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PubMed1983

Effects of continuous levonorgestrel treatment (subcutaneous capsules) on the lipoprotein and carbohydrate metabolism in fertile women.

The lipoprotein and carbohydrate metabolism was studied during contraceptive treatment with levonorgestrel, released at a low rate (70 micrograms/day) from subcutaneous capsules, in five women who were treated for 180-403 days. The serum cholesterol concentration decreased slightly but significantly during treatment. This was attributable to a tendency to a reduction of cholesterol in high-density lipoproteins. The treatment did not affect the lipoprotein lipase activity in adipose tissue. The elimination rates of intravenously injected fat and glucose were unchanged, as were the serum insulin concentrations. Thus, in this pilot study the concentration and composition of the serum lipoproteins altered to only a minor extent during treatment with levonorgestrel in a dose of 70 micrograms/day.

Adult↗
PubMed1995

The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods.

A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of combined and progestogen-only oral contraceptives on well-being and sexuality of women in two contrasting cultures. One-hundred-fifty women, who had been sterilised or whose partners had been vasectomised, were recruited from two centres-Manila, Philippines, and Edinburgh, Scotland. After one month pretreatment assessment, women were randomly assigned to one of three treatments (combined oral contraceptive (COC), progestogen-only pill (POP), or placebo; 50 within each treatment group, 25 per centre) and continued on treatment for four months. Assessment was by daily ratings, questionnaires and interviews. The COC adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The POP was associated with no adverse effects on sexuality and some improvement in well-being in both centres. Possible explanations for the apparent lack of adverse effects in the Manila women are discussed. The negative effects reported may be less evident in women using the COC for contraceptive purposes but may lead to discontinuation in some women and warrant further investigation.

Adult↗
PubMed1998

Norplant as a contraceptive device in Enugu, eastern Nigeria.

This paper is an evaluation of acceptability and use-experience with the contraceptive device Norplant at the University of Nigeria Teaching Hospital, Enugu, Eastern Nigeria. Over a period of 36 months, 173 women (8% of the clinic population) accepted the implant. Use of Norplant was concentrated among high-parity women, and the proportion of Norplant users was highest among women aged 30-34 years. Comparing Norplant and IUD users, we found Norplant users to be significantly less highly educated with < 1% of Norplant users having tertiary education compared to 25% of new IUD users. The continuation rate with Norplant was 89% at three years, suggesting this method has the potential for improving the low contraceptive prevalence in this region.

Age Distribution↗
PubMed1984

[Postcoital contraception with steroid hormones].

Large doses of estrogens employed for postcoital contraception have definitely been shown to be effective, but estrogens used in such high doses would result in a high incidence of side-effects. Therefore this method should be reserved for the occasional emergency. Postcoital estrogen-progestogen-combination is suitable for women exposed to an isolated act of intercourse in midcycle. The advantage of this method is the possibility of a delayed administration after intercourse. Progestogens alone can be used after each coital exposure. One of the most frequent problems is the alteration of the menstrual pattern. Continued use can be recommended for women with occasional intercourse in cycle. Possible mechanisms of action of steroidal postcoital contraceptives are discussed involving problems of this contraceptive method.

Contraceptives, Oral, Combined↗
PubMed1975

Knowledge, attitudes, and practice of family planning in Singapore.

The First National Survey on Family Planning in Singapore was designed to gather data that would aid in evaluating the program of the National Family Planning and Population Board and the influence of government population policies on attitudes toward family planning. Interviews with 2,078 currently married women aged 15--44 revealed high levels of contraceptive knowledge and use, satisfaction of clinic users with the Board's services, and attitudes that favor greater acceptance of abortion and sterilization. Continued promotion of the concept of the two-child family appears necessary in light of divided opinions of respondents on this government recommendation.

Abortion, Legal↗
PubMed1994

Aspects of roaccutane prescription in South Africa.

A nationwide postmarketing surveillance study on the use and outcomes of use of isotretinoin has been conducted in South Africa. A representative sample of prescribers of the drug was identified from drug utilisation data and the overall doctor response rate was 90.1%. A total of 766 patients was enrolled in the study, of which 728 were analysable for safety and efficacy. More than half the patients prescribed isotretinoin were women, of whom only 48.25% were practising some form of contraception. The mean overall dosage prescribed was 0.64 mg/kg/day and the mean overall duration of therapy prescribed was 15.5 weeks. The mean dose and duration of therapy prescribed by dermatologists was significantly higher than that prescribed by general practitioners. Potentially dangerous drug interactions involving the concomitant use of isotretinoin with tetracyclines, vitamin A and oral contraceptives together with antibiotics were noted. Mucocutaneous drying effects were the most common adverse events and the incidence of these effects decreased with continuation of therapy. The known effectiveness of the drug was confirmed by the results of the study.

Acne Vulgaris↗
PubMed1989

Oral contraceptives and vascular disease.

This update on the cardiovascular risks of oral contraceptives unfortunately adds little to our original 1982 review for the following reasons: 1) There are many different formulations on the market, and they keep changing; 2) Women often use different formulations, stopping and starting as well as switching; 3) The statistical power of the studies often does not permit analyses by specific formulations; 4) The required information (brand name) is sometimes not collected or not collected reliably; 5) Apparently few case-control studies are being conducted to address these issues. Data that are available, interpreted cautiously, suggest either a continuance of the previously observed risk or a small to modest diminution with the use of the newer oral contraceptive formulations. The earlier advice to physicians still seems prudent and is briefly stated: 1) Try to avoid prescribing oral contraceptives for women over 35 years of age; 2) Women who smoke cigarettes should avoid using oral contraceptives, and users should not smoke; 3) Prescribe the formulation with the lowest dose and/or potency of estrogen that is effective and that does not cause unacceptable "breakthrough" bleeding; 4) Women with hypertension should be carefully monitored, and women who develop hypertension while on oral contraceptives should be switched to another form of contraception, if possible. Although oral contraceptives are the most effective form of contraception currently widely available, all risks of a contraceptive method must be compared with corresponding measures of effectiveness and with the risks of unwanted pregnancy. In particular, oral contraceptive users can reduce their risk of myocardial infarction by a reduction or elimination of cigarette smoking.

Adult↗
PubMed1991

[Levonorgestrel releasing subcutaneous implants. 1st year's experience].

This multicentric study was done in order to know the contraceptive efficacy and side effects of subdermal implants liberating levonorgestrel, in Mexican women. Results analysis, at one year, of 246 women, at four medical centers of Mexican Institute of Social Security (IMSS), showed that this contraceptive is highly efficacious, as there were no pregnancies in 2326 months of observation. The main side effects were: menstrual disorders in 34.8% of women; soreness in implantation site in 3.6%; headache in 13.4% and nausea, dizziness and vomiting in 11.6%. The most frequent causes for implant retirement were menstrual cycle alterations, and soreness at implantation site, with 7.3 and 3.5 respectively. The continuity rate at one year was 84.3, which was higher to what has been seen at the Institution with other temporal contraceptive methods, so the implants may be considered as one more alternative in family planning methods.

Adult↗
PubMed1991

Drug delivery systems. 6. Transdermal drug delivery.

Transdermal drug delivery system has been in existence for a long time. In the past, the most commonly applied systems were topically applied creams and ointments for dermatological disorders. The occurrence of systemic side-effects with some of these formulations is indicative of absorption through the skin. A number of drugs have been applied to the skin for systemic treatment. In a broad sense, the term transdermal delivery system includes all topically administered drug formulations intended to deliver the active ingredient into the general circulation. Transdermal therapeutic systems have been designed to provide controlled continuous delivery of drugs via the skin to the systemic circulation. The relative impermeability of skin is well known, and this is associated with its functions as a dual protective barrier against invasion by micro-organisms and the prevention of the loss of physiologically essential substances such as water. Elucidation of factors that contribute to this impermeability has made the use of skin as a route for controlled systemic drug delivery possible. Basically, four systems are available that allow for effective absorption of drugs across the skin. The microsealed system is a partition-controlled delivery system that contains a drug reservoir with a saturated suspension of drug in a water-miscible solvent homogeneously dispersed in a silicone elastomer matrix. A second system is the matrix-diffusion controlled system. The third and most widely used system for transdermal drug delivery is the membrane-permeation controlled system. A fourth system, recently made available, is the gradient-charged system. Additionally, advanced transdermal carriers include systems such as iontophoretic and sonophoretic systems, thermosetting gels, prodrugs, and liposomes. Many drugs have been formulated in transdermal systems, and others are being examined for the feasibility of their delivery in this manner (e.g., nicotine antihistamines, beta-blockers, calcium channel blockers, non-steroidal anti-inflammatory drugs, contraceptives, anti-arrhythmic drugs, insulin, antivirals, hormones, alpha-interferon, and cancer chemotherapeutic agents). Research also continues on various chemical penetration enhancers that may allow delivery of therapeutic substances. For example, penetration enhancers such as Azone may allow delivery of larger-sized molecules such as proteins and polypeptides.

Administration, Cutaneous↗
PubMed1994

Billings natural family planning in Shanghai, China.

With cervical mucus, or Billings, method of family planning, a woman learns to recognize the characteristics of her cervical mucus that identify the fertile phase in her menstrual cycle. She and her partner abstain from sexual activity during a period from the first indication of mucus until four days after the mucus peak day, which includes ovulation. They also abstain during menses, because mucus can be confused with menstrual bleeding. This method of family planning is used widely, worldwide, by couples seeking a natural, reliable method of family planning. Between July 1988 and May 1990, 688 couples of child-bearing age, most of whom were parous, used the Billings method for contraception. Five hundred and fifty of these couples used the method for more than 12 months. Efficacy, continuation rates, and discontinuation rates were analyzed using life-table analysis for 10,175 woman-months of data collected. The net cumulative discontinuation rates per 100 women at 12 and 18 months were 19.85 and 34.58, respectively, resulting in continuation rates of 80.15 and 65.42. The discontinuation rates per 100 women for method-related reasons at 12 and 18 months were 1.61 and 2.84, respectively, while the discontinuation rates for unintended pregnancy were 1.02 and 1.18. During the study, 67 subjects volunteered to have vaginal smears taken from the upper part of the vaginal wall for cytologic examinations, and among them serum and urine LH levels were measured in 10 subjects and urinary estrogen and progesterone were assayed in 35 cases. These tests related other indications of the menstrual cycle to the ability of the women to judge ovulation by cervical mucus. Our research suggests that further investigation of the Billings method is warranted and that careful planning and organization are needed to disseminate the method more broadly.

Cervix Mucus↗
PubMed1999

Depot medroxyprogesterone acetate use in inner-city, minority adolescents: continuation rates and characteristics of long-term users.

OBJECTIVE: To identify continuation rates of depot medroxyprogesterone acetate (Depo-Provera) and characteristics of long-term users in a population of inner-city, minority adolescents with high pregnancy rates. DESIGN: Retrospective medical record review. SETTING: An inner-city adolescent clinic and an adolescent pregnancy program. METHODS: A review of the medical records of 250 females aged 13 to 20 years (mean +/- SD, 16.8 +/- 1.1 years), 62.9% Hispanic and 34.2% African American, receiving a first depot medroxyprogesterone acetate injection for contraception between August 1993 and June 1996 was conducted using a standardized form. The mean +/- SD age at menarche of the subjects was 11.6 +/- 1.4 years, and the mean +/- SD age at first intercourse was 14.1 +/- 1.3 years; the mean number of lifetime sex partners was 2.4. Of the subjects, 73.6% had used condoms, 32.0% used oral contraceptives, and none used implants. Of the 201 subjects for whom there were data in the medical records regarding prior fertility, 172 (85.6%) had been pregnant, and 145 (72.1%) had a child. Life table analysis was used to measure depot medroxyprogesterone acetate continuation rates and to compare subgroups of adolescents. RESULTS: Depot medroxyprogesterone acetate continuation rates were found to be 70.3% at 6 months, 48.3% at 9 months, 31.5% at 12 months, and 12.8% at 24 months. The most common reason for depot medroxyprogesterone acetate discontinuation was missed appointments (41.7%). Subjects were followed up for a mean +/- SD of 1.3 +/- 0.7 years after discontinuation of depot medroxyprogesterone acetate use; 46.7% became pregnant. Among those 156 adolescents who discontinued depotmedroxyprogesterone acetate use, 40.0% restarted the method at some later time. Continuation of depot medroxyprogesterone acetate use was more likely if age at first intercourse was younger than 13 years (P = .04). Continuation rates were not related to age, ethnicity, age at menarche, number of sex partners, use of other contraceptives, prior pregnancy, or having a child. CONCLUSIONS: In this study, just less than one third of the adolescents continued depot medroxyprogesterone acetate use for 1 year or longer. This suggests that depot medroxyprogesterone acetate does not function as a long-term method for most inner-city adolescents. The only characteristic that was associated with successful continuation of depot medroxyprogesterone acetate use was young age at first intercourse, implying that experience may be the main determinant of continuation.

Adolescent↗
PubMed2004

Emergency contraception and morality: reflections of health care workers and clients.

In this study, we explore the retrospective reports of 21 US Planned Parenthood clients about their use of emergency contraception pills (ECPs) and the views of ten Planned Parenthood health care workers at two clinics about providing ECPs. We elucidate the sociological phenomena that frame emergency contraception usage: cultural ideology about contraception, sexuality, unintended pregnancy, and abortion. We focus on the ways in which interactions between health care workers and clients both mediate and reinforce such cultural ideology. Our research indicates that the distinctions between fertilization and pregnancy, between contraception and abortion, between responsible and irresponsible procreative behavior, are not hard and fast boundaries upon which everyone agrees. We illuminate the dividing lines and continuities our participants invoked, affirmed, and questioned when contemplating the continuum from potential fertility to realized (and unwanted) pregnancy.

Abortion, Induced↗
PubMed2003

Implanon: user views in the first year across three family planning services in the Trent Region, UK.

OBJECTIVE: Implanon (NV Organon, Oss, The Netherlands) was released in the United Kingdom towards the end of 1999. This survey elicited the experiences of women who had the new implant inserted in three family planning services in North Trent, UK during the first year after its introduction. METHOD: A previously piloted questionnaire was sent to all Implanon users who had the devices fitted in the three services between December 1999 and December 2000. Returned questionnaires were analyzed. RESULTS: Health-care providers and friends or family were the main sources of information about the single-rod contraceptive implant for the survey population. Women considered themselves informed about the method prior to insertion irrespective of whether they continued to use the method or requested early removal. Ease of use was the most common reason for choosing Implanon and one of the best-liked features. Bleeding irregularities were the most commonly reported side-effect, followed by weight gain, moods and headaches. Bleeding problems led to the majority of removal requests; the wish for pregnancy was not stated at all. The single-rod implant compared favorably with most responders' experiences with other methods of contraception. Further research into motivation and perceptions regarding modern contraceptives may be required in different populations.

Adult↗
PubMedDate not supplied

Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

Adolescent↗
PubMed1985

Regression analysis of changes in blood pressure with oral contraceptive use.

Measurements of blood pressure were obtained on 2,673 women from East Boston, Massachusetts, an urban, working class neighborhood, in surveys conducted in both 1973 and 1976-1977. Of these, 927 women participated in a third survey in 1978. The women were 16 to 49 years of age in 1973, premenopausal throughout the study, and not on blood pressure medication. Regression analyses were performed of blood pressure change between the first and second as well as between the second and third surveys on initial blood pressure, age, weight, and patterns of oral contraceptive use. For systolic pressure the effect of starting oral contraceptive use was an increase of 4.1 mmHg (p less than 0.0001), while the effect of discontinuing use relative to continued use was a 4.4 mmHg decrease (p less than 0.0001). These changes were not affected by duration of use or time since last use among past users. For diastolic pressure the average effect of starting use between surveys was an insignificant 1.0 mmHg increase, but diastolic pressure level seemed to increase with duration of use (0.5 mmHg/year, p = 0.0009). The effect of discontinuing use relative to continued use was a drop of 2.7 mmHg in diastolic pressure (p = 0.0004), which was uninfluenced by time since last use.

Adolescent↗