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PubMed2004

Failure of family-planning referral and high interest in advanced provision emergency contraception among women contacted for STD partner notification.

BACKGROUND: Few data are available on the risk of unintended pregnancy in women with STD or how contraceptive services can be integrated into STD control activities. OBJECTIVE: To define the risk for unintended pregnancy and assess the effectiveness of family-planning (FP) referral and interest in advanced provision emergency contraception (APEC) among women with gonorrhea or chlamydial infection. METHODS: Female participants in a randomized trial of different approaches to partner notification were interviewed, offered referral for FP services and asked if they would want APEC. RESULTS: Among participants ages 14-24, the observed past pregnancy rate and age-adjusted anticipated past pregnancy rate were, respectively, 196 and 72 per 1000 women-years. Of 474 nonpregnant participants who did not desire pregnancy, 127 (34%) were using no contraception or condoms alone, of whom 8 (6%) requested a FP appointment and 81% wanted APEC. CONCLUSIONS: Women treated for STD are at high-risk for unintended pregnancy. Although referral for FP was ineffective, interest in APEC was very high.

Adolescent↗
PubMed2004

Emergency contraception.

Women can use emergency contraception to prevent pregnancy after known or suspected failure of birth control or after unprotected intercourse. Many patients do not ask for emergency contraception because they do not know of its availability. Emergency contraception has been an off-label use of oral contraceptive pills since the 1960s. Dedicated products, the Yuzpe regimen (Preven) and levonorgestrel (Plan B), were marketed in the United States after 1998 but had been available in Europe for years before that. A third approved method of emergency contraception is the insertion of an intrauterine device. Emergency contraception is about 75 to 85 percent effective. It is most effective when initiated within 72 hours after unprotected intercourse. The mechanism of action may vary, depending on the day of the menstrual cycle on which treatment is started. Despite the large number of women who have received emergency contraception, there have been no reports of major adverse outcomes. If a woman becomes pregnant after using emergency contraception, she may be reassured about the lack of negative effects emergency contraception has on fetal development. It may be beneficial for physicians to offer an advance prescription for emergency contraception at a patient's regular gynecologic visit to help reduce unwanted pregnancies. Advance provision of emergency contraception can increase its use significantly without adversely affecting the use of routine contraception.

Contraception Behavior↗
PubMed2003

Why do university students use hormonal emergency contraception?

OBJECTIVES: To establish why university students in Finland, who have easy access to well-affordable health services, still use hormonal emergency contraception. METHOD: All students who sought emergency contraception in the Tampere Student Health Station during the period from 1 September 2000 to 31 December 2001 received a questionnaire on their use of it. Of the total, 114 (67%) were returned. RESULTS: Two-thirds of respondents experienced condom failure, and the remainder used no contraception. In open answers, respondents gave many explanations as to why they had used no contraception, e.g. having been over-passionate or drunk. CONCLUSION: Finnish students use emergency contraception, but to no great extent. Our results indicate that service providers should pay attention to sexual health in the full sense but not omit to give detailed advice on condom use during counselling.

Adult↗
PubMed2003

Partner characteristics, intensity of the intercourse, and semen exposure during use of the female condom.

The objective of this study was to assess how characteristics of the intercourse and the couple relate to semen exposure during use of the female condom. From 1996 to 1998, 210 women in Birmingham, Alabama, were trained to use the female condom and follow study procedures during a group session and individually practiced inserting the device. The outcome was semen exposure as defined by comparing pre- and postcoital prostate-specific antigen levels in vaginal fluid. Women who had high income levels had lower rates of semen exposure (odds ratio (OR) = 0.3, 95% confidence interval (CI): 0.2, 0.7), while those in a relationship of less than 2 years were at greater risk (OR = 2.4, 95% CI: 1.3, 4.1). Couples with a large disparity in vaginal fundus size and penis size were at increased risk of semen exposure (OR = 2.7, 95% CI: 1.2, 6.0). Engaging in very active intercourse also increased the risk (OR = 1.7, 95% CI: 1.1, 2.6). Thus, the protective effect of the female condom appears to be a function of user- and intercourse-specific characteristics. Future studies of male condom efficacy should focus on collecting detailed data about the users and characteristics of intercourse to predict failure accurately.

Adult↗
PubMed1979

[The value of irreversible contraception].

8 years after sterilization was in force in GDR it is stated, that this way of female healthy protection was different performed in the varions countries of GDR. The portion of the country Rostock amount to 56,6%. --85,3% of the women were elder than 30 years. 60% of the applicants have had legal abortions. 66,8% of the propositions were based by medical indication. --The rate of complications and failures amount to 0,3%. --By reason of the results it is recommended to regard the sterilization as the adequate method of contraception, if reproduction is finished.

Adolescent↗
PubMed1999

Mechanical failure of the latex condom in a cohort of women at high STD risk.

BACKGROUND AND OBJECTIVES: Mechanical failure may reduce the efficacy of condoms. Little is known about frequency and determinants of condom failure in groups at high risk of sexually transmitted diseases (STD). GOAL: To measure condom breakage and slippage rates and evaluate potential determinants of failure among women attending a public STD clinic. STUDY DESIGN: Women attending an STD clinic participated in a 6-month prospective study of barrier contraception for the prevention of STD. They completed sexual diaries that were reviewed at monthly follow-up visits. No data were collected from the male partners. Baseline characteristics of the participants and time-dependent behaviors were evaluated as potential determinants of condom failure. RESULTS: Of 21,852 condoms used by 892 women, 500 broke during intercourse (2.3%) and 290 slipped (1.3%). Breakage was more common among young, black, single nulliparae who engaged in high-risk behavior. Slippage was more common among married women with children. Failure rates decreased with condom use, with coital frequency, and with use of spermicides. CONCLUSION: User characteristics and experience are determinants of breakage and slippage, which are often regarded only as the effect of product design flaws. Attention to modifiable determinants of failure may improve user counseling and product labeling.

Adolescent↗
PubMed1999

Combining qualitative with quantitative approaches to study contraceptive pill use.

According to large-scale studies, oral contraceptive users become pregnant at rates that exceed ideal use failure rates. It is thought that a major cause is missed pills, but current research on consistent contraceptive pill taking is characterized by inadequate measures and a failure to investigate women's thinking about their own patterns of use. The purpose of this study was to gain some understanding about women's interpretations of consistency in their own pill taking through combining qualitative with quantitative data. The study was conducted in China, where contraception is free and widely available. Five urban and five rural oral contraceptive users were followed for up to three pill-taking cycles during 1996 for a total of 759 person-days. Consistency of pill taking was measured with electronic data obtained from a new blister package made by Anderson Clinical Technologies (Elmhurst, IL). Data from these devices were reviewed and interpreted by the study participants during in-depth private interviews. The users' reasons for missing pills included disruptions in their daily routines, their husband's absence, spotting, and trouble implementing the family planning program's instructions to take one pill per day for 22 days and start the next cycle on the fifth day of menses. One user gave these reasons for two cycles but denied missing numerous pills in her third cycle. Data from a series of four questionnaires showed that most demographic, psychosocial, and service system characteristics were not related to missed pills. However, results suggested that the daily routines of rural living may make consistent use more likely and that instructions for taking the pill may be associated with prolonged pill-free intervals and skipping pills during episodes of spotting. Three of the 10 women were at increased risk of pregnancy during the study period because of their pill-taking pattern. We concluded that the combination of qualitative with quantitative data enhances understanding of contraceptive use. Women themselves offer plausible reasons for their use behaviors. Listening to women could be useful in improving programs.

Adolescent↗
PubMed1975

Evaluation of d-norgestrel 1.0 mg as a post-coital contraceptive.

Two hundred and ninety-eight women were followed for 2578 months (2739 'bleeding intervals') of treatment with d-Norgestrel 1.0 mg given as a post-coital oral contraceptive. Fourteen pregnancies were recorded (general failure rate, 6.5 per 100 woman/years); at least 6 of these patients did not miss any tablet (corrected failure rate, 2.8). The acceptability rates (life table method) were 0.58 and 0.40 after 6 and 12 months of follow-up. The most important medical reason for drop-out was cycle irregularities. The cycle pattern is deeply disturbed by this method of oral contraception.

Adolescent↗
PubMed1993

[Ignorance and misconceptions in the use of contraceptive methods].

Good knowledge of the available contraceptive methods ensures better acceptability, continuity and satisfaction, and lower failure rates of these methods. This paper describes an inquiry on the contraceptive knowledge in 114 women attending three Brussels family planning clinics. Misconceptions, beliefs in false rumors, and considerable insufficiencies in knowledge were detected. In order to increase patient's ability to correctly use birth control methods, so as to lower unwanted pregnancy rate, efforts should be made by health practitioners as well as by mass media and teaching institutions.

Adolescent↗
PubMed2004

Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation.

We assessed to what extent the standard dose of levonorgestrel (LNG), used for emergency contraception, or a single dose (half dose), given in the follicular phase, affects the ovulatory process during the ensuing 5-day period. Fifty-eight women were divided into three groups according to timing of treatment. Each woman contributed with three treatment cycles separated by resting cycles. All received placebo in one cycle, and standard or single dose in two other cycles, in a randomized order. The diameter of the dominant follicle determined the time of treatment. Each woman had the same diameter assigned for all her treatments. Diameters were grouped into 33 categories: 12-14, 15-17 or 18-20 mm. Follicular rupture failed to occur during the 5-day period in 44%, 50% and 36% of cycles with the standard, half dose and placebo, respectively. Ovulatory dysfunction, characterized by follicular rupture associated with absent, blunted or mistimed gonadotropin surge, occurred in 35%, 36% and 5% of standard, single dose or placebo cycles, respectively. In conclusion, LNG can disrupt the ovulatory process in 93% of cycles treated when the diameter of the dominant follicle is between 12 and 17 mm. It is highly probable that this mode of action fully accounts for the contraceptive efficacy as well as the failure rate of this method. The present data suggest that half the dose may be as effective as the standard dose.

Adolescent↗
PubMed1994

Use of Norplant implants in a New York City clinic population.

Two-hundred-eight women attending family planning clinics in New York City who received the Norplant contraceptive system during the first sixteen months of Norplant implants insertions were evaluated. Within this clinic population, Norplant implants were a popular contraceptive choice and were removed from 64 of the 208 recipients. Reasons for removal included bleeding, weight gain, and headache, and were consistent with those found in the clinical trials. Prior satisfaction with oral contraceptives did not predict success or failure with Norplant implants. The rate of follow-up visits to the family planning clinics was low. However, evidence exists that these women did not lose contact with the medical center and continued to receive health care.

Adult↗
PubMed2003

Levonorgestrel as an emergency contraceptive drug.

The potential of low-dose levonorgestrel, alone or in combination with ethynyloestradiol (Yuzpe regimen), as emergency contraception is reviewed for its acceptability and effectiveness. Plasma levonorgestrel concentration ranges from 9-12 nmol/l at 12 hours with a peak of 27-33 nmol/l 2-2.5 hours after taking one 0.75 mg tablet. The concentration of steroid hormone binding globulins in plasma is not influenced by the presence of levonorgestrel during this period. The success rates for levonorgestrel-only and the Yuzpe regimen as emergency contraception are 85% and 57%, respectively, while the failure rates are 1.1% and 3.2%, respectively, within the prescribed time limit of use. The mode of action of levonorgestrel emergency contraception is to prevent or delay ovulation and/or alter the endometrium unfavourably the for implantation of an embryo. The use of emergency contraceptive pills within 72 hours after unprotected sexual intercourse reduces the risk of pregnancy by about 75% and is safe, with no serious side-effects.

Adolescent↗
PubMed2004

Benefit-risk assessment of the levonorgestrel intrauterine system in contraception.

The levonorgestrel-releasing intrauterine system (IUS) is a long-acting, fully reversible method of contraception. It is one of the most effective forms of contraception available, and combines the advantages of both hormonal and intrauterine contraception. The levonorgestrel-releasing IUS also gives the users many non-contraceptive benefits: the amount of menstrual bleeding and the number of days of menstrual bleeding are reduced, which makes it suitable for the treatment of menorrhagia (heavy menstrual blood loss). Dysmenorrhoea (painful menstruation) and premenstrual symptoms are also relieved. In addition, the levonorgestrel-releasing IUS provides protection for the endometrium during hormone replacement therapy. The local release of levonorgestrel into the uterine cavity results in a strong uniform suppression of the endometrial epithelium as the epithelium becomes insensitive to estradiol released from the ovaries. This accounts for the reduction in menstrual blood loss. All possible patterns of bleeding are seen among users of the levonorgestrel-releasing IUS; however, most of the women who experience total amenorrhoea continue to ovulate. The first months of use are often characterised by irregular, scanty bleeding, which in most cases resolves spontaneously. The menstrual pattern and fertility return to normal soon after the levonorgestrel-releasing IUS is removed. The contraceptive efficacy is high with 5-year failure rates of 0.5-1.1 per 100 users. The absolute number of ectopic pregnancies is low, as is the rate per 1000 users. The levonorgestrel-releasing IUS is equally effective in all age groups and the bodyweight of the user is not associated with failure of the method. In Western cultures continuance rates among users of the levonorgestrel-releasing IUS are comparable with those of other long-term methods of contraception. Premature removal of the device is most often associated with heavy menstrual bleeding and pain, as with other long-term methods of contraception, and is most common in the youngest age group. When adequately counselled about the benign nature of oligo- or amenorrhoea, most women are very willing to accept life without menstruation. The risk of premature removal can be markedly diminished with good pre-insertion counselling, which also markedly increases user satisfaction. User satisfaction is strongly associated with the information given at the time of the levonorgestrel-releasing IUS insertion. Thus, the benefits of the levonorgestrel-releasing IUS make it a very suitable method of contraception for most women.

Administration, Intravaginal↗
PubMed1991

A multicenter clinical study on two types of levonorgestrel tablets administered for postcoital contraception.

Contraceptive efficacy, cycle control and side effects of two types of 0.75 mg levonorgestrel tablets taken postcoitally during the periovulatory period of one cycle were studied in a multicenter trial involving 361 women. No significant differences were found between the two types of levonorgestrel pills in terms of contraceptive efficacy, cycle control and side effects. The failure rate observed (1.4% per treated cycle) was similar to that reported for other hormonal approaches to emergency postcoital contraception. Intermenstrual bleeding or spotting occurred in 11.5% of the cycles and anovulation as assessed from BBT charts in 14.4% of cycles. One or more side effects were reported by 22.2% of subjects. The relatively frequent occurrence of cycle disturbances and subjective side effects make it unlikely that the repeated postcoital use of levonorgestrel would be an acceptable routine method of contraception for most women.

Adult↗
PubMed2002

[Contraception in chronically ill adolescents].

Contraception in chronically ill adolescents has to consider side effects with regard to metabolic or hematological disease. Additionally the compliance of the patient has to be taken in account when consulting about contraceptives. In juvenile diabetics with good glycemic control and metabolic diseases of the amino acids oral contraceptives are justifiable. Adolescents with galactose-mia mostly suffer from premature ovarian failure and therefore have to be controlled wether they need contraception at all. Young women with sickle-cell anemia are at risk of thrombophilia. They should not be given hormonal contraceptives. In v. Willebrand-Jürgens-Syndrome oral contraceptives are favourable because it alleviates menorrhagia.

Adolescent↗
PubMed2004

Provision of female sterilization in Ribeirao Preto, Sao Paulo, Brazil.

Forty percent of Brazilian married women from 15 to 49 years of age have undergone surgical sterilization. The 1988 Brazilian Constitution states that all scientifically proven contraceptive methods should be available to all citizens, but it was only in 1997 that specific family planning legislation was approved. This study examines physicians' perceptions and attitudes towards the current provision of female sterilization and its legal implications, as well as women's experience with obtaining and undergoing sterilization. The study design included: (1) an investigation of the hospitals and health professionals and (2) a survey of women sterilized in combination with cesarean delivery in 1998. The survey showed they had a median of 3 living children, 60.0% had been sterilized between 30 and 39 years of age, and 61.0% had paid for the procedure. Many women reported previous method failure and adverse effects with hormonal contraceptives. Women with less schooling and lower socioeconomic status had more children and had begun childbearing and had been sterilized at younger ages than women with more schooling and higher socioeconomic status. Inequalities related to reproduction were strongly associated with teenage pregnancy and inadequate knowledge about contraceptives.

Adult↗
PubMed2002

Status of certain additional over-the-counter drug category II and III active ingredients. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule stating that a certain ingredient in over-the-counter (OTC) drug products is not generally recognized as safe and effective or is misbranded. FDA is issuing this final rule after considering the reports and recommendations of various OTC drug advisory review panels and public comments on proposed agency regulations. This final rule addresses the ingredient octoxynol 9, considered in the rulemaking for OTC vaginal contraceptive drug products. Based on the failure of interested parties to submit new data or information to FDA under the proposed regulation, the agency has determined that the presence of this active ingredient in an OTC drug product would result in that drug product not being generally recognized as safe and effective for its intended use or would result in misbranding. This final rule is part of FDA's ongoing OTC drug product review.

Consumer Product Safety↗
PubMed1999

Evaluation of prostate-specific antigen as a quantifiable indicator of condom failure in clinical trials.

The ability of condoms to retain all elements of semen during intercourse has been assessed by postcoital visual inspection and in vitro permeability studies. Yet, these observations may not be sufficiently precise or realistic. This pilot study evaluated prostate-specific antigen (PSA) as a semen marker of inapparent failure of the condom barrier under conditions of actual use. Twelve couples collected samples from the vagina and surfaces of the condom using sterile cotton swabs. We obtained precoital and postcoital samples for 24 acts of unprotected intercourse, 54 acts of intercourse using intact condoms, and 40 acts of intercourse using condoms that had been deliberately punctured. We used electrophoresis to determine the amount of PSA present in the samples. PSA was detected in 100% (24/24) of vaginal samples collected immediately after unprotected intercourse and in none of the vaginal samples collected more than 24 h after intercourse (0/90). PSA was also present in 98% (83/85) of the samples collected from the inside of the condom that had failed during intercourse. Excluding uses where the condom failed during intercourse, PSA was detected in 2% (1/47) of the postcoital vaginal samples collected after use of intact condoms and in 41% (14/34) of the samples collected after use of condoms with known 1-mm punctures. We conclude that PSA shows great promise as a semen biomarker in clinical trials of barrier methods. We recommend that future studies further investigate the ability of this biomarker to identify condom failures and quantify the extent of semen exposure associated with various types of condom failures.

Adolescent↗