IUD update signals renaissance for long-term contraceptive method.
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Premature introduction of progestin-only contraceptive methods during lactation.
Experts on contraceptive technology concur that progestin-only methods can be used safely during lactation. However, very few studies exist of the effects on lactation of the introduction of progestin-only methods prior to the sixth postpartum week. Since progesterone withdrawal is the likely stimulus that initiates lactogenesis, it appears necessary for natural progesterone levels to decline to baseline before a progestin-only contraceptive is initiated. Therefore, the use of such contraceptive methods should be delayed for at least 3 days after the birth. Non-hormonal methods remain the first choice category of contraceptive methods for breastfeeding women, since there is no possibility that they will interfere with lactation. Progestin-only methods comprise a viable and often desirable next choice category, although the timing of their commencement must be determined with care in order to support lactation.
Animals↗
[Reliability of the vaginal diaphragm as a contraceptive method].
With a failure rate of between 2 and 4 in recent statistics, the vaginal diaphragm can be considered a relatively reliable method of contraception. The physician can therefore recommend this method as an alternative if, e.g., ovulation inhibitors are contraindicated and the patient rejects an intrauterine pessary. In such cases diaphragms are as acceptable as condoms, the more so because the two methods are completely harmless. (Table 9 summarizes the advantages and disadvantages of diaphragms.) Whether, in the final analysis, the condom or the diaphragm is accepted, will largely depend on whether the man or the woman assumes the responsibility for family planning. The physician can use his influence when explaining the contraceptive principle of the diaphragm and showing the patient how to use it to keep the failure rate to a minimum. The present authors consider that even today, good, objective counseling on reliable family planning is one of the physician's most important tasks in the sphere of preventive medicine.
Adolescent↗
Contraceptive methods and the transmission of HIV: implications for family planning.
Heterosexual transmission is the predominant mode of spread of the Human Immunodeficiency Virus (HIV) in most of the world. Whether the use of hormonal contraceptives, IUDs and spermicides is associated with an increased or decreased risk for HIV acquisition remains controversial. Several mechanisms whereby contraceptive methods may influence the transmission of HIV have been proposed. As contraceptive use increases among women of reproductive age, the group most vulnerable to HIV infection, any associations between contraceptive method and HIV risk become even more important. The available studies of these associations are predominantly cross-sectional and give conflicting results. We review the published evidence for associations between HIV and individual contraceptive methods. At this time no definitive conclusions regarding these associations can be drawn. Further research, especially prospective epidemiological studies and basic biological research on mechanisms of heterosexual transmission and the effect of contraceptives on these mechanisms, is urgently needed.
Condoms↗
Dual contraceptive method use for pregnancy and disease prevention among HIV-infected and HIV-uninfected women: the importance of an event-level focus for promoting safer sexual behaviors.
BACKGROUND AND OBJECTIVES: Many women who report condom use also use other methods of birth control such as oral contraceptive pills. The use of 2 or more contraceptive methods often results in less consistent condom use. GOAL: This study sought to document the prevalence and patterns of such dual contraceptive use among HIV-seropositive and HIV-seronegative women, and to assess factors associated with condom-only versus dual contraceptive use. STUDY DESIGN: At 6 months postpartum, 361 sexually active women were interviewed regarding sexual behavior, male condom and other contraceptive use, and psychosocial factors. RESULTS: Dual contraceptive method use was reported by 39% of sexually active women; 30% reported using condoms only. Almost two thirds of dual method users (64%) reported always using these methods together (ie, simultaneously) during vaginal sex. Among dual users, those who used methods simultaneously were more likely to be HIV-seropositive (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.5), to believe that a pregnancy would be very upsetting should it occur in the next 6 months (OR, 2.4; 95% CI, 1.1-5.4), and to report no alcohol use (OR, 3.7; 95% CI, 1.5-9.2). CONCLUSION: Dual contraceptive users should be encouraged to use methods together at every episode of vaginal sex. Interventions promoting simultaneous use should include pregnancy attitudes and the role of alcohol use, as well as a consideration of HIV serostatus as it impacts on dual use.
Adult↗
[Influence of the socioeconomic and cultural level on the use of contraceptive methods].
OBJECTIVE: a) To study the most commonly used Contraceptive Methods (CM) among the population group under survey and b) to analyse the influence of socio-economic (SEL) and educational levels (CL) on their use. DESIGN: Descriptive study of a crossover type by means of a survey. SETTING: Six general medical consulting rooms in two urban Health Centres. PATIENTS: The study was based on a representative sample of 384 women between 15 and 45 years old (a.i.) who attended for health-care for whatever reason. Interventions. A survey carried out by the family doctors in the consulting rooms, where information was gathered on both the CM used and several socio-demographic variables. MEASUREMENTS AND MAIN RESULTS: For most couples, the most commonly used CM was the condom, whose use became greater as the SEL (p < 0.01) and EL (p < 0.0001) rose. Oral contraceptives were used more by women with a lower SEL (p = 0.01). Tubular ligature was more common among women with a lower educational level (p < 0.0001). CONCLUSIONS: The results obtained from our sample by our methodology support our initial hypothesis in the sense that they show the influence of EL and SEL on the use of various contraceptive methods.
Adolescent↗
[Ignorance and misconceptions in the use of contraceptive methods].
Good knowledge of the available contraceptive methods ensures better acceptability, continuity and satisfaction, and lower failure rates of these methods. This paper describes an inquiry on the contraceptive knowledge in 114 women attending three Brussels family planning clinics. Misconceptions, beliefs in false rumors, and considerable insufficiencies in knowledge were detected. In order to increase patient's ability to correctly use birth control methods, so as to lower unwanted pregnancy rate, efforts should be made by health practitioners as well as by mass media and teaching institutions.
Adolescent↗
The link between contraceptive methods and Chlamydia trachomatis infection.
The effect of various contraceptive methods on Chlamydia trachomatis (CT) infection was examined in a group of 158 women, with a mean age of 26.9 years, patients of a family planning clinic. Their symptoms were mild abdominal pain or vaginal discharge. Antibodies to CT were examined by an indirect immunoperoxidase assay, with a commercial kit. From each patient a vaginal smear was collected for bacteriologic and mycologic study. In group I, consisting of 30 married women with a mean age of 31 years, 5 (16.7%) IUD users had a positive test for CT antibodies. In group II, comprising 57 women, with a mean age of 23.3 years, 22 (38.6%) oral contraceptive (OC) users, of whom 94.7% were unmarried, had positive tests for CT antibodies. The difference between these two groups was statistically significant (p less than 0.05). In group III, comprising 71 women with a mean age of 28.1 years, 62% unmarried and using other contraceptive methods, 15 (21.1%) had a positive test for CT antibodies. The incidence of CT infection was not different in the 3 groups under study, when the factors of age and marital status were taken into consideration (p greater than 0.30). Bacterial vaginal infection was found in 43.3% of the IUD users, compared with only 14% of the OC users (p less than 0.01). In contrast, in the OC users, candidiasis was predominant, the difference from the other groups being statistically significant (p less than 0.001). The women with positive antibodies also more frequently had colonies of bacterial and mycological vaginal infection.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Adolescents' experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra.
BACKGROUND: The new combined estrogen & progestin contraceptive patch Ortho Evra was approved by the FDA in December 2001. To date, there is a paucity of data regarding its use in the adolescent age group. We examined adolescents' experience with this new contraceptive method. METHODS: Using a questionnaire designed by the authors, care providers in a hospital based adolescent clinic interviewed and reviewed the charts of adolescent girls who had initiated Ortho Evra in 2002-2003. RESULTS: Twenty-eight adolescent girls (age 18 +/- 1 years, gyn age 6 +/- 1 years, onset of sexual intercourse at 14 +/- 1 years, body mass index (BMI) 27.6 +/- 1.2, 57% Hispanic, 21% Caucasian, 11% African American, 7% biracial, 4% Indian American) who had used Ortho Evra for 7 +/- 1 months were enrolled. Half (50%) were adolescent mothers, and 57% had a history of irregular menstrual periods. All (100%) girls reported regular menstrual periods while using Ortho Evra, with only 14% experiencing occasional breakthrough bleeding. Half reported a shorter duration and 36% reported a lighter flow of their periods. About a third (39%) reported a decrease and 11% reported an increase in dysmenorrhea symptoms. About a third (29%) of those with a history of recurrent headaches at initiation reported decrease in headaches, and about a third (33%) of those with acne at initiation reported decrease in facial acne while on Ortho Evra. There were no significant BMI changes during Ortho Evra use. Although condom use while on Ortho Evra was poor (only 15% reporting consistent condom use), there were no pregnancies reported. A majority (93%) reported that they remembered to apply the patches on time, and 40% stated that Ortho Evra was easier than previous contraceptive methods. Two thirds (68%) were very satisfied and 29% were somewhat satisfied with the method, and 93% stated that they would recommend the method to a friend/relative. The preferred application site was the buttock (40%) followed by the lower abdomen (32%). About a fifth (21%) experienced at least one episode of complete patch detachment and 32% reported partial peeling of the patch corners. About a third (32%) would prefer another patch color, and 25% would like a fourth week placebo patch. The most common side effects were mild temporary application site reactions (64%), some discomfort on patch removal (32%), nausea (18%), and breast tenderness (18%). Eleven girls (39%) discontinued Ortho Evra (three lost health insurance, three because of application site reactions, two found patch application schedule difficult to remember, two desired pregnancy, two because of nausea, one because of perceived weight gain). CONCLUSIONS: Ortho Evra provides excellent cycle control in adolescents. Most adolescents are satisfied with this method. Intensive efforts should be made to increase condom use by adolescents on Ortho Evra.
Abdomen↗
Contraceptive method mix menu: providing healthy choices for women.
This article addresses expansion of the contraceptive method mix, in the specific context of underserved women in developing countries who, like all women, expect to maintain their health status while successfully regulating their fertility. It is a critical review of the health implications of the contraceptive methods most commonly included on a menu of options and includes fertility awareness methods as essential non-supply method options where barriers currently exist for supply methods.
Contraception↗
[Knowledge and use of contraceptive methods by the female population in a health-care district].
BACKGROUND: The use of contraceptives is related to factors including those of a demographic, social, economic, educational and ideological nature. The purpose of our study is that of ascertaining with what contraceptive methods the women of child-bearing age assigned to a given health care center are familiar, in addition to prevalence of the use thereof. METHODS: Based on the health care card listing, 389 of the 5800 women of child-bearing age (15-45 years old) assigned to the health care center in question were selected by means of a systematic sampling. After sending them a letter notifying them of the reason for this study, they were contacted by telephone to fill out the survey, which included questions regarding their knowledge and use of contraceptive methods, their sociocultural characteristics and sexual activity. Appointments at the health center were made with those women who did not have telephones. RESULTS: 178 women were contacted, 166 of whom took part in the survey (42.7% response rate). 86 of these women (51.8%; CI: 44.2-59.4%) were using some means of contraception. Nevertheless, among women at risk of unwanted pregnancies, the prevalence of use was 70.5% (CI: 62.4-78.6%), being worthy of special mention the fact that solely 45.4% of the women within the 40-45 age group were using contraceptives, revealing a frequency significantly lower than the other age groups. The methods known to the greatest degree were the condom (90.4%), oral contraceptives (89.2%) and the IUD (78.3%), the knowledge of other means being scant. CONCLUSIONS: The rate of use of contraceptive methods among women at risk of unwanted pregnancy is acceptable, although strikingly low among the women in the 40-45 age group. The methods known most were the condom, oral contraceptives and the intrauterine device.
Adolescent↗
Past contraceptive method use and risk of ectopic pregnancy.
The relationship between past contraceptive method use and risk of ectopic pregnancy has been analyzed in a case-control study conducted in Milan, Italy. Cases were 158 women with diagnosis of ectopic pregnancy confirmed by laparoscopy or laparotomy, admitted to a network of university and general hospitals of Milan. The first control group (obstetric controls) included 243 women who gave birth at term (more than 37 weeks' gestation) to healthy infants at the same hospitals where the cases had been identified. The second control group (non-obstetric controls) was a random sample of 158 women admitted to the same network of hospitals where cases had been identified for diseases other than malignant, hormonal, or gynecological in origin. A total of 37 (23%) cases, 21 (9%) obstetric and 24 (15%) non-obstetric controls reported ever IUD use. The corresponding relative risk, RR, of ectopic pregnancy was 3.5 (95% CI 1.3-4.6) when non-obstetric subjects were considered as control group. The risk of ectopic pregnancy increased with duration of IUD use: in comparison with obstetric and non-obstetric controls, the RR were 2.3 and 2.0 for users for less than 2 years and 4.3 and 2.6 for longer users. There was no clear relation between time since last IUD use and risk of ectopic pregnancy, and no evidence of a decline of risk with increasing time since stopping use.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Evidence from peninsular Malaysia of breastfeeding as a contraceptive method.
This report examines Malaysian women's perceptions of the contraceptive effect of breastfeeding, the determinants of their perceptions, and any effect these perceptions might have on nursing duration and contraceptive use. The report also considers whether women are consciously replacing breastfeeding with modern contraceptive methods. Data from the 1976 Malaysian Family Life Survey are analyzed, and the author concludes that Malaysian women do perceive that breastfeeding has a contraceptive effect, but that this perception is not universal. Ethnicity and desire for a particular family size are the most significant determinants of this perception. Finally, Malaysian women's recognition of the contraceptive effect of nursing does not influence either the duration of their breastfeeding or their adoption of contraception. Malaysian women may not be abandoning breastfeeding to adopt contraception. More probably, breastfeeding declines and contraceptive prevalence increases with modernization.
Adolescent↗
Relationship between contraceptive method choice and beliefs about HIV and pregnancy prevention.
BACKGROUND AND OBJECTIVES: The goal of this study was to examine the relationship between contraceptive method choice and perceptions of HIV and pregnancy risk among women at risk of HIV infection and transmission. STUDY DESIGN: Women who were infected with HIV or who were at high risk of infection were administered a questionnaire assessing sexual and drug-related HIV risk behaviors and beliefs, STD and pregnancy history, and intentions, beliefs and behaviors regarding pregnancy, childbearing and contraception. RESULTS: Among women who reported using a contraceptive method every time they had intercourse, 43% used condoms only, 22% used birth control pills only, and 11% used both. Only 58% of consistent condom users believed they were very unlikely to become infected with HIV in the next year. Controlling for risk factor differences, pill-only users were less likely to believe themselves at risk of HIV infection, and more confident in their ability to prevent HIV infection, compared with condom-only users. CONCLUSION: Results suggest that women's beliefs about the effectiveness of a method for pregnancy prevention may generalize to beliefs about the efficacy of the method for disease prevention.
Adult↗
A cost-benefit analysis of four hormonal contraceptive methods.
This paper presents the results of a cost-benefit analysis conducted for pregnancy prevention treatment with four hormonal methods of contraception using a managed-care viewpoint. The therapies analyzed are medroxy-progesterone acetate injection (Depo-Provera), levonorgestrel subdermal implants (Norplant), progestogenonly oral tablets (Nor-QD), and combination progestogen/estrogen oral tablets (Ortho-Novum 7/7/7). Cost and benefits associated with the use of therapies are identified and analyzed based on the cost per patient-day of effective pregnancy prevention. The analysis demonstrates that all four methods have a positive net benefit, with Depo-Provera having the highest net benefit. This information can provide decision makers within a pharmacy and therapeutics committee of a managed-care organization the framework on which to base formulary decisions.
Adolescent↗
Acceptance of effective contraceptive methods after induced abortion.
The purpose of this study was to examine possible motivating factors in switching from a relatively inadequate contraceptive method to an effective one. Three groups of women were observed: Group A had induced abortion and routine family planning education; Group B had induced abortion, routine family planning education, and special education on the health hazards of abortion; and Group C had no abortion, but did have both the routine and special education. The rate of women switching from inadequate contraceptive methods to the more effective methods was 45, 86, and 18 percent, respectively. Thus, these findings demonstrate that women who have had induced abortion are more highly motivated to switch from inadequate to effective contraceptive methods, particularly when they have been exposed to routine family planning education and additional education on the health hazards of abortion. It is recommended that emphasis be placed on providing special education for women who have had induced abortion.
Abortion, Induced↗
TCu 380A IUD: a reversible permanent contraceptive method in women over 35 years of age.
OBJECTIVE: The objective of the study was to evaluate the performance of the TCu 380A IUD in women who had been using the device for more than 10 years and who were 35 years of age or more on completion of the 10th year of IUD use. METHODS: A total of 228 women who had an IUD inserted between 1987 and 1992 were included in the study. The cutoff date for analysis was January 31, 2004. Clinical performance was evaluated by life-table analysis. The mean age of women at 10 years of use was 38.8+/-0.4 years and mean parity was 2.2+/-0.08 (mean+/-SD). The duration of follow-up beyond 10 years ranged from 1 to 72 months. No pregnancy was observed in 366 woman-years of observation beyond 10 years of use. The main reason for discontinuation was removal of the device because the clients had previously been informed that the IUD was not approved for use beyond 10 years. This reason accounted for a gross cumulative 6 years discontinuation rate of 42.5 per 100 women beyond 10 years. The other main reasons for discontinuation beyond 10 years of use were surgical sterilization, menopause and expulsion with gross cumulative 6-year termination rates of 19.2, 11.0 and 21.2 per 100 women, respectively. The cumulative continuation rate beyond 10 years was 67.0 at the end of the first year of follow-up and 21.2 at the end of the sixth year. CONCLUSION: We found no evidence that the TCu 380A IUD loses its effectiveness after 10 years of use. RESULTS: The concept that women who have insertion of a TCu 380A IUD at the age of 25 years or older could use this IUD as a reversible but permanent method of contraception up to the menopause continues to be supported by the accumulation of evidence, although definitive evidence remains to be obtained.
Adult↗