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Women who do not have contraindications for oral contraceptives (OCs) and have experienced failure of their contraceptive method or used no contraceptive at all an use emergency postcoital contraceptive pills (ECPs). In fact, if used correctly, they could prevent 1.7 million unplanned pregnancies each year which is 50% lower than such pregnancies which already occur each year. They could also reduce the number of annual induced abortions by 50% from (1.6 million to 800,000). Various postcoital treatments in the US are 2 pills of Ovral within 72 hours of intercourse then 2 more pills 12 hours later and 4 pills of either Lo/Ovral, Nordette, Levlen, Triphasil, or Tri-Levlen followed by 4 more pills 12 hours later. Some gynecologists contend that any low-dose combined OC could be used as an ECP, but not study proves this. Besides, providers who do so risk a malpractice suit, because postcoital contraception is not on OC labels. An attorney suggests using OCs only for an emergency and to document all attempts at informed consent. Many children and clinicians have limited or no knowledge about ECPs. Those health providers who are familiar with them tend not to prescribe them because they fear legal actions. ECP side effects include severe nausea or vomiting, headache, breast tenderness,, dizziness, and fluid retention. These effects are not as great as the health risks of unplanned pregnancies, however. Yet, they are unpleasant enough to discourage repeated ECP use. Use of different methods of determining the number of pregnancies has resulted in broad ECP effectiveness rates (0-96% and 56-94%). Another analysis using combined data from the studies yielding the various results shows the effectiveness rate to be 75%. Anti-abortion groups may object to ECP use, just as they do for RU-486 which has fewer side effects, because one of its mechanisms of preventing pregnancy is it prevents implantation.
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PMID:Postcoital pills could cut unplanned pregnancies by half. 1231 83

35 predominantly multiparous, sexually active women aged 25-44 years were fitted with levonorgestrel 20 T (Schering) IUDS in the post- menstrual phase, or in rare instances, right after abortion. the devices contained 60 mg of levonorgestrel releasing 20 mcg/day with the life span of 5 years. The patients were followed up every 3-6 months to detect side effects and complications. The first year contained a total of 339 months of observation, while the figure rose to 461 months in the second year. Spotting lasting 15-20 days followed insertion, but in later months only 7% of patients complained of bleeding or menstrual spotting. 7-8% of cases tended to have oligomenorrhea in the first year; 1/3 to 1/2 of them had hypomenorrhea during the first and second year. True amenorrhea started in 20-30% of women, persisting through both years. Longer duration of flow occurred in 32.4-4.57.1% of cases during these 2 years. Hormonal effects (headache, acne, hirsutism, depression, mastalgia, and inflamed varicose veins) ranged from 18.2- 33.3%. Levonorgestrel 20 T demonstrated more superior contraceptive efficacy than Progestasert; however, serious menstrual cycle disorders associated with it also increased. All progestin-releasing devices (the minipill, Norplant, Progestasert) induced menstrual changes, thus their use is preferable for therapeutic indications such as hypermenorrhea and uterine fibroid.
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PMID:[Two-year clinical performance of the Levonorgestrel 20 T IUD]. 1231 72

In the US, various anti-abortion groups have committed violent attacks against abortion providers and seekers, harassed them, destroyed property, and disrupted abortion services, leading to an unsurpassed amount of state and local legislation and litigation to make these acts illegal or to broaden the reach of existing laws to protect abortion seekers and providers. In October 1993, a federal appeals court panel repealed a lower court judge's April injunction setting up a 36-foot buffer zone around an anti-abortion clinic in Florida and preventing demonstrations that people in the clinic could hear. The panel argued that the injunction violated the free speech rights of anti-abortion demonstrators, but not those of pro-choice demonstrators. It also claimed that no evidence existed that anti-abortion protesters actually kept women from receiving an abortion, so their rights were more important than the right of women to obtain an abortion free of physical or verbal obstruction. An upcoming US Supreme Court case was filed by Chicago area abortion clinics using the federal Racketeer Influenced and Corrupt Organizations law as their basis. The US Congress will likely consider the Freedom of Access to Clinic Entrances legislation in November 1993. Legislators in 24 states have introduced 51 clinic access bills, the highest number in history. 7 bills have already passed and are law. These new or updated laws are in California, Colorado, Connecticut, North Carolina, Minnesota, Oregon, and Washington. California expanded an existing law by banning chemical attacks, common to anti-abortion groups, which have a corrosive effect and induces nausea, vomiting, dizziness, headaches, and irritation. Some anti-abortion legislators contend that existing trespass and disorderly conduct laws already provide protection to abortion seekers and providers. Yet, these laws do not include public spaces (e.g., sidewalks), grant public officials broad discretion to determine whether to arrest people, do not mandate penalties, and do not allow injunctive relief, damage payments, or civil remedies.
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PMID:"From the world beyond Washington". 1231 82

In Viet Nam, health workers conducted focus groups with women seeking pregnancy termination at 2 rural district hospitals in Thai Binh Province and at 2 urban district hospitals in Hanoi to learn why contraceptives failed and why some of these women did not use contraceptive. Researchers used information from the focus groups to design questions for a July-September 1991 survey of 2088 women seeking an abortion at all 9 rural district hospitals in Thai Binh Province and at 5 district hospitals in Hanoi. 85.3% of the women were married and lived with their husbands. Most women were eligible for menstrual regulation (53.7% in Hanoi and 64.9% in Thai Binh). 50% of all women (52.8% in Hanoi and 47.4% in Thai Binh) had had at last 1 prior pregnancy termination (1.6 pregnancy terminations/woman), suggesting that induced abortion is being used as a substitute for family planning methods. Effective modern contraceptive use by 50% of these women would have reduced the number of abortions during the 3 months by 25%. 36.8% (54.7% in Hanoi and 19.9% in Thai Binh) used traditional family planning methods. 38.3% (25.7% in Hanoi and 49.9% in Thai Binh) did not use any method. The leading reason for not using oral contraceptives (OCs) were personal health problems, unavailability, and the perception that contraceptives were bad for one's health. For IUDs, they were bleeding, lumbago, headache, loss of energy, and dizziness. For condoms, reasons for nonuse were disliked by one spouse and unavailability. Women's fear and husband's disapproval were key reasons for not choosing sexual sterilization. Reasons for failure of condoms, IUDs, and OCs were irregular use (62.6%) and poor quality (27.9), retained but still missed menstruation (74.3%), and used irregularly (23/28), respectively. The researchers recommended using these findings to develop an IEC campaign and training curricula for health workers.
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PMID:Pregnancy termination and contraceptive failure in Viet Nam. 1231 41

It is estimated that 60 million women use the pill worldwide. However, although clinical trials suggest that its efficacy is between 0.12 to 0.34 pregnancies per 100 women years, in general usage the pill has much higher failure rates. The 3% annual failure rate of married women increases to 6% when single women are included. At this rate, close to 50% of users will experience an unintended pregnancy within a period of 10 years. In New South Wales, in a survey of 2249 women seeking abortion at the end of 1992, 323 women (14.4%) stated they were using the pill at the time of conception. Major causes of abrupt cessation of pill taking are anxiety about the risks, poor cycle control, headaches, or other minor side effects. In a 1992 study, 20-25% of women stopped taking oral contraceptives because of weight gain or acne and a further 25% stopped because of the fear of cancer. Studies from the US indicate that, even among consistent users, adolescents missed approximately 2.7 pills per month; 60% of women made mistakes in pill taking; and only 60% used a back-up method if they forgot their pills. At the initial consultation, the general practitioner should explain to the woman the mode of action of the pill, the noncontraceptive health benefits, and she should clearly understand that breakthrough bleeding in the early months does not indicate lack of effectiveness of the method. There is no increased risk of teratogenesis if the pill is taken during early pregnancy. Amenorrhea may create anxiety and it is often associated with discontinuation, resulting in pregnancy in the next cycle. Occasionally, nausea may occur at the beginning of the 1st cycle. Similarly, breast tenderness may occur in the first few months of use. Follow-up of women on the pill is extremely important since most initial side effects will tend to disappear by the end of the third cycle.
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PMID:OCs and community failure rate: what can the GP do to reduce it? 1231 51

Amenorrhea gravely affects the psychic life and profoundly changes the behavior of Rwandan women. Women with primary amenorrhea (failure to menstruate at puberty) who have well-developed secondary sexual characteristics go to traditional healers who have sexual intercourse with them, spreading sexually transmitted diseases, to open the way for the menstrual flow. Women with primary amenorrhea and no breasts (dwarfism and infantilism) are sad, cannot have children, and are considered inferior by society. According to Rwandan beliefs, menstrual bleeding of unmarried women with secondary amenorrhea (absence of menstruation after it has once been established) empties itself into an obscure cavity, causing lumbar pain, nervous tension, and headaches. Rwandan women explain postpartum or lactational amenorrhea as a latent pregnancy causing a psychological shock which mimics a miscarriage. Living together for three months without a pregnancy causes the menstrual cycle to lengthen alternating with regular excessive bleeding (a miscarriage threat). This constitutes amenorrhea of infertile women, according to Rwandan beliefs. Menopausal women live in an illusion of pregnancy. After two years of pregnancy, the menopausal woman worries about the delivery of her fetus transformed into rock and expresses her concerns at a gynecologic visit. She worries about her long and painful tragic death which follows the death of the fetus. All these different types of amenorrhea have two types of effect on Rwandan women's behavior: happy effects and troubling effects. Management of these amenorrheas must be preoccupied with the etiologic problem and the problem of latent pregnancy. The most frequent complaints associated with latent pregnancy are genital bleeding, past-due delivery, reduction of the frequency and amplitude of fetal movements, reduction of the volume of the abdomen, and prolonged labor.
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PMID:[The influence of amenorrhea on the behavior of Rwandan women]. 1231 59

Results are presented of a clinical study of Norplant subdermal implants in Colombian adolescents. Implants have been used by 365 adolescents, of whom 174 have completed 2 years of follow-up. Study participants were monitored at months 1, 3, 6, 12, 18, and 24 postinsertion. Among the 174 women, 14% were 14-17 years old and 87% were 17-19. 21% were single, 30% married, and 49% in consensual unions. 38.5% were nulliparous, 56% had 1 child, and 5.7% had 2. 14.3% had a history of abortion. There were no pregnancies in the 2 years. 47.9% of users experienced menstrual irregularities at least once during the 2 years, with 9.3% reporting spotting or staining, 21.2% bleeding, and 19.3% amenorrhea. 6.4% reported nausea, 4.3% headache, 4.3% weight alterations, 2% acne, and 1.4% hair loss. There were 12 removals in the 2 years, 3 each because of menstrual and weight alterations, 2 for headaches, and 4 because of desire for pregnancy. 91.4% declared themselves satisfied with the method. The continuation rate was 93.2% at 2 years. The results suggest that Norplant is a good contraceptive choice for adolescents, but a prolonged study over 5 years is needed to confirm the findings.
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PMID:[Norplant: an effective option for adolescent women. Subdermal implant contraception in adolescent women. Preliminary findings in 174 cases]. 1231 5

The 832 women who accepted Norplant implants at three hospitals in Peru between December 1988 and February 1991 participated in a study of Norplant method acceptability and user characteristics. The women were seen 1, 3, and 6 months after insertion and every 6 months thereafter. They ranged in age from 18 to 40 years and averaged 28. Nearly 78% had completed secondary school or had higher education. The average number of children was 2.1, and 87% had 3 or fewer children. 30.1% of the women had had 1 abortion, 13.0% had had 2, 2.2% had had 3, and 1.1% had had 4 or more. 47.3% of the women had previously used oral contraceptives or IUDs, 13.1% had used rhythm, 11.2% had used condoms or vaginal methods, 4.9% had used injectables, 1.6% had used other methods, and 21.9% had used no method. 47.9% stated they wanted no future pregnancies, 37.4% wanted to wait at least 3 years, and 6.3% were uncertain. Menstrual problems were the major side effect reported. 22 of the 71 removals were motivated by headaches, 18 by menstrual problems and 13 by medical problems. The continuation rate at 12 months was 88.75%. No pregnancies occurred.
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PMID:[Characteristics of Norplant users in Lima, Peru]. 1232 14

From 1959-1964 the incidence of puerperal sterilization was 3.5% at the Lady Hardinge Hospital in New Delhi, an increase over the incidence of 2.15% from 1952-1957. The group analyzed in this study consists of 301 women sterilized during the 1959-64 period. Sterilizations were postpartum (191), during caesarean section or hysterotomy (74), and miscellaneous (36, including post-abortion). Average age was 32.5; average parity was 6.0. The majority had at least 2 male children. Indications for sterilization were socioeconomic (90%), obstetric (7%), and medical (3.3%). Immediate postoperative sequelae, studied in the postpartum cases only, included pyrexia and sepsis at rates of 25% and 24% of postpartum women. The most common late sequelae among all the women were chronic fatigue (44%), menstrual disturbances (28.9%), headache (28%), backache (26.5%), and lower abdominal pain (27.5%). The high incidence of chronic pelvic inflammation, 15%, was probably associated with the use of silk sutures. 2 patients became subsequently pregnant; the pregnancy rate was thus an unsurprising 0.7%.
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PMID:A review of 301 cases of sterilisation. 1233 82

A tablet of .35 mg of norethindrone was administered daily and continuously for 6 complete cycles to 30 patients suffering from premenstrual tension syndrome and 5 suffering from functional sterility related to a deficiency of the corpus luteum. In the case of premenstrual tension, particularly good results were obtained in reducing pelvic pains, mastalgia, and headache, especially when related to disorders of the estrogen metabolism. In the sterility cases, 2 patients out of 5 responded to the treatment: 1 was in the 7th month of pregnancy at the time of writing and 1 suffered a spontaneous abortion from unknown causes in the 3rd month of pregnancy. It is concluded that this is a promising treatment, especially for premenstrual disorders.
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PMID:[Therapeutic effects of low doses of norethindrone in disorders of the menstrual cycle]. 1233 28


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