contraceptives--postcoital and Pelvic-Inflammatory-Disease

The aim of this chapter is to review the worldwide use of intrauterine devices (IUDs) for contraception and the long-term contraceptive efficacy and safety of copper-bearing IUDs. The TCu380A and Multiload Cu375 have a very low failure rate (0.2-0.5%) over 10 years. The main concerns of the use of IUDs are risk of pelvic inflammatory diseases and increased menstrual blood loss and irregular bleeding. Factors associated with an increase in risk of pelvic inflammatory diseases are discussed. Preventive measures can be taken with careful screening of eligible IUD users, technical training and adequate service facilities for provision of IUDs. Levonorgestrel-releasing IUDs have the benefit of reducing menstrual blood loss in addition to high contraceptive efficacy. The copper IUD is the most effective method for emergency contraception. It can prevent over 95% of unwanted pregnancies within 5 days of unprotected intercourse.

Topics: Contraceptives, Postcoital; Female; Humans; Intrauterine Devices, Copper; Menorrhagia; Oligomenorrhea; Pelvic Inflammatory Disease; Reproductive Medicine; Treatment Outcome

Topics: Abnormalities, Drug-Induced; Arrhythmias, Cardiac; Breast Neoplasms; Contraception; Contraceptive Devices; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Estradiol Congeners; Female; Humans; Intrauterine Devices; Lactation; Male; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Progesterone; Progesterone Congeners; Prospective Studies; Spermatocidal Agents; Thromboembolism; Time Factors; Uterine Cervical Neoplasms

Topics: Animals; Carcinoma; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Corpus Luteum; Embryo Implantation; Female; Humans; Intrauterine Devices; Lactation; Male; Medical Laboratory Science; Methods; Ovulation; Ovum; Pelvic Inflammatory Disease; Pheromones; Pregnancy; Progestins; Semen; Spermatogenesis; Spermatozoa; Sterilization, Reproductive; Technology, Pharmaceutical; Therapeutic Irrigation; Thromboembolism; Uterine Cervical Neoplasms

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

Topics: Adolescent; Adult; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Female; Humans; Intrauterine Devices; Intrauterine Devices, Copper; Male; Pelvic Inflammatory Disease; Pregnancy; Risk; Sexual Abstinence

71 women who presented on or after the 6th day following unprotected coitus were fitted with a copper-containing IUD. There were no postcoital contraceptive failures or later method failures in the 64 women who have been followed up. Medical removal due to bleeding, and requests for device removal, reached 46% within 6 months. Delayed postcoital IUD insertion appears to be a safe, effective procedure in skilled hands and may help avoid pregnancy termination.

Topics: Age Factors; Chemical Phenomena; Chemistry; Contraception; Contraceptives, Postcoital; Copper; Evaluation Studies as Topic; Family Planning Services; Inorganic Chemicals; Intrauterine Devices; Menstrual Cycle; Metals; Metrorrhagia; Pain; Parity; Pelvic Inflammatory Disease; Therapeutics

After the development of postcoital hormonal interception, the postcoital use of IUDs to prevent pregnancy was proposed by Tatum. The major advantage of this treatment is that it avoids the use of the usual massive dose of estrogens (a very effective postcoital method) which is associated with nausea and vomiting. This is the 1st method to be effective up to 5 days after exposure, 3 days more than the estrogen treatment. It may also provide long-term contraception in women who wish to continue using the IUD. A major disadvantage of postcoital IUD use is that IUD insertion can produce serious complications if a patient has a vaginal or venereal infection or an asymptomatic cervicitis or even pelvic inflammatory disease (PID). After proper physical examination, suitable patients are selected from those requesting postcoital treatment. Cases involving rape are mostly excluded from these services; but, if they present early, proper work up and treatment can be performed within the time span of 5 days available for this method and it will still be possible to fit a postcoital IUD. The potential risk of future infertility should be considered as PID rates in nulliparous IUD users are up to 7 times higher than in nonusers. Young nulliparous, sexually active women--especially of the lower socioeconomic strata--are identified as high-risk patients. Over 70% of women requesting interception are nulliparous. Clients asking for postcoital insertion should be informed of its potential risk, as women under 25 years of age are more prone to infection. The risk of septic abortion exists if an IUD is inserted into a gravid uterus due to pregnancy resulting from unreported previous sexual intercourse. Septic abortion is a life-threatening condition. Out of several series, no pregnancies are reported in the month of treatment. The IUD preferred is the Multiload copper IUD or the copper T; the highest expulsion rate proved the Copper-7 Gravigard (Cu-7) inefficient. In suitable circumstances, the IUD can be the 1st choice in postcoital interception.

Topics: Age Factors; Contraception; Contraceptives, Postcoital; Copper; Evaluation Studies as Topic; Family Planning Services; Intrauterine Devices; Intrauterine Devices, Copper; Parity; Patient Acceptance of Health Care; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Research; Therapeutics

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 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