Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study

An intrauterine device, releasing approximately 20 micrograms/day of levonorgestrel (LNg 20), used by 1124 women, was studied in a randomized trial of five years duration in comparison with the Copper T, model TCu 380Agm in 1121 women. At five years, the gross cumulative pregnancy rate of 1.1 +/- 0.5 per 100 among users of the LNg 20 devices was not significantly different from the rate of 1.4 +/- 0.4 per 100 experienced by users of the Copper T 380Ag. The steroid-releasing IUD had significantly higher termination rates for expulsion and amenorrhea, a significantly lower termination rate for other menstrual problems and pain, and a lower continuation rate. The five-year continuation rate among women using the TCu 380Ag was 40.6 per 100 as compared with that of 33.0 per 100 among women randomized to the LNg 20 device (P less than .001). Terminations attributed to amenorrhea with the LNg device primarily account for differences in continuation. These two intrauterine devices are the most effective long-term, reversible IUDs yet reported in the literature. No other contraceptive methods have exhibited such low long-term pregnancy rates in randomized comparative trials.

Long-interval treatment regimen with a desogestrel-containing oral contraceptive

A randomized multicenter study was performed in order to investigate the acceptance of a low-dose OC (30 micrograms of ethinyloestradiol and 150 micrograms of desogestrel), using a 9 weeks on and 1 week off schedule (prolonged regimen, n = 198), compared to a traditional 3 weeks on, 1 week off schedule (standard regimen, n = 96). Haemoglobin and blood pressure remained the same in both groups during the study. No significant differences were found in body weight changes between the two groups. There was significantly more breakthrough bleeding and spotting in the group with prolonged regimen than in the group with standard regimen, but both breakthrough bleeding and spotting decreased during the trial. Irregular bleeding was significantly less in women who were already using OC, compared to "new starters." No serious side effects occurred. Significantly more women stopped the trial because of bleeding problems in the group with prolonged regimen, while there were significantly more women who stopped the trial because of headache in the group with standard regimen. After completing 12 months, or after premature withdrawal from the study, each women completed a questionnaire. Sixty-three per cent of the women preferred the studied alternative and twenty-six per cent preferred the traditional OC.

One year contraception with a single subdermal implant containing nomegestrol acetate (Uniplant)

One single silastic capsule containing nomegestrol acetate, Uniplant, was inserted subcutaneously in 100 women of reproductive age who desired to avoid conception. Insertions and removals of the capsules were made in the gluteal region following intracutaneous local anesthesia with 2% procaine. Eighty women completed one year of use. Eleven women bore the implant for 6-11 months. A total of 1,085 women-months were recorded. One pregnancy occurred, resulting in a Pearl Index of 1.1. Bleeding episodes similar to menstruation occurred in all women but the degree of regularity varied from subject to subject. Amenorrhea developed in the range of 14-18% during the first six months of use but declined to less than 10% during the last six months. Menorrhagia likewise was higher in the first six months (18% in the first month) but fell to less than 10% during the last six months. Spotting was 5% or less. Of the twenty women who did not complete one year of use, nine discontinued because they found other methods were either more practical or less revealing. Three discontinued because of bleeding irregularities, three desired to become pregnant, one became pregnant. Other complaints included dizziness, headache, increased blood pressure, loss of libido, painful breasts and nausea. Over half of the women indicated their desire to continue using the single implant as a contraceptive.

A comparative clinical trial of the TCu 380A, Lippes Loop D and Multiload Cu 375 IUDs in Indonesia

The Copper T 380A (TCu 380A), Lippes Loop D (LLD) and the Multiload Cu 375 (MLCu 375) IUDs were evaluated for safety and efficacy in a multicenter randomized clinical trial in Indonesia. A total of 2992 women were enrolled into the study and data for 2845 women were analyzed (147 cases did not meet protocol criteria). Although study IUDs were randomly assigned, LLD users in this study were older and of higher parity than TCu 380A and MLCu 375 users. The 24-month gross cumulative life-table pregnancy rates for TCu 380A, LLD and MLCu 375 users were 1.2, 2.2 and 2.7, respectively. The 24-month expulsion rates for TCu 380A, LLD and MLCu 375 users were 6.7, 7.5 and 5.3, respectively. Overall, 24-month continuation rates were 85.5%, 85.0% and 85.4% for the respective device groups. Differences in both gross and age- and parity-adjusted life-tables rates for the major outcome variables were not statistically significant at 24 months postinsertion. The study suggests that the TCu 380A, LLD and MLCu 375 IUDs seem to be safe and effective contraceptive options for Indonesian women.

A comparative trial of the Today contraceptive sponge and diaphragm

A comparative trial was conducted in the United States to compare the Today contraceptive sponge and the diaphragm used with spermicide. Subjects were randomly assigned to contraceptive methods and were followed up for 1 year. None of the subjects were previous sponge users, but about 30% were previous diaphragm users. The overall cumulative 1-year life-table pregnancy rate was higher for sponge users compared to diaphragm users. No serious side effects occurred with either product. The discontinuation rates for allergic-type reactions and discomfort were higher for sponge users. Similar rates of method-related complaints and discontinuation rates for personal and product-related reasons suggest there were no differences in the acceptability of the two products. In this trial, the allowable use time for the sponge was 2 days. The sponge is now recommended for 1-day use. The overall results of the study indicate the sponge to be a safe and acceptable method of contraception with an effectiveness rate in the range of that for other vaginal contraceptives.

One-year experience with subdermal contraceptive implants in the United States

Women who received Norplant contraceptive implants from any of fifteen clinical settings in southeast Texas, U.S.A., were followed for one year to determine their reactions to the method. Of 1,385 who enrolled to receive Norplant implants, 1,253 had implants inserted. Side effects were reported by 78% of those receiving implants and 70% described changes in bleeding patterns. Spotting or irregular bleeding, weight gain and headaches were the conditions reported most frequently. Nine pregnancies were reported during the study period. Six of these, however, existed before the implants were inserted. At the one year anniversary, 143 of women receiving implants had had them removed. Those who discontinued method use were less satisfied, reported more side effects and were more likely to have planned to have another child, thus using the method for spacing, or to have had a change in their marital status while they were using the contraceptive. Providers should counsel patients to focus attention on plans for the future in selecting their contraceptive method. In addition, we recommend, as does the product's distributor, that providers confirm that patients are not pregnant prior to inserting implants.

A randomized trial of three copper IUDs (MLCu250, MLCu375 and Nova-T)

A randomized prospective trial of three copper IUDs, Nova-T, MLCu375 and MLCu250, including 200 of each, is presented. Insertion was done at the hospital outpatient clinic on normally menstruating women and on women in puerperio. Follow-up was scheduled after 12, 24 and 36 months. Pregnancy rates were low for all 3 models. Pearl indices after 3 years were 0.5, 0.9 and 0.8 for Nova-T, MLCu375 and MLCu250 respectively (NS). Abnormal bleeding and/or pain was the most frequent termination cause. Minor differences in the termination rates because of abnormal bleeding and/or pain were found and are discussed. The continuation rates based on all medically relevant IUD removals were 74%, 73% and 81% after 3 years for Nova-T, MLCu375 and MLCu250 respectively. No important difference in clinical performance between the three copper IUDs could be demonstrated.

A longitudinal study of contraception and pregnancy outcome in a representative sample of young Swedish women

The prevalence of contraception and pregnancy history in the same women, aged 19 and 24 years, was assessed in a longitudinal cohort study by means of a postal questionnaire. A one-in-four random sample of all the women born 1962, resident in the city of Göteborg in 1981, was obtained from the population register (n = 656). The response rate was 91%. Respondents from 1981 were re-assessed in 1986 (response rate: 83%). The respondents from 1986 (n = 488) represent 74% of the original sample from 1981. Contraceptive usage in the same women aged 19 and 24 years (in brackets) was as follows: Oral contraception (OC) 47% (51%); intrauterine device 3% (11%), p less than 0.01; barrier methods 11% (11%); depot gestagen 0 (0.2%); no contraception 39% (26%), p less than 0.05. OCs were being taken or had been taken by 89%. Reasons given for cessation of OC were as follows: Contraception not required 10% (15%); fear of OC 26% (29%); menstrual disorder 17% (14%); weight increase 18% (10%), p less than 0.05; mental side effects 15% (9%); desire to become pregnant 7% (17%), p less than 0.01. Pregnancies (n = 362) were reported by 194 (43%) of the women. 44% of the pregnancies terminated in legal abortion. The medical complication rate following legal abortion was 15%. Thus, despite the availability of effective contraception, the ratio of legal abortions to live births was high. Fear of side effects was the commonest reason for discontinuing OC.

A randomized trial of the Gyne T 380 and Gyne T 380 Slimline Intrauterine Copper devices

To facilitate manufacture and insertion of the Gyne T 380 IUD, design changes were instituted. Copper collars were seated flush at the ends of the horizontal crossbar of the device. A randomized study of the Gyne T 380 Slimline, the new design, was undertaken in comparison with the standard Gyne T 380. A total of 996 women were enrolled, with 698 Slimline insertions and 298 of the standard Gyne T. No statistically significant difference in ease of insertion or in performance was detected between the models. At one year, the pregnancy rate of each model was below 0.5 per 100 and the continuation rate was 79-80 per 100. Pelvic inflammatory disease or endometritis was found in one percent of subjects in the first year. This is the seventh multicenter randomized study of a collared T IUD with 380 mm2 of copper surface. In all seven, the one-year gross pregnancy rate has been 1.2 per 100 or lower.

The efficacy and acceptability of a low-dose levonorgestrel intravaginal ring for contraception in a UK cohort

The efficacy and acceptability of a levonorgestrel-releasing intravaginal ring (IVR) for contraception was assessed in a British cohort studied as part of a multicentre, multinational clinical trial performed under the auspices of the World Health Organisation. One-hundred-and-fifty women took part in the study in two UK centres and completed 1417.5 months of method use. Fifty-nine women discontinued use of the IVR before the end of one year giving an overall discontinuation rate of 39.9 per 100 woman-years. The discontinuation for pregnancy with the ring in situ, was 3.0 per 100 woman-years (life table analysis). Menstrual disturbance, vaginal problems and involuntary expulsion resulted in discontinuation rates of 8.9, 8.4 and 1.6 per 100 woman-years, respectively. This method is an acceptable and effective method of contraception for women.

Is the copper T 380A device associated with an increased risk of removal due to bleeding and/or pain? An analysis

Previous studies have consistently shown that the family of the Copper T 380 devices is more effective in preventing accidental pregnancies than the inert, as well as most other, if not all, copper devices. However, a number of these studies also reported a higher removal rate due to bleeding and/or pain for the TCu 380A than for other devices. The programmatical importance of these findings prompted us to analyze the international multi-center randomized clinical trial datasets to examine this question on the new TCu 380A (ParaGard) recently marketed in the U.S. Our results, while confirming the inherent superior efficacy of the TCu 380A, did not reveal a significantly higher removal rate because of bleeding and/or pain among TCu 380A users than among users of the comparative devices, which included the Lippes Loop D, the TCu 200, the TCu 220 and the Multiload Cu 250 devices.

A crossover pill study among Sudanese women

A crossover study from a standard-dose to a low-dose oral contraceptive was conducted in the Sudan. Reported side effects were very few, with a headache the most frequently reported. Switching to the other pill did not affect the rate of any side effects.

Laparoscopic removal of translocated intrauterine contraceptive devices

Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper 'T' 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.

An evaluation of the Bioself 110 electronic fertility indicator as a contraceptive aid

The Bioself 110 is a hand-held electronic device that combines the BBT and calendar methods of fertility regulation for planning or preventing pregnancy. A pilot study was undertaken in three centers in the United Kingdom to evaluate the Bioself 110 as a contraceptive aid. This paper deals with 1238 cycles from 131 women. Only one unplanned pregnancy occurred where a volunteer correctly used the Bioself 110 and had intercourse on a supposedly "safe" day. A second pregnancy was experienced by a volunteer who incorrectly used the device and had intercourse on what she though was a "safe" day. Another 11 unplanned pregnancies occurred due to barrier method failures, as well as 11 pregnancies where the volunteers knowingly had unprotected intercourse during the fertile phase. There were five planned pregnancies. The Bioself 110 was correctly used in 71% of the cycles studied. Eighty-four percent of the volunteers indicated that they were satisfied with the Bioself 110 after six to twelve cycles of use. It was concluded that the Bioself 110 can serve as an effective family planning aid and should be added to the menu of contraceptive methods available to women today.

A comparative study of 35 mcg and 50 mcg combined oral contraceptives: results from a multicenter clinical trial

A comparative multicenter clinical trial of two combined oral contraceptives (OCs) differing only in the estrogen content (35 mcg ethinyl estradiol versus 50 mcg mestranol) was conducted at five clinics located in Yugoslavia, Egypt, Sri Lanka, Costa Rica and Mexico. The trial was designed to determine the differences between Norinyl 1+35 (Syntex) and Norinyl 1+50 (Syntex) in rates and reasons of discontinuation, and frequency of selected side effects which might contribute to method discontinuation. This report includes analysis of 1698 women, all of whom were interval patients (at least 42 days but within 26 weeks postpartum), randomly allocated to one of the above OCs between October 1982 and January 1984. Follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. Significantly more women in the Norinyl 1+35 group (p less than .001) reported intermenstrual bleeding (primarily staining and spotting), as well as an increase in the occurrence of intermenstrual bleeding compared to women in the Norinyl 1+50 group. There were no significant differences between the groups for side effects with the exception of more women in the Norinyl 1+50 group (p less than .05) reporting breast discomfort. The lost to follow-up rate at 12 months was 19.3% for both the Norinyl 1+35 and the Norinyl 1+50 groups. The total discontinuation rate (including women lost to follow-up) at 12 months was 43.5% for the Norinyl 1+35 group and 41.0% for the Norinyl 1+50 group. There were no significant differences between the two groups for gross cumulative life table discontinuation rates (p greater than .05). There were six accidental pregnancies attributed to user failure reported during the study period; four in the Norinyl 1+35 group and two in the Norinyl 1+50 group.

Duration of use of copper releasing IUDs and the incidence of copper wire breakage

The incidence of copper wire breakage for IUDs (Multiloads) using 0.3 and 0.4 mm diameter copper wire was evaluated by examining 969 devices that had been removed for various reasons. The IUDs were examined by light microscopy to determine the integrity of the copper wire. As expected, the incidence of breakage increased with increasing duration of IUD use. The cumulative breakage rate (life table) was significantly lower (p less than 0.05) for the Multiload 375 that used 0.4 mm diameter wire, compared to the Multiload 250 that used 0.3 mm diameter wire. The cumulative rates were 5.4 per 100 IUDs after 3 years for the Multiload 250, and 3.8 per 100 IUDs after 5 years for the Multiload 375. In only 1 (0.1%) of the 969 Multiloads examined, the breakage of the copper wire was sufficiently extensive to adversely affect the user's risk of pregnancy.

Clinical experience with triphasic oral contraceptive (Triquilar) in 527 women in China

From October 1987 to May 1989, a total number of 527 women completed a total of 6,291 treatment cycles in 6 centers in China for the study of a triphasic oral contraceptive - Triquilar. The mean age of subjects was 30.21 +/- 2.84 years. There were 7 pregnancies during the study period. Among them, five were patient failures because of missed pill or incorrect intake; one had taken barbiturates along with Triquilar. Only one woman became pregnant in the 11th treatment cycle without any reason being found. In most cases, menstrual flow decreased and dysmenorrhea improved as treatment continued. Of the total treatment cycles, the incidence of missed withdrawal bleeding was 0.25%, spotting 0.97%, and breakthrough bleeding 0.48%. Nausea and vomiting was the most common side effect and accounted for 6.4% of the total treatment cycles. This was followed by breast tenderness (3.7%), dizziness (2.4%) and headache (1.6%). Most of the side effects occurred during the first few cycles and were alleviated later. By the end of one year, the total dropout was 64 cases. The reasons for discontinuing treatment were: pregnancy 1.33 (per hundred women), menstrual disturbances 0.76, side effects 3.80, other medical reasons 2.09, and personal reasons 4.18. The results confirm that Triquilar is an effective oral contraceptive with good cycle control and low incidence of side effects. No serious reaction has been reported. It has been well accepted by the Chinese women. However, due to the low dosage of steroids, it is of utmost importance to avoid errors in its use.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral contraceptive therapy and the surgical management of ENT patients: a review of current clinical practice

The current policy of British Otolaryngologists with regard to the preoperative cessation of the oral contraceptive pill is reported. This is based on a confidential questionnaire sent to all members of the British Association of Otolaryngologists. The overall response rate was 66%, 91% of which were from practising otolaryngologists and forms the basis of this report, the remaining 9% being from respondents not engaged in active surgery. Although there is evidence to show an increased risk of developing thromboembolic complications after major abdominal, gynaecological and hip surgery in those patients taking the oestrogen-containing contraceptive pill, the risk following minor and intermediate surgery (which forms the bulk of the otolaryngologist's workload) is not known. Not surprisingly therefore the results of the survey show a varied policy across the country with 36.5% of respondents choosing to continue the pill and 25% always stopping the pill preoperatively. The remainder elect to stop the pill only in certain circumstances.

A comparative clinical trial of Norinyl 1/35 versus Brevicon in Rio Clara, Brazil

A comparative clinical trial of two combined oral contraceptives (OCs) with equivalent estrogen content, but different amounts of progestogens, was conducted at the Centro Medico Especializado em Planejamento Familiar in Rio Clara, Brazil. The study was designed to determine the differences in discontinuation rates between Norinyl 1/35 (Syntex) and Brevicon (Syntex) as well as the frequency of selected side effects which might contribute to method discontinuation. Both OCs contain 0.035 mg of ethinyl estradiol; Brevicon contains 0.5 mg and Norinyl 1/35 contains 1 mg norethindrone. Three-hundred women enrolled in the study were randomly assigned to either the Norinyl 1/35 or Brevicon OCs and follow-up visits were scheduled at 1, 4, 8 and 12 months after admission. Intermenstrual bleeding was reported by significantly more women in the Brevicon group than in the Norinyl group (p less than 0.05), and significantly more Brevicon users reported an increase in intermenstrual bleeding. At the end of the study period, no differences were found between the two OC groups in terms of discontinuation rates, but a large number of women in each group discontinued for menstrual problems. The total discontinuation rates at 11 months for both groups were extremely high: 68.2 for the Norinyl 1/35 group and 75.2 for the Brevicon users. The largest group of discontinuations were comprised of those discontinuing for menstrual problems, other personal reasons, planned pregnancy and side effects.

Subdermal contraceptive implants in nurse-midwifery practice

Subdermal contraceptive implants have only recently been approved for use in the United States. At present, only one subdermal contraceptive implant, Norplant, is approved in the United States. This article describes the development of Norplant, its efficacy and safety, a description of the system, education for clients, side effects, indications and contraindications, insertion and removal, incorporation into midwifery practice, and education for health professionals regarding its use.

Acceptance and perceptions of NORPLANT among users in San Francisco, USA

Two hundred and five women participating in a five-year clinical trial of NORPLANT and NORPLANT-2 were interviewed about their contraceptive and reproductive history, sources of information and knowledge of NORPLANT, experiences using the method, and the impressions of friends and family about the method. The most common reasons for trying the implants were dissatisfaction with other methods and perceptions about NORPLANT's ease of use. Forty-one percent of acceptors had anxiety prior to insertion; 49 percent of these feared pain, but only 5 percent said that they actually experienced significant pain. Women also feared implant removal, but their fear did not influence their decision to continue or discontinue use, and 74 percent reported little or no pain at removal. Most of the women were pleased with NORPLANT, although 95 percent reported side effects, with 82 percent reporting changes in menstruation. More than one-half of those women who discontinued reported that they would use the implants again. Seventy-four percent of the current users interviewed said they would like to use the implants in the future. For the women enrolled in the clinical trial, NORPLANT appeared to be a highly acceptable method of contraception, despite the frequent occurrence of bothersome side effects.

Hysteroscopic findings in complicated and non-complicated IUD users

The hysteroscopic findings in 100 IUD users have been evaluated. 50 women had no IUD-related problems and requested removal of the device, while the other 50 complained of either bleeding and/or pain or lost strings. Of the 29 cases with IUD-related bleeding and/or pain, hysteroscopy revealed malposition (n=6), partial expulsion (n=3), partial perforation (n=2), embedding (n=1), or disproportion (n=6). Disproportion presented as crumpling of the device in the uterine cavity or protrusion of the tip of the transverse arm inside the tubal ostia. Endometrial lesions were also more commonly seen in the study group than the control group, i.e., endometrial hyperplasia (n=8), endometrial polyps (n=8), intrauterine adhesions (n=5), and submucous fibroids (n=2). Of the 21 IUD patients with missing strings, there were previous failed trial of blind removal in 11 cases. Most lost IUDs were found inside the uterine cavity (81%) with curling and ascending strings. Partial perforation, abdominal translocation, and unnoticed complete expulsion were detected in 19% of the patients. Direct visualization of the endometrial cavity is invaluable in treating IUD users who complain of pain and/or bleeding and in locating and retrieving missing IUDs.

[Utero-vesical perforation caused by an IUD]

A rare complication of positioning of an IUD represented by utero-vesical puncture is reported in a woman of 37 who was using this contraceptive technique for the first time. The IUD was removed endoscopically, about 2 years after its positioning. The observation was an almost chance event by echography performed for vague pains in the suprapubic region.

Eight years experience of the Ortho Gyne 'T' IUCD in general practice

The experiences of 112 women, with a total of 191 IUCD insertions in the period 1978-1986 are reported. The study covers a period of 360 woman years. One pregnancy was reported with the coil in situ, two pregnancies were reported when the coil had either been totally or partially extruded. There were 15 episodes of infection in 15 women. Seventy eight per cent of women were either very or moderately happy with the coil, 10 per cent thought it preferable to other methods though not ideal, and 12 per cent were unhappy with it. Subsequent fertility on removal of the device was not impaired.