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PubMed1977

Microbial flora of the vagina and cervix.

The microbial flora of the vagina and cervix was assessed qualitatively and semiquantitatively in 40 women attending an intrauterine contraceptive device clinic. Both sites harboured many types of macroorganism, the mean number of microbial types isolated being five from the vagina and four from the cervix. Typical lactobacilli were detected in 61% of vaginal and in 53% of cervical specimens; faecal bacteria, including anaerobes, were even more frequently found at both sites. No differences in the microbial populations at either the vagina or the cervix were detected after fitting of the devices, in the different weeks of the menstrual cycle, or with various previously used contraceptive methods.

Adult↗
PubMed1983

Legal teenage abortions in a Swedish population in the 1970s.

The number of teenage abortions increased sharply in the early 1970s but gradually decreased from 1975, in absolute numbers as well as in relation to population figures. Teenage abortions now constitute 15% of the total number of abortions. However, the percentage of teenage pregnancies that are terminated by legal abortion is constantly increasing. As the preservation of childbearing function is of paramount importance in teenagers, a low complication rate is essential. Complications occurred in 7% of the cases studies, and the effects of complications of legal abortion on the later obstetric history are discussed. In 14% of the cases a second pregnancy was also terminated artificially. The repeat abortion rate is discussed, with special reference to the contraceptive method used.

Abortion, Induced↗
PubMed1977

Contraceptive use and pregnancy planning in the Hutt Valley.

This survey, carried out in an area where there are good family planning services, demonstrates that such surveys can be successfully carried out in New Zealand where so far there is little data on contraceptive practice and pregnancy planning. This article compares failure rates of several contraceptive methods and shows that most women in the survey sample had had some experience in contraception during the previous three years. Pregnancy planning overall is seen as poor, with 29.9 percent of all pregnancies being unwanted at the time of conception.

Adult↗
PubMedDate not supplied

[A structural approach to the evaluation of the quality of contraception services].

The quality assessment of the contraceptive service in Belgrade in 1983 was conducted by a structural approach (investigation of the knowledge and attitudes of service providers and the availability of contraceptives). The summaries of the cited publications were used as the standard of knowledge and attitudes. A sample of 42 gynaecologists (16.6% of the total Belgrade population of gynaecologists) was investigated using a mailed questionnaire. Compared with the chosen standard:--two fields of knowledge about combined oral contraceptives (OC) appeared unknown to about 70% of the sample (OC protective effects and effects of previous OC use on the outcome of subsequent pregnancy);--knowledge of IUD as a risk factor in pelvic inflammatory disease is lacking in 33.3% of the sample;--attitudes regarding other contraceptive methods are in accord in about 60% of the investigated sample. Besides, the unavailability of contraceptives is recorded. Methodological shortcomings and a possible positive result of the study are discussed.

Adult↗
PubMed1994

Population and family planning in China.

As the most populous country of the world, China pursues an integrated programme for socio-economic development with family planning as a vital part of it. The aim is to ensure that population growth does not outpace the economic development, the availability of natural resources and environmental protection efforts. Current policy on family planning includes: the promotion of late marriage and deferred child bearing, advocating the practice of "one couple, one child", to encourage birth spacing for those who want a second child. Technical guidelines are: contraception as the priority; comprehensive use of various contraceptive methods in men and women; induced abortion allowed on request if no contraindications; state provided contraceptives, barrier devices and technical services. The birth rate of 33.34/1000, death rate of 7.6/1000 and natural increase rate of 25.83/1000 in 1970 was brought down to 21.04/1000, 6.7/1000 and 14.26/1000 respectively in 1985. A total fertility for 1950 of 5.87 was gradually brought down to 2.31 in 1990. 260 million births were averted between 1970-1991; the world's "5-billion population day" was postponed for 2 years and Asian "3-billion population day" was postponed for 3 years. The State Family Planning Commission under the State Council was set up in 1981. The China Family Planning Association, the China Population Association and non-governmental organisations promote family planning work in a coordinated way. The current family planning policy is now well accepted in the urban area, and gaining increasing momentum in the rural area. Persistant education is still important to break the millennia old tradition of having more children and more boys.

Aging↗
PubMedDate not supplied

Contraceptive risk-taking in a medically underserved, low-income population.

This study examines the phenomenon of contraceptive risk-taking, which is the nonuse of contraception by women who are sexually active, fertile and not pregnant or trying to become pregnant. Based on a survey sample of low-income women in their childbearing years who had not received family planning care or advice from a doctor or clinic for at least three years, the study analyzed demographic predictors of contraceptive risk-taking and also compared levels of contraceptive knowledge and pregnancy histories of noncontraceptors versus barrier contraceptors. Contraceptive risk-taking was found to be higher for minority women, for parous women, for those age 30 and younger, and for those whose knowledge of the fertility cycle is incorrect, but risk-taking was found to be unrelated to the women's marital status. Noncontraceptors were less knowledgeable concerning contraceptive methods and substantially more likely to have had previous unwanted pregnancies due to nonuse of contraception, suggesting that current contraceptive risk-taking probably represents a relatively enduring feature of reproductive behavior for a subgroup of the medically undeserved low-income population.

Adolescent↗
PubMed2006

New approaches for male fertility control: HE6 as an example of a putative target.

Reversible contraceptive methods for males are still not available. During the last few years several marketing studies have clearly shown that men and women would welcome a situation where men could assume responsibility for family planning. Schering AG and Organon are currently collaborating to develop a hormonal method for male fertility control based on the combination of etonogestrel as gestagenic component and testosterone undecanoate. To further optimize male contraceptives in terms of improved efficiency, rapid onset, reversibility, fewer side effects and a convenient method of application, a search for innovative non-hormonal approaches was started. During the last few years, numerous proteins were identified which play a specific role in male fertility. These proteins have first to fulfil a set of indication-specific criteria before a drug discovery process can be initiated. The most important criteria for a putative target protein are tissue-selective expression, crucial biological function in fertility, drugable properties and feasibility of assay development for high-throughput-screening and lead optimization. The G-protein-coupled receptor HE6 was selected as target and the above selection criteria were applied. HE6 displays a preferred epididymis-specific expression pattern and belongs to the superfamily of GPCRs, which are well known to be drugable with small molecules. A knockout mouse was generated which revealed an infertility phenotype with the onset occurring 6 weeks after initiation of spermatogenesis at the latest. Surprisingly, no epididymis-specific phenotype was observed. Instead, the reabsorption of testicular fluid along the efferent ducts was strongly affected. No further obvious side effects were observed in male or female mice. This study with HE6 exemplifies how targets for male contraception have to be validated before drug development can start.

Animals↗
PubMed1999

[A randomized, double-blind, multicentre study on comparing levonorgestrel and mifepristone for emergency contraception].

OBJECTIVE: To compare the efficacy, side effects and the effect on next menstruation of levonorgestrel(LNG) to low dose mifepristone in emergency contraception. METHODS: The study is a randomized double-blind multicenter comparative trial. The clients who have unprotected intercourse within 72 hours were allocated to one of the two study groups. In LNG group, 0.75 mg LNG was taken twice with 12 hours apart. In mifepristone (Mife-) group, single dose of 10 mg mifepristone was taken and a placebo 12 hours after. Follow-up visit was paid on the seventh day of the expected next menstruation to evaluate the contraceptive efficacy and to record side effects and menstruation. Contraceptive efficacy was calculated by Dixon's method. RESULTS: The total valid subjects in LNG and Mife- group were 643 and 633, respectively. There were 20 and 9 pregnancies occurred respectively in each group. The failure rate was 3.1% and 1.4%. Contraceptive efficacy rate of preventing pregnancy was 59.2% and 79.7%, the difference was statistically significant (P < 0.05). The incidence of various side effects was less than 10.0% which were mild. There was no statistically difference between the two groups. The percentage of subjects who had their next menstruation before or after their expected menstruation 3 days in LNG group and Mife- group was 77.7% and 78.5% respectively. The menstrual period less than 7 days was 95.0% and 93.3%. CONCLUSION: Use of levonorgestrel or low dose mifepristone for emergency contraception is effective and safe.

Adult↗
PubMed2006

Young pregnant women's knowledge of modern intrauterine devices.

OBJECTIVE: Modern intrauterine devices (IUDs) are safe, effective, and reversible, but only 2.1% of U.S. women use IUDs. We aimed to estimate young pregnant women's knowledge of IUDs. METHODS: We surveyed 190 women, aged 14-25 years, presenting for prenatal or abortion care about their contraceptive history, plans, and knowledge. We asked if they had heard of IUDs and queried them on IUD characteristics. RESULTS: The women were, on average, 20 years old, 27% had education past high school, and 47% had delivered a child. Half were in prenatal care, and 91% had not planned their current pregnancy. Fifty-two percent wished to wait 4 or more years before their next pregnancy, and 27% did not want to be pregnant ever again. Safety and efficacy were the most important factors in choosing a contraceptive method. Fifty percent had heard of IUDs, 71% did not know about IUDs' safety, and 58% did not know about IUDs' efficacy. Respondents who knew of IUDs were older (21 versus 19 years, P<.001) and more likely to be parous (55% versus 39%, P=.04). CONCLUSION: Young women choosing contraception after a pregnancy would benefit from counseling about the relative safety and effectiveness of IUDs, allowing them to make fully informed contraceptive decisions. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2006

Hormonal versus non-hormonal contraceptives in women with diabetes mellitus type 1 and 2.

BACKGROUND: Adequate contraceptive advice is important in women with diabetes mellitus type 1 and 2 to reduce the risk of maternal and infant morbidity and mortality in unplanned pregnancies. A wide variety of contraceptives are available for these women. However hormonal contraceptives might influence carbohydrate and lipid metabolism and increase micro- and macrovascular complications. So caution in selecting a contraceptive method is required. OBJECTIVES: To investigate whether progestogen-only, combined estrogen/progestogen or non-hormonal contraceptives differ in terms of effectiveness in preventing pregnancy, in their side effects on carbohydrate and lipid metabolism and in long-term complications such as micro- and macrovascular disease, when used in women with diabetes mellitus. SEARCH STRATEGY: The search was performed in MEDLINE, EMBASE, CENTRAL/CCTR, POPLINE, CINAHL, WorldCat, ECO, ArticleFirst, the Science Citation Index, the British Library Inside, and reference lists of relevant articles. Last search was performed in May 2005. In addition, experts in the field and pharmaceutical companies marketing contraceptives were contacted to identify published, unpublished or ongoing studies. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that studied women with diabetes mellitus comparing: 1. hormonal versus non-hormonal contraceptives. 2. progestogen-only versus estrogen/progestogen contraceptives. 3. contraceptives containing <50 microg estrogen versus contraceptives containing > or = 50 microg estrogen. 4. contraceptives containing 'first'-, 'second'- and 'third'-generation progestogens, drospirenone and cyproterone acetate. Principal outcomes were contraceptive effectiveness, diabetes control, lipid metabolism and micro- and macrovascular complications. DATA COLLECTION AND ANALYSIS: Two investigators evaluated the titles and abstracts from the literature search. Quality assessment was performed independently with discrepancies resolved by discussion or consulting a third reviewer. Because the trials differed in studied contraceptives, participant characteristics and methodological quality, we could not combine the data in a meta-analysis. The trials were therefore examined on an individual basis and narrative summaries were provided. MAIN RESULTS: Three randomised controlled trials were included. Only one was of good methodological quality. It compared the influence of levonorgestrel-releasing IUD versus copper-IUD on carbohydrate metabolism in women with type 1 diabetes mellitus. No difference was found in daily insulin requirement, glycosylated hemoglobin (HbA1c) or fasting blood sugar after twelve months. The other two trials were of limited methodological quality. Both compared progestogen-only pills with different estrogen/progestogen combinations. The trials reported blood glucose levels to remain stable during treatment with most regimens. Only high-dose combined oral contraceptives were found to slightly impair glucose homeostasis. Combined oral contraceptives also appeared to have a minor adverse effect on lipid metabolism whereas progestogen-only contraceptives slightly improved lipid-metabolism. Only one study reported on micro- and macrovascular complications. No signs or symptoms of thromboembolic incidents or visual disturbances were observed. However study duration was short. Minor adverse effects were reported in one study. The trial found progestogen-only pills to cause more bleeding irregularities when compared with combined oral contraceptives. Unintended pregnancies were not observed during any of the studies. AUTHORS' CONCLUSIONS: The three included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Two of the three studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (i.e. glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted. However, due to the low incidence of micro- and macrovascular disease and accordingly the large sample size and follow-up period needed to observe differences in risk, a randomised controlled trial might not be the ideal design.

Blood Glucose↗
PubMed1996

Luteinizing hormone releasing hormone agonist for postpartum contraception.

OBJECTIVE: To compare the effects of a GnRH agonist upon ovarian function, bleeding pattern, and nursing practice in two groups of Mexican women during the postpartum period. DESIGN AND PATIENTS: Two doses of a GnRH agonist (300-600 micrograms) were investigated during the postpartum period in fully breastfeeding mothers at 6 weeks postpartum. A total of 29 women who desired to breast feed for at least 6 months were allocated in three study groups; group I (control); group II, taking 300 micrograms; and group III, taking 600 micrograms. RESULTS: After treatment initiation, an increase of estrone levels was observed among treated women; thereafter, irregular fluctuations of estrone levels were observed, mainly among women from group III. All the control women and two participants from group III ovulated during the study. Moderate bleeding was registered in most of the women from group I, while amenorrhea and spotting were observed in participants from groups II and III, respectively. There was no significant effect of the treatment on nursing practice between groups. CONCLUSION: GnRH agonists have advantages over steroids for hormonal contraception during the postpartum period in breastfeeding women. Symptoms of hypoestrogenism were not reported any time in either the controls or the treated groups, as estrone levels were not suppressed to menopausal values. Once-daily administration of GnRH agonist could be a reliable, acceptable and safe contraceptive method during the postpartum period in breastfeeding women. More information is required to establish GnRH analog contraceptive efficacy.

Administration, Intranasal↗
PubMed1985

Contraceptive decision-making in urban, black female adolescents: its relationship to cognitive development.

Contraceptive education and accessible contraceptive methods have not reduced significantly the incidence of adolescent pregnancy. The cognitive development of adolescents makes contraceptive decision-making difficult. This study examined how cognitive development affected contraceptive decision-making among 86 urban black female adolescents attending three family planning clinics. Hierarchical multiple regression analyses revealed that the stage of cognitive development was the best predictor of contraceptive decision-making. Age and relevant sexual knowledge added to the explanation of decision-making variance. Potential nursing implications include: (1) screening of stage cognitive development prior to rendering care, (2) continuation of contraceptive education and (3) presentation of contraceptive education at appropriate cognitive levels.

Adolescent↗
PubMed1999

Contraceptive efficacy of daily administration of 0.5 mg mifepristone.

The antiprogestin mifepristone has shown potential to be used as a contraceptive. If 200 mg mifepristone is administered immediately after ovulation, the endometrium shows sufficient impairment of secretory development to prevent implantation. Low daily doses of mifepristone have been shown to reduce several of the local factors regarded as crucial for implantation in human endometrium. To find out if this regimen is sufficient to prevent pregnancy, 32 women were recruited for a study where 0.5 mg mifepristone was administered daily. A total of 141 cycles were studied. Five pregnancies occurred, which was significantly less than if no contraceptive method had been used. However, the dose chosen did not seem sufficient to act as a contraceptive although it is probably not possible to increase the dose without disturbing ovulation and bleeding pattern.

Adult↗
PubMed2004

Association between sex hormone-binding globulin levels and activated protein C resistance in explaining the risk of thrombosis in users of oral contraceptives containing different progestogens.

BACKGROUND: Epidemiological studies have shown that both the estrogen dose and progestogen type of oral contraceptives contribute to the increased risk of thrombosis in oral contraceptive users. Thrombin generation-based activated protein C (APC) sensitivity is a global test for the net prothrombotic effect of oral contraceptives and predicts the thrombotic risk. Our objective was to test the usefulness of sex hormone-binding globulin (SHBG) as a marker for the thrombotic risk of an oral contraceptive. METHODS: We measured SHBG and APC resistance in 156 healthy users of various types of oral contraceptives. RESULTS: Users of oral contraceptives with a moderately increased risk of thrombosis (gestodene and desogestrel pills) had higher SHBG levels than users of low-risk oral contraceptives containing levonorgestrel. Similarly, for higher doses of estrogen in oral contraceptives we found higher SHBG levels. Women using oral contraceptives with the highest thrombotic risk (cyproterone acetate pills) rendered the highest SHBG levels. Users of oral contraceptives containing gestodene, desogestrel or cyproterone acetate were more resistant to APC than users of levonorgestrel pills. SHBG levels were positively associated with the increased APC resistance. CONCLUSIONS: Our findings support the hypothesis that the effect of an oral contraceptive on SHBG levels might be a marker for the thrombotic risk.

Adolescent↗
PubMedDate not supplied

Prebirth psychosocial factors as predictors of consistency in contraceptive use among Taiwanese adolescent mothers at 6 months postpartum.

OBJECTIVE: To assess contraceptive behavior and whether pre-birth psychosocial factors could predict consistency in contraceptive use among adolescent mothers at six-month postpartum. DESIGN: Prospective study. SAMPLE: 104 Taiwanese adolescent mothers. MEASUREMENTS: Participants completed a contraception questionnaire in their third trimester and a postpartum contraception questionnaire at six-month postpartum. RESULTS: Prior to giving birth, the adolescent mothers most commonly answered that condom use (39.8%) was the contraceptive method they planned to use after delivery. It was also more commonly reported in the postpartum to be the method they actually were using (54.3%). Stepwise logistic regression analysis further showed that a more positive contraceptive attitude (odds ratio=1.104) and a higher self-efficacy (odds ratio=1.068) in contraceptive use in the pre-birth period increased the probability that a participant would report that she always used contraceptives in the postpartum period. Nevertheless, a higher score in the pre-birth period in the area of subjective contraceptive norms (odds ratio=0.978) decreased this probability. The final regression model could correctly classify 81.7% of the participants. CONCLUSIONS: Health care professionals should provide adolescent mothers with the information they need to improve their attitude and self-efficacy toward contraception before they enter the postpartum period.

Adolescent↗
PubMed1984

Medico-social aspects of a house of prostitution.

All the women working in a Sydney house of prostitution were surveyed for one year for the presence of sexually transmitted diseases (STDs) and other medical problems, and for the contraceptive methods they used. Considerable potential morbidity from STD was noted, particularly pelvic inflammatory disease (23 episodes). Contraception was an area of unsatisfactory practice. Suggestions are made for the clinical management of these women, with the intention of diminishing the impact of STDs on them and, as a direct result, rendering them less infectious, to the benefit of the community. It is hoped that greater knowledge will improve the standard of current debate about prostitution.

Contraception↗
PubMed1987

Young women's reproductive health survey.

A survey of reproductive health issues was conducted on 15 year old Hutt Valley secondary school girls by means of a self-administered anonymous questionnaire. The prevalence of sexual intercourse in the sample was 29%. Sixteen percent of the sexually active respondents used no method of contraception. Knowledge of reproductive health facts and contraception was poor both amongst sexually experienced and inexperienced respondents. Twenty-six percent relied on peers for this information, with mothers, teachers and books being other important sources cited. Respondents requested more information on sexually transmitted diseases, contraception and sexual relationships. Most would like this information more readily accessible. Preferred sources of information mentioned were: parents, books, films/videos, family planning clinics and friends.

Adolescent↗