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PubMed1995

Comparison of the efficacy of intrauterine diclofenac and ibuprofen pellets as adjuvants to quinacrine nonsurgical female sterilization.

To investigate relative efficacy of intrauterine diclofenac and ibuprofen as adjuvants to intrauterine quinacrine for nonsurgical sterilization, a total of 900 women were systematically allocated to 2 monthly insertions of pellets of diclofenac (75 mg) or ibuprofen (55.5 mg) as adjuvants to intrauterine quinacrine (216 mg) in a rural private practice in West Bengal, India. All women were prescribed oral contraceptives for three months from first insertion. In the middle of the study increased care was taken to insert pellets at the fundus. There was no statistically significant difference found in cumulative life-table pregnancy failure rates at 36 months for women receiving diclofenac (2.7 +/- 0.82) or ibuprofen (3.4 +/- 0.89). Taking care to insert pellets at the fundus resulted in a decline of failures at 24 months from 4.4 +/- 0.92 to zero. Intrauterine administration of pellets of quinacrine (216 mg) plus diclofenac (75 mg) or ibuprofen (55.5 mg) with 3 months' oral contraception provides acceptable efficacy if pellets are inserted to the fundus.

Diclofenac↗
PubMed1989

[Adenomas of the liver and oral contraception. Clinical and therapeutic aspects apropos of a giant adenoma].

The first cases of benign liver tumors following estroprogestative therapy were described in 1973. Since that time, this relation between cause and effect has been demonstrated. The authors report the case of a giant liver adenoma which developed after 13 years of uninterrupted use of oral contraceptives. The advantage of this disease is not so much its prevalence which is low, but its clinical diagnosis. In fact, failure to recognize this entity may result in dramatic complications such as haemorrhagic rupture of the liver. The therapeutic approaches, whether wait-and-see or aggressive, all present a common objective: permanent discontinuance of estroprogestative drugs.

Adult↗
PubMed2005

Contraception in the chimpanzee: 12-year experience at the CIRMF Primate Centre, Gabon.

The Primate Centre of the International Center for Medical Research in Franceville, Gabon (CIRMF) has had a chimpanzee (Pan troglodytes) colony for more than 20 years. A contraceptive policy was started in 1990, following a rapid increase in the number of individuals in the 1980s. Intrauterine devices were first used in 24 females; 10 failures occurred over a period of about 4 years. Depo-provera was then used in 28 chimpanzees for between 4 months and 4 years; 10 failures occurred, the animals gained weight, and cyclic swelling of the external genitalia was markedly modified. Starting in late 2000, 25 females received progestin implants; only one failure has so far occurred, and the main side effect is a complete abrogation of cyclic sexual swelling.

Analysis of Variance↗
PubMedDate not supplied

Challenges in nursing adults with congenital heart disease.

Heart failure is a growing problem and is commonly associated with an older population. A proportion of young people also have heart failure. These patients are quite rarely seen but are increasing in number, and heart failure nurses need to ensure that when these patients present in clinic they have an understanding of their differing needs in comparison with older cardiac patients.

Adult↗
PubMed1973

Amenorrhoea after discontinuing combined oestrogen-progestogen oral contraceptives.

Out of 210 women seen at the Middlesex Hospital with secondary amenorrhoea the 63 who developed it after stopping oral contraceptives were fully investigated. Five had organic disease sufficient to account for the amenorrhoea (one had severe diabetes, one a pituitary tumour, and three premature ovarian failure); two patients had galactorrhoea (one of whom also had the pituitary tumour); two had anorexia nervosa.Of the 63 women 40 (63%) had suffered from amenorrhoea or prolonged or irregular menstrual cycles before taking the pill, and this suggested that combined oestrogen-progestogen oral contraceptives should be used with caution for women with irregular menstruation.Nineteen patients wished to become pregnant and 12 have so far done so after treatment with clomiphene or gonadotrophins.In another study 204 women recorded when their first menstrual cycle occurred after stopping the pill. Seventy-four had a cycle longer than five weeks but only five exceeded three months, and only one of the five had more than six months' amenorrhoea. These results confirm that the incidence of amenorrhoea after stopping oral contraceptives is low.

Adult↗
PubMed2001

Comparison of a novel norgestimate/ethinyl estradiol oral contraceptive (Ortho Tri-Cyclen Lo) with the oral contraceptive Loestrin Fe 1/20.

This multicenter study compared the contraceptive efficacy, cycle control, and safety of a new triphasic norgestimate (180/215/250 microg)/ethinyl estradiol 25 microg regimen (Ortho Tri-Cyclen Lo) (n = 1,723) with that of norethindrone acetate 1 mg/ethinyl estradiol 20 microg (Loestrin Fe 1/20) (n = 1,171). Healthy women were treated for up to 13 cycles. Demographics were similar between regimens. Contraceptive efficacy was comparable for Ortho Tri-Cyclen Lo and Loestrin Fe 1/20. The overall and method failure probabilities of pregnancy through 13 cycles were 1.9% and 1.5%, respectively, with Ortho Tri-Cyclen Lo and 2.6% and 2.4%, respectively, with Loestrin Fe 1/20. Breakthrough bleeding and spotting was reported by a significantly lower percentage of participants in the Ortho Tri-Cyclen Lo group compared with the Loestrin Fe 1/20 group. At representative Cycles 1, 3, 6, 9, and 13, breakthrough bleeding and spotting rates were 16.3, 11.5, 10.3, 7.9, and 7.7%, respectively, in the Ortho Tri-Cyclen Lo group and 34.9, 22.9, 22.2, 15.9, and 13.1%, respectively, in the Loestrin Fe 1/20 group. Compliance and safety data were similar for the two regimens.

Administration, Oral↗
PubMed1991

The significance of bleeding patterns in Norplant implant users.

The purpose of this study was to examine the bleeding patterns of 234 Norplant users during 5 years of use and to identify the bleeding patterns of users who conceived. During the first year of use, 26.6% of users had regular bleeding cycles, 66.3% had irregular cycles, and 7.1% were amenorrheic. By the fifth year of use, 62.5% of users had regular cycles, 37.5% had irregular cycles, and none had amenorrhea. Of the ten users who became pregnant, eight had regular menstrual cycles in the 6 months before the diagnosis of pregnancy, one had an irregular pattern, and one did not keep a bleeding record. None had amenorrhea. The 5-years cumulative pregnancy rate for patients with regular cycles was 17.4%; this was significantly higher (P less than .05) than the 5-year cumulative rates of 4.4% in users with irregular cycles and 0% in users with amenorrhea. This study indicates that during the first year of Norplant use, only 26.6% of users have regular cycles, but after the first year, 50-60% of users develop regular cycles. The bleeding patterns of women using Norplant improve after the first year of use, and those with regular cycles are at greatest risk for method failure.

Contraceptive Agents, Female↗
PubMed1990

[The nonoxynol content in condoms is insufficient to inhibit the human immunodeficiency virus (HIV)].

The seven makes of condom which are marketed in Denmark were examined for the nonoxynol content with the object of assessing whether the content of nonoxynol in the condoms is sufficient to present HIV spread in connection with use of the condom and assessed in relation to the defects in effectivity (tearing, holes, overflow of semen, sliding off). Compared with the declared content of nonoxynol of 40 mg (100%) per condom, the following nonoxynol quantities could be demonstrated by methanol/water extraction and subsequent high-performance liquid chromatography: One make of condom contained 65%, two 50-55% and four 25-33%. The nonoxynol content was found to be evenly distributed between the outer and inner surface of the condoms. With a theoretical distribution volume of 6 ml (tearing during vaginal coitus), it was found that three of the makes of condoms examined did not achieve the HIV-inhibiting nonoxynol concentration of 0.05%, by means of measuring the quantity of nonoxynol on the distal 5 cm of the condoms. In anal sex, the distribution volume is greater resulting in lower nonoxynol concentrations and thus increased risk for HIV infection. It is concluded that the nonoxynol content in the condoms marketed in Denmark should be increased in order to inactivate HIV in case of condom failure.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The Cochrane Fertility Regulation Group: synthesizing the best evidence about family planning.

The Fertility Regulation Group of the Cochrane Collaboration has been assessing the best available evidence on fertility regulation, family size and birth spacing. By the end of 2005, this group had published 32 systematic reviews and 12 protocols; most reviews were on contraception. Because of suboptimal trial quality, firm conclusions could be made in only five reviews. Threats to internal validity in published trials include the absence of description of allocation concealment, intentional exclusion of participants after randomization, failure to use intention-to-treat analyses and lack of treatment blinding. The precision of results has been limited by small sample sizes. The finding that most trials of oral contraceptives were conducted by pharmaceutical companies raises concerns about potential commercial bias. Of necessity, most information about fertility regulation effectiveness and adverse effects comes from observational studies, which vary widely in quality. Systematic reviews of evidence, with an emphasis on randomized controlled trials when available, will continue to improve fertility regulation in the years ahead.

Clinical Trials as Topic↗
PubMed2003

Economic analysis of contraceptives for women.

OBJECTIVE: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States. METHODS: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables. RESULTS: Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively. CONCLUSION: From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.

Adult↗
PubMed2002

Successful pregnancy after transient ovarian failure following treatment of symptomatic leiomyomata.

OBJECTIVE: To report a case of transient ovarian failure after treatment of symptomatic leiomyomata and review other iatrogenic causes of transient ovarian failure. DESIGN: Case report and literature review. SETTING: University-affiliated private practice. PATIENT(S): A 35-year-old woman with symptomatic leiomyomata. INTERVENTION(S): Bilateral uterine artery embolization with subsequent abdominal myomectomy to treat unchanged regular heavy menstrual flow. MAIN OUTCOME MEASURE(S): Ovarian function. RESULT(S): Because medical therapy failed to control her menorrhagia, the patient proceeded with uterine artery embolization. She had persistent menorrhagia after bilateral uterine artery embolization and underwent exploratory laparotomy and myomectomy. After surgery, she had amenorrhea, hot flushes, and elevated FSH levels for 3 months. Ovarian function recovered after a short course of oral contraceptives, and the patient conceived without assistance. CONCLUSION(S): Several interventions can affect normal ovarian function and can lead to permanent or transient ovarian failure. Possible causes of transient ovarian failure are radioactive iodine treatment, radiation, chemotherapy, pelvic surgery, stress, and uterine artery embolization. Before these interventions are applied, the possibility of ovarian failure and available preventive measures should be discussed with the patient.

Adult↗
PubMed1998

New estimates of the effectiveness of the Yuzpe regimen of emergency contraception.

The purpose of this study was to provide new estimates of the effectiveness of the Yuzpe method of emergency contraception and to offer correctly computed estimates of the confidence intervals for estimated effectiveness rates. Through a literature search, seven studies that present the number of women treated and outcome of treatment by cycle day of unprotected intercourse relative to expected day of ovulation were identified. Probabilities of conception by cycle day of intercourse among women not using contraception and the associated variance-covariance matrix from five other datasets were estimated, and these external estimates were used to assess the effectiveness of the Yuzpe regimen. The 40 estimates of effectiveness, based on seven separate studies and the seven studies combined and five different sets of conception probabilities by cycle day, ranged from a low of 44.2% to a high of 88.7%. The preferred point estimate is that emergency contraceptive pills reduce the risk of pregnancy by 75.4%, with a 95% confidence interval extending from 65.6% to 82.4%. True effectiveness is likely to be at least 75% because treatment failures (observed pregnancies) include women who were already pregnant when treated and women who became pregnant after being treated.

Coitus↗
PubMed1994

Introducing the low-dose pill to Bangladesh; issues of continuation and failure.

In response to government plans to introduce a low-dose pill to the national family planning program of Bangladesh, a comparison of the performance of low-dose and standard-dose pills among a rural Bangladeshi population was conducted. Continuation rates were found to be better among users of the low-dose pill and there was no evidence that failure rates were higher. The relative risk (standard-dose vs. low-dose) over the first 30 months following adoption was 1.25 for first method continuation, and 1.29 for extended use failure. This paper, thus, provides evidence that low-dose pills may be a suitable method of contraception for rural Bangladeshi women.

Adult↗
PubMed1984

Fertility regulation in nursing women. VI. Contraceptive effectiveness of a subdermal progesterone implant.

Six progesterone pellets implanted subdermally were tested as contraceptive method for lactating women. One pregnancy was diagnosed in 1614 woman-months of observation, a failure rate which was similar to that observed in a contemporary group of Copper T users. Nineteen pregnancies were diagnosed in the 677 woman-months observed in untreated lactating women. The progesterone implants were effective when administered either at 30, 60 or 240 days after delivery. The duration of the effective life was 5 months and fertility was quickly restored afterwards. There were no deleterious effects upon maternal or infant health or upon lactation and the rate of child growth. The main problem encountered was the occurrence of pellet expulsion at a variable rate which appeared related to the manufacturing procedure.

Adolescent↗
PubMed1996

Sex differences in correlates of steady state and pulsatile component of blood pressure.

1. The aim of the present study was to evaluate whether metabolic factors are linked to the steady component and the pulsatile component of blood pressure, evaluated as mean arterial pressure and pulse pressure respectively, in a sex-specific manner. 2. A cohort of 299 subjects (152 males, 147 females; 25-80 years of age) was studied. Patients presenting congestive heart failure, coronary insufficiency, severe valvular heart disease, neurological accident in the last 6 months, renal or respiratory failure, cancer, diabetes mellitus or acute infectious disease were excluded. None of the women was taking oral contraceptives or oestrogen supplementation. All cardioactive drugs were withdrawn at least 2 weeks before the subjects entered the study. 3. Men presented higher mean arterial pressure (120 +/- 15 compared with 115 +/- 16 mmHg, P < 0.01) and lower pulse pressure values (63 +/- 16 compared with 67 +/- 18 mmHg, P < 0.05) than women. In men, no significant relation between mean arterial pressure and the tested variables was detected; multiple regression analysis demonstrated that age contributed independently to the model for pulse pressure with a multiple r2 of 0.10 (P < 0.01). In women, body mass index contributed independently to the model for mean arterial pressure, with a multiple of 0.12 (P < 0.005); age and, to a lesser extent, body mass index, glycaemia and triglyceridaemia persisted as independent determinants of pulse pressure at the multiple regression analysis, with a multiple r2 of 0.20 (P < 0.001). 4. Our findings suggest that metabolic risk factors are associated differently with pulse pressure and mean arterial pressure values in the two sexes.

Adult↗
PubMed1975

Natural family planning.

A personal series of 600 private patients using natural family planning techniques is presented. The total failure rate was 4.7 pregnancies per 100 woman-years. The advantages of this method over conventional contraceptive techniques are stressed.

Adult↗