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PubMed1982

Exercise does not change high-density lipoprotein cholesterol in women after ten weeks of training.

Effects of a 10 wk, three times per wk individualized bicycle ergometer training program were investigated in 16 healthy sedentary women 19-29 yr-old who were not taking oral contraceptives or other medications. Twelve women were in an interval type program, 6 in a continuous program, all performing 30 min exercise per session at 70% maximum heart rate reserve. Conditioning responses did not differ between the training regimens. Training produced increases in maximum oxygen uptake and physical work capacity. Percent body fat determined by underwater weighing was significantly reduced as was resting heart rate, after the training program. Maximum heart rate was unchanged. Despite changes in "fitness" variables, post-training values of high density lipoprotein cholesterol and triglycerides did not differ from pretraining. High-density lipoprotein cholesterol was significantly reduced at 2 and 5 wk of training and returned to control levels at 10 wk. Exercise conditioning leading to improved physical fitness in healthy women may not be associated with increments in high density lipoprotein cholesterol levels.

Adult↗
PubMed2004

[Pregnancy in patients with Eisenmenger's syndrome. Experiences from Vilnius 1967-2003].

Pregnancy in patients with Eisenmengers syndrome is associated with high maternal and fetal mortality rates and effective contraception or termination of pregnancy is strongly recommended. When these patients decide to begin or continue a pregnancy against advice a coordinated multi-specialist care at a center for congenital heart disease is mandatory. So far, experience with this demanding group of patients is limited. This report reviews the outcome of 30 pregnancies in 10 patients from a group of 35 women with Eisenmengers syndrome who have been treated at the University Hospital in Vilnius, Lithuania, between 1967 and 2003. The most frequent underlying lesion was a ventricular septal defect in 5 patients, their mean age was 26.2 +/- 5,4 years and they were in functional class II or III (9/1) at the beginning of the pregnancy. In this group 13 pregnancies were terminated (43 %), 4 spontaneous abortions (13 %) occurred at less than 21 weeks of pregnancy and one stillbirth at 23 weeks of gestation. Twelve children were born alive, 10 were premature and 2 term deliveries. One maternal death occurred on the third day following an emergency delivery in week 36 and another patient decompensated immediately following delivery, but could be stabilized with intensive care therapy. During long-term follow-up all of these 9 patients were alive at 10/2003 despite a significant deterioration in functional class. These data are comparable to previously published observations in pregnant women with Eisenmengers syndrome.

Abortion, Spontaneous↗
PubMed1995

Persistent genital human papillomavirus infection as a risk factor for persistent cervical dysplasia.

BACKGROUND: Cervical dysplasia, also referred to as squamous intraepithelial lesion (SIL) in cytology or cervical intraepithelial neoplasia in histopathology, is thought to have the potential to advance in progressive stages to cervical cancer. However, not all cases of SIL progress, and most of the mild lesions spontaneously regress. Factors that govern regression, persistence, and progression of SIL are poorly understood. PURPOSE: Our analysis sought to identify factors that determined persistence or regression of SIL. METHODS: Seventy subjects with histopathologically confirmed cervical dysplasia were followed at 3-month intervals for 15 months. At each visit, the cervix was evaluated by Pap smear and colposcopy, and exfoliated cervicovaginal cells were analyzed for human papillomavirus (HPV) DNA. For each subject, data from every two consecutive visits were grouped as a pair. Persistent SIL was considered present if a lesion was detected at a visit (t) as well as at the next visit (t + 1) and absent if a lesion was detected at visit t but not at visit t + 1. A statistical model for time-dependent data correlated persistent SIL with various risk factors. RESULTS: Age, ethnicity, education, sexual behavior, smoking, and the use of oral contraceptives did not correlate with persistent SIL. The risk of persistent SIL was associated with continual HPV infection in visits t and t + 1 (HPV positive by Southern blot analysis: odds ratio [OR] = 3.91, and 95% confidence interval [CI] = 1.58-9.65; HPV positive by polymerase chain reaction [PCR]: OR = 2.42, and 95% CI = 1.03-5.67) and a persistent high viral load (OR = 4.07, and 95% CI = 1.35-12.30). When typed by PCR, individuals with type-specific persistent infection in visits t and t + 1, and particularly those with a continual high viral load (OR = 4.97; 95% CI = 1.45-17.02), had the highest risk for persistent SIL compared with those with a low level of type-specific persistent infection or non-type-specific persistent infection. The presence of persistent HPV infection in visits t-1 (the preceding time interval) was also predictive of persistent SIL in visits t and t + 1, although the strength of association was weaker, suggesting that persistent HPV and SIL occur synchronously. CONCLUSION: HPV infection and its associated cervical lesions tend to occur concurrently, and type-specific persistent HPV infection, particularly with a high viral load, produces chronic cervical dysplasia. IMPLICATIONS: The natural history of genital HPV infection directly influences the prognosis of cervical dysplasia as measured by persistence of the lesion. Testing for HPV infection may be valuable in the clinical management of women with cervical dysplasia.

Adult↗
PubMed2000

The use of colposcopy in assessing vaginal irritation in research.

Since the early 1990s, colposcopy of the vagina and cervix has been used in the development of vaginal products in order to detect epithelial changes that may increase the likelihood of HIV or acquisition of other sexually transmitted diseases. As part of a continued effort to examine and define the role of colposcopy in a research setting, the Contraceptive Research and Development Program (CONRAD) and the International Working Group on Microbicides (IWGM), in association with the United Nations Program for AIDS (UNAIDS) sponsored a conference entitled, 'The Use of Colposcopy in Assessing Vaginal Irritation in Research', held in Washington, DC in January 1999. This is a report of that conference. The World Health Organization's colposcopy procedure and nomenclature, published in 1995, were reviewed and changes were recommended. The revised procedure involves colposcopic examination of the external genitalia, naked eye examination of the cervix, fornices, and vaginal walls, followed by lavage and colposcopic examination of those areas, and sampling as appropriate for microscopic examination. Revised nomenclature replaces the terms used for findings with descriptions of what is actually seen. Digital video imaging and testing for inflammatory markers may be adjuncts to colposcopy and should be further studied. Other areas requiring additional research include the natural history of colposcopic changes, factors other than product use that may affect colposcopic findings, the clinical significance of findings, and the procedure which best assesses these findings.

Anti-Infective Agents↗
PubMed1997

Trends in abortion 1990-1995.

Trends in legal abortion performed to women resident in England and Wales, between the years 1990 and 1995 are reviewed. This article updates an earlier review of abortion trends from the introduction of the 1967 Abortion Act to the end of 1989 which appeared in Population Trends issue no. 64(1). The main findings of this present article indicate that the number of legal abortions performed in England and Wales have gone down since 1990. Outside factors such as patterns in fertility, the provision and uptake of family planning services, and sexual attitudes and behaviour are likely to influence present and future trends. This article is part of an ongoing review of abortion trends which will be continued in future years.

Abortion, Legal↗
PubMed2003

Sponge versus diaphragm for contraception: a Cochrane review.

The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 h without the insertion of additional spermicide, and it does not require fitting or a prescription from a physician. We conducted a systematic review of randomized controlled trials that compared the vaginal contraceptive sponge with the diaphragm used with a spermicide in order to evaluate the efficacy and continuation rates of the two devices. The sponge was statistically significantly less effective in preventing overall pregnancy than was the diaphragm in the two trials that met our inclusion criteria. The 12-month cumulative life table termination rates per 100 women for overall pregnancy were 17.4 for the sponge versus 12.8 for the diaphragm in the larger US trial, and 24.5 for the sponge and 10.9 for the diaphragm in the UK trial. Similarly, discontinuation rates at 12 months were higher with the sponge than with the diaphragm [odds ratio 1.3; 95% confidence interval (CI) 1.1-1.6]. Allergic-type reactions were more common with the sponge in both trials, although the frequency of discontinuation for discomfort differed in the two trials. Other randomized controlled trials will be needed to resolve the role of spermicides in preventing sexually transmitted infections or in causing adverse effects.

Contraceptive Devices, Female↗
PubMed1972

Animal tests suggest no cancer risk for the pill.

Tests carried out over several years on rats and mice for the possible carcinogenicity of the constituents of oral contraceptives have satisfied the British Committee on Safety of Medicines that there is no carcinogenic hazard to women. The experiments are discussed in a recent publication of the Committee and were continued at varying dosages for most of the lives of the animals involved (both male and female). Progestagens and estrogens were tested both separately and together at a low dose (2-5 times the human dose), a medium dose (50-150 times the human dose), and a high dose (200-400 times the human dose). Only at the medium and high doses were any benign or malignant tumors found in any organs, and these were not always seen in both species of animal tested. While the results are complex, and it is difficult to transfer the experience gained with 1 species to another, the Committee concluded: "Although a carcinogenic effect can be produced when some of the preparations are used in high doses throughout the life-span in certain strains of rat and mouse, this evidence cannot be interpreted as constituting a carcinogenic hazard to women when these preparations are used as oral contraceptives." Long-term experiments on dogs and primates are continuing in the US, and their results will be carefully s crutinized by the Committee when they become available. On present evid ence, however, based on the results of the rat and mice experiments and the added clinical experience and physiological knowledge of the last few years, the Committee has opened the way for a number of new Pills to be licensed for the British market. 10 new preparations are expected to appear - 5 "minipills" or progestagen-only preparations, of which 3 have already been registered, 4 combined oral contraceptives, and 1 sequential preparation.

Animals, Laboratory↗
PubMed1989

Potential acceptors of Norplant implants in comparison with recently sterilized women in Sri Lanka.

This paper analyzes data from a population-based survey fielded in Sri Lanka, which showed that almost half of the women interested in using Norplant contraceptive subdermal implants were actually those who wanted to limit childbearing, a pattern also found in international Norplant clinical studies. A comparison between recently sterilized women and professed limiters of potential Norplant users showed the limiters to be socio-economically and demographically a significantly different group of women from those sterilized. Among several variables analyzed, the most important factor distinguishing the two groups was their relative economic status. Further comparison of the limiters with professed spacers interested in using Norplant showed that the spacers were yet another distinct category of women, the most important characteristic distinguishing between the two groups being the total number of living children. The preliminary results suggest that the Norplant implants system is not necessarily a substitute for sterilization; it appears potentially a popular method among those who want no more children but are not ready to accept sterilization. These findings that the potential Norplant implant users represent different gradients of women in the population have implications for provider counseling and user satisfaction as well as continuation.

Adolescent↗
PubMed1990

Clinical acceptability of monophasic gestodene.

The monophasic low-dose contraceptive containing 30 micrograms of ethinyl estradiol and 75 micrograms of gestodene has been tested in numerous clinical studies to determine contraceptive reliability, cycle control, and influence on metabolism and to uncover concomitant symptoms. Clinical data have been derived from continuous phase III studies. Now that the preparation has been introduced in several countries, the opportunity to assemble comprehensive experience has been taken by initiating phase IV studies. Documentation on 600,000 therapy cycles with monophasic gestodene among 100,000 women is already available. The drop-out rate was low. A large number of women participated in the clinical studies for a long time--some up to 3 years. Study results showed that contraceptive reliability was high and cycle control was excellent. The gestodene combination was well tolerated. The frequency of concomitant symptoms was low. The monophasic gestodene meets the basic criteria essential for an oral contraceptive.

Adult↗
PubMed2000

Teen compliance with contraception. Analysis Of the ohio medicaid claims data

Background: Teen pregnancy is an important and costly issue for society and often commits the mother to a life of poverty. Physicians play an important role in preventing teen pregnancy by identifying teens at risk for pregnancy and prescribing contraception. This study examines for the first time, whether pharmacy data can be used to evaluate teens' compliance with contraception. Such a method may be useful to physician groups, health plans or state agencies to identify teens at risk for unwanted pregnancy and target interventions.Methods: Secondary analysis of the Ohio Medicaid Claims Data from 1998 was done identifying continuously enrolled young women ages 12-19 years, at high risk for pregnancy defined by ICD 9 codes for an STD, an abnormal pap smear, contraception, or a CPT code for a pregnancy test.Results: Between 1/1/98-3/31/98 we identified 4009 females, ages 12-19 years at high risk for pregnancy. During the study interval, 1084 (27%) became pregnant. 1732 (43%) used no prescription contraception and 1190 (30%) used a method at some time. Depo only (551) and OCP only (552) use was equal. Eighty-three combined the use of Depo and OCP. Compliance was poor. Only 20% of the contracepting group had coverage for the full year and approximately 30% used a method for 3 months or less. There was little difference in age or concurrent chronic physical or mental illness between the contracepting and non-contracepting groups. General practice physicians provided 40% of the OCP prescriptions to teens compared with 36% Ob/Gyn, 10% Pediatrics, and 6% Internal Medicine.Conclusions: Analysis of pharmacy data to evaluate the contraceptive compliance of teens at high risk for pregnancy demonstrated poor compliance. This may be a useful tool for identifying teens at risk for unwanted pregnancy and targeting interventions.

Journal Article↗
PubMedDate not supplied

Fertility and family planning in Vietnam: evidence from the 1994 Inter-censal Demographic Survey.

Results from the 1994 Vietnam Inter-censal Demographic Survey reveal substantial change over recent years in reproductive behavior and attitudes. Fertility has continued to decline to a level not far above a total fertility rate of three children per woman. Compared with the late 1980s, contraceptive knowledge has broadened and contraceptive prevalence has increased, reaching a level of 65 percent of currently married women of reproductive age. The dominance of the IUD among modern methods has been reduced somewhat. Stated family-size preferences have shifted noticeably downward. Recently married women indicate that they want only 2.3 children, on average, suggesting that fertility will continue to fall in coming years. These findings suggest that Vietnam is in the midst of a transition that will lead to low levels of fertility in the near future.

Abortion, Induced↗
PubMed1994

Increased 8-hydroxydeoxyguanosine in kidney and liver of rats continuously exposed to copper.

Copper is a ubiquitous metal in the environment, it is a component of dental casting gold alloys and dental amalgams, and it is a main component in some intrauterine contraceptive devices (IUDs). Since copper materials implanted in the human body corrode and release ions into the surrounding tissue, the potential toxicity caused by contact of this metal with bodily fluids needs to be evaluated. We implanted male Wistar rats with osmotic mini pumps that continuously administered saline, CuCl2, or a copper chelate, cupric nitrilotriacetate (Cu-NTA), at a rate of 4 mg copper/kg body wt/day. This experimental design maintained serum copper concentrations at a level 30-70% (CuCl2) or 100-120% (Cu-NTA) higher than in untreated controls. At different times postimplantation, we measured the levels of 8-hydroxydeoxyguanosine (8-OHdG) in DNA of kidney, liver, and tissue surrounding the pump implant, since production of 8-OHdG has been associated with mutagenesis and carcinogenesis. Hepatic and renal levels of 8-OHdG in CuCl2- or Cu-NTA-treated animals were significantly higher than in control animals. In contrast, histopathologic changes in kidneys and livers of rats exposed to CuCl2 and Cu-NTA were limited to mild changes involving hepatic focal necrosis and slightly increased mitotic activity in the renal proximal tubules. These observations suggest that levels of 8-OHdG could be an early marker of copper toxicity. It is unlikely that the high levels of copper at which we observed DNA modification will be encountered after occupational or environmental exposure. A different situation could be found around medical devices that include copper, particularly IUDs, where the amount of copper administered in our experiments could be released in the uterus of women after a few months of continued IUD use.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2006

A public health success: understanding policy changes related to teen sexual activity and pregnancy.

Teenage pregnancy prevention has long been on the American public health agenda. Over the past decade, a number of concurrent federal, state, and local policies have responded to the myriad and diverse needs of adolescents, from supporting adolescents who have not initiated sexual intercourse to strategies aimed at avoiding a repeat pregnancy among teenage parents. Key policies, including comprehensive family life education, access to contraceptive care, and youth development, have resulted in delays in sexual debut, improved contraceptive use, and have achieved reductions in pregnancies, abortions, and births. Although improvements are documented across all ethnic and racial subgroups, substantial health disparities continue to exist. Synergistic policy approaches represent a substantial change from the past when narrow, single-issue strategies were adopted and were limited in their effectiveness. Renewed efforts to implement narrow policy approaches (e.g., abstinence-until-marriage or restrictions to contraceptive access) need to be considered in light of existing research findings.

Adolescent↗
PubMed2004

Fatty acid reesterification but not oxidation is increased by oral contraceptive use in women.

We evaluated the hypothesis that fatty acid reesterification would be increased during rest and exercise in the midluteal menstrual cycle phase and during oral contraceptive use, when ovarian hormone concentrations are high, compared with the early follicular phase. Subjects were eight moderately active, weight-stable, eumenorrheic women (24.8 +/- 1.2 yr, peak oxygen consumption = 42.0 +/- 2.3 ml.kg(-1).min(-1)) who had not taken oral contraceptives for at least 6 mo. Plasma free fatty acid (FFA) kinetics were assessed in the 3-h postprandial state by continuous infusion of [1-(13)C]palmitate and [1,1,2,3,3-(2)H]glycerol during 90 min of rest and 60 min of exercise at 45% and 65% peak oxygen consumption in the early follicular and midluteal menstrual cycle phases and during the inactive- and high-dose phases following 4 mo of oral contraceptive use. Plasma FFA rates of appearance, disappearance, and oxidation increased significantly from rest to exercise with no differences noted between menstrual cycle or oral contraceptive phases or exercise intensities. Compared with either menstrual cycle phase, oral contraceptive use resulted in an increase in plasma-derived fatty acid reesterification and a decrease in the proportion of plasma FFA rate of disappearance that was oxidized at rest and during exercise. Endogenous and exogenous synthetic ovarian hormones do not exert a measurable influence on plasma FFA turnover or oxidation at rest or during moderate-intensity exercise in the 3-h postprandial state when carbohydrate use predominates. The increase in whole body lipolytic rate during exercise noted previously with oral contraceptive use is not matched by an increase in fatty acid oxidation and results in an increase in reesterification. Synthetic ovarian hormones contained in oral contraceptives increase lipolytic rate, but fatty acid oxidation during exercise is determined by exercise intensity and its metabolic and endocrine consequences.

Adult↗
PubMed1996

The effect of desogestrel, gestodene, and other factors on spotting and bleeding.

Spotting and bleeding are among the most common side effects associated with oral contraceptive (OC) use and their occurrence is a prime determinant of whether a new user will continue to use OCs. Desogestrel and gestodene are two new progestins that were developed in part to minimize the occurrence of these side effects. Assessing the effect of these progestins is difficult, however, in part because their effects may be subtle, requiring a large sample size and possibly being overshadowed by other factors. To address these issues, we analyzed data from two comparative multicenter clinical trials that included 15,421 cycles among 2767 women. One study compared 75 micrograms gestodene + 30 micrograms ethinyl estradiol (EE) with 150 micrograms desogestrel + 30 micrograms EE, the other compared the same gestodene preparation with 150 micrograms desogestrel + 20 micrograms EE. Both studies found a higher risk of spotting or bleeding in all cycles among users of the desogestrel-containing preparation, with the differences ranging between 20% and 70% higher for the first study and 40% and 140% in the second. These differences were statistically significant in four of six cycles in each study and persisted after controlling for consistency and recency of OC use as well as smoking. After pooling the data and controlling for estrogen dose, the desogestrel-containing preparation was significantly associated with more frequent spotting or bleeding in five of six cycles. Smoking and consistency and recency of OC use were also independent predictors of spotting or bleeding.

Adolescent↗
PubMed1999

Young women taking isotretinoin still conceive. Role of physicians in preventing disaster.

QUESTION: One of my adolescent patients was prescribed isotretinoin for severe acne by a dermatologist. I was shocked to discover she does not use any means of contraception. The dermatologist insists he told her about the need for contraception. How can we do better? ANSWER: Clearly this dermatologist, like many of his colleagues, does not comply with the Pregnancy Prevention Program. Until physicians become more aware of this program, babies will continue to be born with embryopathy due to isotretinoin.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Hormonal status, fertility, and pregnancy before and after bariatric surgery.

At the present time, the exact etiology and developmental course of obesity in many individuals is still being debated. The majority of healthcare professionals are in agreement, however, that morbidly obese persons are at risk for a wide range of health problems, both before and after bariatric surgery. Obesity is, unfortunately, a condition in which the disease as well as the available treatments have the potential to cause serious alterations in health status. The average candidate for bariatric surgery has experienced decades of varying degrees of obesity as well as multiple failed dietary and medication regimens. As a result of almost continual physiologic instability, these individuals typically are subject to a wide range of hormonal imbalances. Since the majority of persons who are obese, and those seeking bariatric surgery, are women, it is important for healthcare providers to understand how these hormonal fluctuations can have a devastating impact on sexual and reproductive function. Although the research to date has been limited, studies have demonstrated changes in fertility, contraceptive response, and pregnancy outcomes in obese women, as well as obese women who undergo bariatric surgery. As morbid obesity continues to increase in incidence in the female population, greater numbers of women will seek bariatric surgery, and, as a consequence, experience some of the untoward effects shown to date. Addressing the concerns of these patients, both before and after surgery, will continue to be a complex and challenging task.

Female↗
PubMed1998

Adverse effects associated with contraceptive implants: incidence, prevention and management.

Contraceptive implants are increasingly being used for fertility regulation all over the world. Reversible long-term use is their most appealing feature for many users. They have the practical advantage of overcoming the risks of user failure and low continuation rates associated with other methods that require continuous attention or motivation. Disruption of menstruation, complications of insertion and removal, and infection at implant site, constitute the majority of adverse effects associated with contraceptive implants. This article reviews these various common adverse effects associated with contraceptive implants and their possible management and prevention. In addition, we also discuss very rare events, like psychiatric disorders, pseudotumor cerebri, thrombotic, thrombocytopenic purpura and thrombocytopenia, that have been reported by some researchers. Further surveillance and research is necessary to determine if these rare adverse events are causally related to contraceptive implants. Until such a time, providers of contraceptive implants should be more selective in prescribing the contraceptive implants, especially in women with a history of and/or risk factors for stroke, cerebral and coronary heart disease, thrombocytopenia and pseudotumor cerebri.

Adolescent↗