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

Oral contraceptives are one of the most highly effective forms of contraception and provide many short- and long-term noncontraceptive health benefits. They control menstrual cycle irregularities, such as breakthrough bleeding and amenorrhea, and are effective in treating dysfunctional uterine bleeding. In addition, for decades after oral contraceptive use is discontinued they are associated with substantial decreases in the risk of ovarian cancer (up to 80%) and of endometrial cancer (40%-50%), and nearly eliminate benign functional ovarian cysts. Long-term oral contraceptive use confers protection against benign breast disease and colorectal cancer, may help prevent rheumatoid arthritis, decreases ectopic pregnancy and hospitalizations for pelvic inflammatory disease, and helps preserve bone mineral density to reduce risk of fractures. Large bodies of evidence from extensive research have clarified the perceived association of oral contraceptive use with cardiovascular disease and with breast cancer. Findings indicate that there is no increased risk of myocardial infarction or stroke associated with oral contraceptive use in healthy, nonsmoking, normotensive women. Although there is a 3- to 4-fold increased risk of venous thromboembolism with current oral contraceptive use, the absolute risk is very small and is half that associated with pregnancy. Women of all reproductive ages, including perimenopausal women, can realize many health benefits through oral contraceptive use, including improved health status later in life.
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PMID:Current perspectives on oral contraceptive use. 1152 Nov 17

The intrauterine device (IUD) is a highly effective method of contraception that, as opposed to other countries around the world, is underutilized in the United States by women of all ages. Lingering concerns about the safety of IUDs are in large part responsible for their lack of adoption, but a systematic review published recently nullified some of the major safety concerns about IUD use. The author summarized the methodologically sound evidence regarding the risk of upper-genital-tract infection and infertility associated with IUD use and reported that a slightly increased risk of pelvic inflammatory disease (PID) exists only in the first month following IUD insertion; that the risk of PID in women with symptomless sexually transmitted diseases (STDs) having an IUD inserted is similar to the risk in women not having an IUD inserted; and that there appears to be no negative effect on fertility following IUD removal. In addition, Mirena provides noncontraceptive benefits, such as treatment for menorrhagia, dysmenorrhea, and anemia, and ParaGard may help protect against endometrial cancer. An IUD is also a safer alternative to sterilization for perimenopausal women seeking a long-term and also reversible method of contraception. While both IUDs are suitable for many women of all ages, there are differences in their mechanisms of action, physical characteristics, and clinical effects that make each more or less appropriate for certain women.
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PMID:Compelling reasons for recommending IUDs to any woman of reproductive age. 1199 35

A brief summary of safe methods of contraception is presented. Noted is the research in the US and the UK an oral contraceptive (OC) use, which identifies smokers as at risk for circulatory system problems with OC use. Substantial protective effects provided by OCs are protection against pelvic inflammatory disease (PID), ectopic pregnancy, endometrial cancer, ovarian cancer, and benign breast disease. Injectable contraceptives tend to promote an increased appetite for food and may cause menstrual disturbances, but are helpful in the prevention of anemia and crisis situations in sickle cell disease. THe IUD offers a high level of effectiveness and is convenient and reversible; the older women in a monogamous relationship is a suitable candidate. IUDs can increase the risk of PID for women with multiple sexual partners. Other side effects are increased menstrual bleeding and lower back or abdominal pain. Voluntary sterilization vasectomy for males and bilateral tubal ligation for women) is a suitable option for couples desiring no more children but desiring sexual intercourse. The process is not reversible and does not affect sexual desire. Women continue to have menstrual periods and men continue to ejaculate but without any sperm. Proper counseling from family planning clinics is advisable before choosing any contraceptive method. A wide choice of methods and information on method are available. The hope is for couples to make use of family planning and make better decisions about childbearing, which insure an improved quality of life for their families.
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PMID:Planning your family safely. 1217 6

Ever since a gradual but significant reduction in the estrogenic and progestogenic components of oral contraceptives (OCs) was made, there has been a corresponding decrease in adverse effects associated with the pill. The beneficial effects include prevention of pregnancy, reduction in pelvic inflammatory disease, protection against ovarian/endometrial cancer and benign breast tumors and ovarian cysts, reduction in the occurrence of rheumatoid arthritis among OC users, and regulation of the menstrual cycle. The adverse effects include diseases of the circulatory system (myocardial infarction, venous thromboembolism, subarachnoid hemorrhage, hypertension), possible carcinogenicity (breast, cervix, melanoma), pituitary adenomas, liver disorders, glucose metabolix effects (diabetes), vitamin status alteration, delay in return of menstruation and fertility, and a number of minor side effects (nausea, vomiting). Contraindications to OC use include history of malignancy of the breast or genital tract, venous thromboembolism, cerebrovascular accident, undiagnosed abnormal vaginal bleeding, focal migraine, or familial hyperlipidemia. The following situations require medical assessment before OCs are prescribed, and medical supervision if OCs are prescribed: age 40+, smoking and age over 35, mild hypertension or a history of hypertensive disease of pregnancy (toxemia), epilepsy, diabetes mellitus, history of bouts of depression, history of oligomenorrhea or amenorrhea in nulliparous women, and gallbladder disease. Problems could occur with OC use in the following situations: 1) lactation (ideally, OCs should be withheld until the child is weaned but if not possible, OCs should not be given until lactation is established); 2) drug interaction (other contraceptive form should be used when the patient is taking antibiotics or anticonvulsants); 3) tropical diseases (studies are still underway); 4) adolescence (very young girls should use other contraceptive method until regular menstruation is established); 5) postcoital contraception (limited use of steroids in emergency situation); and 6) hormonal pregnancy tests (use of oral steroids for pregnancy testing is not recommended). The 3 main types of OCs currently used are the combined estrogen and progestagen, the progestagen-only OC, and the triphasic OC. The lowest effective dose of a compound should be used, and healthy women may continue to use OCs for many years.
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PMID:Statement on steroidal oral contraceptives. 1226 73

The use of condoms as protection for women at risk for cervical cancer against some of the deleterious effects of sexual intercourse by limiting exposure to agents introduced by male sexual partners is discussed. In a recent study, 286 women with diagnosed cervical intraepithelial neoplasia who received cryosurgery or conization were instructed to use condoms during intercourse. 40 showed regression of the disease. 136 of 139 women treated with condoms alone also showed complete regression. 18 of the 286 women had recurrences, 12 showed regression after condom use was reinstituted. None of the patients showed progression of the disease while relying on condoms. Other contraceptives have also shown noncontraceptive benefits: oral contraceptives offer protection against pelvic inflammatory disease, ovarian and endometrial cancer; progestin releasing IUDs decrease dysmenorrhea and menstrual blood loss; and spermicidal agents may protect women against infection.
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PMID:Consider condoms for the woman at high risk of cervical cancer. 1226 4

The Society for Drug Research, based in the UK organized a 1 day symposium in London during December 1982 entitled "Fertility Control in the 21st Century." The meeting's objective was to stimulate further research into fertility regulation. Professor Carl Djerassi of Stanford University, California eloquently supported the case for postcoital contraception. He focused on teenagers who failed to use reliable contraceptive methods as an example of a subgroup of society who would particularly benefit from postcoital contraception. Djerassi presented a profile of the ideal contraceptive, which emphasized the potential for postcoital contraception. Characteristics of his "ideal" contraceptive included a need to focus on women, independence from coitus, and in the case of systemic contraception, short term exposure to the drug. Djerassi also reviewed the rigorous drug trial procedures that any new contraceptive had to undergo. Professor Martin Vessey of Oxford University focused his comments on the benefits and risks of oral contraceptives (OCs). In addition to the high efficacy of OCs, other benefits included the suppression of pelvic inflammatory disease, endometrial cancer, functional ovarian cysts, and benign breast disease. Regarding the association between OCs and benign breast tumors, Vessey stated that it appeared that it was only the most benign form that was suppressed. The protective effect against ovarian cancer appeared to persist in former users, seemed to be apparent across the spectrum of age groups, and appeared to be most pronounced in nulliparous women. 1 risk associated with OCs, according to Vessey, was the association between hepatocellular adenoma and OC. Dr. Malcolm Potts directed his comments to discussion of contraception in the 3rd world, demonstrating with a series of slides the variety of social and economic circumstances in which family planning services were needed. Other contributors to the symposium discussed new uses for old steroids, prostanoids in fertility control, immunization against fertility, and contraception in the male.
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PMID:Fertility regulation in the 21st century. 1226 52

This study was to observe the longterm safety in using stainless steel ring (metal ring). 6250 cases have been followed up for 15 years. The net cumulative pregnancy rate was 5.51, expulsion rate 17.74, rate of removal due to medical reasons 21.74, continuation rate 6.48/women (life table) after 15 years of insertion. Events took place more frequently in the 1st year of insertion, gradually decreased in the second, and tended to be stabilized to a low level thereafter. The removal rate for nonmedical reasons had been increasing with the increase in the period of insertion. 5 cases of cervical cancer and 2 of endometrial carcinoma occurred within the 15 years of observation. The incidence was not higher than that in the 1971-72 general survey at Shanghai. Among the 6250 cases, there were 43 cases (0.85%) of removal due to infection, and 9 cases of ectopic pregnancy, of which 6 cases occurred within the first 2 years of insertion, and 2 cases of intraperitoneal metal ring were found but with no severe complications. The duration of using the metal ring was also discussed. According to clinical and pathological observations, the metal ring did not increase the risk of uterine cancer and caused only a few mild complications. Therefore, it can be used for 15-20 years, provided there are no clinical symptoms. The relationship between the IUD and ectopic or PID remains to be further explored.
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PMID:[Duration of use for stainless steel ring--15 years of follow-up for 6250 cases]. 1226 99

The article by Benjamin Sachs and several members of the Family Planning Evaluation Division at the Centers for Disease Control states forcefully that the efforts to improve the health of women in their reproductive years have been extraordinarily effective over the past 25 years and that total deaths among women who are either trying to prevent pregnancy or who are pregnant are dropping markedly. Some journalists appear to have gathered the wrong message from this article. Sachs and his colleagues have shown that there are risks from using contraceptives and that those risks are now almost as great, in terms of absolute numbers, as the risks of pregnancies to American women. That does not mean that oral contraceptives (OCs) are as dangerous as pregnancy. The article should have placed more emphasis on the fact that the excess attributable mortality rate from contraceptives is far lower than the mortality rate attributable to pregnancy. Many important points are made in this article, and the following are directed to family planners: 1) the effort should made to think in terms of "reproductive mortality" rather than simply in terms of maternal mortality, 2) over the next 6 months there will be many questions relating to the safety of providing OCs to teenagers without parental consent, 3) there is a need to recognize that the deaths caused by modern contraceptives center primarily in heavy smokers using OCs in the latter half of the their reproductive life span, and 4) there are women dying of contraceptive complications whose deaths might be prevented if closer attention was paid to the OC danger signals. The concept of reproductive mortality allows epidemiologists, clinicians, and women to put into perspective all the risks of sexual intercourse. Most would argue that the benefits of highly effective contraceptives have exceeded the risks. This is particularly the case if one includes the numerous noncontraceptive benefits of OCs such as prevention of pelvic inflammatory disease, anemia, ovarian and endometrial cancer, and fibrocystic breast disease.
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PMID:Family planners need to absorb importance of mortality study. 1227 29

An international study of misinformation about the pill conducted by FHI surveyed 8 countries and found that women everywhere believed the pill dangerous to their health, while remaining ignorant of its benefits and actual complications. The study queried middle class urban women from Thailand, Sri Lanka, Senegal, Nigeria, Egypt, Mexico, Costa Rica and Chile. Some of the findings cited were: significant numbers of women believed pills cause uterine cancer; that pills increase risk of sterility; and that pills cause birth defects. Few women were aware of the reality of risk of cardiovascular disease, particularly for smokers. The pill's non-contraceptive health benefits, such as protecting against ovarian and endometrial cancer, pelvic inflammatory disease, sterility, venereal disease and anemia, were virtually unknown. In the different countries surveyed, from 26 to 60% of women who have tried the pill stopped taking it because they were worried about its safety. Fear of side effects is a major reason why many women do not try the pill. These misconceptions persist because of ignorance and fear, since cancer, rather than lack of it, makes news headlines.
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PMID:World pill poll reveals false fears. 1228 Dec 70

This article examines the issue of breakthrough bleeding, the leading complaint among oral contraceptive users, and strategies developed to combat the problem. In its annual oral contraceptive survey, Contraceptive Technology Update asked clinicians about the most common side effect reported by patients. 73% cited breakdown bleeding. Breakthrough bleeding can be disruptive, frightening, and bothersome for patients. In the survey, about 1/2 of the physicians reported that only a few of their patients find side effects such as breakthrough bleeding bothersome enough to discontinue use of oral contraceptives. The other 1/2 of the physicians, however, reported that up top 25% of the side effects. Due to the decreased estrogen in today's low-dose oral contraceptives, breakthrough bleeding occurs most often in new pill users, usually during the first 4 months of use. Among long-term oral contraceptive users, breakthrough bleeding should be investigated carefully, since it could signal a serious problem, such as a reduction in the efficiency of the oral contraceptive, a spontaneous abortion, an ectopic pregnancy, pelvic inflammatory disease, endometrial cancer, etc. The article goes on to describe several of the strategies used by physicians to stop or minimize breakthrough bleeding. These strategies include switching the types of oral contraceptives, instructing patients to temporarily double up on pills, or prescribing extra estrogen. While no consensus exists on the most appropriate strategy, it is clear that the treatments can be effective. Furthermore, physicians agree that the first and most important step in dealing with breakthrough bleeding is to counsel all new patients on the likelihood of the problem.
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PMID:Breakthrough bleeding number one problem with OC use. 1228 19


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