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PubMed1984

Influence of psychosocial factors on adolescent compliance with oral contraceptives.

This paper prospectively tests the influence of a variety of sociomedical and psychosocial factors on compliance with oral contraceptives among adolescent females from a population at high risk for pregnancy. Fifty-six females aged 14-19 yr from a lower socioeconomic background received a battery of pretest measurements and were then given Ortho-Novum 1/35 combined with riboflavin during an initial visit and 1-, 2-, and 4-month follow-ups. Compliance was measured at each follow-up using a Guttman scale consisting of: (1) avoidance of pregnancy, (2) appointment adherence, (3) pill count, and (4) urinary fluorescence for riboflavin. Six factors were found to be significantly associated with noncompliance: (1) multiple sexual partners, (2) appointment being made by the adolescent, (3) low evaluation of personal health, (4) feelings of hopelessness, (5) worry about becoming pregnant, and (6) previous abortion. These findings suggest that certain indicators of sexual activity and social psychological status may help predict noncompliance in some adolescent females.

Adolescent↗
PubMed2001

Family planning needs: new opportunities, emergency contraception and other new technologies.

Modern contraception is considered to be one the major advances of the 20th century. Yet, as the next century begins, it is estimated that there is still a largely unmet need for contraception, with millions of couples worldwide who express a wish to limit the number of their children but do not use or are not satisfied with their contraceptive method. While the reasons are numerous, it is clear that there is a need for improved and new methods which are easier to use, under the user's control, with fewer side-effects and responding to the needs of different groups of users, including men. To respond to this need, current contraceptive research and development efforts focus on five main areas: emergency post-coital methods, user-controlled long-acting methods, dual protection methods against both pregnancy and sexually transmitted infections, methods for men, and methods with fewer side-effects including some that are more targeted to specific reproductive biological events. A number of leads are presented which are at various stages of development. Concluding remarks stress the numerous challenges of contraceptive development, not the least of which is the vision required of what the needs of future generations will be, since it takes 10-15 years to bring a new contraceptive to the market. More fundamentally, overall progress towards reducing the unmet need for contraception will depend on the status of women, specifically their decision-making power, and access to education and income.

Journal Article↗
PubMed2000

Novel delivery systems in contraception.

Contraception has mainly remained the responsibility of women. The sexually active time during the fertile period of life may last over 30 years and, increasingly, it is more than 10 years before the first baby. It is, therefore, natural that convenient long-acting contraceptive methods are becoming more and more appealing. The discovery of poly(dimethylsiloxane) as a carrier, and controlled release polymers for small molecule drugs allowed the development of contraceptive devices releasing steroids for several years. While contraceptive implants and intra-uterine systems are already marketed in many countries, contraceptive vaginal rings are in their late development phase. The key features of these long acting delivery systems are convenience, efficacy, reversibility and positive long-term health effects. Since these methods are based on new concepts, the provider needs to be prepared for extensive counselling.

Adult↗
PubMed1990

Multicentred clinical study of the metabolic effect of the monthly injectable contraceptive containing dihydroxyprogesterone acetophenide 150 mg + estradiol enanthate 10 mg.

The metabolic effect of the monthly injectable contraceptive containing dihydroxyprogesterone acetophenide (DHPA) 150 mg + estradiol enanthate (EEn) 10 mg was compared to that of other regularly used contraceptive methods (pills containing: ethinylestradiol (EE) 0.050 mg + levonorgestrel (LNG) 0.250 mg, EE 0.030 mg + LNG 0.150 mg; EE 0.030/0.040/0.030 mg + LNG 0.050/0.075/0.0125 mg; norethisterone enanthate (NEE) 200 mg i.m.; non-hormonal methods). Serum triglycerides, HDL/LDL-cholesterol, copper, ceruloplasmin, total and free cortisol, CBG, total and free testosterone and SHBG in chronic users were determined. A total of 237 women took part in this study. Taking users of non-hormonal methods as control, triglyceride levels were higher, and total and free testosterone levels were lower in women using DHPA 150 mg + EEn 10 mg and in those taking contraceptive pills (p less than 0.05 - 0.01). Such modifications were slightly less in the group using the injectable. The effects of DHPA 150 mg + EEn 10 mg on HDL/LDL-cholesterol copper, ceruloplasmin, CBG, total and free cortisol and SHBG were rare or non-existent. Nevertheless, the contraceptive pills (even the low-dose formulations) correlate with modifications of all those variables, which were highly significant in comparison with the injectable (p less than 0.01) and with non-hormonal methods (p less than 0.01); there were no differences between the last two methods. The results suggest that the metabolic effect of DHPA 150 mg + EEn 10 mg is not higher than that of the commonly used oral contraceptives. On the other hand, they do not suggest that the dose contained in this injectable is exaggerated. There is no evidence that it produces accumulation of effects in the organism. These findings should be taken into account when referring to the long-term safety of this injectable.

Adult↗
PubMed1999

Comparative study on the acceptability of two modern monophasic oral contraceptive preparations: 30 microgram ethinyl estradiol combined with 150 microgram desogestrel or 75 microgram gestodene.

Cycle control and tolerability of two monophasic oral contraceptive pills containing 30 microg ethinyl estradiol (EE) with either 150 microg desogestrel (DSG) or 75 microg gestodene (GSD) were compared in women starting oral contraception. A minimum of 200 healthy women at risk for pregnancy were to be treated for a total of 6 cycles per patient in a prospective, randomized open parallel-group multicenter trial. Two hundred and forty-one subjects were randomized, 115 to DSG/EE and 126 to GSD/EE. Compliance to the study preparation was high (around 95%) in both groups and no pregnancies occurred during the study. Cycle control was excellent; there were no differences between the two groups with regard to incidence of spotting and breakthrough bleeding or duration and intensity of withdrawal bleeding. Side-effects were mild and in general comparable in the two groups. Both at baseline and during treatment, a higher proportion of women taking GSD/EE complained about breast tenderness. This resulted in more early withdrawals because of breast tenderness in the GSD/EE group. It was concluded that monophasic DSG/EE and GSD/EE are equally effective, have similar cycle control and both are generally well tolerated.

Adolescent↗
PubMed2003

Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up.

Women who seek an abortion are motivated to use contraceptive methods afterwards. Because the return of fertility after abortion is immediate, there is a need for effective and safe contraception promptly after the termination of pregnancy. A randomized trial of Mirena and NovaT intrauterine contraceptive devices inserted at the time of elective termination of pregnancy, duration no more than 12 weeks, is reported here. Women were randomized 2:1 resulting in 305 subjects with Mirena and 133 with NovaT as a segment of a larger study of 3000 women. In the Mirena group, two pregnancies at year 4 resulted in a final gross rate of 0.8 at 5 years, which was significantly (p < 0.0004) lower than the corresponding rate of 9.5 with NovaT. Terminations because of expulsion, bleeding problems, pain, pelvic inflammatory disease and other medical reasons were less common in the Mirena group, but not significantly different. The cumulative expulsion gross rate for NovaT at 5 years was 15.4 and for Mirena it was 10.5. Termination rates because of amenorrhea were low in both groups. It is concluded that both devices were well tolerated. Mirena was more effective and the rate of adverse events was lower than with NovaT. Special attention should be paid to the insertion procedure when carried out at the time of abortion.

Abortion, Induced↗
PubMed1989

Oral contraceptives and vascular disease.

This update on the cardiovascular risks of oral contraceptives unfortunately adds little to our original 1982 review for the following reasons: 1) There are many different formulations on the market, and they keep changing; 2) Women often use different formulations, stopping and starting as well as switching; 3) The statistical power of the studies often does not permit analyses by specific formulations; 4) The required information (brand name) is sometimes not collected or not collected reliably; 5) Apparently few case-control studies are being conducted to address these issues. Data that are available, interpreted cautiously, suggest either a continuance of the previously observed risk or a small to modest diminution with the use of the newer oral contraceptive formulations. The earlier advice to physicians still seems prudent and is briefly stated: 1) Try to avoid prescribing oral contraceptives for women over 35 years of age; 2) Women who smoke cigarettes should avoid using oral contraceptives, and users should not smoke; 3) Prescribe the formulation with the lowest dose and/or potency of estrogen that is effective and that does not cause unacceptable "breakthrough" bleeding; 4) Women with hypertension should be carefully monitored, and women who develop hypertension while on oral contraceptives should be switched to another form of contraception, if possible. Although oral contraceptives are the most effective form of contraception currently widely available, all risks of a contraceptive method must be compared with corresponding measures of effectiveness and with the risks of unwanted pregnancy. In particular, oral contraceptive users can reduce their risk of myocardial infarction by a reduction or elimination of cigarette smoking.

Adult↗
PubMedDate not supplied

[Evaluation of direct microscopic examination, acridine orange staining and culture methods for studies of Trichomonas vaginalis in vaginal discharge specimens].

Trichomonas vaginalis is the causative agent of human trichomoniasis which is a sexually transmitted disease mainly in women. The infection may be asymptomatic or symptomatic such as severe vaginitis and cervicitis. The aim of this study was to compare direct microscopic examination, acridine orange stained examination and culture in Modified Diamond medium, for the detection of T. vaginalis from the vaginal swab samples of 310 patients (age ranges: 17-45 years old) who were complaining from vaginal discharge. Of them 40 (12.9%) samples were found positive with culture, 20 (6.5%) were positive with direct microscopy and 19 (6.1%) were positive with acridine orange staining method. The positive results were obtained in 17 cases by each of the three methods, in 3 cases by direct microscopy and culture, in 2 cases by acridine orange staining and culture, and in 18 cases by culture only. T. vaginalis has been detected in 19.5% of 41 patients with itching, 15.7% of 190 patient with groin pain and 23.2% of 43 patients with cervical erosion, in addition to vaginal discharge, by at least one of the methods. In conditional evaluation, there were no statistically significant differences between T. vaginalis positivity with age groups and the contraceptive methods used. As a result, it was concluded that for the laboratory diagnosis of T. vaginalis, acridine orange staining technique does not have any superiority over direct microscopy. Although direct microscopy is a practical and economical method, it has low sensitivity, so all of the suspected samples which are found negative by this method, should be cultivated for a definite diagnosis.

Acridine Orange↗
PubMed1990

The contraceptive needs of midlife women.

For those women who have not been contraceptively sterilized, midlife is a period of waning fertility. However, the occurrence of anovulatory menstrual cycles is unpredictable. Contraceptive methods also become increasingly contraindicated, both medically and physiologically. This article reviews the physiology of waning fertility and midlife contraceptive options, and discusses implications for helping women meet their contraceptive needs throughout the perimenopausal period.

Adult↗
PubMedDate not supplied

The clinical performance of NORPLANT implants over time: a comparison of two cohorts.

This paper reports on a study that compared the clinical performance of NORPLANT implants in two separate but similar cohorts: 200 NORPLANT users from 1975 through 1978, when the method was first introduced in the clinic, and 212 users in the same population from March 1982 through December 1983. Two different cohorts of Copper T IUD users were included as controls. Continuation rates, at one and two years of use, were significantly higher in the second group of NORPLANT users (88.1 vs. 60.5 and 76.5 vs. 40.8, respectively). Statistically significant differences between the NORPLANT cohorts were observed in discontinuation due to bleeding, amenorrhea, other medical causes, total medical causes, and personal reasons. No differences in clinical performance of the IUD were observed between the two control groups. The higher continuation rate in the second group of implant users is attributed to greater confidence and experience among the clinic staff between 1982 and 1983, and greater knowledge of and familiarity with the method among those in the target population. The study also shows that the first clinical trials of a new contraceptive method may not provide an accurate picture of that method's ultimate performance.

Adult↗
PubMed1984

A family planning risk scoring system for health care providers.

The potential usefulness of a Family Planning Risk Scoring Sheet was studied in 1720 consecutive women who completed a family planning visit and were prescribed a specific contraceptive method. The results demonstrated that many women had relative or absolute contraindications to their prescribed method that were detected later by the Family Planning Risk Scoring Sheet. There were 29 women in the oral contraceptive and intrauterine device groups who had absolute contraindications detected (2.8 and 2.4%, respectively). The nurse practitioners tended to have fewer unrecognized problems in their groups than did the physicians. The usefulness of the Family Planning Risk Scoring Sheet was demonstrated and its routine use in a busy family planning unit is recommended.

Adult↗
PubMedDate not supplied

[New progress in detection of antigens from human ejaculate in relationship with human sterility (extraction with N-cetylpyridinium chloride) (author's transl)].

In an attempt to obtain certain sub-surface spermatozoa antigens, human spermatozoa were treated with N-cetylpyridinium chloride in basic buffer, The extract was further ultrasonated and separated with gel chromatography over a Sephadex--G--100 column. The obtained fractions were lyophilized and tested against human sperm agglutinating and sperm immobilizing sera, in order to detect their antigenicity. Positive and negative controls revealed intensive precipitations and no precipitations respectively. Fraction A4 reacted intensively with sperm immobilizing sera. The final objectives of these sperm antigens solubilization studies are twofold. On the one hand we are looking for a method to lower sperm antibodies titres in sterile females, and on the other hand we are seeking an immunological contraceptive method.

Antigens↗
PubMed2000

Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil.

The objectives of this study were to evaluate the acceptability of the LNG-IUS Mirena(R), when offered as an additional option in a free choice context, and to evaluate the possibility of using this method in women with increased bleeding wanting an IUD and in copper IUD users requesting removal of the device for bleeding problems. A total of 256 women chose Mirena and were accepted into the study during the enrollment period. This represents 23.3% of all new acceptors of contraceptive methods in the clinic during the same period. Discontinuations were fairly evenly distributed among expulsion, bleeding changes, pain, and personal reasons. Bleeding changes were decreased bleeding, oligomenorrhea or amenorrhea. Comparing the performance in the group of women who chose the LNG-IUS as a first option with those having heavy bleeding, the only difference found was a higher expulsion rate in the group with bleeding problems. No pregnancies occurred and continuation rate was slightly over 75% in the total sample and in both groups. The characteristics of the LNG-IUS (Mirena) allow predicting that this method can effectively contribute to the increase in contraceptive options when introduced to family planning programs in Brazil.

Brazil↗