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CONTRACEPTIVES HORMONAL [keywords]
- Dual method use for protection of pregnancy and disease prevention among HIV-infected women in South East Nigeria. [Journal Article]
- BMC Womens Health 2014; 14(1):39.
sub-Saharan Africa continue to bear the greatest burden of HIV/AIDS epidemic due to its large population, high fertility rate and unmet contraceptive need, most especially with poor uptake of dual methods (use of condom and another effective family planning method) which protects against STIs/HIV and unplanned pregnancy. The aim of this study was to assess the awareness, pattern and practice of dual methods by HIV infected women, and factors influencing its use in southeast Nigeria.This was a cross sectional descriptive study of 658 HIV positive women attending the PMTCT/postnatal/family planning clinics in three health facilities in southeast Nigeria. An interviewer administered semi-structured questionnaire was used to abstract needed information. The data were analyzed with Epi-info™ version 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA), Odd ratio was determined and the test of statistical significance was with Fisher exact test at 95% CI.The mean age of the participants was 29 ± 4.3 years. All the respondents were aware of their HIV status, 62.4% did not know their partners status; 23.1% were sero-concordant, while 14.5% were sero-discordant. Most (67.9%) of the respondents lack awareness on dual methods with only 179/658 (27.2%) practicing it. The commonest (141/179; 78.9%) dual method used was a combination of condom and injectable hormonal contraceptives. Lack of awareness (222/479; 46.3%) and non disclosure (133/479; 27.8%) were the main reasons for non use of dual method in the present study. STI's was higher amongst non users with odd ratio of 1.74 (1.26-2.41), p-value < 0.0004. Unplanned pregnancy was higher in non users with odd ratio of 3.89 (2.52-6.00), p-value < 0.0000 at 95% CI.The awareness and uptake of dual methods amongst HIV infected women in southeast Nigeria is still low and thus associated with a higher risk of STIs and unplanned pregnancy. It is expected that increased awareness, uptake and consistent use will help prevention new infections of HIV/STIs and unplanned pregnancy.
- Attitudes Toward Over-the-Counter Access To Oral Contraceptives Among a Sample Of Abortion Clients in the United States. [JOURNAL ARTICLE]
- Perspect Sex Reprod Health 2014 Mar 6.
Women having abortions are at high risk for future unintended pregnancy, and removing the prescription requirement for oral contraceptives may increase continuation and adoption of this effective method.A survey fielded from May to July 2011 collected information from 651 women aged 15-46 seeking abortion services at six urban clinics from across the United States. Descriptive statistics, chi-square tests and logistic regression analyses were conducted to estimate women's interest in over-the-counter access to oral contraceptives.Eighty-one percent of respondents supported over-the-counter access to oral contraceptives; while 42% of women planned to use the pill after their abortion, 61% said they would likely use this method if it were available over the counter. Thirty-three percent of women who planned to use no contraceptive following their abortion said they would use an over-the-counter pill, as did 38% who planned to use condoms afterward. In multivariable analysis, several subgroups had increased odds of likely over-the-counter use: women who were older than 19 (odds ratios, 1.8 for those aged 20-29 and 1.6 for those aged 30-46), were uninsured (1.5), had ever used the pill (1.4), had had difficulty obtaining a prescription refill for hormonal contraceptives (2.7) or planned to use the pill postabortion (13.0). By contrast, compared with white respondents, women of other races or ethnicities were less likely to say they would use over-the-counter pills (0.4-0.7).Interest in a hypothetical over-the-counter oral contraceptive was high in this sample, and this delivery model has the potential to reduce unintended pregnancy among abortion patients.
- Unsafe use of combined hormonal contraceptives poses health risks for women with medical conditions. [Journal Article]
- J Midwifery Womens Health 2014 Jan; 59(1):103-4.
- [Cardiovascular risks of combined oral contraceptives - beyond the French controversy.] [JOURNAL ARTICLE]
- Gynecol Obstet Fertil 2014 Feb 25.
Combined hormonal contraceptive is the most used contraceptive method in France among childbearing-aged women. Following the temporary delisting of oral contraception containing a 3rd generation progestin and following the market withdrawal of oral pills containing cyproterone acetate in combination with ethynil-estradiol (35μg), the impact of these events on our prescribing practice remains to determine. We will especially discuss the cardiovascular risk associated with combined hormonal contraceptives in the light of the most recent publications either with epidemiological or biological data.
- Premenstrual Syndrome Symptomatology among Married Women of Fertile Age based on Methods of Contraception (Hormonal versus Non-Hormonal Methods of Contraception). [Journal Article]
- Glob J Health Sci 2014; 6(2):105-11.
Premenstrual syndrome (PMS) refers to the cyclic occurrence of a set of disturbing physical, emotional or behavioral alterations that are of sufficient severity to interfere with interpersonal relations and routine life. Normal variations in gonadal estrogen and progesterone lead to biochemical reactions in the brain, resulting in PMS symptoms. This study aims to investigate the prevalence of PMS and PMDD signs among married women of fertile age (MWFA) based on the methods of birth control.In a descriptive study, a number of 400 married women referring to 20 family healthcare clinics that use contraceptive methods were recruited and PMS questionnaire were administered to them.From 400 subjects, 205 took oral contraceptive pills (hormonal methods of contraception) and 195 used other birth control methods (non-hormonal method). A number of 345 subjects (86.25%) at least experienced one PMS symptom and 55 subjects (13.75%) did not report any symptoms. Of those who use hormonal contraceptives (HCs), 182 (88.8%) reported PMS symptoms and 23(11.2) lacked any symptoms.About 86% of the subjects showed moderate to severe of PMS symptoms. Although using hormonal contraceptive method can theoretically reduce PMS symptoms, such effect was not observed in this study. The results of this research should be generalized with caution. Future studies are suggested.
- New and emerging contraceptives: a state-of-the-art review. [REVIEW]
- Int J Womens Health 2014.:221-234.
The first hormonal contraceptive was introduced onto the market in several countries 50 years ago; however, the portfolio of contraceptive methods remains restricted with regards to their steroid composition, their cost, and their ability to satisfy the requirements of millions of women/couples in accordance with their different reproductive intentions, behaviors, cultures, and settings.A literature review was conducted using Medline, Embase, and Current Contents databases, up to September 1, 2013 to identify publications reporting new contraceptives in development using combinations of the search terms: contraception, contraceptives, oral contraceptives, patch, vaginal ring, implants, intrauterine contraceptives, and emergency contraception (EC). Also, several experts in the field were also consulted to document ongoing projects on contraception development. Additionally, the Clinicaltrial.gov website was searched for ongoing studies on existing contraceptive methods and new and emerging female contraceptives developed over the past 5 years. Information was also obtained from the pharmaceutical industry.Early sexual debut and late menopause means that women may require contraception for up to 30 years. Although oral, injectable, vaginal, transdermal, subdermal, and intrauterine contraceptives are already available, new contraceptives have been developed in an attempt to reduce side effects and avoid early discontinuation, and to fulfill women's different requirements. Research efforts are focused on replacing ethinyl-estradiol with natural estradiol to reduce thrombotic events. In addition, new, less androgenic progestins are being introduced and selective progesterone receptor modulators and new delivery systems are being used. In addition, research is being conducted into methods that offer dual protection (contraception and protection against human immunodeficiency virus transmission), and contraceptives for use "on demand." Studies are also investigating non-hormonal contraceptive methods that have additional, non-contraceptive benefits.The most pressing need worldwide is, first, that the highly effective contraceptive methods already available should be affordable to most of the population and also that these methods should fulfill the needs of women of different ages and with different reproductive requirements. The development of new contraceptive methods should also take advantage of the knowledge obtained over the past 30 years on gamete physiology and gamete interaction to avoid the use of steroid compounds.
- Challenges and Methodology for testing young healthy women in physiological studies. [JOURNAL ARTICLE]
- Am J Physiol Endocrinol Metab 2014 Feb 25.
Physiological responses and control of body systems differ between women and men. Moreover, within women female gonadal hormones have important influences on organs and systems outside of reproduction. Until the NIH Revitalization Act of 1993, laboratories focused physiological research primarily on men, and this focus placed limitations on women's health care. Thus, the NIH directive to include women required scientists and physicians studying humans to consider female reproductive physiology. Even though this directive was enacted over 20 years ago, there is still a great deal of misunderstanding as to the best methods control hormones or account for changes in internal hormone exposure in women. This discussion describes common methods investigators use to include women in physiological studies and to examine the impact of female reproductive hormone exposure for research purposes. In some cases, the goal is to control for phase of the cycle, so women are studied when the endogenous hormones should be similar. When the goal of the research is to examine the effects of hormones on a physiological response, it is important to use methods that will change hormone exposure in a controlled fashion. We recommend a method that employs gonadotropin releasing hormone (GnRH) agonist or antagonist to suppress estrogens, gonadotropins, progesterone and androgens followed by administration of these hormones. While this method is more invasive, it is safe and is the strongest research design to examine both hormone effects within women as well as between women and men.
- Indonesia to revive national family planning programme. [News]
- Lancet 2014 Feb 22; 383(9918):683.
- Two women with cerebral venous thrombosis: oral contraceptives? [Journal Article]
- West Indian Med J 2013 Mar; 62(3):260-3.
Two cases of cerebral venous thrombosis are reported. Patients were apparently healthy 39 and 28-year old females with non-specific presenting features. Image findings were characteristic of cerebral sinus thrombosis. The younger patient received progesterone to treat placental abruption eight years previously; she had cerebral venous thrombosis while using oral contraception. Both patients had used contraceptive pills for a long time. Oral hormonal contraceptives may increase the risk of vascular events, even in people without personal or family history of venous thrombosis. Modern imaging methods have contributed to early diagnosis, but the possibility of under diagnosis still persists. This report aims to increase the awareness of health-workers about cerebral venous thrombosis in women, an entity often misdiagnosed, under diagnosed and under-reported.
- Differential Glucocorticoid Receptor-Mediated Effects on Immunomodulatory Gene Expression by Progestin Contraceptives: Implications for HIV-1 Pathogenesis. [JOURNAL ARTICLE]
- Am J Reprod Immunol 2014 Feb 18.
Whether hormonal contraceptives increase HIV-1 acquisition, transmission and disease progression are critical questions. Clinical research has been hampered by a lack of understanding that different progestins used in contraception exhibit differential off-target effects via steroid receptors other than the progesterone receptor. Of particular, relevance is the relative effects of medroxyprogesterone acetate (MPA) and norethisterone enanthate (NET-EN), widely used as injectable contraceptives in sub-Saharan Africa. While most high-quality clinical studies find no increased risk for HIV-1 acquisition with oral contraception or injectable NET-EN, most do find an increase with MPA, particularly in young women. Furthermore, mounting evidence from animal, ex vivo and biochemical studies are consistent with MPA acting to increase HIV-1 acquisition and pathogenesis, via mechanisms involving glucocorticoid-like effects on gene expression, in particular genes involved in immune function. We report that MPA, unlike NET and progesterone, represses inflammatory genes in human PBMCs in a dose-dependent manner, via the glucocorticoid receptor (GR), at concentrations within the physiologically relevant range. These and published results collectively suggest that the differential GR activity of MPA versus NET may be a mechanism whereby MPA, unlike NET or progesterone, differentially modulates HIV-1 acquisition and pathogenesis in target cells where the GR is the predominant steroid receptor expressed.