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At least 19 recordsLinked to original sources
PubMed1996

[Desogestrel contraceptives: the perfect pill for lipids?].

OBJECTIVES: A review of clinical trials of changes in lipoprotein composition in women receiving oral contraceptives containing desogestrel; a comparison of the trials' findings and a discussion of their clinical significance. METHODOLOGY: Using MEDLINE, we searched for articles published in English and French between 1982 and 1993 and reviewed the references they contained. The criteria for inclusion were: the basic design of the study (randomised prospective or with crossover), the age of the women, the use of a monophasic oral contraceptive containing desogestrel, the length of the trial (minimum 3 months), and comparison of patients' lipoprotein composition before and after treatment. RESULTS: Among the 17 articles identified, eight studies that met the criteria were reviewed. Their findings all pointed in the same general direction, but contained several major biases, making interpretation difficult. Overall, oral contraceptives containing desogestrel tended to have a beneficial effect; however, there was no significant effect on total cholesterol, a slight tendency toward an increase in HDL, and a slight tendency toward a decrease in LDL. An increase in TG was the only constant and significant change. CONCLUSION: Oral contraceptives containing desogestrel appear to have a favourable effect on HDL and LDL; however, their effect is not significant. It is, therefore, too early to conclude that they offer protection against coronary heart disease.

Bias↗
PubMed1992

Long-term profile of a new progestin.

Major complications attributable to oral contraceptives (OCs) may occur in the circulatory system. The inherent risk factors, such as race and family history, are unchangeable. Others may be altered by patient counseling and subsequent adjustment of certain behaviors. Hypercoagulability is estrogen dose related. Older, high-dose-estrogen OC users were at 40% increased risk of mortality from thromboembolic phenomena. Reduction in estrogen content has unmasked the androgenic effects of some synthetic progestogens. These effects may include progression of atherogenesis, effected through changes in cholesterol and lipoproteins; reduction in sex hormone binding globulin (SHBG), which enhances the androgenic effect; and changes in carbohydrate metabolism. This review of clinical findings is based on four studies; three had prospective cohort designs, and one was a prospective randomized comparison of a norgestimate-containing OC with a norgestrel-containing one. Numbers of subjects ranged from 20 to 59,701; the largest evaluated 343,348 cycles of treatment. Study intervals were from 4 to 24 months. The findings reported here are from the individual studies. 1. The normal value for cholesterol is less than 200 mg/dL. Of 2,197 women who met this cut-off point, 95% remained below it after 6 months of treatment. Of 756 who initially exceeded this value, 25% were below after 6 months and 75% remained above it. All studies to date have demonstrated that norgestimate produces consistent and significant elevations in high-density lipoprotein levels and variable change in low-density lipoproteins. A similar effect was noted on serum triglyceride values.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation↗
PubMed1981

Experiences with a tampon-spermicide device.

A tampon applicator is described in which a spermicidal solution is stored in the plunger and released into a disposable tampon just prior to insertion of the tampon. The experiences of 26 volunteers who used the device at the time of coitus suggest that the method is both acceptable and feasible, although four of the ten subjects attempting tampon removal by themselves experienced some difficulty. Postcoital studies of the cervical mucus near the time of ovulation were conducted on 16 subjects and no motile spermatozoa were found. This suggests a high degree of theoretical effectiveness.

Contraceptive Devices, Female↗
PubMed1994

Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world's experiences.

The postpartum period is an ideal time to begin contraception, as women are more highly motivated to adopt contraception at this time and it is convenient for both patients and service providers. For intrauterine device (IUD) contraception, this period offers other advantages, such as ease of insertion and minimal adverse impacts on breastfeeding. Among early studies, most postpartum insertions were performed anywhere from a few hours to seven days or more after delivery, and retention of the IUD in the uterus was poor. Since the 1970s, immediate postplacental insertion (IPPI), i.e., IUD insertion performed within 10 minutes after placental delivery, has been advocated, and fairly, low expulsion rates have been reported. Up to now, IPPI has not been widely accepted in clinics because its expulsion rate still appears to be higher than that of interval insertion. In order to further study IPPI and perfect this contraceptive technique, it is essential to comprehensively review IPPI results and compare the Chinese experience with that of the rest of the world.

China↗
PubMed2000

The potential role of contraception in reducing abortion.

This study examines the potential role of further increases in contraceptive prevalence and effectiveness in reducing abortion rates. The model used in this analysis links the abortion rate to its direct determinants, including couples' reproductive preferences, the prevalence and effectiveness of contraceptive practice to implement these preferences, and the probability of undergoing an abortion to avoid an unintended birth when a contraceptive fails or is not used. An assessment of the tradeoff between contraception and abortion yields estimates of the decline in the total abortion rate that would result from an illustrative increase of 10 percentage points in prevalence. This effect varies among societies, primarily because the tendency to obtain an abortion after an unintended pregnancy varies. For example, in a population with an abortion probability of 0.5, a 10 percentage-point increase in prevalence would avert approximately 0.45 abortions per woman, assuming contraception is 95 percent effective. If all unintended pregnancies were aborted, this effect would be three times larger. Eliminating all unintended pregnancies and subsequent abortions would require a rise in contraceptive prevalence to the level at which all fecund women who do not wish to become pregnant practice contraception that is 100 percent effective. A procedure is provided for estimating this "perfect" level of contraceptive prevalence.

Abortion, Induced↗
PubMed2001

[Voluntary interruption of pregnancy: comparative study between 1982 and 1996 in the main center of Côte d'Or. Study of women having repeat voluntary interruption of pregnancy].

UNLABELLED: Since the egal use of induced abortion (1975), all the studies have shown a relative stability of the abortion rate related to delivery. Otherwise since 1985 we have noted an increase of repeat abortions. OBJECTIVE: We compared in same center two populations of aborters with a fifteen year's interval. Then we analysed the psyco-social conditions of patients who had more than one abortion (R). METHODS: It was a comparative study between 1982 and 1996 in the main center of Côte d'Or (France). A representative sample of patients coming for abortion was retrospectively compared, (348 for 1982 and 343 for 1996). RESULTS: There were more not married patients (p = 0.0003), more nulliparous women (p = 0.0017) and more nulligestities' one (p = 0.03) in 1996 than 1982. The interval between the previous pregnancy and in 1996 (p = 0.03). Repeat abortions (R) represented 15.8% in 1982 and 21.6% in 1996. Women who have had two or more abortions had increased significantly between 1982 (1.4%) and 1996 (5.2%) (p = 0.013). The R patients had more living children than patients who accessed for the first time at abortion (noR) in the two periods (p = 0.0003) and there were more women less thirty years old in the R group in 1996 than in 1992 (p < 0.05). The R mean age for the first abortion and for the first pregnancy were lower than the noR group in 1996: respectively 23.7 years versus 27.4% years (p = 0.00009) and 20.8 years versus 23.7 years (p = 0.0001). There were no significant difference between R and noR groups with regards of contraceptive failing, the reasons of abortion and the socio-professional categories. CONCLUSIONS: There were no difference in the number of abortion between 1982 and 1996. However we noted an increase of repeat abortion. This group was characterised by great socio-economic problems, unstable couples and ambivalence with wish of pregnancy and no wish of children. It seemed exist a real psycho-social precariousness. Actually, this population was perfectly aware of contraceptive methods.

Abortion, Induced↗
PubMed2001

[Specific experiences in females receiving an organ transplant].

CONTRACEPTION: As in women who do not have a heart transplant, contraception is never perfect, irrespective of the method, intrauterine device (risk of infection), estrogens, progestogens. PREGNANCY: Besides the general effects also observed in all pregnant women, pregnancy in the heart transplant recipient also carries the risk of cytomegalovirus infection and preeclampsia. IMMUNOSUPPRESSION: Cyclosporin or azathioprine are generally indicated, depending on the individual risks. PREVENTION OF BONE DISEASE: Advice concerning diet and lifestyle should be given prior to transplantation in order to reduce the risk of osteoporosis and osteomalacia. Bone density, particularly of the femoral neck, is essential for screening. A rheumatology examination is also quite useful. CANCER: De novo cancer is favored by the use of antilymphocyte inductors. Most are breast cancers (mean delay 60 months); other gynecology cancers develop after about 50 months. The risk of recurrence in patients who had breast cancer is highest during the first 2 years. The risk of recurrent uterine cancer is constantly observed.

Contraception↗
PubMed2002

Assessment of compliance with a weekly contraceptive patch (Ortho Evra/Evra) among North American women.

OBJECTIVE: To determine compliance with the contraceptive patch (Ortho Evra/Evra) overall and by age among women in North America and to compare rates of perfect use with those of an established oral contraceptive. DESIGN: Data were pooled for three contraceptive studies in which women participated for up to 13 cycles; the subset of centers in North America was used in this analysis. SETTING: 76 North American centers. PATIENT(S): Healthy women 18-45 years of age. INTERVENTION(S): In all studies, the patch regimen was three consecutive 7-day patches (21 days) followed by 1 patch-free week per cycle. MAIN OUTCOME MEASURE(S): Perfect use for the patch or oral contraceptive, defined as 21 consecutive days of drug-taking followed by a 7-day drug-free period; for contraceptive patch users, no patch could be worn for more than 7 days. Oral contraceptives were used according to package labeling. RESULTS: For all contraceptive patch users in North America (n = 1,785), perfect use was consistent across age groups. The percentage of cycles with perfect use of the patch ranged within age groups from 88.1% to 91.0%. In the comparative study conducted only in North America, perfect use was also consistent across age groups for the patch (n = 812), but rates of perfect use for the oral contraceptive (n = 605) differed significantly by age. CONCLUSION(S): Age did not affect compliance with the patch among all North American women studied. In a comparative study of women at North American centers, compliance with the weekly contraceptive patch was significantly better than with an established oral contraceptive. The contraceptive patch is uniformly easy to use across all ages.

Administration, Cutaneous↗
PubMedDate not supplied

Are there unmet family planning needs in Europe?

CONTEXT: The measurement of unmet need for family planning--the discrepancy between individuals' sexual and contraceptive behavior and their stated fertility preferences--has generally focused on developing countries. There has so far been little effort to measure how low unmet family planning needs can go in more developed countries, where contraceptive practice is supposedly (nearly) perfect. METHODS: Data were taken from Fertility and Family Surveys (FFS) conducted in recent years in selected member states of the United Nations Economic Commission for Europe, and minimum and maximum estimates of unmet need were calculated for 10 countries with the requisite data. RESULTS: The proportion of individuals with an unmet need for family planning (i.e., who have a current unwanted pregnancy or who are fecund, are sexually active, want no more births but are not using contraceptives) is as low as 3% in two European countries and below 10% in most. However, levels of unmet need in countries with economies in transition (13% in Latvia and Lithuania and 23% in Bulgaria) surpass some of the lowest levels observed for developing countries. Considerable within-country variations are seen. For instance, unmet need is more prominent among men than among women in seven of the nine countries for which there are data. Moreover, unmet need increases with family size and with age, suggesting an unmet need for limiting rather than for spacing births. In all of the countries except Hungary, unmet need is higher among those in marital unions than among those in less formal relationships. Level of education is another important dimension of unmet need, with less-educated respondents having the highest level of unmet need in nine of the 10 countries. Multivariate analyses confirm most of these results. Moreover, there is a clear association between unmet need and abortion ratios: Where levels of unmet need are high, the number of abortions per 100 live births is also relatively high. CONCLUSIONS: Data on unmet need, supplemented with information on induced abortion and related issues, could provide countries in Europe with useful inputs for formulating and implementing responsive reproductive health policies and programs.

Contraception Behavior↗
PubMedDate not supplied

Contraceptive failure in the United States: an update.

This report provides an update of the authors' previous estimates of first-year probabilities of contraceptive failure for all methods of contraception. Estimates are provided of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct use at every act of intercourse). The difference between these two probabilities provides a measure of how forgiving of imperfect use each method is. These revisions are prompted by recent studies that provide the first estimates of failure during perfect use for periodic abstinence and the cervical cap, by more complete evaluations of implants, and by the appearance of the Copper T 380A and disappearance of other IUDs from the US market. Also provided is a more complete explanation of how the previous estimate of the probability of becoming pregnant while relying solely on chance should be interpreted, and this estimate is revised slightly downward.

Clinical Trials as Topic↗
PubMed1999

Failure rates among perfect users and during perfect use: a distinction that matters.

To make an informed decision when choosing a contraceptive, women and couples need to know how effective different methods are when used perfectly, where perfect use is defined as following the directions for use. In this article, we show that unbiased estimates of pregnancy rates during perfect use can be guaranteed only if information on consistency and correctness of use is available for each menstrual cycle. The estimated probability of pregnancy during a year of perfect use among the subset of women who always used a method perfectly will be biased upward.

Contraception Behavior↗
PubMed1991

Further analysis of contraceptive failure of the ovulation method.

Reanalysis of data on the ovulation method of natural family planning collected by the World Health Organization yields the following conclusions. The method is effective during perfect (correct and consistent) use, with a first-year probability of failure of 3.4%. However, it is extremely unforgiving of imperfect use, with a first-year probability of failure of 84.2% if the method is not used correctly. During the initial year, 87% of the cycles were characterized by perfect use. Nevertheless, the 13% of cycles characterized by imperfect use had a tremendous impact on the overall failure rate. During the first year of typical use 22.5% of the women in the clinical trial became accidentally pregnant.

Adult↗