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Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗

Barrier contraception.

Barrier contraception is a safe, effective, reversible form of contraception acceptable to many couples. The use of barrier contraception may protect against carcinoma of the cervix and sexually transmitted diseases. Distribution and education in the use of barrier contraception does not always require medical supervision. This must make it an attractive form of contraception for agencies supporting family planning programmes in developing countries. The only marketed recent advance in barrier contraception is the collatex sponge. Effectiveness rates range between 9 and 27 pregnancies per 100 woman-years. This is unlikely to make it the first choice of contraception for couples who would find an unintended pregnancy a severe problem, but the sponge will be acceptable to couples who are simply trying to delay a pregnancy. The new surge of interest in barrier contraception could lead to safer more effective forms of contraception being made available to women without medical supervision. This would have many advantages, but could also detract from the ability of family planning clinics to play an important role in preventative medicine for women.

Adrenergic beta-Antagonists↗

Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer.

The effects of barrier and spermicidal methods of contraception on cervical cancer risk were examined by studying 479 cases of histologically confirmed invasive cervical cancer cases and 788 random digit dialing controls. In addition to a detailed history of contraceptive practices, information was available on numerous potential confounders, including demographic characteristics, sexual behavior, reproductive factors, Pap smear screening history, and smoking. After adjustment for relevant confounders, diaphragm and condom use were found not to be significantly associated with risk of cervical cancer. Although there was a small reduction in risk (OR = 0.8) associated with long-term use (5+ years) of the diaphragm, the effect appeared to relate to concomitant spermicide use, since there was evidence of further decreases in risk for women using spermicides alone for extended periods (OR = 0.7 for 5+ years). Effects were only seen among subjects of higher income and education levels, suggesting that patterns of usage may be important. The potential ability of spermicides to reduce cervical cancer risk by neutralizing viral agents warrants further attention.

Adult↗

The use of nonhormonal methods of contraception in adolescents.

Although the 1990s have seen a reduction in unintended pregnancy rates and improved contraceptive-use rates, the negative consequences of unintended pregnancy and STD acquisition continue to plague our youth. Primary health care providers, including pediatricians, play an essential role in further reducing unintended teen pregnancy and STD acquisition rates through the promotion of effective and consistent contraception. Pediatricians need to be aware that now, more than ever, nonhormonal contraceptive methods should be used by every sexually active youth, and counseling of both boys and girls should be routine. Although not as effective at preventing pregnancy as hormonal methods of contraception, many nonhormonal methods provide excellent STD protection. Condoms plus spermicide continue to be a very popular and effective method of pregnancy and STD prevention. The newer polyurethane male and female condoms provide alternative, safe barrier protection, although their efficacy at preventing HIV in vivo needs further study. Diaphragms and cervical caps, in conjunction with spermicide, also provide pregnancy and STD prevention, but not as effectively as male condoms plus spermicide. Although most likely to use condoms in association with another birth control method, adolescents often find dual-method use cumbersome and difficult to comply with. Finally, although IUDs and periodic abstinence are safe methods of birth control for older women in monogamous relationships, they are unlikely to be appropriate for most adolescents. In many respects, we have come full circle back to our "nonhormonal contraceptive roots." As we enter the twenty-first century, we have found that no single "miracle" approach can be used to reduce adolescent pregnancy and STD rates. Rather, pediatricians are obliged to offer nonhormonal methods of contraception, often in conjunction with other birth control methods, as a means of preventing unwanted STDs and pregnancy. Through a comprehensive community approach that uses sex education, abstinence programs, condom-availability programs, and contraceptive-skills training, however, pediatricians can play a central role in the promotion of effective and consistent contraception by adolescents.

Adolescent↗

Barrier contraceptive practice and male infertility as related factors to breast cancer in married women. Preliminary results.

A case-control study was conducted in order to test the hypothesis that a reduced exposure to human seminal factors in the early reproductive life of women is a risk factor in breast cancer. The relative risk of exposure to the hypothetical semen-factor deficiency is 4.7 times greater for breast-cancer patients than for the controls. The risk of developing breast cancer within the same population in the U.S.A. is estimated as 5 times greater for women who use barrier methods (condom and other) than for women who use non-barrier contraceptive methods (diaphragm and other). The reduction of the incidence of breast cancer by eliminating the barrier contraceptive techniques would be not less than 50% in married women in the population.

Adult↗

Barrier methods.

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Contraceptive Devices↗

Menstrual blood-loss with intrauterine devices.

The effect of three intrauterine contraceptive devices (I.U.D.)-Lippes D, Dalkon Shield, and Copper 7-on menstrual blood-loss has been studied serially by objective methods in 279 women. All the women had a minimum of two cycles following delivery, abortion, cessation of lactation, or previous pill or I.U.D. use. All pads and tampons used for two further menstrual cycles before and for 12 cycles after I.U.D. insertion were collected, and the blood-loss was measured by extracting the haemoglobin by conversion to alkaline haematin. Mean menstrual blood-loss increased with all three devices. The amount of loss, the percentage of women losing more than 80 ml, the decline in haemoglobin concentration, and the incidence of anaemia during the 12 cycles following insertion were all greater among users of the Lippes Loop than of the Copper 7 with generally intermediate values for Dalkon Shield users. The mean increases in blood-loss were: for parous women fitted with the Lippes Loop, 48 ml, with the Dalkon Shield, 34 ml, and with the Copper 7, 18 ml; for nulliparae fitted with the small size of Dalkon Shield, 27 ml, and, with the Copper 7, 19 ml.

Blood Specimen Collection↗

[Problems in the evaluation of contraceptives (author's transl)].

For the evaluation of the effectiveness of contraceptives the Life Table method is at present the best method. It is a disadvantage that the original method of Tietze & Potter was restricted to the evaluation of intra-uterine contraception devices. A Belgian team is now in the process of developing a modified life table method for the evaluation of the effectiveness and the side effects of oral contraceptives. The reference to the Pearl-index for the effectiveness of contraceptives is unclear and in the way in which it is at present used scientifically untenable.

Clinical Trials as Topic↗

Serum levels of pregnancy-specific beta 1-glycoprotein (SP1) and human chorionic gonadotropin (beta-hCG) in women using an intrauterine device.

Forty-two women using intrauterine contraceptive devices volunteered in a study in which blood samples were drawn in late luteal phase 1-3 times during 73 menstrual cycles. In all 129 blood samples were collected. Pregnancy-specific beta 1-glycoprotein (SP1) and human chorionic gonadotropin (beta-hC) were measured by radioimmunoassays. SP1 was measurable in 5/129 samples and beta-hCG in 2/123 samples. Both SP1 and beta-hCG were measurable in 2 samples. All women in the study had regular menstrual periods. It is concluded that an early implantation and subsequent abortion in connection with a "normal" menstruation could occur but in a frequency that is much lower than in women using no contraception.

Abortion, Spontaneous↗

[Nova-T and Copper-T in a 5 years' comparison].

A multi-centre randomized comparative study for five years was conducted on the efficacy of the Nova-T and the copper-T-200 intra-uterine contraceptive devices. A total of 1865 insertions during the last days of menstruation or a few days following menstruation or immediately following a therapeutic abortion (in 322 women) was performed. The cumulative total Pearl-Index during the five years of the study was 0.8 for the Nova-T and 2.0 for the copper-T-200. The pregnancy rate for the Nova-T was lower than for the copper-T-200 in each country, each age group and each parity group. The copper-T was expelled most frequently in the youngest age group and most rarely in the oldest age group. Evaluated by the expulsion rate, the retention of the Nova-T was not influenced by age and much less influenced by parity than the retention of the copper-T. Because of the small diameter of the insertion tube, there were no problems with the insertion of the Nova-T. The removal of the Nova-T was easy and uncomplicated. In our study, the fertility returned unencumbered irrespective of a wearing time of the device for more or less than two years. The results show, that the Nova-T is an excellent device for intra-uterine contraception.

Adult↗

[The ultrastructural changes occurring in the endometrium of women who use intrauterine pessaries].

The authors studied ultrastructural changes in the endometrium of 25 women, using intrauterine contraceptive devices, preventing conception, during various time limits. The material of the endometrial biopsy was fixed with glutar and osmium in a phosphate buffer and embedded in durcopan. Section were prepared by a microtome and observed under electron microscope of Hitachi type. Comparing the parameters duration of usage of loops and character of changes in the endometrium an impression was obtained that the usage of contraceptive intrauterine devices for one-year period did not induced changes of pathological character. Functional changes in the endometrium occurred after a two-year stay of the loop in the uterus as there were inflammatory changes of spot-like character in two of the sections. Local areas of inflammation of nonspecific character, manifested under the form of lymphocytes and leucocyte accumulation, were found in women with long usage of contraceptive intrauterine devices. The authors advise to remove the loop 2.5-3 years after its application and to wait for the complete regeneration of the endometrium.

Endometritis↗

[Physico-chemical fate of copper intrauterine devices].

Often when copper intra-uterine contraceptive devices are removed they are found to have deposits on them. Studying these deposits with photonic microscopes and with scanning electronic microscopes and with fluorescence X and X diffraction shows that mostly these deposits are of calcium in the form of calcite. These crystals are not toxic but the fact that they are crystalline could give rise to microtraumatism. The study also shows that there are individual variations between patient and patient and the length of time these intra-uterine devices have been in the uterus is not an important factor in the appearance of these deposits. The phenomenon of dissolution and recrystallisation in situ of the calcite can be a trap because it can be a reservoir for micro-organisms.

Calcium↗