Oral contraceptives: women's rights, nurses' responsibilities.
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Contraceptives, Oral↗
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Do anticonvulsants reduce the efficacy of oral contraceptives?
Women in our area with epilepsy who were also taking oral contraceptives were identified. Of 82 patients taking oral contraceptives, 41 had used both anticonvulsants and oral contraceptives for a total of 955 months. Three documented oral contraceptive (pill) failures occurred during this period, whereas the expected number of 0.12 (relative risk, 25; 95% confience interval, 5 to 73). No pill failures were observed in 2,278 months among women with epilepsy who were taking oral contraceptives but who were not taking anticonvulsants at this time. Thus our data support the suggestion that there is an increased rate of pill failure among women taking anticonvulsants. In view of this diminished effectiveness, the advisability of using oral contraceptives rather than one of the other forms of contraception when anticonvulsant medication is being used concurrently may need to be reevaluated.
Anticonvulsants↗
Oral contraceptives and neoplasia of the ovary.
Epidemiologic literature on oral contraceptives in relation to primary ovarian cancer is reviewed. Compared to women who have never used oral contraceptives, women who have ever taken oral contraceptives have about a 30% reduction in risk for epithelial ovarian cancer, and five or more years of use is associated with a 50% reduction in risk. The protective effect of oral contraceptives persists for ten or more years after use is discontinued, and becomes apparent several years after beginning use. Effects of oral contraceptives are similar for malignant and borderline malignant epithelial ovarian cancer. Reduced risks among oral contraceptive users have been observed for all major histologic subtypes of epithelial ovarian cancer, and for women from developed and developing countries. Risk estimates for epithelial ovarian cancer in relation to oral contraceptive use stratified by age at diagnosis or parity are not uniform across studies. No consistent protective effect is apparent for non-epithelial ovarian tumors or benign ovarian tumors, including teratomas and cystadenomas, although limited data are available on the relationship between oral contraceptives and these neoplasms. Several areas for future research are described.
Contraceptives, Oral↗
Contraception and sexuality in an area-specific group of Swedish women 15-34 years of age.
In a community-based study in a Swedish suburban/rural area, all women aged 15-34 years (n = 671) were invited to the local health centre to be examined for chlamydia infection and for an interview. The attenders were asked about contraceptive history, age at first intercourse, number of life-time sexual partners and socioeconomic background. The net attendance was 69%, and contraceptive information on an additional 20% could be gathered through medical records. The average age at first intercourse was around 16 years, and the average number of sexual partners in the age-groups 20-24, 25-30 and 31-34 years was 4.0, 5.6 and 6.1, respectively. Of all women, around 75% had used contraception at first intercourse, and there was no tendency to a changing pattern during the past 20 years studies through the interviews. Combined estrogen-progestagen pills were by far the most used contraceptive method, presently being used by 42% of the contracepting women, followed by condom (23%), IUD (19%) and other hormonal methods (10%). It is concluded that sexual life in Sweden starts earlier than it did 30 years ago, that the number of sexual partners is higher, that most women in the studied group were efficient contraceptors, and that hormonal contraception was by far the most common method.
Adolescent↗
Contraceptive use in Vietnam: the effect of individual and community characteristics.
Data from the 1988 Vietnamese Demographic and Health Survey and the 1990 Vietnam Study of Accessibility of Contraceptives were used in this analysis to determine how selective individual and community characteristics influenced the use of modern methods of contraception in Vietnam. Although there were no significant differences in the use of contraceptives between women with a primary education and those with a higher educational attainment, the illiterate women with no formal education were significantly less likely to use modern methods of contraception. Women living in provinces with high infant mortality rates were significantly less likely to use modern methods of contraception than women in low-infant-mortality provinces. Independent of other individual and community characteristics, there were no significant differences in the use of contraception between urban and rural women.
Adolescent↗
Carbohydrate metabolism of Indian women taking steroid contraceptives.
Three parameters, serum glucose, insulin, and growth hormone levels, were used to measure carbohydrate metabolism in 25 women not using steroid contraceptives, 48 women using combination oral contraceptives, and 27 women using low-dose progestogen oral contraceptives. Women in the combination contraceptives group had significant modifications in the responses of all three parameters studied. A bias toward modification was also seen in the normal tests of the combination group. The low-dose progestogen, megestrol acetate, did not cause similar changes in glucose, insulin, and growth hormone values.
Adult↗
Women's health: potential for better coordination of services.
OBJECTIVE: To determine the proportion of women attending a genitourinary medicine clinic (GUMC) who are in need of contraception and the proportion of women attending a family planning clinic (FPC) who may require screening or treatment for sexually transmitted disease (STD). DESIGN: Cross-sectional survey. SETTING: A large FPC (17,600 attendances by women a year) and a large GUMC (20,060 attendances by women a year) in an inner London health district. SUBJECTS: All clients attending the two clinics in consecutive weeks (356 GUMC and 335 FPC). In addition a non-random cluster of other women attending the same clinics later in the year were interviewed in depth (21 GUMC and 20 FPC). RESULTS: Of women at the GUMC 10.4% (95% CI 7.2-13.6) were at risk of unwanted pregnancy and not using contraception. Women aged under 20 years and women not registered with a general practitioner (GP) were more likely to be in this group. A further 13.8% may have been using contraception unreliably as they were not obtaining contraception from a GP or FPC. Of women at the FPC 1.8% (95% CI 0.3-3.2) complained of symptoms of genitourinary infection. In-depth interviews showed that some women assumed the staff at both clinics would counsel them in all aspects of sexual health. CONCLUSIONS: The opportunities presented at GUMCs to reduce the incidence of unwanted pregnancy and the opportunities presented at FPCs to reduce the incidence and prevalence of STD should not be missed.
Adult↗
Antibacterial activity of human cervical mucus.
The antimicrobial property of human uterine cervical mucus was tested in three groups of women. Healthy women, using no contraception, women using an intrauterine device and women receiving hormonal treatment for contraception. Cervical mucus was taken on the 10th, 14th, 18th and 22nd day of the menstrual cycle. Cervical mucus had a strong inhibitory effect on the growth of Micrococcus lysodeicticus in all three groups. The strength of the inhibitory effect on the other microorganisms were in the following order: Staphylococcus albus, Staphylococcus aureus, Proteus mirabilis, Escherichia coli, Candida albicans, Streptococcus haemolyticus, Streptococcus faecalis. Use of an intrauterine device did not affect the antimicrobial effect of cervical mucus. The use of hormonal contraceptive canceled the antimicrobial effect on the series of microorganisms, with the exception of M. lysodeicticus. The maximum inhibitory effect occurred on the 14th day and declined toward the end of the menstrual cycle.
Adult↗
Breastfeeding among women in the Alabama WIC Program.
Women who participated in the Alabama WIC Program during 1986-88 and ceased breastfeeding during the months of May to August during those years breastfed an average 5.6 months. Slightly fewer than 15 percent of the women who breastfed continued for 12 months or longer; 45 percent continued for six months; 59 percent did so for 4 months; and 21 percent breastfed for one month or less. Breastfeeding duration was related positively and independently to increased maternal age and parity. Younger women were more likely than older women to stop breastfeeding due to perceived insufficient milk, in order to return to work or school, or to use oral contraceptives. Women who ceased breastfeeding at or after one year postpartum tended to be older.
Adolescent↗
Prevalence of bacterial vaginosis and its association with genital infections, inflammation, and contraceptive methods in women attending sexually transmitted disease and primary health clinics.
In an epidemiological survey of 2128 women attending a sexually transmitted diseases clinic for the first time and 200 attending two primary health clinics, 26% and 27% respectively were found to have bacterial vaginosis. The prevalence increased significantly with age, being diagnosed in 22.8% (326/1431) of women aged 14-24 years, and in 33.3% (232/697) of those aged greater than or equal to 25 years. Bacterial vaginosis was associated with gonorrhoea and with chlamydial infection, but was negatively associated with genital papillomavirus infection and yeast infection. Women using barrier contraceptives had a significantly lower prevalence of bacterial vaginosis than those using an intrauterine device or no contraceptive. Women less than or equal to 24 years old using oral contraceptives had a significantly lower prevalence of bacterial vaginosis than those not using contraceptives. Patients without gonorrhoea or chlamydial infection but with vaginal or urethral inflammatory signs had a significantly higher prevalence of bacterial vaginosis than those without inflammatory signs. These findings may have implications regarding complications associated with lower genital tract infections and may strengthen the hypothesis that bacterial vaginosis is a risk factor for pelvic inflammatory disease.
Adolescent↗
Comparison of spontaneous and contraceptive menstrual cycles on a visual discrimination task.
21 women with spontaneous ovulatory menstrual cycles, and 7 women who were regular users of oral contraceptives were investigated over two consecutive menstrual cycles. There two groups were compared on their two flash threshold performance and on mood ratings. It was found that, for women with ovulatory menstrual cycles, visual sensitivity was enhanced during the late follicular phase of the cycle, as ovulation approached. At other phases of the menstrual cycle (paramenstrual and luteal) visual sensitivity remained constant and comparable to the values found in women who were taking to the values found in women who were taking contraceptives. Women who were taking contraceptives showed no significant variation in visual sensitivity with phase of the menstrual cycle. The overall level of anxiety, as reflected by mood ratings was higher in women with spontaneous cycles compared to those taking contraceptives. Neither group, however, showed significant variation in anxiety with phase of the cycle.
Adolescent↗
[Use of contraception among women applying for abortion].
During a period of one year (1988-89), a questionnaire was distributed to women applying for legal abortion at Frederikssund Hospital in Denmark. Two hundred and eight-eight answered the questions about why they had become pregnant. 84% of the women had used contraceptive methods. The remainder included women who regretted a planned pregnancy and women who believed they were infertile. 50% of the women had at least one intercourse without using contraceptives. Women using barrier-methods who forgot the contraceptive once or women who had stopped using the pill were mainly concerned. 23% of the women said they had used contraceptives correctly and consistently. After the abortions 75% intended to use IUD, oral contraceptives or sterilization. Suggestions to reduce the number of unwanted pregnancies are discussed. Eg. spread of the knowledge of postcoital contraception as an extraordinary measure after an unprotected coitus is suggested. This will not replace other contraceptives, but should be used in a emergency.
Abortion Applicants↗
[Migrating clips; a complication following sterilization].
Almost twenty thousand laparoscopic sterilizations are performed in the Netherlands yearly. The use of clips (Filshie clips) is increasingly common and has replaced coagulation in many institutes. In spite of the fact that the method is known to provide a permanent form of contraception, women and gynaecologists are uneasy about the method, as a result of the publicity around some pregnancies having occurred after tubal sterilisation and the ensuing liability suits. The laparoscopic findings in two patients with migrating clips are presented. It is indicated how accuracy and documentation of the laparoscopic sterilisation may be increased. This is of utmost importance in view of the legal consequences of failure.
Adult↗
Conception delay after oral contraceptive use: the effect of estrogen dose.
A significant delay was observed in conception among 248 former oral contraceptive (OC) users compared with women discontinuing other methods of contraception (n = 1,365). The mean time to conception was 5.88 cycles (95% confidence interval [CI] 5.38, 6.38) for former OC users and 3.64 cycles (95% CI 3.49, 3.79) after other contraceptives. Women discontinuing OCs with higher doses of estrogen (greater than or equal to 50 micrograms) had greater conception delays than those on lower estrogen doses who, in turn, had longer delays than other method users. Oral contraceptive use was associated with significant reductions in conception for each of the first six cycles after discontinuation. This study provides further evidence for a direct effect of oral contraception on delayed conception, suggests that the delay lasts longer than previously thought, and finds that the probability of conception after OC discontinuation depends on the estrogen dose of the OC.
Adolescent↗
[Family planning in primary care. One year of experience at a health center].
We report in the present study the results of one year activity of the family planning (FP) clinic of the health center "Huerta de la Reina". We aimed at the characterization of the population on care and its response to the development of the FP program, as a possible basis for future policies. The consulting women is usually aged between 20 and 29 years, is a housewife, and her socioeconomic status is low. She has between one and three children; she had the first one when she was 20-24 years old, and had sexual intercourse for the first time before age 20. As regards birth control, she has usually not adopted any effective method during most of her fertile years; however, she has been taking oral contraceptives for 1-3 years and attends the FP clinic asking for method to secure no further pregnancies. In most cases she is free of medical risks for eventual pregnancies, and she is prescribed oral contraceptives. Women with the highest number of children are those of lower socioeconomic status (p less than 0.05). Likewise, there is a relationship between the educational level and the method used at the time of consultation (p less than 0.05).
Adolescent↗
Contraceptive use-effectiveness and the American adolescent.
Contraceptive use-effectiveness is significantly shaped by the contraceptors' ages, for pregnancy rates are found to be a function of age. Teenagers are more failure prone than older contracepting women, regardless of method. This higher teenage failure rate can indicate clearly the use-effectiveness of various contraceptive methods. Consequently, both user and method (whether modern or traditional) determine outcome levels of contraceptive use-effectiveness.
Abortion, Induced↗
Estrogen profiles of premenopausal women with breast cancer.
Population surveys have demonstrated an inverse relationship between breast cancer incidence rates and the urine "estriol ratio," the concentration of estriol relative to the sum of the concentrations of estrone and estradiol. In this study, the urine estriol ratio was evaluated in premenopausal breast cancer patients and control women from Boston and San Francisco. Although at least 2 years had passed since last use of oral contraceptives, women with a history or oral contraceptive use for 19 months or longer excreted estrogen in low concentrations compared to nonusers and so were excluded. Among the remaining 73 cases and 55 controls, the cases had lower estriol ratios and higher estrone and estradiol levels than did controls. However, these differences, which averaged about 10%, were not statistically significant. Thus the hypothesis that a low estriol ratio is a cause of breast cancer is given only minimal support. Among women in their 40's, the excretion of estrogens is subject to many influences and is difficult to study. The many determinants of estrogen excretion, including age and oral contraceptive use, should be accommodated in the design of future studies of the estriol ratio.
Adult↗
[Contraception, abortion and sexually transmitted diseases].
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Abortion, Induced↗