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Biomedical subjects

C L Westhoff

Publications and source records attributed to C L Westhoff.

11 recordsLinked to original sources
PubMed2001

Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives.

This review examines the prevalence, associated morbidity, and treatment of primary dysmenorrhea in adolescent girls. Relevant literature was examined by systematic, evidence-based review using MEDLINE and Cochrane Collaboration databases. Dysmenorrhea is highly prevalent during adolescence. Despite differences in measurement methods, 20%-90% of adolescent girls report dysmenorrhea and about 15% of adolescents describe their dysmenorrhea as severe. During adolescence, dysmenorrhea leads to high rates of school absence and activity nonparticipation. Most adolescents with dysmenorrhea self-medicate with over-the-counter preparations; few consult healthcare providers. Combined oral contraceptives (COC) are an accepted treatment for dysmenorrhea in nonadolescent women. However, data supporting the efficacy of COC is limited. Very small studies show decreased prostaglandin in menstrual fluid associated with high-dose COC use. Larger studies are limited to cross-sectional comparisons showing lower prevalence of dysmenorrhea in low-dose COC users compared to non-COC users. One small, randomized controlled trial including some adolescents demonstrated an improvement in dysmenorrhea with high-dose COC treatment compared to placebo. The efficacy of low-dose COC in the treatment of adolescent dysmenorrhea has yet to be determined. If effective, well-established safety and noncontraceptive health benefits may make COC an ideal treatment for dysmenorrhea in adolescent girls.

Absenteeism↗
PubMed1999

Breast cancer risk: perception versus reality.

Evidence that breast cancer is hormonally mediated has fueled women's concern that use of oral contraceptives (OC) will increase their risk of developing the disease. A recent reanalysis of combined worldwide epidemiologic evidence regarding the relationship between breast cancer risk and use of combination OC provides reassurance that there is little or no association between OC use and breast cancer. Ten or more years after discontinuation of OC use, there is no difference in cumulative risk of breast cancer among OC ever-users and never-users. The risk of breast cancer diagnosis is slightly elevated in current OC users and remains slightly elevated until about 10 years after OC discontinuation. Once recency of use is taken into account, other characteristics have little additional effect. There is no increase in breast cancer risk with increasing dose or duration of OC use and no difference in risk related to type of estrogen or progestin used. Moreover, those breast cancers diagnosed in OC ever-users were found to be significantly more likely to be localized than those diagnosed in same-age never-users.

Adult↗
PubMed1998

Oral contraceptives and thrombosis: an overview of study methods and recent results.

Studies of the associations between oral contraceptives and cardiovascular disease are limited by the extreme rarity of these problems among young women. There are no randomized, controlled trials, and the large, prospective cohort studies only have data regarding older oral contraceptive formulations that are now little used. Historical cohort studies that use record-linkage techniques to analyze data from computerized databases represent a new approach to assessing oral contraceptive use and thrombosis. The largest new studies, with the most sophisticated analyses, use the case-control design. A surprising result of the new studies was a difference in risk of thrombosis according to progestin type. Because these are observational rather than randomized studies, clinical factors influence the choice of oral contraceptive and may bias the study results. Controversy about the surprising results has stimulated additional analyses and critical reviews in an attempt to explain the associations.

Contraceptives, Oral, Hormonal↗
PubMed1991

Vaginal birth after cesarean: a meta-analysis of morbidity and mortality.

The cesarean birth rate has continued to climb despite efforts to counteract it. A major reason for this rise is the practice of elective repeat cesarean. We conducted a meta-analysis that included 31 studies with a total of 11,417 trials of labor to evaluate the association between birth route after a cesarean and morbidity and mortality for the mother and infant. Summary odds ratios were calculated. Maternal febrile morbidity was significantly lower after a trial of labor than after an elective repeat cesarean. The intended birth route made no difference in the rates of uterine dehiscence or rupture. The use of oxytocin, presence of a recurrent indication for the previous cesarean, and presence of an unknown uterine scar were also unassociated with dehiscence or rupture. After excluding antepartum deaths, fetuses weighing less than 750 g, and congenital anomalies incompatible with life, we found no difference in perinatal death rates. The proportion of 5-minute Apgar scores of 6 or lower was higher after a trial of labor, but we were unable to exclude very low birth weight fetuses or those with congenital anomalies from this analysis. Our findings argue for trials of labor for more women after a cesarean birth.

Cesarean Section↗
PubMedDate not supplied

Current assessment of the use of intrauterine devices.

The need for effective, long-term contraception remains a significant issue. Intrauterine devices (IUDs) have evolved to the point where currently available devices are comparable, in safety and efficacy, to oral contraceptives. Due to concerns regarding previous devices, available IUDs remain largely underused by midwives and all other providers of reproductive health care. Recent medical data refute many of the medical-legal misconceptions. Currently available IUDs are safe and effective and represent a suitable contraceptive alternative for the appropriate patient.

Copper↗