contraceptives--postcoital and Signs-and-Symptoms

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

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

During a 9-month period, 84 female patients received post-coital contraception consisting either of an association of ethinyl estradiol/norgestrel or of danazol, in order to compare the safety and any adverse reaction of these 2 treatments. Overall, the patients treated with danazol presented 1/3 as many side effects. Nausea was reduced to 1/3 in frequency and vomiting to 1/9 in this group. 5 pregnancies were confirmed in the ethinyl estradiol/norgesterol group and 2 in the danazol group. Although more cases are needed, it would appear that danazol is characterized by greater efficacy and patient acceptability.

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Digestive System; Endocrine System; Ethinyl Estradiol; Family Planning Services; Hormones; Nausea; Norgestrel; Physiology; Signs and Symptoms; Vomiting

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

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

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