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PubMedDate not supplied

Contraceptive options for the 1990s.

Estrogen-progestin combination oral contraceptives (COCs) are well tolerated, offer high reliability, convenience, and ready availability, but require strict adherence to dosing guidelines. Progesterones work by inhibiting ovulation, thickening cervical mucus, and/or suppressing endometrial growth. An FDA advisory committee has concluded that the benefits outweigh the risks of the mifepristone/misoprostol regimen for use in the United States. IUDs are a good choice for women who want to avoid the inconvenience of barrier methods and who cannot use other forms of contraception. Barrier contraceptives offer low cost and easy availability, but lower effectiveness than other methods.

Condoms↗
PubMed1996

Bilateral tubo-ovarian actinomycosis in the presence of an intrauterine device: a case report.

An uncommon case of actinomycosis found in bilateral tubo-ovarian abscess is presented. Preoperatively, bilateral ovarian tumors were initially suspected by pelvic examination and ultrasonography. The patient received total abdominal hysterectomy and bilateral salpingo-oophorectomy. The initial pathology frozen section report showed abscess without evidence of malignancy. The final pathological finding revealed actinomycosis in bilateral tubo-ovarian abscess. In addition, an intrauterine contraceptive device, Copper-T, was found in the uterine cavity. The radiologic findings, gross pathological feature, histopathological pictures and treatment of pelvic actinomycosis are discussed, with review of the literature in English.

Actinomycosis↗
PubMed1994

Epidemiology of urogenital infections caused by Chlamydia trachomatis and outline of characteristic features of patients at risk.

A study of Chlamydia trachomatis infection was conducted in two stages on 15,656 subjects at urogenital clinics of the Faculty of Medicine and Surgery at La Sapienza University in Rome, the S. Anna Hospital in Turin, and the Niguarda Hospital in Milan. The overall incidence of the disease was 6.4% in patients examined throughout the whole study period. The rate of positive cases was 5.8% for the 5270 patients examined up to 1990, and 6.7% for the 10,386 patients examined from 1990 to 1992, showing an increasing trend. There was a much higher positivity rate in men (9.8%) than in women (6.0%); the difference was statistically significant. Of all patients, 60%, were asymptomatic. In symptomatic patients, C. trachomatis was present in 18.5% of cases of non-gonococcal urethritis and in 12.8% of cases of salpingitis. The highest incidence of C. trachomatis infection was in women who had begun sexual activity at an early age, (under 25 years in age), had several sexual partners and used intra-uterine contraceptive devices or spermicides or both.

Adult↗
PubMed1999

Dr. Lippes and his loop. Four decades in perspective.

Forty years ago Jack Lippes, M.D., hand made the first models of his "Double-S" intrauterine contraceptive device (IUD). Subsequently the Lippes Loop became the standard against which other IUDs came to be compared. Though millions of loops have been used, they have mostly been supplanted by copper-bearing, T-shaped devices. Due to the implant nature of IUDs, on occasion a patient presents well into menopause still bearing a Lippes Loop or other early IUD. Although there is no established causal evidence linking IUDs retained after menopause and cancer or other significant problems, such retention does confuse the diagnosis of post-menopausal bleeding and makes difficult such procedures as endometrial biopsy and ultrasonic endometrial evaluation. When contraception is no longer an issue, it is prudent to remove IUDs since they may cloud future necessary evaluations.

Adult↗
PubMed1998

The intrauterine device: dispelling the myths.

The worldwide popularity and usage of intrauterine devices (IUDs) plummeted in the 1970s, when grim reports of septic abortions and pelvic inflammatory disease were published. Although the Dalkon Shield ultimately was determined to be the culprit for these problems, the reputation of all IUDs was damaged, and their popularity spiraled downward. The stigma continues, despite the proven safety and efficacy of newer IUDs, particularly the ParaGard T 380A and the Progestasert, which are now the only two IUDs approved for use in the United States. This article will review how the IUD works and will focus on dispelling the misconceptions surrounding its use. Rigid patient-selection guidelines and strict aseptic insertion techniques can provide safe, long-term, cost-effective, and highly efficacious contraception for monogamous women. Practitioners who follow these guidelines should not fear prescribing IUDs as a contraceptive device in the appropriate female population.

Female↗
PubMed1999

Patterns of contraception in UK women with Type 1 diabetes mellitus: a GP database study.

AIM: To establish the patterns of contraceptive prescribing for women aged 15-49 with Type 1 diabetes mellitus (DM) and compare them with the patterns in women without diabetes. METHODS: This was a cross-sectional study using a UK primary care database. RESULTS: Nine hundred and thirty-eight women with a diagnosis of Type 1 DM were identified. A comparison group of women aged 15-49 without diabetes (n = 10000) were randomly selected from the database. Twenty-five per cent of the women with diabetes and 32% without diabetes were prescribed a hormonal contraceptive in 1994. Women with Type 1 DM were more likely to be prescribed a combined oral contraceptive than a progestogen only pill (POP) but were 2.12 (95% CI 1.65-2.72) times more likely to be prescribed a POP than women without diabetes and were less likely to be prescribed a combined pill - odds ratio 0.53 (95% CI 0.44-0.64). The pregnancy rate in women with Type 1 DM over the age of 25 years was lower than for women without diabetes. Women under 25 years with Type 1 DM seemed more likely to record a pregnancy. CONCLUSIONS: Differences between women with Type 1 DM and those without diabetes highlight the variation in the way that GPs and patients evaluate the risks and benefits when deciding on contraception.

Adolescent↗
PubMed1981

The Pearl Pregnancy Index reexamined: still useful for clinical trials of contraceptives.

Data from 25 studies of intrauterine contraceptive devices show close agreement between the Pearl Pregnancy Index and a cumulative, 12 month, life-table pregnancy rate. Analysis of data from the early stages of these clinical trials shows the Pearl Index to be superior to the short-term life table in predicting the outcome of the study. The error introduced by using the Pearl Index as a single measure of contraceptive efficacy in clinical trials, under conditions in which those trials are often carried out, is probably very minor compared to the effect of situational factors that affect studies and to differences among various life-table methodologies. The real strength of the life-table analysis of contraceptive performance is not the single, summary, 12 month pregnancy rate it provides, but the complete picture of various reasons for termination over time, particularly when a large number of woman-months of experience has accrued.

Actuarial Analysis↗
PubMed2000

Clinical performance of the Nova-T380 IUD in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report.

Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 572 Nova-T380 intra-uterine contraceptive devices (IUDs). The Nova-T (and formerly the identical Novagard) IUDs have copper with a surface area of 200 mm(2). The device used in this study, the Nova-T380, has copper with a surface area of 380 mm(2). The purpose of the study was to evaluate the pregnancy and complication rates of this new device, with its increased area of copper, in comparison with other published results, in the clinical setting of British general practice and family planning clinics. The 12-month cumulative life-table event rates were: pregnancy 0.8, expulsion 5.6, removal for bleeding or bleeding and pain 11.0. The continuation rate was 73.4. The pregnancy rate at 12 months showed good contraceptive performance. The increased surface area of copper was not associated with a reduced pregnancy rate, but as this was not a direct comparative study with the Nova-T, the influence of the increased area of copper must remain somewhat uncertain. This study found the discontinuation rate for bleeding problems and pain with bleeding to be higher than in other published studies. Other event rates were consistent with other published studies.

Adolescent↗
PubMed1974

Blood pressure in women taking oral contraceptives.

A controlled prospective survey of women taking oestrogen-progestogen oral contraceptives showed increases in mean systolic and diastolic blood pressure of 14.2 mm Hg and 8.5 mm Hg respectively after four years. The largest increases in individual cases were 36 mm Hg systolic and 20 mm Hg diastolic. Blood pressure returned to pretreatment levels within three months after oral contraceptives had been stopped. These changes in blood pressure were unrelated to the progestogenic potencies of the preparations being taken.

Adult↗
PubMedDate not supplied

Family planning, obstetrical and gynecological health care provision in the Soviet Far East.

The Soviet model for both obstetrical and gynecological care and family planning provision seems entrenched in the Soviet Far East as found during a July 1991 visit to the Magadan and Chukotka Regions. Modern birth control is minimally practiced, but does include use of the older Soviet Loop intrauterine contraceptive device (IUD), recent introduction of the new Soviet Copper-T IUD and sporadic availability of condoms and foreign made birth control pills. Without male or female surgical sterilizations being performed, the consequence is that the major form of family planning is first trimester abortion. During this visit, I introduced the use of the NORPLANT Subdermal Contraceptive System and the Copper-T380A IUD to physicians at Anadry and Pevek regional hospitals. Gynecological surgery was also performed and fairly typical ob-gyn care units were toured. Ob-Gyn physicians in the Soviet Far East were found to be highly motivated. They look to the West for help in upgrading family planning and ob-gyn health care in the face of severe shortages after a half decade of perestroika.

Contraception Behavior↗
PubMed1987

Adolescent contraception.

Many adolescents are at risk for unplanned pregnancy. Health professionals who care for adolescents should be familiar with the various contraceptive methods and their suitability for teenagers. Each method, with its pros and cons, is described in this article. Ultimately, the health care provider is advised to tailor contraception to fit the needs of the individual patient.

Adolescent↗
PubMedDate not supplied

Differences between physicians and nurses in providing family planning services: findings from a Bogota clinic.

Having nurses provide a variety of services generally available only from physicians is one way to overcome shortages of physicians in family planning programs. To aid in determining if the quality of care provided by nurses is comparable to that of physicians, a study at a Profamilia clinic in Bogota, Colombia, evaluated the management of family planning clients by physicians and nurses. The study found significant differences between physicians and nurses in the prescription of contraceptives on the client's first visit, in prescription of methods to be used temporarily, in deferment of IUD insertions, and in changing of methods for the client. Continuation rates among the physicians' and nurses' clients, however, did not differ significantly, and clients of physicians and nurses were equally successful in preventing unwanted pregnancies.

Colombia↗