Evaluating the training of nurses to do family planning work in India.
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Attitude of Health Personnel↗
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Thailand: family planning activities 1968 to 1970.
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Adolescent↗
Risk of myocardial infarction, angina and stroke in users of oral contraceptives: an updated analysis of a cohort study.
OBJECTIVES: To investigate risk of myocardial infarction, angina and stroke in users of contraceptive pills compared with users of other methods of contraception. DESIGN: Prospective cohort study, with recruitment between 1968 and 1974 and annual follow up until the age of 45 years. After this age, only women who had never used oral contraception or those who had used it for eight or more years continued to be followed up annually until July 1994. SETTING: Seventeen family planning clinics in England and Scotland. POPULATION: 17,032 women aged between 25 and 39 years at entry to the study. MAIN OUTCOME MEASURES: Occurrence of angina, myocardial infarction or stroke that was associated with either hospital admission or outpatient referral to hospital or death. RESULTS: Increased risk of myocardial infarction in oral contraceptive users was observed only in women who were heavy smokers at entry to the study. In this subgroup the relative risk of a myocardial infarction was 4.2 (95% CI 1.4-16.6) in ever users of oral contraception compared with non-users, 4.9 (1.2-23.6) in current users, and 4.0 (1.3-16.2) in ex-users. In all current users the relative risk of angina was 0.5 (0.1-1.4), and the relative risk of ischaemic stroke was 2.9 (1.3-6.7). The increased risk of ischaemic stroke did not persist in ex-users. CONCLUSIONS: Use of oral contraception is associated with increased risk of ischaemic stroke and increased risk of myocardial infarction (only in heavy smokers), but no increased risk of angina. These increased risks need to be considered within the context of the very low absolute risks of cardiovascular disease in this population. 5880 women need to take oral contraception for one year to cause one extra stroke, and 1060 women who are heavy smokers need to take it for one year to cause one extra myocardial infarction.
Adult↗
LH-RH agonists and antagonists.
Large doses of stimulatory analogues of luteinizing hormone-releasing hormone (LH-RH) caused paradoxical antifertility effects. These effects are being utilized for the possible development of contraceptive methods. Several inhibitory analogues of LH-RH have been tested in men and women and shown to be active. The synthetic approach based on inhibitory analogues of LH-RH has been proven to be feasible for development of new methods of birth control. Continued research and testing along these lines may lead to the development of contraceptives based on inhibitory analogues of LH-RH that could be conveniently applied as a nasal spray and could be free of undesirable side effects.
Animals↗
Contraceptive vaccines.
The world's population is growing at a tremendous rate, affecting growth and development. Apart from this population growth, unintended pregnancies resulting in elective abortions continue to be a major public health issue. In over half of these unintended pregnancies, the women have used some type of contraception. Thus, there is an urgent need for a better method of contraception that is acceptable, effective and available. The contraceptive choices available to women at this time include steroid contraceptives, intrauterine devices, barrier methods, spermicides, natural family planning, male and female sterilisation, and recently available emergency contraceptives. Contraceptive vaccines (CVs) may provide viable and valuable alternatives that can fulfill most, if not all, properties of an ideal contraceptive. Since both the developed and most of the developing nations have an infrastructure for mass immunisation, the development of vaccines for contraception is an exciting proposition. The molecules that are being explored for CV development either target gamete production (gonadotropin releasing hormone, follicle-stimulating hormone and luteinising hormone), gamete function (zona pellucida [ZP] proteins and sperm antigens) or gamete outcome (human chorionic gonadotropin [hCG]). Disadvantages of CVs targeting gamete production are that they affect sex steroids and/or show only a partial effect in reducing fertility. CVs targeting gamete function are better choices. Vaccines based on ZP proteins are quite efficacious in producing contraceptive effects. However, they invariably induce oophoritis affecting sex steroids. Sperm antigens constitute the most promising and exciting targets for CVs. Several sperm-specific antigens have been delineated in several laboratories and are being actively explored for CV development. Antisperm antibody-mediated immunoinfertility provides a naturally occurring model to indicate how an antisperm vaccine will work in humans. Vaccines targeting gamete outcome primarily focus on the hCG molecule. The hCG vaccine is the first vaccine to undergo phase I and II clinical trials in humans. Both the efficacy and the lack of immunotoxicity have been reasonably well demonstrated for this vaccine. The present studies focus on increasing the immunogenicity and efficacy of this birth control vaccine.
Female↗
Effect of oral contraception by progesterone pill on lipids and glucose metabolism.
The influence of oral contraception with 0.5 mg ethynodiol diacetate (Femulen) on blood lipid and glucose tolerance test (GTT) was studied in a group of 14 nulliparous women ages 17-24 years before and 3 months after treatment. In another group of 13 women of matched age, contraception was managed by providing a combined pill (estrogen and progesterone). The continuous treatment of ethynodiol diacetate did not result in the increase in serum cholesterol and triglyceride levels and did not affect the GTT, as observed when the combined pill was administered. Femulen had no side effects, except for 2 cases of vaginal spotting. Ethynodiol diacetate does not induce the decrease in high-density lipoprotein cholesterol levels which is an anti-risk factor for the prevention of accelerated atherosclerotic disease. Oral contraception with this pill is indicated for all women, especially when there is an absolute contraindication for the use of combined pills
Biology↗
Fertility and contraceptive practice: Bogota, 1964-74.
The results of a 1974 survey of 6,692 Bogota women aged 15-49 conducted by the Colombian Association for Population Studies show that, in the last decade, approval of family planning practice increased 34 percent, contraceptive practice nearly doubled, and fertility declined by over 45 percent. Life-table analysis shows unusually high continuation rates for Bogota women. Data concerning crossovers between Bogota's three family planning programs and the commercial sector indicate that the manufacturers of contraceptives benefit from program activities. The study demonstrates, for the first time in Latin America, the feasibility of using a probability sample of the general female population to evaluate family planning programs.
Adolescent↗
Use of depot medroxyprogesterone acetate in Thai adolescents.
Depot medroxyprogesterone acetate (DMPA) has been available for several decades in many parts of the world including Thailand, but few data have been reported concerning adolescents. The aim of the study was to determine the use of DMPA for contraceptive use among Thai adolescents. A cross-sectional study has been designed. A total of 108 adolescents who used DMPA as contraception between January 1, 1996, and December 31, 1997, at King Chulalongkorn Hospital were reviewed by chart. Most of the participants were in late adolescence and average age was 17.6 years of age. Six-month continuation rate was 69.4%, and at 9 months and 1 year were 42.6 and 30.6%, respectively. Irregular bleeding, amenorrhea, and weight gain were the side effects frequently reported. The most common side effect that caused discontinuation within 1 year was irregular bleeding. With prolonged use, the number of cases with irregular bleeding decreased and the duration of bleeding was shortened, whereas the rate of amenorrhea increased. No pregnancy occurred during the study period. In conclusion, DMPA is an effective contraception in adolescents. However, the continuation rate is lower than that for adult women. The main reason for discontinuation is irregular bleeding.
Adolescent↗
Contraception and sterilization in the United States, 1965-1975.
Although the pill remains the most popular method of contraception among young married women, sterilization is now the method of choice among couples married a decade or more, as well as among couples who have had all the children they want. Indeed, contraceptive and medical sterilizations combined now comprise the most frequent barrier to conception among all married couples of reproductive age. Three-quarters of couples using contraception now use the most effective methods, the pill, sterilization or the IUD, and the trend data suggest a continuing increase in the reliance on such methods.
Adult↗
One year study of Implanon on the adverse events and discontinuation.
OBJECTIVE: To determine adverse events and discontinuation of Implanon in healthy Thai women between 16 and 45 years of age. DESIGN: Prospective descriptive study. SETTING: Family Planning Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University. SUBJECTS: Ninety-two female volunteers with eligible criteria, no contraindication for hormonal contraceptive and wished to have long-term contraception were recruited. MAIN OUTCOME MEASURES: Determination of adverse events was done three months after Implanon insertion. Discontinuation of Implanon use was reviewed during the study period of one year RESULTS: Amenorrhea (40.2%) and infrequent bleeding (39.1%) were the most menstrual adverse events. While most non-menstrual adverse events were headache/dizziness (27.2%) and lower abdominal pain (23.9%). Severe non-menstrual side effect was rare (1-2%). Seven subjects (7.6%) discontinued using Implanon during the one year period of study. CONCLUSION: Implanon demonstrated a high continue rate at the first year of insertion. It produced similar adverse events like other progestin-only contraceptives. Counseling before insertion is important for increased client satisfaction and a higher continuation rate.
Adolescent↗
Intrauterine device retention: a study of selected social-psychological aspects.
A retrospective study of the association between selected sociopsychological variables and the early discontinuation of intrauterine device use was carried out among patients of the Central Clinic of Family Health, Inc., New Orleans, Louisiana. In toto, 270 women cooperated in a standardized interview which was administered by trained auxiliaries of the clinic's staff; Investigation of sociodemographic characteristics shows a greater proportion of the terminators to be younger, more mobile, and to have experienced more changes in marital partners. Continuers are at greater health risk in pregnancy as rated by the clinic at time of admission, but do not verbalize this as a concern. Responses relating to sexuality image and contraceptive attitudes indicate that a greater proportion of the terminators dislike an internal IUD self string check, hold a more pro-pregnancy attitude, do not feel dependent on the availability of contraceptives, and currently utilize the less effective contraceptive methods. Few significant differences are reported in the side effects experienced after IUD insertion by the terminators or continuers. However, the groups hold decidely different perceptions of the meaning of such complaints. A greater proportion of the terminators perceive themselves as being sick, take to bed during the menses, find that complaints disrupt their normal household activities, and are fearful of the meaning to their health of the difficulties experienced. The majority of both groups are functioning in a segregated marital role pattern. Terminators portray a tendency to be interacting with more "traditional" husbands who visualize the proper role for their wives as mothers whose duty it is to stay home. Continuers, to a greater degree, are more dominant individuals, make more decisions in the running of the home, and feel that contraception is their responsibility alone. Program implications take direction from the findings that the terminator is a more "costly" patient in terms of physician time and is at a decidely greater risk of final closure to all clinic contacts.
Adult↗
Fertility regulation in nursing women. II. Comparative performance of progesterone implants versus placebo and copper T.
A clinical study was designed to test whether sustained administration of progesterone to nursing mothers could prolong lactation and delay the postpartum recovery of fertility. The hormone was administered by subdermal implantation of six pellets that each contained 100 mg of progesterone. This treatment was administered to 84 fully nursing women on day 30 post partum. Control groups were composed of 130 fully nursing women who received an injectably placebo, and by 125 fully nursing women who received a TCu 200 intrauterine contraceptive device. An exacting list of requirements for admission to and continuation in the study was applied to all groups. No pregnancies occurred in the progesterone-treated group from the second to the sixth postpartum month. This period coincided with the period of elevation plasma progesterone attributable to hormone released from the implants. The cumulative probability of pregnancy in the placebo group was 10.2 per 100 women at the sixth month. Treatment with progesterone did not change the duration of lactation or the rate of child growth, and no adverse effects were recorded. These results warrant further investagation of the use of progesterone as an alternative method to prevent conception in nursing women.
Birth Weight↗
Gonadotropin releasing hormone analogs for female contraception by inhibition of ovulation.
One hundred and one healthy regularly ovulating women used two superactive GnRH agonists, Buserelin and Nafarelin, for contraception for 3-26 months. The superagonists were administered once daily by a nasal spray. The treatment was initiated on one of the first 3 days of the menstrual cycle. Seventy-one volunteers used 200, 400 or 600 micrograms of Buserelin for contraception for 3-26 months. Normal ovulation was disturbed in all but 3 of 628 treatment months. No pregnancy occurred. Fifty-three women had regular or sparse menstrual-like bleedings during treatment while 18 developed amenorrhea. Normal ovulation and fertility rapidly returned after cessation of therapy. Thirty women received 125 or 250 micrograms of Nafarelin intranasally once daily for 3 months. The treatment consistently inhibited ovulation without serious side effects. The inhibition of ovulation by prolonged continuous intranasal GnRH agonist therapy is a promising new lead to peptide contraception in women.
Administration, Intranasal↗
Clinical evaluation of an oral contraceptive containing Ethinyl-Oestradiol (30 mcg) and Gestoden (75 mcg).
At the Family Planning Center AIECS in Bari, 383 women have been treated for 6 cycles with an estroprogestinic combination containing Ethinyl-Oestradiol (30 mcg) and Gestoden (75 mcg). We evaluated the following parameters: contraceptive efficacy, cycle control, side effects and acceptability. At the end of the treatment, 346 women (90.4%) decided to continue the treatment while only 22 expressed a negative opinion. The clinical experience has been positively considered by the physician, considering the high contraceptive efficacy, even if 12% of women forgot to take the pill (Pearl Index 0.00) side effects profile and cycle control.
Adult↗
Performance of contraceptive patch compared with oral contraceptive pill in a high-risk population.
OBJECTIVE: To evaluate the potential benefit of the transdermal contraceptive patch compared with the oral contraceptive pill for its acceptability and compliance in a population at high risk for future unintended pregnancies and abortions. METHODS: Assessment of the contraceptive patch and pill was prospective. We gathered information on women undergoing contraceptive counseling at three Planned Parenthood clinics. Discontinuation, adverse effects, and pregnancy outcomes were catalogued. The primary outcome was time to discontinuation of the patch or pill. Survival analyses with life tables and Cox proportional hazards were used to assess acceptability and compliance. Pearl indices were calculated for both the pill and patch. RESULTS: A total of 1,230 contraceptive-naïve women were identified. Subjects were a racially diverse group of primarily single women. Eighty-nine percent of the study population met our definition of being at high risk for a future unintended pregnancy or pregnancy termination. Loss to follow-up was higher among patch users (45.2% versus 29.5%, P<.001). Verified continued use beyond the first three cycles was lower with a patch (67% versus 89%, P<.001). Skin irritation and site reactions were the treatment-limiting factor for 3.3% of patch users. The 3,206 cycles captured in this study resulted in a Pearl index of 3.62 for the pill and 14.84 for the patch. Differences in the baseline demographic and contraceptive practices may account for this discrepancy although, in multivariate analysis, patch users continued to do worse. CONCLUSION: In this high-risk population, we found the contraceptive patch to have lower continuation and effectiveness rates. Further research should investigate factors contributing to poorer real-world performance by the patch.
Administration, Cutaneous↗
Oral contraceptives and breast cancer: what has 20 years of research shown?
This article reviews 20 years of research to determine if oral contraceptive usage increases the risk of breast cancer. Studies using animal models, epidemiology, and human tissues are presented. Results suggest oral contraceptives do not initiate breast cancer, but may act as tumor promoters, stimulating the growth of already transformed cells. The answers are not all in, and the need for continued research is emphasized.
Animals↗
Hormonally impregnated intrauterine systems (IUSs), versus other forms of reversible contraceptives as effective methods of preventing pregnancy.
OBJECTIVES: To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods. SEARCH STRATEGY: Literature was identified through database searches, reference lists and individuals/organisations working in the field. SELECTION CRITERIA: All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate. DATA COLLECTION AND ANALYSIS: The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs <=250mm2 (i.e. Nova-T, Multiload, CuT 200 and CuT 220 IUDs) and non-medicated IUDs. MAIN RESULTS: Nineteen RCTs comparing hormonally impregnated IUSs to a reversible contraceptive method met the inclusion criteria and it was possible to include eight of these in the meta-analyses, four comparing LNG-20 IUSs with non-hormonal IUDs, one comparing the LNG-20 IUS with Norplant-2 and three comparing Progestasert with non-hormonal IUDs. No significant difference was observed between the pregnancy rates for the LNG-20 users and those for the IUD >250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD <=250mm2. Women using the LNG-20 IUS were more likely to experience amenorrhoea and device expulsion than women using IUDs >250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant differences was noted for these two outcomes when Progestasert users were compared to IUD<=250mm2 users. The only other significant differences found in the meta-analyses were that Progestasert users were less likely to expel the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2. REVIEWER'S CONCLUSIONS: Current evidence suggests LNG-20 IUS users are no more or less likely to have unwanted pregnancies than IUD >250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs <=250mm2. The contraceptive effectiveness of Progestasert was significantly better than non-medicated IUDs, but no difference was observed when compared to IUDs<=250mm2. Continuation of LNG-20 IUS use was similar to continuation of the non-hormonal IUDs and Norplant-2. Amenorrhoea was the main reason for the discontinuation for the LNG-20 IUS and women should be informed of this prior to starting this method.
Contraceptive Agents, Female↗
Women's acceptance of an injectable progestin-only contraceptive in a free-choice environment in Turkey.
A progestin-only injectable contraceptive has been integrated into the method mix at a well-woman clinic in Turkey. During the period from 1st December 1996 to 1st December 1997, among 3545 new method acceptors at the clinic, 254 women decided to use the injectable, giving an initial acceptance rate of 7%. Continuation rates, however, were quite low: 43.7% at 6 months and only 18.5% at 12 months. Though all the side-effects were mentioned during the counselling sessions, side-effects such as amenorrhea and spotting might have been underestimated by the potential users of this method, which was new in the country. A more detailed counselling with a strong emphasis on frequent side-effects might lower the initial acceptance rate, but can help to increase the continuation rates.
Adult↗