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At least 1,621 records · Page 90Linked to original sources
PubMed1986

Clinical experience with multiphasic oral contraceptives.

The short-term, mainly estrogen-induced side effects of oral contraceptives (OCs) have been minimized by a reduction in the estrogen component in formulations currently employed. Women may expect to continue OCs for several decades of their reproductive lives, commencing earlier and stopping later than did their mothers. Youth does not appear to offer protection from initiation of cardiovascular pathology. Data from the Bogalusa Heart Study show that risk factors for cardiovascular disease, such as elevated serum low-density-lipoprotein cholesterol, are associated with anatomic changes in the aorta and coronary arteries very early in life. Therefore, the focus now is on long-term OC effects, especially alterations in carbohydrate and lipid metabolism. Progestin components of some OCs may alter both carbohydrate and lipid metabolism significantly, in a dose- and potency-related manner. OC formulations, therefore, are moving toward a reduction in the dose as well as potency of the progestin used, with a special emphasis on lipid profile study. Multiphasic OCs, the most recent generation of formulations, achieve considerable reductions by starting each cycle at a low dose of progestin and altering the dose in stages. Two of the multiphasics incorporate norethindrone as the progestin. Here we examine the clinical experience with one of the norethindrone-containing agents, Ortho Novum 7/7/7, and compare its performance and metabolic side effects with those of the corresponding monophasic preparation.

Adult↗
PubMed2003

[Cyclic psychosis associated with the menstrual cycle].

Cyclic psychosis associated with the menstrual cycle is an uncommon disorder, not included under the accepted definitions of functional psychoses. We present three female adolescents who developed an acute psychosis a few days before menstruation, which resolved completely upon bleeding or several days later, only to reappear in the same form in subsequent cycles. The clinical presentation was not in line with that of the typical functional psychoses. An extensive medical work-up did not show any significant disturbances, with the exception of anovulatory cycles in one youngster. Psychotropic treatment had no effect on the course of the psychosis. Treatment with progesterone in the second half of the cycle in one case, and with a combined progesterone/estrogen contraceptive agent in another, resulted in full recovery within several cycles. The third girl showed a spontaneous remission within four cycles. Remission continued in all cases after discontinuation of the hormonal treatment, and with no need to reintroduce any psychotropic agent, for a period of 2-4 years. We discuss several possible etiologic mechanisms for cyclic psychosis associated with the menstrual cycle, including it being a cycloid non-specific affective disorder, and its association with a temporary functional hypothalamic-pituitary dysfunction, and with anovulation. We also discuss the role of psychotropic and hormonal treatment in this disorder.

Adolescent↗
PubMed2003

Ovarian cancer in Western Australia (1982-98): incidence, mortality and survival.

OBJECTIVES: To investigate the trends in incidence and mortality and estimate survival for women diagnosed with ovarian cancer in Western Australia. CASE SELECTION AND METHODS: There were 1,336 women diagnosed with ovarian cancer in 1982-98. Age-standardised rates were calculated by the direct method. Age-period and age-cohort models were analysed by Poisson regression. The Kaplan-Meier method was used to estimate survival and Cox proportional hazards regression evaluated the relative risk of dying. RESULTS: Trends in age-adjusted incidence and mortality rates showed little changed over the three time periods of diagnosis. A significant birth cohort effect showed a peak in the risk in the 1924 (mid-year) cohort followed by a general decrease in both incidence and mortality risk. Survival at five years was 34% (95% CI 31.3-36.5) overall, but was only 27% (95% CI 17.4-36.7) among women with stage III and IV disease. Aboriginal women showed a risk of dying twice that of non-Aboriginal women. CONCLUSIONS: The birth cohort analysis of ovarian cancer proved better at explaining disease trends than was time period of diagnosis. Survival continues to be poor, but Aboriginal women and those with serous and unspecified adenocarcinoma tumours fair much worse. IMPLICATIONS: As the leading cause of death from a gynaecological malignancy, ovarian cancer is of public health importance. Historical trends in birth rates and the use of oral contraceptives help to explain at least some of the observed birth cohort trends in this study. In the long term, an effective diagnostic technique needs to be developed or this disease will continue to be diagnosed at an advanced stage when treatment options for cure are limited.

Adult↗
PubMed1977

The benefits and risks of IUD use.

Next to combination oral contraceptives (OCs), intrauterine contraceptive devices (IUDs) are the most effect form of contraception available. IUDs require only one-time motivation, cause no systemic metabolic effects, and do not depend on continued action of the user for effectiveness. Risks, side effects and complications of this method, including expulsion, perforation pain, bleeding and infection, are reviewed.

Abortion, Septic↗
PubMed2006

Use of hormone replacement therapy (HRT) among women aged 45-64 years in the German EPIC-cohorts.

OBJECTIVE: To describe the prevalence and to assess type and indicators of hormone replacement therapy (HRT) use in the two German EPIC-cohorts. METHODS: Approximately 30,000 women predominantly aged 35-65 years were recruited in EPIC-Heidelberg and EPIC-Potsdam between 1994 and 1998. Information on diet and lifestyle, medical history and use of hormone therapy was collected at recruitment. Prevalence and type of HRT-regime was described and logistic regression models used to examine correlates of HRT-use. RESULTS: Among women aged 45-64 years, 37.9% in Heidelberg and 35.8% in Potsdam were current HRT users. Among current users without bilateral oophorectomy, 40.5% in Heidelberg and 23.7% in Potsdam used HRT for at least 5 years. Most women in Heidelberg were taking cyclic combined or estrogen monotherapy, whereas in Potsdam both continuous combined and cyclic combined therapies were most frequently used. In both centres, older age, ever use of oral contraceptives, and alcohol consumption were indicators for both current and ever HRT-use. HRT-use was less frequent in obese women as compared to women with lower BMI. In Potsdam, but not in Heidelberg, higher education and current smoking were associated with HRT-use. CONCLUSION: In both German EPIC-cohorts, the prevalence of medication with HRT is high compared to other European countries. Types of exogenous hormones used differed by centre. Various reproductive and lifestyle characteristics were identified as correlates of HRT-use.

Adult↗
PubMed2002

Genetic dissection of mammalian fertility pathways.

The world's population is increasing at an alarming rate and is projected to reach nine billion by 2050. Despite this, 15% of couples world-wide remain childless because of infertility. Few genetic causes of infertility have been identified in humans; nevertheless, genetic aetiologies are thought to underlie many cases of idiopathic infertility. Mouse models with reproductive defects as a major phenotype are being rapidly created and discovered and now total over 200. These models are helping to define mechanisms of reproductive function, as well as identify potential new contraceptive targets and genes involved in the pathophysiology of reproductive disorders. With this new information, men and women will continue to be confronted with difficult decisions on whether or not to use state-of-the-art technology and hormonal treatments to propagate their germline, despite the risks of transmitting mutant genes to their offspring.

Animals↗
PubMed2005

[The gynaecological work by GPs in Brittany].

The aim of this study is to evaluate the gynaecological work done by general practitioners (GPs) in Brittany and the clarify the role that they play in screening for female cancers. Gynaecology represents approximately 10% of the total activity reported by the respondents; however, wide variations have also been noted. This raises important questions on issues such as the competence of these practitioners in this area and equity in access to care and screening, which could potential lead to problems. A large majority of the participating GPs (87%) identified prevention and screening as their primary specific roles to carry out in the care of their female patients. The main reasons for seeking gynaecological consultation are contraception and hormone replacement therapy, and these are the two themes for which GPs request further medical training and continuing education possibilities. Gynaecological work done within the scope of general practice can be hindered by various factors or obstacles: some stem from the doctors themselves (inadequate skills, little interest in this speciality), or rather may be linked to their working conditions (dealing with several reasons for a patient seeking consultation at the same time), while others are a result of how women (or even the doctors themselves) view the tests (reluctance or lack of confidence in the doctors' ability to carry them out properly). In order for GPs to be more involved and implicated in this field, there would need to be the introduction of an efficient and adapted training as well as compatible and effective continuing education programmes suitable to respond to the needs and requirements of the GPs practicing in this area.

Female↗
PubMed1998

[Hormone replacement therapy in hypertension in the postmenopausal woman].

Naturally occurring or surgically related hormonal deprivation at menopause is associated with cardiovascular and non-cardiovascular complications. Hormonal replacement therapy helps to prevent and treat these complications, not only symptoms associated with menopause (which continue to be their major indication) but also bone and cardiovascular related problems. It is well known that oral contraceptive use is one of the most common reversible causes of secondary hypertension. This is, in part, why the use of hormonal replacement therapy has provoked such suspicion among clinicians who have mainly believed that a similar effect on blood pressure would probably occur with the use of hormonal replacement therapy. However, the results of a variety of clinical studies and surveys do not confirm these suspicions. These beneficial effects have to be weighed against the risk of endometrial hyperplasia, endometrial cancer and breast cancer (among other unwanted effects) that could occur when long-term therapy is implemented. If one considers that the overall risk associated with cardiovascular mortality is more than four times higher than the risk associated with gynecological malignancies, even a modest decrease in the cardiovascular risk could easily outweigh other risks and result in an overall improved risk profile in postmenopausal women.

Blood Pressure↗
PubMed2003

[Non contraceptive benefits of oral contraception].

Both women and the medical profession underrate the non-contraceptive benefits of oral contraception, imbued as they are with its sole deleterious effects, such as thromboembolic ones, in particular. However, the pill is quite an efficient means of preventing against troubles of the menstrual cycle, with a betterment of cycle regularity, a diminishing of menstrual flux and a lowering of the frequency and the severity of primary dismenorrhoea. A review of the literature also demonstrates that oral contraception reduce by 40-50% the incidence of endometrial and ovarian cancer, inclusive of women with a previous history, or genetic predispositions. This effect is correlated with time of use and continues until 10 years or more after stopping taking the pill. Also, the positive part of the pill may well be considered as far as colorectal cancer is concerned, with a 40% or so reduction in risk, by means of decreasing bile acids in the colon. Other benefits of oral contraception have been documented, such as prevention of postmenopausal osteopenia when used during perimenopause, decrease in the incidence of adenofibromas, uterine fibromyomas, fibrocystic mastosis and uterine adnexial infections, and, finally, a favourable effect on acne. Preventive action of the pill on rheumatoid arthritis is debatable, the current feeling being that it diminishes severity as well as symptomatology more than risk of occurrence.

Bone Diseases, Metabolic↗
PubMed1987

Comparative analysis of the effectiveness of the diaphragm and birth control pill during the first year of use among suburban adolescents.

Little attention has been paid to the diaphragm as a contraceptive option for adolescents. To compare diaphragm and birth control pill use by adolescents, 124 females (aged 13-20 years) in a suburban-based adolescent health service were interviewed at least one year after receiving a contraceptive prescription. The 73 diaphragm choosers did not differ from the 51 pill choosers in age, race, or reason for their original visit to the health service. Diaphragm choosers, however, were better students, of higher socioeconomic status, and had had fewer prior pregnancies. In the year following prescription, continuous use for 12 months was reported by 43% of diaphragm choosers and 45% of pill choosers, with significantly more pill (26%) than diaphragm (8%) choosers reporting discontinued use for at least one month while remaining sexually active. Regular use (diaphragm every intercourse, missing less than or equal to 1 pill/month) was reported by 36% of diaphragm choosers compared to 88% of pill choosers; and at least one pregnancy during the year was reported by 15% of diaphragm choosers and 18% of pill choosers. At follow-up interviews, diaphragm subjects disliked the immediate annoyances of the diaphragm, and pill users expressed concern about the potential side effects of the pill. No single factor or set of factors correlated with continuous and regular use of either method. Because both methods present specific problems for certain patients, we suggest that in addition to the pill, the diaphragm should receive serious consideration as a contraceptive option for adolescents.

Adolescent↗
PubMed2002

Take a fresh look at IUDs. Things have changed.

BACKGROUND: Over the past few years, the intrauterine contraceptive device (IUD) has overcome many of the problems that had initially made it unpopular. Today it is probably the most cost effective reversible form of contraception available. OBJECTIVE: To examine the reasons for poor utilisation of IUDs in Australia and to describe recent developments in the field of intrauterine devices/systems. DISCUSSION: Myths concerning mechanisms of action and the potential for pelvic inflammatory disease, lack of familiarity, training and high insurance costs continue to limit the ability of general practitioners to fully utilise the potential of IUDs. The introduction of the levonorgestrel releasing intrauterine system has however, broadened the indication for IUDs from just being contraceptive to being therapeutic for several gynaecological conditions.

Attitude of Health Personnel↗
PubMed2002

[Unwanted pregnancy: impact on health and society in Latin America and the Caribbean].

Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted pregnancy is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100% effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occurred. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the same is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs that address gender issues, education programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that health care be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy.

Abortion, Induced↗
PubMed2005

Discontinuous low-dose flutamide-metformin plus an oral or a transdermal contraceptive in patients with hyperinsulinaemic hyperandrogenism: normalizing effects on CRP, TNF-alpha and the neutrophil/lymphocyte ratio.

BACKGROUND: Low-dose flutamide-metformin (Flu-Met) with an oral contraceptive is a therapeutic option for women with hyperinsulinaemic hyperandrogenism. We questioned (i) whether Flu-Met maintains efficacy if given discontinuously; (ii) how the efficacy of discontinuous Flu-Met plus a transdermal contraceptive compares with Flu-Met plus oral contraceptive; and (iii) whether these treatments also lower circulating C-reactive protein (CRP) and tumour necrosis factor alpha (TNF-alpha) and the high neutrophil/lymphocyte ratio. METHODS: Non-obese, young patients (n = 31) with hyperinsulinaemic hyperandrogenism were started on Flu-Met (21/28 days) and randomized to receive in addition either a drospirenone oral contraceptive or a transdermal contraceptive for 6 months. RESULTS: The effects of Flu-Met were similar whether combined with oral or transdermal contraceptive. In both groups, CRP and TNF-alpha levels fell and the high neutrophil/lymphocyte ratio normalized (P < 0.001). Lean body mass increased (P < 0.001) in both groups but, in contrast to earlier experience with continuous Flu-Met, fat mass failed to decrease in either group. CONCLUSIONS: Flu-Met seems less lipolytic, if given for only 21 days in every 28-day period. The efficacy of Flu-Met is comparable when combined with an oral contraceptive or a transdermal contraceptive. The range of Flu-Met effects may henceforth include lower levels of CRP and TNF-alpha, and a normalization of the neutrophil/lymphocyte ratio.

Administration, Cutaneous↗
PubMed1984

The cervical cap: a retrospective study of an alternative contraceptive technique.

A follow-up study on 130 women fitted with a cervical cap over a 12-month period drew a response rate of 43% (56 respondents). The group was young, well educated, and highly motivated. The failure rate was 16.9 per 100 women years (Pearl method), with inconsistent use and dislodgement being of major importance. The continuation rate was 75% (minimum 3 months of use), and 84% expressed satisfaction with the method. No significant side effects or risks to health were encountered. The conclusion is that there is a significant demand for alternative contraceptive methods among a select group of women. However, in the present state of knowledge, use of the cap should probably not be encouraged as a primary means of contraception, but should be reserved for those women with multiple contraceptive problems or for highly motivated women who seek out this means, understand its limitations, and can accept the relative uncertainty of its effectiveness.

Adult↗
PubMed1966

Sequential therapy to achieve anovulatory cycles.

Sequential oral contraceptive therapy was devised to inhibit ovulation by a potent estrogen alone. A progestational agent was added at the end of the course of therapy to prepare the endometrium for adequate withdrawal bleeding. The program consisted of giving 80 mug. of metranol daily for 15 days and then a combination of 80 mug. of mestranol and 2 mg. of chlormadinone acetate for five additional days. Such a regimen proved to be effective in 6070 patients carefully observed for 82,085 cycles of therapy at 25 medical centres.INCREASED CYCLE REGULARITY WAS NOTED: 98.1% of the cycles were 25 to 31 days long. In 80.1% of cycles, the withdrawal interval was two to five days in length. Duration of flow was four to six days in 85.3% of the therapeutic cycles. The amount of flow decreased as compared with pretreatment values. The incidence and severity of dysmenorrhea during sequential therapy were significantly lower than before treatment. Side effects, usually infrequent, diminished as therapy was continued; the average incidence of breakthrough bleeding was 1.9% and nausea was 2.9%. Extensive laboratory studies showed no consistent abnormalities. For oral contraception, sequential therapy has proved to be virtually 100% effective when taken as directed.

Adult↗
PubMed1979

[Comparative electron microscopic studies on benign liver tumors and jaundice associated with contraceptive drugs].

Author compared the ultrastructure of the hepatic tissue in 6 cases with benign hepatic tumours revealed in women taking oral contraceptives and in 3 cases with icterus. The majority of the ultrastructural changes were alike in cases with- or without tumours. Deposition of filamentous material of unknown nature in the biliar canaliculi and Disse-space associated with the damage to the cell membrane author believes to have a significance. Ultrastructure of the sinusoid endothel indicate an increased protein synthesis. The most striking feature of the tumours: formation of continuous capillaries in the place of sinusoids. Author emphasizes that systematic electron microscopic studies may contribute to our knowledge concerning the question of the effect of oral contraceptives on hepatic cells.

Adult↗
PubMed2001

Current status of fertility control methods in India.

Approximately 48.2% of couples of 15 to 49 years of age practice family planning methods in India. Female sterilization accounts for 34.2%, with male sterilization declining from 3.4% in 1992-93 to 1.9% in 1998-99. Use of the condom increased to 3.1% from 2.4%. There is an urgent need for research to develop new contraceptive modalities especially for men and also for women and to make existing methods more safe, affordable and acceptable. Current efforts in India to develop a male contraceptive are mainly directed towards (i) development of antispermatogenic agents to suppress sperm production, (ii) prevention of sperm maturation, (iii) prevention of sperm transport through vas deferens or rendering these sperm infertile and (iv) prevention of sperm deposition. Research work in the field of prevention of sperm transport through vas deferens has made significant advances. Styrene maleic anhydride (SMA) disturbed the electrical charge of spermatozoa leading to acrosome rupture and consequent loss in fertilizing ability of sperm. A multicentre phase-III clinical trial using SMA is continuing and it is hoped that the SMA approach would be available in the near future as an indigenously developed injectable intra-vasal male contraceptive. The safety and efficacy of available oral contraceptives were evaluated. An indigenously developed oral contraceptive 'Centchorman', which is a nonsteroidal, weakly estrogenic but potently antiestrogenic, was found to be safe and effective and is now being marketed in India since 1991 as a 'once a week' pill. Cyclofem and Mesigyna have been recommended as injectable contraceptives with proper counselling and service delivery by Indian studies. It has been recommended that these injectable contraceptives be added to the existing range of contraceptive methods available in the National Family Planning Programme. Based on the Indian studies CuT 200 was also recommended. Studies have indicated the advantage of intrauterine devices (IUD); they are long acting, relatively easily removed and fertility returns rapidly after their removal. Recent studies have recommended CuT 200 for use up to 5 years. The combination of some plant products i.e. Embelia ribes, Borax and Piper longum has been found to be safe and effective as a female contraceptive and the results of phase-I clinical trials are encouraging. Research work is going on in the country in various areas with special reference to hormonal contraceptive - a three monthly injectable contraceptive, immuno-contraceptives, antiprogestins, etc.

Animals↗