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PubMed1990

Oral contraceptive therapy and the surgical management of ENT patients: a review of current clinical practice.

The current policy of British Otolaryngologists with regard to the preoperative cessation of the oral contraceptive pill is reported. This is based on a confidential questionnaire sent to all members of the British Association of Otolaryngologists. The overall response rate was 66%, 91% of which were from practising otolaryngologists and forms the basis of this report, the remaining 9% being from respondents not engaged in active surgery. Although there is evidence to show an increased risk of developing thromboembolic complications after major abdominal, gynaecological and hip surgery in those patients taking the oestrogen-containing contraceptive pill, the risk following minor and intermediate surgery (which forms the bulk of the otolaryngologist's workload) is not known. Not surprisingly therefore the results of the survey show a varied policy across the country with 36.5% of respondents choosing to continue the pill and 25% always stopping the pill preoperatively. The remainder elect to stop the pill only in certain circumstances.

Contraceptives, Oral↗

PubMed1996

A comparison of contraceptive habits and pregnancy outcome at 19 years of age in two cohorts of Swedish women born 1962 and 1972.

The prevalence of contraception and pregnancy outcome in two representative samples of 19-year-old women resident in the city of Göteborg, born in 1962 (n = 596) and 1972 (n = 641), respectively, was assessed and compared using a postal questionnaire technique. The prevalence of different contraceptive techniques was as follows (62/72): Oral contraception (OC) alone 44%/35%, (p < 0.001); OC + condom 1%/12%, p < 0.001; intrauterine device 4%/1%, p < 0.001; condom only 11%/14%; depot gestagen 0%/0.3%; no contraception 40%/38%. The median duration of OC use was 15 and 14 months, respectively. Fear of OCs was the commonest reason given for cessation of OC in the 62 cohort and that contraception was no longer required in the 72 cohort. The proportion of women who gave the latter explanation for cessation of OC had increased (p < 0.001) from 10% in 1981 to 57% in 1991, indicating that young women in Sweden now tend not to continue with OCs when a relationship ends. Although the prevalence of cigarette smoking was reduced (p < 0.05 in the 72 cohort compared to the 62 cohort), there was still an over-representation of smokers in both cohorts among contraceptive users (p < 0.001) and in women who had been pregnant (p < 0.001) or undergone an abortion (p < 0.001). Pregnancies were reported by 11% of the women from the 62 cohort and by 13% from the 72 cohort. A greater proportion (p < 0.001) of pregnancies terminated in legal abortion in the 72 cohort (61%) compared to the 62 cohort (50%). The medical complication rate following legal abortion was lower (p < 0.05) in the 72 cohort compared to the 62 cohort.

Abortion, Legal↗

PubMed1996

[Follow-up of intrauterine contraceptive devices].

The intrauterine contraceptive device (IUCD) is the most popular, reversible contraceptive method, worldwide. Leaving an IUCD in-utero even beyond the time recommended by the manufacturer has been found both safe, and effective in terms of contraceptive ability. In 1995 we screened the medical records of the gynecologic infirmaries of 4 agricultural settlements (kibbutzim) and found 78 women who had worn an IUCD continuously for more than 5 years. All had been regularly examined every 6 months. Most of the IUCDs (63, 80.7%) were copper-containing. Mean IUCD wear was 7.9+/- 2.6 years (range, 5-17 years). At the time of the study, 38 (48.7%) of the IUCDs were still in utero. Related complications were 3 cases of dysmenorrhea (3.8%) and 20 of metrorrhagia. No pregnancies or pelvic infections were recorded. This study also shows that wearing an IUCD beyond the time recommended by the manufacturer is not associated with loss of contraceptive effectiveness. Furthermore, the rate of IUCD-related complications after 5 years of wear was not higher than during the first 5 years. To support these findings further studies with larger samples are needed.

Female↗

PubMed1998

[Occlusion of the right common carotid artery due to oral estrogen overdose].

INTRODUCTION: Continuous use of oral anticontraceptive agents has been related to adverse vascular changes in the form of venous or arterial thromboses and cerebrovascular accidents (CVA). In our case, we describe a CVA due to occlusion of the common carotid artery after an acute massive overdose of estrogens due to error of dosage when using Yuzpe's system or emergency post-coital therapy. CLINICAL CASE: We describe a 26 year old woman with no previous clinical history, who smoked 20 cigarettes per day, did not take oral contraceptive pills and suffered an acute left facial-brachial-crural hemiplegia together with reduced level of consciousness. Imaging tests showed acute occlusion of the right common carotid artery. Etiological study of the patient's cerebral vascular accident was negative. The only etiopathogenic factor to be related was having taken oral contraceptive agents for three days after coitus as emergency post-coital treatment. This treatment was incorrect, since the dose of estrogens was four times that recommended. CONCLUSIONS: The continued use of estrogens, especially at doses over 30 micrograms per day, was considered responsible for approximately 10% of CVAs in young people. The risk of cerebral vascular accident is greater when there is associated migraine and/or smoking. We describe a patient who showed that the acute use of high doses of estrogens may also cause arterial occlusion, in this case in the common carotid artery.

Administration, Oral↗

PubMed1993

Pilot trial of a gonadotropin hormone agonist with replacement hormones as a prototype contraceptive to prevent breast cancer.

Combination oral contraceptive (COC) users have reduced risks of ovarian and endometrial cancer, but COCs have not reduced breast cancer risk. We have previously argued that a hormonal contraceptive with substantially lower doses of sex-steroids should reduce breast cancer risk by decreasing the breast epithelial cell proliferation below usual premenopausal levels. We report here the preliminary results of a pilot trial with such a prototype contraceptive consisting of an agonist of gonadotropin releasing hormone (GnRHA) administered with low doses of an oral estrogen (0.625 mg of conjugated estrogen, CE, for 6 days every week) and intermittent oral progestogen (10 mg of medroxyprogesterone acetate, MPA, for 13 days every 4 months). Eighteen subjects at five-fold or greater increased breast cancer risk were entered and randomized -12 to the contraceptive arm and 6 to a control arm. The principal endpoints included tolerance of the regimen, vaginal bleeding patterns, and the regimen's effect on the endometrium, bone metabolism, and lipids. A symptom questionnaire was used to assess tolerance; the contraceptive subjects had fewer symptoms following initiation of the regimen. This results from the elimination of symptoms associated with the luteal phase of the menstrual cycle, commonly referred to collectively as premenstrual syndrome, PMS. The few occurrences of hot flushes or vaginal dryness that did occur were eliminated by small increases in estrogen dose (0.9 mg CE). Scheduled vaginal bleeding occurred associated with most periods of progestogen administration. Unscheduled bleeding or spotting was infrequent and decreased with time on the regimen. A beneficial rise in high-density lipoprotein cholesterol was evident in the contraceptive subjects. Despite the use of an estrogen dose which is known to prevent loss of bone mineral density in normal postmenopausal women, an annualized loss of 1.9% was seen in contraceptive subjects. It is hypothesized that this is secondary to inhibition of ovarian androgen production by the GnRHA, which may additionally account for changes in libido occasionally reported with GnRHA. The study continues with the addition of a small dose of androgen to replace that lost by the action of the GnRHA.

Adult↗

PubMed1989

[Evaluation and management of post-thrombotic syndrome].

The number of patients with postthrombotic syndrome subsequent to venous thrombosis is continuously increasing. The risk of venous thrombosis is increased by the increasing age of the population, through increasingly-extensive surgical intervention, through hormonal contraception and through prolonged airline flights and the risk appears diminished by modern thrombosis prophylaxis. The course of the disease can be divided into an acute phase of thrombosis with a duration of about one week, the subacute phase lasting from the second to the fourth week and the phase of the postthrombotic syndrome. Pathophysiology Thrombotic occlusion can be compensated for by recanalization and collateralization. Concomitant with the generation of the blood clot, fibrinolytic factors are activated which can serve to lyse the thrombus. After organization of the remaining clot, blood flow can be re-established. The extent of recanalization can be quantified radiologically. In 35.5% of the patients there is complete recanalization, in 53.4% partial and in 11.1% no recanalization. At nearly all sites of venous occlusion preformed collaterals can be found. A hemodynamically meaningful occlusion causes an increase in the peripheral venous pressure. On use of Doppler ultrasound examination, there is absence of respiratory modulation as well as a high-frequency continuous signal which disappears as soon as collateral function is optimal. As the venous circulation adapts, there is dilatation in the collateral vessels, initially with preserved coaptation of the valve leaflets. This stage is designated as compensatory phlebectasia; phlebography of the great saphenous vein shows the typical findings. If the venous valves are incompetent, under some conditions the direction of flow may be reversed. An example of secondary varicosities in the region of the great and lesser saphenous vein is shown in Figure 3. The most frequent causes of valve damage are over-extension of the valve ring through recoil pressure and volume waves during standing, coughing and pressing in addition to local thrombus formation and inflammatory processes. In association with thrombosis in the femoropopliteal region with compensatory phlebectasia of the great saphenous vein, respiratory modulation in this vein can be detected with Doppler ultrasound examination. With secondary varicosities, which have to be differentiated from compensatory phlebectasia, on use of the Valsalva test or calf compression test there is pathologic, persistent retrograde blood flow, the calf compression test shows diminished A-sounds. In contrast to primary varicosities, with secondary varicosities of the great saphenous vein the distal dilatation is more marked than that seen proximally. Retrograde blood flow can extend to the foot with no obstacles.(ABSTRACT TRUNCATED AT 400 WORDS)

Dissection↗

PubMed1994

Dietary lactose intake, lactose intolerance, and the risk of epithelial ovarian cancer in southern Ontario (Canada).

A case-control study of dietary factors and cancer of the ovary was conducted during 1989-92 in metropolitan Toronto and surrounding areas of southern Ontario, Canada. Four hundred and fifty women aged 35-79 years, with newly diagnosed, histologically verified, primary epithelial ovarian-cancer were interviewed concerning reproduction and diet. Over the same period, 564 randomly-selected population controls, frequency-matched to the cases within three 15-year age groups, also were interviewed. From information obtained by quantitative diet history, average daily macro- and micronutrient intake values were calculated through use of the United States Department of Agriculture Food Composition Databank, which was extended and modified for Canadian items and recipes. Analysis was performed with continuous, unconditional logistic-regression methods, adjusting for age at interview, number of full-term pregnancies, total duration of oral contraceptive use, and total daily caloric intake. Neither reported history of lactose intolerance, nor average daily consumption of lactose or free galactose, were found to be associated with risk of ovarian cancer. Lactose intake or intolerance did not appear to modify the protective effects of parity and oral contraceptive use. Nevertheless, other studies suggest that ovarian galactose metabolism still may have a relationship with risk of ovarian cancer, though more evidence is needed.

Adult↗

PubMed2006

Depot medroxyprogesterone acetate and bone mineral density in adolescents--the Black Box Warning: a Position Paper of the Society for Adolescent Medicine.

The purpose of this Position Paper is to review the published Black Box Warning regarding depot medroxyprogesterone acetate (DMPA) and bone loss as it relates to adolescent girls. The scientific findings that prompted the Food and Drug Administration to issue the warning are reviewed and the following additional issues are considered: (1) likely low risk of fracture related to DMPA use, (2) evidence of at least partial recovery after discontinuation of the method, and (3) the need to balance the physical, social and economic cost of adolescent pregnancy versus the immediate and long-term impact of DMPA on bone. A list of clinical guidelines is included, the main recommendation of which is to continue prescription of DMPA, with counseling about the risks and benefits, in most of the adolescent population desiring to use this contraceptive method.

Adolescent↗

PubMed2000

Characteristics of women associated with continuing instruction in the Creighton Model Fertility Care System.

Effective use of natural family planning is strongly dependent upon adequate instruction. The Creighton Model Fertility Care System (CrMS) has a standardized protocol for instruction of new users that includes individual follow-up visits in the first year of use. This study evaluated the number of follow-up visits completed by new CrMS users from eight CrMS centers in the United States. Four follow-up visits were completed by 75.7% of women. Women who continued instruction were more likely to be educated, Catholic, and white, and to have a more challenging reproductive status (discontinuing oral contraceptives, or breastfeeding). These results suggest that the number of follow-up visits needed varies among new CrMS users. Future research should address the optimal length of instruction for adequate use of the CrMS by women with different characteristics and needs.

Adolescent↗

PubMed1987

Effect of treatment with chronic gonadotropin releasing hormone agonist on human testis.

We removed and examined 24 testes from 12 patients with metastatic carcinoma (stages C2 and D2) of the prostate who had been treated previously with either the gonadotropin releasing hormone analogue buserelin alone or combined buserelin and flutamide for a mean of 13.8 months. The histological changes noted included severe generalized atrophy of the seminiferous tubules, prominent degeneration of the Sertoli cells, with ultimate total tubular hyalinization, partial Sertoli-cell-only syndrome in 50 per cent of the testes (number of germ cells less than or equal to 0.95 per tubule), and pronounced collagenization and fibrosis of the interstitium (50 per cent) with total atrophy of the Leydig cells in 92 per cent of the testes. These results show that the effect of prolonged high doses of buserelin in the majority of patients caused irreversible damage, particularly to spermatogenesis and the Sertoli cells, and thus to the intratesticular ultra-short loop. Therefore, when it is applied continuously in a high dose daily for a long period this drug does not appear to be suitable as a male contraceptive.

Aged↗

PubMed1997

Epidemiology, prevention, and early detection of breast cancer.

Breast cancer is a leading women's health issue. Continued advances in understanding the temporal sequencing of relevant exposures promises to shed light on the continuum of breast carcinogenesis. Oral contraceptive use and the transient increase in risk following childbirth are exposures that affect the near-term risk of breast cancer. The availability of commercial testing for inherited susceptibility to breast cancer has accelerated the need for data to develop sound policy for implementing gene testing. The risks associated with BRCA1 and BRCA2 mutations may be less than previously estimated. Antiestrogens with lesser risks than tamoxifen hold promise for chemoprevention, but await testing. Not enough is known to formulate primary prevention strategies based on lifestyle interventions. Further understanding lifestyle factors that may be involved in the etiology of breast cancer and are amenable to preventive intervention thus remains a top priority, with diet and physical activity of greatest interest.

Breast Neoplasms↗

PubMed1999

Recent clinical issues related to the use of depot medroxyprogesterone acetate (Depo-Provera).

This report critically reviews recent original research articles concerning patient use of depot medroxyprogesterone acetate. Specifically, recent studies have been conducted on the following clinical issues: depression, galactorrhea, weight gain, bone mineral density, epithelial and mucus changes in the lower genital tract, and the acceptability of and continuation rates with the use of depot medroxyprogesterone acetate.

Bone Density↗

PubMed2005

Interactive effects of avoidant coping and parental hypertension on rate pressure product reactivity in women.

BACKGROUND: Previous research suggests that personality, situational context variables, and genes might interact to potentiate cardiovascular stress responses. PURPOSE: Our purpose is to examine interactive effects of dispositional avoidant coping and parental hypertension on cardiovascular reactivity to three different laboratory stressors. METHOD: Participants were 63 healthy female students. Stressors were an evaluated videotaped speech, the cold pressor, and viewing of the speech video. Heart rate and blood pressure were continuously recorded during baselines and tasks. RESULTS: After controlling for age, body mass index, smoking status, reported exercise, alcohol consumption, oral contraceptive use, parental hypertension, and avoidant coping, the interaction term of parental hypertension and avoidant coping was the best predictor of rate pressure product (RPP) reactivity to the speech task and to the video-viewing task. In contrast, reactivity to the cold pressor was not significantly predicted by this interaction term. Furthermore, there were no significant main effects of parental hypertension and avoidant coping on RPP reactivity in any of the tasks. There were no significant interactive effects for diastolic blood pressure. CONCLUSIONS: Consistent with an interactive model of cardiovascular reactivity, parental hypertension plus avoidant coping led to enhanced RPP reactivity. This effect, however, was only evident during self-threatening stressors. The results suggest that the coincidence of genetic and personality factors might enhance risk for cardiovascular diseases.

Adaptation, Psychological↗

PubMed1980

Depo-Provera: a critical analysis.

This article discusses the research which has led to the controversy of Depo-Provera, and delineates the risks discovered as a result of the studies. Questions are raised as to the advisability of the continued use of this drug.

Abnormalities, Drug-Induced↗

PubMed1984

The significance of pregnancy among adolescents choosing abortion as compared to those continuing pregnancy.

The significance of pregnancy for adolescent women is usually related to unconscious motivations. Some teenagers faced with the problem choose to abort, and others do not. Psychosocial status, contraceptive and sexual habits, attitudes towards pregnancy and environmental influences were studied in 50 teenagers who chose abortion. These young women were matched for age and parity with a control group of 50 who elected to carry their pregnancies to term. The results point to significant differences between the two groups, particularly as to the meaning of pregnancy and the decision-making process.

Abortion, Legal↗

PubMed1993

[Immediate IUD insertion following induced abortion].

From January 1990 to June 1992, 90 IUD were inserted in immediate post-abortion. We studied the tolerance of this contraception with a questionnaire. We got 83 answers. The rate of complications was 6%. Nine months to three years later the continuation rate was 89%. The insertion of an IUD at time of abortion seems to be an effective and acceptable solution to the problem of recurrent abortion.

Abortion, Induced↗

PubMedDate not supplied

Condom use among women choosing long-term hormonal contraception.

CONTEXT: Women who rely on long-term hormonal contraception may neglect to use condoms, and thus increase their risk of contracting sexually transmitted diseases, including AIDS. METHODS: Data from a prospective, multisite study were collected to examine the probability of condom use among 1,073 new users of either the contraceptive implant or injectable; users were interviewed when they accepted their method and again six months to one year later. Multivariate logistic regression analyses identified factors that significantly predicted the likelihood of dual method use. RESULTS: Condom use dropped markedly among women who adopted long-term hormonal contraception. The proportion who always used condoms in the previous three months fell from 21% at the time of adoption to 11% at follow-up. Among women with one sexual partner, this decrease was from 20% to 10%; however, among those with more than one partner, use increased from 25% to 31%. The factors significantly predicting dual method use included previous condom use (odds ratio of 2.5), receipt of AIDS-specific counseling (odds ratio of 1.6), the perception of being at some risk of AIDS at baseline (odds ratio of 1.4) and having had more than one sexual partner over the study period (odds ratio of 5.4). In addition, injectable users, teenagers and black women were more likely than other women to use condoms with their hormonal method. CONCLUSIONS: Although condom use among all women declined markedly once they initiated long-term hormonal contraception, frequency of condom use varied by subgroup and was associated with several factors. Most importantly, women with more than one sexual partner and those who received a message during counseling on the need to continue using condoms were more likely than others to use condoms in conjunction with the implant or injectable.

Adolescent↗

PubMed2004

Fertility trend and pattern in a rural area of South Africa in the context of HIV/AIDS.

Little is known about the dynamics of fertility transition in South Africa, though recent studies have begun to shed light on demographic changes in the country. This study presents trends and patterns of fertility observed in a rural South African population. Various demographic and statistical techniques were used to examine fertility patterns in a population of 21,847 women in a rural KwaZulu-Natal (KZN) demographic surveillance area. These are compared with patterns seen in another South African rural population under demographic surveillance, and with data from the 1998 South Africa Demographic and Health Survey. Findings are interpreted in light of contraceptive use patterns and HIV prevalence in the population. In South Africa, the end of the fertility transition is now in sight. In rural KZN, where national fertility levels are highest, fertility has declined rapidly for about two decades and would have reached below replacement level in 2003. While fertility has declined rapidly among all women over age 18 years, fertility levels among adolescents have not changed in decades. Although most adolescents in rural KZN were sexually active (60%), few had ever used contraception (200%). High HIV seroprevalence appears to explain a small part of the fertility decline (12%); however, this effect is likely to grow in the near future as the HIV/AIDS epidemic continues in South Africa. If the current trends continue in the future, below replacement fertility, together with high mortality due to AIDS, it could soon lead to negative natural population growth in rural South Africa.

Adolescent↗