Modern Trends in Contraception

Sexually transmitted diseases and oral contraceptive use during adolescence

Sexually transmitted diseases (STD) cause lower genital tract infections (cervicitis, vaginitis) or ascending infections of the fallopian tubes, and, possibly, pelvic inflammatory disease (PID). The syphilis bacterium, human immunodeficiency virus (HIV), and the hepatitis virus cause systematic disease. Although oral contraceptives (OCs) are the most reliable contraceptive method, they have limited anti-STD properties and their relationship with STDs remain unclear. Various mechanisms explain a protective role of OCs against STDs; however, in no way can OCs be considered a safe anti-STD contraceptive method, when compared to specific barrier methods, which provide both contraception and anti-STD protection. The above has been confirmed by a recent study performed in our institution where 10.3% and 6.9% of OC users presented a prevalence of Chlamydia trachomatis and Mycoplasma, respectively, when compared to 0% and 4.5% infection rates found among condom users. It is concluded that although OCs possess some anti-STD properties, mainly in the prevention of PID, they should be used in combination with a barrier method.

Physicians' experience with Norplant implantable contraceptives in Finland

Norplant contraceptives are manufactured in Finland, but the majority of Norplant users live in the Third World. The objective of this study was to study Finnish family planning physicians experience with and attitudes towards Norplant contraceptives. Three data sources were used: (1) review of articles published in non-commercial Finnish medical journals between 1980 and 1990, (2) a sample of eleven physicians known to have experience with Norplant and chosen by a snow-ball method, and (3) a random sample of 22 physicians in charge of public family planning services stratified by municipality and degree of urbanization. The articles reflected a positive attitude towards Norplant, but the authors did not believe that Norplant should replace any previous method of contraception. In the random sample the amount of experience with Norplant was low. In both groups the general attitude towards Norplant was reserved. It was not used as a method of first choice, but was considered a good method for carefully selected women. Norplant was considered troublesome for the physician, requiring surgical procedures, producing side-effects and demanding time for counselling. Adequate use of Norplant calls for a good health care infrastructure, hygienic facilities and trained personnel. These are often lacking in Third World settings.

Noncontraceptive effects of hormonal contraceptives: bone mass, sexually transmitted disease and pelvic inflammatory disease, cardiovascular disease, menstrual function, and future fertility

Noncontraceptive actions of oral contraceptives (OCs) include hormonal effects on bone mass, sexually transmitted disease, pelvic inflammatory disease, the cardiovascular system, menstrual function, and future fertility. Information about the effects of OCs on bone mass is limited and contradictory. Two recent studies failed to show a positive effect of OC use on bone mass or density compared with the three cross-sectional studies and one longitudinal study that showed favorable effects. A recently completed study of 156 healthy females indicated a significant correlation between OC use and the rate of change in total body bone-mineral content. One study involving depot medroxyprogesterone acetate suggests bone density decreases with long-term use of the drug. The use of OCs does not reduce the risk of gonococcal or chlamydial infection of the lower tract and in fact may enhance spread of lower tract infection. However, OCs may exert a protective effect against some types of pelvic inflammatory disease. Regarding transmission of human immunodeficiency virus, the results of recent studies are conflicting. Research related to newer OC formulations containing 35 micrograms or less of ethinyl estradiol suggests that the risk of a negative cardiovascular effect is substantially reduced. All forms of hormonal contraception alter menstrual function to some degree, but most patterns improve with duration of use. No evidence exists that hormonal contraception permanently affects fertility, although fertility restoration may be delayed with some agents.

The pathology of intra-uterine contraceptive devices

The IUCD is a simple and effective way of producing contraception without the need for patient compliance. It is not rendered ineffective by other drugs, as may be steroid contraceptives, and its side-effects, for carefully selected patients, are considered by most practitioners to be acceptably low (Van Kets et al. 1989).

Norgestimate: a clinical overview of a new progestin

The efficacy and safety of a new monophasic oral contraceptive, norgestimate/ethinyl estradiol, containing the third-generation progestin, norgestimate (250 micrograms), and ethinyl estradiol (35 micrograms), are reviewed. Norgestimate/ethinyl estradiol demonstrates excellent contraceptive efficacy, with a Pearl index of 0.25. Cycle control is reliable, with a low incidence of breakthrough bleeding and spotting. Because of the minimal androgenicity of norgestimate, norgestimate/ethinyl estradiol has a low impact on carbohydrate and lipid metabolism. It neither reduces the vasodilatory and antiaggregatory prostacyclin nor increases its endogenous antagonist, thromboxane. Norgestimate/ethinyl estradiol has no significant effect on blood coagulation factors. All these characteristics suggest that norgestimate/ethinyl estradiol may be associated with a lower risk of cardiovascular disease than other oral contraceptives currently available. Epidemiologic data, however, are not available, and physicians should be reluctant to prescribe it or any oral contraceptive to patients who have a history of vascular or thrombotic disorders.