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Factors influencing the time of introduction of steroidal contraception in the breast-feeding mother.

To ensure infertility whilst breast feeding many mothers ingest steroidal contraceptives. Animal experiments have shown how sexual differentiation of the brain occurs during perinatal life and can be affected by exogenous steroids. The amount of sex steroid secreted in the milk of lactating mothers is very small and dependent on the type of steroid chosen. "On demand" breast feeding is associated with a longer period of lactational amenorrhoea, obviating the necessity for early usage of contraceptives. In view of the possibility that sexual differentiation may be disturbed, it is suggested that, where steroidal contraception is required, the progesterone with the minimal amount of oestrogenic metabolite be used.

Animals↗

A comparative study on the effects of a monophasic pill containing desogestrel plus 20 micrograms ethinylestradiol, a triphasic combination containing levonorgestrel and a monophasic combination containing gestodene on coagulatory factors.

The changes in haemostasis during oral contraception are related to the ethinylestradiol dose present in the formulation taken by the patient. An open, randomized longitudinal study was performed to evaluate and compare the effects that low-dose oral contraceptives (OCs) containing different doses of ethinylestradiol exert on the haemostatic system. Eighty-nine healthy women, aged 18-45 years, were randomly assigned to treatment with 3 different OCs: a monophasic pill containing 30 micrograms of ethinylestradiol plus 75 micrograms of gestodene (GSD/30) (30 subjects), a triphasic pill containing levonorgestrel (TRI/LNG) (28 subjects), a monophasic pill containing 20 micrograms ethinylestradiol plus 150 micrograms of desogestrel (DOG/20) (31 subjects). From every woman, blood samples were collected before treatment and at the 3rd and 6th cycle of pill intake. The number of platelets significantly increased (p less than 0.01) during treatment with TRI/LNG. Fibrinogen plasma values were significantly increased (p less than 0.05) only in women treated with the preparation GSD/30. Fibrinopeptide A (FPA) plasma levels significantly increased (p less than 0.01) during treatment with the pills TRI/LNG and GSD/30, but the levels of FPA were unchanged in the group treated with DOG/20. The overall results of this study confirm that the effects of OCs on haemostasis are dependent on the ethinylestradiol dose. Moreover, they suggest that with reduction of the ethinylestradiol component to 20 micrograms, the effects of OCs on haemostasis seem to be virtually eliminated.

Adult↗

Acceptability of a new intravaginal barrier contraceptive device (Femcap).

A comprehensive questionnaire to assess acceptability was sent to 106 participants (and their partners) in a study on the safety and effectiveness of the Femcap. Participants were asked to rate their satisfaction with various aspects of the method, and were also asked about complaints such as vaginal infections, urinary tract infections, or other irritation. Eighty-one percent of the study sample either returned the mailed questionnaires or completed telephone interviews. Results were encouraging in that none of the study subjects or their partners reported any discomfort, trauma, or interference in sexual spontaneity with the cap. Vaginal irritation and infections were infrequently reported. The feature best liked by most participants was the absence of hormones associated with the method; the feature least liked was removal of the device. The Femcap may be an acceptable alternative to currently available barrier contraceptive devices.

Adolescent↗

Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.

The relationships between parity, breast-feeding, and the use of birth control pills and the bone densities of the lumbar spine and the femoral neck, measured by dual-photon densitometry, were studied in normal women. Femoral neck density was found to decrease by 1.1% per live-birth, whereas lumbar spine density showed no significant association with parity. Breast-feeding was found to increase lumbar spine density by 1.5% per breast-fed child, whereas femoral neck density was not significantly correlated. No significant relationships between the use of birth control pills and the bone densities were found.

Adult↗

Frequency of non-hormonal contraception around conception and association with congenital malformations in offspring.

A case-control study using data on deliveries in the mid-1970s at five Connecticut hospitals (cases, n = 1427; controls, n = 3001) found little relationship between delivery of a malformed infant and use by the mother of nonhormonal contraceptive methods at conception. Of particular interest was the lack of an association with use of the rhythm method (odds ratio (OR) = 1.02, 95% confidence limits (CL) = 0.73, 1.42), spermicides (OR = 1.26, 95% CL = 0.85, 1.85) at conception and a modest association for the intrauterine device (IUD) one week before conception (OR = 1.99, 95% CL = 0.98, 4.04). Continued use of the IUD after conception may further increase the risk for malformations but this observation was statistically unreliable in the present study. Mothers of newborns with cleft lip and palate (OR = 2.91) and congenital hydrocele (OR = 4.64) were more frequent rhythm users at conception, and mothers of newborns with multiple anomalies had more recent IUD exposure (OR = 9.87), but these and all other specific congenital malformation groups were not significantly related to any non-hormonal contraceptive after adjustment for multiple observations. Potentially confounding maternal risk factors were controlled.

Adult↗

Fertility and contraceptive adoption and discontinuation in rural Kenya.

After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.

Adult↗

The correlation between family planning program inputs and contraceptive use in Indonesia.

Using 1980 Census and 1986 service statistics program inputs, this paper evaluates the net correlation of socioeconomic, region, and program variables with 1987 contraceptive prevalence and method-specific use rates for Indonesian regencies and municipalities. The region variables--primarily, though not exclusively, reflecting program design and maturity--correlate most strongly with the contraceptive prevalence rates. Field-worker activities, field-worker supervisor activities, and community-based distributors also have a correlation with these rates. Pill use is highest in the areas that are predominantly Islamic and least developed, whereas the pattern is reversed for use of the IUD, condom, and other modern methods (mainly female sterilization). The findings are assessed in terms of their implications for policymaking.

Community Health Services↗

Menstrual bleeding expectations and short-term contraception discontinuation in Mexico.

This study tests the hypothesis that women will be more likely to continue a contraceptive if their expectations about changes in bleeding and discomfort are accurate. The study examined the relationship between women's expectations and discontinuation rates for IUD and pill acceptors over a three-month interval. The results show that attitudes and expectations are as important as actual changes in accounting for contraceptive discontinuation among pill users; the results for IUD users are not as clear. It is recommended that family planning programs make it a priority to inform women about the changes in their bodies that can be caused by contraceptives in order to reduce high rates of discontinuation.

Adult↗

New condoms for men and women, diaphragms, cervical caps, and spermicides: overcoming barriers to barriers and spermicides.

Barriers and spermicides are being developed for the prevention of unwanted pregnancy and sexually transmitted infection. The inconvenience of current methods limits their acceptability and leads to higher user failure rates. New methods, such as female condoms, nonlatex male condoms, and new cervical caps are being developed: the Reality (Wisconsin Pharmacal, Jackson, WI) polyurethane vaginal pouch has already received conditional Food and Drug Administration approval for use in the United States. The material used in a Food and Drug Administration-approved nonallergenic glove is being tested for its effectiveness as a condom. In addition, the Fem Cap, a cervical cap that had a life table probability of failure within 1 year of 4.8%, is expected to be available within the next 2 years. It is important for clinicians to be informed of new options becoming available for those patients who may be good candidates for these barrier methods.

Contraceptive Devices↗