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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Norplant was first introduced in Ethiopia in 1994. This study examines the safety, efficacy, tolerance, and acceptability of Norplant among 364 patients of reproductive age who obtained implants from the Family Planning Department of the Gandhi Memorial Hospital during June-December, 1994. During the study period, 608 patients were provided with information about family planning methods. 110 accepted injectables, and 115 accepted oral pills. 96.7% of patients were married, 84.3% were urbanites, 84.9% were educated, 70.1% were housewives, and 91.5% were Christians. The mean age was 27.9 years. Ages ranged from 17 to 45 years. The mean body weight was 53.5 kg. Blood pressure readings were low for most women. The mean number of living children was 3.1. 70.3% of Norplant patients switched from other family planning methods. The mean duration of contraceptive use was 23.5 months. The average duration of Norplant implants since insertion was 25.3 months. The range was 3-30 months. 33.0% women were lactating at the time of insertion. The mean time of insertion was 12.5 minutes. Times ranged from 5 to 20 minutes. Insertion was made in the medial aspect of the upper left arm for right-handed women. A 2 mm incision was made, and six flexible capsules were inserted in a fan-shaped pattern with the help of a trocar. Insertion was performed under aseptic conditions and local anesthesia. Patients were advised to keep the dressed site clean and dry for a week, at which time dressings were removed and the site was checked for infection. Other check-ups were made at monthly intervals for 3 months. The most frequent complications were irregular bleeding, amenorrhea, headache, weight change, and local pain at the insertion site. The continuation rate was 95.1%. 93.9% rated Norplant highly. Health personnel were the main source of information about Norplant.
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PMID:Norplant implants in Ethiopia. 929 31

Depo-Provera was approved for general contraceptive use in the US in October 1992. This retrospective study examined the records of the first 510 women who initiated Depo-Provera use at a North Carolina county health department in 1993. The mean age of Depo-Provera users in this series was 23.5 years; 80% were unmarried. The mean number of living children was 1.3. At the time of injection, an appointment was set for a second injection 12 weeks later. Women were considered as continuers as long as they received an injection within 16 weeks of the last injection--the maximum duration of effectiveness. A total of 181 acceptors (36%) continued Depo-Provera use for 12 months, with an average interval between injections of 13 weeks. The 4-month and 8-month continuation rates were 67% and 46%, respectively. Of the 227 discontinuations, 64 were due to non-bleeding-related side effects such as weight gain, headache, and hair loss and 56 were because of bleeding problems. An additional 39 discontinuations were by default, i.e., acceptors waited more than 16 weeks for repeat injection and were refused. Another 102 women (20%) were lost to follow-up. If it is assumed that women lost to follow-up continued at the same rate as other women, the 12-month continuation rate rises. Discontinuation rates were significantly lower among only two sociodemographic groups: women covered by Medicaid for either all or none of the injections and women who reported bleeding side effects at their last injection. The provision of estrogen therapy to Depo-Provera users who experience irregular bleeding could increase compliance with this new method.
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PMID:Depot medroxyprogesterone acetate pioneers. A retrospective study at a North Carolina Health Department. 943 59

The newly developed 2-rod levonorgestrel (LNG) implant system has a surface area only 44% that of Norplant yet provides LNG release rates and blood levels similar to the 6-capsule Norplant system. Clinical trials of the 2-rod implant system initiated in 1990 demonstrated an exceptionally low cumulative pregnancy rate (0.8/100) in the first 3 years of use. This paper reports on an extension of the original study for an additional 2 years. 594 women at 4 study sites in the US and the Dominican Republic completed 5 years of method use. No pregnancies occurred in the fourth and fifth years of use. Thus, the 5-year cumulative pregnancy rate was 0.8/100, with an average annual pregnancy rate below 2/1000 women. The mean annual continuation rate during the 5-year study period was 77/100 women, with an average duration of use of 2.96 years. The most frequent reasons for medical removal were prolonged bleeding/spotting (8.2% of women), irregular bleeding (5.6%), headache (4.7%), and weight gain (4.0%). Mean removal time was 5.9 minutes and complications occurred in only 2.3% of removals. Overall, these findings confirm that the 2-rod LNG implant contraceptive has an effectiveness equivalent to the 6-capsule implant for a 5-year period, with good acceptability and a substantially improved ease of removal.
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PMID:Contraception with two levonorgestrel rod implants. A 5-year study in the United States and Dominican Republic. 988 82

This paper presents the 5-year randomized study on the performance of levonorgestrel rod (LNG) and Norplant contraceptive implants in 1198 women in 7 centers. In the first 4 years, no pregnancies occurred. At 5 years, the cumulative pregnancy rate was 1/100 users or less for each regimen. Annual discontinuation rates averaged 11-12/100 users, corresponding to a 5-year continuation rate of 55.1/100 for rods and 53.0/100 for capsules. Mean annual discontinuation rates for menstrual disturbances were 3.5/100 for rod and 4.2/100 for capsule implants. Reasons for discontinuation of use were vaginal spotting or bleeding, irregular bleeding, headache, weight gain and acne. Proportional hazard regression models established that family formation variables, age, parity, and desire for another child, recorded at admission, significantly affected discontinuation rates for major decrement categories and for all reasons combined. Mean rod removal time was half that of Norplant. Complications of rod removal were at a lower rate. This study concludes that there is an extremely high contraceptive effectiveness for LNG rod and Norplant implants; however, LNG rod implants were more preferable than Norplant for its relative ease in removal.
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PMID:The performance of levonorgestrel rod and Norplant contraceptive implants: a 5 year randomized study. 988 17

Menopause and the accompanying reduction in estrogen production may cause a number of symptoms in women which include hot flushes, sweating, mood and sleep disturbances, fatigue and urogenital dysfunction. The effectiveness of estrogen-based hormone replacement therapy (HRT) in ameliorating these symptoms, and in preventing long term sequelae such as osteoporosis, is well established. Comparative trials indicate that oral conjugated estrogens 0.625mg, oral ethinyl estradiol 0.02mg and transdermal estradiol 0.05mg have equivalent efficacy in relief of mild to moderate menopausal symptoms and prevention of bone mineral loss. Concomitant progestogen therapy is usually prescribed for women with intact uteri to protect against endometrial hyperplasia and carcinoma. The addition of progestogen maintains and may even enhance the bone-conserving effects of estrogen, and continuous regimens appear to reduce the incidence of irregular menses. Adverse reactions are predominantly local skin irritation with transdermal preparations (14% of patients) and systemic effects common to most forms of HRT including breast tenderness, flushing, headache and irregular bleeding, occurring in less than or equal to 2% of patients. Data concerning the effect of HRT on quality of life are limited, but most analyses have assigned utility values of 0.99 for mild and 0.95 for severe menopausal symptoms. However, recent clinical data suggest that these utility values may underestimate the impact of menopausal symptoms on quality of life. The cost benefit and cost effectiveness of HRT in the treatment of menopausal symptoms have not been fully researched, although preliminary results suggest that conjugated estrogens and transdermal estradiol compare well with alternative therapies such as veralipride and Chinese medicines. A Swedish study using a prevalence-based approach estimated that estriol treatment in all women with urinary incontinence aged greater than or equal to 65 years resulted in monetary savings compared with treating 20% of women. Cost-utility data indicated that the change in quality-adjusted life years (QALYs) with HRT was always positive, but the degree of change was determined by the baseline assumptions. Estimated changes in QALYs with HRT ranged from 0.006 for 5 years of treatment with unopposed estrogen in women with intact uteri, to 0.5 for 10 years of the same treatment in women with severe menopausal symptoms following hysterectomy. Compliance with HRT is suboptimal as 5 to 50% of women withdraw from therapy, thereby increasing costs per year of life saved.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Hormone replacement therapy: I. A pharmacoeconomic appraisal of its therapeutic use in menopausal symptoms and urogenital estrogen deficiency. 1014 33

In this 4-year open-label, noncomparative, single-center pilot efficacy study, the contraceptive efficacy, safety, bleeding pattern and acceptability of Implanon was studied in 200 sexually active women of proven fertility in Indonesia. All subjects received the single-rod subdermal implant Implanon, which contains 68 mg etonogestrel (3-keto-desogestrel), with an initial release rate of 67 micrograms etonogestrel/day. Contraceptive efficacy was analyzed by calculation of the pregnancy rate, bleeding patterns were determined by the 90-day reference period method, and acceptability by the discontinuation rate. No in-treatment pregnancies were reported during 658.4 women-years of exposure, resulting in a Pearl Index of 0.0 (95% CI 0.0-0.6). The overall bleeding pattern was acceptable, with no discontinuations because of irregular bleeding. Incidence of irregular bleeding was highest during the first two reference periods and decreased thereafter. Amenorrhea was experienced by 7%-12% of subjects during years 1 and 2, by 5%-7% during year 3, and by 2%-5% during year 4, with one discontinuation because of amenorrhea. No clinically significant changes were reported for systolic and diastolic blood pressure, body mass index, and hemoglobin level. Three adverse experiences were related to treatment and resulted in discontinuation (two headaches and one dyspnea). One difficult implant removal was reported. In conclusion, this pilot efficacy study indicates that Implanon provides excellent contraceptive reliability and an acceptable bleeding pattern. Overall safety and acceptability are good, as suggested by the low incidence of adverse experiences and the low discontinuation rate.
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PMID:A pilot efficacy study with a single-rod contraceptive implant (Implanon) in 200 Indonesian women treated for < or = 4 years. 1550 85

A one-year longitudinal study was undertaken in Kingston, Jamaica, to examine (i) the experience of side effects among female contraceptive users, (ii) the role of side effects in method continuation, and (iii) counselling regarding side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at the women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, contraceptive history, service factors, experience with method and length of use. Forty-eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side effects were irregular bleeding no period, headaches, nausea/dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty-seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side effects and make informed choices about contraception.
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PMID:The impact of side effects on family planning use among female clients of the public health services in Jamaica. 1176 25

The efficacy of continuous treatment with the progestin Exluton (.5 mg/day lynestrenol) was evaluated in 361 women over a total of 3553 cycles. The treatment was 100% effective in preventing pregnancy. The length of the menstrual cycle and intensity of menstrual flow were not appreciably altered. Breakthrough bleeding and spotting were reported during the early stages of treatment, but the incidence of irregular bleeding dropped to an average of 2.4% of the cycles between the 4th and 12th cycles. Increased libido was reported by some patients, while headache appeared to occur less frequently. 4 women who desired to become pregnant, became pregnant within 6-10 weeks after discontinuing treatment. It is concluded that Exluton is a safe, reliable, and acceptable method of contraception.
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PMID:Contraception with the lynestrenol "mini-pill.". 1227 28

The efficacy, clinical tolerance, and safety of combined oral contraceptives of .5-2 mg and of continuous progestagens of 30-300 mcg are summarized. The low-dose combined pills still inhibit the preovulatory LH peak, suppress the endometrium, and modify cervical mucus. They rarely cause trivial side effects like weight gain, headaches, gastrointestinal symptoms, but are accompanied by more irregular bleeding than are conventional combined pills. Rish of thromboembolism is unknown but probably less than that associated with high-dose pills. Continuous 300 mcg norethindrone or 30 mcg norgestrel is less effective (2% failures) and permits more menstrual side effects than do combined pills.
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PMID:[Advantage of low-dose oral contraception]. 1227 40

The effectiveness and side effects of Marvelon (0.150 mg desogestrel and 30 mcg ethinyl estradiol) were evaluated in a multicenter study of 1570 women for a total of 22,158 menstrual cycles. Half the women in the study were under age 25. Only 1 pregnancy was reported, and this was due to patient failure. The frequency of spotting and breakthrough bleeding decreased steadily from 22.3% in the 1st treatment cycle, 14.9% in the 2nd, 8.4% in the 6th, 5.6% in the 12th, to 2.8% in the 21st and then rose slightly from 3.6% in the 24th cycle. This pattern of irregular bleeding during the early cycles is common to all oral contraceptive preparations. Changes in body weight were almost negligible and restricted to women under age 20. There was no change in average blood pressure when compared with pretreatment values. Superficial thrombophlebitis occurred in 7 women. Side effects, including nausea, headache, nervousness, depression, and breast tenderness, declined to negligible levels as treatment progressed. Levels of plasma protein sex-hormone-binding globulin (SHBG) appear to be higher with Marvelon than with a similar preparation containing levonorgestrel and ethinyl estradiol. Other studies have noted significantly higher serum high density lipoprotein (HDL) cholesterol levels with Marvelon than with combined levonorgestrel and ethinyl estradiol. This is attributed to the lack of androgenicity of desogestrel in the clinical dosage used in this study. SHBG and serum HDL levels are increased by estrogens and decreased by androgens.
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PMID:Desogestrel and ethinyloestradiol. 1227 90


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