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 11,379 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Currently, more than 50% of married women of childbearing age are using a form of contraception. Between 1960-65 and 1985-90, the number of contraceptive users in all developing countries increased from 31 to 381 million, in East Asia from 18 to 217 million, in Latin America from 4 to 44 million, in South Asia from 8 to 94 million, and in Africa from 2 to 18 million. WHO has recently estimated that over 500,000 women die each year from causes related to pregnancy and childbirth. With a worldwide estimate of 36-53 million induced abortions performed each year, between 125,000 and 170,000 women die each year because of unsafe abortions. According to data from the World Fertility Survey, short spacing between births raises the average chances of offspring dying in infancy by 60-70% and the chances of dying before the age of 5 years by about 50%. WHO's minimal estimate for yearly incidence of bacterial and viral STDs (excluding HIV infection) is 130 million. Most STDs have more serious sequelae in women than in men and lead to pelvic inflammatory disease (PID), permanent infertility, and the risk of ectopic pregnancy. African countries with high incidence of STDs have the lowest prevalences of contraceptive use. A recent examination of the WHO international data base of 22,908 IUD insertions and 51,399 woman-years of follow-up indicates that the occurrence of PID in IUD users is most strongly related to the insertion process and to background STD risk and suggests that PID is an infrequent occurrence after the insertion period. A WHO Scientific Working Group review confirmed the beneficial effects of oral contraceptives in reducing the risk of ovarian cancer, endometrial cancer, and biopsy-proven benign breast diseases. A WHO collaborative study in 5 centers in Kenya, Mexico, and Thailand provided assurance that women who used DMPA for a long time and who initiated use many years previously are not at increased risk of breast cancer.
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PMID:Contraception and women's health. 832 13

The use of combined oral contraceptives carries a number of well-established major non-contraceptive benefits. Of these, the most important protective effects are suppression of the risk of epithelial cancer of the ovary and cancer of the endometrium. Also of great importance is a reduction in the risk of pelvic inflammatory disease. Needless to say, there are also some established risks of combined oral contraceptives. The most important of these are the vascular ones, comprising effects on acute myocardial infarction, thrombotic stroke, haemorrhagic stroke, and venous thrombosis and embolism. Possible risks which are still under evaluation include an adverse effect on breast cancer and, likewise, on carcinoma of the cervix. More information is needed about both these conditions. A number of authors have provided analyses of varying degrees of complexity in which they have attempted to weigh the benefits and risks of combined oral contraceptives. Results from some of these studies are presented in the paper. On the whole, the findings are reasonably reassuring.
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PMID:Benefits and risks of combined oral contraceptives. 834 Nov 54

Since their introduction nearly 30 years ago, oral contraceptives have been widely researched regarding their contraceptive and noncontraceptive effects. With proper usage, oral contraceptives provide highly effective contraception. In addition, oral contraceptives confer significant noncontraceptive health benefits, including prevention of ovarian and endometrial cancer and reduction in the incidence of pelvic inflammatory disease, endometriosis, benign breast disease, and dysmenorrhea, among others. Today's low-dose oral contraceptives have an improved safety profile when contrasted with their early higher dose counterparts. Yet oral contraceptive use continues to be associated with a variety of minor side effects, which range from menstrual changes such as breakthrough bleeding, spotting, or amenorrhea, to androgenic effects, including weight gain and acne. These androgenic effects are important factors in patient discontinuation of oral contraceptives. Progestins with increased selectivity have the potential to cause fewer androgenic side effects while retaining appropriate progestin suppression of the endometrium and hypophyseal-pituitary-ovarian axis. A combination oral contraceptive (30 micrograms of ethinyl estradiol with 150 micrograms of desogestrel) has been evaluated extensively by European investigators. This literature suggests that a low-dose oral contraceptive formulated with the selective progestin desogestrel offers a favorable profile of reduced androgenic side effects while retaining the cycle control associated with low-dose oral contraceptives currently marketed in the United States.
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PMID:Combined oral contraception with desogestrel/ethinyl estradiol: tolerability profile. 844 56

Researchers continue to search for newer oral contraceptive (OC) formulations that retain the pill's beneficial effects while minimizing side effects. Changes in the clinical profile of OCs since their introduction in 1960 have enhanced their safety and acceptability. Most notable has been a trend toward the reduction of the pill's estrogen dose to 15-20 mcg of ethinyl estradiol and the consequent decline in cardiovascular risks attributable to thromboembolic processes. In addition, research has been directed toward the identification of selective gonane progestins that do not have the same atherogenetic impact as their predecessors. The low-dose gonane progestins may provide protection against cardiovascular disease through their beneficial impact on lipid profile. New regimes currently under study include a 23-24-day/month use pattern to reduce follicular ripening, use of estradiol rather than ethinyl estradiol, and the identification of progestins with special anti-androgenic effects. Also under investigation is the contraceptive potential of antiprogestogens such as RU-486. At present, the non-contraceptive benefits of OC use include reductions in ovarian and endometrial cancer, fewer ovarian cysts, less benign breast disease, a lower incidence of pelvic inflammatory disease, and less menorrhagia.
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PMID:Advances in oral hormonal contraception. 853 89

This paper reviews the noncontraceptive benefits and therapeutic uses of depot medroxyprogesterone acetate (DMPA). Relevant articles were reviewed using a computerized Medline search of the literature from 1966 to 1995. Good evidence shows that DMPA use is associated with reduced iron-deficiency anemia, protection against pelvic inflammatory disease, protection from endometrial cancer and improved hematologic parameters among users with sickle cell disease. More studies are needed to fully assess DMPA's impact on other disorders.
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PMID:Noncontraceptive benefits and therapeutic uses of depot medroxyprogesterone acetate. 872 6

Epidemiological research serves to continue surveillance of fertility regulation agents once phase 3 clinical trials have been completed and the contraceptives have been marketed. Epidemiologic research conducted during the past 20 years has had a major impact on family planning program policies and clarified many concerns about contraceptive side effects that emerged in the early 1970s. Central has been the reassessment of the risk of malignant neoplasms associated with use of hormonal contraception. Data from large-scale studies such as the Cancer and Steroid Hormone Study in the US and the World Health Organization Collaborative Study involving 9 developing and 2 developed countries suggest that combined oral contraceptives (OCs) decrease the risk of ovarian and endometrial cancer, especially in long-term users. Although there is emerging evidence that OC use exceeding 5 years is associated with a modest increase in cervical cancer risk, the causality of the association is questionable given the probable influence of confounding factors such as sexually transmitted diseases. Moreover, epidemiologic studies launched in the 1980s confirmed that the previously noted association between OCs and cardiovascular diseases has been reduced as a result of lower doses of ethinyl estradiol and revised prescribing practices. Other foci of epidemiologic investigations have included possible side effects associated with natural family planning, the impact of modern IUDs on pelvic inflammatory disease and ectopic pregnancy risks, and the association between vasectomy and testicular and prostate cancer. Given the observational nature of epidemiologic research and the potential for bias, findings from several studies addressing the same research question with different methodological approaches are generally assessed.
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PMID:Twenty years of epidemiology in fertility regulation. 900 93

Numerous studies have shown that oral contraceptives (OC) provide protection against a wide variety of illnesses and conditions, including loss of bone density, ovarian cysts, menstrual cycle irregularities, dysmenorrhea and menorrhagia, ectopic pregnancy, pelvic inflammatory disease, benign breast disease, endometrial cancer, and ovarian cancer. How OC can be used not only for contraception but also to improve health among women throughout their reproductive years is illustrated by four case presentations: an adolescent with menstrual problems; a 25-year-old mulligravida who wishes to delay childbearing; a 35-year-old who has completed her family and requests tubal ligation; and a 45-year-old with perimenopausal symptoms. In view of their numerous health benefits, OC are to reproductive-age women as hormone replacement therapy is to menopausal women.
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PMID:Oral contraceptives: therapeutic uses and quality-of-life benefits--case presentations. 1034 95

This article concerns the essential findings of the task force created by the Special Programme of Research, Development, and Research Training in Human Reproduction in 1985 to conduct research on the safety and efficacy of fertility-regulating methods. The task force had 9 research priorities which include: 1) effects of contraceptive use during lactation; 2) pelvic inflammatory disease and contraception; 3) cardiovascular disease and hormonal contraception; 4) cancer and hormonal contraception; 5) interactions between contraceptive use and disease; 6) morbidity due to female sterilization; 7) induced abortion; 8) safety of Norplant; and 9) IUDs. It then established epidemiological studies in 47 countries, which were mostly from the developing world. Some main achievements were: 1) identification of the beneficial and possible adverse effects of oral contraceptives (OCs) on the risk of neoplasia; 2) demonstrating that injectable depot-medroxyprogesterone acetate protects against endometrial cancer and does not increase the overall risk of breast cancer; 3) clarifying which groups of women are prone to the complications of OCs; and 4) establishing the long-term effectiveness and safety of IUDs. Furthermore, the valuable information produced by this research program has already had a significant impact on family planning policies and practice. This venture also strengthens the value of mission-oriented research and demonstrates the potential of collaborative research between developing and developed countries.
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PMID:Safety and efficacy of fertility-regulating methods: a decade of research. 1053 94

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.
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PMID:The intrauterine device and its dynamics. 1099 94

A sizeable literature corroborates the multiple health benefits of oral contraceptive use. The first estrogen/progestin combination pills were marketed to treat a variety of menstrual disorders. Although currently used oral contraceptives no longer carry FDA-approved labeling for these indications, they remain important therapeutic options for a variety of gynecologic conditions. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID. Although older, higher-dose pills reduced the incidence of ovarian cysts, low-dose pills suppress follicular activity less consistently. Nevertheless, cycle-related symptoms, including functional cysts, dysmenorrhea, chronic pelvic pain, and ovulation pain (mittelschmerz), generally improve. Women with polycystic ovary syndrome note improvement in bleeding patterns and a reduction in acne and hirsutism. Symptoms from endometriosis also improve with oral contraceptive therapy. Current data suggest that oral contraceptive therapy increases bone density and that past use decreases fracture risk. Oral contraceptives also improve acne, a major health concern of young women. Oral contraceptives provide lasting reduction in the risk of two serious gynecologic malignancies--ovarian and endometrial cancer. The data with respect to ovarian cancer are compelling enough to recommend the use of oral contraceptives to women at high risk by virtue of family history, positive carrier status of the BRCA mutations, or nulliparity, even if contraception is not required. Health care providers must counsel women regarding these benefits to counteract deeply held public attitudes and misconceptions regarding oral contraceptive use. Messages should focus on topics of interest to particular groups of women. The fact that oral contraceptives increase bone mineral density and reduce ovarian cancer is of great interest to women in their forties and helps influence use and compliance in this group. In contrast, the beneficial effects of oral contraceptives on acne resonates with younger women. Getting the good news out about the benefits of oral contraceptives will enable more women to take advantage of their positive health effects.
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PMID:Health benefits of oral contraceptives. 1109 85


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