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PubMed2005

Pharmacological female contraception: an overview of past and future use.

Female hormonal contraceptive methods have undergone slow change over the past four decades. Due to social, political and legal reasons, as well as medical complications, several new methods have been removed from the contraceptive armamentarium almost as quickly as they have been added. With worldwide unintended pregnancy rates approaching 50% of all pregnancies, there is an increased need for the development of new methods of effective, safe, acceptable hormonal contraception. Pharmacological methods of contraception are reversible and contraceptive steroids are now formulated in pills, patches, intravaginal rings, subdermal implants and injections. All currently marketed formulations are made from synthetic steroids and contain no natural oestrogens or progestins. This article reviews the current state of female contraception and explores future directions.

Administration, Cutaneous↗
PubMed2005

Vaginal delivery of contraceptives.

Although a steady increase in contraceptive use has been observed both in developed and less-developed countries, the large number of unplanned pregnancies may indicate that the contraceptive needs of a significant percentage of couples have so far not been met. Several new contraceptive products have reached the market during the last 2 years. Among these is a new contraceptive vaginal ring, which has become available for prescription. This new female method has been developed to expand the contraceptive choices available to couples. This review will address the specifics of the vaginal route for delivering contraceptive steroids and describe the various systems available or under evaluation.

Contraceptive Agents↗
PubMed2000

Patterns of contraceptive use in 5 European countries. European Study Group on Infertility and Subfecundity.

OBJECTIVES: The use of contraception in Denmark, Germany, Poland, Italy, and Spain is described. METHODS: Data were drawn from a population-based cross-sectional study, the European Study of Infertility and Subfecundity. Interviews were conducted with 6630 women aged 25 to 44 years. Logistic regression was used to estimate the effect of factors associated with contraceptive use. RESULTS: Residents of Northern European countries tended to use more effective methods of contraception than residents of Southern European countries. The use of contraception was generally more common among single women, the more highly educated, those with children, and those with a previous induced abortion. These characteristics were also the main determinants of the use of more effective methods. Periodic abstinence and withdrawal were more common among older women. CONCLUSIONS: The European countries are in different phases of contraceptive practice: in Northern and Western Europe, use of more modern methods has been stable over the past 10 years, whereas these methods are less common in Southern and Eastern Europe. The results suggest the need for information, education, and provision of contraceptive services in Eastern and Southern Europe.

Abortion, Induced↗
PubMed1976

Drug stimulated biotransformation of hormonal steroid contraceptives: clinical implications.

On the basis of well documented biochemical and pharmacological data about the influence of drug mediated enzyme induction on the biotransformation of natural and synthetic sex steroids, practical consequences for hormonal steroid contraception are described and discussed. Clinical reports dealing with this problem are still sparse. The clinical symptoms of drug stimulated biotransformation of hormonal steroid contraceptives are characteristic. Spotting or breakthrough bleeding are observed and in the extreme case conception may occur despite the regular intake of the contraceptive. The appearance of these symptoms differs from one individual to another. With a strong enzyme inducer, bleeding disorders can be provoked artifically in 50 to 60% of the women receiving hormonal contraceptive treatment. The range of drugs which stimulate biotransformation of hormonal contraceptives with consequent loss of their biological effectiveness is not completely known. For practical purposes, it is recommended that bleeding disturbances under hormonal steroid contraception in a previously regular cycle be regarded as loss of reliability; they should be remedied and taken as a sign to search for uncontrolled drug taking.

Ampicillin↗
PubMed2003

Transdermal ethinylestradiol/norelgestromin: a review of its use in hormonal contraception.

UNLABELLED: Ethinylestradiol 20 microg/day plus norelgestromin 150 microg/day have been formulated into a transdermal patch for hormonal contraception. The predominant mechanism of action for transdermal ethinylestradiol/norelgestromin (Ortho Evra, Evra) is inhibition of ovulation by suppression of gonadotropins. It suppresses follicular development, induces changes to the endometrium that reduce the probability of implantation, and increases the viscosity of cervical mucus, which may prevent sperm penetration into the uterus. Two large randomized, nonblind efficacy studies demonstrated that transdermal ethinylestradiol/norelgestromin was as efficacious in preventing pregnancy as oral triphasic ethinylestradiol/levonorgestrel or oral ethinylestradiol/desogestrel. A large, noncomparative study also showed transdermal ethinylestradiol/norelgestromin to have good contraceptive efficacy. Moreover, in the two comparative trials, women using transdermal ethinylestradiol/norelgestromin had higher rates of perfect compliance than women using oral contraception. Age did not affect the rate of perfect compliance in women using the transdermal ethinylestradiol/norelgestromin patch, whereas the rate of compliance reduced with younger age in oral contraceptive users. Pooled results from three efficacy studies found that 1.8% of patches were replaced as a result of complete detachment and 2.9% because of partial detachment. Physical exercise, water immersion, and living in a humid climate did not affect patch adhesion. Transdermal ethinylestradiol/norelgestromin was generally well tolerated in clinical trials. The most common menstrual disturbances were breakthrough bleeding/spotting and dysmenorrhea. The incidence of discontinuation of treatment because of an adverse event was < or = 3.2%, with the most common reason being application-site reactions. CONCLUSIONS: Transdermal ethinylestradiol/norelgestromin offers a well tolerated, effective, reversible, and easy-to-use method of hormonal contraception with an increased likelihood of compliance relative to oral contraceptives.

Administration, Cutaneous↗
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↗
PubMed2005

Contraceptive behaviors in adolescents.

A wide range of factors influence adolescents' contraceptive behaviors, from personal characteristics to family context to social support to knowledge about and access to contraception. Improving knowledge about contraception and counseling about successful contraceptive use can be helpful in decreasing the remarkably high US rates of adolescent pregnancy. Encouraging the postponement of sexual activity until an individual adolescent is developmentally capable of participating in a mature, healthy, mutually respectful relationship that incorporates effective contraception clearly is a goal that most clinicians, parents, teachers, and other responsible adults can support. Contraceptive technologies that incorporate delivery systems that are "user-friendly" and long-acting also will help to further lower US adolescent pregnancy rates that, while improving, are currently among the highest in the world.

Abortion, Induced↗
PubMed2006

Hormonal contraception update.

Unintended pregnancy continues to be a serious public health issue in the United States. Of the 3 million unplanned pregnancies per year, 60% occur in women using some form of contraception. Educating and helping women choose a contraceptive agent that best suits their needs will improve compliance and contraceptive efficacy. A multitude of new contraceptive agents are now available. We review new hormonal contraceptive options and discuss newer oral agents, extended-cycle contraception, and innovative delivery methods.

Contraception↗
PubMed2000

Levonelle-2 for emergency contraception.

About 190,000 therapeutic terminations of pregnancy occur in the UK each year. Many of these could be prevented by the use of emergency contraception. We have previously discussed the use of combined hormonal emergency contraception. Now, a progestogen-only emergency contraceptive, levonorgestrel in the form of [symbol: see text]Levonelle-2 (Schering Health), has been licensed in the UK. The manufacturer claims that the treatment offers "unsurpassed efficacy in oral emergency contraception" with "significantly less nausea and vomiting than combined oral emergency contraception". We investigate these claims and discuss whether Levonelle-2 is an advance in emergency contraception.

Adolescent↗
PubMed2002

A new monophasic oral contraceptive containing drospirenone. Effect on premenstrual symptoms.

OBJECTIVE: To determine whether a new monophasic oral contraceptive containing drospirenone/ethinyl estradiol reduces premenstrual symptoms. STUDY DESIGN: In an open-label study measuring intrasubject changes in premenstrual symptoms and comparing effects between women who were new users of oral contraceptives and those who switched from previous contraceptives, ethinyl estradiol (30 micrograms) and drospirenone (3 mg) were administered for 13 menstrual cycles to 326 healthy women aged 18-35 years. Subjects completed the 23-item Women's Health Assessment Questionnaire at baseline and at the end of the sixth cycle. RESULTS: At the end of cycle 6, premenstrual and menstrual symptom scores on the negative affect and water retention scales were reduced significantly relative to baseline, as was increased appetite during the premenstrual and menstrual phases. Similar improvements were seen among new users of hormonal contraceptives and those who switched from previous contraceptives. Impaired concentration scale scores were not significantly reduced from baseline, and assessments of undesired hair changes and feelings of well-being did not change appreciably. CONCLUSION: An oral contraceptive containing drospirenone/ethinyl estradiol may reduce the premenstrual symptoms of negative affect, water retention and increased appetite.

Adolescent↗
PubMed2002

Emergency contraception.

BACKGROUND: Humans have long sought an effective method of contraception that could be utilised after unprotected sex. OBJECTIVE: This article aims to examine the range of available emergency contraceptive options, with particular emphasis on the advantages of progestogen only emergency contraception over the combined regimens advocated in the past. DISCUSSION: The recent release of the first commercially packaged emergency contraceptive regimen on the Australian market has refocussed attention on this important public health issue. The widespread adoption of effective emergency contraceptive regimens has the potential to reduce the rate of unplanned pregnancy and termination of pregnancy in Australia. This article aims to discuss available regimens, their mode of action and existing barriers to use, and controversies such as over-the-counter supply of emergency contraception.

Contraception↗
PubMed2002

[Study on the male contraceptive based on epididymis].

More and more study on the epididymal function and sperm maturation has shown that epididymis will be one of the best target organs of male contraception, although at present there is not a male contraceptive medicine based on epididymis for clinical practice. The promoting research aspects in epididymal contraception in animal included affecting directly epididymis (such as Sulpasalazine), interfering energy metabolism and sperm mobility (such as Chlorinated Glycerol), altering the internal environment of epididymis (such as copper particles and TW19). The epididymal specific proteins could bring out some new target antigens for immunological contraception, to produce contraceptive vaccine. Some special genes, which expressed distinctively in epididymis such as SC342, bin1, have been cloned and studied on their function. These works would be helpful not only for clinical diagnosis and treatment of epididymitis and male infertility, but also for male contraceptive research and progress.

Contraception↗
PubMed2004

SOGC clinical practice guidelines: Canadian contraception consensus.

OBJECTIVE: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases. OUTCOMES: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada. EVIDENCE: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed. VALUES: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.

Canada↗
PubMed2004

Gender issues in contraceptive use among educated women in Edo state, Nigeria.

BACKGROUND: While traditional contraception is widely used, in southern Nigerian modern contraception is a relatively recent phenomenon. Modern contraception is more wide spread among the educated and sexually active youth in Nigeria. Few studies have been done on contraception among educated women in Nigeria. OBJECTIVES: This study was carried out in December 2000 to determine factors that influence the choice of contraceptives among female undergraduates at the University of Benin and Edo State University Ekpoma. METHODS: Data was collected from a sample of 800 female undergraduates matched ethnic group, socio economic status, religion and rural urban residence. Subjects were selected by proportional representation and the instrument used was closed ended questionnaire. RESULTS: The responses obtained were analysed using Spearman Rank Correlation co-efficient and regression analysis. Findings revealed the highest correlation for availability (r =.96) vis a vis the use of various types of artificial contraceptive and cost (r =.96), next was safety (r =.95) and effectiveness (r =.95). Others were peer group influence (r =.80) and convenience (r =.77). CONCLUSION: An important step in improving women's reproductive health is the involvement of men. Health programmes should conduct campaigns to educate men about reproductive health and the role they can assume in family planning.

Adult↗
PubMedDate not supplied

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.

Contraceptive Devices, Female↗
PubMed2005

[Knowledge, attitudes and practices about contraception in an urban population].

We studied knowledge, attitudes and practices (KAP) regarding contraception of 1003 married women (aged 15-49 years) randomly recruited from private clinics (490 women) and community clinics (512 women) in Beirut in the year 2000. A standardized KAP questionnaire was administered to the 2 groups and differences between the groups were analysed. Contraceptive methods were used by two-thirds of the women. The private clinics group reported a significantly higher socioeconomic status and educational level than the community clinics group. Despite the free availability of contraceptive methods in the community clinics, the women's level of knowledge of, attitude towards and practice of contraception was significantly lower than those of women in the private clinics. Knowledge, attitudes and practices toward contraception did not depend on the free availability of contraceptive methods but rather on the socioeconomic and educational level of the women.

Adolescent↗
PubMed2006

Sexual behaviour, contraception and fertility among in-school adolescents in Ikenne Local Government, south-western Nigeria.

A cross- sectional study was conducted among in-school adolescents in six secondary schools in the health districts of Ikenne Local Government to assess the sexual behaviour, contraception and fertility experiences of the adolescents between the months of May and November 2002.Relevant information was collected from 1140 in-school adolescents with the aid of pre-tested, structured, self-administered questionnaires, selected by using multistage and stratified random sampling techniques Information sought from the questionnaires included socio-demographic characteristics of the respondents, parental background, their sexual behaviour, knowledge and use of contraception, human development, pregnancy and fertility experiences, information on sexually transmitted infections (STIs) and HIV/AIDS. During the same period, twelve (12) Focus Group Discussions (FGDs) sessions were conducted using an FGD Guide in the selected schools to highlight differences in opinions of students and also to highlight identification of the group consensus. The mean ages at first intercourse were 13.9 +/- 2.8 years and 14.8 +/- 2.4years for males and females respectively. Boys initiated sex earlier than girls. This difference was found to be statistically significant (p<0.05). Sexual intercourse had been experienced by 28.5% of the adolescent students, significantly more (37.6%) males than females (20.4%) The school adolescents that responded as being married were.4.5% (26males, 23 females) of the respondents. Knowledge on contraception was 36.9% and 22.1% for male and female students respectively, more males than females had knowledge of contraception in a significant proportion, apparently due to increase awareness of the male condom among males. Current use of contraception was equally low, and was found to be 10.9% and 6.0% for males and females respectively. The reasons for non-use were mainly that of non-availability (22.3%), cost (11.8%) negative attitude towards contraception due to societal disapproval (33.2%) and lack of knowledge of how to use them (21.3%). The proportion of adolescents that had ever experienced symptoms associated with Sexually Transmitted Infections (STIs) was 26.8%. Multiple factors were found to be responsible for the deplorable reproductive health situation of the adolescents in this community. The need for provision of sexuality and life planning education in schools including the provision of Youth friendly health services in the community were highlighted.

Adolescent↗
PubMed1990

[Doctors and injectable contraception. Analysis of the logistics of prescribing in accordance with the views expressed by doctors].

Injectable contraception (IC) using medroxyprogesterone acetate (Depoprovera) and norethisterone enanthate (Noristerat) has been discussed in numbers of publications since the Food and Drug Administration (FDA) of the USA have refused to authorize the use of Depoprovera as a contraceptive in America. This has provoked a large number of publications in the international literature. The refusal was based on the potential oncogenic risk of the molecule. The distribution of this product as a contraceptive in developing countries and its restricted authorisation in many industrialised countries including France has brought about contradictory debates about the assessment of this method (secondary effects, risks of developing cancer and teratogenesis). In 1986 we started a research using close collaboration between the health teams of Seine-Saint-Denis (which control clinics, family planning clinics and hospitals) in order to try to find some solution to this problem "for or against IC". The object of this research was to find out how acceptable this method was as compared with other contraceptive methods. The fact that many disciplines were involved (gynaecologists, sociologists, epidemiologists and pharmacologists) in this work made it possible first to find out the conditions under which IC was prescribed (by sociological analysis and discussions with doctors). And the socio-cultural features in which the doctors who prescribed this method of contraception were situated also came into play. The criteria under which ICs are prescribed are not mainly medical but are narrowly linked to socio-cultural factors and the socio-economic factors of the women for whom it is prescribed: and this is in comparison with other methods of contraception. Prescribing this substance has a degree of urgency about it.

Attitude of Health Personnel↗