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PubMed1993

Comparative study on the efficacy, acceptability, and side effects of a contraceptive pill administered by the oral and the vaginal route: an international multicenter clinical trial.

The objective of this multicenter randomized clinical trial was to compare the efficacy, acceptability, and occurrence of side effects associated with the oral versus vaginal route of administration of contraceptive pills. Eight hundred nineteen healthy, parous women of reproductive age were recruited at family planning clinics and research centers, members of the South to South Cooperation in Reproductive Health, in seven countries of the developing world. These women were randomly assigned to use either oral or vaginal administration of the same contraceptive pill, which contained 250 micrograms levonorgestrel and 50 micrograms ethinyl estradiol. No statistically significant differences were found in discontinuation rates between the two groups after 1 year. Involuntary pregnancy rates after 1 year were not statistically significantly different between the two groups. The vaginal route of administration appears to be as acceptable and efficacious as the oral route.

Administration, Intravaginal↗
PubMed2001

New options in contraception for adolescents.

There have been several recent advances in the contraceptive methods available to adolescents in the United States. A new monthly injectable method combines efficacy and ease of compliance with excellent menstrual cycle control. Very low-dose oral contraceptive pills containing gonane progestins decrease the incidence of estrogen-related side effects, and are associated with low rates of breakthrough bleeding. Oral contraceptive pills prescribed in continuous cycles can provide relief from menstrual-related symptoms, and may improve contraceptive effectiveness. Noncontraceptive benefits of oral contraceptive pills, such as improvement in dysmenorrhea and acne, may motivate more consistent pill-taking, and should be identified as additional reasons for pill continuation. Maximizing the prescribing time limit of emergency contraception to 120 hours after unprotected intercourse may improve access. Emergency contraception is more effective the sooner it is used, and should be provided in advance to adolescents for immediate use in the event a postcoital method becomes necessary.

Adolescent↗
PubMed1997

Current status of injectable hormonal contraception, with special reference to the monthly method.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.

Contraceptive Agents, Female↗
PubMed2003

Contraceptive use before and after marriage in Shanghai.

Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples' needs in Shanghai and that the family planning program's attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services.

Adult↗
PubMed1986

Performance of supply-oriented family planning policy in Bangladesh: an examination.

Using data from four nationally representative sample surveys conducted since 1968, this paper examines the performance of the family planning program of Bangladesh, which placed emphasis on its supply component. The very low contraceptive prevalence rate and the large gap between knowledge and use of contraceptive methods indicates the poor performance of the program. After discussing the probable reasons for such performance, the paper suggests accelerating the demand for contraceptives among the married women of Bangladesh through persuasion and by improving the existing contraceptive distribution system. This is required for increasing the use of family planning methods in the country.

Bangladesh↗
PubMed1985

Gynaecology of middle-aged women--menstrual and reproductive histories.

The aim of this study was to investigate menstrual history, reproductive functions, fertility regulation and gynaecological operations is a representative sample of middle-aged women. A sample consisting of 1746 women aged 40-66 was randomly selected. Of those initially selected, a total of 1413 (81%) were investigated. Gynaecological data were acquired by means of questionnaires. Eighty-six percent of menstruating women reported a cycle length of 22-30 days and menstrual flows lasting 4-7 days. The median age at natural menopause was 50.9 yr. The oldest menstruating women were 57 yr old. Curettage had been performed in 53%, and 9% were hysterectomised. Every fourth woman had had three or more children, and 15% were nulliparous. Abortion (spontaneous or induced) was reported by 28% of the women. Of 714 menstruating women, 62% were utilising contraceptive methods, among which barrier or natural methods predominated. Nine percent of women aged 40-44 used combined oral contraceptives. Previous or current use of contraceptive pills was reported by 32% of all the women, and of these 20% had been on the pill for 10 or more yr.

Adult↗
PubMed2006

Comparison profiles of cycle control, side effects and sexual satisfaction of three hormonal contraceptives.

OBJECTIVE: The objective of this study was to compare cycle control, tolerability and sexual well-being with the use of three hormonal contraceptives. METHODS: In this prospective randomized study, the effects of two combined oral contraceptives [20 microg of ethinylestradiol (EE)/100 microg of levonorgestrel and 15 microg of EE/60 microg of gestodene] were compared with those of the vaginal ring (15 microg of EE/120 microg of etonogestrel). One-year data from 280 women were obtained. We investigated the pattern of menstrual cycle and the incidence of weight gain, nausea, headache, breast tenderness, irritability, depression and vaginal dryness. Moreover, desire and sexual satisfaction were evaluated. Finally, the cumulative rate of discontinuation in the three groups was estimated. CONCLUSION: The analysis of adverse events revealed two crucial points for acceptability, compliance and continuation: poor cycle control and disturbance of sexual intercourse due to vaginal dryness and loss of desire.

Administration, Intravaginal↗
PubMed1997

Current practice of family planning in China.

Current practice of family planning in China is based on the population policy and strategy of the country. Comprehensive contraceptive methods are provided in family planning clinics at all levels. Among the methods used, intrauterine devices and tubal sterilization are most popular. Vasectomy is popular in some provinces. Oral pills, injectables and subdermal implants occupy a small proportion. Incidence of abortion is high due to failure of methods and unprotected intercourse. Attention is paid to the adoption of emergency contraception to prevent unwanted pregnancy. Improvement in quality of care is the key to a successful family planning program. Basic research is essential for development of new contraceptive technology.

China↗
PubMed2002

Contraception--past and future.

Modern contraceptive methods have a surprisingly short history and are dominated by the oral contraceptive pill, which came on to the market in 1960. New developments since the advent of the pill have been largely limited to tinkering with the contents and routes of administration of hormonal contraception. The knowledge that would allow a more exciting approach to new contraceptives does exist but the will to proceed is hampered by financial, political and moral factors, and perhaps ironically by the AIDS epidemic.

Contraception↗
PubMed1996

Contraceptive use among female adolescents.

Teenage pregnancy continues to be a problem in the United States despite the availability of reliable contraceptive methods. A pilot study was conducted to determine the use of reliable contraception by teenagers following an abortion or negative pregnancy test. The results indicated that 96.6% of the teenagers experiencing a therapeutic abortion and 49.6% of the teens having a negative pregnancy test reported choosing reliable contraception after the procedure or the test. At a subsequent clinic visit, however, only 27.5% in the abortion group and 5.7% in the negative pregnancy test group reported use of reliable contraception. Further research is needed to identify factors involved in teenagers' use or nonuse of contraception.

Abortion, Legal↗
PubMed2000

Clinical profile of Implanon: a single-rod etonogestrel contraceptive implant.

This 3-year study investigating the contraceptive efficacy and tolerability of Implanon in 635 volunteers demonstrates that it was well tolerated and had excellent, reversible, contraceptive efficacy. No pregnancies (Pearl index, 0; 95% CI 0.0-0.2) occurred during 1,200 woman-years of exposure. Irregular bleeding, mainly frequent and prolonged, was the primary reason for discontinuation (19.0%). Infrequent bleeding (29-51%) was the most common bleeding disturbance. Adverse events, other than bleeding irregularities, were generally mild to moderate in intensity and resulted in 9.3% of discontinuations. Over 85% of women with dysmenorrhea at baseline noted an improvement at the end of treatment, while 4% reported new or worsened symptoms. The most commonly reported non-bleeding adverse events were breast pain (16%), acne (12.6%), vaginitis (12%) and pharyngitis (10.5%). However, acne present at enrolment improved or disappeared during treatment in 59% of women. Less than 5% of women experienced implant site symptoms after insertion or removal, mainly mild pain of short duration. Average insertion and removal times were 2.2 and 5.4 min, respectively. In most women, menses returned to normal within 3 months of implant removal. Of those using no contraceptive method, 13.8% became pregnant within 90 days. Implanon represents a highly effective contraceptive option for women.

Adolescent↗
PubMed1984

Breast feeding.

Breast feeding is becoming more popular among all socioeconomic classes. By providing instruction and care of the mother and infant, the physician can greatly enhance the chances for success. Although breast feeding is a natural function, the proper technique needs to be learned. There are relatively few contraindications. The infant requires vitamin K at the first opportunity and supplementation with vitamin D and fluoride as necessary. Recommended daily dietary allowances are increased for nursing mothers. The physician must understand the effects of different contraceptive methods on lactation.

Breast Feeding↗
PubMed1995

Impact on sexually transmitted disease spread of increased condom use by young females, 1987-1992.

BACKGROUND: Sexual behaviour data are crucial for understanding the spread of sexually transmitted diseases (STD). Over a period (1987-1992) in which the HIV epidemic increased public awareness of safe sexual practices, we describe predictors of condom use, changes in condom use over time, and the estimated effects of these changes on the spread of STD. METHODS: Condom use reported by females aged 18-35 years with non-cohabiting partners was analysed using data from two cross-sectional postal surveys performed 5 years apart (1987 and 1992) on two separate representative samples of 10,000 subjects aged 18-60 years living in Norway. A simple mathematical model was used to assess the effects of selection bias. A more complicated model was used to predict the effects of condom use on the prevalence of STD in a population which includes a core group of highly sexually active subjects. RESULTS: We found an increase in the prevalence of condom use in the latest intercourse from 14% to 20% with non-foreign partners and from 10% to 38% with foreign partners, from 1987 to 1992. In a logistic regression model, low frequency of intercourse, high education, one lifetime partner, and late sexual debut were predictors for condom use. Controlled for these variables, the odds ratio (OR) for condom use in 1992 versus 1987 was 1.4 (95% confidence interval [CI]: 0.9-2.0) if the partner was non-foreign, and 7.1 (95% CI: 2.5-20.5) if the partner was foreign. Not using other contraceptive methods was a strong predictor for condom use; OR = 17.4 (95% CI: 8.0-38.0). Condom use in the first intercourse with the last partner was a strong predictor for condom use in the last intercourse; OR = 19.2 (95% CI: 8.2-45.3). It appeared unlikely that the increase in condom use could be explained by response bias. The predicted reductions in STD prevalence due to the increase in condom use ranged from zero to 30% depending on consistency of use, and on the agent that is transmitted. CONCLUSIONS: Condom use among 18-35 year old women has increased over the period, particularly with foreign partners. Condoms are used primarily as contraception. The prevalences of STD with high transmission rates are not reduced by inconsistent condom use, while the prevalences of STD with low transmission rates are reduced by both consistent and inconsistent condom use. Condom use in a core group is more effective for reducing the STD prevalence than condom use in the non-core group for gonorrhoea and HIV. For chlamydial infection, condom use in the non-core group is more effective.

Adolescent↗
PubMed1993

"Natural family planning": effective birth control supported by the Catholic Church.

During 20-22 September Manchester is to host the 1993 follow up to last year's "earth summit" in Rio de Janeiro. At that summit the threat posed by world overpopulation received considerable attention. Catholicism was perceived as opposed to birth control and therefore as a particular threat. This was based on the notion that the only method of birth control approved by the church--natural family planning--is unreliable, unacceptable, and ineffective. In the 20 years since E L Billings and colleagues first described the cervical mucus symptoms associated with ovulation natural family planning has incorporated these symptoms and advanced considerably. Ultrasonography shows that the symptoms identify ovulation precisely. According to the World Health Organisation, 93% of women everywhere can identify the symptoms, which distinguish adequately between the fertile and infertile phases of the menstrual cycle. Most pregnancies during trials of natural family planning occur after intercourse at times recognised by couples as fertile. Thus pregnancy rates have depended on the motivation of couples. Increasingly studies show that rates equivalent to those with other contraceptive methods are readily achieved in the developed and developing worlds. Indeed, a study of 19,843 poor women in India had a pregnancy rate approaching zero. Natural family planning is cheap, effective, without side effects, and may be particularly acceptable to the efficacious among people in areas of poverty.

Catholicism↗
PubMedDate not supplied

Who continues using the diaphragm and who doesn't: implications for the acceptability of female-controlled HIV prevention methods.

OBJECTIVES: This study examines the acceptability of the diaphragm with the aim of facilitating the development of female-controlled human immunodeficiency virus (HIV) prevention methods. More specifically, we assess associations between being a current (vs. former) diaphragm user and characteristics that are hypothesized to influence the acceptability of contraceptive methods; and explore reasons for discontinuing use of the diaphragm among former diaphragm users. DESIGN: The study involved a cross-sectional telephone survey with women who were members of a nonprofit health maintenance organization and who were either a current (n = 215) or former (n = 172) diaphragm user. METHODS: Participants were interviewed about the importance of contraceptive attributes; perceptions for the diaphragm; diaphragm use self-efficacy; perceived risk of and motivation to avoid pregnancy, HIV, and other sexually transmitted infections; and demographic characteristics, sexual, and contraceptive behavior. RESULTS: The likelihood of being a current diaphragm user (vs. former) increased with age, greater confidence in being able to use the diaphragm, greater perceived risk of pregnancy and more positive perceptions of the diaphragm. Women who valued attributes of hormonal contraceptives were less likely to be current users. Former diaphragm users reported that the following reasons were moderately to extremely important in their decision to stop using the diaphragm: difficulty inserting or removing the diaphragm (50.8%), dislike of leaving the diaphragm inside the vagina (46.8%), and wanting a more effective method for preventing pregnancy (44.2%). CONCLUSIONS: The findings suggest that specific characteristics of a product influence continued use and have implications for improving the acceptability of existing and new female-controlled HIV prevention methods.

Adult↗
PubMed2005

Contraception and sexually transmitted infections.

BACKGROUND: Many women seek contraceptive advice from general practitioners. These consultations provide an opportunity to discuss the prevention of sexually transmitted infections (STIs) including human immunodeficiency virus (HIV). OBJECTIVE: This article discusses the effect of various contraceptive methods on the transmission of STIs and HIV. It also highlights issues relevant to achieving both contraception and STI/HIV prevention, with a focus on younger women. DISCUSSION: There is no ideal method to achieve protection against both pregnancy and STIs/HIV. Counselling about risks of STIs/HIV, providing the option of being tested for bacterial STIs, hepatitis B and HIV at the start of new relationships and promoting condom use for casual sex and concurrent sexual relationships is to be encouraged.

Adolescent↗
PubMed1995

The economic value of contraception: a comparison of 15 methods.

OBJECTIVES: The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS: Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS: All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS: Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods.

Contraception↗