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PubMed2005

Unsafe abortion in Tanzania and the need for involving men in postabortion contraceptive counseling.

Targeting male partners involved in unsafe abortions for contraceptive counseling could be an important strategy for decreasing the incidence of unwanted pregnancies, yet few postabortion-care programs have attempted to involve these men. To assess the need for and determine the content of postabortion contraceptive counseling for men, this study examined the contraceptive knowledge, attitudes, and practices of male partners of women who have had an unsafe abortion. A survey was administered to 213 men accompanying female partners receiving hospital care after having undergone an unsafe abortion in Dar es Salaam, Tanzania, and 20 of these men participated in in-depth interviews. Sixteen percent of the men surveyed accompanied an extramarital partner, and of those, only 44 percent reported having practiced contraception in the last six months, compared with 81 percent of the men accompanying their wives and 83 percent accompanying their girlfriends. In general, the men wished to support their partners in practicing contraception, and the majority were willing to participate in contraceptive counseling. These findings suggest that male partners should be included in postabortion contraceptive counseling, which should be sensitive to the nature of the partners' relationship, the risk of HIV transmission, and the importance of promoting gender

Abortion, Induced↗
PubMed1974

Vitamin A, pregnancy, and oral contraceptives.

It has been shown that women receiving oral contraceptives have increased levels of serum vitamin A. High vitamin A levels may constitute a teratogenic hazard and it has been suggested that women who conceive soon after discontinuing oral contraceptive therapy may be especially at risk to this hazard.We have confirmed a significant increase in vitamin A levels in women taking oral contraceptives. During early pregnancy there is no significant difference in vitamin A levels between women who have recently been taking oral contraceptives and those who have not. We have been unable to show that either taking oral contraceptives shortly before pregnancy or a high vitamin A level during the first trimester of pregnancy, comparable to that of a woman taking oral contraceptives, has any detrimental effect on the outcome of pregnancy. It seems unlikely that women who conceive soon after discontinuing oral contraception run any teratogenic risk from increased vitamin A levels.

Abnormalities, Drug-Induced↗
PubMed1987

Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.

The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.

Adult↗
PubMed1993

Oral contraceptive use among young women in southern Sweden.

STUDY OBJECTIVE: The aim was to survey oral contraceptive usage among women under 25 years of age. DESIGN: This was a cross sectional population study based on information collected by questionnaire mailed to randomly selected individuals. SETTING: The study population consisted of Swedish women born between 1960 and 1964 and living in the southern Swedish health care region which has about one and a half million inhabitants. PARTICIPANTS: The sample consisted of 3477 women, of whom 2573 or 74% agreed to participate in the study and were interviewed between November 1990 and April 1991. MAIN RESULTS: Of the 2573 women participating, 2254 (88%) reported having used oral contraceptives at some time, 77% of them having started during their teens. Teenage start of oral contraceptive use was found to be related to a lower age at menarche, a higher marriage/cohabitation rate, a lower rate of teenage full term pregnancy, a higher rate of spontaneous abortion, a lower frequency of teetotalism, and a higher frequency of smoking. Longterm use of antipsychotic drugs appeared to be less common among women who started oral contraceptive use early, but no relationship with other pharmaceutical drug usage was found. No relationship was found between oral contraceptive use and the presence of a first degree relative with cancer. CONCLUSIONS: A large proportion of Swedish women start using oral contraceptives during their teens, and report long duration of usage both before their first full term pregnancy and before the age of 25 years. The few women who have never used oral contraceptives do not appear to be representative of the general population.

Abortion, Induced↗
PubMed2004

Fatty acid reesterification but not oxidation is increased by oral contraceptive use in women.

We evaluated the hypothesis that fatty acid reesterification would be increased during rest and exercise in the midluteal menstrual cycle phase and during oral contraceptive use, when ovarian hormone concentrations are high, compared with the early follicular phase. Subjects were eight moderately active, weight-stable, eumenorrheic women (24.8 +/- 1.2 yr, peak oxygen consumption = 42.0 +/- 2.3 ml.kg(-1).min(-1)) who had not taken oral contraceptives for at least 6 mo. Plasma free fatty acid (FFA) kinetics were assessed in the 3-h postprandial state by continuous infusion of [1-(13)C]palmitate and [1,1,2,3,3-(2)H]glycerol during 90 min of rest and 60 min of exercise at 45% and 65% peak oxygen consumption in the early follicular and midluteal menstrual cycle phases and during the inactive- and high-dose phases following 4 mo of oral contraceptive use. Plasma FFA rates of appearance, disappearance, and oxidation increased significantly from rest to exercise with no differences noted between menstrual cycle or oral contraceptive phases or exercise intensities. Compared with either menstrual cycle phase, oral contraceptive use resulted in an increase in plasma-derived fatty acid reesterification and a decrease in the proportion of plasma FFA rate of disappearance that was oxidized at rest and during exercise. Endogenous and exogenous synthetic ovarian hormones do not exert a measurable influence on plasma FFA turnover or oxidation at rest or during moderate-intensity exercise in the 3-h postprandial state when carbohydrate use predominates. The increase in whole body lipolytic rate during exercise noted previously with oral contraceptive use is not matched by an increase in fatty acid oxidation and results in an increase in reesterification. Synthetic ovarian hormones contained in oral contraceptives increase lipolytic rate, but fatty acid oxidation during exercise is determined by exercise intensity and its metabolic and endocrine consequences.

Adult↗
PubMed1975

Plasma dopamine-beta-hydroxylase activity in oral contraceptive hypertension.

A prospective study was undertaken to evaluate the relative contribution of changes in sympathetic nervous system activity, as reflected by changes in dopamine-beta-hydroxylase (DBH) activity, to the pathogenesis of oral contraceptive-induced hypertension. Precontraceptive and serial post contraceptive determinations of blood pressure, plasma renin activity (PRA), DBH activity, and changes in body weight were obtained in twelve control patients and forty-one oral contraceptive users. Forty-four percent of oral contraceptive users had increases in blood pressure but remained normotensive and 17% became frankly hypertensive. The precontraceptive and average post contraceptive levels of mean arterial pressure (MAP), PRA and DBH activity in each patient were compared using paired group analysis. Control patients (group I) exhibited no significant changes in these variables, while the patients with contraceptive-induced increases in MAP (groups III and IV) underwent significant, parallel increases in DBH activity. Finally, the linear regression of changes in MAP on the percent change in DBH activity was examined. The positive slopes in groups III and IV differed significantly from the negative slope of the controls (group I). The data have been interpreted to reflect an inappropriate oral contraceptive-induced stimulus to sympathetic nervous system activity, leading to increases in MAP in susceptible individuals.

Adult↗
PubMed1998

Not a 'proper' solution? The gap between professional guidelines and users' views about the safety of using emergency contraception.

OBJECTIVES: As a form of contraception which is used after sex, emergency contraception occupies a singular place in the birth control repertoire. The relatively high UK incidence of pregnancy terminations and of teenage pregnancy, combined with the recognition that much early sex remains unplanned and unprotected, has led to calls for better access to emergency contraceptive methods. In this study a combination of self-completion questionnaires and semi-structured interviews was used to explore views of emergency contraception among women who were using the method. METHODS: Five hundred and ten women attending two family planning clinics in Oxford and London completed a questionnaire in the waiting room and 53 women who were attending for emergency contraception took part in semi-structured interviews. RESULTS: The view, presented in recently published UK guidelines, that emergency contraception is a reliable method and not dangerous to repeat, was not shared by the respondents. The rationale for and sources of women's concerns about the strength of the dose of hormonal emergency contraception and the nature of side-effects are explored.

Adolescent↗
PubMed2006

Antiepileptic drugs and hormonal contraceptives in adolescent women with epilepsy.

Both estrogen and progesterone influence seizure activity in women with epilepsy, with estrogen generally demonstrating proconvulsant and progesterone anticonvulsant effects. Women with epilepsy exhibit a variety of endocrine disturbances, probably due to a combination of factors, including the epilepsy syndrome and the effect of interictal and ictal epileptic discharges in the brain. The direct effects of some antiepileptic drugs (AEDs) further increase this risk, apparently related to a specific drug's effect on hepatic microsomal enzymes of the cytochrome P-450 system. AEDs that induce hepatic microsomal enzymes also interact with hormonal contraception to increase estrogen's metabolism and progesterone's protein binding, decreasing concentrations of both hormones and thus reducing contraceptive efficacy. Some evidence indicates that concurrent use of hormonal contraceptives and lamotrigine significantly decreases the plasma concentration of lamotrigine, suggesting that close monitoring is warranted. Nevertheless, hormonal contraception confers comparable or superior efficacy compared with such other contraceptives as the intrauterine device and barrier methods and remains an appropriate option in women with epilepsy. Importantly, concurrent use of hormonal contraception and AEDs does not adversely affect seizure control. Careful patient management, including the use of increased estrogen doses (> or =50 microg) in patients receiving enzyme-inducing AEDs, may further minimize the risk for unintended pregnancy. Special considerations in women of childbearing age include decreased compliance and disease prevention. Although adequate seizure control is the critical requirement of an AED, the potential for interactions with hormonal contraception and the increased risk for endocrine disturbances caused by drugs that alter hepatic microsomal enzymes suggest additional potential advantages for AED treatment that does not affect these enzymes. Both the constellation of physicians treating women with epilepsy and the patients themselves have a poor understanding of the spectrum of reproductive health issues involved, and increased awareness is needed to improve patient management.

Adolescent↗
PubMed2005

Is genitourinary medicine meeting the contraception needs of clinic attendees?

Providing a service that incorporates both sexually transmitted infection (STI) treatment and contraception may provide an opportunity to reduce the spread of infection and unintended pregnancies by identifying women using inadequate contraception. Genitourinary (GU) medicine clinics are well equipped to do this. This study looked at current contraception needs of, and provision where inadequate to, new patients attending a department of GU medicine. Two hundred consecutive new patients ranging in age from 13-60 years were included in the study. Overall 164 (82%) women attending for testing for STIs had no contraceptive needs. In this GU medicine clinic population the majority of attendees were using a reliable form of contraception correctly. Where contraception was inadequate there was discussion of this and documentation of the advice and/or treatment given in the notes of all except one woman. This suggests that for this group of women their attendance at a GU medicine clinic was appropriate to meet their main need, which was related to STIs, and where contraception was inadequate this was managed appropriately within the GU medicine clinic attendance.

Adolescent↗
PubMed2005

Teen contraceptive decisions: childbearing intentions are the tip of the iceberg.

OBJECTIVE: To validate a model we developed while trying to understand why pregnant teens so often report that they did not want to become pregnant and could have obtained contraceptives before they conceived. METHOD: The study enrolled a racially/ethnically diverse group of 351 teenagers. Participants completed a questionnaire that asked about teen pregnancy risk factors, the expected effects of childbearing, the desire to remain non-pregnant, deterrents to contraceptive use, and contraceptive plans. RESULTS: Most participants were capable of using contraceptives but at high risk for unintended conception because they exhibited numerous sociodemographic risk factors, were unsure that pregnancy would affect their lives adversely, and were ambivalent about remaining non-pregnant. Believing a boyfriend wanted a baby and the anticipated effect of childbearing on 5 specific aspects of life explained 63% of the variance in the desire to remain non-pregnant, which, in conjunction with fears about using contraceptives, explained 20.5% of the variance in future contraceptive plans. CONCLUSIONS: Our new findings that expectations about the effect of childbearing explain the desire to remain non-pregnant may well help providers determine why teenagers who do not plan to conceive are often willing to allow themselves to do so by default. Further research is needed, as the model did not explain contraceptive decision-making adequately.

Adolescent↗
PubMed2002

Contraceptive use among Jamaican teenage mothers.

OBJECTIVE: To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. METHODS: A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptive use among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. RESULTS: Contraceptive use at first intercourse was found to be higher among WCJF program participants (44%) than among nonparticipants (37%), but this difference was not significant (P = 0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94%) than among nonparticipants (86%), and this difference was significant (P = 0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69%). CONCLUSIONS: Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed2005

A qualitative study of women's use of emergency contraception.

BACKGROUND: While the use of emergency contraception (EC) is becoming more widespread in Australia, little is known about the reasons for, and the social context of, this use. METHODS: In order to explore the use of EC from the perspective of users, a qualitative study was conducted with women presenting to one of three health care settings in Melbourne, Australia for EC. RESULTS: Thirty-two women ranging in age from 18 to 45 years were interviewed. While a number of themes were discussed with the women, this paper reports on four 'types of users' of EC identified from the data. 'Controllers' experienced failure of their contraceptive method and were very uncomfortable needing EC. They changed their contraceptive strategy in an attempt to avoid needing EC in the future. 'Thwarted controllers' were similar to controllers except that they could not improve their contraceptive strategy due to medical or social limitations. 'Risk takers' saw the use of EC as a component of their overall contraceptive strategy. They did not rely on EC regularly, but were comfortable to use it occasionally when the need arose. A final group of women were 'caught short' by a sexual experience that was unplanned and therefore they did not manage to use their chosen contraceptive strategy. CONCLUSIONS: The findings from this study challenge the assumptions that are often made about the users of EC and highlight the need to acknowledge the different ways that women make sense of, and make decisions about, contraception.

Adolescent↗
PubMed1978

Effect of oral contraceptive therapy on gingival inflammation in humans.

One hundred sixty-eight female patients between the ages of 18 and 35 were evaluated with an Oral Debris Index and a Gingival Inflammatory Index. The patients were then divided into groups and subgroups according to their intake of oral contraceptives. Statistical analysis revealed that the group currently taking oral contraceptives had a higher mean Gingival Inflammatory Index than the group not presently taking oral contraceptives. The group taking oral contraceptives also revealed a lower mean Oral Debris Index than the control group. Further analysis revealed that while some brands of oral contraceptives produced more dramatic index changes than others, no relationship appeared to exist due to the differences of progesterone or estrogen content in the various brands. Increased accumulative exposure to oral contraceptives apparently had no effect upon Oral Debris Indices or Gingival Inflammatory Indices. Further studies with older population groups should be conducted in an attempt to answer questions concerning the effect of long term oral contraceptive intake on periodontal diseases other than gingivitis.

Adolescent↗
PubMed2002

Male hormonal contraception: an update on research progress.

New male contraceptive options are needed to provide couples with additional well-tolerated, effective, and reversible contraceptive choices. Research and development of new male hormonal contraceptives have produced many exciting possibilities over the past 20 years. Two large, multicenter, World Health Organization (WHO) trials demonstrated that high-dosage testosterone provides effective suppression of follicle-stimulating hormone, luteinizing hormone, and spermatogenesis. In men whose sperm counts suppress to < or = 3 million/ml, high-dosage testosterone provides contraceptive efficacy similar to female oral contraceptives. Since the WHO efficacy studies, investigators have focused on evaluating combination regimens that include lower dosages of testosterone plus gonadotropin-releasing hormone (GnRH) analogs or progestogens (progestins). In small, randomized trials, combination regimens of testosterone plus GnRH analogs or progestogens have produced more uniform suppression of spermatogenesis than high dosage testosterone alone. The major adverse effects of most of the studied male hormonal contraceptives are modest bodyweight gain and suppression of high density lipoprotein-cholesterol levels. The latest research studies indicate that a well-tolerated, effective male hormonal contraceptive may soon be developed.

Androgens↗
PubMed2000

Self-reported oral contraceptive use and peripheral joint laxity.

STUDY DESIGN: A masked, single-factor, posttest-only control group design. OBJECTIVE: To explore the relationship between reported oral contraceptive use and peripheral joint laxity. BACKGROUND: Studies have found an association between increased ligamentous laxity and changes in serum levels of hormones such as estrogen, progesterone, and relaxin. Two of these hormones, estrogen and progesterone, are present in most oral contraceptives. Oral contraceptive users, therefore, provide a population for studying the effects of these hormones on the degree of ligamentous laxity. METHODS AND MEASURES: Fifty-five women between the ages of 20 and 25 years participated in this study. Thirty users of oral contraceptives were a test group and 25 nonusers of oral contraceptives were controls. The KT-1000 Arthrometer was used to measure passive anterior translation of the tibia in relation to the femur in both knees. Passive abduction and adduction of the proximal interphalangeal (PIP) joint of the second digit of the nondominant hand and distal interphalangeal (DIP) joint hyperextension of the fifth digit of the nondominant hand were measured using a goniometer. A subjective measurement of passive second PIP joint motion was also assessed and a value of minimum, moderate, or maximum laxity was assigned. Independent sample t tests were performed to compare the measurements of the oral contraceptive user and nonuser groups for each joint. A chi-square test compared the subjective PIP joint data between the 2 groups. RESULTS: No significant differences in laxity measurements at the knee or hand were found between the 2 groups. Average knee laxity varied between 5.7-7.9 mm of anterior displacement for both groups. Average PIP abduction and adduction varied between 6.5-6.7 degrees for both groups and DIP hyperextension was 28.6-29.9 degrees. CONCLUSIONS: Results of this study indicate that self-reported oral contraceptive use was not associated with peripheral joint laxity.

Adult↗
PubMed1999

Contraceptive services for adolescents in Latin America: facts, problems and perspectives.

This review presents facts about sexual and contraceptive behavior of Latin American adolescents, analyzes barriers to contraception, and summarizes present perspectives. Between 13 and 30% of Latin American adolescent women live in union before their 20th birthday and between 46 and 63% have had sexual relations. The prevalence of contraceptive use among adolescents at risk of pregnancy remains very low. The pill is the best known contraceptive method. When sexual activity becomes a permanent practice, contraceptive use increases but remains low. Barriers to contraception can be identified as: (1) arising from adolescents themselves (moral objections, alleged medical reasons, lack of confidence in adults and in the health system, promiscuity; (2) arising from the sexual partner (partner's opposition, masculine irresponsibility); (3) arising from adults (moral objections, fear of sex education, adult control and power of decision-making); (4) arising from the health system (inappropriateness of services, regulatory barriers, gender inequality); (5) arising from health professionals (medical barriers to contraceptive use, discomfort with sexual matters); (6) arising from the educational system (educational failure, teachers' reluctance); and (7) arising from other social agents (religious opposition, media ambivalent messages, fund restraints). There have been improvements in recent years, including the achievements of groups working for and with adolescents, and the support from distinguished personalities.

Adolescent↗
PubMed2006

Serum copper in rural women taking combined oral contraceptive.

This prospective case-control study included 78 women between 15 to 45 years of age from rural area to see changes in serum copper level as a consequence of oral contraceptive use. Among the subjects, 34 women were included as controls because of not taking any form of hormonal contraceptives neither during the time of selection nor during one-year period prior to the study. Women in the control group were motivated to consume oral pill (Sukhi) for 3 consecutive cycles. At the 3(rd) month, 25 such women became available and henceforth included as cases on longitudinal basis. Another 44 women were randomly selected as cases on the basis of using combined oral contraceptives (Sukhi) for a duration of 4 months onwards. Considering different duration of oral contraceptive (OC) use, subjects were grouped as follows: Group I (n=34)--> controls, Group II (n=25)--> 3 months, Group III (n=17)--> 4 months - 2 years and Group IV (n=27)--> >2 years. Finally, 103 samples of blood (34 from controls and 69 from oral contraceptives users) were collected for estimation of Serum Copper (mgm/dl) by Atomic Absorption Spectrometry using UNICAM-AA Spectrometer. Mean+/-SD of Serum Copper significantly increased in all 3 contraceptive groups in comparison to controls (p<0.001). Further study including larger population from rural area was recommended to see correlation among serum copper and other trace elements with side effects of hormonal contraceptives. This preliminary study tried to explore the possibility of establishing biochemical monitoring of serum trace elements in OC users.

Adolescent↗
PubMedDate not supplied

Oral contraception: safety issues re-examined.

Oral contraceptives are highly effective contraceptive agents that are used throughout the world. However, misperceptions about the safety of oral contraceptives as well as a relative lack of information concerning their numerous and important noncontraceptive benefits may limit their use and place women at increased risk for unintended pregnancy. Safety issues concerning the use of oral contraceptives have largely been laid to rest; indeed, except for a slight increased risk of venous thromboembolism in combination oral contraceptive users, conventional oral contraceptive use is not associated with an increased risk for cardiovascular events. In addition, fears regarding breast cancer development in OC users have been unsubstantiated by the plethora of available data. Clinicians must provide accurate and empathetic counseling concerning the safety and applicability of oral contraceptives and other pregnancy prevention methods.

Breast Neoplasms↗