The combined contraceptive vaginal ring (NuvaRing): first experience in daily clinical practice in The Netherlands.

OBJECTIVES: The combined contraceptive vaginal ring (NuvaRing) has been shown to be safe and effective, with high levels of user compliance, acceptance and satisfaction. However, the data collected from registration studies may differ from the clinical situation. The Dutch NuvaRing Experience Project was initiated to gain insight into NuvaRing use in daily clinical practice. METHODS: A total of 1,130 women, recruited by 257 general practitioners, participated in this observational study. Data on compliance, acceptance, satisfaction, and adverse events were collected during the first 3 months of ring use via an online questionnaire. RESULTS: The results of this study were almost identical to those of the international registration studies. The majority of women complied with the prescribed regimen and were (very) satisfied with NuvaRing, primarily because of the once-a-month administration, low hormonal dose, and ease of use. Only one pregnancy was recorded throughout the study period. The bleeding pattern was better than with the pill, and there were few estrogen-related adverse events. Only a small proportion of women discontinued because of local adverse events such as discomfort during intercourse and expulsion. Following study completion, 80% of women continued with NuvaRing. CONCLUSIONS: In The Netherlands, the first clinical experiences with NuvaRing in daily practice confirm that the contraceptive ring is a reliable, safe, and convenient method of contraception.     

Cycle control, tolerability, efficacy and acceptability of the vaginal contraceptive ring, NuvaRing: results of clinical experience in Germany.

OBJECTIVES: To investigate the real-life clinical experience of NuvaRing users in Germany. METHODS: An open-label, prospective, uncontrolled, non-randomized, multicentre postmarketing surveillance study was conducted by 1204 gynaecologists amongst 5823 women requesting contraception. The women underwent routine examinations and contraceptive counselling, and were assessed after three and six cycles of NuvaRing use. RESULTS: Good cycle control was observed and there was a reduction in cycle irregularity and inter-menstrual bleeding, bleeding duration and intensity, and dysmenorrhoea. NuvaRing was well tolerated, and had no significant effect on body weight or blood pressure. Nine women became pregnant unintentionally (two had conceived before they started to use NuvaRing, three due to non-compliance, one because of repeated ring expulsion/loss and three during treatment in spite of having applied this latter as instructed). Most women expressed their satisfaction with NuvaRing; 82% were 'very satisfied/ satisfied', 72% planned to continue using it and 82% would recommend it to others. More than 90% of women found NuvaRing 'without problems/easy' to insert and to remove, and more than 80% of the women and their partners were not disturbed by its presence during intercourse. CONCLUSION: NuvaRing is a highly effective and acceptable method of once-monthly contraception that is safe and well tolerated.     

The female condom: acceptability and perception among rural women in Zimbabwe

This study was conducted to generate data for developing an action plan for accessing the female condom through primary health care centres in Zimbabwe. It used both quantitative and qualitative methods to gather information from sexually active women and men on the perception and acceptability of the female condom among users in rural areas of Zimbabwe. The findings show that very few women had used the female condom prior to the survey. Several women (93%) liked the condom especially young women aged 20-39 years (83%), compared to older women aged 40 years and above (11%). Both women and men liked the dual role of contraception and protection against STIs including HIV/AIDS played by the female condom. Most women (98%) felt that it is important for women to have their own condom. However, both men and women pointed out that it will be difficult to introduce the female condom in married situations due to the stigma associated with condoms in general. Over 80% of women said they will have to seek permission from their partners to use the female condom. Women had problems with inserting the condom and were concerned with lubrication, size and appearance, and how to dispose of used condom. Regarding cost, 77% felt that the female condom is too expensive given that the male condom can be obtained free from health centres. The cost of the female condom could hinder its continued use and would encourage women, especially commercial sex workers, to re-use it. Respondents still require more information relating to side effects (45%), effectiveness in STIs prevention including HIV/AIDS (44%), proper use (43%) and cost (32%).     

The menstrual cycle: relations of biophysical and hormonal determinations in normal women of reproductive age.

Appropriate relationships between circulating levels of 17 beta-E2 and P are necessary for normal endometrial development and blastocyst implantation. The aim of this study was to relate biophysical and biochemical measurements obtained during the menstrual cycle of six healthy women in 25 menstrual cycles. One hundred eighteen vaginosonographic determinations of the endometrial thickness together with serum E2 and P assays were performed at 5-day intervals. The three parameters studied were standardized by the formula: observation minus mean determination for that parameter divided by the standard deviation of that parameter. Using this common unit, the physiological relations between ultrasonographically determined endometrial thickness, E2, and P were readily seen.     

Use of the NuvaRing hormone-releasing system in late reproductive-age women with type 1 diabetes mellitus.

AIM: To evaluate the effect of the vaginally inserted hormone-releasing system NuvaRing on carbohydrate and lipid metabolism and the hemostasis system, over 6 months of use, in late reproductive-age women with type 1 diabetes mellitus (DM). METHODS: The open randomized study included a total of 25 women with type 1 DM using NuvaRing. Average daily insulin requirements, levels of glycosylated hemoglobin (HbA1c), total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, the state of coagulation hemostatis and fibrinolytic activity were determined at baseline and after 3 and 6 months of contraception. The control group was composed of 20 age-matched women with type 1 DM using no methods of contraception, as well as 20 apparently healthy women using the NuvaRing device. RESULTS: Use of the NuvaRing contraceptive system in type 1 DM women in the late reproductive period was shown to exert no clinically significant effect on carbohydrate and lipid metabolism on the background of persistent and satisfactory compensation of carbohydrate metabolism (HbA1c < or = 7.5%), with a neutral impact on the hemostasis system. CONCLUSION: The NuvaRing hormone-releasing system proved to be a reliable and safe means of contraception for late reproductive-age women with type 1 DM.     

Deaths among women of reproductive age in Cape Verde: causes and avoidability

SUBJECT: In 1992-93 all deaths (n=97) of women 15 to 49 years old in three islands of Cape Verde were investigated to determine the cause of death, the maternal mortality ratio, the reliability of cause-of-death ascertainment, and the level of avoidability. METHOD: Data were obtained through interviews with the deceased person's family members and other knowledgeable persons (verbal autopsy) and through hospital files. RESULTS: The overall mortality rate was 163 per 100,000 women 1549 years old, and the maternal mortality ratio was 127 per 100,000 live births. A plausible diagnosis could be determined in 77%. The most frequent causes of death were circulatory disorders, external causes, maternal causes, infectious diseases. and neoplasms. CONCLUSIONS: It was estimated that three of four of the deaths were avoidable with locally available resources. Since access to health care in the study area is not a major hindrance, a further decrease of female mortality depends mainly on improved quality of care in health facilities.     

A comparison of psychological stress among women with and without reproductive failure

Objective

To determine whether women with recurrent implantation failure (RIF) after in vitro fertilization (IVF), similar to women with recurrent pregnancy loss, have significantly higher stress levels than women without reproductive failure, and to compare stress levels between women with RIF and women with recurrent pregnancy loss.

Methods

In a questionnaire-based study between September 2009 and January 2011, psychological stress was measured among patients attending recurrent pregnancy loss and RIF clinics at the Royal Hallamshire Hospital, Sheffield, UK. Participants completed the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PSS), and the Positive and Negative Affect Schedule (PANAS) on their first visit to their respective clinic. Thirty fertile control women also completed the 3 validated questionnaires.

Results

Compared with the control group, women with RIF and recurrent pregnancy loss had significantly higher scores in the FPI (RIF, P < 0.001; recurrent pregnancy loss, P = 0.003) and the PANAS negative affect domain (RIF, P = 0.004; recurrent pregnancy loss, P = 0.001), and lower scores in the PANAS positive affect domain (RIF, P < 0.001; recurrent pregnancy loss, P < 0.001). Whereas the perceived stress score (PSS) of the recurrent pregnancy loss group was significantly higher than that of the control group (P = 0.006), the score of the RIF group was not, although the difference tended toward statistical significance (P = 0.058).

Conclusion

The study findings confirm the stressful nature of RIF and recurrent pregnancy loss.     

Women who have sex with women: their sexual biography, reproductive health and experience with violence

OBJECTIVE: To compare sociodemographic characteristics, sexual and reproductive biographies and experience of violence according to the fact that women have or have not had homosexual relationship. PATIENTS AND METHODS: From the national survey on violence against women in France carried out in 2000 by phone, two groups have been compared: 78 women who have had at least one woman sexual partner and 6332 women who have had only male partners during lifetime. RESULTS: Women who have had sexual relationships with women more often have high level social positions and live in large cities. They have a more diverse sexual life that they begin younger and more partners, mainly men. They use contraception less often. They have more sexually transmitted infections and are more often tested for HIV. They visit gynaecologists as often as other women. They are more often victims of violence, especially physical violence as adults. DISCUSSION AND CONCLUSION: These results, in an understudied field in France, are consistent with findings from the international literature. They attest to the difficulties women may be confronted with in situations where autonomy and marginality are combined. Doctors need to be better informed about the diversity of their trajectories in order to provide appropriate medical care.     

The acceptability of isoflavones as a treatment of menopausal symptoms: a European survey among postmenopausal women.

OBJECTIVE: To investigate determinants of the acceptability of isoflavone products among postmenopausal women with regard to social and lifestyle factors, dietary habits, health concerns, food beliefs, menopausal symptoms and therapies, and to elucidate preferences for specific products. METHODS: A consumer survey was conducted among postmenopausal women in four European countries (Germany, Denmark, Italy and the UK), including a total of 465 respondents. RESULTS: The declared acceptability of isoflavones was highest in Germany (80%), followed by Italy (75%), the UK (59%) and Denmark (55%; p < 0.001). Among other factors, prior information about isoflavones (odds ratio (OR) 2.64, 95% confidence interval (CI) 1.54-4.51, p < 0.001) and belief that foods can be used to treat medical conditions (OR 2.18, 95% CI 1.17-4.05, p = 0.014) were the strongest predictors of potential acceptability. The preferred forms in which isoflavones might be taken differed markedly between countries. CONCLUSIONS: Information about the health effects of isoflavones and health-diet links should be considered the most important factors in attempts to influence the potential acceptability of isoflavone products. Foods enriched with isoflavones need to be developed with regard to specific cultural demands in order to assure consumer acceptance on the marketplace.     

Sexual abuse and reproductive health among unmarried young women seeking abortion in China.

OBJECTIVE: To investigate sexual violence and its impact on reproductive health in unmarried young women seeking abortion in China. METHODS: A total of 2002 participants were surveyed by questionnaire, gynecologic examination, and laboratory tests for sexually transmitted disease (STD). RESULTS: Overall, 14% of participants had experienced sexual violence and 43.4% were diagnosed with STD. Among victims of sexual abuse, 8.6% had their first sexual encounter when they were younger than 18 years; 42.7% had had 2 or more sexual partners; and 21.6% never used contraception. Multivariate analysis revealed that sexual abuse, multiple sexual partners, sexual activity before the age of 18 years, and not using contraception were important indicators of the presence of STD. CONCLUSION: The prevalence of sexual abuse is high in China; and among unmarried young women seeking abortion, those who experience sexual abuse are at significantly increased risk for STD.     

Emotional impact and acceptability of medical abortion with mifepristone: A German experience

In Germany, four years of experience with mifepristone as an alternative procedure to surgical abortion have revealed a still reluctant use of the new method. In the public discussion, the more participatory role of the women in the abortion procedure is often feared to have negative consequences for the emotional processing of the event. This study compares the women's criteria for selecting a method and the psychological responses before and four weeks after medical or surgical abortion. Two hundred and nineteen women answered questions regarding demographic data, motivation, medical details and social support. Additionally, the women completed the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). There were no differences regarding sociodemographic and reproductive characteristics among both groups. Comparing data before and a month after the abortion, our study showed a significant decline of both anxiety and depression for both abortion methods. The medical group had significantly lower entrance levels of anxiety than the surgical group. The medical regimen caused significantly more sequelae such as prolonged bleeding, pain and other side effects. However, this did not have a negative influence on the coping process. A vast majority of women in both groups evaluated choosing between different abortion methods as being highly important to them. Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.     

Emotional impact and acceptability of medical abortion with mifepristone: a German experience

In Germany, four years of experience with mifepristone as an alternative procedure to surgical abortion have revealed a still reluctant use of the new method. In the public discussion, the more participatory role of the women in the abortion procedure is often feared to have negative consequences for the emotional processing of the event. This study compares the women's criteria for selecting a method and the psychological responses before and four weeks after medical or surgical abortion. Two hundred and nineteen women answered questions regarding demographic data, motivation, medical details and social support. Additionally, the women completed the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES). There were no differences regarding sociodemographic and reproductive characteristics among both groups. Comparing data before and a month after the abortion, our study showed a significant decline of both anxiety and depression for both abortion methods. The medical group had significantly lower entrance levels of anxiety than the surgical group. The medical regimen caused significantly more sequelae such as prolonged bleeding, pain and other side effects. However, this did not have a negative influence on the coping process. A vast majority of women in both groups evaluated choosing between different abortion methods as being highly important to them. Our study supports the consensus view that termination of an unwanted pregnancy is a positive first solution to the conflict, regardless of the chosen method. The positive outcome and high satisfaction levels among the participants illustrate the importance of an ongoing and improved accessibility of medical abortion for women in Germany.     

Sociodemographic factors associated with female genital cutting among women of reproductive age in Nigeria

Objectives: The aims of the study were to determine the prevalence of female genital cutting (FGC) among women of reproductive age in Nigeria and identify the sociodemographic factors associated with the practice.

Methods: A secondary analysis of the 2013 Nigeria Demographic and Health Survey was carried out in 38,948 women of reproductive age (15–49 years).

Results: The prevalence of FGC among respondents was almost 25%, most of whom (82%) had undergone the procedure when they were under 5 years of age. Traditional circumcisers performed 72.2% of all procedures. Type 2 was the common form (62.6%) of FGC. Almost a quarter of respondents (23.1%) wanted the practice to continue. Women aged 45–49 years were approximately twice as likely to have undergone FGC compared with women aged 15–19 years (odds ratio [OR] 2.41; 95% confidence interval [CI] 1.99, 2.92; p?p?p?Conclusions: Our findings have programmatic implications for ending the practice of FGC in Nigeria. Elimination efforts should be intensified among women of Yoruba ethnicity. To instigate behavioural change, communication interventions should particularly target residents in parts of Nigeria other than the North East zone.     

Comparison of implantation and pregnancy rates in African American and white women in an assisted reproductive technology practice.

OBJECTIVE: To compare IVF outcomes between infertile African American and white women. DESIGN: Retrospective cohort study. SETTING: Hospital-based IVF practice. PATIENT(S): Women undergoing IVF procedures between November 1996 and June 2000. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Implantation and pregnancy rates. RESULT(S): There were 24 African American and 273 white women < or =40 years of age who underwent 25 and 333 IVF cycles, respectively. African American women were more likely to have had tubal factor as a primary diagnosis, to have had a child, and to have undergone fewer previous assisted reproductive technology (ART) cycles as compared to white women. No differences between the two groups for clinical variables were noted with the exception of body mass index (BMI [kg/m(2)], 27.1 in African Americans vs. 24.8 in whites). Implantation rates were higher in African American than in white women (35% vs. 23%, respectively). Pregnancy rates were 71% in African Americans and 48% in whites. After adjustment for tubal factor, BMI, and parity, the odds ratio for pregnancy in African American women versus white women increased from 2.6 to 3.3. CONCLUSION(S): This is the first study to demonstrate a significantly higher clinical pregnancy rate in African American women as compared to white women undergoing ART. These data strongly contradict a recent study comparing the same two groups of women undergoing ART. We urge other ART centers to report their data pertaining to race.     

Breastfeeding, amenorrhea and contraceptive practice among postpartum women in Zibo, China.

This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at 42 days. 4 months and 1 year after delivery. The results showed that the full breastfeeding rate (including exclusive and almost exclusive breastfeeding) was 78% and 43% at 42 days and 4 months after delivery, respectively. The mean reported length of abstinence from sexual intercourse after delivery was 71 days. The mean reported time to menses resumption was 184 days. Ninety-three per cent of women had resumed sexual intercourse at 4 months after delivery. Seventy-three per cent of women were using contraceptive methods when they resumed sexual activity after delivery. After childbirth, the majority ofthe women interviewed used condoms within 3 months. Thereafter, most of them switched to intrauterine device (IUD)). Life table analysis shows that the continuation rates of full breastfeeding and amenorrhea at 4 months after delivery were 35% and 68%, respectively. This implies that if the full breastfeeding rate can be prolonged, it is feasible to use the lactational amenorrhea method (LAM) among Chinese postpartum women. The policy implications of this study are that quality care on contraceptive services and information for postpartum women in urban areas need to be improved further.     

薄型子宫内膜合并甲状腺功能减退不孕患者的辅助生育治疗结局

目的探讨薄型子宫内膜合并甲状腺功能减退不孕患者行辅助生育治疗后的效果。方法 165例因新鲜周期内膜≤7 mm而取消胚胎移植的不孕患者,在拟行冻融胚胎移植前,对游离甲状腺素T4(FT4)正常、促甲状腺激素(TSH)2.5 mIU/L的患者进行左旋甲状腺素片干预治疗。经治疗4~8周后,患者依据TSH水平分为A组(n=70),TSH2.5 mIU/L;B组(n=95),TSH≤2.5 mIU/L。所有患者均采用相同剂量激素替代方案准备子宫内膜,分析子宫内膜情况及辅助生育结局。结果 A组与B组相比,虽然子宫内膜下血流数量和阻力指数(RI)组间无统计学差异(P0.05),但B组内膜下血流数量的均值高于A组,RI均值低于A组。且B组的子宫内膜厚度、临床妊娠率显著高于A组(P0.05),流产率显著低于A组(P0.05)。结论薄型子宫内膜合并TSH升高的不孕患者,给予干预至TSH2.5 mIU/L后,行辅助生育治疗可改善这些患者的妊娠结局。     

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Objective

To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV.

Methods

A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire.

Results

Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30 years age group residing in towns.

Conclusion

These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.