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PubMed2001

Preclinical profiles of progestins used in formulations of oral contraceptives and hormone replacement therapy.

Progestins used in oral contraceptive formulations available in the United States include norgestimate, desogestrel, norethindrone, norethindrone acetate, and levonorgestrel. Progestins used in the United States in continuous and intermittent formulations of hormone replacement therapy are norgestimate, medroxyprogesterone acetate, and norethindrone acetate. The chemical structure of a progestin determines its relative binding affinity for the progesterone and androgen receptors, as well as the sex hormone binding globulin in human serum, and determines its clinical profile. Overall, the properties of levonorgestrel or norethindrone acetate in this regard differ from norgestimate and are more conducive to androgenic stimulation. Estrogen replacement offers cardioprotective effects in postmenopausal women. Progestins are added to hormone replacement therapy to counteract the well-known increased risk of endometrial hyperplasia associated with the use of unopposed estrogen. Animal models show that for some parameters, including improvement of lipid profiles, progestins can diminish the cardioprotective effect of estrogen. Initial animal studies of norgestimate combined with estrogen do not show an attenuation of estrogenic effects.

Animals↗
PubMed2001

Effect of counseling to improve compliance in Mexican women receiving depot-medroxyprogesterone acetate.

This study purported to determine the effect of pretreatment counseling upon discontinuation of 150 mg depot-medroxyprogesterone acetate (Depo-Provera) given for contraception. A total of 350 Mexican women participated: 175 received detailed structured pretreatment counseling about the hormonal effects of the injectable vs. routine counseling upon duration of use and efficacy of the method. Study termination rates were significantly lower in the structured counseling group than in the control group. Cumulative life table discontinuation rates were 17% (30/175) and 43.4% (76/175), respectively (p <0.05). The most common reasons for terminating DMPA were menstrual changes (8.6 and 32% for counseling and control group, respectively). The findings suggest that pretreatment counseling on expected side effects increases the continuation rates of DMPA users.

Adult↗
PubMed1991

Long-term use of depot-norethisterone enanthate: effect on blood coagulation factors and menstrual bleeding patterns.

Fifty-six women using depot-norethisterone enanthate injections for contraception for 2 years or more were compared with a control group of 48 women not using hormonal contraception. No significant difference was found between the study group and controls for Factors VIIc and Antithrombin III. Factor Xc was reduced in women who had used the injections for over two but less than five years [controls: mean 90.3% SD31.2 vs users for 2-5 yr: 78.7% SD17.1, 95%CI difference in means -0.3, -22.9]. In the group using Net-En for five years or more, Factor Xc was significantly higher than in the control group, but only by 14% of the mean control value [users for over 5 yr: 103.2% SD15.2, 95%CI difference in means 3.1, 22.7]. Haemoglobin levels, red cell count and packed cell volume were higher in those using the injections than in the control group. Changes in the platelet count were not statistically significant. Twenty-three women using the injection agreed to keep menstrual diaries. Of these, 20 experienced amenorrhoea for more than two consecutive injection intervals (112 days). It is concluded that long-term use of norethisterone enanthate is not associated with any markedly deleterious effects on Factor VIIc, Xc, or antithrombin III or haemoglobin levels. Amenorrhoea of 4 months or more can be expected after two years of continuous use.

Adult↗
PubMedDate not supplied

Comparative effects of two different delivery systems on gonadotropin-releasing hormone (GnRH) antagonist-induced suppression of gonadotropins and testosterone in man.

The Nal-Glu gonadotropin-releasing hormone (GnRH) antagonist, when given in daily subcutaneous (SC) doses of 5 mg or higher, maximally suppresses serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels to near undetectable levels and induces azoospermia in normal men; lower doses (1.5 and 3.0 mg) are less effective. Cost and convenience are important considerations in contraceptive development. Studies with GnRH agonists suggest that constant delivery is more effective in suppressing gonadal function than equal doses by single daily injection. In this study, we examined whether the constant infusion (CI) of a submaximal suppressive dose (1.5 mg) of Nal-Glu would be more effective in suppressing the pituitary-gonadal axis than its repeated single daily injections (SDI). This (1.5 mg) dose was selected because the 5 mg dose given once daily SC for 21 days led to maximal suppression of LH, FSH, and testosterone (T) levels, whereas 1.5 mg once daily for 21 days gave only partial suppression. It was felt that if continuous infusion was considerably more effective than intermittent administration of this submaximal dose, then the development of long-acting sustained release delivery systems for contraceptives based on GnRH antagonist analogs would allow both reduced cost and enhanced convenience. One and a half mg of Nal-Glu was administered SC either as a SDI or CI over 24 hours for 21 days to two groups of five normal men. Three measurements of serum LH, FSH, and T were performed before antagonist injection and 1, 2, 4, 8, 12, 16, and 24 hours after Nal-Glu injection on days 0, 1, 7, 21.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Norplant and other implantable contraceptives.

Implantable contraception represents a safe, reversible form of long-term family planning with distinct advantages. It does not contain estrogen, thus avoiding many of it contraindications. Importantly, it is extremely effective, has high continuation rates, and is well tolerated. The main side effects of Norplant are irregular menstrual bleeding and the occasional difficult removal. Although recent high-profile litigation has severely diminished enthusiasm for Norplant, the FDA has reaffirmed its safety and efficacy. Norplant remains a viable family planning option for carefully selected women. New contraceptive implants may soon be available accentuating the advantages of Norplant while minimizing the disadvantages.

Biodegradation, Environmental↗
PubMed1986

The contraceptive diaphragm. Is it an acceptable method in the 1980s?

A prospective study of diaphragm users at the Family Planning Association of Victoria was undertaken. Despite the women being well motivated and instructed the pregnancy rate was high (24 per 100 woman years) and the continuation rate was only 35% at 12 months. Three-quarters of the women who became pregnant admitted that they did not use a diaphragm on every occasion. Therefore emphasis must be placed on the committed use of the diaphragm every time coitus occurs. Even so, the diaphragm does not appear to be a very safe method of contraception, and may be better suited to family spacing rather than as a method when high efficacy is required.

Contraception Behavior↗
PubMedDate not supplied

Contraceptive failure rates based on the 1988 NSFG.

Analysis of data from the 1988 National Survey of Family Growth--corrected for the underreporting of abortion--reveals that contraceptive failure during the first year of use remains a serious problem in the United States, contributing substantially to unintended pregnancy. The pill continues to be the most effective reversible method for which data were available (8% of users accidentally became pregnant during the first year of use), followed by the condom (15%). Periodic abstinence is the method most likely to fail (26%), but accidental pregnancy is also relatively common among women using spermicides (25%). Failure rates vary more by user characteristics such as age, marital status and poverty status than by method, suggesting the extent to which failure results from improper and irregular use rather than from the inherent limitations of the method.

Abortion, Induced↗
PubMed1997

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

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

Contraceptive Agents, Female↗
PubMed2005

Spontaneous coronary artery dissection associated with oral contraceptive use: a case report and review of the literature.

Spontaneous coronary artery dissection (SCAD) represents a rare cause of acute coronary syndromes with complex pathohysiology. We briefly describe a 50-year-old woman, without traditional cardiovascular risk factors, hospitalized for an acute ST-elevation myocardial infarction and treated with thrombolytic therapy. Notably, the patient was on oral contraceptives for the past 10 years. Coronary angiography showed a dissection of the distal left anterior descending artery. She was treated conservatively and her clinical status improved without evidence of continuing ischemia, while a repeated catheterization 6 months later showed a complete resolution of the dissection. It has been speculated that the female hormones may be responsible for the increased incidence of SCAD among women particularly during the peripartum period or during the exogenous administration of such agents. A systematic review of the literature revealed 4 further cases reporting an association of SCAD with oral contraceptive use.

Aortic Dissection↗
PubMed1996

Sterilization.

Sterilization is accepted as a permanent method of contraception by many couples in the world. Female sterilization is more widely used than male sterilization, but the latter is used by many couples in developed countries. The most widely used methods for female sterilization are simple tubal ligation, electrocautery of the fallopian tubes, and occlusion of the tubes by Hulka or Filshie clips or Falope rings. These procedures may be carried out either by minilaparotomy or by laparoscopy, under local anaesthesia. Sterilization may be performed immediately following pregnancy, or as an interval operation. The effectiveness of female sterilization is high, with failure rates of about 1-2 per 1000 procedures. Immediate complications are few and minor, while there appear to be no serious, long-term adverse effects. It is possible that there is a protective effect against ovarian cancer. Potential new technologies for female sterilization include the use of chemicals, such as quinacrine, for transcervical tubal occlusion, and hysteroscopic methods. Male sterilization is more simple and can readily be performed under local anaesthesia. A new technique originating in China, the no-scalpel technique, has made the procedure even more simple and produces fewer complications such as haematoma. It is possible that the direct injection of plug-forming material into the vas may render the procedure more reversible. Concerns about possible adverse effects of vasectomy on cardiovascular diseases and testicular cancer largely have been dispelled, but a possible weak association between vasectomy and prostatic cancer continues to be studied.

Female↗
PubMed2005

[Sexual debut in adolescence and gender relations: a cross-sectional study in São Paulo, Brazil, 2002].

This cross-sectional study aimed to assess gender differences in adolescents in relation to onset of sexual activity. A total of 406 15-19-year-old adolescents from a family health unit in the city of São Paulo, Brazil, were interviewed from May to December 2002. Nearly half had already had their first sexual intercourse, at a mean age of 15, independently of gender. Sexual debut was usually unplanned (72.7%) and inside the home (86.1%). An equal proportion (61.0%) of males and females used some contraceptive method in their first sexual intercourse; however, more males had used a contraceptive method in their most recent intercourse. Having initiated their sexual activity in stable, affective relationships, females proved to be more vulnerable to STD/AIDS, since they switched from condoms to the pill in their subsequent sexual activity. Male adolescents continued to use mostly condoms, probably because they were involved mainly in non-stable relationships.

Adolescent↗
PubMed1998

The introduction and use of Norplant implants in Indonesia.

In this study, patterns of Norplant use in Indonesia are reviewed to assess the implications of this experience for the introduction of new contraceptive methods. Data from the Norplant Use-Dynamics Study and the 1994 Indonesia Demographic and Health Survey are analyzed, and patterns of acceptance, continuation, and removal are described. Acceptance of Norplant has increased steadily since it was first introduced. The method is now used by more than 5 percent of all married women of reproductive age. Continuation rates among Norplant users are higher than among users of the IUD. One factor behind high continuation rates may be that a substantial proportion of acceptors were not told that removal before five years was possible. Results indicate that deficits occurred in the quality of service delivery and that a need exists for improved provider training, better supervision, and clearer and better-enforced guidelines regarding women's right to have Norplant removed on demand.

Adolescent↗