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PubMed1998

Compliance and use behaviour, an issue in injectable as well as oral contraceptive use? A study of injectable and oral contraceptive use in Johannesburg.

This study examines the compliance, use behaviour and knowledge of method of women using injectable and oral contraceptives in two clinic sites in the Johannesburg area, South Africa. An interviewer administered questionnaire was used to collect information in the clients' home language. A total of 400 women were interviewed in the clinics. The mean age of clients was 26.2 years (range 13 to 43 years). Of the clients not wanting to get pregnant, 30.4 per cent of injectable users and 18.4 per cent of oral contraceptive (OC) users had stopped using their method temporarily before returning to the same method (called the nonuse segment) and had not used any other form of contraception during this time. Almost one third of injectable users (31.2 per cent) had been late for their next injection at least once. Although nearly all women using injectables had experienced some menstrual disturbances, over one third (38.5 per cent) had not been informed by the providers about the possibility of these changes. Many women gave the disruption of their menstrual cycle as the reason for the nonuse segment. The majority of OC users lacked information on how to use their method correctly. Nearly all women expressed an interest in obtaining more information on their current method and other available methods. This study shows that compliance is an issue in injectable as well as OC users.

Adolescent↗

PubMed1991

Hormonal content of combined oral contraceptives in relation to the reduced risk of endometrial carcinoma. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

The relationship between the strength of the estrogenic and progestational components of combined oral contraceptives and risk of endometrial carcinoma was examined in a multinational hospital-based case-control study comparing 220 cases from 7 countries with 1,537 age- and hospital-matched controls. Oral contraceptives were classified according to their relative content of estrogen and progestin. The risk was not altered in women who used preparations containing high-dose estrogen/low-dose progestin compounds [odds ratio (OR) = 1.10, 95% CI = 0.13-9.96]. In contrast, the risk among users of low-dose estrogen/high-dose progestin oral contraceptives was greatly decreased (OR = 0, 95% CI = 0-1.08). Risks observed for users of high-dose estrogen/high-dose progestin (OR = 0.15, 95% CI = 0.045-0.50) and low-dose estrogen/low-dose progesterone (OR = 0.59, 95% CI = 0.26-1.30) preparations were intermediate between those for users of the 2 other types of preparation. A significantly lower risk was observed for high-dose progestin users than for low-dose users [ratio of odds ratios (ROR) = 0.21, 95% CI = 0.05-0.84]. Although the numbers are small, findings from this study suggest that combined oral contraceptives with varying strengths of estrogen and progestin have different effects on the risk of endometrial carcinoma.

Case-Control Studies↗

PubMed1993

Invasive squamous-cell cervical carcinoma and combined oral contraceptives: results from a multinational study. WHO Collaborative Study of Neoplasia and Steroid Contraceptives.

Data from a hospital-based case-control study collected in 11 participating centers in 9 countries were analyzed to determine whether use of combined oral contraceptives alters risk of invasive squamous-cell cervical cancer. Information on prior use of oral contraceptives, screening for cervical cancer, and suspected risk factors for this disease were ascertained from interviews of 2361 cases and 13,644 controls. A history of smoking and anal and genital warts was obtained, and blood specimens were collected for measurement of antibodies against herpes simplex and cytomegaloviruses, from selected sub-sets of these women, as was a sexual history from interviews of husbands. The relative risk of invasive squamous-cell cervical carcinoma was estimated to be 1.31, with a 95% confidence interval that excluded one, in women who ever used combined oral contraceptives. Risk of this disease increased significantly with duration of use after 4 to 5 years from first exposure, and declined with the passage of time after cessation of use to that of non-users in about 8 years. No sources of bias or confounding were identified that offered plausible explanations for these findings. The strength of these results, and their consistency with those from other studies, suggest that a causal relationship may exist between use of combined oral contraceptives and squamous-cell cervical carcinoma. Women who have used these products for 4 or more years, and who most recently used them within the past 8 years, should receive high priority for cervical cytologic screening.

Adult↗

PubMed2005

Feasibility study of Nestorone-ethinylestradiol vaginal contraceptive ring for emergency contraception.

OBJECTIVE: The Nestorone/ethinylestradiol (NES/EE) vaginal ring is being developed as a regular contraceptive method by the Population Council. This ring is designed to release NES 150 microg/day and EE 15 microg/day during 1 year. Here, we report a Phase I clinical trial to determine the usefulness of this ring for emergency contraception. To that end, we tested the ability of this ring to interfere with ovulation when it is inserted during the follicular phase. METHOD: Forty-eight women protected from the risk of pregnancy by nonhormonal methods were divided into three groups, which differed by the size of the dominant follicle at the time of ring insertion: 12-14 mm (n = 16), 15-17 mm (n = 18) and >or=18 mm (n = 14) diameter. The NES/EE ring was left in the vagina for 7 consecutive days, after which it was removed. The growth of the leading follicle and plasma levels of estradiol, progesterone (P), luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the ensuing 5 days after ring insertion were determined. Afterwards, steroid hormones were measured twice a week, until menses took place. All women had a control cycle before the ring cycle, and the range of maximum follicular diameter assigned to each volunteer was the same for the control and the ring cycle at the time when placebo was ingested or the ring inserted. RESULTS: During the 5-day period after ring insertion with follicles 12-17 mm, ovulation was absent in 25 of 34 cycles (p < .01 vs. control), and ovulatory dysfunction (absent, blunted or mistimed LH peak) occurred in 8 of the 9 remaining cycles (33/34 ovulatory processes altered; p < .005 vs. control). After ring insertion with follicles >or=18 mm in diameter, ovulation did not occur in 2 of 14 cycles or was dysfunctional in 7 of the 12 remaining cycles (9/14 ovulatory processes altered; p<.025 vs. control). Altogether, 87.5% of ring cycles (42/48) had either no ovulation or ovulatory dysfunction in the 5-day study period, in contrast to 39.6% (19/48 cycles) in control cycles (p < .001). Among follicles that failed to rupture within the 5-day study period, none ruptured later on in the ring-treated cycles, while 9 of 16 did so in control cycles. Sixty-two percent of ring-treated cycles were shorter than 24 days. Nausea, vaginal discharge and abdominal pain were the most frequently reported adverse events during ring use. CONCLUSION: Interference with 87.5% of ovulatory processes, without ovulation occurring later in the cycle and shortening of cycle length, suggests the NES/EE ring may be used as an emergency contraceptive method, with the potential advantage of providing continuing contraception after it has performed its emergency function.

Administration, Intravaginal↗

PubMed2003

[Non contraceptive benefits of oral contraception].

Both women and the medical profession underrate the non-contraceptive benefits of oral contraception, imbued as they are with its sole deleterious effects, such as thromboembolic ones, in particular. However, the pill is quite an efficient means of preventing against troubles of the menstrual cycle, with a betterment of cycle regularity, a diminishing of menstrual flux and a lowering of the frequency and the severity of primary dismenorrhoea. A review of the literature also demonstrates that oral contraception reduce by 40-50% the incidence of endometrial and ovarian cancer, inclusive of women with a previous history, or genetic predispositions. This effect is correlated with time of use and continues until 10 years or more after stopping taking the pill. Also, the positive part of the pill may well be considered as far as colorectal cancer is concerned, with a 40% or so reduction in risk, by means of decreasing bile acids in the colon. Other benefits of oral contraception have been documented, such as prevention of postmenopausal osteopenia when used during perimenopause, decrease in the incidence of adenofibromas, uterine fibromyomas, fibrocystic mastosis and uterine adnexial infections, and, finally, a favourable effect on acne. Preventive action of the pill on rheumatoid arthritis is debatable, the current feeling being that it diminishes severity as well as symptomatology more than risk of occurrence.

Bone Diseases, Metabolic↗

PubMed2003

Risk of invasive cancer of the cervix in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen oral contraceptives (South Africa).

BACKGROUND: Cervical cancer is caused by specific types of the human papilloma virus (HPV), but not all infected women develop cancer. It has been hypothesized that hormonal contraceptives may potentiate the oncogenicity of HPV infection. METHODS: In a case-control study of colored and black women in the Western Cape Province, South Africa, 524 incident cases of clinically evident invasive cervical cancer (stages 1b-1V) were compared with 1541 controls, and with a subgroup of 254 HPV-positive controls. FINDINGS: For injectable progestogen contraceptives (95% of which were depot medroxyprogesterone acetate) the overall relative risk, adjusted for confounding, was 1.0 (95% confidence interval 0.8-1.3); for combined estrogen/progestogen oral contraceptives the corresponding estimate was 0.8 (0.7-1.1). When the data were divided into categories of duration of use extending to > or = 15 years, or according to age, ethnic group, or recency of use, there was no consistent evidence of an increased risk. The findings were unchanged when the cases were compared with the HPV-positive controls. INTERPRETATION: The present findings suggest that neither injectable progestogen-only nor combined estrogen/ progestogen oral contraceptives increase the risk of clinically evident invasive cancer of the cervix.

Adult↗

PubMed1989

Oral contraception, smoking and inflammatory bowel disease--findings in the Royal College of General Practitioners Oral Contraception Study.

Data from the Royal College of General Practitioners Oral Contraception Study have been examined to determine whether oral contraceptive use was associated with the development of Crohn's disease or ulcerative colitis. Over a 17 year period Crohn's disease developed in 42 women and ulcerative colitis in 78. The incidence of both diseases was greater in oral contraceptive users compared to non-users with the rate ratio for Crohn's disease being 1.7 (95% confidence limits, 0.88, 3.2) and for ulcerative colitis being 1.3 (95% confidence limits 0.82, 2.0). For both diseases incidence was unrelated to parity or social class, but women smoking at recruitment had a greater incidence of Crohn's disease (rate ratio 1.8, 95% confidence limits 0.93, 3.3) and a reduced incidence of ulcerative colitis (rate ratio 0.68, 95% confidence limits 0.41, 1.1). Although these results are based on small numbers and could be chance findings, they are consistent with other studies showing associations between oral contraceptive use, smoking and the development of Crohn's disease and ulcerative colitis.

Adolescent↗

PubMed2000

Risk of breast cancer in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen contraceptives.

Recent studies have suggested that progestogen-only contraceptives and combined estrogen/progestogen oral contraceptives (COCs) may increase the risk of breast cancer among women less than 35 years of age or among recent users. The authors conducted a case-control study, in which cases of breast cancer (n = 484) [corrected] and controls (n = 1,625) hospitalized for conditions unrelated to contraceptive use were interviewed from 1994 to 1997 in hospitals in greater Cape Town, South Africa. The women were aged 20-54 years, resided in a defined area around Cape Town, and were Black or of mixed racial descent. The relative risk for exposure to injectable progestogen contraceptives (IPCs), mostly depot medroxyprogesterone acetate, was 0.9 (95% confidence interval (CI) 0.7, 1.2). There were no consistent associations within categories of age or recency or duration of use. For exposure to COCs, the overall relative risk was 1.2 (95% CI 1.0, 1.5). Among women below age 35 years, the relative risk was 1.7 (95% CI 1.0, 3.0), and it was unrelated to the duration or recency of use. The findings suggest that IPCs do not increase the risk of breast cancer, and that COCs may increase the risk among women below age 35 years, although bias cannot be excluded.

Adult↗

PubMed1994

Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study.

BACKGROUND AND PURPOSE: A nested case-control analysis of data collected during the prospective Royal College of General Practitioners' Oral Contraception Study was performed to examine the relation between use of oral contraception and risk of stroke. METHODS: The 253 women who had a first-ever stroke (International Classification of Diseases, eighth revision, codes 4300 to 4389) or amaurosis fugax (code 3791) between 1968 and 1990 (case subjects) were compared with 759 women who did not have this diagnosis (control subjects). RESULTS: Smoking, social class, and history of hypertension were found to be important risk factors for stroke. Women who had ever used oral contraceptives had an increased risk of all stroke (odds ratio, 1.5; 95% confidence interval, 1.1 to 2.0, adjusted for smoking and social class) and of a fatal event (adjusted odds ratio, 2.3; 95% confidence interval, 1.2 to 4.4). A significant doubling of all stroke risk was observed among current users, an effect that was apparent in both smokers and nonsmokers. Former users had a small nonsignificant elevation in risk of all stroke but a stronger risk of a fatal event. The effects in former users appeared to be restricted to women who smoked. CONCLUSIONS: Current users of oral contraceptives appeared to be at increased risk of stroke. There is some evidence that former users may also have a persisting effect, although further research is needed to confirm these observations.

Adult↗

PubMed2003

The efficacy of non-contraceptive uses for hormonal contraceptives.

In addition to providing safe and effective contraception, both the combined oral contraceptive pill (COCP) and selected long-acting progestogen-only contraceptives have significant health benefits. The COCP may reduce menstrual blood loss, dysmenorrhoea and premenstrual syndrome; unequivocally reduces the later incidence of endometrial and ovarian cancer; appears to help protect future fertility, probably by reducing the risk of acute pelvic inflammatory disease, endometriosis and uterine fibroids. The quality of evidence for individual non-contraceptive health benefits of the COCP is very variable.

Contraceptives, Oral, Combined↗

PubMed2003

[Vaginal contraception: new form of administration of hormonal contraception].

The vaginal contraceptive ring works systemically by releasing 120 micrograms etonogestrel (a third generation progestogen) and 15 micrograms ethinylestradiol per day. As little independent research has been done on the efficacy and effectiveness of the vaginal contraceptive ring, it seems too early for the uncompromising propagation of systemic vaginal contraception. Women who occasionally omit to take the pill and those reluctant to use an intra-uterine device may possibly benefit from this form of contraception.

Administration, Intravaginal↗

PubMed2005

Effects of low dose oral contraceptives on serum total cholesterol, TAG, HDL-C & LDL-C levels in contraceptive users.

This study was done to appraise the effects of low-dose oral contraceptives (OC(s)) containing synthetic estrogen ethinyl estradiol and synthetic progestin levonorgestrel on serum total cholesterol, TAG, HDL-C and LDL-C levels. Ninety young women within reproductive age group were picked for this study. Sixty women using low-dose oral contraceptives served as experimental group and thirty age matched hormonal contraceptive non-users were selected for control group. Experimental group was again subdivided into OCP users for last one-year group, three-year groups and five-year group. The results showed that there were no significant differences on most of the study parameters between users and non-users women. But there was a significant accession of serum triacylglycerol only in OCP user groups. The results hint that low-dose oral contraceptives regimens partly impaired the lipid metabolism. So, the safeness of low-dose OCP used in National Population Control Program is further inspired. The value of studied parameters for serial longer continuation of OCP uses need to be renegotiated.

Adult↗

PubMed1978

Reduction in incidence of rheumatoid arthritis associated with oral contraceptives. Royal College of General Practitioners' Oral Contraception Study.

Analyses of the frequency of reporting of rheumatoid arthritis have been undertaken as part of the continuing major prospective survey of oral contraceptives. The rate of reporting in oral-contraceptive users (takers) is half of the rate in non-users (controls). The rates for ex-takers and controls are not materially different. The expected rise in the rate of reporting in women over 35 is apparent in controls but suppressed in takers. In the absence of any accountable bias, it is concluded that oral contraceptives protect against the development of rheumatoid arthritis. Although the effect is small, the observation may be valuable in understanding the aetiology of the disease and the mechanism of action of oral contraceptives.

Adult↗

PubMed2000

Comparison of ovarian follicular activity during treatment with a monthly injectable contraceptive and a low-dose oral contraceptive.

Ovarian follicular development occurs during treatment with combined and progestin-only oral contraceptive (OC) pills and progestin-containing subdermal implants, and can be associated with the development of persistent functional cysts that may require surgical removal. Lunelle is a once-a-month injectable contraceptive containing estradiol cypionate 5 mg and medroxyprogesterone acetate 25 mg. A randomized, comparative study was undertaken to compare the effect on ovarian follicular activity associated with use of Lunelle and a low-dose OC. A total of 30 ovulatory subjects were randomly assigned to receive two cycles of treatment with either an OC containing ethinyl estradiol 20 microg and 0.1 mg levonorgestrel or Lunelle. During the second cycle of treatment, pelvic sonography was performed every 4 days, at which time the maximum follicle diameter was measured. Study end points were the presence of follicles >/=10, 20, and 30 mm. In all, 13 of 15 subjects in the OC group and 14 of 15 in the Lunelle group completed the study. Follicles measuring >/=10 mm were present in 11 of 13 (84.6%) in the OC users and in four of 14 (28.6%) in the Lunelle users (p <0.05). In the OC group, six of 13 subjects (46.1%) developed follicles >/=20 mm, and one of 13 (7.7%) developed follicles >/=30 mm. No subjects in the Lunelle group developed a follicle >/=20 mm in diameter. This study indicates that Lunelle is associated with a significantly lower incidence of ovarian follicular development compared to that of an OC containing 20 microg ethinyl estradiol and 0.1 mg levonorgestrel.

Adult↗

PubMed1980

Oral contraceptive steroids and atherosclerosis: lipogenesis in human arterial smooth muscle cells and dermal fibroblasts in presence of lipoprotein-deficient serum from oral contraceptive users.

The incorporation of [14C]-acetate into lipids by cultured human arterial smooth muscle cells and dermal fibroblasts was studied in the presence of lipoprotein-deficient serum from oral contraceptive users (OC) and control women. Exposure to OC serum: 1) significantly increased the synthesis of cholesterol above controls in both fibroblasts (+25-56%) and smooth muscle cells (+28-42%) without a significant change in the synthesis of lecithin; and 2) resulted in increased cholesterol/lecithin ratios in newly synthesized lipids which were higher than controls in both fibroblasts (+50%) and smooth muscle cells (+30%). In vitro addition of the steroid ingredients of the "pill" to the growth medium containing control serum did not result in a stimulation of lipogenesis by the cells. [3H] - mevalonate incorporation into cholesterol was no different with OC and control serum, indicating that the stimulation noted in cholesterol synthesis by OC serum was due to an increased HMG-CoA reductase activity. These findings suggest that increased sterol synthesis in arterial smooth muscle cells of oral contraceptive users may be one pathogenetic factor which adversely influences their risk of atherosclerosis.

Adult↗

PubMed2006

Contraceptive use and discontinuation: findings from the contraceptive history, initiation, and choice study.

OBJECTIVE: The purpose of this study is to provide insight on the continuing high rate of unintended pregnancy among adult women. STUDY DESIGN: Contracepting women were recruited while they waited for primary care appointments. A total of 369 completed the baseline questionnaire, and 145 oral contraceptive (OC) users were enrolled in a 5-week, diary-based study of adherence and sexual activity. RESULTS: Most women who reported having discontinued OCs did so because of medical side effects, and most had switched to less effective methods. Among OC users, 26.4% had sexual intercourse on days they missed pills just before or after their placebo week. Nonadherence did not differ by socioeconomic factors or obesity. CONCLUSION: Clinicians may need to encourage their patients to discuss their reasons for wanting to discontinue the use of an effective contraceptive method and assist them with their concerns or to switch to other effective methods to protect themselves from unintended pregnancy.

Adult↗

PubMed2005

Comparison of the metabolic effects of oral contraceptive and nonhormonal contraceptive use in women over 40 years old.

The aim of this study was to compare metabolic changes during use of low-dose combined oral contraceptives (COCs) and those of nonhormonal contraceptives in perimenopausal women. Thirty-nine healthy women over 40 years old who attended the Family Planning Clinic of the King Chulalongkorn Memorial Hospital, Bangkok, Thailand, were recruited, 20 in the COC group received COC preparations containing 30 microg of ethinyl estradiol and 150 microg of levonorgestrel and 19 in the nonhormonal group were intrauterine device users. Blood samples were taken upon admission and 6 months later. Minor biochemical changes associated with low-dose COC use included an increase in glucose tolerance, triglycerides, serum albumin, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) levels but a decrease in fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, total bilirubin and alkaline phosphatase levels. There was no clinical significance for the metabolic changes. Low-dose COCs can be a satisfactory contraceptive choice for healthy perimenopausal women.

Adult↗

PubMedDate not supplied

Survey of knowledge and practice on oral contraceptive and emergency contraceptive pills of drugstore personnel in Hat Yai, Thailand.

In Thailand, oral contraceptive (OC) and emergency contraceptive pill (ECP) are available as over-the-counter (OTC) drugs, and drugstores share 30% of services. While the rate of dispensing contraceptive pills has increased, the knowledge and awareness of ECP use is limited among users and providers. The objective of this study was to assess knowledge and practice of drugstore personnel on providing OC and ECP, in order to improve the quality of services. Drugstores located in Hat Yai District, Songkhla Province, Southern Thailand, were the accessible population. There were 109 drugstores, half of them owned by pharmacists. The population was stratified by owner (pharmacist or non-pharmacist) and randomly selected to obtain a sample size of 30 drugstores for each class. Two study methods, questionnaire interview and secret shopping, were used to measure knowledge, and practice, respectively. History-taking, drug-choosing, and advice-giving were the domains measured. The results demonstrated that knowledge on OC was fair, but that on ECP was poor. Pharmacists had better knowledge of proper history taking and ECP indication than non-pharmacists. OC and ECP provision were inappropriately practised in drugstores in the study area. A majority of drugstores were mainly owned by non-pharmacists. For OC practice, drug-choosing was good, but history-taking and advice-giving were poor in both groups. Although both groups dispensed ECP poorly, pharmacists dispensed significantly better than non-pharmacists. Among non-pharmacist staff, the average scores of OC advice-giving, and ECP dispensing, were statistically significantly better among those working in pharmacist-owned drugstores. Both knowledge and practice on OC and ECP should be improved in both types of drugstores in the study area.

Community Pharmacy Services↗