contraceptives--postcoital and Disease

This multinational clinical trial compared the efficacy and side effects of single doses of 600 mg, 50 mg, and 10 mg of mifepristone in emergency contraception when given within 120 hours (5 days) of unprotected coitus. A total of 1717 women from 11 family clinics in six countries (Australia, China, Finland, Georgia, UK, US) were enrolled and randomly assigned to the 3 treatment groups (559 to 600 mg, 560 to 50 mg, and 565 to 10 mg). The study revealed that mifepristone treatment prevents 85% of expected pregnancies. It was also found that proportions of pregnancies were similar in the 3 treatment groups; 1.3% in the 600-mg treatment group, 1.1% in the 50-mg group, and 1.2% in the 10-mg group. Delayed menstruation was seen as the most significant side effect of the treatment (P 0.01) and was more likely to occur in women receiving the 600-mg treatment (36%); it occurred in about 23% of the women receiving 50 mg and in 18% of the women receiving 10 mg of mifepristone. Moreover, bleeding within 5 days of treatment was found to be significantly associated with the treatment dosage. Overall, bleeding occurred in 15%, 31%, and 35% of women who received 10 mg, 50 mg, and 600 mg of mifepristone, respectively. Other dose-related reactions included fatigue, weakness, nausea, vomiting, headache, and dizziness.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Disease; Endocrine System; Family Planning Services; Hemorrhage; Hormone Antagonists; Hormones; Menstruation Disturbances; Mifepristone; Physiology; Research; Signs and Symptoms

This article answers some questions about use of emergency contraceptive pills (ECP) in the US. It is acceptable to prescribe ECPs over the telephone. ECPs should not be given to women with severe migraine headaches with neurologic impairment. ECPs are acceptable for women who are smokers and over 35 years old, diabetics with vascular disease, women with a history of severe migraine, and women with a benign or malignant liver tumor. Women who seek ECPs over 72 hours after unprotected sexual intercourse could have ECPs, insertion of a Copper T380 IUD, or Ru-486, when available in the US. Lo-Ovral4+4 is the preferred ECP. Ovral2+2 is less often available and tends to cost more. An ECP prescription might indicate Phenergan (25 mg), 4 tablets, taken between 6 and 7 PM, and repeated in 12 hours. Another ECP prescription might indicate Lo-Ovral (21-pill pack), 4 tablets taken one half hour after anti-nausea medication, and repeated in 12 hours. If nausea is severe from the first or second dose of Lo-Ovral, an extra tablet of Phenergan may be taken. For continued contraception, the patient should be prescribed a low-dose pill and not a 50 mcg pill. The most common transition from ECP combined pills to regular oral contraception is to prescribe 4 tablets followed by 4 tablets 12 hours later, and to start a new package of pills the Sunday after menstruation begins. Nonlapsed pill taking involves taking the 4 tablets, followed by 4 tablets in 12 hours, and 1 tablet taken daily for the next 13 days (with backup contraception the first 7 days), and a lapse for 7 days. Nothing needs to be done for vomiting. Women are not likely to abuse this option. It should be widely known and appreciated that mistakes do happen, emergency contraception does work, and women should be aware of ECPs. 98% of women bleed by 21 days after ECP use. There appears to be no increased risk of birth defects among pill users who become pregnant.

Topics: Americas; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Delivery of Health Care; Developed Countries; Disease; Drug Prescriptions; Family Planning Services; Health Planning; Health Planning Guidelines; Migraine Disorders; North America; Organization and Administration; United States; Vascular Diseases

Science and modern medicine accord us many advantages, e.g., contraceptive drugs, but many people still do not use them. Contraceptive drugs include oral contraceptives and injectables. OCs are very effective and are associated with minor side effects (e.g., mood changes, breast tenderness, nausea, and changes in weight, mild headache, and spotting between periods), perhaps explaining why they are one of the most often used contraceptive in essentially every country. Women who smoke; are 35 years old; or either have or have a family history of hypertension, diabetes, cardiovascular disease and use OCs are at higher risk of a cardiovascular episode. On the other hand, OCs protect against ovarian and endometrial cancers. Research does not yet confirm or disprove their effect on breast cancer development. OCs appear not to be linked to breast cancer through age 59. Yet, studies of women 45 years old suggest that OCs increases the breast cancer risk in these women who had their first menses before age 13 and used OCs for a long time before their first pregnancy. OCs may facilitate growth of breast tumors that other causes activated, and therefore, do not likely increase the overall risk. Researchers recognize the death of knowledge about breast cancer development, so they call for more research, including basic molecular, cellular, and biochemical studies. In Nigeria, breast cancer is rare, while deaths due to pregnancy and childbirth are common, indicating that OC use can prevent many female deaths. Prolonged breast feeding; later age at first menses; earlier age at menopause; earlier age at first full-term pregnancy larger families; low fat, high fiber diets; and thinness, all of which are common in developing countries, have a protective effect against breast cancer. Further, women in developing countries begin OC use later than women in developed countries.

Topics: Africa; Africa South of the Sahara; Africa, Western; Ambulatory Care Facilities; Biology; Birth Rate; Breast Neoplasms; Communication; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Counseling; Demography; Developing Countries; Disease; Endometrial Neoplasms; Evaluation Studies as Topic; Family Planning Services; Fertility; Health Planning; Injections; Neoplasms; Nigeria; Organization and Administration; Ovarian Neoplasms; Parity; Population; Population Dynamics; Progesterone Congeners; Research; Risk Factors

RU-486's primary use as an abortifacient stirs controversy in the US. Changes in US policy have opened the door for RU-486 to be made available for research. The Population Council plans on conducting a multicenter clinical trial of RU-486 involving at least 2000 women. This is the first step to obtaining possible approval from the Food and Drug Administration. RU-486 alone has an effectiveness rate of inducing abortion between 80 and 90%. When taken 36 to 48 hours before a prostaglandin (PG) analogue, the rate climbs to about 95%. Possible side effects of RU-486 and the analogue are bleeding, abdominal pain, and cardiovascular problems (rare). More than 100,000 women in France have undergone the RU-486/PG analogue regimen. RU-486 also has contraceptive qualities. If taken every day during the week before ovulation, it prevents ovulation. 12 days of RU-486 administration followed by 10 days of administration of a synthetic progestin also suppresses ovulation. Taking RU-486 during the last 10 to 12 days of the menstrual cycle alters the endometrium, thereby preventing implantation. A single dose of RU-486 during the late luteal phase is about 80% effective at bringing on menses. The aforementioned effects of Ru-486 demonstrate that it may be an effective postcoital contraceptive. Besides, RU-486 has fewer side effects than other postcoital contraceptive regimens. Further, RU-486 softens and dilates the cervix, thus it can be used to induce labor and ease delivery. Evidence suggests that RU-486 may be used to treat hormone-dependent breast tumors, Cushing's syndrome, meningiomas, and endometriosis.

Topics: Abortifacient Agents; Abortion, Induced; Americas; Biology; Breast Neoplasms; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Developed Countries; Disease; Embryo Implantation; Endocrine System; Endometrium; Europe; Family Planning Services; France; Genitalia; Genitalia, Female; Hormone Antagonists; Hormones; Labor Stage, First; Menstruation; Mifepristone; Neoplasms; North America; Ovulation; Physiology; Therapeutics; United States; Urogenital System; Uterus

Most clinicians advise women to continue using contraception for 12 months after menstruation has ceased. Some recommend that women less than 45 years old continue contraception for 2 years after menstruation has ceased. A fertility specialist says that women can stop taking nonhormonal methods after 6 months of amenorrhea if women experience hot flushes. If there are no classic menopausal symptoms, however, they should wait for 12 months before stopping contraception use. Hormonal methods may mask menopausal signs. If a woman has no contraindications, she can use them safely until age 50, however. Women should still use contraception after menopause because irregular ovulation may occur. In older women, the most useful measure of ovarian history is perhaps a good menstrual history rather than a high level of follicle stimulating hormone. A woman needs to consider her age, health status, menstrual history, sexuality, risk of sexually transmitted diseases, past contraception use, lifestyle, obstetric history, and attitude toward abortion when choosing a contraceptive method during the perimenopausal years. Options may include male or female sterilization, combined oral contraceptives, the progestogen-only pill, Depo-Provera, IUD, female barrier methods (diaphragm, cervical cap, contraceptive sponge, and female condom), condoms, spermicides, and postcoital contraception. Assuming the mucus signs can be reliably determined, natural family planning is an alternative for some older women. Depending on coitus interruptus can be stressful for older women because it is not easy to distinguish between a possible pregnancy and an irregular menses.

Topics: Coitus Interruptus; Condoms; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Disease; Family Planning Services; Intrauterine Devices; Medroxyprogesterone Acetate; Menopause; Progesterone Congeners; Reproduction; Signs and Symptoms; Spermatocidal Agents; Sterilization, Reproductive

Over 60 million women use highly efficient and safe modern combined oral contraceptives (OCs) every day. A women who takes the oral contraceptive for 5 years before the age of 30 will actually live 12 days longer, although a woman taking the pill for the 1st time for 5 years after the age of 30 will have her life span reduced on the average by 80 days. OC related morbidity and mortality mostly occur in women over 35 who smoke. Combined low dose OCs are safe for women who do not smoke, at least to 45 years of age and probably to the menopause. The prescription of OCs is also safe to the young adolescent. The pill does not interfere with maturation of the hypothalamic-pituitary ovarian axis and does not increase the incidence of amenorrhoea, oligomenorrhoea or infertility in later life. Patients with contraindications to estrogen therapy are excluded from OC use (history of thromboembolism, major heart disease, liver disease, breast cancer). Low-dose (30-35 mcg estrogen-containing monophasic or triphasic) pills are recommended. Combined oral contraceptives contain either ethinyl estradiol (1.7 to 2 times more potent) or mestranol. After absorption the progestagens, norethisterone acetate, ethynodiol diacetate and lynoestrenol are all metabolized to norethisterone. The progestagen-only pill has about a 2% failure rate and poorer cycle control than the combined pill, but it lacks estrogenic, progestagenic and androgenic side effects. This pill is suitable for the lactating mother, for smokers over 35, for hypertensive patients, and for those with a history of thrombosis. The efficacy of the progestagen-only pill is restored in 3 days of pill taking. Postcoital contraception is an alternative: treatment can be given for at least 72 hours after intercourse. The Yuzpe method calls for the patient to take 2 combined oral contraceptive tablets containing levonorgestrel and ethinyl estradiol (Eugynon or Ovral) followed by a further 2 tablets 12 hours later. This regimen probably reduces the risk of pregnancy about tenfold and it is generally well tolerated.

Topics: Age Factors; Behavior; Biology; Breast Feeding; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Disease; Embolism; Endocrine System; Ethinyl Estradiol; Family Planning Services; Health; Heart Diseases; Hormones; Hypertension; Infant Nutritional Physiological Phenomena; Levonorgestrel; Liver Diseases; Mestranol; Morbidity; Mortality; Norethindrone; Nutritional Physiological Phenomena; Physiology; Population; Population Characteristics; Population Dynamics; Progesterone; Progestins; Smoking; Thromboembolism; Vascular Diseases

This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it can be considered if the combined OC is contraindicated, as it is more advisable than an IUD if ectopic pregnancy is feared. Barrier methods will not affect the incidence of ectopic pregnancy and may protect against pelvic infection. It is still being debated whether the absolute incidence of ectopic pregnancy in IUD users is increased. A woman has a 0.3-5% risk of having a 1st ectopic pregnancy and a 15% chance of having a recurrence when given postcoital contraception. As w

Topics: Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Demography; Diagnosis; Disease; Family Planning Services; Incidence; Intrauterine Devices; Mortality; Population; Population Dynamics; Pregnancy Complications; Pregnancy, Ectopic; Research; Research Design; Sexual Abstinence; Sterilization, Reproductive

The postcoital contraceptive is a remedial measure used when other contraceptive devices fail or no contraceptive measure was taken. 50 healthy women, aged 21 - 40, participated in a clinical study of the contraceptive efficacy and acceptibility of 0.75 mg levonogestrel taken within 8 hours after coitus in the preovulatory cycle. The subjects agreed to use condoms or a cervical cap during the experiment, but a few days before and after ovulation, only post-coital pills were used. The study lasted through 4 menstrual cycles. The 1st and 2nd cycles were used to determine basal body temperature (BBT), the 3rd cycle was the treatment period, and the 4th was the posttreatment period. During each period, the BBT was taken. 3 days before and after ovulation during the 7-day administration period, only levonogestrel was used for contraception. After each coitus, 1 pill containing 0.75 mg levonogestrel was administered within 8 hours. In the 24 hours after the 1st administration, 1 pill was administered with or without coitus. Thereafter, the participants took 1 pill after each coitus, so that the maximum number of pills did not exceed 7 in the 7 day period. Among the 50 cases, 7 took 3 pills, and 43 took 4 pills. 1 of the 7 cases failed; all the other cases succeeded. 12 subjects had side effects including nausea, dizziness, somnolence, fatigue, abdominal swelling and breast distension, but they were not serious and did not affect daily activities. 15 of the 49 participants reported an effect on their menstrual cycle, including shortened menstrual cycle (9 cases), prolonged menstrual cycle (3 cases) and breakthrough bleeding (3 cases). 41 participants reported a normal flow; 3 reported a heavier flow than usual; and 3, a lighter flow. 80% of the participants intended to use the pill again.

Topics: Age Factors; Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Disease; Economics; Endocrine System; Family Planning Services; Hormones; Levonorgestrel; Menstruation Disturbances; Physiology; Population; Population Characteristics; Reproductive Control Agents; Research; Technology

The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion.

Topics: Biology; Birth Rate; Breast; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Developed Countries; Digestive System; Disease; Embryo Implantation; Embryonic Development; Endocrine System; Ethics; Ethinyl Estradiol; Europe; Family Planning Services; Fertility; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Levonorgestrel; Menstruation Disturbances; Nausea; Netherlands; Parity; Pelvic Inflammatory Disease; Physiology; Population; Population Dynamics; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Reproduction; Signs and Symptoms; Vomiting

Current interceptive methods of contraception utilizable between ovulation and nidation include hormonal methods and IUDs. Since the 1st clinical study of the use of high doses of estrogen as a postcoital contraceptive appeared in 1967, the remarkable efficacy of the method has been confirmed by numerous other studies. The most important series used 50 mg diethylstilbestrol (DES) or 5 mg ethinyl estradiol (EE) per day for 5 days beginning within 72 hours of unprotected intercourse. The mechanism by which estrogens exercise their interception are unclear, but there are probably several factors involved including luteolysis and anomalies in endometrial development. The method is highly effective but rates of nausea, vomiting, breast tenderness, and to a lesser degree menorrhagia are high. The incidence of extrauterine pregnancy is about 1 per 10 intrauterine pregnancies for any postcoital method. Estrogen postcoital contraception is preferable to DES because of the fear of genital adenosis or vaginal adenocarcinoma in case of failure of DES. Opinion is divided as to the teratogenic risks of high doses of estrogens in general. Postcoital contraception with a progestin, levonorgestrel, which renders the endometrium inhospitable to nidation, was 1st described in 1973. The efficacy of norgestrel alone depends on the dose used. The most common secondary effects are spotting and cycle shortening. The method has the advantage of requiring a very small dose, but the disadvantage of requiring administration in the 12 hours following intercourse. Several combinations of estrogens and progestins have been proposed for postcoital use, of which the most interesting consists of 1 mg of dl-norgestrel and 100 mcg of EE repeated exactly 12 hours later. The treatment should be administered within 12 hours of unprotected intercourse. A multicenter study of 692 women treated with this method gave a pregnancy rate of 1.6%, which would have been lower if 4 women not meeting the conditions of treatment had been excluded. 52.7% of women treated had nausea or vomiting. Compared to estrogens alone, the EE-Norgestrel combination takes less time, requires 4 pills instead of 50 or 60, is better tolerated overall, and requires much less estrogen. Postcoital insertion of an IUD is very effective and has the advantages that it can be used later than 72 hours following intercourse, it is the only method currently available in case OCs are contraindicated, it allows subsequ

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Endocrine System; Estrogens; Ethinyl Estradiol; Family Planning Services; Hormones; Intrauterine Devices; Levonorgestrel; Norgestrel; Physiology; Pregnancy Complications; Pregnancy, Ectopic; Reproductive Control Agents

If used correctly, only 2 out of every 100 women using a diaphragm would conceive over a year; however, because of forgetfulness the figure increases to 19 out of every 100. With good care they can last up to 12 years. The contraceptive sponge works because of the sperm-killing ingredients in the spermicide and because it blocks the cervix. The condom may also provide some protection against a variety of sexually transmitted diseases (STDs), such as herpes and gonorrhea. Missing one day of a low-dose oral contraceptive formulation (35 mcg) will have no consequences since the pill works by keeping hormone levels in the body elevated over time. With IUDs the only potential pitfall is forgetting to check for the tail every week of the first month and once a month thereafter to be sure the IUD is still in place. Some physicians suggest using a second form of contraception for the first three months after an IUD is inserted, since the odds are slightly higher it will be dislodged during this time. The manufacturers of Cu-7's and Cu-T's, as well as most physicians, recommend replacement of this device every three years. Experts are in agreement, however, that copper-containing IUDs carry a slightly lower risk of infection than Progestasert and the Lippes Loop. For postcoital contraception douching or using a spermicide within 10 minutes may help a bit. Although an IUD insertion can prevent pregnancy 90-95% of the time if it is done within five days of unprotected intercourse, because of the infection risk, this is not recommended unless a woman is planning on leaving the device in place as a contraceptive. The morning-after pill also works by preventing implantation of the fertilized egg. Taking two within 24 hours and two more 12 hours later prevents pregnancy 90-95% of the time, possibly with mild nausea or headache.

Topics: Condoms; Contraception; Contraceptive Agents; Contraceptive Devices, Female; Contraceptives, Oral; Contraceptives, Postcoital; Disease; Family Planning Services; HIV Infections; Infections; Intrauterine Devices; Sexually Transmitted Diseases; Spermatocidal Agents; Virus Diseases

This work describes oral contraceptives (OCs) in current use and examines their risks. OC pills are composed of synthetic estrogens, usually either ethinyl estradiol or mestranol, and progestins. Either estrogens or progestins can be used alone, but combinations permit smaller doses to be used. Combined pills are available in monophasic, biphasic, or triphasic formulations. Different modalities of administration are also available for progestin-only pills. The "morning after" pill containing high doses of steroids to be taken within 72 hours of unprotected intercourse can contain either estrogen or progestin alone or combined. The mechanisms of action of OCs vary according to the type of pill. Classic combined OCs inhibit ovulation, render the cervical mucus inhospitable to sperm, and cause endometrial atrophy which hinders nidation. Low-dose pills have various effects but in general depend on changes in the cervical mucus for their contraceptive effect. Pregnancy may result from forgetting pills or using them incorrectly, or in the case of low-dose pills may occur even if they are used correctly. Some drugs can lower the concentrations of the OC hormones at the level of the receptors by hindering their intestinal absorption or by increasing the metabolic power of the liver. Considerable individual variability limits the incidence of pill failure due to drug interactions, but OC use should be avoided if rifampicine or certain other drugs are used. Among undesirable effects of OCs on endocrine glands and reproductive function are the adaptation syndrome characterized by symptoms similar to those of early pregnancy and reversible in most but not all women; galactorrhea resulting from diminished levels of "prolactin inhibiting factor"; and virilizing effects such as alopecia, hirsutism, and acne usually occurring during use of high-dose formulations. Pills should be carefully adapted to the hormonal profile of the user to avoid these side effects. OCs very rarely entail longterm infertility. OCs in current use do not appear to be teratogenic but it is advisable to wait 2 months after termination of use before becoming pregnant. Lactation is a contraindication to OC use. Combined OCs frequently cause problems in glucose tolerance of variable significance. Low-dose progestins do not seem to affect lipid metabolism, but low and normal dose combined pills may provoke increases in the levels of cholesterol and triglycerides. OCs are implicated

Topics: Biology; Cardiovascular System; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Disease; Endocrine Glands; Endocrine System; Family Planning Services; Hormones; Lipids; Liver; Metabolism; Neoplasms; Physiology; Research

The authors discuss the menstrual pattern during lactation, which lengthens the birth interval primarily by extending the period of postpartum amenorrhea. The length of postpartum amenorrhea varies greatly as it is influenced by such factors as breastfeeding practices (duration and extent of supplementry feeding); maternal constitution factors (e.g., maternal age and nutritional status); and pregnancy wastage and infant survival. Since full lactation prevents menstruation for a longer period of time than does partial lactation, supplementary feeding of suckling infants influences the return of menstruation. Also, increase in age and parity is frequently associated with longer periods of postpartum amenorrhea. It is difficult to determine if ovulation occurs during the 1st menstrual cycle after delivery or if it occurs regularly during subsequent menstrual cycles. It is assumed that the 1st 1 or 2 menstrual cycles following delivery are anovulatory, apparently in the cycle before menstruation. Thus about 1/2 of all nonlactating women are fertile before the 1st postpartum menstrual period. Ovulation is likely to precede menstruation in fully lactating women, but the longer menstruation is delayed by lactatioon, the more likely that the ust cycle will be ovulatory. The occurance of ovulation after return of menstruation is significantly higher than ovulation before the return of menstruation until 9th postpartum month during lactation. The incidence of pregnancy in fully lactating mothers is 1.3% by the 3rd postpartum month, increasing to 26% at the 12th postpartum month. The incidence of pregnancy before and after return of menstruation is significantly high. This is due to the high rate of ovulation after return of menstruation. When pregnancy rate in ovulating lactating mothers before and after return of menstruation is compared, no significant difference is detected. Also discussed are the ovulation inhibiting effects of progestational drugs (medroxyprogesterone acetate) used as a contraceptive during the postpartum period, as well as those of the nonhormonal drug, sulpiride, on the menstrual pattern during lactation. The authors' discussion refers to the results of other studies in the field.

Topics: Amenorrhea; Breast Feeding; Contraception; Contraceptives, Postcoital; Demography; Disease; Family Planning Services; Health; Hormones; Infant Mortality; Infant Nutritional Physiological Phenomena; Injections; Lactation; Maternal Age; Medroxyprogesterone Acetate; Menstrual Cycle; Menstruation; Nutritional Physiological Phenomena; Ovulation; Ovulation Detection; Parity; Population; Population Dynamics; Postpartum Period; Pregnancy; Puerperal Disorders; Reproduction; Time Factors

Low-dose progestin only contraceptive agents seem to respect the hypothalamo-hypophyso-ovarian system, thus respecting the physiology of the menstrual cycle, and to inhibit fertility simply by interfering with estrogen action at the level of the cervical mucus. The incidence of ectopic pregnancies is apparently greater with failure of this method than with failure of regular hormonal contraception. Postcoital single-dose progestin oral contraception acts at the level of the endometrium creating conditions unfavorable to nidation, and also on the cervical mucus and on the system of transport of the ovum. Both contraceptive methods are worth new and larger investigations to discover their limits and mode of action.

Topics: Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Disease; Evaluation Studies as Topic; Family Planning Services; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Progesterone Congeners

Menstrual regulation as a contraceptive method, as well as a form of early pregnancy termination, was studied in 200 patients presenting at the All India Institute of Medical Sciences Hospital for pregnancy termination. Findings supported the contention that menstrual regulation is a simple, safe, and effective procedure. Recommendations were made to incorporate the procedure into family planning services. Women were deemed eligible for the menstrual regulation study if no more than 45 days had elapsed since their last menstrual cycle and if their medical history did not contraindicate the use of the procedure. The women were given a pregnancy test prior to aspiration. The menstrual regulation procedure was performed with an electric vaccum aspirator and the patients received no anesthetic. Following the procedure the aspirate was histologically examined for pregnancy determination. Four weeks later the patients were given a pelvic examination and a urine pregnancy test. Histological examination of the aspirate confirmed pregnancy in 80.5% of the patients. When the findings were compared to the preoperative pregnancy test results, 2.5% of the pregnancy tests were false positives and 4% were false negatives. No severe complications occurred at the time of the procedure an only 2% of the patients required additional curettage. In the 4 week follow-up examination, 10% of the patients reported minor symptoms, 3% reported minor infections, and all pregnancy tests were negative. Following the procedure, 20% of the patients accepted IUDs, 15% accepted horomonal contraceptives, and the remaining 65% opted for conventional methods. Tables show 1) age distribution of patients; 2) distribution of patients by gestation and amount of aspirate; 3) accuracy of pregnancy test compared to histological findings; 4) frequency of histological findings; 5) reported follow-up symptoms for those patients who accepted IUDs and those who did not accept IUDs immediately after menstrual regulation.

Topics: Asia; Asia, Southeastern; Contraceptives, Postcoital; Developing Countries; Disease; Family Planning Services; Follow-Up Studies; General Surgery; Gynecologic Surgical Procedures; Health Planning; Histology; India; Infections; Intrauterine Devices; Menstruation; Pain; Patient Acceptance of Health Care; Pelvic Inflammatory Disease; Postoperative Care; Pregnancy; Pregnancy Tests; Pregnancy Trimester, First; Preoperative Care; Reproduction; Research; Signs and Symptoms; Therapeutics; Women

The 3 main methods of oral contraception (OC) are: 1) the sequential method, reproducing the hormonal sequence of the normal cycle; with this method the estrogen component is the one which inhibits ovulation; 2) the combined method, using estrogen and progesterone agents, and whose effectiveness is practically absolute; 3) the minipill, or low-dose progestin method. Other methods include the use of medroxyprogesterone acetate, which is 100% effective but has too numerous side effects, and the morning after pill. Estrogens utilized for OC are mestranol and ethinyl estradiol, while progestational agents can be derived from the natural progesterone, such as medroxyprogesterone, chlormandinone, and megestrol or from nor-19 testosterone. The minipill entails much fewer side effects than regular estroprogestational drugs, such as lower risk of thromboembolitic and metabolic processes; it does cause, however, a number of serious anomalies in the menstrual cycle. OC with low-dose progestin agents are recommended for women with pathologic antecedents, such as diabetes, cardiopathy, and hyperlipidemia.

Topics: Chlormadinone Acetate; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Disease; Estrogens; Ethinyl Estradiol; Family Planning Services; Injections; Medroxyprogesterone Acetate; Megestrol Acetate; Menstruation Disturbances; Mestranol; Progesterone Congeners

This discussion focuses on the presently available technology of abortion induction techniques, which, though recent scientific interest has been in abortifacient agents, still primarily consists of some variation on the ancient technique of forcible cervical dilatation and pregnancy extraction in the first trimester. With the advent of legal abortions in the United States, technology and expertise that will lower the already low rate of abortion-associated complications are of paramount importance. That abortion may be preferable to contraception as a fertility control measure is argued from the following 3 drawbacks of present means of contraception: 1) they are preventitive and must be used in advance of need; 2) they fail more frequently than is usually thought (e.g., 4% for birth control pills, 5% for IUDs, and from 17-21% for more conventional methods); and 3) they are associated, though rarely, with potentially fatal side effects such as heart attack, stroke, or infection (some also raise the incidence of pathological pregnancies). The article devotes itself to an overview of complications of induced abortions (the mortality for legal abortions is 1/100,000 vs. maternal mortality of 10/100,000 in the United States), and to discussions of appropriate evacuation procedures per gestational age. Instruments and techniques for menstrual regulation (uterine aspiration during first trimester), are discussed. Procedures and instrumentation required for standard vacuum aspiration are covered. Use of analgesics and anesthetics during abortion procedures comprises one topic, with especial focus on the use of curettage for midtrimester terminations. Midtrimester terminations by amnioinfusions of abortifacients (saline, urea, and prostaglandins, e.g.) are analyzed. And, in addition to discussing sequelae for each particular abortion type, a section is devoted to the sequelae of induced abortion for subsequent pregnancy. Though 100% effectiveness has not been achieved yet, today a procedure which is 98% effective, menstrual regulation with Karman cannula and 50-ml syringe, already exists and focus should be placed on training developing-nation practitioners to master this relatively simple, safe, effective, and inexpensive procedure.

Topics: Abortifacient Agents; Abortion, Induced; Anesthesia; Biology; Catheterization; Chemical Phenomena; Chemistry; Contraceptives, Postcoital; Curettage; Diagnosis; Disease; Endocrine System; Equipment and Supplies; Family Planning Services; General Surgery; Hormones; Labor Stage, First; Laminaria; Menstruation; Mortality; Obstetric Surgical Procedures; Oxytocin; Physiology; Pituitary Hormones; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prostaglandins; Reproduction; Saline Solution, Hypertonic; Therapeutics; Vacuum Curettage

Various postcoital contraceptive regimens are described. An antiemetic can be given to minimize the nausea and vomiting which are side effects of high-dosage estrogen. If pregnancy occurs despite treatment, the possible risk to the fetus is unknown. This method of contraception is only for emergency use. Regular contraception should be employed if sexual exposure is to be continuing.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Embryo, Mammalian; Embryo, Nonmammalian; Endocrine System; Estrogens; Estrogens, Conjugated (USP); Estrone; Ethinyl Estradiol; Family Planning Services; Fetus; Hormones; Nausea; Neoplasms; Physiology; Pregnancy; Reproduction; Signs and Symptoms; Vomiting

The current status of and prospects for contraceptive methods is reviewed. Regulations governing the development, safety, and effectiveness of contraceptive methods are discussed, as well as the nature of the female and male reproductive system. Methods reviewed include coitus interruptus, the condom, spermicidal contraceptive agents, postcoital douching, the vaginal diaphragm, male and female sterilization, the rhythm method, oral contraceptives, IUDs, induced abortion, progesterone-releasing IUDs, postcoital estrogens, abortifacient agents (prostaglandins), immunization against human chorionic gonadotropin (HCG), pharmacologic suppression of the corpus luteum, long-acting injections of Depo-Provera, implantation of capsules containing norgestrel, the intravaginal ring, intracervical devices, release of contraceptive steroids through an arm bracelet, and male contraceptive agents. New areas of contraceptive research include influencing the release of luteininzing hormone-releasing hormone, ''turning-off'' corpus luteum function in early pregnancy by competitors for HCG, affecting sperm or ovarian membranes to prevent fertilization, and interferring with sperm and egg development.

Topics: Abortifacient Agents; Abortion, Induced; Biology; Blood; Blood Coagulation; Chorionic Gonadotropin; Coitus Interruptus; Condoms; Contraception; Contraception, Immunologic; Contraceptive Agents; Contraceptive Agents, Female; Contraceptive Agents, Male; Contraceptive Devices, Female; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Corpus Luteum; Culdoscopy; Curettage; Diagnosis; Diethylstilbestrol; Disease; Economics; Electrocoagulation; Endocrine System; Endoscopy; Estrogens; Family Planning Services; Fertilization; General Surgery; Genitalia; Genitalia, Female; Germ Cells; Gonadotropins; Gonadotropins, Pituitary; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Laparoscopy; Laparotomy; Luteinizing Hormone; Membrane Proteins; Menstruation; Menstruation Disturbances; Natural Family Planning Methods; Norgestrel; Obstetric Surgical Procedures; Ovary; Ovum; Pelvic Inflammatory Disease; Physical Examination; Physiology; Pituitary Hormone-Releasing Hormones; Prostaglandins; Reproduction; Research; Spermatocidal Agents; Spermatozoa; Sterilization, Reproductive; Sterilization, Tubal; Technology; Therapeutics; Urogenital System; Vacuum Curettage; Vasectomy

The results of 2 studies on the use of high doses of progestins as postcoitum contraceptives are reported. 1 of the studies was carried out in Peru and involved 4632 women, treated for 41,802 months with single doses of 150, 250, 300, 350, and 400 mcg of D-Norgestrel, administered within 3 hours postcoitum (the doses were administered to 28, 699, 544, 559, and 2801 women, respectively). 165 unwanted pregnancies were reported; their incidence was higher among women treated with the smaller doses. The most important side effects were changes in the duration of the cycle; spotting was present in 10% of the cases and independent of the dose; liver disorders, thromboembolic accidents and breast pains were absent; treatment had to be suspended because of side effects in 5-8% of the cases. The 2nd study was carried out in Chile and involved 136 fertile women for 184 months, treated with 3 different progestins. A total of 5 pregnancies were reported and the treatment was well tolerated by all patients. Generally, it is concluded that these 1st studies suggest that high doses of progestins are effective and well tolerated postcoitum contraceptives, and side effects are less frequent and serious than those produced by estrogen preparations.

Topics: Blood Coagulation; Breast; Chile; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Disease; Evaluation Studies as Topic; Family Planning Services; Levonorgestrel; Liver; Menstruation Disturbances; Peru; Pregnancy, Unwanted; Research

To study the contraceptive effective in human beings, large doses of estrogen were administered to 2000 women between 14 and 52 years of age. In 1418 cases (71%) ethinyloestradiol (EO) was used, in 524 cases (26%) diethylstilbestrol (DS), and in 58 cases (3%) the estrogen administered was not recorded. Initially 2-5 mg of EO or 25-50 mg DS were given for 5 consecutive days. Later 5 mg EO or 50 mg DS were given for 5 days. Administration was to start within 48 hours of coitus, preferably within 24 hours. In 47.5% the unprotected coitus occurred between 12 and 16 days before the next expected menstruation, in 60.9% it occurred between 10 and 17 days, and in 9.6% (193 cases) the day of the cycle was not mentioned. There were 14 pregnancies among the 2000 women. In only 3 cases did the pregnancy occur after 3 mg doses of EO or 30 mg DS started within 36 hours. No pregnancies occurred after 5 mg EO or 50 mg DS. In 3 cases the pregnancy could have been the result of a later unprotected coitus. In another 3 cases medication was started after more than 48 hours. In cases of vomiting occurring within 1 hour after ingestion of a tablet, another tablet was given 30 minutes after an anti-emetic. If all tablets were vomited estradiol benzoate, 30 mg per day for 5 days, was injected. Other side effects were tender breasts, menorrhagia, headache, dizziness, abdominal pain, and amenorrhea. Changes in their cycle were reported by 662 women. Most stabalized after 1 cycle. Side effects prohibit this method for routine contraception but it could be valuable in special cases. There is as yet no statistical proof of its degree of effectiveness. The method of action of these drugs is not certainly known.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Embryo Implantation; Endocrine System; Estrogens; Ethinyl Estradiol; Evaluation Studies as Topic; Family Planning Services; Hormones; Incidence; Menstruation Disturbances; Physiology; Research; Research Design

122 patients with histologically confirmed squamous cell carcinoma of the cervix admitted to the gynecological wards of Charity Hospital in New Orleans from July 1, 1959, through March 31, 1960, were studied; suitable controls were selected from the same wards. All interviews were conducted by the same interviewer nurse who was unaware of the diagnoses. Hospital charts were later examined. Educational level of patients, occupation of husband and father, residence, original diagnosis, and religion were similar to those of controls. Less than 1/3 had more than grammar school education. Most husbands and fathers were farmers of unskilled laborers. In only 1/5 of the patients had the original cancer diagnosis been made by private physicians or at noncharity hospitals. About 45% were Catholics, 45% Baptists, and the remaining 10% other Protestant denominations. 49% of the patients and 43% of the controls reported 6 or more pregnancies. Douching practices were similar to controls; few had ever used other contraceptive measures. 13 patients and 6 controls had positive serological tests for syphilis. Only 6, 1 patient and 5 controls, had never been married. Of cancer patients, 47% had been married more than once vs. 16% of controls. 34% of the patients with cancer were married before the age of 17 vs. 14% of controls. 54% of patients with cancer and 26% of controls reported extramarital partners. 53% of patients had 1st coitus before age 17 vs. 26% of the controls. There was a considerably higher frequency of coitus in patients than in controls. It is concluded that no relation between number of pregnancies and cancer was shown. Douching with coal tar derivatives was not a factor. The association of carcinoma and syphilis was not certain as many had never had a serological test. The effect of circumcision of partners was not determined as it was often unknown. A significant association was shown with early marriage, extramarital relations, coitus at an early age, and frequent coitus at all ages.

Topics: Age Factors; Behavior; Birth Rate; Coitus; Contraception; Contraception Behavior; Contraceptives, Postcoital; Demography; Disease; Education; Epidemiologic Methods; Family Planning Services; Fertility; Infections; Marital Status; Marriage; Neoplasms; Parity; Population; Population Characteristics; Population Dynamics; Religion; Reproduction; Research; Sexual Behavior; Sexually Transmitted Diseases; Social Class; Uterine Cervical Neoplasms