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PubMed1980

Incidence, prevalence, and trends of acute pelvic inflammatory disease and its consequences in industrialized countries.

Pelvic inflammatory disease is used herein synonymously with acute salpingitis. In modern industrialized countries, the annual incidence of PID in women 15 to 39 years of age seems to be 10 to 13 per 1,000 women, with a peak incidence of about 20 per 1,000 women in the age group 20 to 24 years. Since 1960 an increase in incidence by a factor of 1.6 to 1.9 has been observed in the age group 20 to 29 years. The incidence of PID is correlated strongly with the prevalence of sexually transmitted diseases, although a fraction of the infections might be of endogenous origin. Use of intrauterine contraceptive devices and operations for legal abortions contribute to the increase in incidence. The prevalence of women in the post-PID state has increased by a factor of about 1.5 since 1960. Women in the post-PID state have a tenfold increased risk for ectopic pregnancy and 25% of the increase in ectopic pregnancy can be accounted for by the increase in post-PID women. Infertility after PID ranges between 5.8% and 60% depending on severity of infection, number of infections, and age of the women. The fraction of women rendered infertile because of PID has increased by a factor of about 1.6 since 1960.

Adolescent↗
PubMed1982

Fertility regulation in nursing women. II. Comparative performance of progesterone implants versus placebo and copper T.

A clinical study was designed to test whether sustained administration of progesterone to nursing mothers could prolong lactation and delay the postpartum recovery of fertility. The hormone was administered by subdermal implantation of six pellets that each contained 100 mg of progesterone. This treatment was administered to 84 fully nursing women on day 30 post partum. Control groups were composed of 130 fully nursing women who received an injectably placebo, and by 125 fully nursing women who received a TCu 200 intrauterine contraceptive device. An exacting list of requirements for admission to and continuation in the study was applied to all groups. No pregnancies occurred in the progesterone-treated group from the second to the sixth postpartum month. This period coincided with the period of elevation plasma progesterone attributable to hormone released from the implants. The cumulative probability of pregnancy in the placebo group was 10.2 per 100 women at the sixth month. Treatment with progesterone did not change the duration of lactation or the rate of child growth, and no adverse effects were recorded. These results warrant further investagation of the use of progesterone as an alternative method to prevent conception in nursing women.

Birth Weight↗
PubMed2002

[Intrauterine devices in general practice: a prospective study of 300 insertions].

OBJECTIVE: To assess the effectiveness of management practices of copper intrauterine devices (IUD) in general medicine. MATERIAL: and methods. A prospective study was conducted over a four-year period. Thirty-four experimented and volunteer general practitioners inserted 300 IUDs. Two hundred and ninety-seven patients were evaluated. A 375-mg copper IUD was used. Results are presented by 12-month device survival, cumulative discontinuation, and event rates per hundred women. RESULTS: At the end of the study 19.8% (n=59) of the women were lost to follow-up. Exposure time to IUD was 9245 cycles. Mean exposure time was 3917 cycles. Discontinuation rates for IUD were 82%, 67%, and 31% at 12, 36, and 48 months respectively. Renewal rate for this contraceptive device was 31.5%. Results confirmed that IUD were highly effective in this population: Pearl index 0.51% with four pregnancies. A very low expulsion rate (1.68%) and good tolerance (cumulative removal rate for medical reasons at 60 months=6.1%) were observed. At the end of the study, 61.3% of the women included had no complaints and had their IUD removed for desired pregnancy, replacement or personal reasons. CONCLUSIONS: Our findings are similar to reports in the literature; there was no evidence of differences between general practitioners and gynecologists. IUDs inserted by experimented general practitioners are safe and should continue to be offered as a contraceptive option for properly selected women. These findings suggest that specific training on contraceptives should be provided to interested general practitioners

Adult↗
PubMedDate not supplied

Trends in contraceptive use at one university: 1974-1978.

In a group of 2,700 women making initial visits to the contraception clinic at one university (California State University at Fullerton) between 1974 and 1978, oral contraceptives were the most frequently chosen of three prescription methods. (The others were the IUD and diaphragm.) The proportion of women choosing the pill, however, declined sharply over the period--from 89 percent of patients in 1974 to 63 percent in 1978. Choice of the diaphragm rose substantially: In 1978, 33 percent chose it, compared to six percent in 1974. The proportion of women choosing the IUD fluctuated over the four-year period, showing no clear trend, and averaging eight percent over the entire span. The decline in the proportion of women choosing the pill was sharpest among white Anglo students--down from 85 percent to 63 percent; among nonwhites and Hispanics, the proportion fell from 89 percent to 80 percent. The increase in the choice of the diaphragm was also greatest among the Anglo students. These trends of decreased choice of the pill and increased acceptance of the diaphragm are much sharper than those shown among young married women at the national level.

Adolescent↗
PubMed2001

The safety and effectiveness of a new hysteroscopic method for permanent birth control: results of the first Essure pbc clinical study.

BACKGROUND: Current methods of female surgical sterilisation require incisional surgery, general anaesthesia and a prolonged recovery time. We studied the safety and effectiveness of Essure pbc, a minimally invasive, transcervically placed micro-insert that occludes the Fallopian tubes, resulting in permanent female contraception. Device under study: The Essure pbc implant is a dynamically expanding micro-insert which is placed in the proximal section of the Fallopian tube using a modified minimal access technology for cannulating the tube. STUDY POPULATION: Women aged 21-43 seeking permanent birth control. METHODOLOGY: Essure pbc micro-inserts were inserted into the proximal portion of the Fallopian tubes under hysteroscopic visualisation with intravenous sedation or paracervical block. RESULTS: Bilateral device placement was achieved in 111 of 130 (85%) women who underwent device placement attempts. Women found the device placement procedure to be highly acceptable. Of women wearing the device for up to two years rate, 97% rated it to be very good to excellent. There have been no pregnancies reported in 1894 woman-months of effectiveness. Adverse events preventing women from relying on Essure pbc were < 5%. DISCUSSION: This first clinical trial showed the Essure pbc method of permanent contraception to be safe and highly acceptable to women. Experience and improvements to the delivery system should increase overall micro-insert placement rates. CONCLUSION: The Essure pbc method of permanent contraception is an exciting alternative to vasectomy or laparoscopic sterilisation that does not require general anaesthesia or incisions.

Adult↗
PubMed1992

Teen contraception in the 1990s.

Basic information about appropriate contraceptive methods for teen-agers is provided. Methods most commonly used will be reviewed and an overview of alternative methods available for use in special subgroups will be provided.

Adolescent↗
PubMedDate not supplied

[Emergency contraception].

INTRODUCTION: The aim of this study was to point to the significance of emergency contraception following unsafe sexual intercourse. This method of contraception has been in use since the middle sixties, although in our country it is not applied very often. Indications for emergency contraception comprise every woman who experiences contraceptive failure or those not using any common contraception for any reason. MATERIAL AND METHODS: Emergency contraceptive devices are most often applied either in combination with estrogen and progesterone or only progesterone in high dosage (0.25 mg levonorgestrel and 50 mg ethinyl-estradiol) during 72 hours after the intercourse and a repeated dose 12 hours later. CONCLUSION: Emergency contraception is recommended as a single procedure. If used several times during a year, the risk of unwanted pregnancy increases. The mechanism of effect of emergency contraception depends on the timing during menstrual cycle; it can prevent ovulation, fertilization or implantation. Emergency contraception does not cause abortion and it is not effective if the process of implantation has started. Unwanted side-effects are not known.

Contraceptives, Postcoital↗
PubMed1989

Sexually transmitted diseases and Chlamydia trachomatis in women consulting for contraception.

To study the frequency of genital infections in women consulting their family doctor for contraception, 248 women (median age 23 years) were examined for a range of genital microorganisms. The prevalence of clue cells, Candida albicans and Trichomonas vaginalis were 21.0%, 12.9% and 2.0%, respectively. Neisseria gonorrhoeae was isolated in only one case, whereas Chlamydia trachomatis was found in 6.3% of women. A specific clinical picture for an infection with C. trachomatis in women was not seen. Given the prevalence of over 5% for C. trachomatis and the absence of typical signs and symptoms in infected women, screening for this organism is recommended in women requesting an intrauterine contraceptive device, to prevent complications such as pelvic inflammatory disease and their sequelae.

Adolescent↗
PubMed1998

The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania.

OBJECTIVES: To determine the risk factors for HIV seroconversion and assess the association between contraceptive use and HIV infection among women attending three large family planning clinics in Dar es Salaam, Tanzania. DESIGN: Prospective cohort study. METHODS: Between 1992 and 1995, 2471 HIV-negative women were followed prospectively. Information about sociodemographic characteristics, sexual behavior, contraceptive use and other risk factors was collected at recruitment and updated at follow-up visits. At the end of the study, specimens were collected for HIV testing and laboratory diagnosis of sexually transmitted diseases. RESULTS: The overall HIV incidence was 3.4 per 100 person-years [95% confidence interval (Cl), 2.6-4.1]. The risk of HIV seroconversion decreased with increasing age (P=0.04, test for trend). Women reporting three or more sex partners during the follow-up period had the highest risk of HIV [age-adjusted relative risk (RR), 4.89; 95% Cl, 2.61-9.17]. Having an uncircumcised husband was associated with a significantly increased risk of HIV (age-adjusted RR, 3.60; 95% Cl, 1.12-11.59). The risk of HIV was also significantly increased among women with gonorrhoea (age-adjusted RR, 3.51; 95% Cl, 1.60-7.71) and candidiasis at baseline (age-adjusted RR, 1.98; 95% Cl, 1.17-3.33) and among women reporting alcohol consumption during the follow-up period. After controlling for other risk factors, the risk of HIV infection amongst users of oral contraceptive, intrauterine device and injectable contraceptive was not significantly increased. Similarly, there was no significant trend associated with increasing duration of use of any of these contraceptive methods. CONCLUSION: These findings confirm that a large number of new HIV infections continue to occur in this population. Reassuringly, no significant association was observed between HIV and use of specific contraceptive methods. Interventions to reduce further spread of HIV are still urgently needed.

Adolescent↗
PubMed1989

Serum CA 125 in acute pelvic inflammatory disease.

Serum levels of CA 125 and other selected tumour markers were measured in 31 patients with proven pelvic inflammatory disease (PID). Ten (32%) of the patients had elevated CA 125, one (4%) had elevated CEA, and none had elevated CA 15-3, AFP or beta 2-microglobulin. Compared to patients with normal CA 125, patients with elevated CA 125 were older, more often users of intrauterine contraceptive devices, had longer duration of symptoms, higher erythrocyte sedimentation rates, and more often had an adnexal mass on pelvic examination. There was a correlation between CA 125 levels and the severity of adnexal inflammation as defined by laparoscopy. Isolation of specific micro-organisms from the upper genital tract was not associated with elevated CA 125. In most women serum levels of CA 125 decreased during treatment. PID should be considered as a major cause of positive CA 125 findings among young women.

Adult↗
PubMed1975

IUD-related hospitalizations. United States and Puerto Rico, 1973.

In a mail survey of physicians likely to be involved with intrauterine contraception in the United States and Puerto Rico, 49.2% of the physicians responded, describing 3,502 unduplicated reports of hospitalizations related to the use of intrauterine contraceptive devices (IUDs) during the first six months of 1973. We estimate from this response that approximately 7,900 IUD-related hospitalizations occurred during that period. Interviews with a probability sample of nonrespondents demonstrated that their IUD complication experience was not substantially different from that reported through the mail survey. Estimates of the number of IUDs worn in 1973 permit rate calculations of three to ten IUD-related hospitalizations per 1,000 woman-years of IUD use. The rate of hospitalizations attributable to the IUD is probably higher that that attributable to combination oral contraceptives.

Adolescent↗
PubMed1984

Mortality among young black women using contraceptives.

Data on the risk of death associated with various contraceptive methods are incomplete. Therefore, we analyzed the mortality rates for young, black inner-city women who used one of four methods of contraception--oral contraceptives, depomedroxyprogesterone acetate, intrauterine (contraceptive) devices, and barrier methods. The subjects were 30,580 15- to 44-year-old women who enrolled at a family planning clinic between 1967 and 1972 and who were observed by monitoring death certificates through the end of 1977. Forty percent of the 218 deaths observed were from accidents and violence. Use of this family planning clinic greatly reduced the risk of death from childbearing; only two deaths were associated with pregnancy and childbirth, compared with the 24 deaths expected. Overall, users of the four methods died at similar, low rates. Given that this study involves considerable loss to follow-up, possible acute effects of contraceptives (eg, infections or thrombosis) are more accurately estimated than possible long-term effects (eg, cancer).

Adolescent↗