with a given partner is affected by experience with other relationships. Results indicate that (a) with the exception of African-American men, sexual and contraceptive behavior varied considerably with different kinds of partners; (b) heterosexual oral and anal intercourse is more common among Hispanic than African- American youth; and (c) regardless of experience with other relationships, consistent condom use as well as use of any type of contraceptive method tend to be less likely with a casual sex partner. Data regarding percentages of consistent condom use (20%-45%) and increased involvement in risky behavior associated with multiple partners further emphasize the need for interventions that enhance condom use and discourage involvement with multiple partners.

Adolescent↗
PubMed1990

Contraceptive and sexual behavior of black female adolescents. A test of a social-psychological theoretical model.

To test a previous theoretical model, we studied the relationships between social, attitude, and psychological factors and adolescent contraceptive behavior over a 6-month period. A pretested questionnaire was administered to a random sample of 115 black females aged 12 to 18 years from a low socioeconomic population. Six months after the initial interview 113 of the subjects were administered a second questionnaire assessing their sexual and contraceptive behavior. Based on regression analysis, previous pregnancy and coital frequency explained 12.7% (p less than or equal to 0.0001) of the variation in engaging in unprotected coitus. When controlling for sexual activity, birth control knowledge and previous broken appointments explained an additional 5.5% of variation in the regression model (total R2 = 0.185). Coital frequency of the subjects was positively associated with Tanner stage, length of the relationship, effectiveness of previous contraceptive method(s), and degree of birth control knowledge. Coital frequency was inversely associated with a negative attitude toward pregnancy and negative parental attitudes toward adolescent pregnancy. The perceived risk of pregnancy was positively correlated with coital frequency and previous pregnancy. These findings support our model, but suggest that among low socioeconomic black female adolescents the interpretation of several model components depends on the subjects' attitude toward pregnancy and her perception of her parent's attitude toward adolescent pregnancy.

Adolescent↗
PubMed1976

Contraceptive choice and prevalence of cervical dysplasia and carcinoma in situ.

Whether use of oral contraceptives is associated with subsequent development of cervical neoplasia is an important public health question. Before evaluating this issue, we must determine if choosing oral contraceptives identifies a woman who is intrinsically at high risk of developing cervical neoplasia. We have examined the demographic and reproductive characteristics as well as cervical premalignant changes manifest by 15- to 44-year-old black women who enrolled in a public family-planning clinic. When compared to IUD acceptors, oral contraceptive acceptors did not have a disproportionately large number of women with traits which predicted for high risk of developing cervical neoplasia. Oral contraceptive acceptors, compared to IUD acceptors, did not have a higher prevalence rate of carcinoma in situ. Oral contraceptive acceptors with no Pap smears prior to initial choice of contraceptive method did have a 1.4-fold higher prevalence rate of cervical dysplasia than IUD acceptors. These results suggest that the deicision to use oral contraceptives, per se, does not identify a group of women at higher risk to develop cervical carcinoma in situ. Such a decision may, however, identify a group with a small increased propensity for developing cervical dysplasia.

Adolescent↗
PubMed1994

Menstrual impact of contraception.

Persistent bleeding is a common reason for the discontinuation of contraception. Standard terminology for describing bleeding patterns by reference period is presented. Observed bleeding patterns with oral contraceptives, depot medroxyprogesterone acetate, the levonorgestrel subdermal implant, and intrauterine devices are described. Bleeding days are least with oral contraceptives that are highest in progestin and estrogen potency and dose, but the ratio of the two steroids is also important. Published studies suggest that oral contraceptives containing new nonandrogenic progestins have bleeding patterns as acceptable as older low estrogen formulations. Approaches to the evaluation and treatment of intermenstrual bleeding with contraceptive methods are reviewed. Patient education on expected bleeding patterns is essential to compliance and continuation.

Contraceptive Agents↗
PubMed1985

The pill does not cause 'thrush'.

Contraceptive method, presence or absence of genital candidosis and other genital infections or conditions were recorded in 1363 new patients attending three different genitourinary medical clinics. Genital candidosis was present in 28% but was not associated with oral contraceptive usage; it seemed more likely to be associated with other genital disorders, especially non-specific infection and viral infections.

Candidiasis, Vulvovaginal↗
PubMedDate not supplied

Premature discontinuation of contraception in Australia.

Life-history data from a nationally representative survey of Australian women were used to examine discontinuation of contraceptive methods because of accidental pregnancy, side effects or dissatisfaction. The pill was the most successfully used method, with a first-year discontinuation rate of 10% for all three reasons. Side effects dominated the reasons for the premature discontinuation of both the pill and the IUD, while the reasons for discontinuing the condom stemmed equally from pregnancy and dissatisfaction with the method. Discontinuation of the diaphragm resulted largely from accidental pregnancy. Hazards models were used to identify the correlates of discontinuation of each method. Predictors of premature discontinuation reflect the availability of methods, physiological reactions to them and the social characteristics of their users. Discontinuation of the pill because of side effects or dissatisfaction was more likely among poorly educated women, non-Protestants and recent users, and less likely among teenagers. Discontinuation of the IUD was related entirely to physiological factors: Nulliparous women and users of unmedicated devices were at a greater risk than other women of accidental pregnancy, and nulliparous women were at greater risk of discontinuation associated with side effects. Nulliparous women were also more likely to discontinue the condom because of pregnancy, as were non-Protestants and the Australian-born.

Adolescent↗
PubMed1994

[The 1st phase of a prospective study of the effectiveness of natural family planning conducted in French-speaking Belgium].

UNLABELLED: The aim of this pilot-study is to check the practical efficiency and the acceptability of a recent NFP method in Western Europe. MATERIAL AND METHODS: In a first stage, 58 participants, aged 18 to 49, provided 940 cycles (78 woman-years) being with an average of 16 cycles each, all well-documented (sympto-thermal chart and supporting card). The average age of the women was 32 years. 53% of them have chosen NFP after giving up another contraceptive method. The applied NFP method uses a double check to accurately define the beginning as well as the end of the fertile phase of the menstrual cycle. The indicators of the beginning of the fertile phase were: the first sign of cervical mucus and a calendar calculation. The indicators of the end of the fertile period were: the third morning of high temperature and the evening of the fourth day after the peak mucus or the peak cervix. Four participants out of five regularly uses the cervix index. RESULTS: No method failure was seen. One unplanned pregnancy (user failure) was recorded. Pearl-Index (practical effectiveness of the method) was: 1.75. Pure NFP (i.e. no additional contraceptive means during the fertile phase) was applied in 85% of the cycles. Moreover unprotected sexual intercourse during the fertile phase occurred in 17% of the cycles. So in 71% of the cycles, couples had accepted periodic abstinence. CONCLUSIONS: After more than 78 years of use, it appears that an accurate and thoroughly taught sympto-thermal method of NFP shows a use-effectiveness which can be compared to that of the up-to-date contraceptive methods. The acceptance of the method proved to be excellent. The acceptability turns out to be very good.

Adolescent↗
PubMed2003

Mechanisms of action of mifepristone when used for emergency contraception.

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

Contraceptives, Oral↗
PubMed1982

A comparative study of the effectiveness of the Lippes Loop, the Copper-T-200, and the Nova-T intrauterine contraceptive devices in Lagos, Nigeria.

Two hundred five women attending the Family Planning Clinic of the Department of Community Health were admitted into a nonrandomised study to compare the effectiveness of the Copper-T-200, Nova-T, and Lippes Loop intrauterine devices. Members of the study group of women were found to be older than their European counter-parts and also tended to have a higher parity (81.0% of the total group having more than three children). The expulsion rates and removal rates for bleeding and pain for Copper-T-200 and Nova-T users were respectively 6.5 and 3.8 and 5.0 and 1.5. These results were significantly lower than the rates for the Lippes Loop users which were 14.7 and 6.7, respectively. The continuation rates were higher for the Copper-T-200 (88.2) and the Nova-T (91.3) than for the Lippes Loop (75.5). These findings were essentially similar to those of other worldwide studies.

Adult↗
PubMed2003

New contraceptive choices across reproductive life.

The range of contraceptive options and consumer awareness of new contraceptive methods have both increased significantly over the past 10 years. New methods available in Australia include lower-dose oral contraceptive pills, new oral progestogens, progestogen implants, a progestogen-bearing intrauterine device and polyurethane female condoms. Contraceptive options which may soon be introduced in Australia include novel methods of administering combined (oestrogen-progestogen) contraception, such as dermal patches and vaginal rings.

Adolescent↗