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PubMed2003

New contraceptive choices across reproductive life.

The range of contraceptive options and consumer awareness of new contraceptive methods have both increased significantly over the past 10 years. New methods available in Australia include lower-dose oral contraceptive pills, new oral progestogens, progestogen implants, a progestogen-bearing intrauterine device and polyurethane female condoms. Contraceptive options which may soon be introduced in Australia include novel methods of administering combined (oestrogen-progestogen) contraception, such as dermal patches and vaginal rings.

Adolescent↗
PubMed2004

Nondaily hormonal contraception: considerations in contraceptive choice and patient counseling.

PURPOSE: To review currently available choices for non-daily hormonal contraception, considering efficacy, safety, patient counseling issues, and appropriate patient selection. DATA SOURCES: Worldwide medical literature and the individual products' prescribing information. CONCLUSIONS: Patients and clinicians have many nondaily hormonal contraceptive options available--from Depo-Provera quarterly injection, which has been available in the United States for over 10 years, to several new entries (Mirena 5-year intrauterine system, Lunelle monthly injection, NuvaRing monthly intravaginal ring, and Ortho Evra weekly transdermal patch). All these options offer high efficacy and enhanced convenience for many patients over daily oral contraceptives (OCs). Barriers to use of these agents may include patients' lack of information as well as fear or misconceptions regarding the hormones and methods. All of these can be addressed with adequate patient counseling and open dialogue. The clinician and patient need to be well-informed regarding these options so that they can work together and identify the best contraceptive fit for the patient---with the ultimate goal being to increase patient satisfaction and adherence and, thus, avoid unintended pregnancy. IMPLICATIONS FOR PRACTICE: Despite the efficacy of OCs, missed pills are quite common and contribute to unintended pregnancy. Many women in all population categories would benefit from the convenience and reliability of nondaily hormonal contraceptives. The highest efficacy rates with typical use are associated with agents that require minimal user participation (i.e., Depo-Provera, Mirena). Compared to daily regimens, all nondaily options offer increased convenience and may contribute to improved patient adherence. However, barriers to use may exist. Patient fears regarding use of hormones can be minimized by discussing the long-term safety of hormonal contraceptives. (The data are predominantly derived from Depo-Provera and OCs because these agents have been available in the United States and in the rest of the world for much longer than the newer nondaily options.) Patient counseling and appropriate expectations regarding changes in menstrual pattern have been demonstrated to further enhance patient adherence to therapy. Finally, patient lifestyle preferences must be considered. The finding that many women are comfortable with or even prefer amenorrhea, which is associated with options such as Depo-Provera, highlights how important it is for clinicians to avoid making assumptions about a patient's contraceptive preferences. Rather, clinicians and patients should exchange information through an open dialogue. For the majority of patients, nondaily hormonal contraceptives should be considered and offered as first-line options.

Choice Behavior↗
PubMed1985

Cervical dysplasia: association with sexual behavior, smoking, and oral contraceptive use?

Information on possible risk factors of cervical dysplasia, including indices of sexual behavior, smoking habits, and the use of oral contraceptives was obtained from a case-control study in Ontario in which 250 cases of histologically proved cervical dysplasia and 500 age-matched neighborhood controls were interviewed. Initial analysis showed an increased risk associated with more than one sexual partner, an early age at first intercourse, current smoking, the use and duration of use of oral contraceptives, and education. However, the increased risk of use and duration of use of oral contraceptives and education was reduced after adjustment for indices of sexual behavior and smoking. This finding does not confirm previously reported large adverse effects of pill use. The relationship between smoking and cervical dysplasia might be explained by some agent in cigarette smoke which depresses the immune mechanism, thus permitting a sexually transmitted agent to result in abnormal cellular development that leads to the onset of cervical dysplasia.

Adolescent↗