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PubMed1989

Norplant contraceptive subdermal implants: two-year experience in Singapore.

Norplant contraceptive implants are Silastic containing levonorgestrel implants. This study describes our two-year experience with 100 acceptors of Norplant implants in Singapore. No pregnancies occurred during the first two years of use. Desire for planned pregnancy and disruption of menstrual rhythm were the two main reasons for twenty implant removals during the two years. The continuation rate at the end of two years was 79%. The post-removal conception rate in women desiring pregnancy was 90% at the end of one year. It thus appears that the Norplant contraceptive system offers a highly effective, acceptable, reversible and safe method of contraception.

Adolescent↗
PubMed2002

Adolescent sexuality and sexual behavior.

PURPOSE OF REVIEW: Adolescence is a time of self-discovery and physical, as well as cognitive, development. It is within this context that adolescent sexual development and sexual behavior occur. While curiosity and experimentation are normal, sexual behaviors, both coital and non-coital, place adolescents at risk for undesired consequences including sexually transmitted disease acquisition and pregnancy. Trends in adolescent sexual behavior are changing, and health care professionals must be aware of these trends to provide necessary medical care and education to this population. RECENT FINDINGS: While the sexual activity of teenagers garners much attention, attention must also be directed at non-coital activities such as masturbation, mutual masturbation and oral sex, as the riskier of these behaviors appear to be increasing. The trends in sexual activity and contraceptive use are encouraging with a decrease in the proportion of adolescents reporting sexual activity, and an increase in the proportion reporting using contraception. These trends, however, are not shared equally among racial groups with the greatest decline reported in the in lowest risk groups. Sexual minority youth continue to report a higher prevalence of high-risk behaviors, both sexual and non-sexual, as compared to their heterosexual peers. SUMMARY: These findings highlight the multiple roles health care professionals can play in caring for this unique population: firstly as health care providers, offering age appropriate, confidential health care; secondly, as reproductive health care educators providing factual, balanced, and realistic information to both teenagers and the community; and thirdly, as advocates lobbying for greater education and services for this at-risk population.

Adolescent↗
PubMedDate not supplied

Contraceptive practice in the United States, 1982-1988.

Use of oral contraceptives by married women declined markedly between 1973 and 1982, but analysis of data from the 1988 National Survey of Family Growth shows that this decline stopped between 1982 and 1988. Reliance on female sterilization continued to increase, however, and it remained the leading method among currently married and formerly married women. Among women of all marital statuses, IUD use dropped by two-thirds between 1982 and 1988, from 2.2 million to 0.7 million women. As the proportion of less-educated, low-income, black and Hispanic contraceptive users choosing the IUD decreased, the proportion relying on female sterilization increased. Among college-educated white women, use of female sterilization did not increase; instead, pill use rose in this group. Condom use increased most sharply among teenagers and rose among never-married white and black women, but the pill was still the leading method by far in these groups, regardless of race. Among never-married black women, reliance on sterilization increased significantly between 1982 and 1988, with female sterilization becoming the second leading method. Use of the diaphragm declined sharply over the same period among never-married white women and among those who intended to have more children, as did use of periodic abstinence (rhythm and natural family planning) and foam.

Adolescent↗
PubMed1993

Postpartum bilateral renal vein thrombosis in the primary antiphospholipid syndrome.

A young Caucasian woman developed bilateral deep vein thromboses (DVT) while taking the oral contraceptive (OC) in 1984. After a 9-month period of longterm anticoagulation therapy with warfarin, she experienced recurrent DVT 2 weeks following discontinuation of anticoagulation. She was then maintained with warfarin for the following 6 years. Elevated antibodies to cardiolipin (IgG aCL) were first detected in 1988. In 1990, warfarin was switched to aspirin and low molecular weight heparin as she wished to become pregnant. At 24 weeks she developed eclampsia and labor was induced. During the first postpartum week she experienced loin pain, associated with rapidly rising creatinine levels and features of a nephrotic syndrome. An abdominal ultrasound showed bilateral renal vein thrombosis with enlarged kidneys. She was treated with continuous ambulatory peritoneal dialysis (CAPD) for 4 months and her renal function is now recovering. Our patient is another example of the primary antiphospholipid syndrome.

Adult↗
PubMed1991

Phase II--clinical trial with biodegradable subdermal contraceptive implant Capronor (4.0-cm single implant). Indian Council of Medical Research Task Force on Hormonal Contraception.

The subdermal biodegradable contraceptive implant Capronor (4.0 cm) was implanted in 41 women to observe the efficacy and side effects. Only one pregnancy was reported at 10 months of use, and the life table continuation rate at 12 months was 82.2 per 100 users. No serious clinical side effects were reported during the study period. The menstrual pattern was disrupted during the first 3 months of implant use in two-thirds of the women which improved by the end of 12 months of use. The results of this Phase II study suggest that Capronor is a safe and effective long-acting contraceptive. These findings need to be confirmed in a Phase III clinical trial on a larger sample size.

Adolescent↗
PubMedDate not supplied

The epidemiology of breast cancer.

Table 5 presents risk factors for breast cancer generally regarded as established, together with their approximate relative risks. With the exception of age, country of birth, and a history of breast cancer in both a mother and a sister, all of the relative risks reported to date are of a relatively modest magnitude. Thus, new risk factors need to be identified and knowledge of existing risk factors refined. Factors for which the evidence of an etiologic role has mounted over the past several years, but which are not yet considered to be established, include the protective effects of parity and lactation in certain age groups and the increased risks associated with alcohol consumption and with DES exposure during pregnancy. In addition, physical activity has emerged as a factor worthy of further study. Some evidence suggests that use of oral contraceptives for several years at an early age modestly increases the risk for breast cancer diagnosed before age 35 and perhaps age 45. Use of estrogen-replacement therapy for 20 years or more has been found by a few studies to increase the risk for breast cancer in the postmenopausal years; further studies of very long-term users are needed. Also, other risks and benefits of these hormones need to be taken into account when women decide whether to use them. Surprisingly elusive has been the etiologic role of endogenous hormones, especially in view of the large number of studies that have been concerned with them. A better understanding of the role of endogenous hormones should help explain the mechanisms of action of known and suspected risk factors. Areas of high priority for further research thus include establishing with more certainty whether the risk for breast cancer is increased in any subgroups of women who use oral contraceptives and estrogen-replacement therapy and determining the etiologic roles of specific endogenous hormones. The possible risks associated with alcohol consumption and lack of physical activity need to be studied more thoroughly, and ideas about new potential risk factors are needed. Although epidemiologic studies will continue to be concerned with diet, enthusiasm for its etiologic role in women has been considerably dampened by the lack of association in many of the studies reported to date. The studies in women exposed to radiation, DES, and oral contraceptives suggest that the timing of some exposures may be critical, since the effects of these agents may mostly be limited to specific time periods of rapid breast development.(ABSTRACT TRUNCATED AT 400 WORDS)

Breast Neoplasms↗
PubMed2001

[Olanzapine and pregnancy. 2 case reports].

We report on two schizophrenic females who both had unexpected first pregnancies in their mid-thirties while being treated with olanzapine. Both patients had histories of psychosis of several years with some relapses and were treated previously with traditional antipsychotics. Since they wished to have children, no contraception had been performed past the age of 30. Both pregnancies occurred within a few months after the drug treatment was switched from traditional agents to olanzapine. Olanzapine was continued throughout the pregnancies, which were without complication. It is well known that treatment with traditional neuroleptics may lead to elevated prolactin levels and thus to relative infertility. Like clozapine, olanzapine has minimal effects on prolactin levels. These cases indicate that after switching from traditional neuroleptics to atypical agents, fertility may normalize and unplanned or even unwanted pregnancies may occur. Since olanzapine is widely prescribed, it is essential to inform women about the increased probability of pregnancy and the need of appropriate contraception.

Adult↗
PubMed2002

Breastfeeding, amenorrhea and contraceptive practice among postpartum women in Zibo, China.

This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at 42 days. 4 months and 1 year after delivery. The results showed that the full breastfeeding rate (including exclusive and almost exclusive breastfeeding) was 78% and 43% at 42 days and 4 months after delivery, respectively. The mean reported length of abstinence from sexual intercourse after delivery was 71 days. The mean reported time to menses resumption was 184 days. Ninety-three per cent of women had resumed sexual intercourse at 4 months after delivery. Seventy-three per cent of women were using contraceptive methods when they resumed sexual activity after delivery. After childbirth, the majority ofthe women interviewed used condoms within 3 months. Thereafter, most of them switched to intrauterine device (IUD)). Life table analysis shows that the continuation rates of full breastfeeding and amenorrhea at 4 months after delivery were 35% and 68%, respectively. This implies that if the full breastfeeding rate can be prolonged, it is feasible to use the lactational amenorrhea method (LAM) among Chinese postpartum women. The policy implications of this study are that quality care on contraceptive services and information for postpartum women in urban areas need to be improved further.

Adolescent↗
PubMed1995

Preventing unplanned pregnancies among married couples: are services for only the wife sufficient?

Unplanned pregnancies among married couples in the United States remains an important problem today. The effects of predisposing factors (conceptualized according to the Luker theory of contraceptive risk taking) on use of effective contraceptive methods and on the occurrence of an unplanned pregnancy were examined among a sample of 150 white married couples who did not desire a(nother) child within 2 years. The effects of husbands' predisposing factors on both dependent variables were highly significant, either directly or through interaction with their wives. The findings demonstrate the need for continued research on wife and husband effects on reproductive behaviors and outcomes.

Adolescent↗
PubMed1999

Development of an immunocontraceptive vaccine. Current status.

Development of an effective and modern contraceptive vaccine is a key factor in the global issue of regional population growth as well as agricultural, medical, economic and social development. A review was done of the current medical literature concerning development of an immunocontraceptive vaccine and relative molecular biology technology. Various approaches have been taken to identify candidate-specific antigens for immunocontraceptive development, such as sperm, zona pellucida and hormonal antigens. Suppressed fertility and the reversibility of these effects on mammalian species, including humans, have been demonstrated. The successful results obtained so far support the continued investigation for an effective immunocontraceptive vaccine.

Animals↗
PubMed1999

[Norplant: a 3-year experience of the National Institute of Perinatology in Mexico].

We present the experience from Instituto Nacional de Perinatología (INPer) with the use of subdermal contraceptive implants Norplant from 1995 to 1997. The purpose was to Know the sociodemographic characteristics and evaluate contraceptive efficacy, adverse effects and tolerance on the users of Norplant. We carried out a prospective, observational trial in the Family Planning Clinic, during the period january 1o, 1995 through december 31, 1997. Women with desire of long term hormonal contraception, and without contraindications for the use of progestins were eligible for the study. The follow up consisted in visits every 6 months, and in some cases we obtain the information by telephonic interviews. One hundred an two women were included in the study; the median age of the subjects was 21.6 years, the median number of pregnancies were 2.0. In 53% of the subjects an obstetric risk factor was present such as adolescence (25.5%), social (8.8%), and others. Seventy-four women were followed up, and accumulated 1,064 months of observation. (Average 14.4 months). Menstrual irregulaties (83%), and headache (30%) were the most frequent adverse effects. The continuity rate was 81%, and during the study no pregnancy was observed. The principal causes for the extraction of the implants were menstrual irregulaties and headache. The contraceptive subdermal implants Norplant, constitutes and excellent choice because of its high efficacy, safety and good tolerance.

Adolescent↗
PubMed1980

[Uremic hemolytic syndrome in the adult. A study of four cases (author's transl)].

Four cases of the uremic-hemolytic syndrome in the adult are presented. One of them was associated with the presence of the Australia antigen in the plasma. Another had recurrent and familial characteristics associated with the ingestion of oral contraceptives and exhibited a persistent activation of the C3 fraction and the presence of C3NeF (nephritic factor). The two remaining cases were associated with the post partum. Three patients have received sodium heparin continuously, two of which (post partum uremic-hemolytic syndrome) recovered the renal function. A third case, with recurrent uremic-hemolytic syndrome, presented an improvement of the renal function under heparin treatment after the first episode of the disease, but not after the second. Two patients are included in a program of periodic hemodyalisis. The mechanisms by which infections, ingestion of oral contraceptives or post partum can produce an intravascular coagulation syndrome or immunitary disorders are analyzed, both phenomena being interrelated and apparently playing an important role in the pathogenesis of the uremic-hemolytic syndrome.

Adolescent↗
PubMed1989

[The applied of computer for analysis on contraceptive efficacy of IUD of rural women in Guangdong province].

This paper discussed the usage and effect of IUD-type O use for rural married women in Guangdong province. The continuation rate of IUD-type O is 71.7 per cent 100 women in one year. The main problem for failure was expulsion. This paper have used a combination of univariate and multivariate analytic methods. On the whole, the important factors were number of gravid and parity, number of induced abortion and medical technical level etc.

Adult↗
PubMed2006

The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis is a rare clinical condition in which patients display hypersensitivity to endogenous progesterone. It manifests as a cyclical cutaneous eruption that flares during the luteal phase of the menstrual cycle, when progesterone levels peak, and resolves partially or completely a few days after menses. Its cutaneous manifestations are variable and include urticaria, eczematous eruptions, vesiculopustular eruptions, fixed drug eruptions, stomatitis, erythema multiforme, and anaphylaxis. Autoimmune progesterone dermatitis has been diagnosed previously with intradermal skin testing or intramuscular progesterone challenge. Treatment of progesterone hypersensitivity generally consists of ovulation inhibition with pharmaceutical agents or oophorectomy; other therapies (eg, thalidomide) have also been used with success. We report a case of cyclical erythema multiforme (EM) induced by hypersensitivity to endogenous progesterone in a patient with a history of past oral contraceptive use. After herpes simplex virus was ruled out as an etiologic factor, a diagnosis of progesterone hypersensitivity was confirmed with intradermal skin testing. Results of subsequent patch testing with various progesterone derivatives were negative. The EM outbreaks were suppressed temporarily by continuous administration of Loestrin (ethinyl estradiol plus norethindrone), which also increased the responsiveness of the outbreaks to prednisone tapers.

Adult↗
PubMed1975

Insulin metabolism, insulin sensitivity and hormonal responses to insulin infusion in patients taking oral contraceptive steroids.

The metabolism of unlabelled human monocomponent insulin was studied in a group of six patients being treated with combined oestrogen-progestogen oral contraceptives (OC) and compared with a group of ten normal subjects. The parameters of insulin metabolism were determined by a priming dose-continuous infusion technique which enabled measurements of metabolic clearance rate (MCR) of insulin to be made at four separate steady state hormone concentrations spanning the physiological range. In normal subjects MCR was greatest at low insulin concentrations, falling from 24.7 ml/kg/min. at 16 muU/ml to 11.4 ml/kg/min. at a mean concentration of 280 muU/ml. In the OC group, MCR averaged 20.5 ml/kg/min. and did not change with increasing plasma insulin concentration. The plasma half-disappearance time (T 1/2) was longer than normal in the OC group (5.6 vs. 4.4 min., p less than 0.05) despite a higher MCR. The prolonged T 1/2 indicated that the apparent distribution space was increased in those on OC (166.6 vs. 82.7 mg/kg., p less than 0.0025). The results are interpreted as indicating increased capillary permeability to insulin and increased peripheral degradation. The fact that MCR did not fall in the OC group with increasing plasma insulin concentrations whereas it did in normal subjects, suggested that OC leads to the loss of saturable component of insulin degradation that is present in normal subjects. Insulin sensitivity (as judged by induced hypoglycaemia) was reduced in the OC group while growth hormone responses were within the normal range. Plasma cortisol was increased in those taking OC but the response to insulin induced hyperglycaemia was less marked than normal. The results indicate a significant alteration in insulin metabolism in these subjects, which may contribute to the impairment of carbohydrate tolerance seen in some women taking combined OC.

Adult↗
PubMed1993

Development of copper male contraceptive. Contribution of India.

In this review article the author discusses the possibility of making a male contraceptive with the inclusion of copper. The contributions made by different groups of workers in India towards this, are critically analysed. Aspermatogenic status of copper is recognised. The toxicity of copper on tissue is a great concern for continuation of this programme. Recently a hypothesis for slow delivery system of copper for functioning as aspermatogenic and spermatostatic was mooted. The veracity of the proposal is yet to be seen.

Contraceptive Agents, Male↗