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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study compares the risks of pregnancy, infertility, heart disease, cancer, and death associated with various contraceptive methods with the risks faced by women using no method. Estimated risks are derived from a decision-tree analysis program for a hypothetical cohort of 100,000 women. Method-specific estimates of the probability of various outcomes were obtained from published reports. Low estimates of typical use, first-year failure rates were used in the models. Tabulated data reveal that women who use no contraceptive method throughout their reproductive life (aged 15-44) and never have an abortion would have 18 births as compared to no more than five for women who use any contraceptive method. Data were also tabulated for the method-specific risks of developing upper genital tract infections, ectopic pregnancies, and tubal infertility (caused by the acquisition of a sexually transmitted disease [STD]) were calculated with method differences modeled for women at high and at low risk of acquiring a STD. The third table shows the estimated annual number of deaths per 100,000 ectopic pregnancies, live births, and induced abortions by five-year age groups. The annual pregnancy-related and method-related mortality rates per 100,000 women at risk of unintended pregnancy and at low risk of STDs was also calculated by contraceptive method. The fifth table illustrates the estimated annual incidence of and number of deaths from cardiovascular diseases per 100,000 women by smoking status, age group, and use of nonuse of oral contraceptives. OC use is also compared in a determination of the estimated annual number of ovarian, endometrial, and breast cancers diagnosed per 100,000 women by age at diagnosis. Finally, estimated deaths averted by each age group annually per 100,000 were calculated for current users of barrier and spermicide methods and of OCs and for ever-users before age 45. The conclusions drawn from these comparisons are that each contraceptive method presents different combinations of risks and benefits to women at different stages of their lives. Engaging in multiple sexual relationships, smoking, and irregular or incorrect method use are the three factors which most compromise a woman's ability to reach her reproductive and health goals.
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PMID:Comparing the health risks and benefits of contraceptive choices. 206 Jun 12

Waning fertility, contraceptive use, beliefs about fertility, contraceptive choices, and implications for health care are discussed in relation to women at midlife. Contraceptive choices are limited, but pregnancy is still a possibility. assessment of women in midlife should include fertility status and future pregnancy goals. Teaching, counseling, and contraceptive techniques should be made available and be appropriate for current and future needs. Consideration must be given to a Women's physiological status as well as her personal preferences. If abortion is not an option, then reliable contraception is a necessity. The perimenopausal period between the ages of 35-50 is characterized by increasingly variable menstrual cycles and questionable fertility. In 1985, there were 4 live births/1000 women 40-44 years and .2/1000 women 45-49. Hypothalamic/pituitary/ovarian system changes and uterine integrity account for the decrease in fertility, i.e., change in cycle length. It can last from 1 to 10 years, with cycles ranging from 26 to 32 days. Prolonged cycles are not uncommon and signal many false alarms. During this transition phase, it has been shown that there are gradual increases is follicle stimulating hormone, particularly 5-6 years before menopause. luteinizing hormone levels rise 3-4 years before menopause. Sometimes there are lower levels of midfollicular and midluteal levels of estrogens and midluteal levels of progesterones. It is hypothesized that hormonal changes may be due to a depleting supply and eventual absence of primordial follicles, or follicles in various states of atresia, and hence no longer sensitive to gonadotropin stimulation. Inhibin is also decreased. irregularity does not mean sterility. Survey Data indicate that 26% of 40-44 year olds could become pregnant. There is sometimes the false belief that unprotected sex and not becoming pregnant means infertility. Contraception is recommended for 2 years after cessation of menses. Birth control pills are usually contraindicated. However, the FDA suggests low dose estrogen pills for those who do not smoke, are not obese, hypertensive, diabetic, lipidemic, or have a history of thrombosis, heart disease, or pregnancy-induced hypertension. The IUD is a possibility unless there is a history of problems with menorrhagia, fibroids, or prior cervical surgery. Barrier methods are the most commonly used: condoms, Contraceptive foam, diaphragms, either alone or in conjunction with rhythm or fertility awareness. The symptothermal method is recommended. Menstrual assessment, annually, should include length of cycles, length and nature of flow (number of tampons/napkins per day), and any changes in flow, spotting, metrorrhagia, or dysmenorrhea. Women's knowledge and feelings about fertility needs to be assessed.
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PMID:The contraceptive needs of midlife women. 186 2

Medroxyprogesterone acetate (MPA; Provera) was given orally to 449 women from the 5th to 7th week of pregnancy until at least the 18th week. Data are recorded from two treatment groups (recurrent abortion and threatened abortion) and are compared to a matched series. A total of 1,016 pregnancies are included in the study, and all patients were recruited from a subfertile population conceiving from a range of infertility treatments. Early pregnancy wastage was high throughout the groups and was significantly elevated (43%; P less than .001) in those women who had vaginal bleeding in early pregnancy. The study focuses on the question of potential teratogenicity of progestagens administered in the first trimester. There were 15/366 (4.1%) infants with congenital abnormalities in the MPA-treated group and 15/428 in the untreated group (3.5%). The difference was not significant, and MPA is considered to have no embryopathic risk, nor is it likely to retain an abnormal fetus that might otherwise abort. It appears that MPA is a safe drug to use in pregnancy although the question of efficacy has not been addressed in this report. Considering other recent negative epidemiologic studies with regard to teratogenicity, we add to the conclusion that MPA cannot be demonstrated to have a measurable teratogenic risk and certainly does not present a risk for congenital heart disease and limb reduction defects.
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PMID:Medroxyprogesterone acetate therapy in early pregnancy has no apparent fetal effects. 317 47

This review was limited to topics of current concern with respect to the use of oral contraceptives (OCs). Thromboembolism, liver injury, fertility and infertility, miscellaneous adverse effects (such as headaches and psychological and metabolic effects), and acceptance were the topics covered. It was found that the risk of death due to pulmonary embolism or cerebral thrombosis among users of OCs amounted to 1.5 per 100,000 women aged 20-34 years as against .2 for a comparable group not using drugs; for users 35-44 years old the risk rose to 3.9 per 100,000 compared to .5 for nonusers. The increased risk associated with suppression of lactation by administration of diethylstilbestrol was most striking among women over 25 years of age; in this group the risk was 10-fold greater than that of lactating mothers. 1 report suggested that women with pulmonary hypertension due to congenital heart disease should probably not receive OCs. Contraindications to the use of OCs must now include any history of thromboembolic disease or disorders of the blood-clotting mechanism. There appeared to be a predisposing factor among women who develop jaundice while taking OCs. A remarkable number of such subjects had had idiopathic jaundice of pregnancy. There seems to be little evidence for permanent liver damage but very definite evidence for bile stasis and transient morphological changes. Much more work needs to be done before any adverse effect on fertility is established. In cases where fertility reduction is suspected, it must be demonstrable that fertility prior to the use of OCs was unimpared. Among 20 patients on OCs who had had migraine, the attacks became more intense and their frequency increased for 15 of the 20 patients. Generally speaking, those using the intrauterine device (IUD) were more persistent in accepting the method than those on OCs probably because the IUD may be used more extensively than OCs in underdeveloped countries.
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PMID:Effects of oral contraceptives. 489 31

Each organ of a patient with the Down's Syndrome (trisomy 21) shows the pathology. One notices the specific features already with an infant. The life expectation of these children has increased considerably and it depends upon the appearance or not of a heart defect. The ventricular septum defect is most frequent but a small number of these patients show a complex cardiopathy. The incidence of pulmonary hypertension is also high. The obstruction of gastroenteric tract can cause problems from the prenatal phase onwards. The main endocrinological difficulties are dysfunction of the thyroid gland and also infertility. Ocular disorders like refraction disorders occur frequently. Due to decreased conduction, there is a hearing loss. The cellular immunity is clearly reduced, hence, the susceptibility to infections like hepatitis B, increases. The major oral problems are apparently oversized tongue and a high sensitivity to gingivitis.
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PMID:[Down syndrome: 1. Medical aspects]. 865 Mar 77

The reproductive effects of metabolic disorders in women can be divided into four categories. The first of these is infertility. Galactosemia with its complication of ovarian failure is the disorder in this category. This complication may be prenatal in origin but whether this is so and its cause are unknown. The second category includes pregnancy effects of maternal metabolic disorders. The urea cycle disorder ornithine transcarbamylase (OTC) deficiency, maternal maple syrup urine disease and maternal homocystinuria are in this category. In the first two disorders, postpartum life-threatening illness due to metabolic crisis has occurred. Maternal homocystinuria is associated with a high risk for postpartum thromboembolic complications. The third category is the pregnancy effect of a fetal metabolic disorder. Pregnancies in which the fetus had long-chain hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) have been complicated by the life-threatening (HELLP) syndrome during the third trimester. Rapid recovery of the mothers followed delivery, on occasion by emergency cesarean section. The fourth category is the fetal effects (teratogenicity) from a maternal metabolic disorder. The best-known example of this is maternal phenylketonuria (PKU), which produces microcephaly, mental retardation, congenital heart disease and intrauterine growth retardation. Treatment with a low phenylalanine diet begun before conception or no later than the earliest weeks of the first trimester markedly reduces the risk to the fetus and can result in normal offspring. Other examples of teratogenicity may include maternal homocystinuria and maternal hypothyroidism.
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PMID:Reproductive effects of maternal metabolic disorders: implications for pediatrics and obstetrics. 882 3

The interval from the initiation of declining estrogen levels to final ovarian failure usually encompasses many years. The age of onset and duration of this perimenopausal time can vary greatly. While many patients may have minimal to no symptoms as estrogen levels first begin to decrease, most patients will eventually develop symptoms and sequelae as they approach ovarian failure. The consequences of this decline in ovarian function are numerous, and include vasomotor symptoms, declining bone mass, urogenital changes, infertility, irregular uterine bleeding, and psychosexual dysfunction. The women of today entering the perimenopausal period are unique because of their vast numbers, a consequence of the aging of the "baby boomers." Their reproductive history is also different from that of their ancestors in that many have chosen to delay childbearing into their thirties and even forties, and many have elected not to have children. Because of the unique characteristics of this extremely large population of women that are approaching or currently in the perimenopausal period, it is vital that healthcare providers fully understand the variability, consequences, and treatment modalities of this time of declining ovarian function. Risk factors for such common health problems as osteoporosis, heart disease, and cancers must be assessed and managed appropriately. Screening tests including mammography and cholesterol profiles should be offered along with dietary and exercise recommendations. Low-dose oral contraceptive pills and hormone replacement therapy are often effective in preventing and treating many of the common problems encountered during the perimenopausal period.
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PMID:The perimenopause: a critical time in a woman's life. 882 3

A comprehensive survey of late effects (physical, social and reproductive) following treatment at a single institution for early stage Hodgkin's disease (HD) was performed. A total of 611 patients with stage I and II HD treated between 1973 and 1984 were reviewed; 460 were alive and were mailed a self-reported questionnaire. A total of 363 (79%) replies were received. Twenty patients died of second malignancy, 14 of heart disease and nine from respiratory disease. There were 37 cases of second malignancy [relative risk (RR) 2.2, absolute excess risk (AR) 35.8]. The 15-year incidence of heart disease was 11% and there were nine myocardial infarction deaths (RR 1.55, AR 5.4). Twenty-eight (8%) respondents stated that their career had been greatly interfered with, 53 (14.5%) perceived financial loss. Sexual activity was disrupted in 25.8%. In total, 56 men had fathered 112 pregnancies. Of 171 women, 40.3% became pregnant, resulting in 92 live births. A total of 43 men and 16 women had sought medical advice with regard to infertility.
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PMID:Late effects of treatment for early-stage Hodgkin's disease. 957 37

Women have a higher prevalence of obesity than men in most developed countries. Obesity affects many aspects of women's health by increasing risk for heart disease, diabetes, breast cancer, and infertility. One reason for the gender difference in obesity may be that fluctuations in reproductive hormone concentrations throughout women's lives uniquely predispose them to excess weight gain. Studies in experimental animals and women have shown that hormonal changes across the menstrual cycle affect calorie and macronutrient intake and alter 24-hour energy expenditure. Pregnancy is a significant factor in the development of obesity for many women. Various factors are associated with excess weight retention following pregnancy, including weight gain during pregnancy, ethnicity, dietary patterns, and interval between pregnancies. There is a need to tailor recommendations for energy intake during pregnancy to individual women, and recent evidence also suggests that the timing of weight gain during pregnancy is a critical factor. Menopause is also a high-risk time for weight gain in women. Although the average woman gains 2-5 pounds during menopausal transition, some women are at risk for greater weight gains. There is also a hormonally driven shift in body fat distribution from peripheral to abdominal at menopause, which may increase health risks in older women. Hormone therapies have varying impacts on body weight and fat distribution. In summary, hormonal fluctuations across the female life span may explain the increased risk for obesity in women. Awareness of these factors allows development of targets for prevention and early intervention.
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PMID:The influence of sex hormones on obesity across the female life span. 992 57

A wide QRS complex tachycardia with right bundle-branch block morphology and left axis deviation observed in a young patient without structural heart disease may pose a diagnostic and therapeutic challenge. The surface ECG may provide several diagnostic clues to make a correct diagnosis of left posterior fascicular tachycardia and may help to differentiate it from both a supraventricular tachycardia with aberrant conduction and a typical ventricular tachycardia related to coronary artery disease. Although this tachycardia is sensitive to verapamil, this medication may probably cause transient infertility in males. The presence of a Purkinje potential preceding the QRS complex during tachycardia and optimal pace mapping may guide radio-frequency ablation resulting in a definite cure.
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PMID:Left posterior fascicular tachycardia: a diagnostic and therapeutic challenge. 1021 76


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