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PubMed1986

Association between diaphragm use and asymptomatic bacteriuria.

The prevalence of asymptomatic bacteriuria was assessed in women using different contraceptive methods. Three hundred and twenty women attending a family planning centre were studied, 80 in each of the following groups: diaphragms, intrauterine contraceptive devices (IUCDs), oral contraceptives (OCs) and no contraception. The numbers with asymptomatic bacteriuria in the 4 groups were as follows: diaphragm - 12 (all E coli); IUCD - 3 (E coli; P mirabilis; S saprophyticus); OC - 5 (all E coli); no contraception - 4 (3 E coli; 1 S saprophyticus). The prevalence of Gram-negative bacteriuria in women using diaphragms was significantly higher than for women in the other groups (chi 2 = 8.98; p less than 0.05). Factors such as parity, numbers of sexual partners and frequency of sexual intercourse had no apparent effect. The use of diaphragms may contribute to the risk of Gram-negative urinary tract infections in sexually active women.

Adolescent↗
PubMed1991

Pooled analysis of 3 European case-control studies of epithelial ovarian cancer: III. Oral contraceptive use.

The relationship between use of oral contraceptives (OCs) and other contraceptive methods and the risk of ovarian cancer was examined in a combined analysis of 3 hospital-based case-control studies conducted in Italy, the United Kingdom, and Greece, for a total of 971 ovarian cancer cases and 2,258 controls under age 65. Compared with never-users, the combined multivariate relative risk (RR) for ever-users was 0.6 (95% confidence interval, CI = 0.4-0.8) and the estimates were consistent in the 3 datasets. The protection was also similar across strata of age and parity. Considering various measures of OC use, available in the Italian and British datasets only, the protection conveyed on ovarian cancer risk increased with the duration of use and persisted in the medium-long period: the RR in women reporting their last OC use greater than or equal to 15 years prior to diagnosis was 0.5 (95% CI = 0.2-1.0). The risks in ever-users were appreciably lower in those women who reported their first OC use before 25 years of age (RR = 0.3 for first use before age 25, 0.8 for first use at age 25-34 and 0.7 at 35 years or after). Such findings emerged similarly from Italian and British data. This combined analysis, besides offering further quantitative estimates of the protective effects of OCs on ovarian cancer risk in European populations, provides useful insights into the time pattern of the relationship between OC use and ovarian carcinogenesis, suggesting that the protection persists for 15 years or more after cessation of use and may be larger for use at younger age.

Adult↗
PubMedDate not supplied

Constrains on effective family planning in urban Sudan.

This article is an investigation of the constraints on contraceptive use in Sudan, from the perspective of current nonusers, never-users, and discontinuers, based on data obtained from 305 married women aged 15-49 through a field survey undertaken in Khartoum city. Results indicate that lack of knowledge of contraceptive methods accounts for the low level of contraceptive prevalence, 15 percent overall, found in this study. The overwhelming majority of nonusers (85 percent) either perceive contraception as a risk to their health and fertility, regard it as unacceptable, or do not know which method to choose. A comprehensive and rigorous family planning information program is crucial to address existing constraints on the use of contraceptives in urban Sudan.

Adolescent↗
PubMedDate not supplied

Assessing family planning service-delivery practices: the case of private physicians in Jamaica.

This report presents the results of a study of the family planning service-delivery practices of private physicians in Jamaica. All 367 private physicians in Jamaica who offer family planning services, counseling, or referral were included in the survey. The study revealed that a client seeking services might be given a method by one provider and not by another, and that the methods clients use are likely to be influenced by the providers' preferences. Private physicians in Jamaica are in need of access to current international guidance on contraceptive methods and service practices.

Adult↗
PubMedDate not supplied

Sex, contraception and parenthood: experience and attitudes among urban black young men.

Eighty-seven percent of black adolescent males attending an inner-city junior high school and senior high school in Baltimore report that they have had sexual intercourse. Eighty percent of the sexually experienced teenagers have used a contraceptive method--and 60 percent used one at last intercourse. Contraceptive practice is characterized by heavy reliance on male methods: Of those using a method at last intercourse, 41 percent relied on the condom; 15 percent, on withdrawal; and 14 percent, on a combination of male and female methods. Use of female methods alone (mostly the pill) accounted for 28 percent of contraceptive practice at last intercourse. Nine-tenths of the teenagers have heard of the pill and condom, but far smaller majorities have heard of the IUD and diaphragm (about three-fifths each). In general, this population regards the condom as comparable in effectiveness to the pill. More than two-fifths of those recognizing these methods believe the pill--and the condom--to be "very good" at preventing pregnancy, and one-fifth believe that about the IUD and diaphragm. Nearly four in 10 mistakenly believe that they need a parent's permission to attend a birth control clinic, while slightly more than half think they need permission to buy nonprescription contraceptives in a drugstore . Although nearly nine in 10 respondents recognize that boys share a responsibility for preventing pregnancy when they have sex, more than half are willing to tolerate unprotected coitus. Most wish to delay parenthood until their early 20s, but many of these adolescents appear to hold attitudes conducive to out-of- wedlock conception.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1980

Contraception and the etiology of pelvic inflammatory disease: new perspectives.

The dramatic increase in use of contraception worldwide makes it imperative to understand the effects of contraceptives on the health of women using them. In this article, we review the literature on the relationships of modern nonsurgical contraception with pelvic inflammatory disease. Subsequently, we identify areas where further research is needed to better define the risks and benefits of these contraceptive methods in various settings. From our review, two new conclusions emerge. First, our reanalysis of published data on the risk of PID associated with intrauterine device (IUD) use compared with no contraceptive use shows, with one exception, less risk than the previous comparisons to all non-IUD use. Second, and probably most importantly, the studies, when taken together, strongly imply that oral contraceptives have a protective effect against PID. Only one study of 11 is equivocal on this point.

Adolescent↗
PubMed1992

Retinoids and contraception.

The main side effect of the retinoids is teratogenicity. Every dermatologist has a moral obligation to ensure that this effect is avoided, and the present publication is aimed at helping prescribe these drugs. After a review of the key properties of each of the retinoids on the market, the different forms of contraception available and their indication in young patients undergoing retinoid treatment are discussed. Unless otherwise contraindicated, oral contraception with an estrogen-progestogen formulation is the contraceptive method of choice for women undergoing retinoid treatment. The intrauterine device (IUD) is of little or almost no relevance for young women undergoing treatment with a retinoid. IUDs are indicated in older multiparae who have practised this form of contraception before starting retinoid treatment and who refuse to take the pill. Natural and local methods of contraception are totally unsuitable for women undergoing treatment with retinoids. However, they may be used as an additional precautionary measure by IUD users.

Abnormalities, Drug-Induced↗
PubMed1984

Use of oral contraceptives in women with cystic fibrosis.

Oral contraceptive pills (OCP) represent the most common contraceptive method among teenagers and young adults. Because many women with cystic fibrosis (CF) are now surviving into childbearing age and are at risk for the complications of pregnancy in CF, oral contraceptive use may be indicated. However, it has been suggested that OCP use by CF patients may be associated with deterioration in pulmonary function. Ten adolescent and young adult women with CF and moderate-to-severe obstructive lung disease were studied while taking a combination oral contraceptive pill (Ovral 28). No significant deterioration was found in clinical status or pulmonary function. Careful follow-up should nevertheless be continued to monitor for other adverse effects of oral contraceptive use in CF, such as cholelithiasis.

Adolescent↗
PubMed2005

Contraceptive use--United States and territories, Behavioral Risk Factor Surveillance System, 2002.

PROBLEM: Contraceptive use is an important determinant of unintended pregnancy. In the United States, approximately half of all pregnancies are unintended. Population-based information about contraceptive use patterns is limited at the state level. Information about contraceptive use for states can be used to guide the development of state programs and policies to decrease unintended pregnancy and the spread of sexually transmitted infections. Information about contraceptive use for specific subpopulations can be used to further refine state efforts to improve contraceptive use and subsequently decrease the occurrence of unintended pregnancy. REPORTING PERIOD: Data were collected in 2002 for men and women. DESCRIPTION OF SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is a random-digit--dialed, telephone survey of the noninstitutionalized U.S. population aged > or =18 years. All 50 states, the District of Columbia, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands participated in BRFSS in 2002. These data can be used to track state progress towards the national health objectives for 2010 for responsible sexual behavior. The 2002 BRFSS data represent the first time state data on contraceptive use in all 50 states will be presented and examined by selected sociodemographic characteristics. The 2002 BRFSS also, for the first time, provided an opportunity to examine state-level contraceptive use patterns among men. RESULTS: Variation across states and territories was observed for the majority of contraceptive methods among the different demographics analyzed and among men and women. The percentage of men and women at risk for pregnancy who said they or their partner was using birth control was high overall and ranged from 67% (Guam) to 88% (Idaho). Oral contraceptives (i.e., the pill), vasectomy, tubal ligation, and condoms were the methods most frequently reported by both male and female respondents who said they or their partner was using birth control. Among female respondents using birth control, the pill was the most common method reported. Among men, vasectomy was the most commonly reported method. The prevalence of use for the four most commonly reported methods (pills, vasectomy, tubal ligation, condoms) varied as much as six-fold among states for vasectomy and three- to four-fold for condoms, pills, and tubal ligation. INTERPRETATION: The findings in this report document substantial differences among states and sociodemographic groups within states in contraceptive method use. PUBLIC HEALTH ACTION: These data can help states identify populations with an unmet need for birth control, barriers to birth control use, and gaps in the range of birth control methods offered by health-care providers. An analysis of the prevalence of birth control use by state and selected population characteristics can help states target contraceptive programs to best meet the needs of their population.

Adult↗
PubMed1982

Two oral contraceptives, efficacy, serum proteins, and lipid metabolism. A comparative multicentre study on a triphasic and a fixed dose combination.

A triphasic, combined oral contraceptive containing 30 - 40 - 30 micrograms ethinyloestradiol (EE), and 50 - 75 - 125 micrograms levonorgestrel was compared with a fixed dose combination containing 30 micrograms EE and 150 micrograms desogestrel in a randomized multicentre trial in 193/199 women and 1 063/1 073 cycles, respectively. The duration of the trial was six months. Eleven centres in Denmark, Sweden, and Norway participated. Contraceptive reliability, bleeding control and side effects were evaluated. Influence on serum sex hormone binding globulin (SHBG) and transcortin was assayed as well as lipid metabolism. Three pregnancies occurred in the group using the triphasic regimen but none in the fixed dose regimen. Two of the three pregnancies were considered drug failures and the third a possible interaction. Possible reasons for the triphasic contraceptive failure are discussed with special reference to a British report on eight pregnancies. Bleeding control appeared to be equally good for the two preparations. However, the number of cycles with spotting, breakthrough bleeding and missed withdrawal bleeding were above the levels reported earlier on the triphasic regimen. About 80 per cent of the women completed the planned six months on either combination. Side effects were generally mild and in accordance with earlier reports on low dose oral contraceptives. Metabolically the triphasic levonorgestrel combination increased SHBG 100 per cent versus 200 per cent for the fixed desogestrel combination. Transcortin rose about 98 and 110 per cent, respectively. Both preparations induced similar changes in the levels of lipids and lipoproteins with the exception of a significant increase in the arachidonic content of cholesterol during treatment with the desogestrel-containing preparation.

Adolescent↗
PubMed2003

Detection of raised FSH levels among older women using depomedroxyprogesterone acetate and norethisterone enanthate.

The objective of this study was to investigate whether follicle-stimulating hormone (FSH) levels can be used reliably to indicate approaching menopause in older (aged 40-49), long-term users of depomedroxyprogesterone acetate (DMPA) and norethisterone enanthate (NET-EN). One-hundred and seventeen women using DMPA, 60 NET-EN users and 161 nonusers of contraception were recruited. At recruitment, serum FSH levels were measured and questions were asked regarding menopausal symptoms, menstrual cycle and date of last injection. Results of the recruitment blood test showed that 32% of the nonusers had FSH levels in the menopausal range >25.8 mIU/mL compared to 28% of the DMPA users and 9% of the NET-EN group. After adjusting for age, there was no significant difference between the 3 groups (p = 0.13). An increase of 1 year in age increased the FSH level by 3 mIU/mL (p < 0.001). All the hormonal contraceptive users were between 1 day and 12 weeks of their injection interval. Many had been using the injectable contraceptive method for over 10 years and almost all were amenorrheic at the time of recruitment. The data show that a raised FSH level can be detected during use of DMPA and NET-EN and could be used as a menopausal indicator without interrupting method use in this group of contraceptive users.

Adult↗
PubMed2003

Mifepristone for luteal phase contraception.

The concept of luteal phase contraception and the use of mifepristone in clinical trials, which allows for testing of its validity, as well as clinical pharmacological research designed to understand its mode of action, are reviewed. Early luteal phase administration has a variety of morphological, physiological and biochemical effects on the endometrium that are likely to interfere with embryonic-endometrial interactions. In fact, specifically designed pilot clinical trials as well as data derived from emergency contraception studies indicate that early luteal phase administration of mifepristone is highly effective in preventing pregnancy, with minimal disturbance of hormonal parameters or menstrual cyclicity. Mid and late luteal phase administration of mifepristone at doses above 25 mg are highly effective in inducing endometrial bleeding in nonconceptional cycles. However, administration of mifepristone within the period between implantation and expected menses fails to induce bleeding in a significant proportion of cases, and furthermore the bleeding induced does not insure the termination of pregnancy. While the data suggest there is potential for a once-a-month contraceptive pill, it is likely that no molecule endowed with partial agonistic properties, like mifepristone, will completely and reliably suppress the essential functions of progesterone in order to achieve contraceptive efficacy comparable to that of modern contraceptive methods.

Contraceptives, Postcoital, Synthetic↗
PubMed2001

Current options for injectable contraception in the United States.

Two injectable forms of hormonal contraception, depot medroxyprogesterone acetate (DMPA, Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E(2)C, Lunelle), are now available to American women. Both formulations have demonstrated high degrees of efficacy, safety, and ease of use in international and U.S. trials. Data on DMPA have shown a number of noncontraceptive and therapeutic benefits, the most prominent of which is an 80% reduction in the risk of endometrial cancer. Although such benefits are less documented for MPA/E(2)C, they are expected to be similar to those seen with DMPA and oral contraceptives. Minor side effects of both formulations include menstrual irregularities in the early months of treatment and amenorrhea with DMPA. Patient counseling about the potential for these side effects, as well as possible risks, is important to long-term successful use of these contraceptive methods.

Contraception↗
PubMed2006

Awareness and determinants of family planning practice in Jimma, Ethiopia.

BACKGROUND: The continuing growth of the world population has become an urgent global problem. Ethiopia, like most countries in sub-Saharan Africa, is experiencing rapid population growth. Currently, the country's population is growing at a rate of 3%, one of the highest rates in the world and if it continues unabated, the population will have doubled in 23 years, preventing any gain in the national development effort. AIM: To determine the level and determinants of family planning awareness and practice in one Ethiopian town. METHODOLOGY: A quantitative study using a descriptive survey design was conducted in Jimma University Hospital. DISCUSSION: The findings revealed that the knowledge and practice of modern contraception methods was low. Most women's contraceptive knowledge and practice was influenced by socio-cultural norms such as male/husband dominance and opposition to contraception, and low social status of women. A lack of formal education for women was identified as a key factor in preventing change in the patterns of contraceptive knowledge and use by women in this part of Ethiopia. CONCLUSION: The support and encouragement for women and men to enter and complete formal education is essential in bringing about a cultural and social change in attitude towards the economic and social value of family planning. This study and others suggest that education can address the imbalance in decision making about contraception and the role of women in society generally.

Adolescent↗
PubMed1986

A prospective randomized comparative trial of the Gravigard, Latex Leaf, Dalkon Shield and Multiload Cu 250 IUDs.

This prospective randomized trial in 843 patients compared the effectiveness and complications of 4 intrauterine devices. At 24 months the gross accidental pregnancy rate for the Dalkon Shield was higher than for the 7Cu200 (p less than 0.05) and the ML Cu250 (p less than 0.05). The 7Cu200 had a higher expulsion rate than the Dalkon Shield (p less than 0.01), Latex Leaf (p less than 0.001) and ML Cu250 (p less than 0.001). Use-related terminations were higher for the 7Cu200 than for the ML Cu250 (p less than 0.01). Removal for pelvic inflammatory disease was necessary in 8 women (2 for the Latex Leaf and 3 each for the 7Cu200 and Dalkon Shield). There was no significant difference in termination rates between the ML Cu250 and Latex Leaf but subsequently the Leaf has given problems with removal particularly in women who have defaulted follow-up for several years.

Adult↗