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PubMed2000

[Contraception in perimenopause].

Perimenopausal women are still potentially fertile and pregnancy is attended with increased maternal and perinatal mortality. Several contraceptive methods can be used therapeutic for the treatment of climacteric symptoms like menstrual irregularities, flushes and vaginal dryness. Low-dose oral contraceptives (OC) prevent climacteric symptoms and additionally protect from perimenopausal bone loss. However, the individual cardiovascular risk increases with age and is even higher in perimenopausal women using OCs. Therefore for women with cardiovascular risk factors sterilization, barrier methods, progestin-only methods and intrauterine devices (IUD) are the better choice. Prolonged and heavy menses can be treated with the levonorgestrel-releasing IUD or injectable progestogens. If estrogen replacement is necessary, a low-dose treatment with natural estrogens can be combined with barrier methods, the levonorgestrel-releasing IUD and injectable progestogens. The variety of contraceptive options available to perimenopausal women allows individual counseling and thus may enhance compliance.

Adult↗
PubMed1998

From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

This paper reviews the results of clinical trials and community studies of lactational amenorrhoea and its role as a contraceptive method (LAM). Indicators which are used in efficacy trials and effectiveness interventions are compared and sets of indicators of effectiveness appropriate to community-based LAM programmes are recommended. A five-tiered ecological framework is used to facilitate selection of indicators which range from individual to policy level outcomes. The indicator framework is intended as a tool for health practitioners in family planning and maternal and child health service delivery settings who are interested in designing programmatic interventions for the promotion of LAM, particularly among less well-educated women of lower socioeconomic communities.

Amenorrhea↗
PubMed2003

Expanded clinical trial of emergency contraception with 10 mg mifepristone.

We conducted a clinical single-arm trial to evaluate the effectiveness of 10 mg mifepristone for emergency contraception (EC) in a large population in China. The participating centers were 31 family-planning clinics and hospitals in the following 19 provinces or municipalities in China: Beijing, Shanghai, Tianjin, Harbin, Changchun, Shengyang, Shijiazhuang, Zhengzhou, Taiyuan, Nanjing, Jinan, Hangzhou, Guangzhou, Wuhan, Changsha, Chongqing, Guiyang, Chengdu, Kunming. A total of 4945 women requesting EC within 120 h after a single act of unprotected intercourse were recruited and treated with 10 mg mifepristone. A total of 28 women were lost to follow-up, and 4917 women were included in the analysis, of whom, 69 became pregnant. The combined pregnancy rate was 1.4 [95% confidence interval (CI): 1.0-1.9] and the percentage of pregnancies prevented was 82.2% (95% CI: 77.5-86.2%). There was a significant inverse trend in pregnancy rate with body mass index that disappeared when adjusted for other variables. The pregnancy risk was double among nulliparous women compared to parous women (2.3% compared to 1.0%), and it increased by a factor of 1.5 when the treatment was administered at 25-48 h and at 49-72 h compared to administration within 24 h, although this association was not significant. The risk of pregnancy was higher if intercourse took place during the follicular or preovulatory phase of the cycle. Women having repeated intercourse after treatment without any contraceptive methods had a dramatic increase in the risk of pregnancy, while those who used contraceptives had similar risk to those without acts. Side effects were mild and present in only small proportions of women: nausea and vomiting in 9% and other side effects in 2-3%. Delay of menstruation of 7 days or more occurred in 6.5% of women. The expanded study confirmed the high efficacy and safety of 10 mg mifepristone for EC.

Adult↗
PubMed2004

Potential factors associated with contraceptive intention among adolescent males in Taiwan.

This study explored the predictors of contraceptive intention in adolescent males in Taiwan. It used a cross-sectional design and a sample of 1,000 vocational high school male students to determine the potential factors associated with contraceptive intention. Data were collected on an anonymous, self-administered questionnaire, including personal background variables, prior sexual experience, contraceptive knowledge, contraceptive attitude, contraceptive self-efficacy, perception of peers' contraceptive behavior, perception of support from significant others, and parental-adolescent communication about contraception. A total of 230 participants (23%) had prior sexual experience, 13% (30) of whom reported being involved in their girlfriends' pregnancies. Of the participants, 45% recognized the use of condoms as the most favorable contraceptive method for future sexual intercourse. Second to condom use, the combination of the calendar method and condom use was also popular (13.1%). Multiple stepwise regression indicated that better contraceptive attitudes, higher contraceptive self-efficacy, no prior sexual experience, more perception of peers' contraceptive behavior, and higher perception of support from significant others were predictors of higher contraceptive intention. The above predicting factors explained 31.9% of the total variance for contraceptive intention among adolescents. These results provide health professionals with important information to understand the reality adolescents encounter and to design effective contraceptive programs for male adolescents.

Adolescent↗
PubMed2002

Levetiracetam does not alter the pharmacokinetics of an oral contraceptive in healthy women.

PURPOSE: This study was designed to evaluate whether levetiracetam, a novel antiepileptic drug (AED), influences the pharmacokinetics of steroid oral contraceptives. METHODS: During a run-in phase, 18 healthy female patients received an oral contraceptive containing ethinyl estradiol, 0.03 mg, and levonorgestrel, 0.15 mg, for the first 21 days of two consecutive menstrual cycles. In a subsequent double-blind, randomized, two-way crossover treatment phase, subjects received either levetiracetam, 500 mg, or placebo twice daily concomitant with the oral contraceptive. Plasma concentrations of ethinyl estradiol and levonorgestrel were measured on days 14 and 15 of the two treatment periods for the evaluation of the 24-h kinetic parameters, and an additional sample was collected on day 21 to determine the trough plasma concentrations. Serum progesterone and luteinizing hormone (LH) levels were determined on days 13, 14, 15, and 21 of each cycle of the treatment phase. RESULTS: The plasma concentration-time curves and pharmacokinetic parameters of ethinyl estradiol and levonorgestrel were not statistically different during concomitant treatment with either levetiracetam or placebo. The ratios of the log-transformed geometric mean areas under the plasma concentration-time curves (AUCs), maximal (Cmax) and minimal (Cmin) plasma concentrations, and trough concentrations on day 21 (C21) ranged from 99.12 to 99.96% for ethinyl estradiol and from 97.13 to 99.41% for levonorgestrel. The 90% confidence intervals of these ratios were well within the 80 to 125% acceptance range for lack of interaction. Serum progesterone and LH concentrations were fairly constant during the run-in and treatment phases and remained markedly below their respective physiologic levels. Safety and menstrual-bleeding patterns were comparable during levetiracetam and placebo administration. CONCLUSIONS: Levetiracetam does not affect the pharmacokinetics of an oral contraceptive containing ethinyl estradiol and levonorgestrel, and on the basis of serum progesterone and LH levels, it does not affect the contraceptive efficacy.

Adult↗
PubMedDate not supplied

Women, contraception and STDs including HIV.

It is estimated that eight million women are infected with the human immunodeficiency virus (HIV) worldwide. Heterosexual transmission is the predominant mode of HIV transmission on a global basis and is becoming increasingly important in the Western world. Women have long used contraceptives as a means of protection against an unwanted pregnancy, some of which may also protect against sexually transmitted disease (STD) including HIV. We review the relationship between contraceptive methods and STD acquisition and transmission; HIV acquisition and transmission; and the implications of contraceptive use, particularly regarding disease progression, in those women who are already infected with the virus. It is important for all women that protection against both unwanted pregnancy and HIV acquisition and transmission are considered together and not in isolation as nowhere is the argument for a broad based multi-disciplinary approach more cogent.

Contraception↗
PubMedDate not supplied

New aspects of injectable contraception.

Despite the availability of efficacious and safe contraceptive agents, not all women's contraceptive needs are being met. An injectable contraceptive method offers convenience and encourages compliance, both very important aspects for women seeking ideal contraception. Depot medroxyprogesterone acetate (DMPA) is a long-acting injectable, and is highly effective; one injection provides 3 months of contraception. Drawbacks of DMPA include irregular bleeding and a slow return to fertility. A new monthly injectable contraceptive agent is medroxyprogesterone acetate/estradiol cypionate suspension (Lunelle). It provides menstrual regulation and a rapid return to fertility. The estrogen ensures a withdrawal bleed monthly; however, women with contraindications to estrogen-containing contraception are not candidates for Lunelle.

Contraception↗
PubMed1979

Factors associated with ex-nuptial birth.

The paper examines the background to 210 live exnuptial births studied in the first phase of the Christ-church Child Development Study. The results show: 1. That nearly half of the children had been conceived within cohabiting situations. 2. That nearly one in five ex-nuptial children was the result of a planned pregnancy. 3. Maternal reactions to the birth and pregnancy varied with the mother's situation: cohabiting mothers reported considerably less adverse reaction to the birth than did non-cohabiting mothers. 4. Overall, mothers of ex-nuptial children had a fairly sophisticated appreciation of contraceptive methods. 5. One quarter of unplanned ex-nuptial pregnancies were the result of contraceptive failure and three-quarters were the result of contraceptive non-usage. 6. In common with previous findings for nuptial pregnancies, about 35 percent of unplanned ex-nuptial pregnancies were ascribed to a breakdown in the mother's pattern of usage of the contraceptive pill.

Adolescent↗
PubMed1988

Contragestion with late luteal administration of RU 486 (Mifepristone).

The efficacy and tolerance of RU 486 prescribed as a late luteal contragestive agent have been evaluated in 139 women at risk of pregnancy. They were given 400 or 600 mg of RU 486 once on the day before the expected menses. Among these women, 48 (34.5%) were pregnant (positive plasma beta-human chorionic gonadotropin, [beta-hCG]) at the time of RU 486 intake. Bleeding occurred in all but six women. An ongoing pregnancy after treatment was found in nine cases (failure rate, 9/48, 18.8%), which was subsequently terminated by surgical procedure in all cases. There was no disturbance in the menstrual cycle, and the tolerance was very satisfactory. In conclusion, this method is acceptable for women at risk of pregnancy in whom other usual postcoital contraceptive methods cannot be prescribed.

Abortion, Induced↗
PubMed2005

Increasing contraceptive use in rural Pakistan: an evaluation of the Lady Health Worker Programme.

Past efforts to promote family planning in Pakistan have been disappointing, but between 1990-91 and 2000-01 contraceptive use has more than doubled. This rise has coincided with a concerted effort on the part of the Pakistani government to increase access to contraceptive services, particularly in rural areas. The Lady Health Worker Programme (LHWP), initiated under the Ministry of Health in the early 1990s, aimed at integrating family planning into the doorstep provision of primary health care. This paper presents findings from the first national evaluation of this Programme. Data are analyzed from a random sample survey of 4277 women living in households served by the LHWP and those living in control areas. Logistic regression analysis was performed to determine the effect of the Programme on the uptake of modern reversible contraceptive methods, controlling for other independent variables. The data provide strong evidence that the LHWP has succeeded in increasing modern contraceptive use among rural women. Women served by Lady Health Workers are significantly more likely to use a modern reversible method than women in communities not served by the Programme (OR=1.50, 95% CI=1.04-2.16, p=0.031), even after controlling for various household and individual characteristics. The model of providing doorstep services through community-based female workers should remain central to achieving universal access to safe family planning methods by the end of the decade--the long-term objective of Pakistan's most recent population policy adopted in 2002.

Adolescent↗
PubMed1991

The cervical cap.

The cervical cap is a barrier contraceptive method with an efficacy similar to that of the diaphragm. It has several advantages over other barrier contraceptives. In particular, it can be left in place for up to 48 hours, and repeated applications of spermicide are not necessary, even if sexual intercourse occurs more than once. In addition, the side effects seen with other barrier methods do not occur with the cervical cap. In some women, Papanicolaou tests may become abnormal, especially during the first three months of cap use. Therefore, careful monitoring of cervical cap users is essential.

Contraceptive Devices, Female↗
PubMed2001

Contraception. Myths, facts and methods.

OBJECTIVES: After reading this article, the reader should be able to: 1. Recognize the mechanism of action, side effects, contraindications, precautions and instructions for use of a variety of contraceptive methods. 2. Understand the advantages and disadvantages of the various contraceptive methods. 3. List the common myths and misconceptions about conception and contraception, and recognize how they can influence contraceptive decisions. Unintended pregnancy is a serious problem in the United States. Counseling a patient about conception and contraception involves more than simply imparting information and answering questions. Clinicians should actively detect and correct any myths and misapprehensions on the patient's part. These myths are quite common and can interfere with treatment if not attended to. This article summarizes common myths about pregnancy and contraception and reviews the key facts about both.

Contraception↗
PubMed1998

Contraceptives: regional perspectives, issues, and unmet needs--the European perspective.

Existing methods of contraception clearly do not meet all the needs of European women. Studies have shown that women continue to want contraceptive methods with the lowest possible risks and highest possible health care benefits. In addition to offering health benefits, these methods must have extremely low failure rates and permit good compliance. Studies reflect high rates of non-compliance and discontinuation with the combined OC and the progestogen-only contraceptive pill. Methods, such as the IUDs, subdermal implants, and injectable contraceptives offer significant advances in continuation of contraception coupled with low failure rates. In the past, the use of injectable contraceptive methods in Europe was low because only the progestogen-alone methods were available - Depo-Provera and Noristerat. Both methods have been linked with extensive menstrual cycle disturbance, which has not been noted with the combined injectable methods, as reviewed by Newton et al.. The author believes that combined injectable methods should be added to the list of contraceptive methods freely available to women in Europe, not only because of their lack of disruption of the menstrual cycle, but also because of their high efficacy, good cycle control, and other health benefits. This method may prove extremely useful over the next 10-20 years. Market surveys will determine whether combined monthly injectables are perceived by potential contraceptive users as having health benefits, and focus group discussions will allow an appropriate range of contraceptive products to be available. These should increase patient choice and allow clinicians to make available a wider range of products for those seeking contraception.

Abortion, Legal↗
PubMedDate not supplied

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997.

CONTEXT: If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives. METHODS: A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race. RESULTS: In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues. CONCLUSION: Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

Adolescent↗
PubMedDate not supplied

Family planning in rural Uganda: knowledge and use of modern and traditional methods in Ankole.

Ankole has recorded the highest fertility in Uganda over the past several decades. One of the main proximate determinants of fertility in the area is the low level of contraception. A study of knowledge and use of modern and traditional contraceptive methods is reported in this paper. It is shown that higher proportions of women known and practice traditional methods compared with modern ones. Several factors contributing to past low use of modern contraceptives in the area are examined and current contraceptive use is also examined.

Adolescent↗
PubMedDate not supplied

[Family planning].

According to the fact that a great majority of women have expressed their wish to have only two children, two main questions have arised: what are the means that women use to limit their family size and what are the acceptable measures which the society can undertake to avoid further decline of crude birth rate in order to attain a stable population. Except for Kosovo and Macedonia, namely, in all other parts of Yugoslavia depopulating trends are present. Adequate data about contraceptive prevalence are not available, and according to some partial data, even among the women wanting no additional children, the percent of those planning no use of contraception is as high as 17.3 and further 21.2% are planning to rely on less effective contraceptive methods. The result of this situation is a relatively high number of induced abortions in Croatia 1989: 43227 or 77.7 per 100 live births). To improve this unfavourable situation, medical profession has to promote a wider use of contraception in general, particularly with more effective methods. Unfavoured decline of crude birth rate could be corrected, however, only through complex activities of long duration in order to achieve thorough improvement of the standard of living. With these improved living conditions more women would, most probably, want to have more than two children, thus avoiding the present depopulating trends in some parts of the country. On the other hand, any restriction of legal rights and availability of fertility regulation methods would be fully anachronistic and therefore unacceptable, since the only predictable result would be the increase of illegal abortions with all the well-known health risks and life-threatening conditions.

Contraception↗
PubMed2005

Sexual behaviour and contraceptive practice of future doctors in Southwest Nigeria.

The sexual behaviour and contraceptive practice of 498 clinical students of a randomly selected medical college in Southwest Nigeria was studied in June 2003. More than two-thirds (67.5%) of the students had (ever had) sexual intercourse while 49.8% of them had ever used contraception. Only 26.1% of the 119 sexually active students used contraception during their last sexual intercourse. The most common contraceptive methods ever used by the students were the condom (54.6%) and rhythm method (39.5%) though a third of them incorrectly identified the limits of the fertile period. Contraception for single sexually active students was disapproved by 11.2% of the participants while 9.8% of them regarded avoidance of HIV patients in the hospital as a preventive measure against HIV infection. This survey reinforces the need for integration of a suitable sexuality course into our medical undergraduate curriculum in order to facilitate the delivery of reproductive health programmes in the future.

Adult↗
PubMed1996

Development of new immunocontraceptives-industrial perspective.

Contraception has been practiced for thousands of years. Nevertheless, it took until the late 1950s and early 1960s before a major breakthrough in contraceptive technology was achieved by the introduction of oral hormonal contraceptives. However, we have not succeeded in the development of non-hormonal contraceptive that is comparable to the pill regarding its efficacy, safety, and acceptance. The immunological interference with the complex fertilization process is a very attractive target in this respect, whereby the zona pellucida, a non-cellular surrounding of all mammalian eggs, represents a potentially ideal target. Another interesting target are sperm: either for the development of a female contraceptive or for a male contraceptive, although the latter approach does not look very promising so far. In conclusion, given the enormous impact on mankind of a growing world population and given the very individual needs for contraceptive methods of different women in one and the same country and in different cultures we should make widely available a whole set of suitable, adjusted methods of fertility control and this includes the search for an effective method of male fertility control.

Contraception, Immunologic↗