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PubMed2006

Progesterone receptor modulator for emergency contraception: a randomized controlled trial.

OBJECTIVE: Compare the efficacy and adverse effects of CDB-2914, a new progesterone receptor modulator, to levonorgestrel for emergency contraception. METHODS: We performed a randomized, double-blinded noninferiority trial, enrolling healthy women seeking emergency contraception within 72 hours of unprotected intercourse. Participants were randomly assigned to receive a single dose of 50 mg of CDB-2914, plus a placebo 12 hours later or two doses of 0.75 mg of levonorgestrel taken 12 hours apart. Follow-up was scheduled 5 to 7 days after the expected onset of the next menstrual period. Posttreatment pregnancy was established by a positive urine test at follow-up and confirmed by quantitative serum beta-hCG. Daily diaries were used from the time of emergency contraception use until next menses to record adverse effects and sexual activity. RESULTS: Product efficacy was evaluable in 775 of CDB-2914 users and 774 of levonorgestrel users. Pregnancies occurred in 7 (0.9%, 95% confidence interval 0.2-1.6%) and 13 (1.7%, 95% confidence interval 0.8-2.6%) women, respectively. Based on the estimated cycle day of unprotected intercourse, 85% and 69% of anticipated pregnancies, respectively, were averted. Nausea was reported by a somewhat greater percentage of CDB-2914 than levonorgestrel users (29% compared with 24%, P=.03), but the distribution of other adverse effects was similar in both groups. Women in both groups experienced considerable variation in menstrual cycle length as compared with their reported individual normal cycle lengths. CONCLUSION: CDB-2914 is at least as effective as levonorgestrel in preventing pregnancies after unprotected intercourse and has a similar side effect profile. LEVEL OF EVIDENCE: I.

Adolescent↗
PubMedDate not supplied

The patient's choice in contraception.

The patient's choice of a contraceptive method is seemingly influenced by six factors: (a) her attitude toward contraception, (b) the physician's choice, (c) her assessment of risk, (d) her motivation and compliance for reliable contraception, (e) her previous experience with contraception and (f) her partner's influence. Recommendations are made for dealing with three groups of patients who present particular problems: (a) the patient who insists on the pill despite the contraindications for her emphasized by the physician; (b) the patient on the pill who is aging; and (c) the patient or couple who chooses tubal ligation at whatever age and regardless of the number of children she has borne.

Adult↗
PubMed2003

Counseling in the clinical setting to prevent unintended pregnancy: an evidence-based research agenda.

Unintended pregnancies account for about half of all pregnancies in the United States and, in 1995, numbered nearly 3 million pregnancies. They pose appreciable medical, emotional, social and financial costs on women, their families and society. The US is not attaining national goals to decrease unintended pregnancies, and little is known about effective means for reducing unintended pregnancy rates in adults or adolescents.To examine the evidence about the effectiveness, benefits and harms of counseling in a clinical setting to prevent unintended pregnancy in adults and adolescents and to use the evidence to propose a research agenda.We identified English-language articles from comprehensive searches of the MEDLINE, CINAHL, PsychLit and other databases from 1985 through May 2000; the main clinical search terms included pregnancy (mistimed, unintended, unplanned, unwanted), family planning, contraceptive behavior, counseling, sex counseling, and knowledge, attitudes and behavior. We also used published systematic reviews, hand searching of relevant articles, the second Guide to Clinical Preventive Services and extensive peer review to identify important articles not otherwise found and to assure completeness. Of 673 abstracts examined, we retained 354 for full article review; of these, we used 74 for the systematic evidence review and abstracted data from 13 articles for evidence tables. Four studies addressed the effectiveness of counseling in a clinical setting in changing knowledge, skills and attitudes about contraception and pregnancy; all had poor internal validity and generalizability and collectively did not provide definitive guidance about effective counseling strategies. Nine studies (three in teenage populations) addressed the relationship of knowledge on contraceptive use and adherence. Knowledge of correct contraceptive methods may be positively associated with appropriate use, but reservations about the method itself, partner support of the method, and women's beliefs about their own fertility are important determinants of method adherence that may attenuate the knowledge effect. Many factors influence contraceptive use and adherence; among them are age, marital status, ambivalence about becoming pregnant, attitudes of partner, side effects, satisfaction with provider and costs; however, the impact of such factors may not be consistent across populations defined by cultural, age or other factors. The studies themselves differed materially in outcome variables, populations and methodologies and did not yield a body of work that can reliably identify specific influences on contraceptive use and adherence. No literature reports on harms of counseling or on the costs or cost-effectiveness of different approaches to counseling about unintended conceptions in the primary care setting. Virtually no experimental or observational literature reliably answers questions about the effectiveness of counseling in the clinical setting to reduce rates of unintended (unwanted, mistimed) pregnancies in this country. Existing studies suffer from appreciable threats to internal validity and loss to follow-up and are extremely heterogeneous in terms of populations studied and outcomes measured. The quality of the existing research does not provide strong guidance for recommendations about clinical practice but does suggest directions for future investigations. Numerous issues warrant rigorous investigation.

Adolescent↗
PubMed2005

Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria.

The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.

Adolescent↗
PubMed2001

Is breast-feeding a substitute for contraception in family planning?

Using data from the Cebu Longitudinal Health and Nutrition Survey, I disentangle the complex interrelationship between breast-feeding, postpartum amenorrhea, and choice of contraceptive method. I find evidence that women substitute breast-feeding for contraception. Further, endogeneity bias, if not controlled, would cause the relationship to be slightly overstated. In addition, the results suggest that although increased education and income result in decreased breast-feeding, any effect on fertility will be offset by changes in contraceptive use.

Adult↗
PubMed2001

Male hormonal contraceptives.

As the world human population continues to explode, the need for effective, safe and convenient contraceptive methods escalates. Historically, women have borne the brunt of responsibility for contraception and family planning. Except for the condom, there are no easily reversible, male-based contraceptive options. Recent surveys have confirmed that the majority of men and women would consider using a hormonal male contraceptive if a safe, effective and convenient formulation were available. Investigators have sought to develop a male hormonal contraceptive based on the observation that spermatogenesis depends on stimulation by gonadotropins, follicle-stimulating hormone (FSH) and luteinising hormone (LH). Testosterone (T) and other hormones such as progestins suppress circulating gonadotropins and spermatogenesis and have been studied as potential male contraceptives. Results from two large, multi-centre trials demonstrated that high-dosage T conferred an overall contraceptive efficacy comparable to female oral contraceptives. This regimen was also fully reversible after discontinuation. However, this regimen was not universally effective and involved weekly im. injections that could be painful and inconvenient. In addition, the high dosage of T suppressed serum high-density lipoprotein (HDL) cholesterol levels, an effect that might increase atherogenesis. Investigators have attempted to develop a hormonal regimen that did not cause androgenic suppression of HDL cholesterol and that was uniformly effective by suppressing spermatogenesis to zero in all men. Studies of combination regimens of lower-dosage T and a progestin or a gonadotropin-releasing hormone analogue have demonstrated greater suppression of spermatogenesis than the WHO trials of high-dosage T but most of these regimens cause modest weight gain and suppression of serum HDL cholesterol levels. Overall, the data suggest that we are close to developing effective male hormonal contraceptives. The focus is now on developing effective oral regimens that could be safely taken daily or long-acting depot formulations of a male hormonal contraception that could be conveniently injected every 3 - 6 months. In this article, we shall review the exciting new developments in male hormonal contraception.

Contraceptive Agents, Male↗
PubMed2004

Coil or intrauterine device? Patient preferences for contraceptive terminology.

OBJECTIVE: To discover what terminology women prefer to use when referring to contraceptive methods and to investigate the understanding of and ideas associated with contraceptive names. DESIGN: A self-administered questionnaire was answered by 191 new patients at family planning clinics (FPCs). Women were asked if they understood the terms used by the fpa (Family Planning Association), if they knew of any alternatives and, if so, which they preferred. SETTING: Selected FPCs across the city of Manchester. RESULTS: Patients preferred to use familiar terms, e.g. pill, mini-pill, coil and morning-after pill. There was no difference in preference when the results were compared by age or educational level. A greater proportion of non-Caucasians than Caucasians preferred the precise (fpa) terms. Although precise terms were not widely known or understood, when used they were associated with more information than were the familiar terms. CONCLUSION: All FPC staff should evaluate the language used by individual patients and, where appropriate, introduce precise terminology to help patients to make informed, appropriate choices.

Adolescent↗
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↗
PubMed1992

[Care for women: where and how].

OBJECTIVE: To analyse the demand for family planning, gynecological cancer tests and pregnancy supervision in an area with no public resources devoted specifically to these questions. To evaluate users' level of satisfaction and their readiness or otherwise to be visited at the Health Centre (HC), with a view to planning out a specific programme. DESIGN: Descriptive study. SITE. Health Centre at Castelldefels. (Barcelona). PATIENTS AND OTHER PARTICIPANTS: Random stratified sample of 595 women over 14, living within the centre's catchment area. The age distribution was selected in line with the town's population pyramid. MAIN MEASUREMENTS AND RESULTS: We undertook a self-administered, anonymous survey of 437 women. 4.9% of those sexually active between the ages of 14 and 20 and 13.2% of women aged between 21 and 45 use no contraceptive method. The greater attendance at private rather than public centres for contraception (73% as against 23.8/1000 p less than 0.001) and for regular check-ups (63.8% as against 32.1/1000 p less than 0.001) was notable. But for pregnancy care it was the other way round (29.3% as against 61.2/1000 p less than 0.001). 64.1% have regular check-ups; 48.8% annually. A higher level of satisfaction is shown by women seen at private (95.2%) than at public centres (75.1/1000 p = 0.0159). 68.9% would use a special care services for women if offered by the HC. CONCLUSIONS: Existing services offer scant cover to sections of the population more at risk and tend to make everything a medical problem. The public centres give little user-satisfaction. The Primary Care teams could cover these deficiencies with their services and would be welcome by the public.

Adolescent↗
PubMed2006

Early childbearing in Honduras: a continuing challenge.

(1) Honduras has the highest adolescent birthrate in Central America, at 137 births for every 1,000 15-19-year-olds. This rate has remained unchanged over the past two decades, despite declines in the birthrate among women in all other age-groups. In absolute numbers, births to adolescents increased by 50% between 1987 and 2001. (2) As of 2001, only one-third of all women aged 20-24 (and only one-seventh of those in rural areas) had completed primary school; less education is associated with a higher likelihood of early childbearing. (3) One-half of 20-24-year-olds give birth by age 20; this proportion is higher among the least-educated women (70%), the poorest women (64%) and those in rural areas (60%). (4) In 2001, 40% of all recent adolescent births were unplanned, and the highest proportion was among those with the most education (48%). Most sexually active 15-19-year-olds (70%) do not want to have a child in the next two years. (5) Despite these reproductive preferences, just one in three sexually active adolescents uses a modern contraceptive method. Overall, 48% of adolescents have an unmet need for effective contraception. (6) High levels of early childbearing coexist with low rates of professional prenatal and delivery care. In 2001, one-third of recent 15-24-year-old mothers did not make a single prenatal care visit. The same proportion gave birth without a medical professional in attendance. (7) Policies and programs that aim to promote adolescents' reproductive health and support their childbearing preferences exist, but they are often not fully implemented and need more official commitment and resources.

Adolescent↗
PubMedDate not supplied

Fertility reduction and the quality of family planning services.

The purpose of this paper is to determine whether a focus on quality of family planning services is consistent with meeting demographic objectives. An analytical framework that links the six elements of quality with fertility is described. A review of existing literature and analysis suggest that improvements in quality of family planning services by enhancing the choice of contraceptive methods available in a country would increase the overall practice of contraception and thus would result in fertility reduction.

Contraception↗
PubMed1998

[Contraceptive behavior of young Latin-American adults living in Montreal].

Recent research on the contraceptive practices of Hispanics adolescents living in Latin America and the United-States indicates that their practices are inadequate. However, contraceptive practices can vary according to levels of traditionalism and acculturation. In order to verify these hypotheses, the contraceptive behaviors of a group of 114 young adults from both genders of Hispanic origin were evaluated. Results indicate that half of the participants did not use any contraceptive method during the first intercourse and that condoms were the most common method. Contrary to American results, acculturation levels were not significant in contraceptive use. Degree of traditionalism in sexual roles was more significant.

Adult↗
PubMedDate not supplied

New options for teen pregnancy prevention.

Teenage pregnancy rates remain unacceptably high in the United States, despite the availability of numerous contraceptive options. This article examines contraceptive methods currently available to adolescents and highlights newer products that may help meet some of the unique contraceptive needs of sexually active teens. The three newest agents (OrthoEvra trade mark, NuvaRing trade mark, and Seasonale) offer advantages such as higher contraceptive efficacy, increased privacy, ease of use, and low side effect profiles. A major advantage of each of these methods is that they eliminate the need for the teen to take daily action to prevent pregnancy. Nurses can be instrumental in helping teens to avoid unwanted pregnancy by assessing teens' contraceptive needs and educating them about contraceptive options. However, it is important to remember that because none of these new methods offer protection against sexually transmitted diseases, we should continue to educate adolescents about the need for condom use and provide them with instructions on using condoms correctly.

Adolescent↗
PubMed2000

Efficacy, acceptability, and clinical effects of a low-dose injectable contraceptive combination of dihydroxyprogesterone acetophenide and estradiol enanthate.

A total of 1,904 women, aged 15-38, used an injectable contraceptive combination of 90 mg dihydroxyprogesterone acetophenide with 6 mg estradiol enanthate, given once during each menstrual cycle between the 7th and 10th day, and preferably on the 8th day of the cycle, for a total of 17,576 cycles. Of these 1,904 women, 1,197 completed 12 cycles of use of the injectable combination. One subject became pregnant during the trial, resulting in a cumulative pregnancy rate of 0.07%. Principal reasons for discontinuation were personal, non-medical reasons, such as lost to follow-up, no longer wished to continue, protocol violation, desire to change to another contraceptive method, moved away, or other personal reasons. Mean weight of 1,901 subjects at admission to the trial was 53.5 +/- 0.2 kg and this increased to 54.3 +/- 0.3 kg after 12 cycles of use. Approximately 50% of subjects experienced menstrual bleeding similar to normal throughout the study period. The most frequent menstrual abnormality was irregular bleeding, experienced by approximately one-third of subjects.

Adolescent↗
PubMed2006

Influence of avosentan (SPP3OI) on the pharmacokinetics of a second generation oral contraceptive containing ethinylestradiol and levonorgestrel in healthy female volunteers.

BACKGROUND: Avosentan (SPP301) is a potent and highly selective ETA receptor blocker and is clinically investigated in diabetic nephropathy. This study was designed to evaluate whether avosentan influences the pharmacokinetics of steroid oral contraceptives. METHODS: During a run-in phase, 16 healthy females received an oral contraceptive containing ethinylestradiol 0.03 mg and levonorgestrel 0.15 mg for the first 21 days of a minimum of one menstrual cycle. In a subsequent double-blind, randomized two menstrual cycle crossover treatment phase, subjects received either avosentan 25 mg or placebo once daily concomitantly with the oral contraceptive. Serum ethinylestradiol and plasma levonorgestrel concentrations were measured on Days 14 and 15 of the two treatment periods for the evaluation of the 24-hour kinetic parameters, and an additional sample was collected on Day 21 to determine their trough concentrations. Serum progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels as well as plasma avosentan and Ro 68-5925 levels were determined on Days 13, 14, 15 and 21 of each cycle of the treatment phase. RESULTS: Avosentan had a statistically significant lowering effect of 9 - 15% on the ethinylestradiol serum concentration levels. The 90% confidence intervals of the pharmacokinetic parameters did not include 1 or exceeded the 0.8 - 1.25 acceptance range for lack of interaction. The plasma concentration-time curves and pharmacokinetic parameters of levonor-gestrel were not statistically different during concomitant treatment with either avosentan or placebo. Compared to placebo, avosentan lowered the serum concentrations of progesterone statistically significantly by about 8% and increased slightly the LH and FSH serum concentrations. Safety and tolerability patterns were comparable during avosentan and placebo administration. CONCLUSION: Because of the effect of avosentan on the concentration levels of ethinylestradiol and progesterone, it is possible that the contraceptive efficacy of low-dose combination oral contraceptives may be adversely affected during avosentan treatment.

Adult↗
PubMedDate not supplied

Finding the best fit: a grounded theory of contraceptive decision making in women.

PROBLEM: Half of the pregnancies in the United States that occur annually are unintended, and of these, half occur among women using contraceptives. METHODS: Interviews with 16 women,field notes, and memos were analyzed using constant comparative analysis and the methods of open, axial, and selective coding were used until saturation occurred. FINDINGS: The core category that describes the process of contraceptive decision making in women is "finding the best fit." Women choose a method or methods to prevent pregnancy based on their knowledge, experience, and evaluation of what would be the best fit within the context of their current life situation. CONCLUSIONS: It is important that nurses obtain a thorough contraceptive history, and realize that women may have different perceptions and knowledge level of methods.

Adaptation, Psychological↗
PubMed1995

Hormonal contraception in women with IDDM. Influence on glycometabolic control and lipoprotein metabolism.

OBJECTIVE: Safe and effective contraceptive methods are essential for women with insulin-dependent diabetes mellitus (IDDM), but opinions on the use of hormonal oral contraceptives by these women are conflicting. We evaluated the effects on glycometabolic control and lipoprotein metabolism in women with IDDM treated with an oral contraceptive not previously studied in a diabetic population. RESEARCH DESIGN AND METHODS: A total of 22 women with IDDM received a monophasic combination of ethinyl estradiol and gestodene for 1 year; 20 women of comparable diabetic status using nonhormonal contraception were selected as control subjects. Evaluation was performed before and after 1, 3, 6, and 12 months of hormonal intake using nonparametric statistical methods. RESULTS: Except for a higher median age of the control group, the baseline values for all clinical and metabolic variables were similar in the two groups, and in neither of the groups were changes in blood pressure, body mass index, or glycemic control observed. In the oral contraceptive group, decreased serum levels of low-density lipoprotein (LDL) cholesterol and increased levels of triglycerides and lipoprotein A were noted, whereas total cholesterol and high-density lipoprotein cholesterol levels were unchanged. In the control group, a decrease of LDL cholesterol was observed. No effect of tobacco smoking on glycometabolic control or lipoprotein metabolism could be demonstrated during hormonal intake. CONCLUSIONS: No evidence of impaired glycometabolic control or adverse changes in serum levels of lipoproteins known to be associated with atherosclerosis was observed in women with well-controlled IDDM during 1 year of oral contraception with ethinyl estradiol and gestodene.

Adult↗
PubMed1978

Studies on vaginal malodor. I. Study in humans.

Forty-two percent of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of the sponges, odor formed only in 4% of the sponges worn by sexually inactive users. No difference in the rate of odor formation was found when neutral pH (7.0) and acid pH (3.4) collagen sponges were tested, although we believe that a pH 3.4 is too acid and promotes odor formation. The optimal pH of the sponge should be 4.5 to 5.5. Malodor was efficiently extracted from sponges by washing in acid milieu of tap water and vinegar or 0.1 M acetate buffer, pH 4.0. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time of malodor development, the high content of polyamines (putrescine, spermine, spermidine) in the ejaculate decreased to undetectable values. We conclude that the ejaculate is the major source of malodor formation in intravaginally worn collagen sponges. Removal, rinsing optimally in vinegar solution, and reinsertion within 24 hours after intercourse reduces the chance of malodor formation.

Adult↗