[Oral contraceptives and the internal ecology of women].
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Abnormalities, Drug-Induced↗
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[Contraception in diabetic women].
The choice of a contraceptive method for diabetic women must take into account metabolic and vascular risks. Combined oestrogen-progestogen contraception is not contra-indicated in insulin-dependent diabetes but requires close supervision. Progestogens alone for nulliparous women and mechanical devices for multiparous women appear to be preferable. Oral contraceptives have a more limited use in insulin-independent overt or chemical diabetes. In such patients combined oestrogen-progestogen contraception is absolutely contra-indicated and progestogens should be given under strict metabolic monitoring. The potential risks incurred by these women already liable to vascular and metabolic complications make male contraception even more desirable.
Adult↗
[Intrauterine contraception from the viewpoint of an ambulatory gynecologic department].
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Adult↗
[Risk of thrombosis with oral contraceptives: value of a thrombophilia screening test].
Oral contraceptives increase the natural incidence of venous thrombosis of 1-2/10,000 women per year 3- to 4-fold. Recent studies have shown that desogestrel or gestodene containing formulations bear twice the risk of older low-dose ovulation inhibitors. During pregnancy, the incidence of thrombosis rises to 10/10,000 women-years and post partum up to 40/ 10,000. For 60% of thromboses no causal explanation can be found. In approximately 40% of the patients an inherited thrombophilia can be presumed. Among the hereditary types of thrombophilia, a resistance to activated protein C (APC-resistance) represents nearly 50%, while in 15 to 20% a deficiency of antithrombin III, protein C or protein S is found. APC-resistance, with a prevalence of 3-5% in the general population, increases the risk of thrombosis 8-fold and in users of oral contraceptives 35-fold. Antithrombin III-deficiency carries a comparable risk. Protein C-deficiency increases the risk of thrombosis 9-fold and in users of oral contraceptives 15-fold. Ovulation inhibitors do not influence the risk of thrombosis in women with protein S-deficiency. Anti-phospholipid-antibodies increase during treatment with oral contraceptives and represent a considerably enhanced risk of thrombosis. Inherent thrombophilia is suspected in a patient with a positive history or family history of thrombosis, especially with thrombosis before the age of 40 or with atypical localisation. Even in these risk groups, the cost-benefit ratio of selective screening is unfavorable, as today at most 70% of the hereditary thrombophilias can be diagnosed by laboratory analysis, and only very few of the patients will actually experience a thrombotic event: only 3 of 1000 carriers of APC-resistance will suffer from thrombosis during oral contraception. On the other hand, a negative result of laboratory tests does not exclude a hereditary thrombophilic disorder. At present, it is unclear whether a selective screening process is superior to a careful assessment of individual and family history. A general screening, however, cannot be justified because of the unfavorable cost/benefit ratio. If the individual or family history or pathological laboratory parameters indicate an increased risk of thrombosis, this risk has to be carefully weighed against the consequences of discontinuation of pill use. Those few individuals with risk factors who will experience a thrombo-embolic event, cannot be identified in advance. If oral contraceptives represent a particularly high risk in patients with thrombophilic disorders and/or other risk factors, other contraceptive methods should be considered. If a patient with risk factors decides on the use of oral contraceptives, she must be informed that in the case of symptoms indicating a thrombosis, a physician should be consulted immediately. The earlier an appropriate therapy is initiated, the more effectively pulmonary thrombo-embolism and permanent damage, such as the post-phlebitic syndrome, can be prevented.
Adult↗
Contraception--a look forward, Part III: Inhibin and brain-enhanced estrogen delivery.
The final installment of this review examines two contraceptive methods, inhibin and brain-enhanced estrogen delivery, which are radically different from any currently available. Inhibin is a gonadal hormone that specifically inhibits pituitary production of follicle-stimulating hormone. Before it was finally isolated in 1985, inhibin was expected to be an ideal contraceptive. Recent research, however, has shown that the inhibin hormonal system is unexpectedly complex, and hopes for clinical use of inhibin must be suspended for the present. Although oral contraception is one of the most effective methods ever devised, use is limited by adverse effects of estrogen (or fears of such effects). A system known as brain-enhanced estrogen delivery specifically delivers estrogen to the brain, including the hypothalamus, there inducing suppression of the gonadotropin-releasing hormone. It has been described and tested in animals, and its successful development could replace current oral contraceptives and extend their availability to many more women.
Contraceptives, Oral, Combined↗
Comparison of androgens in women with hypoactive sexual desire disorder: those on combined oral contraceptives (COCs) vs. those not on COCs.
INTRODUCTION: Approximately one out of four sexually active women in the United States uses some form of hormonal contraceptive method because they provide the most effective reversible method of birth control available. However, little attention has been paid to possible adverse effects of combined oral contraceptives (COCs) on sexual functioning. AIM: The aim of this study was to examine the potential effects of COCs on women with hypoactive sexual desire disorder (HSDD). It was hypothesized that female patients with generalized, acquired HSDD on COCs have lower androgen levels than those not on COCs. METHODS: The patients were healthy premenopausal women with HSDD, aged 22-50 years. Subjects had a history of adequate sexual desire, interest, and functioning. Participants were required to be in a stable, monogamous, heterosexual relationship and were screened for any medication or medical or psychiatric disorders that impact desire. The patients met operational criteria for global, acquired HSDD. The 106 patients were divided into two groups: those on COCs (N = 43) and those not on COCs (N = 63). A two-tailed t-test comparison was made between the two groups comparing free and total testosterone and sex hormone-binding globulin (SHBG). MAIN OUTCOME MEASURES: The main outcome measures are the differences between the two groups comparing free testosterone, total testosterone, and SHBG. RESULTS: These patients with HSDD on COCs had significantly lower free and total testosterone levels compared with those who were not on COCs. The SHBG was significantly higher in the group on COCs compared with those who were not on COCs. CONCLUSION: The result of this study suggests that COCs in premenopausal women with HSDD are associated with lower androgen levels than those not on COCs. Further research is required to determine if low androgen levels secondary to COCs impact female sexual desire.
Adult↗
[Family planning-the pill or natural method of birth control (author's transl)].
Observations made at the Family Planning Clinic and a review of the literature show that there is no increased tendency towards the natural contraceptive method among advice-seeking couples. On the contrary-apart from a few exceptions-the most effective method is always chosen. The natural method presupposes a high degree of motivation, of readiness to communicate and of clarification. These prerequisites underly the relatively high rate of failure because not all couples have the right degree of understanding. Nevertheless, to many people this method is the only acceptable and morally justifiable one. Thus, precise and detailed instructions and frequent check-ups would be necessary especially during the first few months, until adequate experience is gained.
Body Temperature↗
Contraceptive usage during lactation in the United States: an update.
National Surveys of Family Growth data showed that as of 1982, most lactating women who were sexually active used a contraceptive method; barrier methods were most frequently used. Black women and women of higher parity and lower educational level were more likely to be sexually active and not using a method.
Adolescent↗
Counselling on contraceptive use strengthened in Dominican Republic.
In the Dominican Republic a study was conducted to identify the main factors associated with the occurrence of induced abortion. The study involved interviews with 350 women admitted in two hospitals with abortion complications, review of their clinical records, and in-depth interviews with 30 of these patients. The results indicated that the majority of these women had a low socioeconomic status and a low level of education. Many were born in rural areas but had migrated to Santo Domingo, the capital, in search of employment. Their average age was about 26 years. Adolescents represented 16% of the total study sample. Most of these women were in some sort of union, but only 13% were formally married. Contrary to popular belief that it is only unmarried adolescents who resort to induced abortions, the study showed that the majority were in permanent or semi-permanent unions. In fact, most of them had been in the union for three or more years. The use of contraception was low and unsystematic, with high discontinuation rates. Although 75% of the total study population declared to have used at least one contraceptive method during their lifetime, only 42% had tried a second method. This project has had a significant policy impact. In 1993, a revised Health Code was presented to the Dominican Congress for discussion and approval. The Senator who introduced this legislation, using results from the study, proposed to modify the law with respect to therapeutic abortions to include a clause that would make abortion legal under certain conditions and make corresponding services available as part of maternal and child health care programs. Also, with a view to lowering the incidence of abortion, PROFAMILIA, an agency affiliated to the international Planned Parenthood Federation, has adopted improved measures, reinforcing counselling and communication efforts to improve understanding of the correct way of using modern methods.
Abortion, Induced↗
Knowledge, attitudes and practices regarding emergency contraception among family-planning providers in Turkey.
OBJECTIVE: The research was planned descriptively to define the knowledge, attitudes and practices of family-planning providers regarding emergency contraception. METHODS: The sample included 21 Maternal-Child Health/Family Planning Centers located in the European region of Istanbul, and the research was conducted with 41 family-planning providers employed in these facilities. RESULTS: All of the family-planning providers were aware of emergency contraception, 82.9% accurately defined emergency contraception, 61% stated that emergency contraception was legal, and 53.7% expressed that it could be employed in rape indications. All the family-planning providers (100%) cited combined oral contraceptives, 73.2% cited intrauterine devices, and 9.8% cited other methods (mifepristone, high-dose estrogen, menstrual regulation). Seventy-eight per cent of the family-planning providers stated that they had applied emergency contraception previously, while 53.7% gave limited support to emergency contraception. Two sample cases were given to family-planning providers to define their attitudes, to the first of which most of them were positive. All of them were positive towards the second sample. CONCLUSION: Family-planning providers, whose duty is to support women in critical family-planning and reproductive decisions using their experiences and skills, are supposed to have broad knowledge on the matter of emergency contraception.
Adult↗
[The role of copper-releasing intrauterine device or levonorgestrel-releasing intrauterine system on uterine bleeding and iron status (prospective study of 8 years)].
BACKGROUND: The aims of this study were the effects of copper intrauterine device (Cu-IUD) compared to progesterone (PRG-IUS) or levonorgestrel releasing intrauterine system (LNg-IUS) on menstrual bleeding, menorrhagia and dysfunctional uterine bleeding. The authors evaluated the effect of copper surface area on uterine bleeding. METHODS: Between March 1992 and November 1999, 223 women, referred to I Institute of Obstetrics and Gynaecology University of Rome, were recruited in a prospective study with follow up at 3, 6 and 12 months to evaluate the incidence of endometrial pathology. The study includes 38 fertile women with regular menstruations and without intrauterine devices, as control group, and 185 patients with intrauterine devices, divides as follows: - 117 copper-releasing intrauterine devices: 30 with a copper (Cu) surface area =200 mm2, releasing 45 microgram Cu/24h (Nova T (R)); 27 with a copper surface area =250 mm2, releasing 50 microgram Cu/24h (Multiload 250 (R)); 25 with a copper surface area =375 mm2, releasing 65 microgram Cu/24h (Multiload 375 (R)); 20 with a copper surface area =384 mm2, releasing 100 microgram Cu/24h (No Gravid M (R)); 15 with a copper surface area =440 mm2, releasing 120 microgram Cu/24h (No Gravid 0,5 (R)). - 68 progesterone/levonorgestrel-releasing intrauterine devices: 40 progesterone-releasing intrauterine systems (Progestasert(R)); 28 levonorgestrel-releasing intrauterine systems 20 mg/24h (Mirena (R)). A total of 211 subjects had data that were valid for analysis: 12 women out of 223 (5,4%) were excluded from the prospective study lost to follow-up. A venous blood sample for serum ferritin (mg/l), iron (mg/dl), hemoglobin (g/dl), hematocrit (%), blood cell count, MCHC and MCV was taken during follow-up. RESULTS: PRG or LNg-IUSs determined a significant reduction in menstrual blood loss and in irregular bleeding by gradually reducing endometrial fitness and vascularisation. Serum ferritin significantly increased in women inserted with LNg- IUSs already after 6 months (26+/-22 e 28+/-14 microgram/l versus 32.5+/-19 e 34.5+/-25 microgram/l). Hemoglobin significantly increased (p>0.05) 6 months after insertion. On the contrary this did not occur with the insertion of Cu-IUDs. We observed that the increased amount of copper, released by IUD, causes increasing of bleeding. CONCLUSIONS: The LNg-IUS is a new contraceptive method combining the advantages of both hormonal and intrauterine contraception. In addition, it can be considered an alternative method in the treatment of menorrhagia and dysfunctional uterine bleeding. On the contrary, in women inserted with Cu-IUDs, the main reason of menorrhagia probably is due both to the shape of device and to copper surface area.
Adult↗
Postpartum contraception: the lactational amenorrhea method.
Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.
Algorithms↗
Sexual behavior of secondary-school students in Slovenia.
OBJECTIVES: The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia. METHODS: The research was carried out on a representative sample of 4706 secondary-school students aged 15-19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996. RESULTS: The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%). CONCLUSION: By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.
Adolescent↗
Medical care cost savings from adolescent contraceptive use.
An analysis of the economic benefits of adolescent contraceptive use utilizes information from a national private payer database and from the California Medicaid program to compare private- and public-sector costs and savings. The study estimates the costs of acquiring and using 11 contraceptive methods appropriate for adolescents, treating associated side effects, providing medical care related to an unintended pregnancy during method use and treating sexually transmitted diseases (STDs) and compares them with the costs of using no method. The average annual cost per adolescent at risk of unintended pregnancy who uses no method is $1,267 ($1,079 for unintended pregnancy and $188 for STDs) in the private sector and $677 ($541 for unintended pregnancy and $137 for STDs) in the public sector under the most conservative assumptions. At one year of use, private-sector savings from adolescent contraceptive use range from $308 for the implant to $946 for the male condom; public-sector savings rise from $60 for the implant to $525 for the male condom. Both the use of male condoms with another method and the advance provision of backup emergency contraceptive pills provide additional savings.
Adolescent↗
Spermicides and barrier contraception.
The contraceptive failure rate of condoms varies from 2 to 13%, depending on the study population, yet it is the contraceptive method with the greatest capacity to protect against sexually transmitted diseases (STDs) and AIDS. Breakage and slippage during intercourse are important causes of failure, and individual behavior leading to consistent and correct use is the most important factor in condom effectiveness. Female-controlled barrier methods may actually prevent more STDs than condoms, because of their more consistent use. Using the diaphragm continuously and without spermicide was well accepted and effective in preventing pregnancy in one study. The female condom appears to have a contraceptive effectiveness close to that of other vaginal methods. It is likely that it also protects against STDs and AIDS. Nonoxynol-9 appears to have a protective effect against some STDs and the data concerning the protective effect of spermicides containing nonoxynol-9 against HIV is conflicting, yet suggests some protection, especially if products are used with relatively low frequency that avoids dose-dependent vaginal irritation. New spermicides which could also protect against viral infection without affecting epithelial cells are currently being studied.
Acquired Immunodeficiency Syndrome↗
LH-RH agonists and antagonists.
Large doses of stimulatory analogues of luteinizing hormone-releasing hormone (LH-RH) caused paradoxical antifertility effects. These effects are being utilized for the possible development of contraceptive methods. Several inhibitory analogues of LH-RH have been tested in men and women and shown to be active. The synthetic approach based on inhibitory analogues of LH-RH has been proven to be feasible for development of new methods of birth control. Continued research and testing along these lines may lead to the development of contraceptives based on inhibitory analogues of LH-RH that could be conveniently applied as a nasal spray and could be free of undesirable side effects.
Animals↗
Advantages of breastfeeding according to Turkish mother's living in Istanbul and Stockholm.
As part of a cross-sectional study, carried out among Turkish mother-infant pairs, the mothers of 269 infants living in Istanbul and 30 living in Stockholm were asked their opinions as to the advantages and/or disadvantages of breastfeeding. The answers were categorized according to the attributes mentioned, quantified and related to the socio-economic status of the area of residence, maternal education, origin, current infant feeding practice and contraceptive method. In Istanbul, 63% of the responses stressed some advantage and 31% some disadvantage of breastfeeding. The contraceptive effect was considered the major advantage and the possibility of milk insufficiency the major disadvantage. In Stockholm, the nutritional value of breastfeeding was considered the most important advantage. No disadvantage was mentioned in Stockholm, despite the fact that breastfeeding durations among the immigrant group was shorter than that of the group in Istanbul. The implications of the responses are analyzed. It is hypothesized that mother-centered advantages, such as the birth-spacing effect of breastfeeding, may be more important motivators for continuing breastfeeding among women living under less-advantaged social conditions, and that, if this is true for some groups of mothers, the infant-centered emphasis in the breastfeeding promotional messages may need modification to include the interests of the mothers, as well.
Attitude to Health↗
Contraceptive efficacy determination by postcoital testing.
A new vaginal contraceptive method that offers the ease of use with none of the potentially harmful physiologic effects of hormonal contraception was subjected to direct in vivo tests of its efficacy in immobilizing spermatozoa and preventing their entry into the cervical canal. The new contraceptive, a small avoid only 2.8 cm long and 1.4 cm wide, is easily inserted into the vagina without the need for special applicators. It offers protection through the delivery of a highly effective spermicide by the effervescent formation of foam that disperses over the uterine opening. In the trials, no motile spermatozoa could be found in any samples obtained from the vagina, the os externum, or the cervical canal immediately after intercouse protected with the new agent. In no case were any sperm, even immotile sperm, observed in the cervical canal. By contrast, examination of 30 samples obtained immediately after coitus protected with another contraceptive agent (used as a control) revealed motile spermatozao in the cervical canal in nine cases, and propulsive motility was seen on five occasions. The new contraceptive proved highly effective in preventing conception.
Coitus↗