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PubMed1975

Menstrual regulation in family planning services.

Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.

Abortion, Induced↗

PubMedDate not supplied

Menstrual regulation and the law.

The advent of menstrual regulation techniques has further clouded the once-clear legal distinction between contraception and abortion. This study, which attempts to assess the relationship between menstrual regulation and abortion laws throughout the world, focuses on the three distinct types of abortion laws that impinge on menstrual regulation practice: (1) those that focus on the "intent" to interrupt pregnancy, (2) those that require proof of pregnancy and (3) those that make abortion readily accessible for a wide variety of indications.

Abortion, Induced↗

PubMed1978

Menstrual regulation in Ibadan, Nigeria.

Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.

Adult↗

PubMed1985

Comparison of intramenstrual IUD insertion with insertion following menstrual regulation.

To evaluate the use-effectiveness and safety of IUD insertion immediately after menstrual regulation (MR) for delayed menses, a Lippes Loop D (LLD) intrauterine device was inserted in each of 100 consecutive clients at the University College Hospital, Ibadan, immediately after menstrual regulation. Pertinent event rates after 12 months of use were compared with those of 100 consecutive women who had the LLD inserted during menstruation. The cumulative net expulsion rate after 12 months of use was 8% for the study group and 4% for the controls. The overall rate of removals was 15% for the study group and 16% for the control group. None of the observed differences was statistically significant. The continuation rates at 12 months were comparable for both groups (78% and 80%, respectively). There were no accidental pregnancies during the study period. The authors suggest that IUD insertion immediately after menstrual regulation is as effective and safe as intramenstrual insertion, provided prophylactic antibiotics are given.

Adult↗

PubMed1980

Disposable menstrual regulation kits in a non-throw-away economy.

The directions for use that are packaged with plastic menstrual regulation kits state that the kits are designed to be durable for approximately 50 procedures when used as directed. However, in much of the developing world, directions for use are ignored, equipment is not maintained properly and nothing (including disposable medical equipment) is discarded until it is unless. Therefore, it is of interest to know for how many procedures the disposable menstrual regulation kit can safely be used. This paper describes a study conducted in Singapore to determine the durability of three menstrual regulation kits manufactured by different companies and comments on how cleaning and sterilizing affects the durability of these kits.

Developing Countries↗

PubMed1988

Menstrual regulation in Bangladesh: an evaluation of training and service programs.

This article evaluates the performance of three urban menstrual regulation (MR) training and service programs in Bangladesh. Virtually all of the MR providers including physicians and paramedics in the three centers received training in various MR procedures by means of demonstration or class lectures. However, a significant proportion of the trained MR providers were unable to render proper MR services due to the lack of clinical facilities and lack of equipment. Analysis of follow-up data for MR clients revealed that those women who utilized MR procedures offered through the centers had an average of about three live births. Physician providers were more likely to serve clients from a higher socioeconomic strata, while paramedical providers were more likely to serve MR clients from lower socioeconomic strata or agricultural background. Most of the clients receiving MR services were ever and current users of contraceptives and developed fewer complications from MR procedures than those served by untrained traditional herbalists, healers or birth attendants.

Adult↗

PubMed1995

Menstrual regulation by mifepristone plus prostaglandin: results from a multicentre trial. World Health Organization Task Force on Post-Ovulatory Methods of Fertility Regulation.

A multicentre trial was conducted to evaluate whether a combination regimen of a 600 mg dose of the antiprogestogen, mifepristone, followed 48 h later by a 1 mg vaginal suppository of the prostaglandin analogue, gemeprost, could be an effective pharmacological method for menstrual regulation. A total of 228 women with menstrual delay of < or = 11 days were studied in nine centres; 35 of the women (15%) received the treatment without having been pregnant as determined by human chorionic gonadotrophin measurements performed retrospectively. The mifepristone-gemeprost regimen induced vaginal bleeding in all of the pregnant women and in all but two of the non-pregnant women, and a complete abortion in all but four of the 193 pregnant subjects. The four failures included one incomplete and two missed abortions and one continuing live pregnancy. Most women reported lower abdominal pain during the first few hours after gemeprost administration but few, if any, other side-effects were observed. Most non-pregnant women described the induced vaginal bleeding to be comparable with--albeit somewhat longer than--a normal menstruation. In pregnant women the duration of the bleeding was on average longer, and the amount greater, than normal menstruation, but haemoglobin concentrations in these women as well as in the non-pregnant subjects were not affected. The overall success rate (97.4%; 95% confidence interval: 94.4-99.0%) of the regimen employed in this pilot trial strongly suggests that the combination of an antiprogestogen followed by a suitable prostaglandin is potentially useful for menstrual regulation and probably also as a late luteal, once-a-month contraceptive.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗

PubMedDate not supplied

Sequential hormone measurements after menstrual regulation in normal Nigerian women.

The objective of this study was to examine the dynamics of the pituitary hormones (LH, FSH and Prolactin) and Progesterone in normal adult Nigerian women during the first cycle after a menstrual regulation for delayed periods. Hence, eleven healthy volunteers aged between 19 and 35 years were recruited. All the subjects had consulted the Family Planning Clinic for menstrual regulation. Venepuncture was performed immediately before and every other day after the procedure until the onset of the first menstrual period. Serum from the samples were stored at -20 degrees C and later assayed for LH, FSH, Prolactin and Progesterone. The results showed that nine patients (82%) had a demonstrable LH peak whilst seven patients (64%) had a luteal phase serum progesterone in excess of 6 nmol/l. These criteria were used for the diagnosis of ovulation. The combination of two or three indices i.e. LH + FSH peak (64%) LH + Progesterone (64%) LH + FSH + Progesterone (55%) did not seem to confer any special advantages in terms of the diagnosis of ovulation. These results are considered as further evidence for the need to provide contraception in the first cycle after an abortion in women who do not wish to get pregnant immediately.

Abortion, Spontaneous↗

PubMed1984

Menstrual regulation and contraception in Bangladesh: competing or complementary?

To examine the relationship between menstrual regulation (MR) and subsequent use of contraception in Bangladesh, we studied the birth control practices of a 6-month cohort of 4359 family-planning acceptors in a family-planning clinic in Dacca. We compared their use of birth control measures before and after MR. We attempted to examine the subsequent pregnancy and induced-abortion rates of 1671 of these women through a 3-year non-concurrent prospective study. Of those 1172 made their first visit to the clinic to obtain an MR and the remaining 499 women, who served as a comparison group, made their first visit to obtain contraceptive services not associated with MR. Three years' followup data were available for 558 women in the MR group and 228 women in the comparison group. Based on these data, the 3-year pregnancy rate for the MR group was 37.6/100 women and the induced abortion rate was 4.3/100 women. The 3-year pregnancy rate for the comparison group was 39/100 women and the induced abortion rate was 3.5/100 pregnancies. Thus, during a 3-year period women in the MR group did not obtain abortions significantly more often than women in the comparison group.

Abortion, Induced↗

PubMed1978

Menstrual regulation by mean of endometrial aspiration.

The results of menstrual regulation performed in 181 cases of supposed pregnancy are described. In 166 cases (92%) pregnancy could be interrupted without dilatation of the os uteri and only in 15 cases (8%) was it necessary to dilate the cervical canal by 8.5--9.0 H units. The majority of pregnancies was interrupted by means of vacuum aspiration and only in 15 cases was curettage performed because of a supposed residue. In the postoperative period slight blood discharge occurred in 2 cases and in 1 case the choriodecidual residue had to be removed by curettage one week after vacuum aspiration. The advantage of the method are particularly remarkable in the interruption of the first pregnancy since it can be carried out without an injury to the cervical canal.

Abortion, Induced↗

PubMedDate not supplied

Innovations in reproductive health care: menstrual regulation policies and programs in Bangladesh.

Although abortion is legally restricted in Bangladesh, early menstrual regulation (MR) as a means of reducing female morbidity and mortality associated with indigenous abortion has been part of the government's health and family planning efforts since 1975. Approximately 3,000 doctors and 2,600 female family planning workers (Family Welfare Visitors) have been trained in techniques of MR in a program intended ultimately to serve rural populations in all areas of the country. This paper assesses MR training and service programs in Bangladesh for their capacity to provide high quality reproductive health care for very poor women who are trying to control their fertility. Among other advantages, MR programs serve as an entry point for many women to contraceptive services and to maternal health care.

Abortion, Induced↗

PubMed1977

Menstrual regulation: risks and "abuses".

The definitions, methods, and techniques of menstrual regulation (MR) are presented. The risks and abuses of performing MR by vacuum aspiration to terminate pregnancies of less than 7 menstrual weeks are reviewed.

Abortion, Induced↗

PubMedDate not supplied

Menstrual regulation with prostaglandin analogues.

The development of generally applicable, simple non-surgical methods for menstrual regulation has been desired for a long time. Such an approach to fertility control depends on the availability of a suitable therapeutic agent that should be effective, reliable, simple to administer and free from disturbing side effects. The classical prostaglandins have shown the capability but are unsuitable mainly due to high incidence of side effects. Most of these drawbacks seem to be overcome when prostaglandin analogues are used; however, vaginal administration caused appreciable pain in 10-30% of women, and so severely limits self-administration of these analogues.

Abortifacient Agents↗

PubMed1989

Menstrual regulation by intramuscular injections of 16-phenoxy-tetranor PGE2 methyl sulfonylamide (sulprostone). A multicentre study. World Health Organization.

In a previous study we have shown that three intramuscular injections of 0.5 mg of the prostaglandin analogue, sulprostone (16-phenoxy-W-17,18,19,20-tetranor PGE2 methyl sulfonylamide), were equally effective as vacuum aspiration for menstrual regulation in women with a delay of up to 21 days in the onset of expected menses. To assess whether lower doses of the prostaglandin could be effective if treatment were restricted to women with a delay of menses of up to 14 days, a multicentre trial investigated the effect of two injections of 0.25 mg sulprostone given with a 4-h interval. After an interim analysis showed a clinically unacceptable low rate of complete abortion (41%) amongst the 64 pregnant women thus treated, the dose was doubled to two injections of 0.5 mg. In the group of 51 pregnant women treated with the increased dose, the frequency of complete abortion (67%) was significantly higher although still well below the 91% success rate achieved in our previous study. Both the duration and the subjective vaginal blood loss were greater in women with complete abortion than in those with incomplete abortion or continuing pregnancy. It is concluded that the sulprostone dose used in our previous study (3 x 0.5 mg) represents the minimal, required dose for menstrual regulation.

Abortifacient Agents↗

PubMed1984

Menstrual regulation with prostaglandin (Pg ONO 802) in Indonesia.

This study was conducted to evaluate the safety, efficacy and acceptability of PGE1 vaginal suppositories (Pg ONO 802) in menstrual regulation. Each vaginal suppository contains 1 mg of 16,16 dimethyl-trans-delta 2 PGE1 methyl ester. Five suppositories were inserted as high as possible into the fornix posterior of the vagina at intervals of 3 h. Five hundred thirty four subjects with delay of menses mostly of up to 14 days were included in the study. Blood chemistry was evaluated and urine analysis performed in all subjects. Success of treatment was assessed on two alternative groups of criteria: (A) induction of bleeding by Pg ONO 802; (B) induction of bleeding achieved by Pg ONO 802 and not followed by surgical intervention. The success rate based on criteria A was 98.9%, and on criteria B 86%. If heavy bleeding occurred and signs of pregnancy were found during the trial period, intervention was made by vacuum aspiration or curettage when necessary. If bleeding did not occur and/or pregnancy continued, treatment was declared a failure and pregnancy was terminated by vacuum extraction or curettage. For non-pregnant subjects no intervention was made but careful re-evaluation was carried out. Mean duration of bleeding after Pg ONO 802 treatment was 6.7 days. Side-effects were generally mild. The incidence of diarrhea was 8.8%, nausea 7.8%, headache 5.8%, vomiting 2.8%; abdominal cramp occurred in as many as 66% of subjects. No treatment was given for these side-effects as they were within acceptable limits.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗

PubMedDate not supplied

Menstrual regulation training and service programs in Bangladesh: results from a national survey.

Using nationally representative sample survey data collected in 1986, this study evaluates the training and service programs for menstrual regulation (MR), and estimates the number of MR procedures performed during 1986, in Bangladesh. The results show that most of the MR providers, who received either formal or informal training, were physicians and family welfare visitors (paramedics) employed by the government. They were trained in various aspects of MR performance, including contraindications and complications associated with MR, the techniques of MR performance and follow-up procedures, and maintenance and sterilization of MR equipment. Averages of 20.5 and 13.0 MR procedures were performed by formally and informally trained physicians, respectively, in the three-month period preceding the date of interview. The corresponding average numbers for formally and informally trained family welfare visitors were 11.6 and 9.1, respectively. A total of 241,442 MR cases were estimated to have been performed between August 1985 and July 1986.

Abortion, Incomplete↗

PubMed1988

A study of costs and behavioral outcomes of menstrual regulation services in Bangladesh.

This paper reports the results of a program evaluation of menstrual regulation (MR) services provided by the Bangladesh Women's Health Coalition, a nongovernmental organization formed in response to a concern about the availability of quality MR services to Bangladeshi women. The program emphasizes individual counseling which stresses informed choice in reproductive health care. The evaluation examines the cost of this process as a function of behavioral outcomes which include the percentage of clients who are post-MR contraceptive acceptors and the percentage which return for follow-up care and consultation 2 weeks after the procedure. The average cost per post MR contracepting client is $3.75; the average cost per returning client is $5.68, figures which appear to be well within the range of costs reported by family planning programs in developing countries.

Bangladesh↗

PubMed1978

Evaluation of 496 menstrual regulation and abortion patients in Calcutta.

From March to December 1975, 496 patients were studied to compare the safety and effectiveness of menstrual regulation (MR) performed with a Karman hand syringe and first trimester abortion performed with an electric vacuum aspirator. All procedures were done on an outpatient basis. The complication rate for the MR patients was significantly lower than that for the other first trimester abortion patients. Study results indicate that MR with the Karman syringe is a safer, simpler and less costly procedure than first trimester abortion with the electric vacuum aspirator. Further research and study are necessary to determine the effect of the initial and repeat MR procedures on women's menstrual patterns and future pregnancies, including any subsequent prematurity, stillbirths and Rh immunization.

Abortion, Induced↗