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PubMed1980

Use-effectiveness of standard-dose and low-dose oral contraceptives in Dacca.

Five hundred women accepting oral contraceptives at an urban clinic were alternately prescribed standard-dose (50 microgram of estrogen) or low-dose (30 microgram of estrogen) combined pills. Life-table continuation rates at 12 months were approximately 40% for both groups, with no significant differences between or within the two groups after controlling for sociodemographic variables and nutritional status. Approximately three fifths of those who discontinued using both formulations cited medical reasons, especially dizziness. The low-dose oral contraceptive appeared to be as acceptable to these urban Bangladeshi women as the higher-dose pill.

Adult↗
PubMed1997

Self-administration with UniJect of the once-a-month injectable contraceptive Cyclofem.

The objective of this study was to evaluate women's acceptance of and ability to self-administrate the injectable contraceptive Cyclofem using prefilled UniJect devices. A total of 102 women were invited to participate in the study. Fourteen women (13.7%) refused to participate. Of the remaining 88 women, 32 women (31.4%) consented to participate and were trained using oranges but were still afraid of the procedure and ultimately refused to self-administer the injections. Only 56 women (55%) ultimately self-injected Cyclofem with UniJect. They performed a total of 144 injections, all of them on the ventral side of the thigh. When nurses evaluated women's ability to activate the devices, they found that more than 80% were successful in both the group of women that later self-administered the injections and the group that did not. The evaluation of the self-administered injection technique showed that more than 90% of the women correctly self-administered the contraceptive using UniJect. With respect to the opinion of the women about the self-administration of the contraceptive, more than 50% (32 of 56) of women who self-injected preferred to self-administer the injection and said that they wished to continue with the self-administration, one-third (17) reported that they were afraid, and seven women (12.5%) expressed the opinion that the injection in the thigh was more painful than the administration in the buttocks or arm. In conclusion, our study showed that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to UniJect.

Brazil↗
PubMed2001

New contraceptive options.

New contraceptive modalities that are being introduced into the US marketplace reflect many changes in the delivery of existing steroidal products. These products are available now not only as oral medications but also as transdermal, intravaginal, intrauterine, and implantable or injectable devices. Each of these has its own unique profile and enhances the ability of consumers to pick and choose the product that is most acceptable to them. However, development of new barrier contraceptives, particularly those that have the potential to reduce the heterosexual transmission of HIV or to reduce a bacterial infection such as Chlamydia or Neisseria gonorrhea, continues to be moving forward in clinical trials. These products can have a lower efficacy compared with the steroidal products but, because of their other benefits, may be of significant medical use.

Choice Behavior↗
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↗
PubMed1998

AIDS and reproductive health.

Over 24 million adults worldwide have been infected with HIV. Primarily a sexually transmitted disease, AIDS is inexorably linked to reproductive health and care. Because HIV tends to infect those who are in their reproductive years, the impact of this disease on population growth and life expectancy is projected to be immense in some parts of the world, especially in sub-Saharan Africa. Not least is the challenge to individual families and infant care programs to care for AIDS babies. Estimates of the rate of vertical transmission of HIV range from < 10 to 46%. Transmission through sexual contact accounts for 75-85% of HIV infection worldwide, and today, nearly 20 years into the epidemic, the main tool to stall the spread is advocating change in sexual conduct. Numerous studies leave no doubt that the attributable risk of co-infection with other STDs--both ulcerative and non-ulcerative--in heterosexual transmission is substantial. The only known contraceptive method proven to reduce both infectiousness and susceptibility to HIV is barrier contraception. Spermicidal agents currently available have not been shown to reduce HIV concentrations in genital secretions, or to reduce transmission of the virus. The challenges that lie ahead are tremendous: we must continue to focus on development of affordable preventive measures; urge policy-makers to back further research in prevention to complement condom use; and advocate for continued support of basic research to learn more about fundamental mechanisms of HIV transmission.

AIDS-Related Opportunistic Infections↗
PubMed1989

Bleeding patterns and acceptability among Norplant users in Singapore.

Norplant contraceptive implants are silastic implants containing levonorgestrel. This study describes our experience with 100 acceptors of NORPLANT implants in Singapore. No pregnancies occurred during the first year of use. The majority found the method's ease of use to be the most attractive feature. Disruption of menstrual rhythm appeared to be the least liked feature. However the incidence of these menstrual irregularities appeared to diminish with time. Implant users have tolerated this early disruption of their menstrual rhythm well and the continuation rate at the end of the year was 97%. Thus it appears that Norplant is a safe, effective and acceptable method of contraception.

Adolescent↗
PubMed2002

The introduction of Norplant in Cambodia through the private sector.

The objectives of this study are to determine whether Norplant would be an acceptable contraceptive method for Cambodian women, given its technology and the socio-cultural context, and whether it can be delivered by a private sector clinic with good quality care. This is a prospective cohort study of the first 966 acceptors. It was found the one-year continuation rate was 90.5%, there were no pregnancies and client satisfaction was high. In general, Norplant was delivered with high quality of care. Findings indicate that Norplant suits the contraceptive needs of many Cambodian women and is appropriate for their socio-cultural context. Norplant can be introduced, with high quality care, in a private clinic in a developing country.

Cambodia↗
PubMed2006

From naughty goods to Nicole Miller: medicine and the marketing of American contraceptives.

In the rich history of modern pharmaceutical advertising in the United States, few medical objects have been as controversial as contraceptives. Condemned in the 1870s as lascivious devices whose commercial visibility would tarnish female sexual purity, contraceptives have in the late twentieth century been repackaged by pharmaceutical companies as the smart, progressive, and fashion-conscious woman's ally. This article explores evolving perspectives on the place of birth control in public spaces from the mid-nineteenth century to the present. In so doing, it elucidates the changes and continuities in the long and contested history of marketing, medicine, sexuality, and reproductive control.

Advertising↗
PubMed1976

Serum prolactin concentrations in women treated with chlormadinone acetate.

Serum prolactin concentrations were measured serially in eight normal women who used continuous chlormadinone acetate treatment (500 mug per day) for six months as part of an investigational new drug contraceptive study. Circulating prolactin was also measured in women using several additional oral contraceptive steroid preparations including a sequential mestranol-mestranol + chlormadinone acetate regimen. No increase in basal serum prolactin concentration was produced by chlormadinone acetate treatment, either alone or when added to estrogen therapy. These results suggest that chlormadinone acetate may not alter human mammary tissue through a prolactin mechanism.

Breast↗
PubMed1996

Differences in risk factors for epithelial ovarian cancer by histologic type. Results of a case-control study.

A case-control study of associations between dietary and reproductive factors and cancer of the ovary was conducted during 1989-1992 in metropolitan Toronto and nearby areas of southern Ontario, Canada. In total, 450 women aged 35-79 years with histologically verified new primary epithelial ovarian cancers were interviewed concerning their reproductive history and dietary practices. Over the same time period, 564 randomly selected population controls, frequency-matched to the cases according to three 15-year age groups, were also interviewed. Continuous unconditional logistic regression methods were used for analysis. It was found that childbearing and use of oral contraceptives were associated with significant decreasing trends in the risk of epithelial ovarian cancer of all principal histologic types except mucinous tumors. For each full-term pregnancy, the odds ratio was 0.76 (95% confidence interval (CI) 0.69-0.85) for nonmucinous tumors and 1.03 (95% CI 0.88-1.21) for mucinous tumors; for each year of oral contraceptive use, the odds ratio was 0.89 (95% CI 0.85-0.93) for nonmucinous tumors and 0.98 (95% CI 0.93-1.04) for mucinous tumors (p = 0.00051 and p = 0.0040, respectively, for the difference in odds ratios between mucinous and nonmucinous tumors). Saturated fat intake also appeared to convey greater increased risk for women with mucinous tumors than for women with neoplasms of other histologic types (p = 0.029). Among women with nonmucinous tumors, increasing trends in risk of invasive serous cancer (p = 0.018), and particularly endometrioid cancer (p = 0.0041), were seen with use of noncontraceptive estrogens. Otherwise, borderline-malignant neoplasms seemed to have a similar spectrum of risk factor associations as invasive cancers. On the basis of this study and a number of others, the authors suggest that mucinous ovarian tumors may be etiologically unrelated to other types of epithelial tumors, and thus should be considered separately in studies of ovarian cancer.

Adult↗
PubMed2004

Hysterectomy and endometrial ablation in New South Wales, 1981 to 1999-2000.

OBJECTIVE: To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999-2000 and the impact of endometrial ablation. DATA: Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994-1995 and 1999-2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988-1989 for hysterectomy and ablation were also obtained. FINDINGS: Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992-1993 and has declined since. The hysterectomy rate in 1999-2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued. CONCLUSION: The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.

Catheter Ablation↗
PubMed1994

Can testosterone alone maintain the gonadotrophin-releasing hormone antagonist-induced suppression of spermatogenesis in the non-human primate?

The combination of gonadotrophin-releasing hormone (GnRH) antagonist and delayed testosterone substitution provides a promising approach towards male contraception. However, the GnRH antagonists used clinically so far cause side-effects and have to be administered continuously. We therefore used the non-human primate model to see whether the GnRH antagonist cetrorelix (which exhibits a favourable benefit-to-risk ratio in terms of anti-gonadotrophic action in normal men) induces complete and reversible suppression of spermatogenesis and whether GnRH antagonist-induced suppression of spermatogenesis can be maintained by testosterone alone. Four groups of adult cynomolgus monkeys (Macaca fascicularis; five per group) were injected daily with 450 micrograms cetrorelix/kg ([N-acetyl-D-2-naphthyl-Ala1, D-4-chloro-Phe2, D-pyridyl-Ala3, D-Cit6, D-Ala10]-GnRH). Group 1 received the GnRH antagonist for 7 weeks followed by vehicle administration for another 11 weeks; group 2 was treated with GnRH antagonist for the entire 18 weeks with each animal receiving a single testosterone implant during weeks 11-18 to restore the ejaculatory response to electrostimulation; group 3 received the GnRH antagonist for 18 weeks and testosterone buciclate (TB) was injected during week 6 of GnRH antagonist treatment; group 4 was subjected to GnRH antagonist administration for 7 weeks and received TB (200 mg/animal) during week 6. Under GnRH antagonist treatment alone serum concentrations of testosterone were suppressed. TB maintained testosterone levels two- to fourfold above baseline levels in groups 3 and 4 and prevented the recovery of LH secretion for about 20 weeks after GnRH antagonist withdrawal, whereas inhibin levels increased significantly from week 8 onwards. Group 2 animals were azoospermic during weeks 12-18 of GnRH antagonist administration. The TB-replaced groups developed azoospermia or became severely oligozoospermic. Quantitation of cell numbers by flow cytometry during weeks 6 and 18 revealed that TB (groups 3 and 4) had prevented a further decline of germ cell production compared with group 2 but had maintained the spermatogenic status present at week 6 (onset of TB substitution). All inhibitory effects of cetrorelix and/or TB were reversible after cessation of treatment. These findings demonstrate that cetrorelix reversibly inhibits spermatogenesis in a non-human primate model. Although TB maintained the GnRH antagonist-induced suppression of spermatogenesis, azoospermia was not achieved. This latter effect may reflect either a direct spermatogenesis-supporting effect of the high dose of TB or the partial recovery of inhibin secretion (indirectly reflecting FSH secretion) or a combination of both.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2000

Acne vulgaris: pathogenesis and therapeutic approach.

AUDIENCE: This activity is designed for primary care providers, internists, and general audiences. GOAL: To provide the reader with a basic understanding of the pathogenesis of acne vulgaris and the rationale behind several treatment options. Clinicians should be aware of treatment strategies for various subtypes of acne vulgaris. OBJECTIVES: 1. To describe the emotional and financial impact of acne. 2. To describe the differential diagnosis of acne vulgaris. 3. To discuss acne's pathogenesis. 4. To provide information on topical therapy for the treatment of acne vulgaris. 5. To discuss oral therapy for the treatment of acne vulgaris.

Acne Vulgaris↗
PubMed1984

Fertile inventions: new contraceptive techniques.

Research into contraception is producing new techniques that involve everything from vaccinations to nasal sprays. Steroids are the basis of the conventional contraceptive pill and much current research is on alternative ways of introducing the same drugs into the woman's reproductive system. Norplant is 1 approach. It involves implanting 6 tiny silicone-rubber tubes just beneath the skin of a woman's underarm. The tubes contain a drug, widely used as an ingredient of the contraceptive pill, which is slowly released from the tubes over a period of 5 years. It is understandable that much contraceptive research is focused on the womb. The brain, however, seems a strange place to be concerned with when trying to prevent conception. But it is the brain that controls a woman's ovulation by sending signals to the reproductive system via the pituitary gland. And now it is possible to synthesize chemicals which, when given in the form of a nasal spray, will inhibit ovulation by mimicking the brain's signals to the pituitary gland. It may even be possible to develop drugs which act directly on parts of the brain itself--a prospect we should be aware of, whether we would approve of it or not. There has been such an explosion of knowledge of the neural transmission systems that this may not be so far-fetched as it sounds. Research in China tends to concentrate more on naturally occurring substances--like a new form of female sterilization which involves not anesthetics or surgery but a substance called "mucilage"--1 of the ingredients of birds-nest soup. If mucilage is passed through the cervix into the fallopian tubes it causes them to block up and so prevents the passage of the ovum. There is a Western "high-tech" alternative to this, called methylcyanoacrylate--you might be more familiar with it as "superglue" or "crazy glue." Used carelessly it can stick your fingers together, but this tendency to join human tissues can be more productively used to block up the fallopian tubes. The Chinese are also looking at another natural substance as the basis of the possible "male pill." This is gossypol which occurs in cottonseed. A major reason why most research has been focused on contraception for women is that men present problems of quite a different order of magnitude. While a woman only ovulates once every 28 days or so, male sperm are produced continuously, with 200-400 million of them in each ejaculation. But drugs based on gossypol, which seems to have the effect of reducing the sperm count, may be the answer. Under the auspices of the World Health Organization, research on gossypol and other plants with contraceptive potential is now going on over all the world. Some 350 have been put under the microscope so far and about 30 look worth pursuing.

Contraception↗
PubMed1972

Chlormadinone acetate and its effect on the hemostatic mechanism.

There is an apparent discrepancy between the effects on the hemostatic mechanism of synthetic progestins alone and synthetic progestins in combination with synthetic estrogens. Coagulation studies were carried out on 21 patients treated with chlormadinone acetate 0.5 mg. on a continuous daily basis for 12 weeks in order to determine its effects on hemostasis. Unlike the standard estrogen/progestin contraceptive agents, this synthetic progestin appears to have no effect on the coagulation system as determined by standard laboratory tests.

Blood Coagulation↗