The birth of a healthy child due to negligent failure of "Pill": Benefit or loss?
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Contraceptives, Oral↗
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[The effects of MLCu 250 and VCu 200 on rural women who had experienced failure with ring IUD].
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Asia↗
A 4-year follow-up study of women with Norplant-2 contraceptive implants.
One-hundred-thirty of 178 women who received Norplant-2 implants were followed prospectively for 4 years. Menstrual disorders were the most common reason for discontinuation. Only one patient conceived, for a failure rate of 0.6%.
Adult↗
Hormonal contraception and epilepsy.
Attempts to normalize lifestyle and optimize quality of life in women with epilepsy should include the option of a reliable method of birth control, including oral contraceptives (OCs). Despite the well-known effects of estrogen on lowering seizure threshold, it has never been shown that estrogen-containing OCs worsen seizures in epileptic patients. In theory, the presence of progesterone (which is known to inhibit seizures experimentally) in OCs could counterbalance the seizure-promoting effects of estrogen. However, there is evidence that some OCs may fail when combined with antiepileptic drugs (AEDs), possibly because of the latters' inducing effects on endogenous estradiol and progesterone. Physicians have a duty to offer appropriate and accurate counseling to epileptic patients concerning optimal choice in the use of OCs for those considering this method of contraception. Recommendations include possible use of a noninducing AED, or (for patients taking inducing AEDs) use of an OC containing > or = 50 microg estrogen. Patients should be warned that midcycle bleeding indicates possible OC failure and that the absence of such bleeding is not an indication of OC effectiveness. Additional contraceptive measures are also advised.
Anticonvulsants↗
[Surgical hysteroscopy in preventing the occurrence of Asherman's syndrome following the removal of intrauterine contraceptive devices].
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Amenorrhea↗
Early human embryo metabolism.
Non-invasive microanalytical methods have been devised to study the energy metabolism of single human preimplantation embryos. Pyruvate, which is added routinely to all media used to culture human embryos, is consumed throughout the preimplantation period, with glucose assuming an increasing role at embryo compaction and blastocyst formation. All of the glucose consumed may be accounted for by the appearance of lactate in the incubation medium. The enzyme hexokinase may be involved in regulating this aerobic glycolysis. There is considerable indirect evidence for the utilisation of endogenous as opposed to exogenous energy substrates, the most likely candidate being protein. Information on early human embryo metabolism is likely to find application in a number of areas: these include the improvement of techniques for assisted human conception, notably in the selection of embryos for transfer following In Vitro Fertilisation; the diagnosis of genetic defects at the preimplantation stage; increased understanding of the causes of implantation failure and miscarriage, and the development of novel post-coital contraceptives.
Adenosine Triphosphate↗
Gonadal cell apoptosis: hormone-regulated cell demise.
It has become evident that apoptosis, an active form of cell 'suicide', plays an important role in the normal function of all tissues. A balance of cell proliferation and apoptosis is maintained in a healthy individual and any imbalance of the two processes could lead to pathological changes. In both sexes, massive apoptosis accounts for the demise of a majority of gonadal cells (ovarian granulosa cells and male germ cells) during reproductive life. Recent studies have indicated the important role of gonadotrophins as survival factors in both the ovary and the testis. Furthermore, intra-gonadal survival. factors in the ovary (oestrogens, insulin-like growth factor I, epidermal growth factor, basic fibroblast growth factor, interleukin-1 beta, nitric oxide, etc.) and testis (androgens) have been shown to act in concert with the gonadotrophins. In contrast, several apoptotic factors (androgens, gonadotrophin-releasing hormone-like peptide and interleukin-6) may be important in inducing the demise of ovarian follicles. Understanding of the hormonal and cellular mechanisms responsible for gonadal cell apoptosis will provide new approaches for the treatment of gonadal degenerative conditions such as premature ovarian failure and cryptorchidism, as well as for the design of new contraceptive approaches.
Animals↗
[Abortion-related mortality in Brazil: decrease in spatial inequality].
Abortion is not only a major cause of obstetric hospitalization in poor countries, but it also represents the failure of the public health system to provide enough information about contraceptive methods and thus prevent pregnancies. In Brazil, the high utilization rates of health facilities due to abortions reflect the ongoing difficulties with family planning and contraception. In addition, mortality resulting from abortions serves as an indicator of the quality of abortion procedures, an important point in a country where the practice is illegal and therefore done clandestinely. In this study, we analyzed the rates of mortality resulting from abortions among women 10 to 54 years old, including women who died from spontaneous and induced abortion, from 1980 to 1995, for the various regions of the country. The information we used came from the mortality data bank of the public health system of the Ministry of Health. Population data were obtained from the Brazilian Institute for Geography and Statistics. We studied 2,602 deaths, 15% of which were due to missed abortion, spontaneous abortion, or legally permitted induced abortion. The other 85% of the deaths were due to illegal induced abortions or to nonspecified abortions. The mortality rates from abortion-related causes have steadily decreased in all the regions of Brazil, but this improvement has been unevenly distributed in the country. The region with the smallest decrease in this rate (38% over 15 years) was the Northeast. The age of women dying from abortions progressively declined over the period studied.
Abortion, Induced↗
Diagnosis and management of post-pill amenorrhea.
Post-pill amenorrhea is, in most cases, a relatively uncomplicated medical problem to diagnose and treat, but it is imperative to exclude pituitary tumors or serious endocrinological abnormalities before treatment is begun. Subjectively, post-pill amenorrhea is the failure to resume menstruation within six months after discontinuation of oral contraceptives. Objectively, a pattern of hypothalamic deficiency may be found, which usually consists of low values for the gonadotropic and ovarian hormones and mild to moderate elevations of prolactin. Treatment is required only if pregnancy is desired. Two very effective drugs are available that can be safely administered by the interested family physician: bromocriptine and clomiphene. Women not desiring pregnancy at the time can be managed with reassurance in the expectation of a spontaneous return of menstruation and with periodic follow-ups that may include progesterone withdrawal testing.
Amenorrhea↗
[Selenium and antioxidant status in various diseases].
All healthy mammalian organisms are characterized by an equilibrium between the occurrence of highly reactive oxygen species and their destruction by anti-oxidants. Numerous diseases go hand in hand with a disturbance of the homoeostatis. In order to avoid or minimize the destructive effect of the oxidant stress on biological structures, therapies utilizing drugs with anti-oxidant effects are increasingly being applied. Preconditions for these therapies are a characterisation and a follow-up of the anti-oxidant status in the diseased organism. In the course of the present study selenium, glutathione peroxidase and malondialdehyde were determined in patients with various clinical pictures (terminal renal insufficiency, septic shock, high-risk gravidieties, arterioscleroisis, pulmonary carcinoma, acute myocardial infarction, test patients taking the contraceptive pill). Patients with terminal renal insufficiency and those suffering from septic shock syndromes clearly show a selenium decrease in serum and whole blood as well as a drop in the GSH-Px-activity, and increased malondialdehyde concentrations in the serum. Both are a reflection of an increased lipid peroxidation. First results of a selenium therapy are available for patients with therminal renal insufficiency and post-traumatically induced renal failure. The interpretation of the findings in the categories "high-risk gravidity" and "women on the contraceptive pill", which show a normal GSH-Px-activity and significantly increased malondialdehyde concentrations, seems problematic. The organism counteracts an increased lipid peroxidation with a normal plasma-GSH-Px-activity, clearly a sign of a still normal anti-oxidant potential.
Acute Kidney Injury↗
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↗
Immediate postabortion intrauterine contraception in nulliparous adolescents.
Immediate postabortion insertion of an intrauterine device (IUD) was performed in 162 nulliparous adolescents. No insertion failures occurred. Twelve-month continuation rates were 86.6% for the Copper-7 IUD, 75.4% for the Copper-T device and 48.2% for the Lippes loop. Overall complications were greater for the Lippes loop than for the other two devices. The results suggest that immediate postabortion insertion should be considered for poorly motivated or uneducated adolescent girls who have already failed in contraception and require abortion.
Abortion, Induced↗
Contraceptive efficacy and patient acceptance of Lunelle.
PURPOSE: To review the efficacy, safety, and patient acceptance of the Lunelle monthly contraceptive injection and to raise awareness of this new contraceptive in the United States. DATA SOURCES: Worldwide scientific literature, reports of clinical trials, and manufacturers' product information and guidelines. CONCLUSIONS: Lunelle is a combined hormonal method with a safety/tolerability profile comparable to that of oral contraceptives (OC) and a high efficacy rate and provides a rapid return of fertility after discontinuation. Moreover, Lunelle was well accepted in a large clinical trial, with satisfaction levels similar to those of new-start OC users. IMPLICATIONS FOR PRACTICE: Oral contraceptives are the most popular hormonal birth control method in the United States; however, typical use is associated with higher failure rates than those observed with perfect use because of poor compliance. Poor compliance has been attributed in part to the need for daily administration. A new contraceptive method that does not require daily administration and is readily reversible may be suitable for many women, resulting in better overall efficacy.
Contraceptive Agents, Female↗
Identifying adolescents at risk for noncompliance with contraceptive therapy.
The sociomedical characteristics of 96 sexually active adolescent females have been studied in order to understand noncompliance with the contraceptive prescription, an important antecendent of adolescent pregnancy. Compliance was found to correlate positively with postmenarchal age, frequency of intercourse, autonomy in making and paying for a clinic appointment specifically for the purpose of obtaining contraception, and acceptance of a method at the time of the initial clinic visit. These findings serve to alert the pediatrician to the adolescent at risk for noncompliance before the experience of failure, and in so doing to identify those in need of special assistance to ensure the success of contraceptive measures.
Adolescent↗
Reproductive health and AIDS prevention in sub-Saharan Africa: the case for increased male participation.
Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexually transmitted diseases (STDs) including AIDS. Failure to target men in reproductive health interventions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Africa and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and education of men. Men's perceptions, as well as determinants of sexual behavioural change and the socioeconomic context in which STDs, including AIDS, become rife, should be reviewed. There is a need to study and foster change to reduce or prevent poor reproductive health outcomes; to identify behaviours which could be adversely affecting women's reproductive health. Issues of gender, identity and tolerance as expressed through sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact of male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health problems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Behaviour specific influences in sexual partnership include the degree of interpersonal support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths. Perceived efficacy and situational variables influencing male compliance in, say, condom use, form part of the wider study that addresses men. Thus preventive reproductive health initiatives and information should move from the female alone to both sexes. Women need men as partners in reproductive health who understand the risks they might be exposed to and strategies for their prevention.
Acquired Immunodeficiency Syndrome↗
Effect of oral contraceptive on ovarian function in young females undergoing neoadjuvant chemotherapy treatment for osteosarcoma.
We compared the residual ovarian function and the fertility of two groups of female patients treated at different times at the authors' institution by neoadjuvant chemotherapy for localized osteosarcoma of the extremities. From 1997 to 2000, one group of 31 females received neoadjuvant treatment according to the IOR 6 protocol, which included high-dose ifosfamide, high-dose methotrexate, adryamycin, and cis-platinum. In this group of patients an oral contraceptive (OC) was given in an attempt to prevent post-chemotherapy ovarian failure. Another group of 90 patients was treated between 1974 to 1995 with the same antiblastic drugs according to similar protocols (IOR 1-IOR 5). These patients did not receive OC or other treatment to protect ovarian function. There were no significant differences between the two groups of patients. Early chemotherapy-induced menopause occurred in 3 out of 19 postpubertal patients who received the OC and in 3 out of 71 postpubertal patients in the control group. In the OC group there were 2 cases of thrombophlebitis. No delay in menarche was seen in prepubertal patients. From statistical evaluation we underline that age and alkylant doses are the most important predictive factors for early menopause and that oral contraceptives during chemotherapy do not protect ovarian function in patients receiving high-dose alkylant based chemotherapy.
Adolescent↗
Oral contraceptives and thrombosis.
The debate on whether the so-called third-generation progestogens (desogestrel, gestodene, and norgestimate) are associated with a higher risk of venous thrombosis than the older, so-called second-generation progestogens (principally levonorgestrel and norethindrone) continues. Much of the debate focuses on finding alternative explanations for the observed relationship. Alternative explanations include a prescribing bias, in which women at greater risk of venous thromboembolism were preferentially prescribed newer preparations; a failure by researchers to adjust adequately for residual confounding by age; and a failure by researchers to allow adequately for confounding by the duration of use of oral contraceptives. None of these explanations have been accepted without dispute, and the debate will clearly continue. A possible biologic explanation for the observed relationship of higher thrombosis risk with use of third-generation preparations has been put forward by Rosing et al. from Maastricht, who developed a new way of measuring activated protein C (APC) resistance. They found that users of third-generation preparations have higher acquired APC resistance than users of second-generation products. This finding requires confirmation.
Activated Protein C Resistance↗
Optimal treatment of premature ovarian failure after treatment for Hodgkin's lymphoma is often withheld.
BACKGROUND: The purpose of this study is to determine: 1. the effect of treatment for Hodgkin's lymphoma on ovarian function, and 2. the interventions to relieve postmenopausal symptoms. METHODS: Seventy-seven consecutive patients treated between 1989 and 2003 in the Rotterdam region for Hodgkin's lymphoma stages I and II were approached for this study. A questionnaire consisting of 45 questions was carried out to evaluate premature menopausal symptoms, hormonal replacement therapy and use of contraception, menstrual cycle, and subsequent pregnancies. RESULTS: After informed consent 67 patients were willing to participate in the study and 66 patients filled in a questionnaire. After antitumor treatment 13 patients developed treatment-related premature ovarian failure, 35 patients had a spontaneous cycle, and 18 patients could not be classified as they used hormonal contraception. Women who developed treatment-related premature ovarian failure had a significantly higher mean age at the start of treatment for Hodgkin's lymphoma than women who remained premenopausal (p < 0.002). Only 6 of these 13 women (46%) received hormonal substitution. In all, 21 women conceived after antitumor treatment, and 28 children were born. All pregnancies were the result of spontaneous conception. CONCLUSIONS: The effect of antitumor treatment for Hodgkin's lymphoma on ovarian function is age dependent (odds ratio of 1.18 per year). There is a striking inconsistency regarding the management of ovarian protection before and during antitumor treatment. Premenopausal women who undergo therapy for Hodgkin's lymphoma should be offered hormonal substitution therapy after loss of ovarian function.
Adolescent↗