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PubMed2001

Contraceptive practices of women after abortion in Turkey.

OBJECTIVES: The aim ofthis study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the 1-year follow-up period were also assessed. METHODS: Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion family planning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-up for 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period. RESULTS: Following counselling, 79.64% of the patients signed for immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten out of 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs) (n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively. At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). In one case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up. CONCLUSION: The use of postabortion family planning significantly decreased the postabortion pregnancy rate. The use of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptable in our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate on the ideal conditions for conception or they do, in fact, practice some form of family planning.

Abortion, Induced↗
PubMed2002

Increasing contraceptive acceptance through empowerment of female community health volunteers in rural Nepal.

The purpose of the study was to enhance contraceptive acceptance among currently-married women of reproductive age (CMWRA) through empowerment training of female community health volunteers (FCHVs). Seventeen FCHVs, who were working in Kakani Village Development Committee in the hills of central Nepal, attended an empowerment training that used participatory action research and reinforcement mechanisms. Following the training, the FCHVs were expected to empower the CMWRA to increase their contraceptive use. The impact of the intervention was assessed in a sample of 241 CMWRA, who were neither pregnant nor using contraceptives at the time of selection, by interviewing them before and six months after the intervention. The implementation of the intervention significantly increased the proportion of CMWRA knowing at least one contraceptive method (chi2(ldr)=71 .7, p=0.001). The use of modern contraceptives among the CMWRA from none before the intervention increased to 52.3% six months following the intervention. Satisfaction of the CMWRA with services provided by the FCHVs also significantly increased. The study concludes that empowerment training of FCHVs using participatory action research and peer reinforcement help increase the acceptance of contraceptives among CMWRA.

Adult↗
PubMed2003

Transdermal delivery of sex steroids for hormone replacement therapy and contraception. A review of principles and practice.

The percutaneous route is an effective method for delivery of reproductive hormones. Several transdermal therapeutic systems (TTS) releasing estrogens, progestogens and androgens from patches attached to the skin are currently in clinical use. For women, transdermal systems have been developed for hormonal replacement therapy (HRT) and recently for contraception. HRT with patches releasing only estradiol (E2) should be supplemented with a progestogen to protect the endometrium. Patches simultaneously releasing both E2 and a progestogen are also available. Combined regimens are either continuous or sequential. In the latter, estrogen-only patches are applied for 14 days, followed by 14-day application of patches releasing both hormones. Transdermal HRT successfully treats menopausal symptoms and has a bone-sparing effect. Transdermal contraceptive patches deliver ethinyl E2 in combination with the progestogen norelgestromin. This system provides an effective contraceptive and acceptable bleeding pattern not different from that of oral contraceptives. The types of adverse events experienced are approximately the same as with oral contraceptives. Reactions at the application site cause about 3% women to discontinue the use of patches. Transdermal systems also have been designed to supplement testosterone in hypogonadal men. Testosterone released from patches produces positive effects on mood and sexual behavior and significantly increases bone mass. Men using testosterone patches have to be regularly monitored for an increase in prostate volume and changes in prostate-specific antigen. Reproductive steroids delivered by the skin avoid first-pass liver metabolism, typical of oral dosing; consequently, the liver tissue is affected to a lesser degree. Other advantages include rapid onset and termination of action, noninvasive self-administration and attainment of therapeutic hormone levels with low daily doses. Reduced frequency of dosing has the potential to improve patient compliance. While compliance is important for any hormone, it is particularly important for contraceptive purposes. Like oral delivery of sex steroids, percutaneous absorption is characterized by intra- and interindividual variability. New technologies under development, combining electronics and low-frequency ultrasound, have the potential to provide precise dosing as well as drug delivery "on demand."

Administration, Cutaneous↗
PubMed2003

[Medication of the month. Evra: first contraceptive transdermal patch].

Evra is a transdermal patch releasing 20 micrograms of ethinylestradiol and 150 micrograms of norelgestromin/day during one week. The circulating levels of steroids attained are of similar amplitude though steadier than after intake of an oral combined low-dose estrogen-progestin pill. The transdermal method is user-friendly and is abided by a high degree of acceptability, and a low level of skin irritability. Its contraceptive effectiveness is similar to that conferred by oral contraceptives except if the treated woman is over 90 kg, in which case Evra should not be prescribed. Cycle control is excellent and similar to that of triphasic pills. Adverse effects and tolerance are comparable to those described with low-dose oral contraceptives with a slight estrogen dominance. Lipid and glucose metabolism as well as coagulation are influenced in the same way. Gastrointestinal disturbances (nausea, vomiting) do not prevent the efficacy of the transdermal patch. Compliance with Evra is significantly higher than with oral combined contraceptives--a major point for an effective contraception. Accordingly, Evra constitutes an useful addition to the current array of contraceptive methods.

Administration, Cutaneous↗
PubMed2004

[Emergency contraception with levonorgestrel in adolescents].

OBJECTIVE: The aim of the study was to asses effectiveness and adverse reactions in adolescent girls received Postinor (0.75 mg Levonorgestrel) for emergency contraception. METHOD: Forty-two teenage girls with established regular menstrual cycles for 24 months period and 128 intercourses are included. Excluding criteria are: clinical data for gynecological endocrine diseases, other contraceptive methods used and contraindication for using gestagens. The girls received tablets Postinor containing 0.75 mg levonorgestrel in dosage 1 or 2 pills after non-protected sexual contact. Before the study the girls are examined for their knowledge about fertile period of the menstrual cycle, opportunities of hormonal contraception and about their ability to make adequate decisions in unpredicted situations and complications of the unprotected or inadequate protected intercourse. RESULTS: No one pregnancy occurred during the study period. Main first adverse reactions after receiving Postinor were nausea (12.4%) and intermenstrual bleeding (30.9%), persisting up to three days. Systemic adverse reactions reported from the women were breast tenderness (11.2%), dizziness (6.5%) and headache (5.6%). These side effects were mild and did not require treatment. CONCLUSION: Emergency contraception with Levonorgestrel is effective, with less contraindications compared with other emergency contraception methods. Postinor is available and reliable contraceptive medication.

Adolescent↗
PubMed1986

The contraceptive and hormonal requirements of the premenopausal woman: the years from forty to fifty.

There is a growing awareness that many women over 40 require both contraceptive protection and hormonal replacement for the symptoms of the climacteric. These women are still menstruating and the risk of pregnancy remains, overshadowed by the increased life-threatening risk due to childbirth in this age group. The risk of mortality due to the use of oral contraceptives is little increased for the nonsmoking woman in the over 40 years compared with the years under 40. In contrast, women over 40 who smoke are best advised not to use hormonal contraceptives. It is evident from all the existing data that combination therapy is strongly advised if any replacement therapy is to be given a woman. There is considerable evidence suggesting that estrogen alone may be insufficient therapy and progestogen should be added to prevent endometrial hyperplasia, decrease the risk of breast cancer and prevent bone loss. In the premenopausal woman, such therapy should also provide contraception. Many physicians allow women 35 to 45 who do not smoke to continue on an oral contraceptive if there is no contraindication. However, a minimum-dose product has yet to be found close to the ideal of fulfilling both the contraceptive and therapeutic needs of women traversing a physiologically very hazardous period.

Adult↗
PubMed1988

High school students' attitudes towards and use of contraceptives.

A questionnaire survey was conducted in an urban coeducational secondary school in the North Island region. Of the 162 adolescents sampled in this study, 39 percent reported coital experience. Of these coitally experienced students, contraception was always used by only 42%. The pill and the condom were reported as the most used contraceptives. Females were found to be significantly better contraceptive users than males. Although many students report preferring their parents as a source of contraceptive information, the majority of both males and females relied upon school sex education classes as their main source of their contraceptive education. Students ability to discuss contraceptive matters with parents was found to have no effect upon coital activity. These results indicate that society must come to terms with the fact that many adolescent New Zealanders are sexually active and run a high risk of having unplanned, unwanted pregnancies.

Adolescent↗
PubMed1979

Human cervical mucus. V. Oral contraceptives and mucus rheologic properties.

Mucus viscoelasticity on individual samples obtained from patients using combination oral contraceptives was quantitated by microrheometry. These results, in conjunction with mucus chemical characterization, indicate that combination oral contraceptive use eliminates the cyclic variations in mucus chemical, physicochemical, and rheologic properties associated with the ovulatory menstrual cycle. A correlation was demonstrated between the mucus elastic modulus and mucus nondialyzable dry weight, and the mucins produced during oral contraceptive therapy were shown to be similar to those recovered from ovulatory donors. Differences in mucus properties were noted when donors using estrogenic contraceptives were contrasted with those using androgenic contraceptives. On the basis of established relationships between sperm penetrability and mucus solids content, it was concluded that the use of contraceptives, as examined in this study, provided a secondary degree of fertility control at the cervical level.

Cervix Mucus↗
PubMedDate not supplied

Ethnic differences in contraceptive use in Sri Lanka.

In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.

Adult↗
PubMed1983

[Hormonal contraception - possibilities and problems].

The wide-spread usual habits of contraception plead for the fact that hormonal contraceptives after a longer time, possibly till beyond the change of the millennium, will be applied as the most secure remedy of prevention of pregnancy. The author deals with the hormonal contraceptives being at the disposal in the GDR, such as combination preparations, sequential preparations week pill, minipill, postcoital contraception. It is referred to the fact that the variety of hormonal contraceptives being at our disposal is fully to be used and the prescription has to be done corresponding to the hormone-depending symptoms on the basis of the anamnesis. Mode of intake, reliability, control measures, the pro and contra of an interval in taking the pill, the prescription to young girls as well as the subdivision of the side-effects on account of their clinical importance are treated. The criteria which lead to the assessment of innocuousness and tolerability are also to be taken into consideration as the evidence got by casuistics, controlled clinical studies and epidemiological studies and its possible misinterpretations. The argument takes place on the basis of the mortality risks for cardiovascular diseases. The necessary consequences are pointed out: establishment of the mortality risks on the basis of GDR-owned cohort- and trohoc-studies, differentiation of the findings not only according to the hormonal contraceptives in general, but preparation-specific, increase of the autoresponsibility of the user.

Contraceptives, Oral↗
PubMed1998

Recent advances in contraception.

BACKGROUND: Advice regarding contraception, the means of fertility regulation for millions of women, is part of a general practitioner's bread and butter work. The area is however, developing at a rapid pace with the refinement of hormonal methods and the development of new and easier modes of delivery. OBJECTIVE: This article will review the results of recent studies in the area of reproductive health that better clarify the critical issues in the prescription and use of contraceptives. It will also describe contraceptive products that will soon be available in Australia. DISCUSSION: General practitioners need to convey the results of this research to patients so that they may make informed contraceptive choices based on evidence. Patients should also be made aware of all of their contraceptive options as well as the availability of emergency contraceptives.

Australia↗
PubMed1976

[Effect of oral contraceptive on the pituitary and plasma L.H. levels and on the hypothalamic LH-RH level (author's transl)].

The effects of the oral contraceptive on the pituitary content and plasma level of LH and the hypothalamic LH-RH level were investigated in 16 adult female rabbits. The oral contraceptive preparation, Sophia-C (Norethindrone 2mg + Mestranol 0.1 mg), as administered orally by a stomach tube each day for 7 days in 8 adult female rabbits. At the end of the treatment, the rabbits were bled from the abdominal aorta into heparinized syringes and the plasma was separated. The stalk median eminences were excised. All the materials were stored in -80 degrees C until assayed. Plasma level and the pituitary content of LH and the hypothalamic LH-RH were measured by radioimmunoassay. All the dose response curved were drawn using logitlog transformation. Radioimmunoassay procedures for LH was described in detail elsewhere. Purified rabbit LH for iodination (125-I) and strandard were prepared by T. Makino and R.O. Greep, at Research Laboratories for Human Reproduction, Harvard Medical School, Boston, U.S.A. The starting B/T was 25% at the final dilution of the antibody of 1/20,000. Minimal detectable quantity was about 40 pg/tube. The 50% intercepts were approximately 460 pg/tube. Radioimmunoassay procedures for LH-RH were performed according to the method described by Arimura et al. Antiserum against synthetic LH-RH was kindly supplied to us by Drs. A. Arimura and A.V. Schally, New Orleans, U'S.A. The synthetic LH-RH was kindly supplied to us by Dr. N. Yanaihara. The starting B/T ratio was 29% at the final dilution of the antibody of I/17,500. Minimal detectable quantity was about 40pg/tube and the 50% intercepts were 150pg/tube. It has been assumed that oral contraceptive drugs exert their action by blocking the hypothalamic LH-RH, resulting in a depression of the plasma level of LH, because plasma level of LH returned to the normal level when LH-RH was administered intravenously even while oral contraceptive steroids were given continuously. However, these findings concerning the site of action of the drugs furnished only indirect evidences. The possibility of a direct inhibitary effect of these steroids on the anterior pituitary cannot be ruled out. Administration of 2mg of Norethindrone and 0.1mg of Mestranol significantly depressed both the pituitary content and the plasma level of LH. On the other hand, they significantly increased the hypothalamic LH-RH level. Those findings strongly suggested the direct action of this drug on the anterior pituitary in the female adult rabbits. Detailed mechanisms on how the hypothalamic LH-RH was increased were not known in this experiment, further investigations are now in progress.

Animals↗
PubMed1982

Two oral contraceptives, efficacy, serum proteins, and lipid metabolism. A comparative multicentre study on a triphasic and a fixed dose combination.

A triphasic, combined oral contraceptive containing 30 - 40 - 30 micrograms ethinyloestradiol (EE), and 50 - 75 - 125 micrograms levonorgestrel was compared with a fixed dose combination containing 30 micrograms EE and 150 micrograms desogestrel in a randomized multicentre trial in 193/199 women and 1 063/1 073 cycles, respectively. The duration of the trial was six months. Eleven centres in Denmark, Sweden, and Norway participated. Contraceptive reliability, bleeding control and side effects were evaluated. Influence on serum sex hormone binding globulin (SHBG) and transcortin was assayed as well as lipid metabolism. Three pregnancies occurred in the group using the triphasic regimen but none in the fixed dose regimen. Two of the three pregnancies were considered drug failures and the third a possible interaction. Possible reasons for the triphasic contraceptive failure are discussed with special reference to a British report on eight pregnancies. Bleeding control appeared to be equally good for the two preparations. However, the number of cycles with spotting, breakthrough bleeding and missed withdrawal bleeding were above the levels reported earlier on the triphasic regimen. About 80 per cent of the women completed the planned six months on either combination. Side effects were generally mild and in accordance with earlier reports on low dose oral contraceptives. Metabolically the triphasic levonorgestrel combination increased SHBG 100 per cent versus 200 per cent for the fixed desogestrel combination. Transcortin rose about 98 and 110 per cent, respectively. Both preparations induced similar changes in the levels of lipids and lipoproteins with the exception of a significant increase in the arachidonic content of cholesterol during treatment with the desogestrel-containing preparation.

Adolescent↗
PubMed1992

Oral contraceptives and risk of benign proliferative epithelial disorders of the breast.

In a case-control study conducted in Adelaide, South Australia, we investigated the hypothesis that use of oral contraceptives is associated with increased risk of benign proliferative epithelial disorders (BPED) of the breast, conditions strongly associated with increased risk of breast cancer and thought to have pre-malignant potential. The study was restricted to women with no prior history of breast biopsy, and involved 383 cases of biopsy-confirmed BPED, 192 controls whose biopsy did not show epithelial proliferation, and 383 unbiopsied community controls individually matched to cases by age and socio-economic grading of area of residence. When cases were compared with community controls, the adjusted odds ratio (OR) for the association between ever-use of oral contraceptives and risk of BPED was 1.1 (95% CI 0.7 to 1.7), while when cases were compared with biopsy controls, the adjusted OR was 0.9 (95% CI 0.5 to 1.5). There was little variation in risk of BPED with total duration of use of oral contraceptives, and with duration of use before first pregnancy, while current users had a statistically significant 60% reduction in risk, irrespective of the control group used for comparative purposes. Also, there was little variation in risk with years since first and last use of oral contraceptives, and there was no trend in the association between ever-use of oral contraceptives and risk of BPED by degree of cytological atypia.

Adult↗
PubMed1986

Opioid regulation of pituitary gonadotropins and prolactin in women using oral contraceptives.

To determine the effect of oral contraceptives on endogenous opioid modulation of the hypothalamic-pituitary axis, we gave a bolus dose of 10 mg of naloxone intravenously in women using Lo/Ovral-28 oral contraceptives and in normal (control) women during the follicular (days 8 to 9) and luteal (days 21 to 23) phases. Plasma follicle-stimulating hormone, luteinizing hormone, and prolactin were measured by radioimmunoassay before and after naloxone at regular intervals. In oral contraceptive users (n = 5) basal plasma follicle-stimulating hormone (3.7 +/- 0.4 mIU/ml) and luteinizing hormone (3.2 +/- 0.5 mIU/ml) levels were significantly lower than in control subjects during both follicular (10.7 +/- 0.9 and 16.7 +/- 2.0) and luteal (7.7 +/- 1.4 and 10.0 +/- 0.9, respectively) phases (p less than 0.05 to 0.001). In contrast the basal plasma prolactin level was significantly higher in oral contraceptive users (25.0 +/- 4.1 ng/ml) than in control subjects during the follicular (11.8 +/- 1.2) and luteal (11.0 +/- 0.8) phases (p less than 0.01). In control subjects, follicle-stimulating hormone, luteinizing hormone, and prolactin levels did not change significantly after naloxone in the follicular phase, but naloxone elicited a significant synchronous release of luteinizing hormone and prolactin during the luteal phase. In contrast, oral contraceptive users showed increases in luteinizing hormone and prolactin after naloxone that were not significantly different from the basal plasma levels.

Adult↗
PubMed1985

Interaction of anticonvulsants and oral contraceptives in epileptic adolescents.

Oral contraceptives are in widespread use, and are commonly prescribed for contraception in patients taking other medications. An example of this is the concomitant use of oral contraceptives and anticonvulsants in epileptic patients. This combination creates a potential for drug interactions which may alter the efficacy of both medications. An apparent interaction between oral contraceptives and anticonvulsants was observed in this study of epileptic adolescent females. This interaction was evidenced by menstrual irregularities which occurred in 65% (7 of 11) of adolescents on both medications concomitantly. The frequency of irregularity was significantly higher in these adolescents when compared to adolescents on either medication alone. Irregularities appeared to be alleviated by increasing the strength of the oral contraceptive, and although a concern, the increased dosage did not affect seizure control.

Adolescent↗
PubMed1994

Acceptability of the once-a-month injectable contraceptives Cyclofem and Mesigyna in Egypt.

A study of the acceptability of two once-a-month injectable contraceptives, Cyclofem and Mesigyna, in Egypt included 1091 women participating in the clinical trial of the two methods carried out during the period from November 1989 to July 1992. The acceptability of the two contraceptives proved to be high when measured by the rate of continuation at 12 months of injectable use, by method satisfaction, service satisfaction, rec recommending use to others, intent of future use, as well as willingness to pay for them when the injectables are marketed. The most important determinants of use discontinuation were young age, large family size, first time contraceptive use, previous experience with menstrual problems, dissatisfaction with clinic services, lack of counseling, lack of social support, as well as the husband's negative attitude towards contraceptive use. Side effects were more frequently reported by discontinuers; however, continuers appeared to be more tolerant of the same side effects. This study provided in-depth information about the social aspects affecting the acceptability of monthly injectable contraceptives in the different Egyptian localities, in addition to its being useful in monitoring activities in the clinical setting during these trials.

Attitude↗
PubMed1981

The first abortion - and the last? A study of the personality factors underlying repeated failure of contraception.

The causes leading to a second abortion were outlined in a psychological study comparing 30 women expecting a second abortion with 29 women who had successfully prevented conception after a first abortion. It was found that both groups improved their contraceptive practices after the first abortion. However, while the latter group continued with their improved practices, the former group went back to the earlier inefficient or non-existent contraceptive behavior. The inability to improve contraception in the long run was not related to differences in educational level or knowledge about contraceptive techniques but to the developmental level of personality structures. The women expecting their second abortion rated lower in control of impulsivity, emotional balance, realism, self-esteem and stability of life as well as capacity for more integrated personal relationships. The differences in personality development and consequently in the capacity for long-term contraception were found to be due to growth conditions in childhood.

Abortion, Legal↗