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PubMed2002

Is postpartum contraceptive advice given antenatally of value?

In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three centers (Edinburgh, Scotland; Shanghai, People's Republic of China; Cape Town, South Africa) were randomized to receive expert contraceptive advice (participants, n = 771) or the standard advice routinely given in that setting (controls, n = 866). Follow-up was by postal or interviewer-administered questionnaires at 16 and 52 weeks after childbirth. There were no significant differences in the prevalence of contraceptive use at one year (over 79% in all centers) between participants and controls. In Edinburgh, participants were more likely to undergo sterilization (p < 0.01) than controls, otherwise there were no differences among Edinburgh, Shanghai, or Cape Town in either the methods of contraception chosen or in the methods used over time. Contraceptive counseling delivered antenatally appeared to have no impact on the pregnancy rate during the first year after childbirth. In Shanghai, over 11% of women in both groups underwent termination of pregnancy in the year of follow-up. In conclusion, although women in all centers said they found the opportunity to discuss contraception antenatally was useful, it had very little effect on contraceptive use or on subsequent pregnancy rates.

Adult↗
PubMed1985

The pill does not cause 'thrush'.

Contraceptive method, presence or absence of genital candidosis and other genital infections or conditions were recorded in 1363 new patients attending three different genitourinary medical clinics. Genital candidosis was present in 28% but was not associated with oral contraceptive usage; it seemed more likely to be associated with other genital disorders, especially non-specific infection and viral infections.

Candidiasis, Vulvovaginal↗
PubMed1986

Observational studies of cause-effect relationships: an analysis of methodologic problems as illustrated by the conflicting data for the role of oral contraceptives in the etiology of rheumatoid arthritis.

We review the structure of the two most common observational study designs, cohort and case-control studies, and outline guidelines to help clinicians evaluate the validity of studies that employ these designs. To demonstrate the use of these guidelines we apply them to the important issue of whether oral contraceptive usage may reduce the risk of developing rheumatoid arthritis. A recent case-control study has contradicted provocative evidence from two previous studies suggesting the existence of such a protective effect. Our analysis leads to the conclusion that the case-control study suggesting no association of oral contraceptives with the subsequent development of rheumatoid arthritis provides the best estimate of the effect of oral contraceptives currently available, and furthermore, the analysis permits recommendations to be made for the design of future investigations on this topic.

Arthritis, Rheumatoid↗
PubMed2003

[Contraceptive practices among students].

Research has shown that university students tend to have specific sexual behaviour. It is worth mentioning that not much attention has been paid to pregnancy prevention practices among medical students nor has any survey been conducted in this matter. The purpose of this survey was to ascertain the frequency of contraceptive usage among students at Medical University of Warsaw. Specially designed questionnaires were anonymously self-administered by 634 female and 354 male medical students. 52.2% of the female students and 67.2% of the male students were sexually active at the time. 43.4% of the survey participants used condoms, while 26.3% used oral contraception pill (OCP) as contraceptive methods. Only 0.5% of those participants used intrauterine device. The survey result indicates an apparent dichotomy between the male and female students in terms of (appropriate) choice of the following contraceptive methods: condom, OCP, withdrawal, basal body temperature and Billings' methods.

Adult↗
PubMed1986

Cancer of the cervix uteri and vitamin A.

The concentrations of retinol and beta carotene were measured in serum samples taken from 113 women with cervical cancer, 32 with invasive and 81 with pre-invasive disease, and compared with those from 226 age-matched control women. There was little difference in serum retinol levels between women with cancer of the cervix, at any stage, and the control women, after adjusting for potential confounding factors. Serum beta carotene concentrations were likewise similar in women with invasive disease and the controls. However mean beta carotene levels were significantly reduced in women with pre-invasive disease compared to the controls (221.3 cf. 291.6 micrograms l-1, P less than 0.05). This reduction was more evident amongst women with a diagnosis of carcinoma-in-situ (mean 213.1 micrograms l-1 than amongst those with severe dysplasia (mean 228.7 micrograms l-1. There is a negative trend between beta carotene and risk of pre-invasive disease which is of borderline significance. These data have also been used to investigate the effects of smoking and oral contraceptive usage on the serum levels of retinol and beta carotene. Both habits tend to increase retinol and decrease beta carotene concentrations.

Carcinoma in Situ↗
PubMed1992

Oral contraceptive use and histopathology of cancerous breasts in young women. Members of the U.K. National Case-Control Study Group.

A retrospective histopathological study of 300 women under 36 years of age was carried out to determine whether breast cancers occurring in oral contraceptive users showed any differences in pathological features compared with non-users. The patients belong to an age group in which an increased risk of cancer development has been reported following oral contraceptive usage. The incidence of non-neoplastic conditions in the residual breast was also studied in the two groups. There was little difference between breast cancers arising in pill users and non-users but in the residual non-neoplastic breast a decreased incidence of cysts and blunt duct adenosis was found in current users of the contraceptive pill. In contrast, lactational foci were found only in the breasts of pill users. The incidence of intraductal hyperplasia was not significantly different in the two groups.

Adult↗
PubMed1982

Budd-Chiari Syndrome and antithrombin III deficiency.

Presented herein is a case report of a 20-year-old woman with a past history of oral contraceptive use who developed Budd-Chiari syndrome. Onset of her illness was abrupt and stormy, simulating fulminant viral hepatitis or toxic hepatic injury. She died within six months of her initial presentation. Although the patient discontinued the use of oral contraceptives two years prior to the initial presentation of the disease, the morphologic features of the venous thrombosis and hepatic damage were indicative of a chronic, ongoing process of longer than six months' duration, thus raising the possibility of a cause-effect relationship between the "pills" and thrombotic process. Of interest was the finding of persistently depressed antithrombin III levels. While a relationship between oral contraceptive usage, antithrombin III deficiency and the Budd-Chiari syndrome is strongly suggested in this case, prospective studies are needed to substantiate this view.

Adult↗
PubMed1999

The identification of vaginal Lactobacillus species and the demographic and microbiologic characteristics of women colonized by these species.

Lactobacillus acidophilus has been reported to be the predominant vaginal species. Vaginal lactobacilli isolated from 215 sexually active women were identified using whole-chromosomal DNA probes to 20 American Type Culture Collection Lactobacillus strains. Most women were colonized by L. crispatus (32%), followed by L. jensenii (23%), a previously undescribed species designated L. 1086V (15%), L. gasseri (5%), L. fermentum (0.3%), L. oris (0.3%), L. reuteri (0.3%), L. ruminis (0.3%), and L. vaginalis (0.3%). H2O2 was produced by 95% of L. crispatus and 94% of L. jensenii isolates, compared with only 9% of L. 1086V. Colonization by L. crispatus or L. jensenii was positively associated with being white (P<.001), age >/=20 years (P=.05), barrier contraceptive usage (P=.008), and lower frequency of bacterial vaginosis (P<.001) and gonorrhea (P=.03). L. crispatus and L. jensenii, not L. acidophilus, are the most common species of vaginal lactobacilli.

Adolescent↗
PubMed1996

Sexual behaviour, contraceptive practice and reproductive health among school adolescents in rural Transkei.

OBJECTIVES: To determine the patterns of sexual maturation, sexual behaviour, contraceptive practice and reproductive health among Transkeian adolescents. DESIGN: Cross-sectional descriptive study, using self administered questionnaires. SETTING: Twenty-six schools in 22 rural districts of the Transkei region of the Eastern Cape. SUBJECTS: Standard 5, 6 and 7 pupils of both sexes. OUTCOME MEASURES: Demographic and social characteristics, maturational and sexual behavioural milestones, and the prevalence of contraceptive use, pregnancies and sexually transmitted diseases (STDs). RESULTS: Data from 1,072 girls and 903 boys were analysed. The mean ages (+/-SD) of the girls and boys were 15.29 +/- 1.89 and 16.25 +/- 2.05 years, respectively. Menarche and semenarche occurred at 13.90 +/- 1.23 and 15.12 +/- 1.58 years in girls and boys, respectively. Overall, 76% of the girls and 90.1% of the boys in this survey were already sexually experienced. The age of initiation of sexual activity was positively correlated with the age of first dating and the age of menarche and semenarche. The boys initiated sexual activity at an earlier age (13.43 v. 14.86 years, P = 0.0000), had sexual intercourse more regularly (61.6% v. 42.3%, P = 0.0000) and more frequently, and had more lifetime sexual partners (mean of 3.27 v. 1.35, P = 0.0000) than the girls did. Nearly twice as many sexually experienced boys as girls had a history of STD (48% v. 25%, P = 0.0000) and, of these, 19.1% of the boys and 6.5% of the girls had a history of genital ulcer disease. The prevalence of whether contraceptives had ever been used was only 23% among sexually experienced girls and, of these, only 19.4% used condoms. Surprisingly, 62.1% of the sexually experienced boys had used condoms, and of these nearly one-third enjoyed using them. The prevalence of adolescent schoolgirl pregnancy was 31.3%. CONCLUSIONS: Sexual maturation occurs at an earlier age than previously among rural Transkeian adolescents. This is associated with early initiation and a high level of sexual activity, low contraceptive usage, and a high rate of adolescent pregnancy and STDs, which therefore expose adolescents to a high risk of HIV infection.

Adolescent↗
PubMed2007

Women's stories of abortion in southern Gabon, Africa.

The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.

Abortion, Induced↗
PubMed2001

Cyclical mastalgia: prevalence and associated health and behavioral factors.

Perimenstrual breast pain (cyclical mastalgia) is a common problem that can be sufficiently severe to interfere with usual activities, and has been associated with elevated mammography usage in young women. This study was undertaken to replicate clinic-based research on cyclical mastalgia, and to examine the association between this disorder and health-related behaviors and perceived stress. Using random digit dialing throughout Virginia, 874 women aged 18-44 were interviewed. Sixty-eight per cent of women experienced cyclical breast symptoms; 22% experienced moderate to extreme discomfort (classified as cyclical mastalgia). Hormonal contraceptive usage was associated with significantly less mastalgia and premenstrual syndrome (PMS). Smoking, caffeine consumption and perceived stress were associated with mastalgia (odds ratios = 1.52, 1.53 and 1.7, respectively). Young women (under 35 years) with mastalgia were more likely to have had a mammogram (20.2%) than those without mastalgia (9.9%). Most women with this disorder (77.5%) did not have PMS. The prevalence of cyclical mastalgia and its association with mammography replicate clinic-based findings. Associations with smoking and stress had not previously been reported. Prospective research is needed to determine the biopsychosocial factors contributing to this disorder.

Adolescent↗
PubMed1998

[Female hormones and oral health].

A common oral manifestation of elevated levels of the ovarian hormones estrogen and progesterone, as seen in pregnancy or oral contraceptive usage, is an increase in gingival inflammation. Estrogen and progesterone probably induce a physiologic vascular phenomenon with swelling and redness. Furthermore, these hormones alter the microenvironment of the oral bacteria so as to promote their growth and cause shifts in their populations. The resulting gingivitis can be avoided or at least minimized by establishing low plaque levels at the beginning of pregnancy or at the start of oral contraceptive therapy.

Adult↗
PubMed1984

General yeast infection in Bangladeshi women using contraceptives.

A study on the vaginitis due to candida infection among Bengali women using different contraceptives was carried out. A total of 368 patients using three different contraceptives (Pills, Injectables, IUD) and 316 age and parity matched women as control were studied. The incidence of vaginal yeast infection was highest (17.6%) among pill user. In control group, the incidence is lower (6.7%). The difference is statistically significant (P less than 0.05). No significant difference in vaginal yeast infection in women using other two types of contraceptives (Injection, IUD) in contrast to control group was found (P greater than 0.5). Candida albicans was the most common type of yeast infection (91.8%). No Torulopsis glabrata was isolated in this study. we did not find any relationship between duration of contraceptive usages and higher incidence of vaginal candidiasis (P greater than 0.5). This study also indicated that culture examination is much more sensitive than microscopic examination of vaginal swab in detecting yeast infection.

Adult↗
PubMed2000

Risk factors for pre-cancerous lesions of the cervix.

Studies on risk factors for pre-cancerous lesions of the uterine cervix have shown strong association with sexual practice. Women with multiple sexual partners and intercourse at early age are at high risk. A role of male partners in further enhancing the risk has been identified. All these support the hypothesis relating to a sexually transmissible aetiological agent. An extensive review of the literature on the risk factors for pre-cancerous lesions of cervix has been carried out. The risk factors were grouped into genital, sexual, chemical, dietary and life factors. Human papilloma virus (HPV) is the major infectious aetiological agent associated with the development of pre-cancerous lesions of cervix. Other co-factors such as multiple sexual partners of the male as well as the female and early age of first intercourse are also involved at the critical aetiological step of progression from low-grade to high-grade lesions. The role of other infectious agents in terms of supportive or interactive effects is not clear. No independent effect for herpes simplex virus 2 on risk is observed. Other risk factors include cigarette smoking, oral contraceptive usage, certain nutritional deficiencies and poor personal hygiene. However, it is not clear whether these factors operate independently from HPV. There is no consistency in the independent effect of these factors on the development of low- to high-grade lesions of cervix. There is a similarity in the patterns of risk between pre-cancerous lesions of the cervix and cervical cancer. Monogamy, late commencement of sexual activity, personal hygiene and use of barrier contraceptive methods help towards primary prevention. In the long-term, primary prevention of cervical neoplasia through HPV immunization of population may be a possibility.

Coitus↗
PubMed1991

Trends in European breast cancer incidence and possible etiology.

In this study the trends in breast cancer incidence in a number of European countries, over the last 20 years, have been evaluated. There is a wide range in incidence; the risk being highest in north and west Europe (and highest in Switzerland) and lower in south and in east Europe. There was little difference, however, between countries in the incidence of the disease occurring before the menopause, and this incidence has shown little temporal change in the time period 1960-1985. Indeed, in many countries there has been little change in incidence in any age band since 1975. The use of oral contraception has been claimed to be a risk factor in premenopausal breast cancer. In two countries, the data on oral contraceptive usage were available; in neither was there any evidence that the introduction and growth in such usage was related to the risk of breast cancer in any age band that might have been exposed to them. The reasons for this are discussed in the light of recent reports to the contrary.

Adolescent↗
PubMed1997

Trying to prevent abortion.

It is known that, since antiquity, women confronted with an unwanted pregnancy have used abortion as a means of resolving their dilemma. Although undoubtedly widely used in all historical ages, abortion has come to be regarded as an event preferably avoided because of the impact on the women concerned as well as considerations for fetal life. Policies to reduce numbers and rates of abortion must acknowledge certain observations. Criminalization does not prevent abortion but increases maternal risks. A society's 'openness' in discussing sexual matters inversely correlates with abortion rates. Correlation between contraceptive use and abortion is also inverse but relates most closely to the efficacy of contraceptive methods used. 'Revolution' in the range of contraceptive methods used will have an equivalent impact on abortion rates. Secondary or emergency contraceptive methods have a considerable role to play in the reduction of abortion numbers. Good sex (and 'relationships') education programs may delay sexual debut, increase contraceptive usage and be associated with reduced abortion. Finally, interaction between socioeconomic factors and the choice between abortion and ongoing pregnancy are complex. Abortion is not necessarily chosen by those least able to support a child financially.

Abortion, Illegal↗
PubMed1992

Factors influencing first relapse in patients with Crohn's disease.

To determine whether information available at time of diagnosis of Crohn's disease can predict initial clinical course, I followed 239 patients prospectively from time of diagnosis to initial relapse. The patient's sex, smoking habits, contraceptive usage, disease extent, and presence of granulomas in the first histological specimen were recorded. No association was found between this demographic data and the interval between onset of symptoms and diagnosis, the severity of symptoms at presentation, or the time to relapse. The type of relapse, however, was influenced by the type of the first attack; 70% of relapses were of the same type as the initial attack. Cigarette smoking was associated with ileocolitis (p = 0.028). There was a trend for oral contraceptive users to have ileocolitis, whereas the presence of granulomas in the first histological specimen was not associated with a specific disease distribution. Patients with ileocolitis had more inflammatory attacks than those with ileitis or colitis (p = 0.001). There was also a trend for cigarette smokers and those on oral contraceptives to have more inflammatory attacks, but the presence of granulomas had no effect on the type of relapse. There is little to assist in prognosis of early disease when the diagnosis of Crohn's disease is first made, although the types of attacks tend to repeat themselves.

Adult↗
PubMed1986

Successful treatment with streptokinase of renal vein thrombosis associated with oral contraceptive use.

The case of a 25-year-old diabetic female presenting with acute right main renal vein thrombosis associated with oral contraceptive usage is described. Rapid diagnosis with ultrasound and resolution of the thrombosis was accomplished with streptokinase. Ultrasound may be the diagnostic test of choice in selected patients with renal vein thrombosis. Streptokinase was an effective therapy in this case of acute renal vein thrombosis.

Adult↗