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PubMed1991

[Effect of HFMC injection of various concentrations on patency of vas deferens and resumption of fertility in rats].

Great efforts have been made to develop non-occlusive or non-ever-lasting-occlusive contraception devices in vas deferens during the recent decade at home and abroad. In our previous studies both in vivo and in vitro, polymer HFMC was found to have a spermicidal effect. In this investigation in SD rats, the relationship between the concentration of HFMC injected into the vas deferens and the resumption of fertility was studied by means of continual observations on the existence of sperms in vaginal smears from the caged female and on pup-birth delaying, so as to determine occlusion of the vas lumen and the effect of HFMC on contraception in male. The histopathological changes in the vas deferens and caudal epididymis of the HFMC-injected male rats were also observed. The results indicated: (1) HFMC in concentration over 7.5% could show temporary contraception effect by its slow releasing of H+; (2) HFMC could induce definite contraception effect which lasted longer as the concentration of HFMC given increased; (3) HFMC had no effect on the descendents in number, mortality, sex ratio, body weight and appearance; (4) the bilateral internal reproductive structures were identified normal after resumption of fertility, but 20% HFMC induced vas deferens occlusion and spermatoceles; (5) moderate concentration of HFMC was considered favorable for reversible intra-vas deferens contraception.

Animals↗
PubMed1995

Subdermal levonorgestrel implants. Three years' experience in Cairo, Egypt.

OBJECTIVE: To assess the efficacy, safety and acceptability of the subdermal levonorgestrel implant (SLI), a new, long-acting, low-dose, progestin-only contraceptive method for women. STUDY DESIGN: A prospective, observational study conducted in the family planning clinic, Department of Obstetrics and Gynecology, Ain Shams University Hospital, Cairo, Egypt, as an advanced phase III clinical trial. RESULTS: This paper describes three years' experience with the SLI in 350 women. The net three-year cumulative pregnancy rate was 0.98%. Menstrual disturbances, ranging from amenorrhea to menorrhagia, were the major side effects and were present in 25% of women during the third year. These disturbances resulted in 28 removals, 19 of which were because of amenorrhea. Medical complications, including headache, hypertension and non-insulin dependent diabetes; desire for pregnancy; and complications at the insertion site (such as infection, spontaneous expulsion of the capsules and arm pain) were the principal reasons for another 57 implant removals. So far, no gynecologic or breast lesions have developed, and weight changes were not noted. The continuation rate after three years was 65.5%. CONCLUSION: The efficacy, safety and acceptability of the implant suggest that it will provide an important addition to the contraceptive armamentarium.

Administration, Cutaneous↗
PubMed1999

Reason, myths and fantasies: preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea.

OBJECTIVE: To evaluate the efficacy and tolerance of the levonorgestrel-releasing intrauterine system (LNG-IUS) among Portuguese women, with particular emphasis on the implications of changes in bleeding pattern. STUDY DESIGN: Forty healthy premenopausal women (average age 42.7 +/- 4.5 years) were recruited in each one of the three Portuguese centers (a total of 120) where the LNG-IUS was used as a contraceptive method during a maximum period of 5 years. All women had previously given their informed consent and were informed about the eventual changes in bleeding pattern. Serum ferritin levels and hemogram measurements were performed before and 1 year after the introduction of the IUS. The results were analyzed by the Student t test (raw data and paired test). RESULTS: Preliminary data showed a continuation rate of 70% with an excellent efficacy rate (no pregnancies) 1 year after the introduction of the IUS. The hypomenorrhea rate was 35% while 12.5% of the women had amenorrhea. The average increase in serum ferritin level was 13 ng/ml and of hemoglobin 0.4 g/dl. The comparisons of hemoglobin results were statistically significant (p = 0.05, t raw data and p = 0.028, t paired test). Most complaints were related to cultural difficulties in accepting the changes in menstrual bleeding pattern. CONCLUSION: In order to minimize and control the most common menstrual bleeding side-effects that occur when using this IUS, as well as to improve the continuation rate, clinicians must make a judicious choice of potential users, owing to the psychological and cultural implications that menstrual bleeding changes can have, mainly among women of low socioeconomic levels. Moreover, non-contraceptive therapeutic benefits should be emphasized.

Adult↗
PubMed2004

New delivery systems in contraception: vaginal rings.

Vaginal rings, made of soft flexible silicone rubber, for delivery of contraceptive hormones are currently gaining clinical acceptance. This method provides extended release of hormones, which are implanted in the core of the ring and slowly disseminate into vaginal tissue. Although formulations and sizes vary, most rings are approximately 58 mm in diameter with a cross-section of 8.4 mm. Depending on the type of ring used, prolonged hormone release may occur from 3 weeks to 1 year. Advantages of the vaginal ring method are that it is user controlled, does not interfere with intercourse, does not require daily intake of a pill, and allows continuous delivery of a low dose of steroids. The Population Council has developed a progesterone-releasing ring, which is currently on the market in Chile and Peru for contraception in breastfeeding women. This ring may be effective for progesterone therapy during in vitro fertilization as well. A contraceptive ring releasing very low doses of the potent progestin Nestorone (Population Council, New York, NY) for 6 to 12 months is also under investigation. The optimal ring formulations, however, contain hormone combinations that provide excellent contraceptive efficacy with few side effects and good control of menstrual bleeding. The Food and Drug Administration has recently approved Organon's monthly ring releasing etonogestrel and ethinyl estradiol. The Population Council is developing a 1-year contraceptive ring releasing low doses of Nestorone and ethinyl estradiol. Combination rings are associated with very low pregnancy rates and side effects consistent with those of oral contraceptives.

Contraceptive Devices, Female↗
PubMed1987

Clinical performance of a levonorgestrel-releasing intracervical contraceptive device during the first year of use.

One-hundred-and-ninety-eight women used a new type of levonorgestrel-releasing intracervical contraceptive device (LNG-ICD) designed to release 20 micrograms levonorgestrel/day. The insertion took place within 7 days of menstruation. Clinical performance during the first year of LNG-ICD use was evaluated. Seven pregnancies occurred during the study period; one in an epileptic woman using carbamazepine, 300 mg/day, and the other six in healthy women after unnoticed expulsion of the ICD. Sixteen spontaneous expulsions occurred. The most common reasons for removal were side effects, including bleeding disturbances, hormonal side effects and other medical reasons. The continuation rate was 72.6 per cent after one year. Three pelvic infections were observed.

Adult↗
PubMed2001

Temporary discontinuation: a compliance issue in injectable users.

This study examined compliance in injectable users and followed women post-discontinuation to document their contraceptive practices. A cohort of 189 predominantly new users of depot-medroxyprogesterone acetate and norethisterone oenanthate were recruited and followed for 2 years regardless of whether or not they continued the method. Continuation rates were 42% at 1 year and 21% at 2 years. Of the 78 women who discontinued the method, 31 reported that they were "taking a break." For 20 of these women, this break (nonuse segment) occurred within the 2-year period, and 15 of them returned to the injection before the end of study period. The other five switched methods after the nonuse segment. The mean length of the nonuse segment was 7 months (range 2-13 months). In all 20 women, no other contraceptive method was used, they remained sexually active, and started the break within 6 months of commencing use of the injectable. In addition, 11 women were in a self-reported nonuse segment at the end of the study and stated their intention to return to the method at a later date. Menstrual disturbances were cited as the main reason for the break. Strengthened counseling at method acceptance was identified as a strategy to decrease the frequency of breaks in injectable method use.

Adult↗
PubMed1991

Norplant: a new contraceptive.

Norplant is a new method of birth control recently approved for use in the United States. It consists of flexible Silastic capsules filled with levonorgestrel, which are inserted subdermally on the inside of the upper arm. Norplant provides a near steady-state level of levonorgestrel for five years. It has been used in many European, South American and Asian countries, and in clinical studies in the United States. Norplant has an excellent continuation rate by users, and it is highly effective. It causes minimal adverse effects other than irregular menstrual patterns.

Anesthesia, Local↗
PubMedDate not supplied

Future of emergency contraception lies in pharmacists' hands.

OBJECTIVE: To increase community pharmacists' awareness about issues related to the provision of emergency contraception (EC) to women by describing pharmacist outreach and training programs and discussing pharmacy access and stocking issues, California's EC Pharmacy Program, methods for raising pharmacists' awareness, and professional development opportunities. SUMMARY: EC is both safe and effective in reducing the risk of unintended pregnancy after unprotected intercourse, yet awareness of and demand for the medication has not been high, and it often is not stocked in pharmacies. Various advocacy organizations have engaged in educating the public and physicians about EC, but relatively little attention and few resources have been targeted to ensure that the pharmacy community is aware of and educated about EC. Increased visibility and access to EC in the several states that allow pharmacists to provide EC directly to women have resulted from the active participation and leadership of pharmacists. In these states, women are showing interest in and receptivity to reproductive health services provided by pharmacists. In California, some 3000 pharmacists statewide have completed training, and in 2004 they provided EC directly to approximately 175,000 women. Pharmacists who provide EC overwhelmingly (91%) report that they do so because they see it as an important community service, and many (57%) recognize the opportunity for professional development. CONCLUSION: Pharmacists are uniquely positioned to improve access to EC, and leadership within the pharmacy community can facilitate efforts to improve access. Increased education and training of pharmacists about EC--such as continuing education programs available online at www.pharmacyaccess. learnsomething.com--are critical to ensure not only that EC is available in pharmacies but also that pharmacists are engaged in meeting the reproductive health needs of women. Increased access to EC can expand pharmacists' role in health care provision. State-specific information about EC pharmacy access initiatives is available on the Web at www.GO2EC.org.

California↗
PubMedDate not supplied

Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania.

This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es Salaam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life.) A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies--precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics.

Abortion, Illegal↗
PubMed1991

Illegal induced abortion--a continuing problem in Nigeria.

Illegal induced abortion is still a major contributing factor to maternal morbidity and mortality in Nigeria. It is very common among school girls who are still ignorant of contraception. A good percentage of the abortions are procured by nonmedically qualified personnel. The author has not only advocated the introduction of sex education into the school curriculum as a redeeming measure, but also the provision of contraception in schools and the liberalization of the abortion law.

Abortion, Illegal↗
PubMed2000

Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18-31 years of age.

Women who exercise during their second and third decades may increase their peak bone mass and lower their eventual risk for postmenopausal fracture. However, the effects of exercise in younger women can be modulated by the use of oral contraceptives, which may prevent the normal accretion of bone mass that would otherwise occur. We hypothesized that exercise intervention in young adult women would significantly increase both bone mass and the bending rigidity of the femoral neck. We further hypothesized that exercise intervention in the presence of oral contraceptive use would have a negative effect on bone mass and bending rigidity. Women 18-31 years of age (n = 123) were classified by oral contraceptive use (OC, NOC) and age (18-23, 24-31 years), and then randomized into exercise or nonexercise groups. The exercise protocol consisted of three sessions/week of aerobic and nonaerobic exercises, and continued for 2 years. Each 6 months, the femoral neck of each subject was scanned using a Lunar dual-energy X-ray absorptiometry (DEXA) scanner, and bone mineral content, density and geometric information were used to calculate estimated stresses and bending rigidity at the hip. Percent changes from baseline were analyzed using two-way analysis of variance (ANOVA) at 6, 12, 18, and 24 months. Women who neither exercised nor took oral contraceptives (NE/NOC) had the greatest percentage increases in cross-sectional area (4.98 +/- 2.29%), cross-sectional moment of inertia (9.45 +/- 2.37%), total bone mineral density (2.07 +/- 2.09%), fracture index (8.03 +/- 2.03%), and safety factor (20.03 +/- 5.79%) over the 24 month exercise program. Women who exercised and did not take oral contraceptives (E/NOC) declined on most variables related to femoral strength and bone mass, whereas those women who took oral contraceptives were usually intermediate between NE/NOC and E/NOC, whether they exercised or not. These data show that either exercise or OC use is associated with a suppression of the normal increase in bone mass and mechanical strength in the femoral neck in women 18-31 years old, but the combination of exercise and OC use appears to have a less suppressive effect.

Absorptiometry, Photon↗
PubMed2005

Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception.

CONTEXT: Legislation has been proposed that would mandate parental notification for adolescents younger than 18 years (minors) obtaining prescription contraception from federally funded family planning clinics. OBJECTIVE: To determine the extent to which parents are currently aware that their teenage daughters are accessing reproductive health services and how minors would react in the face of mandated parental involvement laws for prescription birth control. DESIGN, SETTING, AND PARTICIPANTS: A total of 1526 female adolescents younger than 18 years seeking reproductive health services at a national sample of 79 family planning clinics were surveyed between May 2003 and February 2004. MAIN OUTCOME MEASURES: Proportions of minor females who reported that a parent or guardian was aware that they were at the family planning clinic and, under conditions of mandated parental involvement, proportions of minors who would access prescription contraceptives at family planning clinics or engage in unsafe sex. RESULTS: Sixty percent of minors reported that a parent or guardian knew they were accessing sexual health services at the clinic. Fifty-nine percent of all adolescents would use the clinic for prescription contraception even if parental notification were mandated. This response was less common (29.5%) among adolescents whose parents were unaware of their clinic visits and more common (79%) among those whose parents were aware. Many adolescents gave more than 1 response to mandated parental involvement. Forty-six percent would use an over-the-counter method, and 18% would go to a private physician. Seven percent said that they would stop having sex as one response, but only 1% indicated this would be their only reaction. One in 5 adolescents would use no contraception or rely on withdrawal as one response to mandated notification. CONCLUSIONS: Most minor adolescent females seeking family planning services report that their parents are aware of their use of services. Most would continue to use clinic services if parental notification were mandated. However, mandated parental notification laws would likely increase risky or unsafe sexual behavior and, in turn, the incidence of adolescent pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed1998

Chemical interference with sperm metabolic pathways.

During the 1960s, the quest for a simple non-steroidal chemical possessing male antifertility activity culminated with the discovery of the activity of alpha-chlorohydrin in 1970. Investigations into the mechanism of action of this compound revealed that it was affecting the glycolytic pathway within mature spermatozoa through its conversion to an inhibitory metabolite. Use of these and other simple chemical inhibitors has subsequently led to a clearer understanding of the metabolic pathways involved in the generation of ATP, which is necessary for sperm motility. Mature boar spermatozoa from the cauda epididymidis are almost totally reliant on the glycolytic pathway, not necessarily for the immediate generation of ATP, but for the ultimate production of lactate, which appears to be the sole substrate used for the mitochondrial production of ATP. The only exogenous substrates that support lactate production in vitro are fructose, glucose, glycerol and glycerol 3-phosphate and when these substrates are plentiful, there is evidence that compounds can be retained as such or as intermediates of the glycolytic pathway. When exogenous substrates are limited, the cells have the capability to mobilize endogenous compounds and to maintain the continuous synthesis of ATP.

Adenosine Triphosphate↗
PubMedDate not supplied

Planning status of marital births, 1975-1976.

Fertility rates in the United States continued to decline between the early and mid-1970s as they had during the previous decade. This change was part of a larger trend which was associated with widespread adoption of effective contraception and with the diminishing of many long-standing social and economic differentials in fertility. 1 This article focuses on the fertility of married women in the 1975-1976 period, as measured by Cycle II of the National Survey of Family Growth (the 1976 period, NSFG) conducted by the national Center for Health Statistics of the U.S. Department of Health and Human Services (DHHS). Data from this survey indicate a continued increase in the proportion of marital births that were reported as planned. Despite a rapid decline in fertility and improvement in birth planning, there were still distinct differences in the mid-1970s in fertility and in the control of recent fertility.

Adolescent↗
PubMed1993

Combined oral contraceptives: risks and benefits.

By the age of 25 years, more than 95% of sexually active women have been exposed to combined oral contraceptives (COCs). Any effects associated with their use, therefore, carry important public health implications. COCs exert major protective effects against ovarian and endometrial cancer, which continue many years after cessation of use. COCs increase the risk of cardiovascular disease, but this risk is probably confined to current users. It is unclear whether lower dose preparations carry less risk. The precise relationship between COC use and risk of breast and cervical cancer is uncertain, although it is clear that COCs do not influence the overall risk of breast cancer. The risk-benefit equation for COC use depends crucially on assumptions about the true breast cancer risk. If there is no increased risk then COCs have a net beneficial effect on mortality, mainly due to the saving in ovarian cancer deaths. However, with more pessimistic assumptions about breast cancer, COCs have an adverse effect. The risk-benefit equation will vary for individual women. Most research has related to the developed world and extrapolation of findings to developing countries is inappropriate.

Adolescent↗
PubMed2005

Family planning practices among currently married women in Khairpur District, Sindh, Pakistan.

OBJECTIVE: To determine the prevalence and sociodemographic factors associated with family planning practices among currently married women in Khairpur District, Sindh, Pakistan. DESIGN: Cross-sectional community-based survey. PLACE AND DURATION OF STUDY: From May to June 2000 in Khairpur District, Sindh. SUBJECTS AND METHODS: A pre-tested structured questionnaire was used to interview 300 subjects from the study area. Stratified cluster sampling was done to collect information on knowledge and use of family planning methods and other sociodemographic factors from the respondents. RESULTS: In this series 62% of the women were illiterate. Nearly 45% of the women were in the age group of 25-34 years. Exposure to family planning messages was greater by television (66%) than by radio (55%). The prevalence of family planning methods among married women was 27%. Oral contraceptive pills were the predominant method used (32%). Regarding sociodemographic factors, more than four living children, exposure to family planning messages on TV, and husband's approval were the main factors associated with the use of family planning methods. CONCLUSION: Prevalence of family planning is still low in upper Sindh area. In addition to continued use of mass media (television and radio), involvement of males should be incorporated in future family planning initiatives.

Adolescent↗
PubMed2005

Over-the-counter availability of Plan B emergency contraception: further discussion and commentary.

The controversy surrounding the potential switch of the Plan B emergency contraceptive therapy from prescription to over-the-counter status has been unprecedented. Regulatory, professional, and societal aspects of this issue have been discussed recently and will no doubt continue to be debated. In this editorial, members of the Medicine, Law, and Ethics panel of The Annals of Pharmacotherapy's Editorial Board offer a sampling of viewpoints touching on varying aspects of the controversy. Readers may wish to consider the ramifications of their professional decisions in this and similar situations in advance of having to make such decisions.

Contraceptives, Postcoital↗
PubMed1976

Follow-up study of oral contraceptive acceptors in Howrah District in India.

In the Howrah District in India, three clinics--one in each of the urban, slum, and rural areas of the city--were initiated by the Humanity Association of Howrah in November of 1968 to supply oral contraceptives (OCs) to women from 15 to 45 years of age. The project was discontinued in September, 1972. Of the 1700 patients still active when the project ended, 1527 were contacted for the follow-up survey. Findings indicate that most women in this district were satisfied with OCs and would continue to use them if they were available. In corroboration of this, it was found that 43% of the women had used OC'S obtained from other sources after the project was discontinued. While 35.5% of the women who used no contraceptive method after project ended reported becoming pregnant or suspected that they were pregnant at the time of the interview, only 4.2% of those who reported using some form of contraception reported pregnancy or suspected pregnancy. The demographic impact of the project will be evaluated on the basis of data to be obtained in a subsequent survey of the same communities.

Abortion, Induced↗