Psychological aspects of male contraception

Now that women are responsible for contraception, a socio-cultural revolution is in progress. The advent of male sterilization will upset male and female sexual roles again. The numerous demands for vasectomy in the new world are astounding to Europeans, who would prefer to select vasectomy candidates carefully, by searching their implicit and explicit motivation, to avoid psychological complications.     

Effect of supplementary oral estrogen on long-acting injectable progestogen contraception

To test the effectiveness of daily oral doses of estrogen in regulating the menstrual cycle of women receiving 150 mg of depo-medroxyprogesterone acetate (DMPA), 32 women were administered 1 mg of stilbestrol daily in conjunction with their DMPA injections for 90 days. A control group of 31 women received DMPA with a placebo for the same period of time. After the first 90 days, 28 women were chosen from both the stilbestrol group and placebo group, and were instructed to take 1 mg of stilbestrol daily for 3 weeks of each of the 3 subsequent 4 week periods, with 22 women receiving no medication. Continuous daily doses during the first 90 days failed to diminish the incidence of uterine bleeding of the silbestrol group when compared to the controls. Supplemental administration of estrogen did not significantly alter the appearances of endometrial biopses or kayopyknotic indices. Cyclic administration of oral estrogen for 3 weeks of a 4 week period caused regular withdrawal uterine bleeding. It was concluded that there was very little advantage to the administration of supplemental oral estrogen to women using DMPA, except in the case of a women who psychologically needs a bleeding period.     

Coagulation studies in Asian women using injectable progestogen for contraception

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.     

Estrogenic activity in women receiving an injectable progestogen for contraception

121 multiparous women (aged 15-37) who had received injections of 150 mg of depomedroxyprogesterone acetate (DMPA) every 3 months as a contraceptive for more than 1 year, were examined to assess possible clinical alterations due to low estrogen levels. Serum samples were taken to evaluate estradiol levels by radioimmunoassay. Clinical examination did not reveal any sign of estrogen deficiency, except a smaller uterine than expected. Serum estradiol concentrations (36-42 pg/ml) were in the range of the follicular phase estradiol levels of the normal ovulating woman. As this follicular level probably persists throughout treatment, total estrogenic stimulation of end organs was much lower than for cycling women, but greater than for post-menapausal women. Patients receiving DPMA have functioning ovaries which continue to secrete estradiol at follicular levels. Uterine atrophy and shift in maturation index during contraceptive treatment with this drug is due to the large dose of progestogen outweighing the low levels of estradiol. It is suggested that long-term studies are needed to determine the possible advantage of increasing the estrogen effect on end organs over the known adverse effects of estrogen administration.     

Self-care provision of contraception: Evidence and insights from contraceptive injectable self-administration

As new reproductive health products become available, women increasingly want to take a participatory role in their health. New developments and formulations of contraceptive products provide an opportunity to support this evolving trend toward self-care. Self-care, as defined by the World Health Organization (WHO), highlights the ability of individuals to promote health, prevent disease, and manage their own health with or without the support of a health care provider. The recently released WHO Guidelines on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights included new self-care recommendations related to use of family planning, including self-injection of injectable contraceptives and over-the-counter provision of oral contraceptive pills.This paper focuses on the research evidence of self-administration (self-injection) of subcutaneous depot medroxyprogesterone acetate (DMPA-SC), and the practical experience of providers, women, and family planning programs adopting self-injection practices. We also explore the role of self-care in the provision of other contraceptives.     

New forms of contraception

Women have many options regarding contraception. A patient's desire for a long- or short-term method, for one that is reversible or permanent, and her belief that she can be compliant with the method all factor into the choice of contraceptive method. Practitioners must discuss coexisting conditions, contraindications, and whether the patient desires scheduled monthly bleeding or if she will tolerate unscheduled bleeding. Finally, cost and coverage by insurance tends to be one of the most important factors in choosing the method of contraception.     

Technical aspects of intrauterine contraception in difficult cases

Intrauterine contraception is unusual in that its effectiveness depends on the characteristics of the women using it. Good results therefore depend on the successful selection of candidates. Any factors likely to affect the effectiveness of the IUD are considered on the basis of investigation of previous history, physiologic or pathologic features of the morphology of the genital tract, and on the basis of difficulties encountered when previously using an IUD. (author's)     

New technologies in contraception

New technologies in both reversible contraception and sterilisation are described. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception, intrauterine devices, spermicides and barrier methods. It also covers methods of transcervical female sterilisation and more easily reversible male sterilisation. The emphasis is on the technology and its safety and effectiveness. Hormonal delivery systems are described in some detail. Mention is also made of research into vaccines and male hormonal methods, where progress has been disappointing.     

New forms of hormonal contraception

Among new forms of hormonal contraception, three interesting exemples are described with a high level of effectiveness and low dosage regimen that allow improved safety and tolerance: a very low-dose estrogen-progestogen combination of ethinylestradiol and gestodene for 24-day cyclical administration; a progestogen-alone subcutaneous implant containing etonogestrel; and a levonorgestrel-releasing intrauterine system. These preparations appear to be particularly interesting as they provide additional possibilities for individualizing contraceptive therapy.     

Bone mineral density in adolescent and young adult women on injectable or oral contraception

PURPOSE OF REVIEW: This report critically reviews recent original research articles that pertain to bone mineral density in young adult women utilizing injectable depot medroxyprogesterone acetate or oral contraceptives. RECENT FINDINGS: Some evidence indicates that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives (containing 20 microg ethinyl estradiol) may interfere with the large increases normally observed in adolescence; however, the same degree of bone loss (or lack of bone gain) associated with these drugs is not so impressive in young adult women who would typically be experiencing small changes in bone mass. Data obtained from young adult women show that low dose (30-40 microg ethinyl estradiol) oral contraceptives seem to be more protective of bone than ultra-low dose oral contraceptives. The few extant data suggest that there may be substantial increases in bone mass after discontinuation of depot medroxyprogesterone acetate; no information is available regarding the response of bone after discontinuation of oral contraceptives. As the clinical risk for fracture is usually several decades later, several exogenous factors such as diet and exercise may exert overriding influences on later bone health. Moreover, without contraception, the clinical outcome may be unwanted pregnancy and its potential impact on bone health. SUMMARY: Recent findings suggest that depot medroxyprogesterone acetate and ultra-low dose oral contraceptives may interfere with achieving optimal peak bone mass in very young women; however, there may be substantial recovery after cessation of these methods and overriding long-term influences on bone health imposed by a myriad of lifestyle factors.     

New options for barrier contraception

Barrier contraceptives are a safe alternative to hormonal methods of fertility management. Newer barrier method options include the Today Sponge, the FemCap, and the Lea's Shield. Understanding the use, benefits, and limitations of these barrier methods of birth control will assist women's health care providers to better meet the family planning needs of their patients.     

Some social aspects of providing contraception for under-16-year-olds

Focus is on the social implications of providing contraception for females under age 16 in Scotland, with attention directed to the effects of the law, factors influencing the use of contraception by young people, and the role of the clinic in providing advice and contraception. The law -- The Criminal Law Amendment 1885 -- was introduced tp protect young girls from being procured for prostitution and to prevent older men from taking advantage of young females. The law was apparently not introduced to prevent sexual activity between consenting young couples. Although it is not the under-16-year-old adolescent who is committing an illegal act and it is not "aiding and abetting an offense" to prescribe contraception for her, many physicians are reluctant to prescribe contraceptives for this age group. Many of the adolescents younger than age 16 are reluctant to seek contraceptive advice or fear of disapproval or trouble for themselves or their partners. Apart from the effects of the law on this age group, the factors preventing the effective use of contraception are similar to those in the older age group. The behavior displayed is "serial monogamy," and it seems that the young peoplea re less likely to use contraception when theyare involved in casual relationships than when they are in a serious and steady relationship. There is a denial of sexuality, and linked to this is the willingness to take a chance. although these factors seem to continue to operate, there is some indication that adolescents may be increasingly willing to seek contraceptive advice. The responsibilities of the clinic in dealing with adolescents seeking contraceptive advice are outlined.