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Query: UMLS:C0598853 (forgetting)
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5 major criteria are used to evaluate family planning methods: efficacy, both theoretical and practical; acceptability as measured by continuation of use; safety; reversibility; and cost, including the cost of treatment, follow-up, and screening for contraindications. Traditional family planning methods are mostly based on periodic abstinence during the presumed fertile period. The calendar, temperature, Billings or cervical mucus, and symptothermal methods are based on observation of different symptoms of ovulation and fertility. Their advantages are that they do not require intervention by health personnel, their costs of use are nil, and they are morally acceptable to some couples. Their efficacy is lower than that of other methods and they should be viewed as methods to space rather than limit births. The withdrawal method, also less effective, requires active cooperation by the male partner. Among mechanical methods, the use of condoms has increased recently because of the protection they offer against HIV infection and other sexually transmitted diseases. Their efficacy depends on correct use, regular use, and the quality of the condom. The Pearl index varies from 93099 per 100 woman-years. The diaphragm must be individually measured and should be used with spermicides. The Pearl index ranges from 85095 per 100 woman-years. Spermicides, generally either nonoxynol-9 or benzalkonium chloride, are surfactants that have a Pearl index of 83-97 per 100 woman-years. They are available as creams, jellies, foams, suppositories, tablets, or impregnated sponges. Most failures appear due to errors of utilization. The mechanism of action of the IUD is imperfectly understood, but it is known to prevent nidation of the fertilized egg. Copper devised have higher rates of efficacy and tolerance. Pearl indices range from 95-99.5. Contraindications include genital infection, uterine anomalies, valvular cardiopathy, and coagulation problems. The IUD is relatively contraindicated if there is history of ectopic pregnancy or upper genital tract infections. The combined oral contraceptive is the most widely utilized method in France. The Pearl index is nearly 100 in the absence of forgetting, vomiting, or drug interactions. The contraindications are basically those of estrogens: history of thrombosis, prolonged bedrest, hypertension, hyperlipidemia, hepatic disorders, hormonodependent cancers, or smoking after age 35. Progestin-only methods are available in 3 forms: low-dose pills which must be taken at the same time each day, higher-dosed progestins taken for 20 days each month, and injectable progestins providing contraception for 8-12 weeks. Postcoital contraception using OCs or IUDs is possible but not well known among women or physicians. The Neuwirth law authorizing use of contraception in France was passed in 1967. Amendments in 1974 improved access and provided for reimbursement for some methods, but some newer forms are not reimbursed.
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PMID:[Family planning. Objectives, measures, regulations, structures]. 185 35

Changes in combined oral contraceptives (OCs) include reduction in the estrogen and progestogen dose and recourse to the third generation, less androgenic progestogens. They retain the efficacy and convenience of OCs while reducing the metabolic and cardiovascular effects and the need to identify contraindications and subjects at risk. OCs sometimes cause menstrual cycle problems: spotting and intercurrent bleeding or bleeding at any time other than menstruation (metrorrhagia). OCs cause loose and edematous stroma in the endometrium where glands maintain a proliferative-like phase throughout the cycle. Many dilated capillaries with hyperplasia of the endothelial cells rise to the surface. Forgetting or failure to take OC pills are often responsible for intercurrent bleeding. It is hard to determine what OCs cause less bleeding than other OCs. The third generation progestogen, gestodene, appears to have better cycle control than the two other third generation progestogens (desogestrel and norgestimate). It is not clear whether triphasic OCs with second generation progestogens are better than monophasic third generation OCs. The OC with low dose ethinyl estradiol (20 mcg) (Mercilon) has as low a bleeding rate as does the OC, Varnoline (30 mcg). Menstrual cycle disturbances rarely happen. Providers must emphasize to new OC users the possibility of spotting or intercurrent bleeding, especially during the first cycle. Providers must also inform them that these disturbances do not affect the effectiveness of the OCs and that they should not stop taking OCs if they are concerned about bleeding. Providers must instruct them what to do if they forget to take a pill(s). Providers should schedule an appointment after a new OC user has completed the third OC packet. They should do a gynecologic exam to search for a genital infection, endo-uterine polyp or fibroma, and hyperplasia of the endometrium. If bleeding persists during the third cycle, the client should change contraception.
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PMID:[Metrorrhagia caused by estrogen-progestin combinations]. 1231 56