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Reduction by naproxen of excessive menstrual bleeding in women using intrauterine devices.

Thirty-four patients using intrauterine contraceptive devices and experiencing excessive menstrual bleeding (more than 80 ml average loss for 2 cycles) were treated with the prostaglandin synthetase inhibitor naproxen. The trial was conducted according to a double-blind placebo-controlled crossover design. Each patient received 2 of 3 treatments: naproxen in high dose (1250 mg/day for 5 days), naproxen in low dose (500-mg loading dose, than 750 mg/day for 5 days), or placebo. Each treatment was taken during 2 consecutive menstruations. When all data were pooled, statistically significant reduction in menstrual bleeding was found with both high- and low-dose naproxen treatment compared with placebo therapy (P < .002). Low- and high-dose naproxen reduced menstrual blood loss by 22% and 32%, respectively, whereas the change with placebo was minimal. Although the dose had no significant effect on mean menstrual loss, the number of treatment cycles in which menstrual blood loss was reduced by 50% as compared with pretreatment cycles strongly suggested a dose response. In almost 60% of naproxen-treated cycles, mean menstrual blood loss was less than 80 ml, whereas during placebo-treated cycles the distribution of menstrual loss was similar to that of control cycles.

Clinical Trials as Topic↗

Protective effect of intrauterine release of levonorgestrel on pelvic infection: three years' comparative experience of levonorgestrel- and copper-releasing intrauterine devices.

A randomized, multicenter comparison of two intrauterine contraceptive devices (IUDs) was carried out. Nine hundred thirty-seven women were fitted with a copper-releasing IUD, the Nova-T, and 1821 women with an IUD that releases 20 micrograms of levonorgestrel daily. After 36 months, the cumulative gross rates of amenorrhea and hormonal side effects were significantly higher in the levonorgestrel-IUD users. The cumulative 36-month gross pregnancy rate was 3.7 for the Nova-T and 0.3 for the levonorgestrel IUD (P less than .001), demonstrating the levonorgestrel IUD's high contraceptive efficacy. For the first time, a protective effect of the levonorgestrel IUD against pelvic inflammatory disease as compared with the Nova-T was seen statistically. The cumulative 36-month gross rate of pelvic inflammatory disease was 2.0 in Nova-T- and 0.5 in levonorgestrel-IUD users (P less than .013). This significantly lowered incidence of pelvic inflammatory disease may help to solve one of the major concerns associated with intrauterine contraception.

Adult↗

Factors predicting abnormal hysterosalpingographic findings in patients treated for acute pelvic inflammatory disease.

One hundred forty-six consecutive inpatients with acute pelvic inflammatory disease (PID) were randomly treated either with the combination of doxycycline and metronidazole or with the combination of penicillin G/amoxicillin and metronidazole. Forty-three women underwent hysterosalpingography (HSG) 6 months after the treatment, and a multivariate statistical analysis was used to study the effect of 11 different variables (parity, history of previous abortion, history of previous PID, use of an intrauterine contraceptive device (IUD), use of oral contraceptives, presence of adnexal mass, results of cervical cultures for Neisseria gonorrhoeae, and Chlamydia trachomatis, presence of serum antichlamydial antibodies, penicillin-metronidazole treatment, and doxycyclin-metronidazole treatment) on the hysterosalpingographic findings. Abnormal HSG was most likely to occur in women who had antichlamydial antibodies present in the serum, an adnexal mass detected on the initial bimanual examination, or had an IUD (positive associations) and least likely to occur in women who had been treated with the combination of doxycycline and metronidazole (negative association).

Acute Disease↗

Levonorgestrel-releasing intrauterine device-wearing women express contraceptive glycodelin A in endometrium during midcycle: another contraceptive mechanism?

Intrauterine devices (IUDs) exert contraceptive action by interfering with sperm transport, ovum development, fertilization and implantation. Glycodelin A (GdA) is a uterine glycoprotein that has local contraceptive activity by inhibiting sperm-egg binding. GdA is normally absent from endometrium during the fertile midcycle and it is not expressed until the fifth postovulatory day. The phase of menstrual cycle addressed in this study covers the phase when conception is most likely to follow an unprotected intercourse and when GdA is normally absent. We present here evidence that levonorgestrel-releasing IUD (LNg-IUD) is accompanied by 'inappropriate' expression of GdA in endometrium between days 7 and 16 of the menstrual cycle (six out of six cases). The same was also found in copper-releasing IUD (Cu-IUD)-wearing women, but less frequently (four out of 11 cases, P < 0.0345, Fisher's exact test). In-situ hybridization localized GdA mRNA into endometrial glands in the midcycle endometrium, confirming the cellular site of synthesis. Based on the potent inhibitory activity of GdA on sperm-egg binding, the presence of GdA in uterine glands of IUD wearers may lead to prior exposure of sperm to contraceptive GdA, thus contributing to the contraceptive activity of the IUD.

Contraception↗

Effects of smoking and oral contraception on plasma beta-carotene levels in healthy women.

Oral contraceptive use and smoking have been known to affect plasma vitamin levels. Total carotenoids have been studied with spectrophotometry, a relatively insensitive technique. In this study plasma concentrations of beta-carotene and retinol were measured in coded samples by sensitive high-pressure liquid chromatography in a cross-sectional study of 149 normal healthy women attending a family planning clinic. At the time of recruitment in the morning, a general health questionnaire was administered for patient age, methods of contraception, smoking habits, and food intake at breakfast. Of the 149 enrolled volunteers, 88 were oral contraceptive users and 61 were not users. Among users, 21 smoked cigarettes, and there were 18 smokers among nonusers. Oral contraceptive users had significantly lower plasma concentrations of beta-carotene (p less than 0.001) and higher retinol levels (p less than 0.0001). Plasma beta-carotene or retinol levels did not differ among users of intrauterine contraceptive devices or barrier methods of contraception. No association was noted between the plasma levels of these two micronutrients and age greater than or less than 30 years. Cigarette smoking alone was associated with significantly reduced plasma beta-carotene levels in nonusers (p less than 0.001). Combined cigarette smoking and oral contraceptive usage were associated with low plasma beta-carotene levels; the results appear to be additive. These findings suggest a possible synergistic effect on plasma beta-carotene levels from the use of both cigarette smoking and oral contraception.

Adolescent↗

Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse.

OBJECTIVE: This article reopens the issue of a medical practice that has been well established for more than three decades by proposing an extension of the period during which treatment with the "morning-after" pill is currently prescribed. The objective is to determine the effectiveness of the regimen of Yuzpe and Lancee when it is administered between 72 and 120 hours after sexual intercourse. STUDY DESIGN: We conducted an observational study comparing 2 groups of women for whom the regimen of Yuzpe and Lancee was administered after unprotected sexual intercourse. One group (usual time frame treatment group) sought consultation within 72 hours (n = 131), and the other (extended time frame treatment group) after 72 to 120 hours (n = 169). RESULTS: The pregnancy rate was 0.8% for the <72-hour group and 1.8% for the 72- to 120-hour group. The effectiveness rate varied from 87% to 90% for the <72-hour group and from 72% to 87% for the 72- to 120-hour group. In both groups the chi(2) tests showed that emergency contraceptive pills significantly reduced the risk of pregnancy. CONCLUSIONS: Women should be encouraged to seek consultation as quickly as possible after unprotected sexual intercourse. However, if the usual time limit (<72 hours) has expired, the so-called "morning-after" pill should be recommended if an intrauterine contraceptive device is not available. Emergency contraceptive pills have a favorable success rate after 72 hours, with a pregnancy rate that is significantly lower than would be expected if no contraceptive were administered.

Adolescent↗

Reproductive function and contraception in the postpartum period.

The postpartum period is a time of major cellular and hormonal change enabling the return of pelvic organs and the hypothalamic-pituitary-ovarian axis to the nonpregnant state. Breast-feeding modifies this change and maintains the endocrine profile and uterine endometrium in a "static" state. In nonlactating women, menstruation returns on average by day 55 to 60 postpartum and ovulation returns on average by day 40 to 50 postpartum. Breast-feeding prolongs the return of menstruation to some 8 to 15 months postpartum and the first ovulation on average was between 30 to 40 weeks postpartum. However, in breast-feeding women, the return of menstruation and ovulation can be quite variable and is influenced by the pattern of breast-feeding, in particular, the intensity and pattern of suckling. There is concern that breast-feeding, although an effective contraceptive on a wide population scale, is unpredictable for the individual. An overall pregnancy rate of 2 to 10 per cent during lactational amenorrhea has been reported. Barrier methods, intrauterine contraceptive devices, and progestogen-only contraceptives are some of the highly effective and most commonly used additional methods of contraception by lactating women. Other methods of contraception during this period include the use of periodic abstinence and combined oral contraceptives. This paper provides an overview of postpartum reproductive function in relation to breast-feeding and the use of contraception in this unique period.

Breast Feeding↗

Effect of a new contraceptive ring releasing 20 micrograms levonorgestrel daily on blood lipid levels and glucose tolerance.

Fifteen healthy subjects used a contraceptive device, namely an intravaginal ring releasing 20 micrograms levonorgestrel daily, for 12 weeks. High, low and very low density fractions of cholesterol, triglyceride and phospholipids were measured, together with oral glucose tolerance before and after 12 weeks of use. There were no significant differences in any of the plasma lipid fractions or in glucose tolerance.

Adult↗

Intrauterine contraception with the copper 7: evaluation after two years.

From 1,156 insertions of the copper 7 contraceptive device with 15,044 women-months of use we conclude that it offers advantages in intrauterine contraception. Continuity is improved for all users. It is a useful method for those who have not been pregnant and as an exchange device for patients having problems with other intrauterine devices or contraceptive methods. These advantages must be set against the necessity of replacing the copper 7 after a limited life span. In no cases in our series did cervical cytological examination show anything abnormal, and a 98.1% follow-up was achieved.

Copper↗

Fertility control services for adolescents: access and utilization.

More than one million teenagers get pregnant each year; six in 10 pregnancies end in live births--the rest in induced or spontaneous abortions. More than one-third of the births are out of wedlock. Yet, two-thirds of teenage pregnancies and half of the births are not intended. Some two million teenagers at risk of unintended pregnancy are now using effective birth control methods; but two millions are still denied them.

Abortion, Induced↗

Ultrasound detection of the Essure permanent birth control device: a case series.

BACKGROUND: The current recommendation to check the position of the Essure permanent birth control (PBC) micro-insert device after its insertion is by abdominal X-ray 3 months after insertion. We propose that ultrasound imaging is more suited for this purpose and gives reassurance much earlier. The sonographic appearance of the micro-inserts and the reliability of this modality in localising the devices is described in the present study. OBJECTIVE: To ascertain the appearance of the Essure PBC device at transvaginal and transabdominal ultrasound scanning and to determine the reliability of this approach in localising the contraceptive device. STUDY POPULATION AND METHODS: All patients who had the Essure PBC procedure between June 2002 and January 2003 at our centre were offered an ultrasound scan to check device position. RESULTS: The micro-inserts were easily distinguished by their echogenic coil-like appearance within each uterine cornua extending into the proximal fallopian tube. Of the 15 patients examined, 14 pairs of devices were seen: one device was malpositioned in the lower part of the uterus. In one patient, only one device was seen in the correct position but the other device was not identified and presumably expelled after a notably difficult insertion. DISCUSSION: Ultrasound appears to be well suited for micro-insert localisation. An early post insertion ultrasound scan is recommended to reassure about correct positioning of device and may potentially alleviate patient anxiety, or diagnose malposition early.

Adult↗

Oral contraception in Bangladesh.

In rural Bangladesh, the continuation rate of oral contraceptives (OCs) is the lowest among all methods except for condoms, and the pregnancy rate for OC users is comparable to that for users of traditional methods, which lies halfway between that for foam and condom users (high) and Depo-Provera and IUD users (low). To determine why postpartum amenorrheic OC acceptors have shorter pregnancy intervals than postamenorrheic OC acceptors who were matched on time of acceptance as well as on age and parity, subintervals of the pregnancy interval are examined. Results reveal significantly shorter duration of use by amenorrheic acceptors. This short duration of use overrides their significantly longer duration to pregnancy since discontinuation, to give overall shorter duration to pregnancy since last birth.

Adult↗

Corrosion of a new copper-gold or copper-platinum intrauterine device.

It has been shown previously that supplementing plastic intrauterine devices (IUDs) with copper wire enhances the antifertility effect of the device. The use of copper intrauterine contraceptive devices, however, is currently limited to two to three years, mainly because of wire fragmentation, which was observed as early as after eight months of use. In the resulting search for a long-lasting device, two new systems of duplex wire, with gold and platinum cores electrolytically coated with copper, were devised and studied. Initially, duplex wires and controls were exposed to physiological solution. Copper dissolution rate and corrosion morphology were studied by weight-loss measurements and optical metallography. Similar systems were then surgically implanted in rat uteri for varying periods of up to 26 weeks. Electron microanalysis of corrosion products, in addition to weight-loss measurements and metallography, was performed. The results showed that a uniform and ductile copper coating is obtainable by electroplating on gold and platinum wires. Rate of copper dissolution is similar to that of solid copper wire. No dissolution of gold and platinum in the controls or coated wires was detected by weight loss, metallography, or atomic absorption measurements. Microanalysis of the deposits and corrosion products on the wires in the uteri environment showed sulfur, chlorine, and calcium, in addition to copper. The results of this study suggest that supplementing IUDs with copper-coated gold or platinum wires may result in significant prolongation of the life span of the device by preventing uncontrolled loss of copper caused by wire fragmentation.

Animals↗

Hormone-releasing silastic intrauterine devices: effect or provera-releasing intrauterine devices on two species of primates.

Silastic intrauterine contraceptive devices (IUDs) 13 mm long and 1.07 mm in diameter could be inserted easily into patas monkey uteri which, like human uteri, expelled them. Addition of 10% Provera to these devices did not reduce the expulsion rate significantly in our study. Control devices had no effect on cycle length in rhesus monkeys. After insertion, the active IUDs frequently caused a delay in onset of menstruation; however, cycles did occur with the device in situ, and normal-length cycles were resumed following removal of the device. A short period of rapid release (almost 35% of the total amount) of Provera from the device was followed by a longer period of sustained release of low levels of the hormone. Even 9 mug/day were sufficient to maintain a decidual reaction in the endometrium of the rhesus monkey. The drug could not be detected in the blood stream at 3,6, or 12 hours in patas monkeys or at 1 or 2 months in rhesus monkeys and so may never have reached the systemic circulation. Devices currently under study in baboons catain Provera or one of three other steroids to determine whether these compounds improve retention rates as well as meet the other two criteria set for the ideal IUD incorporation, for unless we meet this first criterion we can never achieve, let alone test, the others.

Animals↗

A multi-compartment vaginal ring system for independently adjustable release of contraceptive steroids.

A multi-compartment contraceptive vaginal ring system has been designed for the simultaneous zero-order release of contraceptive steroids, the rates of which can be programmed independently. This vaginal ring system consists of two or more drug-containing Silastic tubes with an outer diameter of 5 mm. The tubes with different lengths, with a total length of 16.5 cm are connected with specially-shaped glass stoppers to obtain a ring with an outer diameter of 60 mm. The stopper prevents migration of the steroids from one compartment to the other and guarantees optimal release characteristics of both steroids even after long-term storage. An additional advantage of glass is the good adherence to Silastic, enabling construction of systems with sufficient tensile strength. The release characteristics have been followed in vitro and can be programmed independently by changing the wall thickness of the tube (membrane thickness) and/or the length of each individual steroid-containing compartment. Multicompartment vaginal rings were made and tested with 3-keto-desogestrel and ethinylestradiol. The rings had an outer diameter of 60 mm, and were fabricated with independent in vitro release rates ranging from 75 to 300 micrograms/day and 10 to 30 micrograms/day for, respectively, 3-keto-desogestrel and ethinylestradiol. Using the multi-compartment vaginal ring system, contraceptive devices can be fabricated relatively simply with pre-programmed release rates for a progestogen and an estrogen to investigate the optimal daily doses for vaginal hormonal contraception.

Administration, Intravaginal↗

Contraceptive use at the family planning clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria.

During the five year review period (January 1993-December 1997), 19,470 clients visited the family planning clinic of the University of Nigeria Teaching Hospital, Enugu. Of these, 2402 clients (12%) were new patients and 17,068 (88%) were old patients. Among the new clients, 2262 (94%) eventually accepted a contraceptive method. The majority of the women (60%) chose the intrauterine contraceptive device (IUCD), 20% chose the injectables, while bilateral tubal ligation and norplant were chosen by 8% and 7%, respectively, of the clients. The oral contraceptive pill was the least popular (1%). Variations in the pattern of contraceptive use among clients at the family planning clinic were discussed. Measures to increase the contraceptive prevalence, and particularly strategies to meet the specific contraceptive needs of clients at the clinic, were also examined.

Contraception Behavior↗

Rate of formation of hydrogen peroxide (H2O2) in IUD-fitted human endometrium--a preliminary report.

Endometrial biopsy samples of (i) women (20-40 yr) using no contraceptive methods and (ii) women (25-45 yr) fitted with intrauterine contraceptive devices (CuT/Lippes loop) were analysed for the rate of H2O2 formation. The mean value for a normal proliferative endometrium was 10.56 +/- 1.45 nmoles H2O2 per milligram protein per 2 min, whereas the rate observed for samples of the same phase of the IUCD-fitted group without any bleeding episodes was 14.76 +/- 1.28 and that for members of the same group but who experienced excessive menstrual blood loss (menorrhagia) was 17.26 +/- 2.00, which was significantly higher than that of the control group.

Adult↗

Postcoital contraception.

Changes in sexual mores have led to the need for an effective emergency postcoital contraceptive agent. To meet this need various individual steroids, either alone or in combination, have been evaluated and shown to be effective in preventing pregnancy as a result of a single, unprotected coital act. No drug has received specific marketing approval in North America for this purpose. However, in western Europe, the combination of ethinyloestradiol and levonorgestrel is marketed specifically for use as a postcoital contraceptive agent. Intrauterine copper contraceptive devices have also been shown to be effective postcoital contraceptive agents, but their applicability is confined to a specific segment of the population. Other agents are also being investigated for their postcoital contraceptive effectiveness, including prostaglandins, anti-progestins, GnRH agonists, super agonists and antagonists, and HCG antagonists. Sufficient interest exists in postcoital contraception that the World Health Organization has undertaken, through their task force dealing with postcoital, once-a-month and menses-inducing agents, to develop other postcoital drugs.

Contraceptives, Postcoital↗