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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Women 35 years old must choose their contraceptive method by balancing between an acceptable failure rate and manageable side effects. In Birmingham, England, 1985 data show that among those women 35 years old, 28.8% chose oral contraceptives (OCs), 38% IUDs, 31.1% barrier methods, and 2.1% other methods. The incidence of irregular menstrual cycles, luteal phase deficiency, and short cycles increases with age. On the other hand, the frequency of intercourse declines with age thereby reducing fertility. These and other factors increase couples' anxiety about pregnancy as they grow older therefore establishing a need for adequate and informed counseling concerning all available contraceptive methods. Any counseling on choice or change of method should start before age 35 to allow the couples to make a logical choice based on their needs. Individuals must 1st consider the risk factors of combined OCs, especially smoking, obesity, and family history of cardiovascular diseases, before agreeing to use them. Progestogen only OCs provide a safer alternative. The IUD provides effective protection from pregnancy with minimal side effects, particularly copper IUDs. The death rate/year for IUDs for women 35-39 years old is 2/100,000 compared to 13.4 for smoking OC users, 4.5 for nonsmoking OC users, 5 for users of barrier methods, and 20.8 for women using no method at all. Since fertility declines with age, many women may choose barrier methods, but must realize that the chance of conception is higher than for the other methods and therefore must consider postcoital contraception or abortion. Sterilization is a popular contraceptive method for these women, but they should receive adequate counseling before the operation.
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PMID:Contraception for the woman aged 35 yr and over. 323 15

Data from 4 case-control studies conducted in the US and Canada in 1974-81 were examined to identify risk factors for spontaneous abortion. The 2068 women aged 20-79 years at interview whose histories were investigated reported 6282 pregnancies, including 805 spontaneous abortions. Relative risk binomial regression methods were used to evaluate the roles of factors such as previous pregnancy history and age at pregnancy. The risk of miscarriage during a given pregnancy was found to increase directly with the number of previous miscarriages, but was unrelated to the order of miscarriages within all previous pregnancies. Age at pregnancy was also a risk factor. With adjustment for gravidity and number of previous spontaneous abortions, the relative risk of miscarriage remained near unity through age 30 years, after which it increased to 2.0 at age 40 years and 3.0 at age 45 years. The risk of spontaneous abortion was not associated with years since previous pregnancy, height, weight or obesity, use of oral contraceptives (OCs) within the year before pregnancy, or duration of OC use. There was a slightly increased risk (1.4) of spontaneous abortion among women who had ever regularly smoked cigarettes. The findings of this analysis are consistent with those of previous investigations and suggest that age at pregnancy and number of prior miscarriages are important variables in predicting the occurrence of spontaneous abortion.
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PMID:Risk factors for spontaneous abortion and its recurrence. 232 57

Induction of ovulation with pulsatile luteinizing hormone-releasing hormone (LH-RH) therapy was attempted in 48 women with polycystic ovary disease (PCOD) and clomiphene citrate (CC) resistant anovulation. Fourteen women ovulated regularly, 23 ovulated variably, but 11 did not ovulate at all. Fifty-two of the 108 cycles of pulsatile LH-RH therapy alone (15 mu gm per pulse, one pulse every 90 minutes) administered through the subcutaneous route were ovulatory. In patients who did not ovulate on subcutaneous LH-RH, treatment with CC (100 mg per day for 5 days) was added to the LH-RH therapy in an additional 33 cycles, of which 21 were ovulatory. In those who did not respond to the combination of treatments, the same dose of LH-RH was administered intravenously: 14 of 29 cycles of intravenous therapy were ovulatory. The overall cumulative conception rate after 6 months of therapy was 60%. When recalculated for ovulatory cycles alone it was 90%, indicating that failure of ovulation was the only cause of the failure of conception. Analysis of the clinical and endocrine findings indicated that failure to ovulate was associated with obesity and hyperandrogenization. Ten of the 23 conceptions ended in miscarriage, 8 within 4 weeks of ovulation. The authors conclude that infertility in patients with PCOD is not optimally corrected by pulsatile LH-RH therapy.
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PMID:Pulsatile luteinizing hormone-releasing hormone therapy in women with polycystic ovary syndrome. 328 91

The diabetic embryopathy syndrome comprises a number of developmental anomalies among fetuses of diabetic mothers. Fetopathia diabetica, on the other hand, is characterized by typical, hormonal, and metabolic dysfunctions and their morphological sequelae in fetuses and offsprings of diabetic mothers. We observed the combination of both these conditions in an immature stillborn fetus. The 34 year-old diabetic mother, who had been treated by insulin since age 16, was first seen at 27 weeks of gestation. Sonography revealed severe congenital malformations of the fetus, and a late abortion was induced. The stillborn female revealed the typical congenital malformations of the diabetic embryopathy syndrome, such as abnormalities of face and skull, skeletal malformations of the thorax, spine, and lower extremities, and malformations of the heart, great vessels and the genitourinary system. We, too, found the characteristic features of fetopathia diabetica, i.e. obesity, macrosomia, increased weight and size of the internal organs, polynesia and macronesia of the pancreas, increased extramedullary hematopoiesis and cellular depletion of lymphoid tissues. A review of the literature revealed various hypotheses about the etiology and pathogenesis of both conditions.
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PMID:[Embryopathy and diabetic fetopathy in a premature stillborn infant. Case report and review of the disease picture]. 329 May 73

Litigation in the UK resulting from sterilization failures is on the increase, with claims averaging 40,000/case. This suggests that physicians must be extremely careful with preoperative counseling and the conduct of the sterilization procedure. Failed sterilization litigation may allege negligence, trespass to the person, or breach of contract. It is important be patients be informed that there is a risk of failure, especially when sterilization is performed at the end of a cesarean section procedure or induced abortion. Patients should be asked to sign the specially designed consent form, and the record should state that the implications of the procedure and its risks were explained. Another way failures can be minimized is through improvements in surgical technique. If there are problems with laparoscopic visualization, a laparotomy should be performed and patients with obesity or pelvic adhesions should be warned of this possibility in advance. Laparoscopic sterilization should be performed only by those with thorough training in the method, and junior staff should be carefully supervised. Given the fact that the world "sterilization" implies permanence, which can't be guaranteed, it is suggested that the procedure be referred to by what is actually done--e.g., tubal ligation and excision or laparoscopic application of clips to the fallopian tubes.
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PMID:Failed sterilization and the law. 334

A population-based case-control interview study of thyroid cancer (159 cases and 285 controls) was conducted in Connecticut. Prior radiotherapy to the head or neck was reported by 12% of the cases and 4% of the controls [odds ratio (OR) = 2.8; 95% confidence interval = 1.2-6.9]. Risk was inversely related to age at irradiation and was highest among children exposed under age 10. Few persons born after 1945 received prior radiotherapy, consistent with the declining use of radiation to treat benign conditions in the 1950's. Among females the radiogenic risk appeared to be potentiated by the number of subsequent live-births. Other significant risk factors included a history of benign thyroid nodules (OR = 33) or goiter (OR = 5.6). Miscarriage and multiparity increased risk but only among women who developed thyroid cancer before age 35 years. Consumption of shellfish (a rich source of iodine) seemed to increase the risk of follicular thyroid cancer, whereas consumption of goitrogen-containing vegetables appeared to reduce risk of total thyroid cancer, possibly because of their cruciferous nature. A significantly low risk was observed among persons of English descent, whereas Italian ancestry appeared to increase risk. No significant associations were found with a number of suspected risk factors: diagnostic x-rays, radioactive isotope scans, occupational radiation exposure, tonsillectomy, Jewish ethnicity, alcohol intake, cigarette smoking, oral contraceptives, lactation suppressants, menopausal estrogens, most other common medications, and water source. New associations were suggested for obesity among females (OR = 1.5), surgically treated benign breast disease (OR = 1.6), use of spironolactone (OR = 4.3) or vitamin D supplements (OR = 1.8), and a family history of thyroid cancer (OR = 5.2). About 9% of the incident thyroid cancers could be attributed to prior head and neck irradiation, 4% to goiter, and 17% to thyroid nodular disease, leaving the etiology of most thyroid cancers yet to be explained.
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PMID:A population-based case-control study of thyroid cancer. 347 36

The article reports upon the characteristics of 300 abortion applicants in Arkansas manifesting significant stress from unwanted pregnancy between May 1, 1970 and June 30, 1971. The sample is limited by the fact that all of these women had been willing to seek medical aid. Patients ranged from ages 13-47, 131 of them ages 17-21. 35% had had some college education; another 29% were high school graduates. 50.6%, 20.6%, and 27.3% were single, divorced, and married, respectively. 59.6% of the patients were primiparas. 18.3%, 9.6%, and 12.3% were classified as being neurotic, having psychophysiologic tendencies (gastrointestinal problems, obesity, chronic headaches), and having sociopathic features (passive-aggressive, frankly rebellious, delinquent, antisocial, alcoholic), respectively. 12 women had noticeable schizoid features; 4 women had mildly active schizophrenia. Fathers of the women were usually blue-collar workers (55.3%) or white-collar workers (24.6%). The most frequent ordinal sibling position among the women was oldest child (38%). Parental instability (1 or both parents lost through death, divorce, father usually away working, chronic alcoholism, etc.) was reported by 39.6% of the patients. Patients' attitudes toward the unwanted pregnancy included dislike of inexpediency of the situation (82.6%), self-depreciation (55.6%), and aversion (28.6%). Precipitated psychiatric disorders were for the greatest part mild. Manifesting symptoms included depression (66.7%), anxiety (21%), and mixed anxiety and depression (12.2%). Suicidal threats and gestures were made by 22 and 8 patients, respectively. In summary, the study reveals a group of predominantly Caucasian women from unstable, middle-class urban families who were going through an adjustment reaction to adolescence or adult life.
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PMID:Abortion applicants in Arkansas. 426 12

A young girl 12 old, sent to us for obesity, and coxa-epiphysiolysis showed signs of mental retardation and bilateral thumb ankylosis. The fact that the mother was also affected by both of these signs, led to a more detailed genetic research. The latter revealed that not only the daughter, the mother, but also their own mother and may be, the sister, the grand-mother and the great-aunt of the patient had a retardation, a slight dysmorphia, a type A brachydactylia, signs of obesity and an identical ankylosis of both thumbs. This vertical inheritance, affecting apparently females only, but not associated with a high rate of miscarriage, has, it seems, never been reported. The characteristics of this family are being considered and discussed.
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PMID:[Regular dominance of thumb ankylosis with mental retardation transmitted over 3 generations]. 663 21

The association between factors of reproductive life and the occurrence of epithelial ovarian cancer were examined and anovulation and reduced gonadotrophin secretion were considered as mechanisms through which such factors might play their protective roles. All women with newly diagnosed epithelial ovarian cancer and who were resident in 6 counties of Washington and Utah during 1976 through 1979 were interviewed concerning their menstrual, reproductive, and medical histories. For comparison, interviews were also obtained from a random sample of women living in the same counties. To consider adequately the simultaneous effects of multiple relevant and possibly confounding variables, linear logistic regression techniques were used to analyze the data. Women with cancer reported fewer full-term pregnancies, fewer miscarriages, and less total time breastfeeding than controls. Cases in the Washington counties reported fewer exposures to combined oral contraceptive (OC) preparations. The difference between cases and controls was not apparent in the Utah data, possibly because of the low frequency of OC use among Utah residence and the small size of Utah samples. Obesity, defined as more than 20% excess weight at age 30 over the upper limit of ideal for a woman of a given height and medium frame was reported slightly more often by the cases than by the controls. Results obtained for reproduction variables appeared largely consistent with those of previous studies, in that factors associated with suppression of ovulation were generally protective. Histories of childbearing, miscarriages, lactation, and (in Washington) OC use were found to be associated with decreased risk of ovarian cancer. The estimated relative risks were, respectively, 0.88/pregnancy, 0.82/miscarriage, 0.79/year of lactation, and 0.89/year of OC. It was observed that the magnitudes off the diminished risks from these exposures substantially exceeded those which would have been expected solely on the basis of their inhibition of ovulation. The lack of association found between the occurrence of ovarian cancer and either total dose or total time of exposure to noncontraceptive estrogens, or with a history of usage of thyroid medications, suggests that periods of reduced pituitary gonadotrophin secretion fails to reduce risk of ovarian cancer. Pregnancy, lactation, and OC use appear to offer some protection against the development of epithelial ovarian cancer, yet the reasons remain obscure.
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PMID:Events of reproductive life and the incidence of epithelial ovarian cancer. 668 35

Since 1976, data were collected to evaluate risk factors for breast cancer in a hospital-based case-control study of 1185 women with breast cancer and 3227 controls. The risk of breast cancer increased with increasing age at first birth; this effect was not accounted for by parity. An early age at first birth appeared to reduce the risk relative to no pregnancy, whereas a late age at first birth was associated with a higher risk than not having a full-term pregnancy. High parity was associated with a reduction in the risk that was independent of that of age at first birth: for parity greater than or equal to 5, compared with parity 1-2, the relative risk estimate was 0.7 (95% confidence interval, 0.5-1.0). Late age at menarche was associated with a lower risk among premenopausal women but not among postmenopausal women. The relative risk decreased with increasing obesity among premenopausal women. Among postmenopausal women, the risk was higher among those who were obese, but there was no evidence of a trend with increasing body mass index. Risk did not vary materially according to history of abortion when gravidity was controlled. Risk was lower among postmenopausal women than among premenopausal women of the same age and increased with increasing age at menopause; bilateral oophorectomy reduced the risk more than hysterectomy alone. A positive history of benign breast disease, a positive family history of breast cancer, Jewish religion, and 12 or more years of education were each independently associated with an increased risk of breast cancer.
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PMID:Risk factors for breast cancer. 682 51


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