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PubMed1978

[Serum concentrations of prolactin, growth hormone, and alpha-fetoprotein under long-term administration of an oral contraceptive containing cyproterone acetate (author's transl)].

Serum prolactin, growth hormone, and alpha-fetoprotein were determined in women taking a new oral contraceptive, consisting of 2 mg cyproterone acetate and 50 microgram of ethinylestradiol. Because these women were suffering from acne vulgaris they were taking this contraceptive containing a gestagen with antiandrogenic activity. Prolatin and growth hormone were determined because both may favour the development and the growth of mammary tumors and because their secretion may be stimulated by estrogenic compounds. Alpha-fetoprotein is a marker of hepatocellular carcinoma, which may be associated with long-term use of oral contraceptives. During one year of treatment with cyproterone acetate and ethinylestradiol there was a continuous rise of serum concentrations of prolactin. However, this rise did not exceed the normal range. In contrast, serum concentrations of growth hormone did not change significantly. Serum alpha-fetoprotein levels remained below the detection limit of the method.

Acne Vulgaris↗
PubMedDate not supplied

[Use of long-acting contraceptives in the treatment of mastopathy].

Effects of long-acting contraceptives on mammary glands of patients with diffuse fibrocystic mastopathy were under study. A total of 206 women aged 17 to 38 were examined. In 50 of them fibrocystic mastopathy was detected by palpation, non-contrast mammography, and ultrasonic examination. On days 5-7 of the cycle the patients were injected 1 ml of depot provera or noristerate or subcutaneously implanted norplant. Injections of the two former agents were repeated in 3 months if necessary. Control examinations were carried out 3 months to 5 years after the contraceptives were started. The results indicate that long-acting contraceptives did not cause any negative changes in the course of mastopathy in 32 of 50 women. In 18 women the general status improved (pain and induration in the mammary glands disappeared), mammographic, thermographic, and ultrasonic data improved, this prompting us to continue our research.

Adolescent↗
PubMed1965

THE EMOTIONAL RESPONSES OF MARRIED WOMEN RECEIVING ORAL CONTRACEPTIVES.

One hundred women taking oral contraceptives were questioned concerning their opinions about personal and sociological effects of this method of conception control. Fifty-three per cent reported improved coital satisfaction while 4% noted the opposite effect. Libido was increased in 22% and decreased in 13%. One woman in five believed that an increase in premarital and extramarital sexual activity would take place in the general population as a result of tablet-induced infertility. The problem of population control is discussed. It is paradoxical that the incidence of unplanned pregnancies continues to increase despite the availability of completely reliable conception control. This reflects present inability to communicate contraceptive knowledge to the appropriate people.

Adult↗
PubMed1982

Risk factors for cervical cancer.

Despite a long history of research into the epidemiology and biology of cervical carcinoma, a definitive statement about its probable causes still remains elusive. This review recognizes the population based data on high and low risk groups and summarizes the findings from numerous case-control studies which have explored the marital, sexual and reproductive factors associated with cervical cancer. Although vigorously pursued, an increased risk from oral contraceptives has not been convincingly demonstrated. A variety of venereally transmitted organisms appear to be frequent cohabitants with cervical neoplastic cells. Herpesvirus type 2 still remains the prime suspect in the complex pathogenesis of cervical neoplasia. Clinical findings, biological characteristics of the virus, serological studies and interactions of host cells and viral particles continue to stimulate the most intensive investigative efforts.

Age Factors↗
PubMed1997

[Ovarian activity, cycle behavior and tolerance of low dosage oral contraceptives: a comparative study].

In a double-blind randomized study, the suppression of ovarian activity, the effects on the cervix and endometrium, menstrual bleeding patterns and overall tolerance were assessed during administration of two low-dose oral contraceptives (20 micrograms ethinylestradiol EE, 500 micrograms norethisterone--Eve 20, Grünenthal, Aachen; 20 micrograms EE, 150 micrograms Desogestrel--Lovelle, Organon, Munich), 118 healthy women (ages: 18 to 35 years) with comparable bioprofiles (height, weight, menstrual cycle patterns) were studied in 10 investigation centres during medication with either Eve 20 (n = 59) or Lovelle (n = 59). During 3 treatment cycles, ovarian activity was evaluated by sonographic determination of follicular size and by simultaneous assessment of serum endocrine profiles (gonadotropins LH and FSH, ovarian steroids estradiol [E2] and progesterone [P]). Treatment cycles 4 to 6 served to evaluate the patterns of menstrual bleeding and the overall subjective tolerance on each contraceptive. While on the preparations, no ovarian activity (as judged by a lack of follicular growth and suppressed sex steroid levels) was found in over 90% of all investigated cycles. Follicular activity and/or cyst formation were detected in 18 of 173 cycles (Eve 20) and in 5 of 175 cycles (Lovelle) respectively. Gonadotropin levels were suppressed (LH < 6 IU/l, FSH < 8 IU/l) in most treatment cycles (Eve 20: 76.6% vs. Lovelle: 84.8%). Serum E2 concentrations exceeding 0.1 nmol/l indicated residual follicular activity in 19.3% (Eve 20) vs. 12.2% (Lovelle) of all cycles. As estimated by serum P levels over 5 nmol/l, ovulation had presumably occurred in 4.1% (Eve 20) vs. 2.9% (Lovelle) of treatments respectively. However, when the sonographic and endocrinological data were combined, no ovulation was documented in any treatment cycle. In addition, the quality of the cervical mucus was minimal and a low endometrial thickness was found in the majority of women, indicating strong progestogen effects of both contraceptives. Menstrual irregularities (intermenstrual spotting, break-through bleeding) occurred initially on each preparation, but were mostly resolved when the pills were continued. The acceptance of each investigated drug was rated as very good or good by most subjects. These observations allow us to conclude that the rate of ovarian suppression with inhibition of follicular activity is high under low-dose oral contraceptives. The different progestogens as components of these contraceptive pills display equally good anti-conceptive effects on both the cervix and the endometrium. Furthermore, the rate of irregular menstrual bleeding is acceptable for these low-dose contraceptives. The high acceptance of each preparation suggests that such agents will have a high rate of acceptability in clinical use.

Adult↗
PubMed1997

Sexual behaviour of adolescents before and after the advent of AIDS.

OBJECTIVES: To asses changes in sexual behaviour and use of contraceptive methods in Danish adolescents from the period before the advent of AIDS up to the present. DESIGN: Comparative study comparing data obtained from two identical cross sectional surveys SETTING: Grenaa Gymnasium, Denmark. SUBJECTS: 626 high school students in 1982 and 499 high school students in 1996. METHODS: An anonymous standardised self administered questionnaire handed out to high school students at Grenaa Gymnasium in spring 1982. In spring 1996 an identical questionnaire was handed out to every high school student at the same gymnasium. MAIN OUTCOME MEASURES: Age at first sexual intercourse, contraceptive use, and reasons for choice of contraceptive strategy. RESULTS: Today more males had experienced the first sexual intercourse before their 16th birthday (p = 0.047) compared with 1982, the reverse held for females (p = 0.003). From 1982 to 1996 condom use increased in males with no regular partner (p = 0.009). In females with no regular partner, there was during the same period an increase in considering the condom a personal contraceptive method (p = 0.017). In 1982 and 1996 protection from sexually transmitted diseases was given as reason for the choice of contraceptive strategy by 21% and 72% of males with no regular partner (p < 0.001), and by 7% and 32% of males with a regular partner (p < 0.001). The corresponding figures for females in 1982 and 1996 were 10% and 71% (p < 0.001) for those with no regular partner and 4% and 21% (p < 0.001) for those with a regular partner. CONCLUSION: Condom use has increased among adolescents with no regular partner brought up under the widespread awareness of AIDS, and the reason for this is to be protected from sexually transmitted diseases. A future decline in the incidence of various sexually transmitted diseases may be expected, and information on safe sexual practices should be continued.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Oral contraceptives: where are the excess deaths?

In the 1960s and 1970s a substantial body of data was published indicating an excess death rate, mainly related to a cluster of cardiovascular complications, in women who either were taking or had ever taken oral contraceptives. The epidemiological interpretation of these data has been seriously questioned, and many workers now think that the excess deaths in these women are almost entirely attributable to smoking. In addition, it is clear that the death rate from myocardial infarction in women in Australia, which has declined significantly in the last twelve years, is quite different from that seen in women in the United Kingdom, where the death rate from myocardial infarction continues to increases. The validity of basing warnings, contraindications and advice to patients regarding the use of oral contraceptives on data from different populations should be reconsidered.

Adolescent↗
PubMed2005

TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age.

OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.

Adult↗
PubMed2000

Efficacy and acceptability of depo-medroxyprogesterone acetate injection. As a method of contraception in Saudi Arabia.

OBJECTIVE: To determine the efficacy and acceptability of Depo-Medroxyprogesterone acetate (depo-provera) among the women using that method of contraception at King Faisal Military Hospital in the south-west region of Saudi Arabia. METHODS: A preliminary retrospective and questionnaire analysis of 165 Saudi women who had depo-provera as a method of contraception at the contraception clinic of King Faisal Military Hospital over a period of 2 months. RESULTS: The mean age of the women was 31.21 years and the mean parity 6.77. There was no pregnancy reported during the period of use of the contraceptive method which ranged from 3 months to 7.25 years. The side effects were mainly irregular spotting (69%), continuous bleeding per vaginam (7%), amenorrhoea (8%) and menorrhagia (1%). The rest reported normal menstrual pattern. Irregular spotting was common in women who had used the method for less than 2 years while amenorrhoea was the most common menstrual abnormality after 3 years of use. The other complaints included weight gain, loss of hair, abdominal pain and backache. The side effects were not acceptable to 4% of the women and they tried other methods of contraception. Thirteen percent of the women became pregnant after stopping the injections within intervals varying between 6 months to 2 years. Seventeen percent were using the method for the 2nd time. CONCLUSION: Depo-provera is a very effective form of contraception in our community. While a few of the patients (4%) in our series would try other methods if not happy with the side effects, the majority were prepared to cope with the side effects as long as the desired prevention of pregnancy was guaranteed. Further studies are needed to validate these findings.

Abdominal Pain↗
PubMed1998

Oral contraceptives and thrombosis.

The debate on whether the so-called third-generation progestogens (desogestrel, gestodene, and norgestimate) are associated with a higher risk of venous thrombosis than the older, so-called second-generation progestogens (principally levonorgestrel and norethindrone) continues. Much of the debate focuses on finding alternative explanations for the observed relationship. Alternative explanations include a prescribing bias, in which women at greater risk of venous thromboembolism were preferentially prescribed newer preparations; a failure by researchers to adjust adequately for residual confounding by age; and a failure by researchers to allow adequately for confounding by the duration of use of oral contraceptives. None of these explanations have been accepted without dispute, and the debate will clearly continue. A possible biologic explanation for the observed relationship of higher thrombosis risk with use of third-generation preparations has been put forward by Rosing et al. from Maastricht, who developed a new way of measuring activated protein C (APC) resistance. They found that users of third-generation preparations have higher acquired APC resistance than users of second-generation products. This finding requires confirmation.

Activated Protein C Resistance↗
PubMed2000

Menstrual patterns and fecundity among non-lactating and lactating cycling women in rural highland Bolivia: implications for contraceptive choice.

Choosing an appropriate contraceptive method, particularly one based on fertility awareness, depends in part upon the degree of a woman's cycling regularity. However, while the suppressive effect of lactation on ovarian function is well established, the potential influence of continued breastfeeding on menstrual patterns once post-partum cycling has resumed is largely unexamined. This longitudinal study in a population of non-contracepting Aymara women (n = 191 providing 665 non-truncated menstrual segments) identified conceptions and fetal loss via urine tests for hCG and classified segments accordingly to test the hypotheses that (1) cycles in lactating women are significantly different in length and regularity from those of non-lactating women, and (2) cycles in women living at high altitude are significantly different in length and regularity from those at lower altitudes. Analyses found that segments are significantly longer and regularity tends to be less common among lactating than non-lactating women; however, the rate of conception is twice as great among the former than the latter, and the distribution of conception outcomes does not differ between the two groups. Menstrual regularity is not the norm in this population, even among those who are not currently breastfeeding. High altitude per se does not appear to influence menstrual cycling as both regularity and segment length are comparable to other populations, hence women indigenous to high altitude are suitable candidates for a wide variety of contraceptive choices. In addition, these findings suggest that studies of fecundability limited to non-lactating women may be biased towards those of relatively lower fecundity.

Bolivia↗