Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation

Background

We aimed to evaluate whether emergency contraception with levonorgestrel (LNG-EC) administered after ovulation is equally effective to LNG-EC administered before ovulation.

Study design

We studied a cohort of women attending a family planning clinic for EC. From interview, we recorded menstrual history, time of intercourse and of intake of LNG-EC. On the day of intake of LNG-EC and during 5 days' follow-up, blood samples were taken for examination of luteinizing hormone, estradiol and progesterone concentrations, and vaginal ultrasound examinations were done for size of the leading follicle and/or corpus luteum. Thereafter women were not contacted until next menses or pregnancy occurred.

Results

Of 388 women attending for LNG-EC, 122 women had intercourse on fertile cycle days according to ultrasound and endocrine findings. At the time of LNG-EC intake, 87 women were in Days −5 to −1 and 35 women were in Day 0 (day of ovulation) or beyond. With the use of the probability of clinical pregnancy reported by Wilcox et al. [N Engl J Med 333 (1995) 1517-1521], expected numbers of pregnancies among the 87 and 35 women were 13 and 7, respectively, while 0 and 6 pregnancies, respectively, occurred.

Conclusion

We conclude that LNG-EC prevents pregnancy only when taken before fertilization of the ovum has occurred.     

Effect of oral administration of a continuous 18 day regimen of meloxicam on ovulation: experience of a randomized controlled trial

Background

Cyclooxygenase-2 (COX-2) is expressed in all female reproductive organs. Therefore, inhibitors of COX-2 may affect reproductive function. We evaluated the effect of extended administration of meloxicam on ovulation and the menstrual cycle. Our hypothesis was that meloxicam administered from menstrual cycle day 5- 22 could interfere with follicular rupture, without disrupting the menstrual cycle, and could be a potential non-hormonal contraceptive method.

Methods

The study was conducted in 56 healthy sterilized women. Before the onset of treatment and after the end of treatment, participants were observed during a control cycle to ensure that they had progesterone (P₄) serum levels (> 12 nmol/l) consistent with ovulation. Participants were treated for 18 days, during three consecutive cycles. They were randomized to 15 or 30 mg/day. The menstrual cycle was monitored with serial ultrasound and hormone assays in blood.

Results

Fifty-six volunteers completed the study. In 55% of cycles treated with 15 mg/day and in 78% of cycles treated with 30mg/day (p<0.001) we observed dysfunctional ovulation defined as follicular rupture not preceded 24–48 h earlier by an LH peak or preceded by a blunted LH peak (< 21 IU/l) or not followed by an elevated serum P₄ level > 12 nmol/l. Ovulation was observed in 44.6% and in 21.7% of women in the lower dose group and the higher dose group, respectively. There were no differences between the two doses in other parameters measured. There were no serious adverse events and adverse events were not different between doses or between control and treated cycles.

Conclusions

Although administration of meloxicam on menstrual cycle days 5- 22 resulted in a dose-dependent inhibition of ovulation, more than 20% of subjects had normal ovulation with the highest dose.

Implications

Previous studies have shown that oral meloxicam can delay follicle rupture. This study investigated daily oral meloxicam as a non-hormonal contraceptive. Since ovulation occurs in over 20% of cycles even with a high dose of 30 mg daily, it is not likely that the approach would be a highly effective contraceptive strategy.     

TwoDay Method: a quick-start approach

Background

Requiring that women wait until the onset of menses to initiate a family planning method is a medical barrier that can result in unintended pregnancies. In the efficacy study of the TwoDay Method, a new fertility awareness-based method of family planning, women were taught the method in the first seven days of their cycles. This study tested a quick-start approach (providing the method at any time in the cycle) to TwoDay Method delivery.

Study Design

In Peru, 167 women were counseled in TwoDay Method use (regardless of cycle day) and followed for up to 7 months. They were interviewed periodically to assess their use of and satisfaction with the method. Simulated clients gauged providers' ability to correctly counsel in method use at different times of the cycle.

Results

No significant differences were observed in correct use, continuation rates, and acceptability of the method among women who were counseled at different points in the cycle; quality of counseling was not undermined by the quick-start approach.

Conclusions

There is no need to limit delivery of the TwoDay Method to the first seven days of the menstrual cycle.     

Menstrual effects among women exposed to polychlorinated biphenyls and dibenzofurans

Background

Polychlorinated biphenyls (PCBs), dibenzofurans (PCDFs), and dibenzo-dioxins (PCDDs) may affect the female reproductive system in humans. A mass poisoning occurred in Taiwan due to PCBs/PCDFs-contaminated cooking oil, and was called the Yucheng (oil-disease in Chinese). We aimed to determine whether Yucheng women were affected in their menstruation.

Methods

After the event, we followed the exposed individuals and an age-matched neighborhood reference group. Menstrual cycle characteristics and age at menarche were obtained by a telephone interview. We used multiple linear and logistic regression to examine the association between PCBs/PCDFs and menstrual cycle characteristics, after adjusting for confounding factors.

Results

Totally 445 women responded satisfactorily and were included in the analyses of menstrual characteristics. Menstrual cycle irregularity and dysmenorrheal did not differ between Yucheng and referents. Yucheng women's menstrual cycles were 0.5 (95% CI: 0.0–0.5; p=0.03) days shorter than those of the referents. The Yucheng women with skin lesions caused by PCBs/PCDFs were more prominently affected, with the cycles 1.2 days shorter than the referents. Yucheng women exposed to PCBs/PCDFs at the premenacheal period had reduced cycle length (−0.7 day, 95% CI: −1.4 to 0.0; p=0.04) and longer days of menstrual flow (0.5 day, 95% CI: 0.0–1.0; p=0.04). Among those women who were exposed at an age of 5–9 years, menarche started slightly earlier with borderline significance.

Conclusions

Shorter menstrual cycle length and a longer duration of bleeding in each cycle were found among women previously exposed to PCBs/PCDFs. These effects were more obviously observed among those exposed at premenarcheal ages.     

Effects of low-dose mifepristone administration in two different 14-day regimens on the menstrual cycle and endometrial development: a randomized controlled trial

Background

This study was conducted to evaluate the effects of treatment with mifepristone 5 mg given every day or every other day for 14 days, starting 15 days after menses started for endometrial development.

Study Design

Ten women recruited to the study were given mifepristone 5 mg beginning 15 days after initiation of menses. In Group A, five women were administered mifepristone every day for three cycles; in Group B, five women were administered mifepristone every other day for three cycles. The effects on the menstrual cycle and endometrial development were investigated.

Results

Following these treatments with mifepristone 5 mg, there was slight suppression of ovulation in both treatment cycles compared with control cycles. The follicular phase in subsequent cycles was prolonged after daily treatment with mifepristone, which was not observed after administration every other day. In addition, continuous treatment increased progesterone receptor (PR) expression and reduced leukemia inhibitory factor (LIF) expression in the endometrial epithelium.

Conclusion

Treatment with low-dose mifepristone every day or every other day starting 15 days after initiation of menses retards endometrial development and impairs endometrial receptivity but has minor effects on the menstrual cycle.     

A randomized, double-blind, noninferiority study to compare two regimens of levonorgestrel for emergency contraception in Nigeria

Background

Unplanned pregnancies are common in Nigeria. Much of the unplanned pregnancies is due to low contraceptive prevalence and high contraceptive user failure rates. High user failure rates suggest the important role of emergency contraception to prevent unplanned pregnancy.

Study Design

Randomized, controlled, double-blind, multicenter, noninferiority trial comparing efficacy and side effects of two emergency contraceptive regimens up to 5 days after unprotected intercourse among 3022 Nigerian women: levonorgestrel administered in two doses of 0.75 mg given 12 h apart and levonorgestrel administered in a single dose of 1.5 mg.

Results

Efficacy was similar between the treatment groups; post-treatment pregnancy proportions were 0.57% in the two-dose regimen vs. 0.64% in the single-dose regimen (risk difference 0.07% (95% CI −0.50 to 0.64). The majority of women menstruated the first day of expected menses and the groups did not differ regarding reported side effects.

Conclusions

This study shows the simplified emergency contraceptive regimen of single-dose levonorgestrel is not inferior in efficacy to the two-dose regimen among Nigerian women.     

The COX-2 inhibitor meloxicam prevents pregnancy when administered as an emergency contraceptive to nonhuman primates

Objective

Cyclooxygenase-2 (COX-2) inhibitors reduce prostaglandin synthesis and disrupt essential reproductive processes. Ultrasound studies in women demonstrated that oral COX-2 inhibitors can delay or prevent follicle collapse associated with ovulation. The goal of this study was to determine if oral administration of a COX-2 inhibitor can inhibit reproductive function with sufficient efficacy to prevent pregnancy in primates.

Study Design

The COX-2 inhibitor meloxicam (or vehicle) was administered orally to proven fertile female cynomolgus macaques using one emergency contraceptive model and three monthly contraceptive models. In the emergency contraceptive model, females were bred with a proven fertile male once 2±1 days before ovulation, returned to the females' home cage, and then received 5 days of meloxicam treatment. In the monthly contraceptive models, females were cocaged for breeding with a proven fertile male for a total of 5 days beginning 2±1 days before ovulation. Animals received meloxicam treatment (1) cycle days 5–22, or (2) every day, or (3) each day of the 5-day breeding period. Female were then assessed for pregnancy.

Results

The pregnancy rate with meloxicam administration using the emergency contraception model was 6.5%, significantly lower than the pregnancy rate of 33.3% when vehicle without meloxicam was administered. Pregnancy rates with the three monthly contraceptive models (75%–100%) were not consistent with preventing pregnancy.

Conclusions

Oral COX-2 inhibitor administration can prevent pregnancy after a single instance of breeding in primates. While meloxicam may be ineffective for regular contraception, pharmacological inhibition of COX-2 may be an effective method of emergency contraception for women.

Implications

COX-2 inhibitors can interfere with ovulation, but the contraceptive efficacy of drugs of this class has not been directly tested. This study, conducted in nonhuman primates, is the first to suggest that a COX-2 inhibitor may be effective as an emergency contraceptive.     

A single dose of mifepristone (200 mg) in the immediate preovulatory phase offers contraceptive potential without cycle disruption

A single dose of mifepristone is an effective emergency contraceptive and has potential as a regular "once-a-month" pill. If given in the early luteal phase, the formation of a secretory endometrium is inhibited or delayed and implantation of the embryo prevented. We have explored the effect of giving the mifepristone just prior to ovulation on the ovarian and endometrial cycle. Seven women with regular menstrual cycles were studied during a control cycle and then in a second cycle when 200 mg mifepristone was given within 24 h of ovulation, i.e., when luteinizing hormone (LH) in serum was >15 IU/L and the dominant follicle was >18 mm. Ovulation was confirmed within 48 h by ultrasound in five of the seven women. The remaining two women had luteinized unruptured follicle. Following mifepristone, menses occurred after a normal luteal phase compared to control cycle (13.7 +/- 0.7 vs. 13.7 +/- 0.9 days). In all subjects the endometrium on LH + 6 in the treatment cycle showed no, or very little, secretory changes, suggesting it was unlikely that pregnancy would have occurred. We conclude that mifepristone could be given as a "once-a-month" contraceptive pill without causing significant disruption in the menstrual cycle in the majority of women for a 4-day period from just prior to ovulation until LH + 3.     

Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel

Background

Emergency contraception (EC) does not always work. Clinicians should be aware of potential risk factors for EC failure.

Study Design

Data from a meta-analysis of two randomized controlled trials comparing the efficacy of ulipristal acetate (UPA) with levonorgestrel were analyzed to identify factors associated with EC failure.

Results

The risk of pregnancy was more than threefold greater for obese women compared with women with normal body mass index (odds ratio (OR), 3.60; 95% confidence interval (CI), 1.96–6.53; p<.0001), whichever EC was taken. However, for obese women, the risk was greater for those taking levonorgestrel (OR, 4.41; 95% CI, 2.05–9.44, p=.0002) than for UPA users (OR, 2.62; 95% CI, 0.89–7.00; ns). For both ECs, pregnancy risk was related to the cycle day of intercourse. Women who had intercourse the day before estimated day of ovulation had a fourfold increased risk of pregnancy (OR, 4.42; 95% CI, 2.33–8.20; p<.0001) compared with women having sex outside the fertile window. For both methods, women who had unprotected intercourse after using EC were more likely to get pregnant than those who did not (OR, 4.64; 95% CI, 2.22–8.96; p=.0002).

Conclusions

Women who have intercourse around ovulation should ideally be offered a copper intrauterine device. Women with body mass index >25 kg/m² should be offered an intrauterine device or UPA. All women should be advised to start effective contraception immediately after EC.     

A randomized study on pharmacodynamic effects of vaginal rings delivering the progesterone receptor modulator ulipristal acetate: research for a novel estrogen-free,method of contraception

Objective

To determine whether a 3-month contraceptive vaginal ring (CVR) delivering ulipristal acetate (UPA) can inhibit ovulation in 90% of cycles.

Study Design

This was a randomized dose-finding parallel group clinical trial. Fifty-five healthy women with normal ovulation at baseline were randomized to receive a low-dose (1500 μg/day) or a high-dose (2500 μg/day) UPA-CVR for two consecutive 12-week treatment periods, followed by a recovery cycle. A subgroup of women received levonorgestrel (LNG) 1.5 mg orally twice (at the end of both 12-week ring periods) or once (at the end of the 24-week treatment). The primary outcome was ovulation suppression assessed by transvaginal ultrasound and hormone levels. Secondary outcomes included endometrial safety and bleeding patterns.

Results

All subjects showed normal ovulation at baseline and recovery. Ovulation suppression was seen in 81.8% (95% CI: 73.3%, 88.5%) and 86.1% (95% CI: 78.1%, 92%) of treatment cycles with low and high-dose, respectively. Benign progesterone receptor modulator associated endometrial changes (PAEC) were seen during treatment; 78.8% at week 24, but resolved at recovery cycle. A few cases of heavy bleeding occurred near the end of the 24-week treatment, but a single dose of LNG every 12 weeks reduced the increase in endometrial thickness during the second treatment period and prevented excessive bleeding.

Conclusion

The 3-month UPA-CVR may become an effective long-acting, user-controlled estrogen-free contraceptive. The greatest suppression of ovulation was seen with the 2500-μg/day ring.

Implications

The 3-month CVR delivering UPA 2500 μg/day can become an effective user-controlled estrogen-free contraceptive method. Benign PAEC during treatment returns to normal after discontinuation. The prevention of occasional excessive withdrawal bleeding, either by a progestin or by using higher UPA levels to increase follicle suppression may permit prolonged treatment.     

Ease of insertion and clinical performance of the levonorgestrel-releasing intrauterine system in nulligravidas

Background

Despite the high contraceptive efficacy and the additional noncontraceptive benefits of the levonorgestrel-releasing intrauterine system (LNG-IUS), concerns persist with respect to its use in nulligravidas. The objective of this study was to evaluate the ease of insertion and clinical performance of the LNG-IUS in nulligravida women up to 1 year after insertion.

Methods

Two cohorts were formed after LNG-IUS insertion, one consisting of 159 nulligravidas and the other of 477 parous women. Each nulligravida women was paired with three parous women who had an LNG-IUS inserted on the same day. Insertion was classified as easy or difficult, and when classified as difficult, the use of Hegar dilators and/or misoprostol and insertion failure were additional factors recorded.

Results

In almost 80% of cases, no difficulty was encountered during insertion, and dilators and misoprostol were seldom required; however, when necessary, dilator use was almost threefold higher in nulligravida women. Insertion failed in one nulligravida women and in two parous women. Contraception was the most common reason for insertion, although some of the women received the LNG-IUS for both contraceptive and therapeutic purposes, including heavy menstrual bleeding, hematologic diseases, warfarin use, endometriosis-associated pain and following kidney or liver transplantation. The clinical performance of the device showed zero pregnancy rate, expulsion rates of ∼4/100 women-year and 1-year continuation rate of over 90% in both groups.

Conclusions

The LNG-IUS is suitable for use by nulligravidas. It is simple to insert, and its clinical performance in nulligravidas is similar to that found in parous women.     

Pregnancy outcomes associated with extended use of the 52-mg 20 μg/day levonorgestrel-releasing intrauterine system beyond 60 months: A chart review of 776 women in Brazil

Objective

To assess the contraceptive performance of the 52-mg 20 μg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena; Bayer Oy, Turku, Finland) among women who maintain the same device without changes after 60 months.

Estimating the Fertility Effect of Expansions of Publicly Funded Family Planning Services in California

Objective

To estimate the number of unintended pregnancies averted through the provision of family planning services to low income women in Family PACT, California's Medicaid waiver program.

Study Design

We use a Markov model to estimate the number of pregnancies in the absence of Family PACT based on the contraceptive method mix used before program enrollment, and pregnancies in the presence of the program, based on method dispensing claims.

Results

Nearly 1 million (998,084) women were provided with contraceptives in Family PACT in 2007. Contraceptive services averted over an estimated 286,700 unintended pregnancies including 122,000 abortions, 133,000 unintended births, and over 40,000 births among teens.

Conclusion

This conservative measure of the effect of Family PACT on unintended pregnancies indicates the benefit of expanding access to contraceptive services, an example for other states considering expanding access to family planning services through a state plan amendment under health care reform.     

Use of the levonorgestrel-releasing intrauterine system, quality of life and sexuality. Experience in an Italian family planning center

Background

The levonorgestrel-releasing intrauterine system (LNG-IUS) was first marketed in 1990 in Finland. Since then, it has been approved in approximately 120 countries throughout the world, with almost 50 million women-years of cumulative experience to date. Its high contraceptive effectiveness and favorable bleeding profile, leading to significant reduction of menstrual bleeding both in women with idiopathic menorrhagia and in those with normal menstrual bleedings, have been the key to the success of the system. At the same time, women need to be provided adequate preinsertion counseling about changes in menstrual bleeding to be expected. In the Italian context, it is important to highlight during counseling that amenorrhea is not harmful but can lead to health benefits such as an increase in iron blood stores and blood hemoglobin concentration.

Study Design

To evaluate contraceptive efficacy, compliance and the effect of changes in menstrual cyclicity on quality of life and sexuality of the LNG-IUS (Mirena®), 156 women attending the Family Planning Clinic to request contraception were enrolled in the study and inserted with the device.

Results

Menstrual blood flow decreased in all users, in terms of both quantity and duration; although spotting was present in 93.7% of the women, it disappeared within 6 months in the majority of cases. Amenorrhea occurred in 29.5% of all women, with onset within the first six cycles postinsertion. Data from the EuroQuality of Life-5D and Female Sexual Function Index questionnaires showed improvement in the quality of life, with a decrease in intercourse-related pain and an improvement in sexual desire.

Conclusions

Although in Italy intrauterine contraception is poorly accepted, once started on LNG-IUS, women found that the device represents a safe and effective contraceptive modality, with valuable noncontraceptive benefits, especially in the presence of heavy or prolonged bleeding.     

Patients' attitudes and experiences related to receiving contraception during abortion care

Background

High risk for additional unintended pregnancies among abortion patients makes the abortion care setting an ideal one for facilitating access to contraception. This study documents attitudes of abortion patients about contraceptive services during their receipt of abortion services and identifies patient characteristics associated with desire for contraception and interest in using a long-acting reversible contraceptive method (LARC).

Study Design

Structured surveys were administered to 542 patients at five US abortion-providing facilities between March and June of 2010. Supplementary information was collected from 161 women who had had abortions in the past 5 years through an online survey.

Results

Among abortion patients, two thirds reported wanting to leave their appointments with a contraceptive method and 69% felt that the abortion setting was an appropriate one for receiving contraceptive information. Having Medicaid and having ever used oral contraceptives were predictive of wanting to leave with a method. Women having a second or higher-order abortion were over twice as likely as women having a first abortion to indicate interest in LARC, while black women were half as likely as white women to indicate this interest.

Conclusion

Many women are interested in learning about and obtaining contraceptive methods, including LARC, in the abortion care setting.     

The efficacy and safety of an oral contraceptive containing chlormadinone acetate: results of a pooled analysis of noninterventional trials in adult and adolescent women

Background

The study was conducted to assess the contraceptive efficacy, cycle events, dysmenorrhea symptoms and skin complaints of a combined oral contraceptive containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol (CMA/EE) (Belara®, Grünenthal GmbH, Aachen, Germany) in adolescent and adult women using a conventional- or extended-cycle regimen.

Study Design

Data were pooled from six noninterventional trials with CMA/EE intake over 4–12 cycles.

Results

The data pool contained 62,218 women (345,964 cycles), of whom 60,508 were analyzed (325,937.5 cycles), including 46,335 adults, 13,478 adolescents and 695 age unknown; 1710 retrospective documented patients were excluded from analysis. A total of 85 women became pregnant (including women missing pills) on the conventional-cycle regimen (21+7), giving a practical Pearl index of 0.34 [95% confidence interval (CI) 0.27–0.42]. Within this group (n=85), there were 19 pregnancies associated with regular pill intake, which represent a theoretical Pearl index of 0.08 (95% CI 0.05–0.12) per 100 women-years. Overall, cycle stability, bleeding profile, dysmenorrhea and the incidence of seborrhea/acne improved with CMA/EE, and there was no clinically relevant change in body weight or body mass index. Six venous thromboembolic events were reported, equating to an incidence of 2.4 per 10,000 women-years.

Conclusions

Chlormadinone acetate/ethinylestradiol is effective and well tolerated in adolescent and adult women.     

Contraceptive Changes after Reproductive Events among Australian Women Born in 1973 to 1978: A Longitudinal Study from 1996 to 2009

Background

Women change contraception as they try to conceive, space births, and limit family size. This longitudinal analysis examines contraception changes after reproductive events such as birth, miscarriage or termination among Australian women born from 1973 to 1978 to identify potential opportunities to increase the effectiveness of contraceptive information and service provision.

Methods

Between 1996 and 2009, 5,631 Australian women randomly sampled from the Australian universal health insurance (Medicare) database completed five self-report postal surveys. Three longitudinal logistic regression models were used to assess the associations between reproductive events (birth only, birth and miscarriage, miscarriage only, termination only, other multiple events, and no new event) and subsequent changes in contraceptive use (start using, stop using, switch method) compared with women who continued to use the same method.

Results

After women experienced only a birth, or a birth and a miscarriage, they were more likely to start using contraception. Women who experienced miscarriages were more likely to stop using contraception. Women who experienced terminations were more likely to switch methods. There was a significant interaction between reproductive events and time indicating more changes in contraceptive use as women reach their mid-30s.

Conclusion

Contraceptive use increases after the birth of a child, but decreases after miscarriage indicating the intention for family formation and spacing between children. Switching contraceptive methods after termination suggests these pregnancies were unintended and possibly due to contraceptive failure. Women’s contact with health professionals around the time of reproductive events provides an opportunity to provide contraceptive services.     

Evaluation of estrogenic receptors in the nasal mucosa of women taking oral contraceptives

Background

There is evidence that the nasal mucosa is affected by estrogen influence. Some authors have already detected estrogen receptors (ER) in the nasal mucosa. However, there doesn't seem to be a consensus about the concentration and distribution of the ER or the possible influence of hormonal contraceptives in the nasal mucosa.

Objective

The study was conducted to evaluate the influence of oral contraceptives on the distribution and concentration of estrogenic receptors in nasal mucosa.

Study Design

Two groups of 32 women with regular menstrual cycles were selected. One group of women was taking oral contraceptives and the other was not. Samples of mucosa of inferior nasal turbinate were analyzed by immunohistochemical staining for alpha and beta ER.

Results

The use of oral contraceptives induced a decrease of beta-receptors only in lamina propria cells. In both groups, there was a predominance of beta-receptors.

Conclusion

Women who took oral contraceptives showed a decrease of beta-receptors in some cells of the lamina propria. These findings show us the possibility of effects of contraceptive pills on the cells such as fibroblasts, mast cells, plasmocytes, and other inflammatory cells.     

Trends and correlates of hormonal contraceptive use among HIV-infected women in Rakai, Uganda, 1994-2006

Background

Little is known about what factors correlate with hormonal contraceptive (HC) use in HIV-infected women in sub-Saharan Africa.

Methods

We assessed the trends in HC use among HIV-infected women in Rakai, Uganda; determined factors associated with HC use and considered whether those factors changed over time.

Results

HC use among HIV-infected women in Rakai increased from 5.7% in 1994 to 19.2% in 2006, but nearly half of all pregnancies in this population were unintended. Variables associated with increased HC use included higher education, socioeconomic status, parity, sexual frequency, being currently married or in a relationship, discussion of family planning with a partner and receipt of HIV results. Variables negatively associated with HC use included symptoms suggestive of opportunistic infections, having no sex partner in the past year, condom use, breastfeeding and older age. Most associations remained stable over time.

Conclusion

Although contraceptive use by HIV-infected women has increased three-fold in this rural population, unintended pregnancies persist, placing women and their children at risk of adverse consequences.     

Pain during medical abortion: predicting factors from gynecologic history and medical staff evaluation of severity

Background

We studied whether it is possible to predict severity of pain during medical abortion. We also studied how well medical staff recognizes the pain perceived by these women.

Study Design

Fifty-four women (mean age 26 years, range 18–42 years) undergoing medical abortion before the 64th day of gestation (mean 47 days, range 32–63 days) were asked to estimate their menstrual pain and the pain perceived during medical abortion by visual analogue scale (VAS). Both the intensity and unpleasantness of pain were evaluated separately. The nurses observing the women undergoing medical abortion at the outpatient clinic were asked to estimate by VAS scores their perception of the intensity of pain of the women.

Results

Higher age (magnitude r=−0.30; unpleasantness r=−0.28), increasing number of previous pregnancies (r=−0.34; r=−0.36) and deliveries (r=−0.57; r=−0.60) correlated negatively and advanced gestational length (r=0.31; r=0.32) positively with magnitude and unpleasantness of pain evoked by abortion. Twenty-eight (51.8%) of the women were nulliparous. Pain during medical abortion correlates positively (magnitude r=0.34; unpleasantness r=.0.41) with pain during menstruation. There was no difference between either the intensity or unpleasantness of pain during menstruation and pain during medical abortion. Medical staff accurately assessed the pain women experienced during medication abortion (magnitude r=0.83; unpleasantness r=0.79).

Conclusion

Pain during medical abortion correlates with the pain during menstruation. This finding makes counseling of women choosing medical abortion easier and helps in planning the pain relief needed.