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PubMed2000

Estimating the balance of general practice versus family planning clinic coverage of contraception services in London.

OBJECTIVE: To compare levels of provision of contraception from general practice and family planning clinics for the populations of the 32 London Boroughs. METHOD: Retrospective analysis of routine activity data, including the estimated numbers of first attendance, for 295 family planning clinics (managed by 28 NHS Trusts) and more than 1800 GP partnerships in Greater London, supplemented by data from a survey of family planning clinics. The results were expressed as the estimated percentage of women aged 16-49 obtaining advice on contraception from GPs and family planning clinics. These results were compared to those expected based on results in the General Household Survey. RESULTS: Across London in 1995/96, 12% of women aged 16-49 obtained contraception services from family planning clinics, and 24% obtained contraception services from a GP. At a borough level there was variation from 11% to 25% in coverage by family planning clinics, and from 11% to 41% in coverage by GPs. Estimates of the proportion of women in this age group not using NHS-provided medical or surgical contraception ranged from 0 to 30%. Across all boroughs, there was no consistent relationship between levels of GP activity and family planning clinic activity. CONCLUSION: The results indicate substantial variations between boroughs in the proportion of women using NHS-provided medical or surgical methods of contraception. The absence of any clear inverse relationship between activity in family planning clinics and activity in general practice suggests that changes to one will not be compensated by changes in the other. More specifically, health authorities that opt to purchase lower levels of family planning clinic activity cannot assume that women may opt to use GPs as an alternative. Such a strategy may increase the likelihood that women who would have used family planning clinic services will either not use contraception at all, or will use less effective 'over the counter' methods.

Adolescent↗
PubMedDate not supplied

Teenage women's use of contraceptives in two populations.

BACKGROUND: Adolescent patterns of contraceptive use might be different in various populations and might have changed in the last 30 years. More appropriate use of contraception could prevent unplanned pregnancy. METHODS: We interviewed 378 women in rural East Tennessee and 396 women in suburban-urban Baltimore, all of whom were aged 18 to 50 years, in a convenience sampling about their memories of sexual experiences and early contraceptive use. RESULTS: First sexual experiences began at a younger age in women from Tennessee than in women from Baltimore. Sexual experiences occurred at an earlier age during the last 15 years in Baltimore women. Contraceptive use at first sexual experience has approximately doubled in both locations, from 7% to 15% in Tennessee and from 42% to 75% in Baltimore during the last 15 years. The primary reason in Baltimore is increased use of condoms. Condom use in Tennessee is very low. CONCLUSIONS: These two populations are using contraception and condoms differently. Although the two populations are diverse, it could help physicians to learn about the particular contraceptive practices of their patient population to help their patients more appropriately with their contraceptive needs.

Adolescent↗
PubMed2001

[Effects of second and third generation oral contraceptives on hemostasis].

Use of oral contraceptives induce changes in haemostatic parameters: changes occur in the procoagulant, anticoagulant, and fibrinolytic systems. The increased risk of venous thromboembolism with use of third, as compared with second generation oral contraceptives, found in epidemiological studies, has stimulated new research in haemostatic changes induced by both generations of oral contraceptives. A randomized crossover study showed that use of the third generation pill caused a greater increase of factor VII and prothrombin and a more pronounced decrease of factor V than the second generation pill. Acquired resistance to activated protein C (APC) was induced more strongly by preparations of the third than by those of the second generation. The concentration of protein S decreased markedly exclusively during use of the third generation pill, while it did not change during use of the second generation pill. The oral contraception-related effects on the anticoagulant system strongly resemble those of some forms of hereditary thrombophilia. If a woman with hereditary APC resistance (caused by factor V Leiden) uses oral contraceptives as well, and especially when she uses those of the third generation, she is subject to a considerable increase of the risk of venous thrombosis and becomes even more resistant to the anticoagulant action of protein C. In view of the epidemiological backgrounds of the difference in risk of thrombosis between second and third generation contraceptives, the second generation pill is recommended as the first choice for oral contraception.

Activated Protein C Resistance↗
PubMedDate not supplied

[Children's knowledge of sex behavior and contraception].

INTRODUCTION: Adolescent sexuality is not a new phenomenon, but it has been accepted differently at various times and societies. In modern times, adolescents start sexual life early, not well educated and not prepared for possible consequences. The period between the first sexual relationship, marriage and having children is prolonged with a greater possibility of having artificial abortions or sexually transmitted diseases (STD). It is of great importance to work on proper education of children and adolescents on sexual life and contraception. MATERIAL AND METHODS: An inquiry into the knowledge of sex and contraception was performed in an elementary school in Novi Sad, comprising 134 children from VII and VIII grade (aged 13-14, 77 girls and 57 boys) in order to prepare a lecture on these topics. RESULTS: Most of the knowledge on these topics children aged 13 and 14 got watching TV and reading magazines (44.15% girls and 70.17% boys) and from their friends (42.1%). Communication about sex and contraception exists mostly among friends (51.95% girls and 82.46% boys). One third of girls talk with parents and one quarter got knowledge from them. Only four boys (2.98%) had sexual intercourse without complications: artificial abortion or STD. Almost every child (96.95%) knows about AIDS and 89.25% children know about at least one method of contraception (mostly condom). Three quarters claim artificial abortion is harmful. 50% of children want more education about sex and contraception. DISCUSSION AND CONCLUSIONS: Most of the knowledge on sexual life and contraception children get from various forms of mass-media and from one another which is unreliable and incomplete. Unfortunately, parents and teachers play a minor role in sex education of children. In order to prevent spreading of sexually transmitted diseases and to decrease the percentage of adolescent pregnancy and artificial abortions, it is of great importance to investigate knowledge, attitudes and practice of children and adolescents in regard to sexual life and contraception and to prepare acceptable and efficient programs for education on these topics. However, not only education is important, but also acceptance and behavior of children and adolescents resulting from these programs.

Adolescent↗
PubMed2001

[Thromboembolic complications in the use of oral estrogen-gestagen contraceptives].

Deep vein thrombosis is a serious complication of oral contraception. The most serious complication, pulmonary embolism, could be lethal. The relative risk of thromboembolic disease is four time higher in women using oral contraception. Both the amount of estrogen and the type of gestagen can increase the relative risk of thromboembolic disease. Oral contraceptives influence procoagulants, fibrinolytic system and inhibitors of coagulation. The choice of oral contraceptive should be very careful. It is advised to use preparations with less then 50 micrograms of ethinyl-estradiol and the type of gestagen that has minimal metabolic side effects, including minimal effect on coagulation. It is not recommended to perform screening of trombophilia before prescribing oral contraception. Family history of thrombosis is indication for more detailed investigation. However in the case of positive history of thromboembolic disease use of oral contraception is contraindicated. Oral contraception users should be informed about increased risk of deep vein trombosis, and what to do to prevent deep vein thrombosis.

Blood Coagulation↗
PubMed2002

An animal welfare view of wildlife contraception.

Although there is some dissent, the animal protection community generally supports the concept of wildlife contraception. However, some contraceptive agents, delivery mechanisms and specific applications will be opposed by animal welfare advocates on environmental, humane or other ethical grounds, and some animal rights advocates may oppose wildlife contraception entirely. The Humane Society of the United States (HSUS) has supported and conducted wildlife contraception studies for more than 10 years. In general, we have invested in contraceptive agents (such as porcine zona pellucida) that we believe will prove environmentally, physiologically and behaviourally benign, and in delivery mechanisms that are narrowly targeted. As we consider contraception to be a major intervention into natural processes, we believe that wildlife contraception should be applied judiciously, locally and in a manner that is sensitive to the needs of animals, humans and ecosystem function.

Animal Rights↗
PubMed2002

[Causes of non-use of contraceptives in the immediate postpartum period].

OBJECTIVE: To determine the causes of not use of contraceptive during immediate postpartum period. METHODOLOGY: Cross-section observational descriptive study. We include women that went for attention of obstetric event, we identified those were in immediate postpartum period, and we selected the women which not started contraceptive use. Data were collected directly with an interview; the causes of not use of contraceptive were classified in three groups. Group I: causes be derived by patient: personal, religious, moral, families, culture, etc. reasons, when they received information, and advice or when they did not attend to educational actions. Group II: causes be derived by the hospital: technique administrative factors, insufficient educational communication activities by service provider. Group III: Medic Indication: presence of risk factors for health women. We found 2,593 women, we identified 1,493 (57.5%) in immediate postpartum period, 478 (32%) not started contraceptive use. In 349 (73%) women the causes were group I, in 91 (19%) group II, and 38 (8%) group III. CONCLUSION: Is necessary more research to know users concerns, ideas and perspectives in relation with methods of contraception, contraceptive counseling, informants, advisers, and with health service institution, to improve educational communication strategies; and to unify medical criterions for not use contraceptive during immediate postpartum period.

Adolescent↗
PubMed2003

[Depot medroxyprogesterone acetate (DMPA) injectable contraception--safe, effective but neglected method of family planning in Poland].

As it is known from demographical prognosis for Poland, in the nearest years significant increase of the number of women in the childbearing age is expected (reflecting high, postwar, demographical wave). In spite of that, the prognosis of the number of live births is low, and does not exceed 450 thousands. The reason for this phenomenon is the change of life style among young people. They postpone delivery of the first baby, and use modern contraceptives. It is also expected that the number of women using modern contraceptives (especially combined oral contraceptives: estrogen + progestin) should significantly rise. It is well known, that with the age of a woman, there is an increasing number of contraindications for the estrogen use. It is the sufficient reason to think about alternate methods of contraception. DMPA (DEPO-PROVERA-150) is the very effective and safe method of family planning. It is used in many countries all over the world, since the sixties, but it is almost unknown in Poland. The use of DMPA is not reserved only for special cases. After many years of experience, it is possible to select the best candidates for this injectable contraception (patients with contraindications for estrogens, lactating women, smokers--especially over 35 years of age etc). DMPA appears to be acceptable method of fertility regulation. Clinical evidence after more than 30 years of use shows no additional adverse effects and possibly fewer than in the case of other hormonal methods of contraception. The particular advantages of DMPA, as a highly effective, long-lasting and reversible contraceptive, make it important option for Polish women, desiring a modern method of fertility regulation.

Adult↗
PubMed2004

Implant contraception in Singaporean women: one decade of experience in KK Women's and Children's Hospital.

INTRODUCTION: The aim of this study was to assess user acceptability and effectiveness of implant contraception in Singaporean women. METHODS: A prospective study was carried out on 553 patients who received Norplant implant in our hospital from 1 January 1992 to 31 December 2000, and followed-up till 15 July 2003. The patients' profile, side-effects, satisfaction and continuation rate of Norplant implant were studied. RESULTS: The mean age of the subjects was 29.4 (plus or minus 5.1) years. The mean parity was 2.1 (plus or minus 1) live births. More than one-half (55.2 percent) of the subjects had used other methods of contraception before. The main reason for them to switch to implant contraception was convenience (63.6 percent). Of the 516 users on follow-up, the common side-effects were menstrual irregularity (51 percent), secondary amenorrhoea (9.6 percent) and weight gain (15.7 percent). 29.3 percent of users did not experience any side-effect. There was only one contraceptive failure, which may be related to drug interaction. The Pearl Index was 0.054 per hundred women years. There was only one serious adverse event of a patient (0.2 percent) who developed severe hypertension requiring treatment. The continuation rate was 92.4 percent after one year, 80.8 percent after two years, 68.9 percent after three years and 58.5 percent after four years. The main reasons for early implant removal were side-effects and desire for future pregnancy. Re-insertion was carried out in 53.7 percent of users who had completed five years of Norplant contraception. CONCLUSION: This largest sub-dermal hormonal implant contraception study in multi-racial Singapore showed that Norplant contraception had a high degree of effectiveness with relatively high user satisfaction and continuation rate.

Adult↗
PubMedDate not supplied

Correlates of short interbirth intervals in Peninsular Malaysia: their pathways of influence through breastfeeding and contraceptive use.

Recent research has shown that children born before and after short birth intervals run a considerably greater risk of dying in infancy or childhood than do others. This report investigates which women have short interbirth intervals, under what circumstances, and for what reasons. The analysis uses data from the Malaysian Family Life Survey to examine influences on the two main behaviors--breastfeeding and contraceptive use--that affect birth interval length, and assesses the the impact of these same variables on the probability of having a birth interval of less than 15 months. The analysis shows that many of the independent variables affect breastfeeding and contraceptive use in opposite directions, with no significant net effect on the likelihood of a short interval. For example, a woman's education is negatively related to the probability that she breastfeeds, positively related to the probability that she uses contraceptives, and has no significant effect on the likelihood that the interpregnancy interval is less than 15 months. Having a family planning clinic nearby is associated with less breastfeeding, offsetting whatever positive effects family planning clinics have on contraceptive use in terms of the percentage of birth intervals that are so short as to be detrimental to infant and child health. Hence, factors that increase contraceptive use do not necessarily reduce the incidence of short interbirth intervals, because they are also associated with reduced breastfeeding. We simulate the proportion of intervals that would be short for alternative combinations of breastfeeding and contraceptive use in the population and show that over the period covered by the data (1961-75), breastfeeding had a considerably greater effect on preventing short interbirth intervals than did contraceptive use.

Adult↗
PubMed1988

[Breast diseases (fibroadenomas, mastopathies, breast cancers) in hormonal contraception].

282 female patients with histologically confirmed fibroadenomas (71), mastopathies (187) and breast carcinomas (24) were questioned for hormonal contraception. 144 women had taken oral steroid contraceptive pills, 138 denied such treatment. Statistically significant differences could not be observed in the occurrence of the breast diseases studied. Under hormonal contraception, fibroadenomas were found in 28% (without contraception in 22%), simple mastopathies in 41% (without in 40%), proliferative mastopathies in 22% (without in 30%) and mammary carcinomas in 9% (without in 8%) of the corresponding cases. The histological finding of a so-called apocrine metaplasia was found in all the diseases (except carcinomas) more frequent in the contraceptive group. Histometrically, the breast parenchyma showed a changing lobular hyperplasia under hormonal contraception in all the disease groups studied. An influence of questioned gynecological risk factors for a breast carcinoma was not striking in the women with and without hormonal contraception.

Adult↗
PubMed1987

Excessive deposition of fibrin, platelets and platelet thrombi on vascular subendothelium during contraceptive drug treatment.

We investigated the effect of oral contraceptives on thrombogenesis induced by subendothelium of rabbit aorta (SE), exposed to flowing non-anticoagulated blood in an annular flow chamber. Six healthy women on sequential contraceptive drugs (0.05 mg aethinylestradiol/day, 0.125 mg desogestrel/day) were compared with 6 women without hormonal contraception and 6 men. On contraceptive drug treatment, blood values were significantly increased for fibrinogen (2.6 +/- 0.2 vs 1.9 +/- 0.1 g/l) and fibrinopeptide A (3.9 +/- 0.9 vs 0.9 +/- 0.1 ng/ml), whereas antithrombin III was decreased (81 +/- 4 vs 97 +/- 6%). Fibrin deposition on vascular subendothelium was more than four-fold increased when measured morphologically (63.4 +/- 2.5 vs 14.6 +/- 6.8% coverage of SE surface with fibrin) as well as immunologically (29.3 +/- 2.2 vs 4.5 +/- 1.9 micrograms fibrin/cm2 of SE). Thrombus volumes were more than two-fold increased in women with contraceptives (9.0 +/- 1.4 vs 3.7 +/- 1.0 micron 3/micron 2). Our study shows that during contraceptive drug treatment the exposure of flowing blood to vascular subendothelium leads to excessive deposition of fibrin and platelet thrombi. Measurement of blood interactions with subendothelium might be of predictive value in hypercoagulable states such as contraceptive treatment.

Adult↗
PubMed1986

[Status of oral contraceptives as a risk factor in cerebrovascular diseases].

A critical review of the relevant literature revealed that the incidence of subarachnoid haemorrhage is increased in women taking oral contraceptives and the mortality rate is higher. The data concerning correlation between the use of oral contraceptives and other cerebrovascular disorders are less conclusive. Taking oral contraceptives seems to result in a higher risk of stroke, but there is no definite correlation to the incidence of strokes with a fatal outcome. However, in the case of the coexistence of more than one risk factor, including cigarette smoking, the risk of cerebrovascular disease is considerably increased for women using oral contraceptives. Age also seems to be a significant factor. Women older than 44 should avoid oral contraceptives in general; women between 35 and 44 should use oral contraceptives only if additional risk factors are absent, i.e. if they are non-smokers. Indeed, in the presence of this or other risk factors younger women should also avoid taking oral contraceptives.

Adult↗
PubMedDate not supplied

The next contraceptive revolution.

The availability of modern birth control methods has wrought a veritable contraceptive revolution in both developed and developing countries over the past two decades. But concerns about safety, costly lawsuits involving current methods, as well as diverse and changing life-styles, have left the current array of contraceptives grossly inadequate to meet growing world-wide needs. Steroid implants and improved injectables, IUDs, barrier methods and sterilization devices should be widely available in the next few years. But the long-sought-after radically new methods that will constitute the next contraceptive revolution--like vaccines, a male contraceptive and a once-a-month pill--will not be developed in the foreseeable future without a massive infusion of new funds. The eight contraceptive research and development (R&D) programs that are responsible for more than half of all current product development efforts now spend about $30 million a year on contraceptive research. With an additional $23 million annually, they could considerably accelerate current research efforts and begin new ones on products that have become possible only as the result of recent scientific discoveries. Even this level of investment--representing a 75 percent increase over current expenditures by the eight groups--would probably not be sufficient to make optimum progress in the development of radically new methods. Since the pharmaceutical industry can no longer be depended upon to take the leading role that it did 20 years ago, current public-sector R&D organizations may need to expand their efforts to include most aspects of the process of contraceptive development and introduction, and new dedicated R&D centers will probably have to be established.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraception↗
PubMed1985

Clinical chemistry alterations in pregnancy and oral contraceptive use.

In this study the effects of pregnancy and oral contraceptive use on plasma glucose concentrations, hepatic, renal, and thyroid function tests, and their relationships to plasma lipoprotein lipids after an overnight fast are compared. Observations were made in 546 pregnant women at 36 weeks' gestation, 56 women using oral contraceptive hormones, and 77 women not using sex hormones. All subjects were randomly selected from defined populations. Compared with nonpregnant women not using hormones, median plasma glucose concentrations are 3% lower with oral contraceptive use and 17% lower in pregnancy. Plasma total bilirubin concentrations are lowered by similar amounts in oral contraceptive users (29%) and in pregnancy (32%). Serum glutamic oxaloacetic transaminase is slightly lower among hormone users (9%) but is significantly higher (27%) in pregnancy. Alkaline phosphatase is significantly lower in oral contraceptive users (23%) but is higher in pregnancy (86%). Serum globulin concentrations are unaffected by pregnancy or oral contraceptive use. Compared with nonusers, thyroxine is 30% higher in oral contraceptive users and 100% higher during pregnancy. Serum creatinine is unaffected by sex steroid use but is 28% lower in pregnancy. Associations of these test results with plasma hormone concentrations corroborate hormonal mechanisms and suggest that some alkaline phosphatase and serum glutamic oxaloacetic transaminase come from the placenta. Relationships of these clinical measurements to lipoprotein lipids in pregnancy are generally weak and do not point to important controlling relationships, but effects similar to those seen in nonpregnant subjects are seen with hyperglycemia (associated with elevated triglyceride) and elevated thyroxine levels (associated with lower cholesterol and triglyceride).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Long-term oral contraceptive use and the risk of breast cancer. The centers for Disease Control Cancer and Steroid Hormone Study.

Using oral contraceptives for long periods or using them when one has other risk factors has been hypothesized to increase the risk of breast cancer. To study these issues, we analyzed data from a multicenter, case-control investigation--the Centers for Disease Control's Cancer and Steroid Hormone Study. All women 20 to 54 years old with a first diagnosis of breast cancer ascertained by eight population-based cancer registries are study subjects; controls are selected at random from the general population of these eight areas. Analysis of the first 689 cases and 1,077 controls studied showed that women who had used oral contraceptives at some time in their lives had a relative risk of 0.9 compared with never-users (95% confidence interval, 0.8 to 1.2). Neither duration of oral contraceptive use nor time since first use altered a user's risk of breast cancer; women whose first use was more than 15 years ago and who used oral contraceptives for 11 years or more had a relative risk of 0.8 (0.5 to 1.4). Oral contraceptive use did not increase the risk of breast cancer among women with benign breast disease or a family history of breast cancer. Oral contraceptive use before a woman's first pregnancy did not increase her risk of breast cancer significantly more than other methods of delaying first pregnancy. This study provides no support to the hypothesis that oral contraceptive use increases a woman's risk of breast cancer.

Adult↗
PubMed1995

[Megaloblastic changes in cervical epithelium associated with oral contraceptives and changes after treatment with folic acid].

OBJECTIVE: To study the influence of oral contraceptives on cervical epithelium, serum and red blood cell folate levels of users and to observe the changes after treatment with folic acid. METHODS: Morphology of cervical epithelium, serum folate and red blood cell folate levels were studied in 101 women who had used oral contraceptives for over 6 months and 33 intrauterine devices users served as controls, 29 women using oral contraceptives with cervical megaloblastic changes were treated with folic acid (5mg daily) for 3-4 weeks and followed up for observation on morphological changes of cervical epithelium. RESULTS: The mean nuclear diameter of cervical epithelial cells was larger in the oral contraceptive group than that in the control group (P < 0.001). Megaloblastic changes in cervical epithelium occurred in 29 women in the oral contraceptive group (28.7%). There was significant difference in the occurrence of cervical megaloblastic changes between the two groups (P < 0.01). The level of red blood cell folate was lower in the oral contraceptive group than that in the control group (P < 0.05). There was no difference in serum folate, hemoglobin and neutrophil nuclear index between the two groups (P > 0.05). The mean nuclear diameter of cervical epithelial cells decreased significantly (P < 0.001) and multinuclear and vacuolar changes disappeared after folic acid therapy in 26 women with megaloblastic changes. CONCLUSIONS: Oral contraceptives reduced folate storage in the body and resulted in megaloblastic changes in cervical epithelium. This condition was improved with folic acid therapy.

Adult↗
PubMed1996

[Induced abortions in relation to the use of contraceptive agents].

The aim of the study was to investigate the use of contraceptive methods among women referred to an induced abortion. The design was a prospective study of women seeking abortion, 854 were included consecutively. All were asked about the contraceptive methods used preceding their actual pregnancy. Was the contraceptive method used in a regular way, and what was the motive for her voluntary abortion? Of the 854 women, 831 chose to participate and answered the questions (97.3%). We found that 35% had used their contraceptive method in a regular way but became pregnant nevertheless. Another group of 33% had forgotten to use their contraceptives for a few days and became pregnant by accident. In the last group of 32% the women had not used any contraceptive methods. It is concluded that more information is necessary to get women and men to use contraceptive methods regularly with better precision and more seriousness.

Abortion Applicants↗