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PubMed1978

More research on the pill and alternative methods (of contraception).

More research on the pill and alternative methods of contraception was urged by Ralph Nader's Health Research Group (HRG), which also recommended that the Food and Drug Administration develop a new patient package insert for all forms of contraceptives, including nonprescription methods. The group also said the government and drug companies should share the cost of long-term follow-up studies of the effects on health of the pill and other birth control methods. The recommendations followed presentations at an HRG forum from NIH scientists and S. Ramcharan, principal investigator of the Walnut Creek (California) Contraceptive Study supported by the National Institute of Child Health and Human Development. Ramcharan studied 15,000 women over 10 years and found cervical cancer incidence of 173/100,000 person years for women who used the pill for more than 4 years, compared with a rate of 32/100,000 for women who never used the pill. Ramcharan declined to draw any cause-effect conclusions based on these results, stating they were "confounded" by possible differences in sexual activity between the 2 groups. She said a preliminary case comparison study to adjust for these differences "suggests sexual behavior may account for some, but not all," of the 5-fold increase in cervical cancer incidence among pill users. HRG director S. Wolfe said enough data exists to state a relationship between the pill and cervical cancer. "There's no other explanation for the increase," he said, adding that Ramcharan had controlled for the effects of age, education, marital status, number of Papanicolaou smears, religion, number of pregnancies, a history of genital infections, and smoking. Forum participants urged more research on contraceptive devices and drugs now in use, long-term effects of sterilization, value of condoms and spermicides in preventing VD, and development of a patient package insert for all forms of contraception stating the relative effectiveness and risks of each. The group discussed the need for long-term funding of follow-up studies, and suggested that drug companies be required to pay for at least some of the pre- and postmarketing research.

Contraception↗
PubMed1970

The effect of an intrauterine thread on tissue changes in the endometrium of the pseudopregnant rat.

1. Changes in the fresh weight of uterine horns bearing unilateral intrauterine threads have been measured during early pseudopregnancy in the rat.2. Such a thread, which acts as an intrauterine contraceptive device, causes an increase in weight in the horn which carries it, compared to the untreated contralateral horn, on days 2, 4, 5 and 7 of pseudopregnancy. This increase is observed when the device has been present either for 25 or for 45 days.3. The fresh and dry weights of samples of endometrial tissue together with the concentration of chloride and potassium in these samples have also been determined, both in control horns and in horns which have contained a device for 45 days.4. The fresh and dry weights of samples from the device side are greater than the control. However, the weights of the endometrial samples recovered showed considerable variation, particularly in the device side. The weight of water per unit dry weight of endometrial tissue remains constant in the control side but falls steadily from day 2 to day 7 in the device side. The extracellular fluid space, as measured by the weight of chloride per unit dry weight, follows a similar pattern in each side. The weight of potassium per unit dry weight of control tissue falls on days 4 and 5 but rises again on day 7. By contrast, the potassium content of endometrial tissue from the device side falls steadily, reaching its lowest value on day 7.5. These results suggest that the presence of an intrauterine thread alters the composition of the connective tissue matrix of the uterine endometrium. It is likely that these changes are partially responsible for the contraceptive action of such a foreign body.

Animals↗
PubMed2005

FFPRHC Guidance (July 2005): The use of contraception outside the terms of the product licence.

This Guidance provides information for clinicians and women considering the use of contraception outside the terms of the product licence. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: CEU, Clinical Effectiveness Unit; COC, combined oral contraception/contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; IUD, copper-bearing intrauterine contraceptive device; LNG-IUS, levonorgestrel-releasing intrauterine system; NET-EN, norethisterone enantate; PGD, Patient Group Direction; PIL, Patient Information Leaflet; POC, progestogen-only contraception/contraceptive; POEC, progestogen-only emergency contraception; POP, progestogen-only pill; RCT, randomised controlled trial; SPC, Summary of Product Characteristics; UPSI, unprotected sexual intercourse; WHO, World Health Organization; WHOMEC, WHO Medical Eligibility Criteria for Contraceptive Use; WHOSPR, WHO Selected Practice Recommendations for Contraceptive Use.

Contraception↗
PubMed1976

Use of long-acting depot progestogen in domililiary family planning.

Medroxyprogesterone acetate injections have been used as a long-term contraceptive by the domiciliary family planning service in Glasgow. The injections were particularly useful in women with a high risk of becoming pregnant and in whom oral or intrauterine contraception had failed or was unacceptable. The optimum dose was 200 mg every 15-16 weeks. It was accepted by an increasing proportion of women, only 12 out of 162 discontinuing because of side effects. Continuation rates compared favourably with those for the pill, but less well than those for intrauterine contraceptive devices. The theoretical hazards should be weighed against the positive good resulting from controlled fertility in domiciliary patients.

Adolescent↗
PubMed1976

Cervical gonorrhea in women using different methods of contraception.

Cultures were made from the cervix, rectum, and oropharynx of 2,019 women to determine the prevalence of gonorrhea. For patients of similar race and age, the rates of cervical gonorrhea among users of oral contraceptives (10.6/100) or IUD users (9.5/100) were significantly greater than observed with patients using barrier methods, condom-diaphragm-foam (1.7/100). On the other hand, there were no significant differences in rates of rectal or oral infection by method of contraception. Postpartum patients were found to have similar infection rates at all three sites as a comparable group of nonpuerperas. Recommendations for utilization of barrier methods are made for suitable patients, including those in the immediate puerperium.

Contraception↗
PubMed1967

Contraception.

Explore the source record for details and available documents.

Cervix Mucus↗
PubMed1982

The relationship of genital tract actinomycetes and the development of pelvic inflammatory disease.

As a corollary to a case-control study evaluating the risk of pelvic inflammatory disease (PID) among users of an intrauterine contraceptive device (IUD), Papanicolaou smears were studied to detect the presence of actinomycetes. Forty-six PID case patients and 108 control patients were included in the corollary study. The presence of actinomycetes was noted only among current or past wearers of an IUD. Women with actinomycetes present on Papanicolaou smear had a 3.6-fold risk of hospitalization for PID, as compared to women without actinomycetes. This trend persisted when only IUD users were evaluated. Of patients with PID who had actinomycetes noted on the Papanicolaou smear, 87 1/2% had a tuboovarian abscess, compared to 28.9% of patients without actinomycetes. In addition, patients with actinomycetes present had PID treated surgically more frequently.

Abscess↗
PubMed1984

[Uterine measurements in the fitting of intrauterine devices].

Using Hasson's Wing Sound I to determine uterine segmental measurements in 160 women it was found that no constant relationship exists between total uterine axial length and cervical length; therefore uterine cavity size cannot be determined by standard sounding. The importance of fitting an intra-uterine contraceptive device to the endometrial cavity is discussed.

Anthropometry↗
PubMed1997

Ovarian pregnancy; relationship to an intrauterine device.

Ovarian pregnancy is a rare form of ectopic pregnancy in which the gestational sac is implanted within the ovary. The incidence is 0.5 to 3% of all ectopic gestations. In contrast to patients with tubal pregnancies, traditional risk factors, such as pelvic inflammatory disease and prior surgical procedure upon the pelvis, may not play a role in the aetiology. In the 2 cases reported here, it seems that using an intrauterine contraceptive device was an important factor.

Adult↗
PubMed2004

Efficacy of nonhormonal vaginal contraceptives from a hydrogel delivery system.

This investigation describes the synthesis of a biodegradable hydrogel composed of a core surrounded by four concentric sheaths containing dextran, copolymers of polylactide and epsilon-caprolactone. The hydrogel was impregnated with iron (II) d-gluconate dihydrate, which causes complete spermiostasis due to lipid peroxidation, ascorbic acid to increase the viscosity of the cervical mucus and mixtures of polyamino and polycarboxylic acids to sustain vaginal pH close to 4.5. The combined effects of the agents in the daily eluates of the hydrogel were efficacious up to 16 days, within 30 s, as shown by sperm penetration tests. For in vivo studies, rabbits were chosen as the experimental model because they are easy to handle and the female is always in estrus. The anterior vagina of estrous female rabbits was instilled with the hydrogel, and then inseminated with the semen from a fertile male. Postinsemination flush from the female rabbits showed that all of the sperm were dead. These observations demonstrate the potential for the development of a biocompatible, nonhormonal, intravaginal contraceptive device.

Administration, Intravaginal↗
PubMed2006

[The subcutaneous etonogestrel implant: a new contraceptive method in Mayotte?].

The isle of Mayotte is a part of the Comoros archipelago, its political status is that of a French Territory Despite a birth control programme helping to space out the births rather than restricting their number, the Mayotte population growth is soaring. Since the visit of the President in May 2001 the subcutaneous etonogestrel implant became available for the population of Mayotte. We then carried out a study to evaluate the response given by 50 post-partum women to this new contraceptive method. 38% of the women declared to be willing to use this contraceptive device while 52% instead didn't wish to try. Although not clearly expressed, the wish to have large families is still there and can be explained by religious and cultural factors. Considering the study results, this contraceptive method could certainly be useful in Mayotte. However a well-balanced education campaign, neither too negative nor too enthusiastic, should be necessary to avoid false expectations which in that case could induce widespread negative rumour towards the birth control method.

Adolescent↗
PubMed1995

Contraception in the adolescent patient.

Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). If the adolescent plans to be sexually active, however, she is encouraged to select some form of hormonal contraception, namely Norplant, Depo-Provera, or oral contraceptives, in conjunction with condoms. The authors have had little success recommending barrier methods alone. Condoms are used sporadically and the diaphragm is very awkward for adolescents who are still uncomfortable with their bodies and with touching themselves. Of the three hormonal methods, Depo-Provera seems to be well-accepted by our patients. It offers several advantages that we believe make it attractive. First, it does not require any forethought by the patient other than coming in for the injection every 3 months. There is an effective grace period, so the patient is afforded good contraception even if she is up to a month late for her injection. The frequent visits for injections actually can be looked upon as positive, frequent contacts with the patient and can provide opportunities for counseling. In addition, some patients become amenorrheic, which teens view as an advantage, increasing compliance. If it is not likely that a patient will be compliant with every-3-month injections, Norplant is recommended. Studies have shown good acceptance of Norplant by adolescents and that has been the experience of the authors. With appropriate counseling prior to insertion and a counseling session with patients who request removal, the number of actual Norplant removals has been limited. If Depo-Provera and Norplant are not acceptable to the patient, then oral contraceptives are recommended. Of the three methods, more opportunities for failure exist with oral contraceptives. Pills are missed for a variety of reasons, including going away for the weekend; not having a regular schedule, which can interrupt pill-taking; and even ambivalence about becoming pregnant. One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

A colposcopic study of the effect of IUDs on cervical epithelium.

A case-control study was undertaken to investigate the effects of intrauterine contraceptive devices (IUDs) on the histology of cervical epithelium. Ninety-one women who had used IUDs for 2--13 years were case subjects and were compared with the same number of women who had never used any form of contraception (control subjects). Two subgroups were investigated, group A and group B. Group A consisted of 53 IUD users and 53 controls coming to family planning and gynecology clinics, and group B consisted of 38 IUD users and 38 controls from dysplasia clinics. Cervical cytology and colposcopically directed cervical biopsies were taken in all women. There was no difference between IUD users and control subjects in the proportion or the severity of dysplasia in either group A or group B. There was no evidence of an increase in the prevalence or severity of dysplasia with prolonged IUD use.

Adult↗
PubMed1992

Eubacterium nodatum mimics Actinomyces in intrauterine device-associated infections and other settings within the female genital tract.

Eubacterium nodatum is an obligately anaerobic, gram-positive, branching rod that markedly resembles Actinomyces, particularly Actinomyces israelii, in its cellular and colonial characteristics. Its isolation from the female genital tract was examined for a study period in which use of intrauterine contraceptive devices (IUDs) was common, and additional characteristics of the organism were investigated. Fifteen genital isolates of E nodatum were all associated with the presence of a foreign body, usually an IUD (12 patients). Six of these 12 patients had presented with clinically severe pelvic inflammatory disease. The remaining six had signs and symptoms related to IUD use and/or had a report of probable Actinomyces (five patients) by a Papanicolaou smear, demonstrating that E nodatum can be mistaken for Actinomyces in a Papanicolaou-stained smear. The three other patients had different types of foreign bodies. The frequency of isolation from cultures associated with IUD use during the study period was five (6.4%) of 78 for Actinomyces versus the 12 (15.4%) of 78 for E nodatum. In vitro-prepared E nodatum was not demonstrated to cross-react with A israelii or A naeslundii antisera. Both E nodatum and A israelii were shown to adhere in vitro to an inanimate object, indicating their propensities to colonize a foreign body. The present data, with the previous reports of isolation of E nodatum from cases of lumpy jaw and severe periodontitis, suggest that it is an opportunistic pathogen very much like A israelii.

Actinomyces↗
PubMed2001

Association of risk-taking behaviors with adolescent childbearing.

BACKGROUND AND PURPOSE: Risk-taking behavior has been shown to be associated with adolescent pregnancy or childbearing. However, the specific risk-taking behavioral factors and the extent to which they are associated with adolescent childbearing is less clear. The purpose of this study was to determine the risk-taking behavioral factors associated with adolescent childbearing. METHODS: In this case-control study, 198 mothers aged from 16 to 19 years with first-born infants born in Taichung City in 1997 were enrolled. The controls were adolescents with no history of childbearing or pregnancy matched for age and residential neighborhood of each case. A self-administered structured questionnaire inquiring about a variety of risk-taking factors was used to gather relevant information. The logistic regression model was used for univariate, combination of variables, and multivariate analysis. RESULTS: Compared to controls, childbearing adolescents were more likely to have risk-taking behaviors including smoking, drinking, use of illegal substances, working at bars or nightclubs, and lack of use of contraception at first sexual intercourse. Logistic regression analysis for various combinations of risk-taking behaviors revealed that the more items of risk-taking behaviors adolescents had, the higher their risk of childbearing. Multiple logistic regression analysis showed that use of alcohol (adjusted OR = 1.9, 95% CI 1.1-3.1), working at sex-related workplace (adjusted OR = 4.7, 95% CI 2.4-9.3), and no use of contraceptive device at first intercourse (adjusted OR = 3.1, 95% CI 1.3-7.2), were significant risk factors for adolescent childbearing in subjects with previous sexual intercourse. CONCLUSION: Adolescent females who used alcohol, worked at bars or nightclubs or used no contraception at first intercourse were more prone to adolescent childbearing, and a combination of risk-taking behaviors could increase the risk of childbearing. These risk-taking factors should be taken into consideration in the development of prevention programs.

Adolescent↗
PubMed1989

Post-puerperal Cu-T insertion: a prospective study.

One hundred and sixty eight consecutive women accepting copper T (CuT) intrauterine contraceptive device in the post-puerperal period were studied. Out of them, 63 could be followed after 6 weeks of insertion and 65 after 6 months of insertion. The risk of heavy bleeding, pain in abdomen etc. were no greater than those usually found when interval CuT insertion is carried out. There was no case of uterine perforation leading to migration of CuT. But the expulsion rate was found to be high i.e. 16.4%. CuT is a very useful post-puerperal contraceptive method and should be given more importance in MCH programme.

Female↗