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PubMed1997

Blood pressure response to orthostatic and mental challenge in African-American women taking oral contraceptives.

BACKGROUND: Contraceptive use among women with an elevated risk of cardiovascular disease and stroke has generated little concern among primary care physicians. African Americans in the southeastern region of the United States are particularly vulnerable to hypertension but are often neglected in research studies of cardiovascular disease. The current study examines the effect of oral contraceptive use by African-American women on blood pressure response to orthostatic and mental challenges. METHODS: One hundred African-American women between the ages of 19 and 29 years were recruited from the student populations of Meharry Medical College and Flask University in Tennessee for a study of oral contraceptive use and blood pressure. Of 95 subjects on whom complete data were collected, 31 were taking oral contraceptives (OCs). As a measure of orthostatic challenge, each subject's blood pressure was monitored by a Dinamap automated instrument while she moved from a supine to sitting to standing position. To test blood pressure reactivity to mental challenge, a subset of 34 subjects (10 OC users and 24 nonusers) were monitored while they attempted to perform a frustrating cognitive task on a computer. RESULTS: There were no differences between users and nonusers of oral contraceptives with respect to the amount of change in blood pressure associated with either the orthostatic or mental challenge. Levels of systolic blood pressure and mean arterial pressure, however, were consistently higher in subjects using oral contraceptives (P < .05) under both testing conditions. Systolic blood pressure levels were 6.7 mm Hg to 9.7 mm Hg higher in OC users during each of the three conditions of orthostatic challenge and 4.4 mm Hg to 7.4 mm Hg higher during each of the four periods of mental challenge. Among OC users, mean arterial pressure levels were 2.9 mm Hg to 4.7 mm Hg higher during orthostatic challenge and 5.0 mm Hg to 8.3 mm Hg higher during mental challenge. CONCLUSIONS: While absolute levels of systolic blood pressure never exceeded 126 mm Hg under either testing condition, the difference in blood pressure levels between the OC users and nonusers warrants concern about the long-term effects of oral contraceptive use among African-American women. Although all OC users in this study were taking low-dose formulations, OC use did not eliminate the risk of elevated blood pressure in this population. Our findings suggest that caution is warranted and that alternative birth control methods should be advised for African-American women who have additional risk factors for cardiovascular disease.

Adult↗
PubMed1997

[Contraceptive behavior in the population of the Czech Republic: results of a national survey].

Based on an anonymous survey by means of questionnaires in a representative sample of the population of the Czech Republic above the age of 15 years (862 men and 857 women) the use of different types of contraception was investigated at the onset of sexual life with a steady or casual partner, as well as attitudes to contraception. From the results ensues that during the first intercourse no contraception was used by more than half the respondents, a condom was used only by 19% men and 14% women, in particular younger men and women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby about one third have experience with hormonal contraception and two thirds of the respondents have experience with condoms. Among younger age groups of men and women there are more users of hormonal contraception and condoms. The position is similar in intercourse with casual partners. Only 5% men and 4% women oppose any contraception, almost one quarter are in favour of the so-called "natural" method and almost three quarters consider it necessary. The attitudes of atheists, younger and better educated women are more liberal.

Adolescent↗
PubMed1988

Steroid contraceptive use and pregnancy outcome.

Contraceptive use in relation to pregnancy outcome was studied in 8,816 births in Chiang Mai, northern Thailand, by examination of newborn infants and interviews with their mothers. Four thousand twenty-three women used no contraception before the index pregnancy, 1,229 used the injectable contraceptive Depo Provera (DMPA), and 3,038 used oral contraceptives prior to or during pregnancy. No differences were observed between these groups with respect to still births, multiple pregnancies, and birthweight. Women who used oral contraceptives had unexpectedly low rates of major defects and may have been affected by self-selection bias, whereas the noncontraceptors had rates similar to other populations. There was a significantly increased association of polysyndactyly among infants of DMPA users relative to the other groups, which was most pronounced in offspring of women under age 30 years, and persisted after exclusion of subjects with a family history or infants with multiple abnormalities. However, in five out of the ten polysyndactyly cases, the last injection of DMPA occurred more than 9 months before conception, and only three cases had definite gestational exposure. The association of chromosomal anomalies was also significantly increased in infants of mothers who used DMPA. The unrelated nature of these defects, the lack of confirmation from other studies, the distant preconceptional exposure to DMPA in many cases, and chance effects due to multiple statistical comparisons make a causal association unlikely. Other birth defects that had been previously reported in some publications to be associated with progestational steroid exposure, such as neural tube defects, heart malformations, and limb reduction defects, were not found in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗
PubMed1984

Oral contraceptives and benign breast disease: a case-control study.

The relationship between benign breast disease and use of oral contraceptives was analyzed in a case-control study conducted in Milan with 288 cases of clinically relevant and histologically confirmed benign breast disease and 285 age-matched controls with a spectrum of acute conditions apparently unrelated to use of oral contraceptives. Compared to the risk for women who had never used oral contraceptives, the relative risk for users was 1.0 (95% confidence interval: 0.6 to 1.5). There was no significant association with duration of use; however, a significantly lower relative risk was found in women using oral contraceptives during the year before breast biopsy (relative risk: 0.4; 95% confidence interval: 0.2 to 0.8). The protection in current users increased with increasing duration of use. In spite of this finding, the overall results of the present study do not support the hypothesis that oral contraceptive use protects against development of histologically confirmed and clinically relevant benign breast disease.

Adolescent↗
PubMed1990

Enhanced generation and resolution of fibrin in women above the age of 30 years using oral contraceptives low in estrogen.

Epidemiologic studies have suggested a relationship between the use of oral contraceptives and mortality from cardiovascular diseases in older women. Therefore we studied generation and resolution of fibrin in 28 healthy women above age 30 years, using oral contraceptives containing 30 to 50 micrograms of ethinyl estradiol. Thirty healthy nonusers served as control subjects. The oral contraceptive group had increased plasma concentration of thrombin-antithrombin III complexes (p less than 0.01), which indicated an enhanced generation of thrombin, increased plasma activity of tissue-type plasminogen activator (p less than 0.01), decreased plasma activity of plasminogen activator inhibition (p less than 0.01), and increased plasma concentration of fibrin degradation products (p less than 0.04). Interestingly, the ratio of thrombin-antithrombin III complexes/fibrin degradation products did not deviate significantly between groups. Twelve of the 28 women using oral contraceptives were light smokers, that is, less than 15 cigarettes per day. There were no differences in the determined variables between smokers and nonsmokers. Our study suggests that healthy women older than 30 years who use oral contraceptives containing 30 to 50 micrograms of ethinyl estradiol have an enhanced generation and resolution of fibrin, while the hemostatic balance is unaltered. These findings are unaffected by moderate cigarette smoking.

Adult↗
PubMed1980

Effects of contraceptive agents on the biochemical and protein composition of human endometrium.

An analysis of the nucleic acid and protein composition of endometrial tissue was undertaken in normal women and in patients using either steroidal oral contraceptives or intrauterine contraceptive devices (IUCD). In the presence of an IUCD, endometrial RNA/DNA and protein/DNA ratios were elevated in the secretory phase of the menstrual cycle compared to values obtained in normal women. In the oral contraceptive group, endometrial RNA/DNA and protein/DNA ratios were below the normal range in the late proliferative phase of the cycle. Typical electrophoretic profiles in the oral contraceptive group were similar to the control group, although a quantitative analysis revealed that the concentrations of certain characteristic uterine proteins were reduced. In the IUCD group, there was a preferential appearance of two proteins with approximate molecular weights of 36,000 and 26,000 daltons. Another protein with a molecular weight of 48,000 daltons, which demonstrated a cyclic change during the normal menstrual cycle, was reduced in both study groups. The results suggest that both agents studied induce changes in the macromolecular composition of the human endometrium which may relate to their contraceptive effect.

Adult↗
PubMed1981

Polyurethane contraceptive vaginal sponge: product modifications resulting from user experience.

A preliminary study of a new contraceptive vaginal sponge containing the spermicide nonoxynol -9 (N-9), was undertaken to assess acceptability of the method among a group of sexually active volunteers in Mexico City. Numerous modifications of the product and its packaging resulted from user experience and feedback to the physicians and bioengineers conducting the study. Although determining efficacy of the sponge was not an objective, it quickly became clear that spermicide is a crucial component of the intravaginal sponge contraceptive system; a high incidence of pregnancies led us to increase the spermicide level from 10% to 20%, then to the current 30% of dry sponge weight, or about 1.0 gram per sponge. (It should be noted that the high pregnancy rates were consistent with our experience using other vaginal contraceptive methods in the same clinic population). This initial evaluation of the contraceptive sponge has resulted in significant modification which should increase its acceptability to a small but important group of contracepting women. The sponge is currently being evaluated by the International Fertility Research Program (IFRP) in multicentered comparative clinical trials to determine use-effectiveness and acceptability in various cultures.

Clinical Trials as Topic↗
PubMed1988

Metabolic changes in women using a long-acting monthly oral contraceptive and return of ovulation on discontinuation.

Metabolic changes were investigated in two groups of women using oral contraceptives for 5 to 16 years. Blood samples were taken during the last cycle of oral contraceptive use and three months post-treatment. One group had used a monthly oral contraceptive (MOC, 3mg quinestrol and 10mg 16-methylene chlormadinone acetate) and the second group a daily oral contraceptive (DOC, 35 micrograms ethynylestradiol and 0.625 mg norethisterone). During treatment there were increases in serum total cholesterol and triglycerides but not HDL-C, in plasma total cortisol but not in renin activity, angiotensin II or urinary free cortisol excretion, in hemoglobin and some coagulation factors but not Factor X or antithrombin III, platelet function or fibrinolysis. The area under the blood glucose concentration-time curve, but not that for serum insulin, was slightly increased and there was no change in fasting blood sugar concentrations. All metabolic parameters, except plasma cortisol, which had shown an increase on treatment, had decreased to control levels within 3 months. Ovulation returned promptly in all women, the mean time being 70 days for Group MOC and 44 days for Group DOC. Thus, in spite of the long duration of use of the oral contraceptives, metabolic changes were minor.

Adult↗
PubMed1991

Oral contraceptives and breast cancer: review of the epidemiologic literature.

Oral contraceptives have caused little or no overall increase in risk of breast cancer in women in developed countries, even in long-term users or after more than two decades since initial exposure. Limited evidence suggests a possible small increase in risk in users of oral contraceptives in developing countries, and further studies of breast cancer and oral contraceptives in low risk populations are warranted. Oral contraceptives may enhance risk of breast cancer in young women with a history of benign breast disease, and this possibility should also be investigated further. Multiple investigations have fairly consistently shown risk of breast cancer in women under age 45 years to be increased slightly in long-term users of oral contraceptives. Further studies should be conducted to elucidate the mechanism of this apparent phenomenon.

Breast Neoplasms↗
PubMed1994

The use of contraceptive methods among women seeking a legal abortion.

In a simple random sample study of 404 women 20 to 29 years of age, 201 applying for abortion and 203 continuing their pregnancies, all were interviewed personally and requested to complete a questionnaire. The aim of the study was to analyse the use and experience of contraceptives among the abortion applicants in this age group, and to compare their experience with that of women in a matched control group. The most important reasons given for desisting in the use of contraceptives were the experience of side effects, worry about the side effects, and the "human failure" factor involved even with methods of contraception such as pills, which generally are regarded as safe. This study demonstrates that women living alone without any permanent relationship, having a strained economy or having previously had an abortion, need particular and detailed contraceptive advice plus continued close follow-up. To improve the continuation rate, precise contraception counselling focusing on both positive and adverse effects to reduce worry seems essential.

Abortion Applicants↗
PubMed1994

Contraceptive use and attitudes in Great Britain.

In order to update current knowledge on contraceptive use and attitudes in Great Britain (i.e. England, Scotland and Wales), a survey was conducted among 1753 randomly selected British women aged 15-45. Replies were received from 967 women (55.2%). Seventy-three percent (73%) of fertile, sexually active women who wished to avoid pregnancy were using reliable methods of contraception, viz. oral contraceptives (OCs), intrauterine devices (IUDs) or sterilization. However, it was found that adolescents and women over 40 who wished to avoid pregnancy were, nevertheless, especially likely not to be using any contraceptive method at all. The women surveyed were concerned about weight gain, cardiovascular and cancer risks associated with OC use, and infection and infertility risks associated with IUD use. Sixty percent (60%) perceived sterilization as a major and risky surgical operation. It was concluded that contraceptive practice in Britain had not improved greatly in recent years. The latest scientific findings regarding the true advantages and disadvantages of OCs, IUDs and sterilization, therefore, need to be brought to the attention of the lay public more effectively. Special efforts need to be directed towards providing adolescents and women over 40 with proper information. Physicians and the mass media could play a considerable role in this respect.

Adolescent↗
PubMed1984

The effect of low dose oral contraceptives on the initial immune response to infection.

The use of oral contraceptives have been shown to produce alterations in the normal physiology of many organ systems. However, little is known as to the effect of oral contraceptives on the immune response. The current study was undertaken to determine if women on low dose oral contraceptives show alterations in their initial immune response. An in vitro assay stimulating human peripheral lymphocytes was used. No differences were found in the proliferative immune response of B- or T-cells in women taking low dose oral contraceptives as compared to controls. This study suggests that the initial immune response of lymphocytes in patients on low dose oral contraceptives remains intact.

Antibody Formation↗
PubMed1995

Adolescent girls' attitudes toward contraceptive subdermal implants.

Norplant, which has been shown to be a highly effective and acceptable contraceptive for adult women, may also be a very useful contraceptive for adolescents. This study is designed to determine the level of interest in Norplant for adolescent girls with and without children, their attitudes toward various features of Norplant, and the demographic and psychosocial factors predictive of their interest. A self-administered questionnaire was given to 112 adolescents attending our pediatric or adolescent clinic. Data from 28 adolescent mothers and 79 nulliparous adolescents were analyzed. Fifty-six percent of the subjects had heard of Norplant prior to the survey. The overall level of interest in Norplant was high; 70% of the adolescents without children, and 79% of the adolescent mothers were interested. In comparison to oral contraceptives, 73% of those without children and 89% of those with children thought Norplant would be a better contraceptive. The specific features of Norplant liked by 87% and 81% of the subjects, respectively, were not needing to take pills every day and its effectiveness in preventing pregnancy. The characteristics seen as most undesirable related to potential side effects with acne being mentioned by 87% of the subjects. Recursive partitioning analysis demonstrates that more than one prior pregnancy was the main characteristic predictive of very high levels of interest. In summary, this study demonstrates high levels of interest in Norplant by adolescents and suggests that it should be offered as a contraceptive option, especially to those girls who have previously been pregnant.

Adolescent↗
PubMed1982

Breast cancer in relation to patterns of oral contraceptive use.

A total of 112 white females residents of King County, Washington, aged 35-54 years, who had received a first diagnosis of invasive breast cancer between July 1977 add August 1978, were investigated concerning prior use of oral contraceptives. Their responses were compared with those of a random sample of 469 demographically comparable women from the same population. Overall, oral contraceptive use in cases and controls was similar. However, use of oral contraceptives in preparous women was more common among cases than controls, with the estimated risk of breast cancer associated with such use being 2.2 times that of nonusers (90% confidence interval = 1.1-4.6). This relationship could be explained only in part by the effect of oral contraceptives in postponing or preventing childbirth. The association of breast cancer with use of oral contraceptives prior to ever giving birth has been observed in three studies, including this one, suggesting that the susceptibility of breast tissue to hormonal factors that influence the development of malignancy may be altered by having been exposed to the events of pregnancy.

Adult↗
PubMed2000

Relationship of hormonal contraception and cervical ectopy as measured by computerized planimetry to chlamydial infection in adolescents.

BACKGROUND: Adolescents are at increased risk for chlamydial infection and its sequelae. Hormonal contraception and cervical ectopy were previously suggested risk factors for chlamydia. GOAL: To determine if chlamydia is more prevalent in female participants with greater ectopy and in hormonal contraceptive users. STUDY DESIGN: Ninety-seven adolescent females aged 11 to 20 years were recruited from two Baltimore inner-city clinics. After administering a reproductive history questionnaire, endocervical specimens were tested for Chlamydia trachomatis by polymerase chain reaction. After acetic acid application to the cervix, cervical photographs were taken, the area of ectopy was quantified by computerized planimetry, and ectopy was categorized as none (0mm2), mild (< 22mm2), and moderate (> 22mm2). The likelihood of chlamydia by ectopy and type of hormonal contraceptive use was determined by logistic regression adjusted for age and sexual partners. RESULTS: The odds of chlamydial infection was similar in persons with mild ectopy compared with no ectopy (adjusted odds ratio [OR], 0.76; 95% CI, 0.14-4.03), and in persons with moderate ectopy compared with no ectopy (adjusted OR, 1.94; 95% CI, 0.40-9.39). The likelihood of chlamydia was higher in depot-medroxyprogesterone acetate users compared with nonhormone users (adjusted OR, 5.44; 95% CI, 1.25-23.6). Oral contraceptive users did not have an increased likelihood of chlamydia (adjusted OR, 0.92; 95% CI, 0.10-8.78). CONCLUSION: Using a new, reliable, and standardized technique to quantify cervical ectopy, the authors did not find an elevated prevalence of chlamydial infection in adolescents with cervical ectopy. Depot-medroxyprogesterone acetate use may increase the risk of chlamydial infection compared with combined estrogen-progestin oral contraceptives.

Adolescent↗
PubMed1992

A survey of contraceptive use and unplanned pregnancy in Perth, Western Australia.

Contraceptive use and unplanned pregnancy were studied in a stratified cluster sample of 1,511 couples with women aged 16 to 44 years resident in metropolitan Perth in 1988. Twenty-one couples were excluded from analysis owing to missing data. The proportion of couples using contraception was 76.8 per cent (1,144 of 1,490), and all but three of the remaining couples gave a reason for nonuse. Among users, surgical sterilisation made up 42.3 per cent (484 of 1,144) of all methods, with a slight predominance of tubal ligation over vasectomy. Oral contraceptives accounted for just over half of nonsurgical methods. Comparisons with a Victorian survey performed in 1978 suggested that surgical methods and condom use may have increased, whereas use of oral contraceptives and intrauterine devices may have fallen. Unplanned pregnancies conceived during the 12 months before the interview affected 3.4 per cent (51 of 1,490) of respondents. The incidence of unplanned pregnancy was four times higher in couples with inconsistent usage patterns of contraception.

Adolescent↗
PubMed1975

Prevalence of gonorrhoea among women using various methods of contraception.

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

Adult↗
PubMed1985

Oral contraception and serious psychiatric illness: absence of an association.

The incidence of serious psychiatric illness, as measured by first referral to hospital for specialist advice and treatment, has been investigated among 16,746 women taking part in the Oxford Family Planning Association contraceptive study. Of these women, 9,504 were recruited while using oral contraceptives, 4,144 while using a diaphragm and 3,098 while using an intrauterine device. The results are reassuring with respect to oral contraceptive use. First referral rates per 1000 woman-years of observation in the oral contraceptive, diaphragm, and intrauterine device entry groups were 3.0, 2.6, and 2.8 respectively for non-psychotic psychiatric disorders and 0.46, 0.43 and 0.53 respectively for psychotic disorders. Attempted suicide occurred only 40% as often amongst diaphragm users as amongst users of oral contraceptives or intrauterine devices; this finding presumably reflects the characteristics of women who choose the diaphragm as their birth control method.

Adult↗