Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications

Contraception

This article outlines the basics of all contraceptive options available in the United States, providing providers necessary information to best provide equitable contraceptive care for women. Long-acting reversible contraception should be considered in all women as there are few contraindications to use. Levonorgestrel intrauterine devices have been found to be safe for use for longer periods of time, in some cases up to eight years. Combination hormone contraceptives remain popular and offer benefits beyond contraception; importantly newer formulations exist providing patients with more contraceptive options. Education regarding emergency contraception should be provided to all patients.

Knowledge, Attitude, and Practice of Contraception Use Among Childbearing Women in Makkah Region, Saudi Arabia

Introduction The rapid growth of the Saudi Arabian economy led to socio-demographic changes, with an increasing need for birth spacing and the use of contraceptives. This study evaluated the knowledge, attitude, and practice of contraception use in the Makkah region of Saudi Arabia. Methods This cross-sectional study used an online questionnaire involving women aged 18-49 in Makkah, Saudi Arabia. Descriptive analyses were performed and the Chi-squared test was used to compare variables. A p-value of < 0.05 was considered statistically significant. Results The study included 352 women aged 32±9.1 years with a response rate of 91%. Among them, 72.1% had a diploma or bachelor's degree, and two-thirds were married (63.4%). Nearly all respondents had heard of contraception before (96.9%). However, only 44.3% knew contraception is a method of family planning, and 23.9% knew it prevents unwanted pregnancy. During the period of conducting the research, 37.8% reported using some contraception. Oral contraceptive pills (OCP) (97.2%, 33.8%), intrauterine devices (IUD) (97.2%, 22.7%), and male condoms (92.9%, 16.9%) were the most known and popular contraception methods used. Respondents' primary sources of information regarding contraception were relatives or friends (38.3%) and websites (30.2%), and 61.9% needed education on family planning. We found that women with multiple children were significantly more likely to practice family planning (p=0.005). Conclusion We found that participants were aware of and had a good attitude toward family planning. However, they had poor knowledge and poor practice of family planning. Raising awareness and education are recommended to improve knowledge and practice of family planning.

"Did I Choose a Birth Control Method Yet?": Health Care and Women's Contraceptive Decision-Making

In the United States, unintended pregnancy is medicalized, having been labeled a health problem and "treated" with contraception. Scholars find women's access to contraception is simultaneously facilitated and constrained by health care system actors and its structure. Yet, beyond naming these barriers, less research centers women's experiences making contraceptive decisions as they encounter such barriers. Through in-depth, semi-structured interviews with 86 diverse, self-identified women, this study explores how the medicalization of unintended pregnancy has influenced women's contraceptive access and decision-making. We highlight the breadth of such influence across multiple contraceptive types and health care contexts; namely, we find the two most salient forces shaping women's contraceptive decisions to be their insurance coverage and providers' contraceptive counseling. Within these two categories, we offer crucial nuance to demonstrate how these oft-cited barriers implicitly and explicitly influence women's decisions. Paradoxically, it is the health care system, itself, that both offers yet constrains women's contraceptive decisions.

Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open-label, parallel-group, controlled pilot trial

AIM

To evaluate the effect of a ketogenic diet (KD) in women with polycystic ovary syndrome (PCOS) and liver dysfunction who were obese.

METHODS

Women with PCOS and liver dysfunction who were obese were enrolled in this prospective, open-label, parallel-group, controlled pilot trial, and randomly received KD (KD group) or conventional pharmacological treatment (Essentiale plus Yasmin, control group) in a 1:1 ratio for 12 weeks. The primary endpoint was the liver function markers. Secondary endpoints included the menstrual cycle, anthropometric characteristics, body composition, hormonal levels, and metabolic biomarkers.

RESULTS

Of the 20 eligible participants enrolled, 18 participants completed the study. The KD group reported a significant reduction in anthropometric characteristics and body composition from baseline to week 12 (all p < 0.05). In addition, there were significant reductions in menstrual cycle, plasma estradiol, and progesterone levels in two groups (all p < 0.05), but no significant between-group difference was observed. KD significantly reduced the liver function markers compared with control group (p < 0.05). The signs of fatty liver disappeared in six out of seven fatty liver participants in KD group after 12 weeks of intervention, while only one of 10 fatty liver participants in control group disappeared.

CONCLUSIONS

In addition to improving the menstrual cycle, KD had the additional benefits of reducing blood glucose and body weight, improving liver function, and treating fatty liver compared to traditional pharmacological treatment in women with PCOS and liver dysfunction who were obese.

Hormonal Contraception, depression, and Academic Performance among females attending college in the United States

Associations between Hormonal Contraception (HC) and Depression have been previously reported, and indicate increased risk to younger women. These relationships need be explored and expanded to include measures of impact on Academic Performance (AP). Data was acquired from the National College Health Assessment (NCHA), administered from Fall 2008 to Spring 2015 across 370 schools nationwide. The most popular HC method was oral, followed by an IUD, and vaginal ring. HC use increased across all ages groups 18-29, and then decreased in the 30-34 age group. HC use significantly increased the odds of ever being diagnosed with depression in all age groups. HC use was found to have significantly increased odds of reporting AP issues in the 18-19 age group and to have significantly decreased odds of reporting AP issues in the 25-29 age group. Adding depression as a moderator, HC use continued to significantly increase the odds of AP issues. Women and their providers should balance the risks and benefits of initiating HC. Specifically, younger women, and be advised of the risks that HC presents in terms of a potential association with depression. Efforts to develop standardized protocols for discussing the risk-benefits for HC therapy should be pursued.

Alopecia due to high androgen index contraceptives

Adverse reactions to hormonal contraceptives are a common patient concern. Alopecia, an adverse reaction to androgen activity caused by the progestin component of hormonal contraceptives, can cause considerable psychosocial distress for women. This article discusses how to identify the level of androgen activity in certain progestins, how increased androgen activity can lead to hair loss, and alternatives for patients experiencing androgenic alopecia due to high androgen index contraceptives.

Contesting and Differentially Constructing Uncertainty: Negotiations of Contraceptive Use in the Clinical Encounter

Most women of reproductive age have access to highly effective contraception, and all available methods are associated with side effects. Whether a woman will experience side effects is uncertain, however, which can pose challenges for clinicians who discuss the methods with patients. In this study, we analyze 102 contraceptive counseling visits to understand how clinicians discursively construct knowledge in the context of uncertainty. We find that while some present the uncertainty of side effects in a straightforward, patient-accessible way, others negotiate their predictions by (1) differentially constructing uncertainty, suggesting that positive side effects are likely and negative side effects are unlikely, and (2) contesting uncertainty, presenting the risk of serious side effects as controllable. In the end, these strategies deemphasize consideration of negative side effects in women's contraceptive decision making. Our results demonstrate the importance of elucidating the translation, instantiation, and construction of medical uncertainty both in theory and in practice.

European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer

The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.

Chronic exposures to low levels of estradiol and their effects on the ovaries and reproductive hormones: Comparison with aging

Aging in female rats is characterized by a state called "constant estrous" in which rats are unable to ovulate, have polycystic ovaries and moderately elevated estrogen levels. We hypothesized that chronic exposure of young animals to low levels of E2 can produce reproductive changes similar to that seen in aging animals. Adult female rats were sham-implanted (control) or implanted with slow-release E2 (20 ng/day) pellets for 30, 60, or 90 days. Old constant estrous (OCE) rats were used for comparison. Estrous cyclicity was monitored periodically. At the end of treatment, animals were sacrificed, trunk blood was collected for hormone measurements and ovaries for immunohistochemistry. Young animals became acyclic with increasing duration of E2 exposure while OCE rats were in a state of acyclicity. Ovaries became increasingly more cystic with E2 exposure, and were comparable to OCE rats; however, there was a marked reduction in interstitial tissue with exogenous E2 treatment. Exogenous E2 also decreased Mullerian inhibiting substance expression, increased infiltration of macrophages without much impact on apoptosis in the ovaries. Serum testosterone levels decreased in E2-treated young animals, while it increased significantly in OCE rats. There was a marked reduction in LH but not FSH levels with E2 exposure in both young and old animals. These results indicate that even very low doses of E2 are capable of inducing aging-like changes in young animals.

Steroids pretreatment in assisted reproduction cycles

The objective is to present an overview of trials and appreciate the relevant data on the effect of steroids pretreatment (oral contraceptives, 17β-estradiol and estradiol valerate) in assisted reproduction cycles. The subject of the study is to evaluate the clinical characteristics during steroids pretreatment cycles focused on the prevention of ovarian cysts, the positive contraceptive effect on the onset of regular period during long gonadotropin releasing hormone agonist protocol. In gonadotropin releasing hormone antagonist protocol the review is interested in supporting ovarian stimulation in low responders, the idea of cycle scheduling and improving treatment outcomes. The method is a review from MEDLINE/Pubmed database between 1994 and July 2012. We identified 15 randomised controlled trials (n=3069 patients). One trail (n=83 patients) assessed GnRH agonist protocol with or without steroids pretreatment, 8 trials (n=1884 patients) assessed GnRH antagonist protocols with or without steroids pretreatment and 6 trials (n=1102 patients) assessed GnRH antagonist protocols versus agonist ones with steroid pretreatment. Data demonstrates that oral contraceptives offer the effective prevention of functional ovarian cysts, the predictable onset of period during desensitisation. Existing data suggest that pretreatment with oral contraceptive pills or estradiol valerate give no advantage concerning number of oocytes or pregnancy rate. Pretreatment with oral contraceptive pills aiming to avoid weekend oocytes retrievals has to be more elucidated. In low responders oral contraceptive pill pretreatment may be beneficial in improving ovarian responses by reducing the amount of gonadotropins and the number of days required for ovarian stimulation. Current research indicates that also 17β-estradiol may be encouraging pretreatment in low responders and in cycle scheduling. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.

Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review

Oral contraceptives may influence the risk of certain cancers. As part of the AHRQ Evidence Report, Oral Contraceptive Use for the Primary Prevention of Ovarian Cancer, we conducted a systematic review to estimate associations between oral contraceptive use and breast, cervical, colorectal, and endometrial cancer incidence. We searched PubMed, Embase, and Cochrane Database of Systematic Reviews. Study inclusion criteria were women taking oral contraceptives for contraception or ovarian cancer prevention; includes comparison group with no oral contraceptive use; study reports quantitative associations between oral contraceptive exposure and relevant cancers; controlled study or pooled patient-level meta-analyses; sample size for nonrandomized studies ≥100; peer-reviewed, English-language; published from January 1, 2000 forward. Random-effects meta-analyses were conducted by estimating pooled ORs with 95% confidence intervals (CIs). We included 44 breast, 12 cervical, 11 colorectal, and 9 endometrial cancers studies. Breast cancer incidence was slightly but significantly increased in users (OR, 1.08; CI, 1.00-1.17); results show a higher risk associated with more recent use of oral contraceptives. Risk of cervical cancer was increased with duration of oral contraceptive use in women with human papillomavirus infection; heterogeneity prevented meta-analysis. Colorectal cancer (OR, 0.86; CI, 0.79-0.95) and endometrial cancer incidences (OR, 0.57; CI, 0.43-0.77) were significantly reduced by oral contraceptive use. Compared with never use, ever use of oral contraceptives is significantly associated with decreases in colorectal and endometrial cancers and increases in breast cancers. Although elevated breast cancer risk was small, relatively high incidence of breast cancers means that oral contraceptives may contribute to a substantial number of cases.

Oral contraceptive therapy increases oxidative stress in pre-menopausal women

Background:

Oral contraceptive therapy (OCT) is associated with an increased risk of deep vein thrombosis, venous thromboembolism and stroke. However, the underlying mechanisms have not yet been elucidated. The objective of this study was to investigate the influence of OCT on blood levels of an oxidative stress maker in pre-menopausal women.

Methods:

Oxidative stress was determined in 87 pre-menopausal healthy women (24 with and 63 without OCT) using a blood assay for reactive oxygen metabolites (by the d-ROMs test). The subjects with OCT received a triphasic preparation consisting of ethinyl estradiol and norethisterone.

Results:

Subjects with OCT showed significantly higher d-ROMs levels (median: 380; interquartile range: 328-502 Carr U) than those without OCT (325 [271-369]; P < 0.05). The results remained the same after adjusting for potential confounders.

Conclusions:

The use of OCT may increase oxidative stress levels, independent of traditional cardiovascular risk factors, in pre-menopausal women, providing new insights to the primary prevention of vascular complications in these subjects.

Agreement between self-report and prescription data in medical records for pregnant women

BACKGROUND Clinical teratology studies often rely on patient reports of medication use in pregnancy with or without other sources of information. Electronic medical records (EMRs), administrative databases, pharmacy dispensing records, drug registries, and patients' self-reports are all widely used sources of information to assess potential teratogenic effect of medications. The objective of this study was to assess comparability of self-reported and prescription medication data in EMRs for the most common therapeutic classes. METHODS The study population included 404 pregnant women prospectively recruited from five prenatal care clinics affiliated with the University of New Mexico. Self-reported information on prescription medications taken since the last menstrual period (LMP) was obtained by semistructured interviews in either English or Spanish. For validation purposes, EMRs were reviewed to abstract information on medications prescribed between the LMP and the date of the interview. Agreement was estimated by calculating a kappa (κ) coefficient, sensitivity, and specificity. RESULTS In this sample of socially-disadvantaged (i.e., 67.9% high school education or less, 48.5% no health insurance), predominantly Latina (80.4%) pregnant women, antibiotics and antidiabetic agents were the most prevalent therapeutic classes. The agreement between the two sources substantially varied by therapeutic class, with the highest level of agreement seen among antidiabetic and thyroid medications (κ ≥0.8) and the lowest among opioid analgesics (κ = 0.35). CONCLUSIONS Results indicate a high concordance between self-report and prescription data for therapeutic classes used chronically, while poor agreement was observed for medications used intermittently, on an 'as needed" basis, or in short courses.

Knowledge-attitude-practice survey among Portuguese gynaecologists regarding combined hormonal contraceptives methods

ABSTRACT Objectives To evaluate knowledge, attitude and practices of Portuguese gynaecologists regarding combined hormonal contraceptives. Methods A cross-sectional survey was conducted among 303 gynaecologists. Results Ninety percent of the gynaecologists considered that deciding on contraceptive methods is a process wherein the woman has her say. Efficacy, safety and the woman's preference were the major factors influencing gynaecologists, while efficacy, tolerability and ease of use were the major factors perceived by the specialists to influence the women's choice. Gynaecologists believed that only 2% of women taking the pill were 100% compliant compared to 48% of those using the patch and 75% of those using the ring. The lower risk of omission was the strong point for the latter methods. Side effects were the main reason to change to another method. Vaginal manipulation was the most difficult topic to discuss. Conclusions Most gynaecologists decided with the woman on the contraceptive method. The main reasons for the gynaecologist's recommendation of a given contraceptive method and the women's choice were different. Counselling implies an open discussion and topics related to sexuality were considered difficult to discuss. Improving communication skills and understanding women's requirements are critical for contraceptive counselling.

Cognitive-impairing effects of medroxyprogesterone acetate in the rat: independent and interactive effects across time

RATIONALE

The synthetic progestin medroxyprogesterone acetate (MPA), widely used in hormone therapy (HT) and as the contraceptive Depo Provera, is implicated in detrimental cognitive effects in women. Recent evidence in aged ovariectomized (Ovx) rodents shows that short-term MPA treatment impairs cognition and alters the GABAergic system.

OBJECTIVES

Using rats, we evaluated the long-lasting cognitive and GABAergic effects of MPA administered in young adulthood (Early-MPA), modeling contraception, and how this early exposure interacts with later MPA treatment (Late-MPA), modeling HT.

METHODS

Early-MPA treatment involved weekly anti-ovulatory MPA injections (3.5 mg) from 4 to 8 months of age in ovary-intact rats. At 10 months old, rats were Ovx and weekly MPA injections were re-initiated and continued throughout testing for Late-MPA treatment.

RESULTS

On the water radial-arm maze, all MPA-treated groups showed working memory impairment compared to Controls (p < 0.05); Early + Late-MPA rats were impaired on multiple dimensions of working memory (p < 0.05). On the Morris maze, Late-MPA rats showed greater overnight forgetting compared to Controls (p < 0.05). At study conclusion, MPA was detected in serum in all MPA-treated groups except Early-MPA, confirming treatment and clearance from serum in Early-MPA rats. In animals with detectable serum MPA, higher MPA levels were associated with less dorsal-hippocampal glutamic acid decarboxylase, the synthesizing enzyme for GABA (p = 0.0059).

CONCLUSIONS

Findings suggest that MPA treatment leads to long-lasting cognitive impairments in the rodent, even in the absence of circulating MPA in animals given prior MPA treatment, which may relate to the GABAergic system. Further research defining the parameters of the negative impact of this widely used progestin on brain and cognition is warranted.

Depot-medroxyprogesterone acetate contraception use among Salvadoran women: an in-depth analysis of attitudes and experiences

OBJECTIVE

To survey a cross-section of reproductive-age Salvadoran women in order to assess the factors that influence their decision to use depot-medroxyprogesterone acetate (DMPA), an injectable form of contraception.

METHODS

Reproductive-age women at three rural Salvadoran health clinics were asked to participate in a study to assess their current and past experiences using DMPA contraception. Verbal informed consent was obtained, and research coordinators administered a 23-question survey.

RESULTS

Surveys were completed in 425 women with an average age of 27.36 years. Average duration of DMPA contraception use was 2.89 years. The majority (84%) of past and present users were very satisfied with DMPA contraception, most commonly because they did not have to remember to use it daily (44.9%). The side effects of DMPA appear to be a significant indicator of whether women heard about and wanted to use other forms of long-term reversible contraception, such as an intrauterine device (IUD) or implant.

CONCLUSIONS

The main reason Salvadoran women chose to use DMPA is because they do not have to think about it on a daily basis. However, many women do not like the side effects and may be open to explore using other long-term reversible methods of contraception, such as IUDs or implants. It is possible that with increased access to educational information about IUD use, safety, and effectiveness, more women would use this form of long-term contraception as opposed to sterilization.

Doctor contraceptive-prescribing behaviour and women's attitudes towards contraception: two European surveys

RATIONALE, AIMS AND OBJECTIVES

Many women are prescribed oestrogen-containing contraceptives for whom oestrogen-containing methods may be less suitable.

METHODS

Two surveys examining contraceptive prescription practices among doctors (n = 419) and attitudes towards contraception among women (n = 1623) in France, Germany, Spain, Italy and Russia were evaluated.

RESULTS

Progestin-only pills and hormone-free intrauterine devices were the most commonly prescribed contraceptives for women with medical conditions for which oestrogen-containing methods are not preferred (40% and 20%, respectively), those suffering from oestrogen-related side effects (32% and 21%) and those with concerns about the safety of oestrogen-containing methods (28% and 24%). Combined oral contraceptives (COC) were prescribed to ≥ 10% in these two groups. One-quarter of contraceptive users had asked to be switched from one COC to another because of oestrogen-related side effects; a similar proportion had been switched by their doctor for this reason. Half of the women surveyed did not want or had concerns about foreign/additional oestrogen, and about 80% said that they would consider switching to a different hormonal contraceptive to minimize oestrogen exposure. Although most doctors were aware of the World Health Organization medical eligibility criteria for contraceptive use, they still prescribed COCs or other oestrogen-containing contraceptives to women with medical conditions for which oestrogen-containing options are not favoured, suggesting a need for additional education.

CONCLUSION

By complying with guidelines and heeding women's concerns, doctors can individualize their contraceptive recommendation to improve safety, acceptance and compliance and, ultimately, reduce the risk of an unintended pregnancy.

Conventional vs. extended-cycle oral contraceptives on the quality of sexual life: comparison between two regimens containing 3 mg drospirenone and 20 µg ethinyl estradiol

INTRODUCTION

Women may use new oral contraceptives (OC) having flexible extended-cycle regimens with a reduced hormone-free interval.

AIM

To study the changes of the quality of sexual life in users of the traditional 21/7 or extended-cycle 24/4 OC regimens both containing 3 mg drospirenone and 20 µg ethinyl estradiol.

METHODS

One hundred fifteen women (age range 18-37 years) were enrolled. Fifty-four women were randomly placed on traditional OC standard regimen, administered for 21 days, followed by a 7-day hormone-free interval (group A); and 61 women were placed on extended-cycle OC regimen covering 24 days of the cycle with a 4-day hormone-free interval (group B). The Short Form-36 (SF-36) validate questionnaire to assess quality of life (QoL) and the Short Personal Experience Questionnaire (SPEQ) to measure the changes of sexual behavior were administered before starting OC intake and at the 3rd and 6th cycle follow-ups.

MAIN OUTCOME MEASURE

The SF-36 and the SPEQ questionnaires.

RESULTS

Group A women reported QoL improvement during the 6th cycle on all the scales (P < 0.05). Group B women reported QoL improvement during the 3rd and 6th cycle (P < 0.05). Satisfaction with sexual activity, arousal, orgasm, and desire increased during the 3rd cycle in women on the group B (P < 0.05). Group A women did not report any change in all SPEQ items. At the 6th cycle, group B women reported better sexual experience than baseline in all SPEQ items (P < 0.05). All subjects who were affected by dyspareunia before OC intake reported decreased genital pain associated with intercourse at the 3rd and 6th cycle of both OC regimens (P < 0.05).

CONCLUSION

Women could use OCs in a subjective flexible modality. The extended-cycle OC might produce positive effects on the quality of sexual life, enforcing the concept of tailoring an OC to a woman.

Attitudes, awareness, compliance and preferences among hormonal contraception users: a global, cross-sectional, self-administered, online survey

BACKGROUND

Healthcare professionals have a responsibility to help each woman select the most appropriate hormonal contraceptive according to her personal preferences, needs and circumstances.

OBJECTIVE

To assess attitudes, awareness, compliance and preferences of hormonal contraceptive users.

STUDY DESIGN

A cross-sectional survey conducted through self-administered, online questionnaires. One questionnaire was administered in the US and another was administered in the UK, France, Germany, Spain, Italy, Brazil, Australia and Russia (Eight-Country Survey questionnaire).

PARTICIPANTS

Current hormonal contraceptive users, aged 18-44 years, in the general community.

RESULTS

Questionnaires were completed by 5120 women. The mean age of the respondents was approximately 31 years and over 70% were current contraceptive pill users. Many women did not plan on having children in the next 3 years (range 44% in Russia to 77% in the US and UK), but a quick return of fertility upon contraceptive discontinuation was desired by the majority of women in all countries (range 54% in the US to 91% in Russia). Rates of discontinuation or switching to a different hormonal contraceptive in the past year ranged from 30% in Germany to 81% in Brazil. Requests to switch because of side effects ranged from 24% in Spain to 57% in Brazil. Results from the Eight-Country Survey questionnaire indicated that 42% of women would consider using one of the most effective contraceptive methods even if their menstrual cycle changed, 58% would accept irregular bleeding initially if they had fewer periods over time, 53% did not want/had concerns about foreign/additional estrogen in their body, 85% would prefer a monthly option with a lower hormone dose over a daily pill, 80% would consider switching contraceptives to minimize estrogen exposure and 74% would prefer an estrogen-free/progestin (progesterone congener)-only pill to avoid potential side effects from foreign/extra estrogen. Oral contraceptive users across all countries admitted missing (range 39% in the UK to 65% in Brazil) or taking a pill at the wrong time (range 12% in Spain to 67% in Brazil) in the previous 3 months. Approximately 81% of all respondents said they would consider using a method that did not require daily, weekly or monthly dosing. The proportion of women believing themselves well informed about their contraception options ranged from 30% in Russia to 86% in the US. Informed women were generally more aware of alternative methods than their uninformed counterparts. Responses also varied significantly among women in different age groups.

CONCLUSION

These findings demonstrate that a range of factors influence a woman's choice of contraceptive. This highlights the importance of individualized counselling during contraceptive selection to ensure that the option recommended is tailored to the personal preferences of each woman to improve compliance, continuance and prevention of an unwanted pregnancy.

The synthesis and antifertility evaluation of 3 analogs of pyrimethamine on male rat reproductive indices

Side effect assessment of medicaments on fertility indices may be used as a guide in the development of male contraceptive agents. In this study, 3 analogs of pyrimethamine were synthesized and evaluated for antifertility activity on reproductive indices of male rats. Test compounds were administered in a dosage of 50 mg/kg every other day till 60 days. On the 50th day, the fertility of rats was tested. On the 60th day, the gonadosomatic index and the serum testosterone content were determined. Iso-butyloxy and tertiary-butyloxy caused 40% and 11% reduction in sperm viability, respectively. They also significantly reduced fertility indices. Consequently, iso-butyloxy can be one of the best nominees in this class of compound and a suitable candidate for assessment of mechanism involved in future research activity. To synthesize a more effective agent, increasing the lipophilicity may play a major role in the development of more potent promising male contraceptive agents.