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PubMed1993

Condom breakage during commercial sex in Chiang Mai, Thailand.

Used condoms in 30 female brothels in Chiang Mai, Thailand, during the period from August 1992 to October 1992 were examined for breakage. Data were also collected by interviewing 326 prostitutes who accounted for 65 percent of the total prostitutes providing condoms. The prostitutes had a mean age of 20.6 +/- 3.2 years. Sixty-one percent had no formal education. The median duration of prostitution was 13 months. The average number of clients per day in the past 24 hours and in the past 3 months was 4.4 +/- 2.5 and 5.5 +/- 2.2, respectively. Eighty-eight percent charged between $2 and less than $8 for their sexual service. All refused to practice oral or anal sex during the past 24 hours. Of 5,559 condoms, 298 were used two at a time and 15 were used three at a time. The breakage rate per act of intercourse was 5.9 percent (95% CI = 5.3, 6.5). The breakage per total condoms examined was 5.7 percent (95% CI = 5.1, 6.3). Breakage relating to manufacturing defect, i.e., pinholes, and that relating to use was 0.8 percent (95% CI = 0.6, 1.0) and 5.0 percent (95% CI = 4.4, 5.6), respectively. The probability of breakage when using two condoms at the same time was 3.4 percent (95% CI = 0.5, 6.3). Most of the breakage occurred at the distal part of the condom. There was no difference between the breakage rates of condoms provided by the brothels and those brought by the client; nor was there any difference between manufacturing defect or use. The breakage rate per client as estimated by prostitutes in the past 24 hours corroborated with that assessed by examination.

Adolescent↗
PubMed2001

Implanon: when is the ideal time to insert?

The single rod implant was introduced to the UK in October 1999. This case illustrates a problem encountered with the timing of its insertion and highlights a possible note of caution.

Adult↗
PubMed2000

Primary pulmonary hypertension.

Primary Pulmonary Hypertension (PPH) is a rare disease that progressively increases pulmonary arterial pressure and pulmonary vascular resistance to the point of right heart failure, in the absence of secondary causes of the disease. The following specific risk factors that can trigger PPH have been identified and examined: appetite depressant drugs, oral contraceptives and hyperuricaemia. Familial PPH transmitted by an incomplete penetrance dominant autosomic mechanism is responsible for about 6% of PPH cases. Recent research groups have identified the gene responsible for familial PPH. Since pulmonary vasoconstriction is the prime cause of PPH, vasodilation of the pulmonary arterial circulation system (using prostacyclin in the form of epoprostenol or iloprost) is the main aim of treatment.

Humans↗
PubMedDate not supplied

Thrombolytic treatment of portal thrombosis.

BACKGROUND/AIMS: The authors present their experience with thrombolytic treatment of "acute" portal thrombosis. METHODOLOGY: Since 1980, portal thrombosis has been diagnosed in 305 patients treated in our Department. Portal thrombosis, mostly chronic, was associated with liver cirrhosis, Budd-Chiari syndrome, inflammatory and malignant liver tumors, as well as hypercoagulation conditions. In half of the patients the etiology of portal thrombosis remained obscure. Herewith, the authors present a retrospective review of 33 cases of rapidly developing portal thrombosis. Abdominal pain, ascites and jaundice were the most frequent initial symptoms. Time interval from the first symptoms appearance to hospitalization ranged from 8 to 60 days. The acute form of portal thrombosis was confirmed by Doppler sonography, spiral computed tomography and angiography. Sixteen female patients were regularly using oral contraceptives, in 8--portal thrombosis coexisted with the Budd-Chiari syndrome, in another 8--with polycythemia or myeloproliferative disorders and in 1 was observed during acute liver failure following paracetamol ingestion. RESULTS: Conservative treatment was unsuccessful in the first 5 cases: all of them died from esophageal variceal bleeding and liver failure. The next 28 patients received fibrinolytic treatment with streptokinase (3 cases) or recombinated tissue plasminogen activator. The results of therapy were evaluated on the basis of clinical picture and Doppler sonography monitoring. Rapid improvement of general condition, with Doppler sonography signs of the portal vein recanalization was noted in 10 patients, in all of whom the history of the disease did not exceed 14 days. In 13 patients with the longer history, partial portal vein occlusion persisted, but restored hepatopetal flow was sufficient to assure normal liver function. In the remaining 5 patients, with the history of the disease lasting longer than 30-40 days, the treatment failed and no clinical or Doppler sonography evidence of restoring of the portal flow were demonstrated. Four patients died: 2 from portal rethrombosis, 1 from liver failure and 1 from cerebral stroke (12, 16 months, 3 months and 4 years after therapy, respectively). Twenty-four patients are alive, the time of follow-up ranging from 9 months to 6 years. In 8 cases, five years after portal system recanalization the first symptoms of portal hypertension occurred. CONCLUSIONS: Thrombolytic treatment of acute portal thrombosis, if administered promptly, appears to be the only way to improve, or even restore, the portal system patency.

Acute Disease↗
PubMed1996

A practical guide to the diagnosis and management of amenorrhoea.

For women of reproductive age, pregnancy and lactation are the two most common physiological causes of amenorrhoea. This article concentrates on pathological causes of amenorrhoea. Primary amenorrhoea refers to the absence of menarche at the age of 16 and secondary amenorrhoea is the cessation of menses for at least 6 months in already cycling women. Amenorrhoea is not a diagnosis but a symptom indicating anatomical, genetic and neuroendocrine abnormalities. It can be determined by two different groups of causes: (a) anatomical defects of the genital organs; (b) endocrine dysfunctions. Both congenital and acquired anomalies in the structure of the uterus and vagina could produce amenorrhoea; nevertheless, in the vast majority of patients, amenorrhoea is related to an ovarian malfunction. Diagnostic work-up includes history, physical examination, laboratory data and imaging. Amenorrhoea resulting from ovarian malfunction is associated with 4 distinct endocrine conditions. Hyperprolactinaemic amenorrhoea is often associated with a pituitary adenoma. Prolactin-lowering drugs, cyclical progestogen and hormone replacement therapy (HRT) are the different choices of treatment for cycle disturbance; a contraceptive pill can be used to ensure contraception, while prolactin-lowering drugs induce fertility in patients who desire pregnancy. Hypogonadotrophic amenorrhoea is frequently associated with stress and nutritional deficiency. If this is the case the patient should simply be counselled. A sequential use of estrogen and progestogen can be suggested to prevent estrogen deficiency or for psychological reasons. If contraception is needed, oral contraception may be the choice for both cycle and fertility control. If the patient desires pregnancy, ovulation may be induced with pulsatile gonadotrophin-releasing hormone (GnRH) in patients with hypothalamic disfunction and with gonadotrophins in patients with pituitary failure. Hypergonadotrophic amenorrhoea is the result of an ovarian failure. There is no curative therapy for these amenorrhoeas. However, a long term hypoestrogenic condition should be treated with estrogen to cure symptoms and to prevent an increased risk of cardiovascular disease and osteoporosis. Normogonadotrophic amenorrhoea is caused by some disturbance in the pattern of pulsatile GnRH secretion. Since these women have some ovarian activity, they are not hypoestrogenic and will bleed in response to progestogen withdrawal. Most of these patients are likely to have polycystic ovarian disease (PCO). Menstrual bleeding can be induced in these women by cyclical progestogen administration or the sequential use of estrogen plus progestogen. Oral contraception is indicated not only in patients who desire to be protected against pregnancy but also in women with acne and hirsutism. These frequently present signs of hyperandrogenism are consistently improved by the ovarian suppression induced by the contraceptive pill. The beneficial effect of the pill can be reinforced by the simultaneous use of antiandrogens. Women with normogonadotrophic amenorrhoea and desiring pregnancy have a less favourable response to all forms of ovulation induction (antiestrogen, GnRH and gonadotrophin preparations.

Adult↗
PubMed1999

International clinical experience with a new low-dose, monophasic oral contraceptive containing levonorgestrel 100 microg and ethinyl estradiol 20 microg.

Manufacturers have steadily been decreasing the amounts of estrogen and progestin in oral contraceptives (OCs) in an effort to enhance safety and tolerability while preserving contraceptive efficacy. A new formulation containing 20 microg ethinyl estradiol (EE) and 100 microg levonorgestrel (LNG)--representing the lowest available contraceptive dose of each hormone--has undergone extensive clinical testing in the United States and Germany. A total of 1590 women in 61 centers received 20 microg EE and 100 microg LNG for 6 cycles. Overall, 4 pregnancies possibly related to treatment failure were reported, reflecting an overall Pearl Index (number of pregnancies per 100 woman-years of treatment) of 0.65 and a failure rate of 0.34%. Cycle control was typical of low-dose OC use. Spotting and breakthrough bleeding occurred most commonly during the earlier cycles in each study. Adverse events were typical of those seen with OC use and led to study discontinuation in 6.6% of the women. Intermenstrual bleeding was the cause for early study withdrawal in 2.6% of women. The study results suggest that the combination of 20 microg EE and 100 microg LNG offers the benefits of low hormone content with good contraceptive efficacy, cycle control, and tolerability.

Adult↗
PubMed1980

Postcoital contraception with an injectable estrogen preparation (Org 369 - 2).

In one-hundred women age 15 to 45, postcoital contraception was attempted with a "morning-after" injection consisting of 12.5 mg estradiol-benzoate and 10 mg of estradiol-phenylpropionate. Plasma estradiol-178, progesterone, LH, FSH and Prl were measured by specific radioimmunoassays and BBT was recorded. In 97.8% the injection was given within 48 hours after unprotected coitus. The medication induced minimal cycle and bleeding pattern changes. The rate of side effects was low. The incidence of pregnancies due to medication failure was 3%. The plasma hormone patterns before and under therapy are demonstrated and drug-induced changes discussed.

Adolescent↗
PubMed1994

Selection bias associated with contraceptive practice in time-to-pregnancy studies.

In studies of subfertility using data on time to pregnancy (the number of noncontracepting menstrual cycles required to conceive), many pregnancies are not included in analyses because time-to-pregnancy data cannot always be collected. Birth control failures are one such group (couples who are using birth control regularly or sporadically, but become pregnant anyway). The more fecund couples are more likely to have birth control failures, and consequently, more likely to be excluded from analyses. If an exposure of interest is associated with irregular use of birth control or with the choice of less effective methods of birth control, the fecundability in the exposed (based on data from couples who can provide adequate time to pregnancy data) will be underestimated. Such bias may account for the findings in the literature showing reduced fecundability among smokers. More generally, when a subset of couples who differ in their fecundability are excluded from analysis, there will be opportunity for selection bias to produce under or overestimation of the strength of an association between an exposure and fecundability. This problem affects both retrospective and prospective studies. Time-to-pregnancy studies need to be designed to minimize this potential bias and to collect data to evaluate it adequately.

Contraception↗
PubMedDate not supplied

The role of steroid contraceptive hormones in the pathogenesis of invasive cervical cancer: a review.

Invasive cervical cancer remains a leading cause of morbidity and mortality, especially among women in the developing world where screening is either deficient or absent. Of all agents linked to the causation of this disease, high-risk human papillomavirus (HPV) appears to be the strongest factor. However, not all women with HPV develop cervical cancer. Steroid contraception has been postulated to be one mechanism whereby HPV exerts its tumorigenic effect on cervical tissue. Steroids are thought to bind to specific DNA sequences within transcriptional regulatory regions on the HPV DNA to either increase or suppress transcription of various genes. Although some earlier studies were reassuring as no increased incidence of cervical cancer was observed, subsequent research has shown a causative association, especially among long-term users. The role of steroids was further enhanced by the discovery of hormone receptors in cervical tissue. Some earlier studies of oral contraceptive steroids found no increased risk, even after controlling for other risk factors, including smoking and number of partners. However, prospective studies have shown a greater progression of dysplasia to carcinoma-in-situ with more than 6 years of oral steroid contraceptive use. Similar findings were also evident from other work, including the Royal College of General Practitioners Oral Contraception Study. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives showed a relative risk of 1.2 for invasive cancer in users of the long-acting progestational contraceptive, depo-medroxyprogesterone acetate. However, in users of more than 5 years duration, an estimate of 2.4 was reported. The upstream regulatory region (URR) of the HPV type 16 viral genome, mediates transcriptional control of the HPV genome and is thought to contain enhancer elements that are activated by steroid hormones. It has been shown that steroid hormones bind to specific glucorticoid-response elements within HPV-DNA. Experimental evidence has revealed that high-risk type HPV 16 are able to stimulate the development of vaginal and cervical squamous cell carcinomas in transgenic mice exposed to slow-release pellets of 17 beta-estradiol in the presence of human keratin-14 promoter. Squamous cell carcinomas developed in a multi-stage pathway only in transgenic mice and not in nontransgenic mice. The E6 oncoprotein of HPV 16 has been shown to bind to the p53 tumor suppressor gene and stimulate its degradation by a ubiquitin-dependent protease system. Steroid hormones are thought to increase the expression of the E6 and E7 HPV 16 oncogenes, which in turn bind to and degrade the p53 gene product, leading to apoptotic failure and carcinogenesis. However, the molecular basis of this remains to be proven.

Contraceptives, Oral, Hormonal↗
PubMed1998

Concerns and cautions about prescribing and deregulating emergency contraception: a qualitative study of GPs using telephone interviews.

OBJECTIVES: We aimed to describe GPs' responses to a clinical scenario of a request for a repeat prescription for hormonal emergency contraception (EC), their views about over-the-counter availability and beliefs about absolute contraindications. DESIGN: We conducted semi-structured tape-recorded telephone interviews with 76 GPs randomly selected from the medical registers of three health authorities which were chosen for high, medium and low prescribing rates for EC. RESULTS: There was a wide variation in the number of times that GPs would be happy to prescribe EC to the same woman in a year. The content of the consultations appeared patchy. While 59 (77.6%) of the GPs said that they would discuss future contraception with the woman, only 16 (21.1%) said they would talk about possible side effects and 28 (36.3%) would discuss the timing of the next menstrual period and the possibility of method failure. Fifty-two of the practices had a family-planning-trained practice nurse, yet only four (7.7%) had arrangements whereby the nurse could provide EC. Unqualified enthusiasm for deregulation was rare. Concerns included that women would lose out on the benefits of the consultation; worries about the safety of the method; that some women might 'abuse' it by using it frequently; and that certain characteristics of the pharmacy might make it an unsuitable setting for provision of EC. CONCLUSIONS: This qualitative telephone survey revealed concerns about repeated use of EC and caution about the prospects of deregulation. Respondents were worried that pharmacists might not be able to address all of the features of the consultation that may be valued, yet in this sample nor do most GPs. Family-planning-trained practice nurses are an under-utilized resource and could act as a halfway house between provision by GPs and deregulation.

Adult↗
PubMed1993

[The intrauterine device: are there still contraindications? A study on 300 Gyne-T 380 users (1987-1992)].

Uterine malformations, history of infection and nulliparity are the classical contraindications to insertion of an IUD, while uterine scars and malpositions constitute relative contraindications. In a context of a marked reduction in the number of IUD users, the author reviews this method based on his personal experience of 300 cases. The indications for this type of contraception can be safely extended, as it constitutes a valuable alternative to other methods.

Adult↗
PubMed1997

The impact of the October 1995 'pill scare' on oral contraceptive use in the United Kingdom: analysis of a general practice automated database.

OBJECTIVES: We aimed to measure the change in prescribing of oral contraceptives after the October 1995 UK 'pill-scare'. DESIGN: Analysis was undertaken of an automated database of 100 general practices (372 doctors) in England, Scotland and Wales which use the AAH Meditel computer system. Analysis involved two stages. First, we reviewed prescribing of oral contraceptives at three time periods: before the scare (18.10.95); the following three months (19.10.95-18.1.96); and 3-6 months post-scare (19.1.96-18.4.96). Second, we examined the cohort of women on the pill at the time of the scare to assess discontinuation rates and pill switches after 6 months. RESULTS: Six months after the scare the proportion of women between 16 and 50 years of age prescribed any contraceptive pill decreased by only 3.5% (95% confidence limits: 2.2%-4.8%). The proportion of pill-users prescribed third generation pills decreased from 53.4% to 18.1%, while prescribing of second generation pills increased from 20.1% to 48.4%. The proportion of women currently on third or second generation pills at the time of the scare, who were no longer prescribed any pill after 6 months, was the same as for the equivalent period in the previous year. CONCLUSIONS: The number of women prescribed the pill did not alter markedly after the pill-scare. The main change was a switch from third to second generation pill types. In any future pill-scare women should be warned about the risk of pill-failure if the correct procedure for switching pills is not followed.

Adolescent↗
PubMed1986

The effect of vaginal administration of low-dose oral contraceptive tablets on human ovulation.

The effect of vaginal administration of a low dose combined oral contraceptive pill containing 0.15 mg levonorgestrel and 0.03 mg ethinyl oestradiol was studied in twenty women for a total of 58 cycles. Ovulation was suppressed in all treatment cycles in women receiving two pills daily. Failure of suppression of ovulation occurred in four out of 26 treatment cycles in women receiving one pill daily. Only seven women complained of side effects; most of the side effects were mild and disappeared gradually within the first treatment cycle. Intermenstrual spotting was present in only one case receiving one pill daily. It is concluded that vaginal administration of low dose combined pills has a good ovulation suppression effect with minimal side effects and with good cycle control.

Administration, Topical↗
PubMed1991

Phase III clinical trial with a new oral contraceptive containing 150 micrograms desogestrel and 20 micrograms ethinylestradiol.

Results are presented of a Phase III international multicentre trial to study the effect of a new low-dose oral contraceptive (OC) containing 20 micrograms ethinylestradiol and 150 micrograms desogestrel (Mercilon) regarding efficacy, cycle control, blood pressure, and acceptability. Altogether 1,684 women from 12 European countries were included in the study. Four pregnancies occurred, 3 of them patient failures, one tablet failure. The overall Pearl Index was 0.20. The frequency of irregular bleeding was comparable to that recorded with other commonly used low-dose OCs. No serious side effects occurred. The incidence of the most frequently reported subjective side effects--headache, nausea and breast tension--was already low after the first cycle of treatment and decreased to below pretreatment levels with continued use. There was a small increase in mean body weight, which was confined essentially to young women. The preparation did not affect the mean systolic or diastolic blood pressure. This new preparation has thus proved to be an effective, safe and well-accepted ultra low-dose oral contraceptive.

Adult↗
PubMed1999

[An introductory clinical trial of three-monthly injectable contraceptive-depot medroxyprogesterone acetate].

OBJECTIVE: To evaluate contraceptive efficacy, continuative rate of use, side effects and acceptability of depot medroxyprogesterone acetate (DMPA) injectable contraception preparation in Chinese women. METHOD: This was an open study. One thousand nine hundred and eighty-five women acquiring contraception received DMPA injection after obtaining informed consent and were followed-up every 3-month up to one year. RESULTS: The total experience accumulated was 1,731.7 women-year with DMPA for 1,985 users. The one year continuation rate was 77.4%. Three subjects became pregnant, the one year accumulative life table failure rate was 0.2%. The accumulative discontinuation rates at one year for other reasons were amenorrhoea (4.8%), bleeding related (13.4%), other medical reasons (2.6%), other personal reasons (2.1%) and lost to follow-up (1.6%). The main complaints were irregular bleeding, amenorrhoea and prolonged bleeding. Lactating women had significantly lower rate of complaint. CONCLUSION: DMPA is a highly effective long-acting contraceptive, it could have good acceptability, especially for lactating women, under the well consultation.

Adolescent↗
PubMed1985

Worldwide method effectiveness of the Today vaginal contraceptive sponge.

The Today vaginal contraceptive sponge is made of polyurethane and contains 1 gram of the spermicide nonoxynol-9. Following preclinical and phase I and II clinical trials, extensive worldwide phase III trials were conducted. These multiclinic trials were conducted according to a common protocol with regularly scheduled follow-up visits and examinations. The cumulative first year method effectiveness rate (life table) was 90 per 100 women. The second year rate was 97 per 100 women. No statistically significant difference was found in method failures between nulliparous and parous women. No serious complications occurred in over 1000 women-years of sponge use.

Adult↗