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[World Health Organization updates guidance on how to use contraceptives] OMS reactualizeaza recomandarile de practica pentru utilizarea contraceptivelor.
Targu-Mures, Romania, Institutul Est European de Sanatate a Reproducerii, 2006. 7 p. (Actualitati in planificarea familiala No. 2)The World Health Organization (WHO) issued new guidance in 2004 on how to use certain contraceptives safely and effectively, including the following: A woman who misses combined oral contraceptive pills should take a hormonal pill as soon as possible and then continue taking one pill each day. This basic guidance applies no matter how many hormonal pills a woman misses. Only if a woman misses three or more hormonal pills in a row will she need to take additional steps (see p.3). The new guidance simplifies the missed-pill rules issued by WHO in 2002. Men should wait three months after a vasectomy procedure before relying on it. Previous guidelines advised men to wait either three months after the procedure or until they had had at least 20 ejaculations, whichever occurred first. Recent studies have shown, however, that the 20-ejaculation criterion is not a reliable gauge of vasectomy effectiveness. (excerpt)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2005 Apr. 8 p. (INFO Reports No. 4)The World Health Organization (WHO) issued new guidance in 2004 on how to use certain contraceptives safely and effectively, including the following: A woman who misses combined oral contraceptive pills should take a hormonal pill as soon as possible and then continue taking one pill each day. This basic guidance applies no matter how many hormonal pills a woman misses. Only if a woman misses three or more hormonal pills in a row will she need to take additional steps (see p.3). The new guidance simplifies the missed-pill rules issued by WHO in 2002. Men should wait three months after a vasectomy procedure before relying on it. Previous guidelines advised men to wait either three months after the procedure or until they had had at least 20 ejaculations, whichever occurred first. Recent studies have shown, however, that the 20-ejaculation criterion is not a reliable gauge of vasectomy effectiveness. (excerpt)
[First reflection workshop of the research network "Gender, Reproductive Health and Population Policies (GRHPP), Maghreb region, Amsterdam, July 3-7, 1995. General report] Premier atelier de reflexion du reseau de recherche "Gender, Reproductive Health and Population Policies" (GRHPP), region Maghreb, Amsterdam, du 3 au 7 juillet 1995. Rapport general.
Amsterdam, Netherlands, University of Amsterdam, Faculty of Political and Social-Cultural Sciences, Medical Anthropology Unit, 1996. 12 p.This paper reports upon the first workshop of the research network on gender, reproductive health, and population policies in the Maghreb, held in Amsterdam during July 3-7, 1995. The report is comprised of papers by various authors on gender, reproductive health, and population policies in the Maghreb; population policies in Morocco; population policies in Tunisia; population-related debates, including the new concepts introduced by the International Conference on Population and Development; the Rutgers Foundation’s activities with regard to reproduction and sexuality in Holland; the evolution from family planning to an integrated reproductive health approach; discourse on Norplant’s effectiveness; the research network on gender, reproductive health, and population policies in Latin America; identifying relevant research themes in the Maghreb; Internet-based research; a research project; and the decision to submit a project of concerted efforts designed to identify and strengthen research capacity in the countries of the Maghreb. The workshop’s activities are noted in the annex.
British Journal of Family Planning. 2000 Apr; 26(2):67-8.This editorial comments on the superior efficacy of levonorgestrel as an emergency contraceptive. A comparative trial between levonorgestrel and the Yuzpe regimen conducted by the WHO indicated that levonorgestrel has a pregnancy rate one-third that of the comparison group. The result, however, has been questioned in several accounts. First, the Yuzpe regimen did not appear to perform particularly well in the trial, which might have influenced the comparison. Second, the method used to measure the true efficacy of emergency contraception, or proportion of pregnancies prevented, has limitations. Nevertheless, an interesting result of the WHO trial was the correlation between interval to treatment and pregnancy rate, where the shorter the coitus-to-treatment interval, the lower the pregnancy rate. With levonorgestrel, rates of unwanted pregnancies are expected to decrease. However, there are obstacles to the wholesale switch to levonorgestrel; namely, cost, difficulty in distribution relating to its new drug status, and resistance to change. The speed with which levonorgestrel has been introduced in the UK following a high quality randomized trial is impressive. However, the implementation of research findings remains a challenge. The use of levonorgestrel for emergency contraception may be an appropriate service standard for family planning in the future.
[Contraception via a vaginal hormonal ring] Kontratseptsiia posredstvom vlagalishten khormonalen prusten.
AKUSHERSTVO I GINEKOLOGIIA. 1991; 30(1):49-52.Research on the hormonal vaginal ring began in the US in 1973. Its prototype with a diameter of 55 mm releasing in even doses small amounts of hormone was introduced 17 years later. Its high effectiveness with a failure rate of 3-4 pregnancies/100 woman use years is similar to that of most IUDs. The first type contains a combination of estrogen-gestagen consisting of levonorgestrel and 17-beat-estradiol as in oral preparations. It has to be used from the beginning of the menstrual cycle for 3 weeks and removed for 1 week. The second one, devised by a special program of WHO, contains gestagen only in the form of levonorgestrel (LNG) releasing 20-25 mcg of LNG daily. The third type contains progesterone only which is suitable for use by lactating women, as the progesterone eventually absorbed in the maternal system does not pose any risk to the nursing child. At present its effectiveness is being tested, and then its practical application will be examined. The introduction of the prototype was delayed by 2 years when initial investigations showed that the substance used for polymerization of the plastic used for the vaginal ring was carcinogenic, however, this was refuted in subsequent investigations. The vaginal ring is already sold regularly in Great Britain and in some western European countries. This new method allows doctors to provide an alternative contraceptive in addition to the existing ones.
ADVANCES IN CONTRACEPTION. 1990 Sep; 6(3):169-76.Clinical trials of vaginal rings containing progestins or ethinyl estradiol and progestins by WHO, the Population Council and private firms are reviewed. Contraceptive steroids can be formulated into Silastic vaginal rings because they are released continuously from this material (zero-order kinetics). Vaginal rings have the advantage of avoiding the 1st pass effect on the liver, as well as self- administration, unrelated to the timing of coitus and regulation of withdrawal bleeding with removal for 7 days per cycle. The shell vaginal ring, with an inert core, a layer of Silastic containing the progestogen, and an outer Silastic layer is designed to regulate release by the thickness of the outer layer. The WHO tested rings releasing 200 mcg norethisterone/day resulting in too many menstrual side effects; and 50 mcg/day with too high a failure rate. A ring releasing 20 mcg levonorgestrel is expected to perform well. The Population Council designed rings releasing 152 mcg ethinyl estradiol and 252 mcg levonorgestrel, and 183 mcg ethinyl estradiol and 293 mcg levonorgestrel. These resulted in pregnancy rates of 2/100 woman years, and continuation rates of 50%, but unacceptably adverse lipid effects. Women discontinued for vaginal symptoms. Compared to a similar combined oral pill, the rings offered no advantage. WHO subsequently introduced a ring releasing 20 mcg levonorgestrel: efficacy was 3.8 and continuation over 50%. A new segmented ring with desogestrel is causing fewer androgenic effects and bleeding complaints. Another ring in current trials gives off 120 mcg desogestrel and 30 mcg ethinyl estradiol with no pregnancies and good acceptability in 100 women to date. Availability of Silastic material and quality control in manufacture are seen as obstacles to overcome for mass production of these vaginal rings.