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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)
[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of obstetrics and gynecology] De standaard 'Hormonale anticonceptie' (tweede herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de verloskunde-gynaecologie.
Nederlands Tijdschrift voor Geneeskunde. 2004 Jun 26; 148(26):1274-1275.The Dutch College of General Practitioners' (NHG) guideline on hormonal contraception does not follow the WHO criteria for the use of oral contraceptives in contrast to the guideline of the Dutch Society of Obstetrics and Gynaecology. Contrary to the WHO criteria, the NHG guideline considers a blood-pressure measurement before starting with an oral contraceptive to be unnecessary. It also considers no form of migraine to be contraindication for oral contraceptives. The NHG guideline further disclaims the (slightly) increased risk of developing breast cancer in women using oral contraceptives. It advises initiation of oral-contraceptive use two weeks postpartum in non-breast-feeding women and six weeks postpartum in breastfeeding women, instead of the three weeks and six months, respectively, indicated in the WHO guideline. Lastly, the NHG guideline is too optimistic as to the reliability of oral-contraceptive use, as no distinction is made between efficacy and effectiveness. Such discrepancies between two Dutch guidelines can be detrimental to women's health care. The WHO criteria for contraceptive use may be a valuable tool to overcome differences of opinion to as to achieve a badly needed full consensus. (author's)
Journal of Family Planning and Reproductive Health Care. 2004; 30(4):253-254.The Clinical Effectiveness Unit (CEU) presents an illustrative response of a frequently asked question to the Members’ Enquiry Service on whether or not hormonal contraceptive use by women with a history of pregnancy-related cholestasis is safe or associated with recurrence of cholestasis. The Summaries of Product Characteristics (SPCs) for combined oral contraceptives (COCs) and progestogen-only pills (POPs) advise against use by women with a history of cholestatic jaundice or with severe pruritis in pregnancy. The World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (WHOMEC), however, recommends that for women with pregnancy-related cholestasis the benefits of COC use outweigh the risks (WHO Category 2) and progestogen-only methods or non-hormonal methods can be used without restriction (WHO Category 1). No evidence was identified to support an increased risk of recurrence of symptoms with hormonal contraceptive use. The CEU advises that women with a history of pregnancy-related cholestasis should be informed about the unknown risk of recurrence with hormonal contraceptive use. After counselling regarding non-hormonal methods, women with a history of pregnancy-related cholestasis may choose to use hormonal methods (COCs, POPs, progestogen-only injectables, implant or intrauterine system). Women should be informed that the use of COCs and POPs in this situation is outside the product licence. (excerpt)
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
London, FPA, 1972. 48 p.Currently, public authorities pay for almost 2/3 of the family planning consultations conducted by the Family Planning Association, and this is the most significant development since the publication of the last Family Planning Association Report. Additionally, more local health authorities are operating direct clinic and domiciliary services. The Family Planning Association handed over the management of 39 clinics to public authorities in the 1971-1972 year. However, despite this progress, family planning service provision by public authorities throughout England continues to be uneven in quality and extent. Spending by local health authorities for each woman at risk varies from 1 penny per woman at risk in Burnley (excluding the city of London) to 179 pence at Islington. In addition to the problem of inconsistency in spending, there appears to be no immediate prospect of a comprehensive family planning service - one that is available to all, is free of charge, and is backed by an adequate education campaign. Although government help for the extension of domiciliary family planning service is impressive, it should not obscure the false economies in spending on other contraceptive delivery services such as general practitioners, specialist clinics, and specialized advisory centers. Until the government announces the details of its plans for family planning services within the National Health Service beginning April 1974, the Family Planning Association's own detailed planning cannot be exact. The Association's basic policy continues to be to turn over the responsibility for the management of clinic and domiciliary contraceptive services as quickly and as smoothly as possible to the public authorities. Already there is concern that some clinic services managed by public authorities may become less attractive, particularly to young people, and that differences in the quality of service will increase under local public management as well as that backup services will be neglected. Also existing is the realization that the public authorities do not do enough to attract people to the use of contraception.
Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives. Results of an international, multicenter, case-control study. World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception.
CONTRACEPTION. 1998 May; 57(5):315-24.As part of a World Health Organization Collaborative Study conducted at 21 centers in Africa, Asia, Europe, and Latin America in 1989-93, the risks of cardiovascular disease associated with use of oral and injectable progestogen-only and combined injectable contraceptives were investigated. 3697 cases of cardiovascular disease (59% stroke, 31% venous thromboembolism, and 10% acute myocardial infarction) were available for analysis and age-matched with up to three controls. 53 cases were current users of oral progestogen-only contraception, 37 were using an injectable progestogen-only method, and 13 were using combined injectable contraception. The adjusted odds ratios for all cardiovascular diseases compared with nonusers of any type of steroid hormone contraceptive were 1.4 (95% confidence interval (CI), 0.79-1.63) for current users of oral progestogen-only methods, 1.02 (95% CI, 0.68-1.54) for users of injectable progestogen-only contraceptives, and 0.95 (95% CI, 0.49-1.86) for use of combined injectable contraceptives. No significant changes in risk for stroke, venous thromboembolism, or acute myocardial infarction or these three conditions combined was apparent in association with any of the contraceptive methods. However, a nonsignificant increase in risk of venous thromboembolism was apparent for both types of progestogen-only contraceptives. Among women with a history of hypertension, the odds ratio for stroke rose from 7.2 (95% CI, 6.1-8.5) among nonusers of any type of steroid hormonal contraceptive method to 12.4 (95% CI, 4.1-37.6) among current users of all oral progestogens.
CONTRACEPTION. 1992 Apr; 45(4):363-8.Researchers analyzed interview and physician records' data on 45 women with breast cancer (cases) admitted to the Central Institute of Cancer Research in Berlin, East Germany between November 1982-June 1986 and born in 1983 or later and 194 women (controls) admitted to the Klinikum Berlin-Buch also in East Germany for conditions other than breast cancer to compare recall accuracy in women who had ever used an IUD. These women were drawn from case control study of the relationship between breast cancer and oral contraceptive use was part of the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Agreement between patient recall and physician records was exceptional for duration of IUD use (p<.001), number of IUD episodes (kappa=0.79), time since 1st IUD and time since last IUD use (p<.001). Agreement rates did not differ between cases and controls. 75% of the women could not name the IUD brand used so the researcher could not examine agreement of brand name. Thus, other than brand name, this study showed that validity of information on IUD use obtained from interviews is significant. In fact, it also pointed out that case control studies probably yield sound relative risk estimates.
A preliminary pharmacokinetic and pharmacodynamic evaluation of depot-medroxyprogesterone acetate and norethisterone oenanthate.
Fertility and Sterility. 1980 Aug; 34(2):131-9.2 populations attending WHO centers, one in Sweden and one in India, participated in a comparative, pilot trial of 2 increasingly popular injectable progestin-only female contraceptives, Depo-Provera and Norigest. The purpose of the study was to assess the pharmacokinetic and pharmacodynamic properties of the 2 formulations (depot medroxyprogesterone acetate and norethisterone enanthate). Differences were found between Swedish women and Indian women in their reactions to the 2 drugs: 1) Norigest was detectable in blood samples a significantly shorter time after injection of the agent in Indian women than in Swedish women; this difference was not apparent with Depo-Provera. 2) Although there was no difference at the 2 centers in the time of ovulation return for subjects receiving Norigest, 0 of 4 Swedish women ovulated more than 156 days after Depo-Provera injection, whereas all 4 Indian women ovulated within 73 days of Depo-Provera injection; in the Swedish women, the levels of medroxyprogesterone were undetectable at time of return to ovulation, whereas Indian women had levels of .6 ng/ml when ovulation resumed. 3) In both cultures, Depo-Provera users had significantly more episodes of bleeding and spotting than Norigest users. This preliminary report emphasizes the variety of responses possible to injection of different contraceptive progestins among various populations and points to the need for further culturally comparative studies.
IPPF Medical Bulletin. 1977 Oct; 11(5):1-2.Lancet recently published 2 papers which reported research fundings indicating that oral contraceptive users, over 35 years of age, are at greater risk of death from cardiovascular disease than nonusers. The findings also suggested that oral contraceptive users who have taken the pill for more than 5 years, who smoke, or who have diabetes, hypertension, or obesity are also at increased risk of death than nonusers. In view of these findings the Presidents of the Royal College of General Practitioners and of the Royal College of Obstetricians and Gynaecologists revised oral contraceptive prescribing recommendations. According to the new recommendations 1) women, who are under 30 years of age, can continue to use the pill but if they smoke they should be advised to quit smoking; 2) women, between 30-35 years of age, can continue to use the pill but if they have taken the pill for 5 or more years and if they smoke they should be advised to switch to other contraceptive methods; and 3) women, over 35 years of age, should be advised to use other contraceptive methods. The British Committee on Safety of Medicines did not issue new prescribing instructions. The International Planned Parenthood Federation, noting the findings of both U.S. and British studies, said that physicians should be aware that the risk of death from cardiovascular disease may be enhanced for oral contraceptive users over the age of 40. The Federation also recommended that couples with completed families should consider sterilization or other alternative forms of contraception.
Contraception. 1979 Jan; 19(1):39-45.The metabolism rate of orally administered norethisterone (Nor) was compared in 14 WHO Collaborating Centres by measuring plasma steroid levels by radioimmunoassay at varying times after a 1-mg oral dose. Peak plasma concentration was reached between 1 and 2 hours after ingestion in all Centres except Singapore and Seoul. After the peak, a marked decrease in serum Nor concentration occurred, but even after 24 hours, significant amounts were still present in serum, with mean values ranging from 275 pg (Stockholm) to 935 pg/ml (Mexico). As expected, a highly significant decrease (p < .001) of serum Nor values occurred with time, the mean correlation coefficient varying from .8 (Los Angeles) to .96 (Stockholm). Ratios of Nor metabolism were compared in different Centres; mean value for Stockholm was significantly higher than that of all other Centres, and that for Canada (.048) was significantly higher than that of Bangkok and other Centres with a value less than .043. Calculated steroid half-lives for the period 8-24 postadministration were within a range from 9.7-18.9, more consistent than values for the 2-8 hour period. In general, inter-Centre differences were of the same order as the intra-Centre ones. Variations in steroid metabolism did not appear to be caused by body size variations.
Personal communication. 1979 Mar 23; 12.Tables show total purchases direct from manufacturers, in quantities and dollar values, of IUDs, condoms, injectables, and spermicides, out of UNFPA, WHO, Population Council, IPPF, and UNICEF Funds for individuals years from 1974 to 1978 for 40 countries in Africa, Asia, and Latin America. Th 2 types of IUDs that were mainly purchased were the Lippes Loop and the CuT200, both of which are aggregated into a single figure. Figures are given both for total value of purchases, total amounts purchased, and reimbursable procurement.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 283-321This review of low-dose gestagen contraception emphasizes the variety of findings from different studies. For example, studies of chlormadinone acetate have found pregnancy rates of 1.1-12/100 woman-years. Results of trials of megestrol acetate suggested that a 500-mcg dose level yielded unacceptable pregnancy rates. No significant difference between various doses of norgestrel which have been studied were found (e.g., 50 and 75 mcg daily of dl-norgestrel or 30 mcg daily of the d-isomer). Pregnancy rate reported for most trials with this gestagen and also norethisterone and quingestanol were within an acceptable range. With 1 exception, pregnancy rates reported in trials of lynestrenol were remarkable low. Cumulative results of trials with various gestagens show Pearl Index rates between 2 and 3, except for lynestrenol. Dose level was the critical variable; i.e., it must be sufficiently high to exert antifertility action and low enough to avoid a high incidence of irregular bleeding. Apart from menstrual irregularities, other side effects from the minipill seem minor and in general less severe than those encountered with combined oral contraceptives.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagan, Denmark, Scriptor, 1977. p. 323-360Long-acting systemic contraceptives inhibit fertility either at a central or peripheral level. In some instances, a mixed reaction is likely to be working: during the 1st portion of the drug's life-span the contraceptive effect is exerted at a hypothalamic central level, whereas later on--when ovulation is restored--the action is on the cervix or uterus. The most important factor holding back utilization of long-acting agents is serious interference with regularity of the menstrual cycle, and delivery systems must be devised with zero-order release rates to improve cycle control and acceptability. Monthly injectables consisting of synthetic progestins alone proved unsuitable for contraception because of frequent and prolonged amenorrhea. Addition of an estrogenic substance helped cycle control, and a dihydroxyprogesterone acetophenide plus estradiol enanthate combination seems most worthy of clinical investigation; so far, 15,000 woman-months of experience have yielded no unwanted pregnancies. Few bleeding pattern irregularities were reported, but premenstrual tension, dysmenorrhea, and libido changes occurred. Reversibility of drug-induced anovulation has been shown by spontaneous ovulation resumption 12-42 weeks after cessation. Tri-monthly injections of Depo Provera resulted in pregnancy rates averaging .5/100 woman-years of use. Biannual injectable and sustained release systems are discussed and data are presented.
[Unpublished] 1973 Apr. 33 p.A tentative inventory of 31 countries' efforts in commercial distribution of contraceptives is presented in outline form. Funding sources for each project are usually listed, as well as a very brief description of the project. Examples range from contraceptive distribution through a coupon system in Costa Rica to the marketing of condoms through barbershop promotion in Korea.