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At least 127 records · Page 7Linked to original sources
PubMed1998

Experience of Thai women in Bangkok with Norplant-2 implants.

A prospective study of the Norplant-2 contraceptive subdermal implant system was conducted in Bangkok, Thailand. The objective of the study was to evaluate the efficacy, adverse effects, and overall acceptability of Norplant-2 implants. A total of 140 women were enrolled in a 3-year clinical trial. The mean age was 29 years. Of all the acceptors, 70% had completed primary school. The continuation rates at years 1, 2, and 3 were, respectively, 94%, 89%, and 83%. No accidental pregnancies occurred throughout the 3 years of use in this study. Personal reasons were the leading cause for termination of Norplant-2 implant use. The 3-year cumulative termination rate for personal reasons was 7.2%. These personal reasons were divorce, husband having vasectomy, and moving away from the study area. The other leading cause for termination was medical reasons; acne, headache, and pain at the implant site were the complaints. The termination rate for medical reasons in year 3 of the study was 4.6%. Prolonged menstrual flow was the other main reason for termination. The 3-year cumulative termination rate for menstrual irregularities was 3.8%. In this study, the cumulative termination for planned pregnancy at the end of the year 3 was only 1.6%. The incidence of difficult removals was 8%. Breakage of the rods on removal was encountered in the majority of these cases. The study findings presented suggest that the Norplant-2 implants are highly effective with high continuation rates. The Norplant-2 system could become another choice of long acting reversible contraception for Thai women.

Adolescent↗
PubMed2004

[Two patients with a non-palpable, subcutaneously implanted contraceptive].

Two women, 33 and 31 years of age, were referred to a surgeon for the removal of a previously implanted hormonal contraceptive after the general practitioner had attempted this without success. However, no foreign body could be detected in either patient by surgery, echography and MRI and by X-ray, echography and MRI, respectively. They were then referred to a gynaecologist. In the first patient, a low level of etonogestrel confirmed that there was no contraceptive in her body. Subcutaneous contraceptives are sometimes implanted incorrectly. If the rod is not palpable at the site of insertion, then the etonogestrel level should be determined first of all. If the hormone level indicates that a rod is indeed present, then echography or MRI may be considered to localise it before resorting to surgical exploration. Many problems can be prevented by proper implantation.

Adult↗
PubMed1998

Levonorgestrel contraceptive implants in female patients 14 to 21 years old.

OBJECTIVE: To determine which factors are associated with duration of use of a levonorgestrel implant (Norplant) for contraception in adolescents and young adults. DESIGN: We retrospectively studied 144 young women (14 to 21 years of age) who chose a levonorgestrel contraceptive implant at Mayo Clinic Rochester between April 1990 and December 1993. MATERIAL AND METHODS: The following information was obtained at the time of insertion of the implant and from any follow-up visits: demographics, prior contraceptive experiences, frequency and management of complications, complications noted at removal of the implant, and subsequent contraceptive choice. The duration of use was examined. RESULTS: Of the 144 young women who underwent insertion of a Norplant system, 75 telephoned or made a medical appointment because of implant-related side effects. During the follow-up period, 64 patients had the Norplant system removed. The Kaplan-Meier estimate of the probability of the Norplant system remaining in place for at least 12 months was 83 % and for at least 24 months was 63 %. Duration of Norplant use was not found to differ with respect to age, prior contraceptive use, or timing of insertion, but it was significantly shorter among those with a prior pregnancy than in those who had never been pregnant. CONCLUSION: These findings suggest that a group of young women who are likely to continue use of a contraceptive implant (with or without treatment for side effects) are those who have never been pregnant.

Adolescent↗
PubMed1982

Intrauterine devices: insertion and removal: practical procedures.

Intrauterine devices (IUDs) remain a popular and common method of contraception in Australia. Their insertion and removal are commonplace in general practice. Dr Ken Waldron believes the success of the IUD depends, in part, on observing correct insertion techniques.

Female↗
PubMed1991

A pilot study on family spacing attitudes and practices in rural Gezira.

The attitudes towards, and practice of, modern contraception among the rural population of the Gezira area of the Sudan were analyzed using a structured questionnaire. This was part of a comprehensive community survey carried out by the Faculty of Medicine, University of Gezira, Sudan, as part of a rural development program. Eight villages belonging to the Sennar Sugar Scheme were included in the survey. The result showed a low percentage of contraceptive users in all villages. The main reasons given by mothers for not using contraceptives were that contraceptives were against religion, mothers had not heard about them, mothers wanted more children, and contraceptives were not available. These villages were also characterized by high illiteracy rate and large family size. There is a need for health education concerning child spacing. This should be combined with religious education by religious leaders to remove misunderstandings concerning modern contraceptive use. Adult education programs, especially for females, will also have an impact.

Attitude to Health↗
PubMed1989

[Long-term follow-up of women treated with contraceptive implants of levonorgestrel Norplant].

This report describe the long-term follow-up of 376 women who received Norplant implants in the period october 1974 through may 1979. One-hundred-and-ten subjects received replacement implants after variable lengths of use of the first set. The average levonorgestrel plasma levels declined steadily through eight years of use of Norplant capsules (r = -937). Values were 0.35 ng/ml, 0.29 ng/ml and 0.22 ng/ml at treatment years 1, 5 and 8, respectively. Levonorgestrel plasma levels after replacement with a second set of implants were similar to those observed after the first insertion, either when placed in the same site as the first set or in a different area. The levonorgestrel half-life after implant removal was 42 +/- 16 h (X +/- S.E.) and only trace amounts are detected after 96 h. Nineteen pregnancies occurred during 18,530 woman-months of use of the first set of implants, eleven of them during years 6 through 8 of treatment. The Pearl Index for the first years of Norplant implants use was 0.63. No pregnancy has occurred in 5.020 woman-months observed during treatment with a second set of capsules. Fifty-six women (14.9%) out of 376 acceptors of the first implant and 12 (10.9%) out of 110 acceptors of the replacement implants were terminated for other medical reasons, mainly side effects commonly associated with hormonal contraception. Removals for bleeding problems occurred in 5.6% and 3.6% of the acceptors of the first and second implant, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Ultrasonography: usefulness in localization of the Norplant contraceptive implant system.

Norplant is a levonorgestrel-containing contraceptive system that consists of six small capsules (2.4 x 34 mm), which are placed subdermally. Owing to the relative newness of this contraceptive modality, problems with removal of the Norplant implants are just beginning to be reported; these consist primarily of inability to locate and remove all six implant capsules upon discontinuation. Ultrasonographic images of 14 women with the Norplant system in place were obtained in the axial and longitudinal planes. On axial view the capsules consisted of discrete circular individual areas of high echogenicity with prominent posterior shadowing. Capsules scanned in a longitudinal plane demonstrated echogenicity of the superior and inferior capsular walls, giving a tubular appearance. It was possible to demonstrate the depth of capsule placement, spatial relation to surrounding capsules, and orientation in relation to the skin surface. Ultrasonography therefore may provide a useful, noninvasive method for localization of nonpalpable Norplant implants, thus facilitating removal.

Arm↗
PubMed2000

Insertion and removal of Implanon: practical considerations.

Implanon, a novel contraceptive implant containing the progestogen, etonogestrel (68 mg), provides highly effective, well-tolerated contraception for up to 3 years. Its single-rod design, semi-rigid polymer base and convenient pre-loaded presentation mean that Implanon has potential insertion and removal advantages over the six-capsule Norplant implant. Insertion of Implanon is simple: the applicator needle is positioned subdermally and the cannula is withdrawn, leaving the implant rod in place. Implanon is removed using the 'pop out' technique, involving a 2-mm incision. A meta-analysis of data from seven open-label, randomized studies in 1,378 women compared the ease of insertion and removal of the Implanon and Norplant implants and the frequency of associated complications. It was approximately four times quicker to insert and remove Implanon than Norplant (mean insertion times 1.1 vs. 4.3 min, respectively; mean removal times 2.6 vs.10.2 min, respectively). Insertion complications were very rare with both Implanon (0.3%) and Norplant (0.0%). However, Implanon was associated with a significantly lower frequency of removal complications (0.2 vs. 4.8% with Norplant; p < 0.001). Implant site abnormalities were uncommon. The simplicity of the insertion and removal procedures with Implanon may have significant implications for contraceptive implant training programs and user counselling.

Contraceptive Agents, Female↗
PubMed1994

Analysis of polymorphic variation in drug metabolism: III. Glucuronidation and sulfation of diflunisal in man.

The urinary excretion of diflunisal (D) and its metabolites diflunisal sulfate (DS), diflunisal phenolic glucuronide (DPG), and diflunisal acyl glucuronide (DAG) were measured in 110 healthy, drug-free Caucasian volunteers given 50 mg of diflunisal by mouth. When expressed as fractional recoveries, DS, DPG, and DAG were strongly negatively correlated with one another. Metabolic ratios, on the other hand, correlated positively and tended to localize variability within a single enzyme pathway. Thus, females using estrogen-containing oral contraceptives were shown to excrete 50% less DS and 20% more DAG than non-users, and recoveries of DS were reduced by about 30% in cigarette smokers. Kernel density analyses of the log metabolic ratios of DS and DPG were broad-based and unimodal. However, kernel density estimates of the distribution of log metabolic ratios of DAG showed 3 peaks, 1 of which (an extensive metabolizer polymorph) could be removed by excluding contraceptive-using females. Similarly, there were 2 poor metabolizer peaks in the distribution of log metabolic ratios of DS attributable to cigarette smoking and, in females, use of an oral contraceptive. Thus, we conclude that the metabolism of diflunisal is altered by cigarette smoking and oral contraceptives, and that kernel density estimation, as applied to log metabolic ratios, is a sensitive and specific method for detection of polymorphic variation in drug metabolism.

Adolescent↗
PubMed1999

Pelvic actinomycosis: a review and preliminary look at prevalence.

A review of the literature on pelvic actinomycosis reveals that actinomycetes normally reside in the female genital tract. Therefore the identification of actinomycetes in the vagina or cervix by any laboratory technique, including Papanicolaou smears with specific immunofluorescence or culture, is not diagnostic of any disease and is not predictive of any disease. The evidence strongly suggests that removal of the intrauterine contraceptive device of a patient with a positive culture is not necessary and that, in the absence of evidence for pelvic infection, antibiotics are not required. Pelvic actinomycosis is a rare disease whose pathogenesis is poorly understood.

Actinomyces↗
PubMed1990

A comparative evaluation of the Multiload 250 and Multiload 375 intra-uterine devices.

The experience of 1254 women who had Multiload 250s (MLCu250) and 754 women who had Multiload 375s (MLCu375) inserted by the author was evaluated. The performance of the two Multiload models was similar over 4 years of use, except for a significantly lower (p less than 0.05) pregnancy rate for the MLCu375 (4-year cumulative life table rates: 3.0 vs 5.4 per 100 women). Use of the MLCu250 and MLCu375 provided women with a very safe method of contraception. Many of the removals for medical reasons other than bleeding, pain or pelvic inflammatory disease (PID) appeared to be unrelated to IUD use. Thirty-nine women had their IUDs removed for suspected PID, but the diagnosis of PID was confirmed in only 44% of these cases. The overall rate of confirmed cases of PID was 0.3 per 100 woman-years. Except for a higher rate of PID during the first few months of Multiload use, the results of the study did not indicate that IUD use is associated with an increased risk of PID. Multiload use did not impair future pregnancy or affect the outcomes of these pregnancies.

Adult↗
PubMed2003

An unusual cause of vesical stone: a migrant intrauterine device.

Intrauterine contraceptives devices have been in use for many years. Although perforation of the uterus by an intrauterine device is not uncommon, intravesical migration with secondary stone formation is a rare complication. We report on a 32-year-old woman in whom an intrauterine contraceptive device (Copper T) migrated from her uterus into the bladder. She had lower urinary tract symptoms for nearly 2 years but sought no treatment. The onset of hematuria and fear of cancer prompted her to seek treatment. On investigation, a vesical stone was discovered that had formed on a copper T contraceptive device. It was removed via suprapubic cystostomy. In any woman in whom an intrauterine device is fitted and who presents with lower urinary tract symptoms, the possibility of intravesical migration of the device should be included in the differential diagnosis.

Adult↗
PubMed1978

Production of fibrinolytic enzymes by macrophages on intrauterine contraceptive devices.

Intrauterine contraceptive devices (IUCDs) were removed from 44 patients with a variety of clinical conditions, and incubated in culture media. Following incubation for up to 96 hours the total numbers of macrophages on each device were counted. The Lippes loop and Saf-T- Coil had higher counts than the Copper 7. The counts on all devices were higher at mid-cycle and during menstruation and significantly higher in patients with menorrhagia and intermenstrual bleeding (P less than 0.0005). Samples of culture media were taken on a number of occasions for up to 96 hours for fibrinolytic studies, and fibrinolytic activity increased with time in 10 of 16 cases where fibrinolytic activity was detected. There was a weak positive correlation between the number of cells on each of the 10 devices which produced a rise in fibrinolytic activity and the highest level of activity produced by each of the devices (r = +0.59; P less than 0.05). Plasminogen activator activity was maximum early in the incubation period, while plasmin-like activity predominated in later samples. The possible role of macrophages in IUCDs in causing menorrhagia is discussed.

Cell Count↗
PubMed1994

Obstacles to use of hormonal contraception.

Enabling women to control the timing of their childbearing has positive consequences on their physical and mental well-being as well as for society as a whole. Identifying and removing the obstacles to effective contraceptive use, coupled with improvements in the delivery of contraceptive services, must be given high priority from all sectors, both private and governmental. The consequences to a woman of an unintended pregnancy can be physically, psychologically, and economically far-reaching. Assisting women to control the timing or spacing of their childbearing or to help women effectively prevent any future childbearing is a challenge that must be addressed by health professionals and educators. Therefore identification of women who are at risk of unintended pregnancy as a result of inadequate use of contraception, lack of its use, or use of inappropriate methods is important to help women and couples achieve their reproductive goals as well as to reduce the high rate of unintended pregnancy in the United States. In addition, overcoming common obstacles to effective contraceptive use as well as those within the health service delivery arena will enable women to take better control of and improve their lives.

Contraception↗
PubMed1990

Insertion and removal of intrauterine devices.

Although intrauterine contraceptive devices are becoming less commonly used, all general practitioners need to be able to counsel patients about their use. A practical outline of the recommended regimens is provided in this article.

Family Practice↗
PubMed1987

A new delivery system for contraceptive steroids.

Long-acting forms of contraception that take advantage of the tissue compatibility of silicone rubber, a polymer of dimethylsiloxane, have been developed. The most advanced type of subdermal contraceptive capsule contains about 36 to 40 mg of levonorgestrel and is 30 mm in length and 2.4 mm in diameter (Norplant). The set of six implants is placed under the skin of the upper arm with a 10-gauge trocar with the use of a local anesthetic. The basis for the antifertility effect of these implants is continuous, low-dose progestogen therapy without the use of estrogen. The capsules release a total of approximately 39 micrograms of levonorgestrel each day. The blood progestogen level achieved through this microabsorption delivery system is 0.25 to 0.3 ng/ml. There is a sufficient supply of steroid in the capsules to maintain this blood progestogen level for 5 to 6 years. Since the capsules can be removed at any time, this contraceptive method is voluntarily reversible. The effectiveness of these subdermal implants has been evaluated in long-term studies that have progressed for well over 5 years. Therefore one clinic visit eliminates nearly 2000 days of concern over having to remember to take a pill on schedule. There has been sufficient experience to assure that fertility recurs promptly after removal of the subdermal implants.

Clinical Trials as Topic↗