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The case presented in this paper suggests that the levonorgestrel intrauterine system may be an excellent contraceptive method for HIV-positive women. At presentation to a UK family planning clinic, a 32-year-old nulliparous woman was using Depo-Provera for contraception; however, she was bleeding irregularly and complained of acne and lack of vaginal lubrication. The Mirena intrauterine system was considered because it offered lighter menstrual periods or amenorrhea, no need for regular clinic visits, reliable contraception, and fewer systemic side effects than other progestogen-only methods. At follow-up 6 weeks after Mirena insertion, the woman reported one light period, pain on the day of fitting only, and no progestogenic side effects. The reduced blood loss associated with this method is beneficial if mild anemia is present and may reduce exposure of an HIV-negative male partner to infected blood. Moreover, the system's effectiveness is not compromised by the broad-spectrum antibiotics or liver enzyme-inducing drugs taken by women with HIV/AIDS.
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PMID:Successful use of levonorgestrel intrauterine system in a HIV positive woman. 1022 47

Safe, effective and affordable contraceptives have been available for a few decades, yet, in many countries, the struggle for reproductive rights continues. Children, still, are forced to give birth to children in many nations. In most industrialized countries, where contraceptive counselling and abortions have been options, fertility rates have reached all time lows. Effective contraception improves health and well-being as well and may be used for conditions other than birth control. Young girls often initially take oral contraceptives primarily to reduce menstrual pain and blood loss; they also welcome a contraceptive that eliminates menstrual bleeding. Women using oral contraceptives and Norplant experience about 50% reduction in menstrual blood; 90% reduction in blood loss is achieved with the levonorgestrel intrauterine system (Mirena). Teenagers and their parents are often misinformed about the side-effects of oral contraceptives and birth control in general, which may adversely affect compliance. Adequate, user-friendly and supportive information about contraception is necessary to ensure proper use of the pill and other birth control methods. In addition, emergency contraceptives should be easily accessible. The mortality and morbidity of young women would be dramatically reduced by the global use of medical abortion as well. Only a combined effort by policy makers, educators, parents and health-care providers can enhance the reproductive (and future!) health of both young females and males.
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PMID:Contraceptive strategies for young women in the 21st century. 1081 96

The objectives of this study were to evaluate the acceptability of the LNG-IUS Mirena(R), when offered as an additional option in a free choice context, and to evaluate the possibility of using this method in women with increased bleeding wanting an IUD and in copper IUD users requesting removal of the device for bleeding problems. A total of 256 women chose Mirena and were accepted into the study during the enrollment period. This represents 23.3% of all new acceptors of contraceptive methods in the clinic during the same period. Discontinuations were fairly evenly distributed among expulsion, bleeding changes, pain, and personal reasons. Bleeding changes were decreased bleeding, oligomenorrhea or amenorrhea. Comparing the performance in the group of women who chose the LNG-IUS as a first option with those having heavy bleeding, the only difference found was a higher expulsion rate in the group with bleeding problems. No pregnancies occurred and continuation rate was slightly over 75% in the total sample and in both groups. The characteristics of the LNG-IUS (Mirena) allow predicting that this method can effectively contribute to the increase in contraceptive options when introduced to family planning programs in Brazil.
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PMID:Acceptability and performance of the levonorgestrel-releasing intrauterine system (Mirena) in Campinas, Brazil. 1110 88

This article reviews the advantages and disadvantages of progestogen-only contraceptive implants in light of the development of Implanon, a new, single-rod, etonogestrel-releasing system. Implants rapidly produce serum progestogen levels sufficient to ensure contraception for 1-5 years. The steady release ofprogestogen avoids the peaks and troughs associated with oral contraceptives, the profound ovarian suppression observed with depot injections and the need for user compliance. Implants have few serious complications. Ectopic pregnancy rates are low, and follicular hypertrophy is generally self-limiting. The principal acceptability limitation to both users and providers of Norplant is insertion and removal. Implanon is easy to insert and remove with minimal complications and pain. The main adverse event causing discontinuation of implants is a change in bleeding pattern. However, with good counselling, this is well tolerated by most women. Implants thus provide an effective, safe, economical and convenient alternative to oral, injectable or intrauterine contraceptives. Implanon is an extremely effective single-rod implant with a Pearl index of 0. It employs a new polymer and a less androgenic progestogen. These features provide easier insertion and removal for both users and clinicians, a more stable release rate and potentially fewer adverse androgenic effects compared with existing formulations.
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PMID:Implantable contraception. 1124 3

Couples in the Philippines are free to choose the family planning method that best satisfies their health needs and religious beliefs. All service delivery outlets of the Philippines Department of Health and participating agencies should have all approved, safe, effective, and legal family planning methods available. Oral contraceptives (OCs), IUDs, tubal ligation, and vasectomy are at least 92% effective. OCs protect against pelvic infection and reduce the risk of ovarian and uterine cancer. Older OC users who smoke face an increased risk of blood clotting, stroke, and heart attack. The progestogen-only pill is the best OC for lactating women. The IUD can be effective for 6 years assuming no pain or other side effects. Breast feeding mothers can use the IUD safely. IUD contraindications are anemia, active cervical or pelvic infection, abnormal vaginal bleeding, and genital cancer. Condoms protect against pregnancy as well as sexually transmitted diseases, including HIV/AIDS. When practiced correctly, natural family planning methods are 70-90% effective. They are the cervical mucus method, basal body temperature method, sympto-thermal method, and breast feeding. Norplant contraceptive implants are available to Philippine women on a trial basis. They release a progestin slowly into the blood stream, suppressing ovulation and thickening cervical mucus. The long-acting contraceptive injectables are DMPA, Cycloprovera, and HRP 102. Women must receive an injection every 3 months to protect against pregnancy. The first injection should occur within the first 5 days of the menstrual cycle. Women choosing tubal ligation and men choosing vasectomy should be sure in their decision because they are permanent methods and sterilization reversal procedures are rare in the Philippines. Men with diabetes, an infection at the incision site, clotting disorders, enlarged or painful testicles, and an inguinal hernia should not have a vasectomy.
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PMID:The family planning methods. 1217 21

This open, noncomparative study evaluated the rate of premature removals of the levonorgestrel-releasing intrauterine system (LNG-IUS) Mirena because of adverse events. To take part in the study, women had to be aged between 35 years and 45 years, and had to change their contraception for poor compliance, poor tolerance, or unfavorable change in the benefit/risk ratio of their previous contraception (oral contraceptives or copper- or progestin-releasing intrauterine device). One removal of Mirena for a wish for pregnancy was excluded from analyses, so that there were 23 removals among 203 women included. The survival ratio was 88.7%, which corresponds to a 1-year rate of premature removals of 11.3%. No statistically significant difference was found between women switched from IUD and women switched from oral contraception regarding the continuation rate (p = 0.640, log-rank test) and the discontinuation rate (p = 0.430, chi(2) test). The main reasons for premature removal were bleeding problems (11 subjects including 2 amenorrhea, 5.4%), pain (5 subjects, 2.5%), and acne (2 subjects, 1%). Two premature discontinuations occurred after accidental removal. The number of bleeding or spotting days significantly decreased from baseline (p < 0.001), and gynecological symptoms were alleviated. Hematocrit, hemoglobin levels, and serum ferritin increased significantly. No pregnancies occurred. Acne and irregular bleedings were the most frequent adverse events. The results show the excellent acceptability as well as the favorable efficacy/safety ratio of the LNG-IUS Mirena in older reproductive age women whatever the primary method of contraception.
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PMID:Acceptability of the levonorgestrel-releasing intrauterine system after discontinuation of previous contraception: results of a French clinical study in women aged 35 to 45 years. 1220 86

71 Egyptian women using Norplant contraceptive implants for 1 year were followed with laboratory testing of carbohydrate, lipid and protein metabolism, liver and kidney function tests, serum iron and iron binding capacity and pituitary response to GnRH. The subjects were normal, healthy fertile, non-pregnant, non-lactating women who had not used hormone for 6 months. There were no pregnancies. Most women complained of altered menstrual patterns. Some reported headache, dizziness, increased vaginal discharge, nausea, and pain at the insertion site. There was no significant change in fasting or post-prandial glucose, or kidney function. Cholesterol decreased significantly at 3 months, triglycerides fell at 3 and 12 months, and HDL rose significantly at 3 and 12 months. SGPT fell significantly at 3 and 12 months. Total protein and albumin was significantly lower at 12 months. Serum iron and total iron binding capacity were significantly elevated at 3 and 12 months. Secretion of LH and FSH fluctuated around normal limits. The lipoprotein findings are discrepant from those reported from other developing countries in Norplant trials.
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PMID:Clinical chemistry and pituitary response changes in Egyptian acceptors of L. Norgestrel six rods implants during the first year of use. 1228 53

Advancing beyond the copper IUDs and IUDs of varied shapes introduced in the 1970s and 1980s, 3 3rd-generation IUDs are described. Not yet on the market, the Copper Safe 300, the FlexiGard 330 or Copper-Fix 330, and the levonorgestrel-releasing IUDs have been modified to reduce the incidence of expulsion or bleeding and pain complications found as side effects in other IUDS. The Cu-SAFE IUD is flexible, lightweight, and of smaller design to fit more comfortably within the uterine cavity. This IUD requires no pre-insertion loading into an inserted tube with plunger, and work especially well for women who have a relatively narrow endocervical canal. The FlexiGard 330 is frameless, and consists of 6 copper sleeves on a single filament of polypropylene thread. Requiring initial training, the insertion procedure is reported to be easy once mastered. The levonorgestrel-releasing IUD (LNG-IUD) combines the positive aspects of oral contraceptives, IUDs, and steroid-releasing implants. The LNG-IUD release 20 mcg of levonorgestrel daily, and has an estimated effective lifespan of up to 7 years once inserted. Levonorgestrel released into the uterus reduces menstrual blood loss, thereby potentially lessening the iron deficiency anemia often accompanying copper-IUD use. Levonorgestrel has also been associated with significant reduction in menstrual pain. Accordingly, this latter version of IUD may be of particular interest for women suffering menorrhagia, dysmenorrhea, and those experiencing increased menstrual blood loss when using copper IUDs. Early studies of the 1st 2 IUDs have shown favorable results, while the LNG-IUD has been registered in Finland.
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PMID:New developments in intrauterine devices. 1228 81

The Norplant removal method developed by the Population Council has been the standard removal method around the world. However, when the capsules have been improperly put in, it may become difficult to palpate them, and some capsules may be broken or bent. A retrospective analysis of 3416 removals showed that having had a complicated insertion led to a 4-fold increased risk of a complicated removal. Another method of removal is the pop-out method developed at the University of California San Francisco (UCSF) School of Medicine. This method requires an incision close to the implant tips. The UCSF method was compared to the standard method for 102 women, and clinicians reported less immediate and subsequent discomfort with it. 38% of the 62 women reported moderate to severe pain with the standard method compared to 3% of 40 women with the pop-out method. Another method was developed at the Emory University family planning program in Atlanta in 1992. A recent evaluation of 50 patients revealed the average removal time was 8 minutes with 88% being completed in less than 10 minutes. 6 cc of lidocaine (instead of 3 cc) and an 8 mm to 1 cm incision (instead of 3 mm to 4 mm) was used. The next technique, the modified U technique, employs the concept of breaking up the tissue plane before implants are removed. Two features of this method are the modified no-scalpel vasectomy forceps used to snare the implant and the incision made vertically to the implant between implants 3 and 4. Compared to the standard technique the U technique is faster and results in fewer broken capsules. Another new technique using vertical incision is the hook and delivery method, also known as the hypodermic platform technique, because a 2-inch, 21-gauge hypodermic needle is inserted. The vertical incision avoids scar tissue at the spot where the trocar was used for insertion of the capsules.
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PMID:New Norplant implant removal techniques can make your job easier. 1229 Sep 63

Norplant was incorporated into Kenya's national family planning program in 1992. Since then, the Ministry of Health, the Family Planning Association of Kenya, and the Christian Health Association of Kenya have conducted a training the appropriate health personnel, emphasizing counseling and the clinical skills of insertion and removal. By the end of 1995, Norplant was available at 72 public and private sites throughout the country. In 1996, researchers reviewed the records of 225 women who had obtained removal services at six health facilities in Kenya. They also interviewed 35 of those clients to learn why they sought removal and the quality of the services they received. More than half of the 225 clients reported that the main reason for removal was side effects, in particular, heavy or irregular bleeding. About 25% of the women wanted to have the implants removed because they wanted to become pregnant. Because the method is still relatively new in Kenya, only 3 women requested removal because of the 5-year expiration date for the implants. Women reported relative ease in finding a provider to remove the implants, no complications were experienced, and two-thirds reported experiencing no pain during the removal procedure. 33 of the 35 women interviewed said they would recommend Norplant to a friend, although the quality of counseling could be improved. Finally, the number of requests for removal is expected to rise in the next few years as many women reach the 5-year expiration date. AVSC estimates that about 12,500 women in Kenya will request removals in 2000.
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PMID:Norplant removals: taking care in Kenya. 1229 87


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