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Is lactation nature's contraceptive? Data from Samoa.

Data from a Samoan menstruation study suggest that lactation, even intensive on-demand lactation, does not inhibit menstruation or conception. This paper explores the applied and theoretical implications of continuing to accept lactation as a universally effective fertility control mechanism. Such thinking can have disastrous implications for family planning programs, and it keeps us from challenging long-held assumptions about lactation's role in population growth in early populations.

Body Weight↗

Intrauterine contraception in diabetic women.

The results of intrauterine contraception using four different types of Antigen devices in 118 insulin-treated diabetic women are reported. The patients were followed for a total of 24 months. Cumulative closure rates for the 1st year were as follows: pregnancy, 3.5; expulsion, 13.1; removal for bleeding and/or pain, 7.9; and planned pregnancy, 1.2, giving a continuation rate of 74.3. Cumulative closure rates after 24 months were as follows: pregnancy, 6.5; expulsion, 14.4; removal for bleeding and/or pain, 17.1; and planned pregnancy, 8.3, giving a continuation rate of 56.7. These results are not significantly different from those found by us in nondiabetic women, No serious side effects occurred, in particular no pelvic inflammations or perforations. Intrauterine contraception using the Antigon appears to be a well-suited method for diabetic women.

Diabetes Mellitus↗

Morphological studies of human endometrium during continuous LH-RH agonist treatment.

Light and electron microscopic studies were performed on endometrial biopsies from seven healthy women after 2 to 17 months of daily intranasal luteinizing hormone-releasing hormone (LH-RH) agonist treatment for contraceptive purposes. Hormone analyses revealed inhibition of ovulation in all the women. Light microscopy showed an inactive or weak proliferative endometrial pattern, with no signs of hyperplasia. Ultrastructurally, the epithelial and stromal cells of the endometrium displayed signs of low metabolic activity. Since the results are contradictory to those earlier presented by others, further studies are necessary to exclude the potential risk of hyperestrogenic stimulation of the endometrium during continuous LH-RH agonist treatment.

Adult↗

[The place of oral contraceptives and pregnancy in the aetiology of amenorrhoea, a study of 188 cases of secondary amenorrhoea lasting more than one year (author's transl)].

188 patients who had secondary amenorrhoea lasting more than a year were investigated in the same way, in a continuous series, and were classified: - under 6 diagnostic headings: 22 cases of hyperprolactinaemia, 40 cases of primary amenorrhoea, 51 cases of anorexia nervosa, 52 cases of psychogenic amenorrhoea, 9 cases of premature menopause and 5 pregnancies. - and in 3 groups: Group I : 28 cases of amenorrhoea which have been diagnosed as due to the stopping of oral contraception. Group II : 25 cases of amenorrhoea which were found immediately post-partum. Group III : 135 cases of amenorrhoea which did not come into these categories. The authors noted that hyperprolactinaemia was more common and anorexia nervosa was less common in Group I and II as compared with Group III. The results have been interpreted against the age of the patient at the time of diagnosis, at the time of their last period and the relationship to the interval between the amenorrhoea starting and the consultation. A review of the literature demonstrates the methodological problems that are shown up in interpreting these results.

Adolescent↗

Long-term use of an injectable contraceptive: effect of depot-norethisterone oenanthate on carbohydrate metabolism.

In order to determine the metabolic effects of long-term use of the injectable contraceptive norethisterone oenanthate, plasma glucose and serum insulin concentrations were studied in two groups of women who had used the method continuously for at least five years. Group 1 comprised 24 subjects, from whom only fasting blood samples were taken. Despite similar plasma glucose concentrations to those of the controls, the subjects had significantly increased serum insulin concentrations (164.5 (39.9) v 120.3 (34.3) pmol/l, p less than 0.01). In addition the insulin:glucose ratios were also significantly increased (34.3 (8.5) v 24.6 (6.7), p less than 0.01), consistent with decreased insulin sensitivity. Group 2 comprised 13 of the original 24 subjects who also had an oral glucose tolerance test. Basal plasma glucose concentrations were similar in the subjects and their controls, whilst the significantly increased insulin:glucose ratios (35.0 (7.7) v 28.7 (5.6), p less than 0.05) were consistent with the results of the larger group. Following oral glucose challenge, plasma glucose concentrations, serum insulin concentrations and insulin:glucose ratios were similar in the subjects and their controls throughout the test. Thus, long-term use of norethisterone oenanthate injections is associated with a decrease in peripheral insulin sensitivity. However, these changes are not associated with any evidence of oral glucose intolerance.

Adult↗

Immediate postplacental insertion of GYNE-T 380 and GYNE-T 380 postpartum intrauterine contraceptive devices: randomized study.

OBJECTIVE: The purpose of the investigation was to compare the 1-year expulsion and efficacy rates of the GYNE-T 380 and the GYNE-T 380 Postpartum intrauterine contraceptive devices when inserted within 10 minutes after expulsion of the placenta in a term pregnancy. The two intrauterine contraceptive devices were identical, except that one was inserted by means of a temporary fundal suspension system and the other was placed directly into the uterine cavity. STUDY DESIGN: The study was a multicenter, randomized trial of intrauterine contraceptive devices in which 300 subjects accepted the GYNE-T 380 IUD and 292 subjects the GYNE-T 380 Postpartum IUD in clinics with adequate follow-up. RESULTS: At 1 year the gross cumulative expulsion rate was 13.2 per 100 cases (39 expulsions) with the GYNE-T 380 intrauterine contraceptive device and 16.2 per 100 cases (46 expulsions) with the GYNE-T 380 Postpartum device. There was no significant difference in the rate of expulsion between the two devices at any time during the year. There was one first-year intrauterine pregnancy, which occurred in a subject using the GYNE-T 380 device. The continuation rate for each device was above 80 per 100. CONCLUSION: The results indicate that both the GYNE-T 380 Postpartum and the standard GYNE-T 380 intrauterine contraceptive devices are safe and effective when inserted immediately after delivery of the placenta.

Female↗

Family planning in the teen population.

As an increasing percentage of adolescents reach their sexual debut at younger ages, effective contraceptive methods, which will decrease the risks of unintended pregnancies and sexually transmitted diseases (STDs), become even more critical. Contraceptive methods which are less 'compliance-dependent', such as the implantable subdermal levonorgestrel and the injectable depot formulation of medroxyprogesterone acetate, are popular in adolescents but careful counseling before method selection and on-going counseling when side-effects are experienced are necessary and essential. The use of condoms to decrease the risks of STDs will continue to be important for adolescents, and it remains to be seen what impact the long-term methods will have on effective condom use. Adolescents' access to abortions when contraceptive methods fail, or when no method is used, is being challenged with state laws which mandate parental notification or permission. A greater knowledge about the option of emergency contraception could potentially lead to increased use of this method, particularly when the option of medications such as RU486 becomes available. The potential for a reduction in unintended pregnancies in adolescents, and a reduced need for abortions is a welcome prospect.

Abortion, Legal↗

Contraceptive method switching over women's reproductive careers: evidence from Malaysian life history data, 1940s-70s.

Several new concepts are used to describe contraceptive use histories for nearly 1200 women in Peninsular Malaysia. These histories are summarized by 81 episode histories. Transition matrices provide useful summaries of the changes women make in their contraceptive practice from one pregnancy interval to the next. Data from the mid-1940s to mid-1970s, during which period there was a dramatic increase in contraceptive use, reveal considerable inertia in individual couples' contraceptive practice. Persistence with a method was greater the less effective the method: while 86% of couples using no method in one interval used no method in the next, only 56% of couples using the pill in one interval also used it in the next. Virtually all transitions are of three types: continuation with the same method, a change from no method to some method, or a change from some method to no method. For only 1% of all pregnancies did couples use one contraceptive method before a pregnancy and a different method after the pregnancy. Differences are examined by calendar year and education.

Choice Behavior↗

The influence of oral contraceptives and habitual physical activity on serum lipids in black adolescents and young women.

The effects of oral contraceptive use and habitual physical activity on serum cholesterol and lipoproteins were studied in 37 black females ages 16 to 28 years over a 3-month period. By the third month of oral contraceptive use, high-density lipoprotein (HDL) levels were lower and the low-density lipoprotein (LDL) to HDL ratio and total serum cholesterol (T Chol) to HDL ratio were significantly higher in those receiving oral contraceptive with norgestrel. The level of physical activity had no significant effect on HDL levels. The active subjects had lower T Chol and HDL levels and a lower T Chol to HDL ratio at the end of 3 months. Subjects in the active-norethindrone group had lower T Chol to HDL ratios than those taking norgestrel. The nonactive norgestrel group had a continuous increase in their T Chol to HDL ratio over the 3-month period. These effects should be considered when counseling sexually active teenagers and when recommending an oral contraceptive.

Adolescent↗

Benefit-risk assessment of the levonorgestrel intrauterine system in contraception.

The levonorgestrel-releasing intrauterine system (IUS) is a long-acting, fully reversible method of contraception. It is one of the most effective forms of contraception available, and combines the advantages of both hormonal and intrauterine contraception. The levonorgestrel-releasing IUS also gives the users many non-contraceptive benefits: the amount of menstrual bleeding and the number of days of menstrual bleeding are reduced, which makes it suitable for the treatment of menorrhagia (heavy menstrual blood loss). Dysmenorrhoea (painful menstruation) and premenstrual symptoms are also relieved. In addition, the levonorgestrel-releasing IUS provides protection for the endometrium during hormone replacement therapy. The local release of levonorgestrel into the uterine cavity results in a strong uniform suppression of the endometrial epithelium as the epithelium becomes insensitive to estradiol released from the ovaries. This accounts for the reduction in menstrual blood loss. All possible patterns of bleeding are seen among users of the levonorgestrel-releasing IUS; however, most of the women who experience total amenorrhoea continue to ovulate. The first months of use are often characterised by irregular, scanty bleeding, which in most cases resolves spontaneously. The menstrual pattern and fertility return to normal soon after the levonorgestrel-releasing IUS is removed. The contraceptive efficacy is high with 5-year failure rates of 0.5-1.1 per 100 users. The absolute number of ectopic pregnancies is low, as is the rate per 1000 users. The levonorgestrel-releasing IUS is equally effective in all age groups and the bodyweight of the user is not associated with failure of the method. In Western cultures continuance rates among users of the levonorgestrel-releasing IUS are comparable with those of other long-term methods of contraception. Premature removal of the device is most often associated with heavy menstrual bleeding and pain, as with other long-term methods of contraception, and is most common in the youngest age group. When adequately counselled about the benign nature of oligo- or amenorrhoea, most women are very willing to accept life without menstruation. The risk of premature removal can be markedly diminished with good pre-insertion counselling, which also markedly increases user satisfaction. User satisfaction is strongly associated with the information given at the time of the levonorgestrel-releasing IUS insertion. Thus, the benefits of the levonorgestrel-releasing IUS make it a very suitable method of contraception for most women.

Administration, Intravaginal↗

[Clinical study on women with amenorrhea after levonorgestrel intrauterine system].

OBJECTIVE: To study the 5 years contraceptive efficacy of levonorgestrel intrauterine system (LNG-IUS) and the ovarian functions in amenorrhea women. METHODS: LNG-IUS and TCu 380A IUD were randomly inserted in 2 groups of women, 50 each. Women were followed annually for 5 years. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), and T levels in 14 women with amenorrhea, and endometrial biopsies were obtained in 9 cases. RESULTS: By the end of 5 years, there were 2 pregnancies in TCu 380A group, but none in LNG-IUS group; and 24 amenorrhea cases in LNG-IUS. The 5 year cumulative continuation rates were 24% for LNG-IUS and 78% for TCu 380A (P < 0.001). In the 14 women with amenorrhea, the average serum concentrations were not significantly different from that of the normal controls. Histological study showed endometrial atrophy or a few secretory glands. CONCLUSIONS: LNG-IUS is a highly effective and safe contraceptive measure. Oligomenorrhea and amenorrhea caused by the local effects of LNG were reversible and did no harm to women's health. However, comprehensive consultation provided to women before insertion is of utmost importance for continuation use.

Adult↗

Fertility in the United States.

From the postwar high of 3.8 births per woman at the peak of the baby boom, the total fertility rate in the United States has fallen to 1.8, where it has remained unchanged for nearly a decade. This below-replacement level of fertility has, in recent decades, characterized most Western countries, some of which have shown declines to well below 1.5 births per woman. Were it not for the continued infusion of immigrants, the U.S. population, which already shows the aging characteristic of low fertility, would stop growing and begin to decline before the middle of the next century. The low fertility in the United States has been accomplished by a postponement of marriage and by the widespread use of contraception, with heavy reliance on surgical sterilization as a contraceptive method. Judging from the experience of other Western countries and from our own historical experience of two centuries of fertility decline interrupted only by the baby boom, as well as from the absence of social trends that would counteract those contributing to that decline, the prognosis is for a continued low level of fertility in the United States.

Adolescent↗

Family Life Education in the English-speaking Caribbean.

Unique experience has accumulated in the English-speaking Caribbean in the field of family life education for youth. Although birth rates are relatively low, the increase in adolescent pregnancy and births is becoming more visible. Mother-centered homes are frequent, and support from the father is often lacking. A series of family life education (FLE) programs funded by the United National Fund for Population Activities is aimed at providing help to the various groups in the Caribbean in an acceptable and non-threatening manner. These out-of-school FLE techniques include several approaches: integration of the proposed program into an already established place (a factory, youth center, or community center); education in human growth, food and nutrition, environmental health, mental health, safety and first-aid, dental health and human relations, including human sexuality, rights and responsibilities, and decision making; and the use of specially trained personnel who understand the conditions of the particular community. In some countries adolescent pregnancy is viewed as a problem. In others it may not be so considered. It is vital for the staff and community leaders to review proposals for the FLE program and bring into the centers all subjects that are free of controversy. Family planning, contraceptive delivery and even human sexuality may be acceptable subjects in some quarters, and not in others. Efforts must be continued to find innovative approaches to assure that the benefits of these learning activities continue to be provided, and expanded in response to growing acceptance.

Adolescent↗

A prospective study of early pregnancy loss in humans.

OBJECTIVE: To test two hypotheses: In spontaneous conceptions, early pregnancy loss (EPL) is associated with [1] inadequate luteal (ovarian) P, and/or [2] elevated follicular (adrenal) P. DESIGN: A population-based prospective study. SETTING: Thirty rural Bolivian communities. PATIENT(S): Women volunteers (n = 191), 19-40 years old, in stable sexual unions and not using contraception. INTERVENTION(S): Collection of serial saliva samples throughout sequential ovarian cycles and urine samples during late luteal phases. Collections continued throughout pregnancy for each detected conception. MAIN OUTCOME MEASURE(S): Occurrence of spontaneous conceptions and subsequent outcomes. Salivary concentrations of P. Test for elevated urinary human chorionic gonadotropin (hCG). RESULT(S): Luteal (through implantation) P levels were similar in pregnancies lost within 5 weeks after conception (EPL; n = 8) and those pregnancies that were maintained longer (sustained conceptions, SC; n = 32). Follicular P was significantly higher in EPL than in SC. CONCLUSION(S): [1] Elevated follicular P was associated with EPL in natural conceptions in healthy women. [2] Early pregnancy loss exhibits absolute luteal P levels comparable to SC, but lower luteal/follicular P ratios.

Abortion, Spontaneous↗

Synthesis and biophysical characterization of engineered topographic immunogenic determinants with alpha alpha topology.

Model peptides with predetermined secondary, tertiary, and quaternary conformation have been successfully designed, synthesized, and characterized in an attempt to mimic the three-dimensional structure of an antigenic determinant. This work is a continuing effort to map the antigenic structure of the protein antigen lactate dehydrogenase C4 (LDH-C4) to develop a contraceptive vaccine. A putative topographic determinant with alpha alpha topology which associates into four-helix bundles was designed on the basis of the framework model of protein folding. An idealized amphiphilic 18-residue sequence (alpha 1) and a 40-residue alpha alpha fold (alpha 3) have been shown to form stable 4-helix structures in solution with a free energy of association on the order of -20.8 kcal/mol (tetramerization of alpha 1) and -7.8 kcal/mol (dimerization of alpha 3). Both alpha 1 and alpha 3 form stable monolayers at the air-water interface. The CD spectra of Langmuir-Blodgett monolayers are characteristically alpha-helical. Both CD and FTIR spectroscopic studies reval a high degree of secondary structure. The SAXS data strongly suggest that the helices are arranged in a four-helix bundle since the radius of gyration of 17.2 A and the vector distribution function are indicative of a prolate ellipsoid of axial dimensions and molecular weight appropriate for the four-helix bundle. The major contribution to the formation and stabilization of alpha 1 and alpha 3 is believed to be hydrophobic interaction between the amphiphilic alpha-helices. The displayed heptad repeat, helix dipole, ion pairs, and the loop sequence may have also contributed to the overall stability and antiparallel packing of the helices. A detailed structural analysis of a relevant topographic immunogenic determinant will elucidate the nature of antigen-antibody interactions as well as provide insight into protein folding intermediates.

Amino Acid Sequence↗

Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user.

We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.

Actinomyces↗

Nurse-midwives' attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia.

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

Abortion, Induced↗