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PubMed1990

Oral contraceptive use and the risk of myocardial infarction.

The relation of oral contraceptive use to the risk of myocardial infarction was assessed in a hospital-based case-control study of women aged 25-64 years conducted from 1985 to 1988 in New England; 910 women with first myocardial infarctions were compared with 1,760 control women. Oral contraceptive use, after discontinuation, was not associated with an increased risk of myocardial infarction, whether use had ceased in the distant past or more recently. The overall relative risk estimate for women who had used oral contraceptives in the past for at least 5 years compared with nonusers was 1.1 (95% confidence interval 0.8-1.5) after allowance for confounding factors. Past use was not associated with risk in any age group, in subgroups of women with predisposing factors, or in women at low risk because of the absence of predisposing factors. The results suggest that long-term oral contraceptive use, after discontinuation, does not influence the risk of myocardial infarction. There were few current users and the results for current use were inconclusive: for premenopausal women who had used oral contraceptives in the previous month relative to those who had not, the age-adjusted relative risk estimate was 1.1 (95% confidence interval 0.4-3.1).

Adult↗
PubMed1991

In utero exposure to steroid contraceptives and survival during infancy.

A cohort study was conducted in Chiang Mai, northern Thailand, in 1,431 children of women who had used the injectable contraceptive Depo-Provera (The Upjohn Company, Kalamazoo, Michigan), 565 children of women who had used oral contraceptives during pregnancy, and a group of 2,307 control infants with no hormonal contraceptive exposures. In follow-up interviews, information was obtained on stillbirths and deaths. Cause of death was ascertained by interview, death certificate, or medical record, and underlying causes of death were ascribed by a panel. The children exposed in utero to Depo-Provera had higher neonatal and infant mortality rates (44.3 and 62.9 per 1,000 live births, respectively) than did the controls (19.8 and 29.1 per 1,000 live births). Mortality in infants exposed in utero to oral contraceptives was intermediate between that in the other two groups. Adjustment by logistic regression showed no significantly increased risk of mortality among infants exposed to oral contraceptives, but the odds ratio for death was significantly increased with Depo-Provera exposures due to accidental pregnancy (odds ratio (OR) = 1.8 (95% confidence interval (Cl) 1.1-3.0) for neonatal deaths; OR = 2.0 (95% Cl 1.3-3.2) for infant deaths). Adjustment for low birth weight reduced the risks, suggesting that low birth weight may act as an intermediate determinant of Depo-Provera-associated mortality. Among the accidental pregnancies with Depo-Provera, there was a relation between shorter injection-to-conception intervals, when maternal blood levels of the drug are high, and an increased risk of mortality. The odds ratios for neonatal mortality were 2.5 (95% Cl 1.1-5.7), 2.1 (95% Cl 1.0-4.6), and 0.9 (95% Cl 0.4-2.4) for injection-to-conception intervals of less than or equal to 4, 5-8, and greater than 9 weeks, respectively. Adjustment for low birth weight reduced these risks. Chi-square tests for trend were highly significant. Similar associations were also observed between Depo-Provera accidental pregnancies and risks of low birth weight. Thus, infants from accidental pregnancies that occur 1-2 months after a 150-mg Depo-Provera injection may be at increased risk for low birth weight and death. However, the attributable risk is low, because such pregnancies are uncommon.

Cause of Death↗
PubMed1994

A case-control study of oral contraceptive use and invasive epithelial ovarian cancer.

The relation of oral contraceptive use to the risk of ovarian cancer was assessed with data collected during 1977-1991 from patients under 65 years of age in hospitals in Boston, New York, Philadelphia, and Baltimore. We compared 441 women with recently diagnosed invasive epithelial ovarian cancer to 2,065 control women. Logistic regression was used to control risk factors for ovarian cancer. The multivariate relative risk estimate decreased with the increasing duration of oral contraceptive use (p < 0.05): the estimate was close to 1.0 for duration categories of less than 3 years; it was reduced for the categories of 3-4 years of use and greater, but it did not decline further as the duration of use increased. For > or = 3 years of use, the estimate was 0.6 (95% confidence interval 0.4-0.8). The inverse association of risk with > or = 3 years of use was consistently present across categories of age, parity, interview year, and geographic area. It was apparent for as long as 15-19 years after cessation. Many different specific oral contraceptive formulations appeared related to a decreased risk; however, data were sparse for the newer types, particularly phasic preparations, and the ability to assess specific preparations in the context of use of multiple preparations was limited. The present data confirm previous reports of an inverse association of ovarian cancer risk with oral contraceptive use of several years in duration. They also suggest that the association may persist for as long as two decades and that it is not confined to any particular type of oral contraceptive formulation.

Adult↗
PubMed1991

Oral contraceptive use and coronary risk factors in women.

The relationship between oral contraceptive use and other coronary artery disease risk factors was examined in 215 nonsmoking women grouped as never, current, or previous users. Current oral contraceptive users had higher triglyceride levels (p less than or equal to 0.001) than other groups, higher systolic blood pressure, and lower plasma HDL-cholesterol levels (p less than or equal to 0.05) than previous users. The effect of oral contraceptive use on plasma triglyceride values persists on multivariate regression analysis independently of age, body mass index, dietary sodium and cholesterol intake, cigarette smoking, and level of physical activity. Oral contraceptive use also has an independent relationship to the plasma total cholesterol/HDL- cholesterol ratio. These findings indicate that oral contraceptive use is adversely associated with plasma lipid and lipoprotein values.

Adult↗
PubMed1996

Blood pressure rhythm and endocrine functions in normotensive women on oral contraceptives.

DESIGN AND METHODS: Twenty-four hour blood pressure profiles were determined by non-invasive ambulatory blood pressure measurements in young normotensive women during the follicular and luteal phases of the menstrual cycle. Forty women participated, 20 of whom were on oral contraceptives (ethinyl-ethylestradiol 0.03 mg + levonorgestrel 0.15 mg) and 20 of whom were age- and weight-matched control individuals not on oral contraceptives. Data on systolic and diastolic blood pressure and heart rate were analyzed in each case by linear and rhythm analysis. Urine was collected day and night on each occasion on which ambulatory blood pressure measurements were recorded. RESULTS AND CONCLUSION: Daytime, night-time, and 24 h mean systolic and diastolic blood pressure and heart rate did not depend on the cycle phase. The nocturnal fall in blood pressure was preserved in both groups and during both phases. Rhythm analysis by partial Fourier series showed that, of 240 individual 24 h blood pressure profiles, only 12 (5%) did not exhibit a significant circadian rhythm. Linear and rhythm analyses revealed that during both phases of the menstrual cycle systolic and diastolic blood pressure were significantly higher throughout the 24 h, especially during the night, in women taking oral contraceptives. During both phases of the menstrual cycle urinary aldosterone excretion was significantly higher in women taking oral contraceptives. This increase could contribute to the night-time blood pressure elevations caused by oral contraceptives. The results suggest a modulating influence of sex steroids on the circadian blood pressure profile even in normotensive healthy volunteers.

Adult↗
PubMed2005

Bleeding patterns after immediate initiation of an oral compared with a vaginal hormonal contraceptive.

OBJECTIVE: This study compared 84-day bleeding patterns after immediate initiation of a triphasic oral contraceptive with a 25-mug daily dose of ethinyl estradiol (E2) compared with the contraceptive vaginal ring, which has a 15-mug daily dose of ethinyl E2. METHODS: This was an open-label controlled trial. We randomly assigned 201 women to immediate start of a contraceptive pill or immediate start of the ring in a 1:1 allocation ratio. Our primary outcome was difference in mean bleeding-spotting days per woman according to treatment assignment. Secondary outcomes were differences in World Health Organization-defined menstrual indices, differences in perceived bleeding changes, and differences in bleeding according to cycle day at the start of method. RESULTS: The mean bleeding-spotting days in the 84-day reference period for all subjects was 19.2 days (17.0 days for ring users and 21.4 days for pill users, mean difference 4.4 days). Using the World Health Organization menstrual indices, the ring users experienced fewer days or episodes of bleeding-spotting and shorter intervals. Among ring users, no baseline characteristics were associated with bleeding outcomes. Older nulliparous pill users, however, reported more bleeding-spotting days. Significantly more ring users reported a decrease in duration of bleeding compared with pill users (P < .01). We found no significant differences in bleeding patterns based on analysis of cycle day at study enrollment. CONCLUSION: Our study shows advantageous bleeding patterns for subjects using the contraceptive vaginal ring. It also confirms our previous findings that immediate start of hormonal contraception is an acceptable alternative to waiting for menses. LEVEL OF EVIDENCE: II-1.

Adult↗
PubMed1993

Effect of nurse-client transaction on female adolescents' oral contraceptive adherence.

An experimental study was conducted to test the effect of a nurse-client transactional intervention (King, 1981) on 51 female adolescents' oral contraceptive adherence. Subjects were randomly assigned to a control or an experimental group. Both groups experienced the clinics' contraceptive teaching. Subjects in the experimental group experienced the transactional intervention. Contraceptive perceptions were measured immediately post-intervention and at the three-month follow-up. Oral contraceptive adherence was measured at the three-month follow-up. Female adolescents who experienced the transactional intervention had greater levels of oral contraceptive adherence than those who had not (F = 4.15, p < .05).

Adolescent↗
PubMedDate not supplied

On the horizon: new options for contraception.

Future contraceptives include refinements of existing contraceptives and totally new methods. New formulations of oral contraceptives, subdermal hormonal implants, injectable hormones, vaginal spermicides, and intrauterine devices (IUDs) are being tested around the world. New methods that are not yet available include the use of vaginal preparations containing sperm-immobilizing agents, gonadotrophin releasing hormone agonists and antagonists, vaccines against ova and sperm, and endogenous hormones. Male contraceptive methods use hormones to suppress testosterone and vaccines to immobilize sperm. The availability of all future contraceptives is dependent on ample funds for research, development, and testing, and such funds are in jeopardy.

Contraception↗
PubMed1999

Contraceptive switching in Bangladesh.

Bangladesh has experienced a substantial decline in fertility that has been achieved by means of a large increase in the use of modern methods of contraception. As contraceptive prevalence increases, aspects of contraceptive-use dynamics, including reasons for discontinuation and behavior after discontinuation, become important influences on fertility. This report uses calendar data from the 1993-94 Bangladesh Demographic and Health Survey to examine contraceptive behavior following discontinuation of modern-method use. The individual-level characteristics found to influence switching behavior include the method used, method-related difficulties with previous contraceptive use, and education. A large amount of unexplained variation in switching rates remains, however, largely at the individual level, but also at the community level for certain types of transition.

Adolescent↗
PubMed1982

The interaction of cigarette smoking, oral contraceptive use, and cardiovascular risk factor variables in children: the Bogalusa Heart Study.

Two separate surveys were conducted in a total biracial population of children ages 8-17 years to determine the effects of cigarette smoking and oral contraceptive use on blood pressure and serum lipids and lipoproteins. Information regarding smoking habits and oral contraceptive use was obtained from detailed questionnaires. For White boys and White and Black girls, a small but statistically significant decrease in diastolic blood pressure levels for cigarette smokers when compared to non-smokers was noted. A significant increase among cigarette smokers in beta-lipoprotein cholesterol, pre-beta-lipoprotein cholesterol, and triglycerides as well as a decrease in alpha-lipoprotein cholesterol was noted, especially for White girls. This change in lipoprotein levels for cigarette smokers was noted in both surveys. Oral contraceptive users had higher total cholesterol and beta-lipoprotein cholesterol and lower alpha-lipoprotein cholesterol than nonusers. After adjusting for oral-contraceptive use, particularly among White girls, cigarette smokers still demonstrated high pre-beta-lipoprotein cholesterol and lower alpha-lipoprotein cholesterol levels than non-smokers. These results suggest that the lipid and lipoprotein response to cigarette smoking and oral contraceptive use is to increase cardiovascular risk.

Adolescent↗
PubMed1993

Contraception during lactation.

The probability of pregnancy is very small during the first 2 months after delivery if the mother breast-feeds. The risk remains small for 6 months if the mother is fully breast-feeding her infant, is still amenorrhoeic and the child does not receive additional food. Under these conditions there is only about a 2% chance of pregnancy. Even full breast-feeding does not inhibit ovarian function after 6 months. Breast-feeding is a very important and efficient contraceptive method in the developing countries, but it is also a useful method in developed countries during the early puerperium. Barrier methods and progestogen-only hormonal methods (pills, implants and injectables) are the primary contraceptive alternatives during breast-feeding. They have no adverse effects on lactation, the condition of the infant or on maternal ovarian function. Sterilization is only a good alternative if the family wants a permanent method of contraception. Careful insertion of an IUD is possible even before the first menstrual period. Puerperal insertion of an IUD needs expertise and training because of the vulnerability of the very soft puerperal uterine wall. Combined oral contraceptives diminish milk production and therefore combined oral contraceptives are not recommended during lactation.

Amenorrhea↗
PubMed1976

Is absorption of oral contraceptives affected by intestinal bypass for obesity?

QUESTION: Please discuss the effectiveness of oral contraceptives in women who have undergone intestinal bypass surgery for obesity. Is there sufficient steroid absorption to prevent pregnancy? ANSWER: I am not aware of any data on the absorption of oral contraceptives in patients with an intestinal bypass. The effectiveness of oral contraceptives depends on the amount of estrogen and progestin administered, and decreasing the dosage to too low a level will increase the likelihood of pregnancy. Since the bypass will substantially reduce the absorptive area, it is quite possible that effective steroid absorption would not be obtained. In the absence of a study demonstrating adequate steroid absorption in this type of patient, in my opinion a contraceptive procedure other than oral contraceptives should be advised.

Contraception↗
PubMed1978

More research on the pill and alternative methods (of contraception).

More research on the pill and alternative methods of contraception was urged by Ralph Nader's Health Research Group (HRG), which also recommended that the Food and Drug Administration develop a new patient package insert for all forms of contraceptives, including nonprescription methods. The group also said the government and drug companies should share the cost of long-term follow-up studies of the effects on health of the pill and other birth control methods. The recommendations followed presentations at an HRG forum from NIH scientists and S. Ramcharan, principal investigator of the Walnut Creek (California) Contraceptive Study supported by the National Institute of Child Health and Human Development. Ramcharan studied 15,000 women over 10 years and found cervical cancer incidence of 173/100,000 person years for women who used the pill for more than 4 years, compared with a rate of 32/100,000 for women who never used the pill. Ramcharan declined to draw any cause-effect conclusions based on these results, stating they were "confounded" by possible differences in sexual activity between the 2 groups. She said a preliminary case comparison study to adjust for these differences "suggests sexual behavior may account for some, but not all," of the 5-fold increase in cervical cancer incidence among pill users. HRG director S. Wolfe said enough data exists to state a relationship between the pill and cervical cancer. "There's no other explanation for the increase," he said, adding that Ramcharan had controlled for the effects of age, education, marital status, number of Papanicolaou smears, religion, number of pregnancies, a history of genital infections, and smoking. Forum participants urged more research on contraceptive devices and drugs now in use, long-term effects of sterilization, value of condoms and spermicides in preventing VD, and development of a patient package insert for all forms of contraception stating the relative effectiveness and risks of each. The group discussed the need for long-term funding of follow-up studies, and suggested that drug companies be required to pay for at least some of the pre- and postmarketing research.

Contraception↗
PubMed2003

New contraceptive choices across reproductive life.

The range of contraceptive options and consumer awareness of new contraceptive methods have both increased significantly over the past 10 years. New methods available in Australia include lower-dose oral contraceptive pills, new oral progestogens, progestogen implants, a progestogen-bearing intrauterine device and polyurethane female condoms. Contraceptive options which may soon be introduced in Australia include novel methods of administering combined (oestrogen-progestogen) contraception, such as dermal patches and vaginal rings.

Adolescent↗
PubMed2005

A quality of care issue: appropriate use and efficacy knowledge of five contraceptive methods: views of men and women living in low socioeconomic settlements of Karachi, Pakistan.

OBJECTIVE: To assess knowledge regarding availability, affordability, appropriate use and efficacy for five non-permanent contraceptive methods. METHODS: Married Muslim women and men (500 each) were randomly selected from two low socioeconomic settlements in Karachi, Pakistan. Interviews to assess their knowledge on a range of contraceptive and abortion themes were conducted. Four hundred men and 357 women were selected from this larger sample based on their knowledge of condoms, withdrawal, oral pills, injectables and IUDs. RESULTS: Nearly half of the sampled men (56%) and women (48%) were contraceptive users. Knowledge regarding contraception, a specific method, its availability and affordability was high. Appropriate use knowledge for condoms was 73% among men (users 78%, non-users 60%; p-value < or = 0.001 ) and 5% among women. Efficacy knowledge was generally poor. CONCLUSIONS: Low knowledge levels regarding appropriate use and efficacy even among contraceptive users suggests, that quality of family planning services should not be limited to service delivery issues but extend to appropriate use and efficacy knowledge levels among clients.

Adult↗
PubMedDate not supplied

Does choice make a difference to contraceptive use? Evidence from east Java.

This study investigates sustained use of contraceptives among women in East Java, Indonesia. Interest is focused on the effect of whether the client's choice of contraceptive method was granted or denied, and the interaction between whether choice was granted or denied and husband-wife concurrence concerning method choice. Data were collected twice in a panel survey. The first round was conducted in family planning clinics among women initiating contraceptive use; the second was a follow-up household survey carried out 12 months later. Whether the user was granted her choice of method was found to be a very important determinant of sustained use of contraceptives. The interaction between whether choice was granted and whether there was husband-wife concurrence on method choice was also important. The highest rate of discontinuation occurred when method choice was denied in the presence of husband-wife agreement on method choice, and the lowest rate occurred when method choice was granted in the presence of such concurrence. The results imply that contraceptive continuation can be enhanced either when family planning workers pay more attention to the stated desires of their clients, or when policy is instituted allowing clients to use their method of choice.

Choice Behavior↗
PubMed1991

Oral contraceptive use and gestational choriocarcinoma.

Substantial advances have occurred in the treatment of gestational trophoblastic disease, but little is known about the etiology. Routine screening of data from a case-control study of several diseases revealed an association between gestational choriocarcinoma and oral contraceptive (OC) use. A detailed analysis of 23 cases of gestational choriocarcinoma, 34 of invasive hydatidiform mole, and 49 of hydatidiform mole, each matched on age and geographic area to 4 controls who had been pregnant at least once, was carried out. Relative to women who had never used oral contraceptives, the estimated relative risk of choriocarcinoma for women who had used oral contraceptives for at least 5 years was 6.0 (95% CI, 1.3 to 28); for invasive mole and hydatidiform mole, the relative risks were elevated but not statistically significant. Oral contraceptive use has also been associated with an increased risk of gestational choriocarcinoma in a recent study conducted in the western U.S. These findings raise the hypothesis that long-term oral contraceptive use, or a correlate of use such as exposure to sexually transmitted infections, increases the risk of one or more of the manifestations of gestational trophoblastic disease.

Adolescent↗
PubMedDate not supplied

Public-sector savings resulting from expenditures for contraceptive services.

Almost one in four U.S. women who use a reversible method of contraception rely on a publicly funded source of care, either a family planning clinic or a private physician reimbursed by Medicaid. According to three scenarios of alternative contraceptive use patterns, if publicly funded services were not available, these women would have between 1.2 million and 2.1 million unintended pregnancies over one year--substantially more than the approximately 400,000 they currently experience. If these women relying on publicly funded services were using no method of contraception, they would be expected to have more than 3.5 million unintended pregnancies in one year. In FY 1987, federal and state governments spent $412 million on contraceptive services for women who otherwise might not have been able to obtain them. If these services had not been available, the additional public costs for medical care, welfare and supplementary nutritional programs during the first two years after a birth or for publicly funded abortions would have totaled $1.2-$2.6 billion. These savings represent an average of $4.40 saved for every dollar of public funds spent to provide contraceptive services.

Adolescent↗