Non-hormonal Contraception Research Articles

Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study.

Aim: The national Olympic committee of Switzerland has conducted an online survey among female elite athletes with a focus on cycle disorders, contraception, and injuries in 2021. Methods: A total of 1,092 female elite athletes from 107 different sports were asked to answer the questionnaire. A descriptive analysis was carried out to determine location parameters and create frequency tables. Results: The questionnaire was completed by 408 athletes (37.4%) from 92 different sports. 43.4% participated in a lean sport. 57.1% reported no injuries, 32.6% one injury, and 10.2% two or more injuries per year. A considerable proportion reported being affected by primary amenorrhoea (10.8%). Primary amenorrhoea occurred significantly more often in female athletes with a BMI lower than 21.7kg/m2 (15.2%) than in athletes with a BMI above 21.7kg/m2 (7.4%, p = 0.021). Considering contraception, 25.8% of female athletes were currently using an oral contraceptive pill. The proportion of female athletes not using contraception at all or using non-hormonal contraceptive methods was high at 54.4%. In lean sports, significantly more athletes used no or non-hormonal contraceptives (p < 0.05). Conclusion: Among top Swiss female athletes, a considerable proportion used non-hormonal or no contraceptives. This trend was more evident in lean sports. Delayed menarche and cycle irregularities were common among female athletes, especially among athletes with high training volumes as well as a BMI below 21.7kg/m2. This orienting survey underlines the importance of specialized gynecological care for elite female athletes.

Non-Hormonal Contraception.

While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.

PENERAPAN METODE KONTRASEPSI UNTUK PENINGKATAN PENGETAHUAN WANITA USIA SUBUR DI DESA DUMU 1 SIDODADI KECAMATAN SIBIRU BIRU

Family planning is a government program designed to balance the needs of the population. Planning for the number of families through restrictions can be applied when using contraception, both hormonal and non-hormonal contraception. Some women of childbearing age in Desa Dumu I of Sidodadi Village experience a low level of knowledge about contraceptives. This field practice learning activity aims to increase the knowledge of women of childbearing age through counseling to increase the knowledge of women of childbearing age about contraceptive methods. Counseling was carried out on March 15, 2023. Counseling was carried out by the presentation method and giving leaflets about types of contraceptives, things that are dangerous if women of childbearin1. g age do not use contraception.

Retrospective Analysis of Sugammadex Use in Adolescent Females on Progestin-Containing Contraceptives

Sugammadex, a novel neuromuscular blockade reversal agent, functions as a steroid binder postulated to decrease hormone exposure used within progestin-containing contraceptive medications. Thus, alternative non-medication contraceptive methods are recommended to prevent unplanned pregnancies. The study aims were to evaluate sugammadex use in adolescent females prescribed a progestin-containing contraceptive and positive pregnancy screening frequency. We hypothesized that sugammadex use is infrequent in this population and no pregnancy screens would be positive. This is a retrospective observational cohort study utilizing the TriNetX electronic health record database of female subjects aged 12-21 years reported to be prescribed sugammadex. The data collected were analyzed for demographic characteristics, International Classification of Diseases 9th and 10th edition diagnostics, medication, procedural codes, progestin-containing medication timing, and timing of pregnancy screening. We included 18,686 subjects (contraceptive group, 2017 [10.8%], and no contraceptive group, 16,669 [89.2%]). Both groups had similar frequencies of pregnancy screening (contraceptive group, 54 [2.7%], vs no contraceptive group, 366 [2.2%]). Of the contraceptive group, 1 (0.05%) subject, 17 years of age, was confirmed to have a positive pregnancy screen 35 days after surgery. We found that sugammadex may be administered to adolescent females prescribed progestin-containing contraceptives, but positive pregnancy screens are rare. Effective counseling, use of nonhormonal contraceptives 7 days after sugammadex administration, and the theoretical reproductive risks of this agent may have contributed to these findings. Continued counseling after sugammadex use in the adolescent population is recommended to avoid the occurrence of unplanned pregnancies.

Development of allosteric and selective CDK2 inhibitors for contraception with negative cooperativity to cyclin binding

Compared to most ATP-site kinase inhibitors, small molecules that target an allosteric pocket have the potential for improved selectivity due to the often observed lower structural similarity at these distal sites. Despite their promise, relatively few examples of structurally confirmed, high-affinity allosteric kinase inhibitors exist. Cyclin-dependent kinase 2 (CDK2) is a target for many therapeutic indications, including non-hormonal contraception. However, an inhibitor against this kinase with exquisite selectivity has not reached the market because of the structural similarity between CDKs. In this paper, we describe the development and mechanism of action of type III inhibitors that bind CDK2 with nanomolar affinity. Notably, these anthranilic acid inhibitors exhibit a strong negative cooperative relationship with cyclin binding, which remains an underexplored mechanism for CDK2 inhibition. Furthermore, the binding profile of these compounds in both biophysical and cellular assays demonstrate the promise of this series for further development into a therapeutic selective for CDK2 over highly similar kinases like CDK1. The potential of these inhibitors as contraceptive agents is seen by incubation with spermatocyte chromosome spreads from mouse testicular explants, where they recapitulate Cdk2-/- and Spdya-/- phenotypes.

The Use of Non-Hormonal Contraception in Women of Fertile Age

Long-term use of hormonal contraception has various effects on acceptors. These side effects can be minimized by using non-hormonal contraceptives (condoms, IUDs, MOW) where their use is still very low. The purpose of this study was to determine the factors associated with the use of non-hormonal contraceptives in WUS. The research design is quantitative with a cross sectional approach. The sample of this study was 194 women of childbearing age who were taken by random technique. Data were collected using a questionnaire. The statistical test used was univariate with percentage, bivariate with chi square and multivariate with logistic regression. The results of the bivariate analysis of several variables showed that there was a relationship between age (p = 0.049), service availability (p = 0.000) with the use of non-hormonal contraceptives. While the variables of knowledge, husband's support, parity, family income, information on health workers and access proved to have no relationship with the use of contraceptives.

Discovering a Reversible Male Contraceptive Agent Derived from Lonidamine.

There is a huge demand for safe and effective non-hormonal male contraceptives to prevent unintended pregnancy, but research on male contraceptive drugs lacks far behind the pills for women. Lonidamine and its analog adjudin are two of the best studied potential male contraceptives. However, the acute toxicity of lonidamine and the subchronic toxicity of adjudin had impeded their development for male contraception. Here, we designed and synthesized a whole new series of molecules derived from lonidamine according to a structure ligand-based design strategy and obtained a new effective and reversible contraceptive agent (BHD), and their efficacy was demonstrated in male mice and rats. Results showed that BHD had a 100% contraceptive effect on male mice after 2 weeks following a single oral dose of BHD at 100 mg/kg body weight (b.w.) or 500 mg/kg b.w. treatments. The fertility of mice was reduced to 90 and 50% after 6 weeks with a single oral dose of BHD-100 and BHD-500 mg/kg b.w. treatments, respectively. We also revealed that BHD induced the apoptosis of spermatogenic cells rapidly and disrupted the blood-testis barrier effectively. It appears to be a new potential male contraceptive candidate for future development.

Physician Dispositions Toward Noninvasive Non-Hormonal Contraception.

Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols. They are preferred by some patients due to medical contraindications to hormonal contraceptives, lack of side effects, religious convictions, preference to avoid hormones or contraceptive devices, improved body literacy, or a combination of the above. FABMs are infrequently covered in medical school curricula and are often perceived by physicians to be of low efficacy. There is an opportunity for improvement of physicians' evidence-based knowledge of FABMs, which has the potential to improve patient understanding of and access to the full menu of family planning options. A self-administered, cross-sectional survey was distributed to assess physician knowledge and opinions of FABMs by key university contacts. Univariate and bivariate statistics were calculated for close-ended questions and responses to open-ended questions were analyzed for common themes. A total of 79 participants completed the entire survey. Another 11 submitted partially completed surveys. For completed surveys, questions assessing knowledge of key concepts underlying FABMs, performance by specialty was 55% correct for OB/GYN (n = 16), 55% (n = 47) correct for family medicine, 36% (n = 10) correct for internal medicine, and 35% (n = 6) correct for pediatrics. Negative, neutral, mixed, and positive opinions related to FABMs were represented. There are opportunities to improve physicians' evidence-based knowledge of FABMs; this may improve patient-centered contraceptive care.

The effect of rifampin on serum etonogestrel concentrations and biomarkers of ovulation among contraceptive implant users: A pharmacokinetic and pharmacodynamic study

ObjectivesRifampin, a strong CYP3A inducer, is the gold standard for evaluating CYP3A-mediated drug-drug interactions. We aimed to evaluate the pharmacokinetic and pharmacodynamic effects of a short course (2 weeks) of rifampin on serum etonogestrel (ENG) concentrations and serologic measures of ovarian activity (endogenous estradiol [E2] and progesterone [P4]) among ENG implant users. Study designWe enrolled healthy females using ENG implants for 12 to 36 months. We measured baseline serum ENG concentrations using a validated liquid chromatography mass-spectrometry assay and baseline E2 and P4 concentrations using chemiluminescent immunoassays. After 2 weeks of rifampin 600 mg daily, we repeated ENG, E2, and P4 measurements. We compared pre- and post-rifampin serum measurements using paired Wilcoxon signed-rank tests. ResultsFifteen participants completed all study procedures. Participants’ median age was 28.2 years (range 21.8–34.1), median body-mass index was 25.2 kg/m2 (range 18.9–37.3), and median duration of implant use was 22 months (range 12–32). All participants experienced significant decreases from baseline ENG concentrations (median 164.0 pg/mL [range 94.4–265.0]) to post-rifampin measurements (median 47.8 pg/mL [range 24.7–82.8]) (p < 0.001). Serum E2 concentrations also significantly increased with rifampin exposure (median 73 pg/mL vs 202 pg/mL, p = 0.003); increases in serum P4 concentrations were not statistically significant (p = 0.19). Three participants (20%) experienced increased luteal activity, with one presumptively ovulating post-rifampin (P4 = 15.8 ng/mL). ConclusionsWith only short exposure to a strong CYP3A inducer, ENG implant users experienced clinically significant decreases in serum ENG concentrations that led to changes in biomarkers indicative of waning suppression of ovulation. ImplicationsEven a short, 2-week course of treatment with rifampin places etonogestrel contraceptive implant users at risk for decreased contraceptive efficacy. Clinicians should counsel patients using etonogestrel implants considering any duration of rifampin therapy on the need for backup nonhormonal contraception or the use of an intrauterine device to avoid unintended pregnancies.

ABCC4 is a PGE2 efflux transporter in the ovarian follicle: A mediator of ovulation and a potential non-hormonal contraceptive target.

The role of prostaglandins (PGs) in the ovulatory process is known. However, the role of the ATP binding cassette subfamily C member 4 (ABCC4), transmembrane PG carrier protein, in ovulation remains unknown. We report herein that ABCC4 expression is significantly upregulated in preovulatory human granulosa cells (GCs). We found that PGE2 efflux in cultured human GCs is mediated by ABCC4 thus regulating its extracellular concentration. The ABCC4 inhibitor probenecid demonstrated effective blocking of ovulation and affects key ovulatory genes in female mice in vivo. We postulate that the reduction in PGE2 efflux caused by the inhibition of ABCC4 activity in GCs decreases the extracellular concentration of PGE2 and its ovulatory effect. Treatment of female mice with low dose of probenecid as well as with the PTGS inhibitor indomethacin or Meloxicam synergistically blocks ovulation. These results support the hypothesis that ABCC4 has an important role in ovulation and might be a potential target for non-hormonal contraception, especially in combination with PGE2 synthesis inhibitors. These findings may fill the gap in understanding the role of ABCC4 in PGE2 signaling, enhance the understanding of ovulatory disorders, and facilitate the treatment and control of fertility.

Various gene modification techniques to discover molecular targets for nonhormonal male contraceptives: A review.

The identification and characterization of relevant targets are necessary for developing nonhormonal male contraceptives. The molecules must demonstrate that they are necessary for reproduction. As a result, a sophisticated technique is required to identify the molecular targets for nonhormonal male contraceptives. Genetic modification (GM) techniques are one method that can be applied. This technique has been widely used to study gene function that effected male fertility and has resulted in the discovery of numerous nonhormonal male contraceptive target molecules. We examined GM techniques and approaches used to investigate genes involved in male fertility as potential targets for nonhormonal contraceptives. The discovery of nonhormonal contraceptive candidate molecules was increased by using GM techniques, especially the Clustered Regularly Interspaced Short Palindromic Repeats/Cas9 method. The discovery of candidate nonhormonal contraceptive molecules can be a wide-open research for the development of nonhormonal male contraceptives. Therefore, we are believing that one day nonhormonal male contraceptives will be released.

Catspermasome: The matrimony of CatSper and SLCO6C1.

CatSper is a highly specialized Ca2+ channel mediating Ca2+ entry in spermatozoa, which is essential for sperm motility and fertility. CatSper dysfunction would lead to male infertility, and it has been an attractive target for male infertility treatment as well as development of novel non-hormonal contraceptives. CatSper is the most complex ion channel known, consisting of at least ten identified subunits. It is very different from classic Cav channels in many aspects. For instance, the ion conducting pore of CatSper consists of four separate chains CatSper1-4 instead of a single chain in Cav channels. The auxiliary subunits CatSperβ, γ, δ, ε contain large extracellular domains while none of them are homologous to the α2δ subunit of Cav channels, indicating unique assembly of CatSper. To provide structural insights into CatSper composition, assembly, and regulation mechanisms, we purified the native CatSper channel from mouse testicular and epididymal tissues and resolved its structure at an overall resolution of 2.9 Å by cryo-EM. In the extracellular view, CatSper1-4 heterotetramer conform to the conventional domain-swapped voltage-gated ion channel fold, following a counterclockwise arrangement. CatSperβ, γ, δ and ε—each of which contains a single transmembrane segment and a large extracellular domain—constitute a pavilion-like structure that stabilizes the entire complex through interactions with CatSper4, 1, 3 and 2, respectively. Besides, the high-resolution EM map reveals several previously uncharacterized components, including TMEM249, TMEM262 (also named CatSperη) and an organic anion transporter SLCO6C1. Thus, CatSper is actually a channel-transporter ultracomplex that we termed the CatSpermasome. The structure and assembly details of the CatSpermasome revealed by our study help to lay the foundation for the development of CatSpermasome-related treatments for male infertility and non-hormonal contraceptives.

An ex vivo ovulation system enables the discovery of novel ovulatory pathways and nonhormonal contraceptive candidates†.

Ovulation is an integral part of women's menstrual cycle and fertility. Understanding the mechanisms of ovulation has broad implications for the treatment of anovulatory diseases and the development of novel contraceptives. Now, few studies have developed effective models that both faithfully recapitulate the hallmarks of ovulation and possess scalability. We established a three-dimensional encapsulated in vitro follicle growth (eIVFG) system that recapitulates folliculogenesis and produces follicles that undergo ovulation in a controlled manner. Here, we determined whether ex vivo ovulation preserves molecular signatures of ovulation and demonstrated its use in discovering novel ovulatory pathways and nonhormonal contraceptive candidates through a high-throughput ovulation screening. Mature murine follicles from eIVFG were induced to ovulate ex vivo using human chorionic gonadotropin and collected at 0, 1, 4, and 8hours post-induction. Phenotypic analyses confirmed key ovulatory events, including cumulus expansion, oocyte maturation, follicle rupture, and luteinization. Single-follicle RNA-sequencing analysis revealed the preservation of ovulatory genes and dynamic transcriptomic profiles and signaling. Soft clustering identified distinct gene expression patterns and new pathways that may critically regulate ovulation. We further used this ex vivo ovulation system to screen 21 compounds targeting established and newly identified ovulatory pathways. We discovered that proprotein convertases activate gelatinases to sustain follicle rupture and do not regulate luteinization and progesterone secretion. Together, our ex vivo ovulation system preserves molecular signatures of ovulation, presenting a new powerful tool for studying ovulation and anovulatory diseases as well as for establishing a high-throughput ovulation screening to identify novel nonhormonal contraceptives for women.

In vitro contraceptive activities, molecular docking, molecular dynamics, MM-PBSA, non-covalent interaction and DFT studies of bioactive compounds from Aegle marmelos. Linn., leaves.

Introduction: Bioactive molecules from natural sources having contraceptive properties were excellent alternatives for modern hormonal contraceptives. Researchers around the world were working on identifying contraceptive leads targeting the male reproductive system rather than the usual female contraceptives. The lack of proper understanding on male contraceptive protein drug targets leads to insufficient evidence on activities of identified contraceptive compounds. The proteins specific to the male reproductive system and involved in sperm-egg fusion will be an excellent drug target to identify the male non-hormonal, reversible contraceptive leads. Inhibiting sperm hyaluronidase activity by natural non-hormonal compounds will lead to reversible and non-hormonal male contraception. The Aegle marmelos Linn. is one such important medicinal plant with valuable phytocompounds, used traditionally as a potential contraceptive measure. The in vivo experiments on leaf extracts of Aegle marmelos. Linn containing terpenes, sterols, and alkaloids shows prominent contraceptive activities. Moreover, this study explores the potential ability of the leaf extract on inhibiting the sperm hyaluronidase action with additional molecular details on the interaction between sperm hyaluronidases and three phytocompounds such as aegeline, marmin, and marminol. Material and methods: The in vitro hyaluronidase inhibition assay and Computer Assisted Sperm Analysis (CASA) were used to evaluate the male contraceptive properties of the Aegle marmelos Linn. leaf extract. To identify the interaction profile of aegeline, marmin, and marmenol on sperm cell hyaluronidases the in-silico methods such as molecular docking, Non-Covalent Interaction analysis, Molecular dynamics, and Molecular Mechanics Poisson Boltzmann Surface Area were used. Results and discussion: The results of in vitro hyaluronidase inhibition assay and Computer Assisted Sperm Analysis shows the inhibition of hyaluronidase enzymatic activity and reduced sperm activities in the presence of leaf extracts. After incubation with leaf extracts for about 30 minutes time intervals show, the motility drops from progressive to non-progressive and ended up with complete immotile in 100 μg/ml concentration of leaf extract. The results of molecular docking, Non-Covalent Interaction analysis, Molecular dynamics, and Molecular mechanics Poisson Boltzmann Surface Area show that the phytocompounds marmin, and aegeline have the potential ability to inhibit sperm hyaluronidase.

The Relationship Between the Use of Contraceptives and Menstrual Cycle Disorders in Couples of Childbearing Age (PUS) at Puskesmas Piyungan Bantul Yogyakarta Year 2021

Menstrual cycle disorders are often become a problem for couples of childbearing age who use contraceptives, especially hormonal contraceptives namely injectable contraceptives.The problem itself can be in the form of a long cycle or more than 35 days (oligomenorrhea), a short menstrual cycle of less than 21 days (polymenorrhea) and a menstrual absence in 3 months in a row (amenorrhea). This study aims to determine the relationship between the use of contraceptives and menstrual cycle disorders in couples of childbearing age at Puskesmas Piyungan Sub-district, Bantul Yogyakarta in the year of 2021. This study is quantitative analytical study with Cross Sectional approach which was conducted retrospectively. The sampling technique used was Proportional Random Sampling with the total sample of 96 respondents. The analysis used were univariate and bivariate analysis. The results showed that from 58 respondents who used hormonal contraception, 44 respondents (75,9%) experienced abnormal menstrual cycle. Meanwhile, 38 respondents who used non-hormonal contraception at least experienced an abnormal menstrual cycle as many as 6 respondents (15,8%). The Chi-Square test showed that there was a significant relationship between the use of contraceptives and menstrual cycle disorders in couples of childbearing age, namely p = 0,000 &lt; α = 0,05 with OR value of 16,762. There is a significant relationship between the use of contraceptives and menstrual cycle disorders at Puskesmas Piyungan Sub-district, Bantul Yogyakarta.

ANALISIS PEMILIHAN ALAT KONTRASEPSI MODERN DI KECAMATAN KEMAYORAN

In launching the Family Planning Program which aims to maintain a distance between pregnancies and it is enough to have only two children, so that the program can be achieved, one of them is by using modern contraceptives. Modern contraceptives are divided into two, namely hormonal and non-hormonal contraceptives. Participating in the family planning program is expected to improve maternal health and increase non-hormonal family planning users. This study aims to analyze the selection of modern contraceptives in Kemayoran sub-district. The research process is cross-sectional, conducted on 110 Kb acceptor mothers in Kemayoran District. The results showed that the knowledge variable had P=0.055 and OR=2.674, attitude variable P=0.0001 and OR=16,875, information exposure variable P=0.036 and OR=1.096, husband's role variable P=0.0001 and OR=6.333 . Counseling about family planning and the selection of modern contraceptives should be carried out continuously and health workers always advise acceptors on non-hormonal contraception. In addition, prospective acceptors are advised to always follow the counseling organized by the Central Jakarta Administration City PPAPP Sub-Department and receive information related to the selection of contraceptives from both mass media and electronic media. A good husband's role and support is also needed so that the acceptor can change his attitude in choosing contraceptives not based on comfort but because it is in accordance with their needs and health.&#x0D; Keywords: Modern contraceptives, Non-hormonal acceptors, Family Planning Program

Emerging concepts in male contraception: a narrative review of novel, hormonal and non-hormonal options.

Access to reliable contraception is a pillar of modern society. The burden of unintended pregnancy has fallen disproportionately on the mother throughout human history; however, recent legal developments surrounding abortion have sparked a renewed interest in male factor contraceptives beyond surgical sterilization and condoms. Modern efforts to develop reversible male birth control date back nearly a century and initially focused on altering the hypothalamic-pituitary-testes axis. These hormonal contraceptives faced multiple barriers, including systemic side effects, challenging dosing regimens, unfavorable routes of delivery, and the public stigma surrounding steroid use. Novel hormonal agents are seeking to overcome these barriers by limiting the side effects and simplifying use. Non-hormonal contraceptives are agents that target various stages of spermatogenesis; such as inhibitors of retinoic acid, Sertoli cell-germ cell interactions, sperm ion channels, and other small molecular targets. The identification of reproductive tract-specific genes associated with male infertility has led to more targeted drug development, made possible by advances in CRISPR and proteolysis targeting chimeras (PROTACs). Despite multiple human trials, no male birth control agents have garnered regulatory approval in the United States or abroad. This narrative review examines current and emerging male contraceptives, including hormonal and non-hormonal agents.

Evaluation of awareness, acceptability, and clinical outcome of postpartum vaginal insertion and intra-cesarean insertion of intrauterine contraceptive device

Background: Post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD) is a lucrative family planning method which provides safe, effective reversible, inexpensive, non-hormonal, and long-acting contraception. Aims and Objectives: The objective of the study is to evaluate the postpartum insertion of intrauterine contraceptive device in terms of awareness, acceptance, safety, efficacy, continuation, and removal rate and its complications in both vaginal as well as intra-cesarean section (CS) insertion. Materials and Methods: Prospective observational study conducted in Obstetrics and Gynaecology Department GMERS sola for 6 months. Two thousand and ninety-four pregnant women from labor room who delivered vaginally or by CS during study period were asked regarding their knowledge and acceptability for PPIUCD. Results: Total 2094 women evaluated for awareness and acceptance for PPIUCD. About 68.66% were familiar with the concept with 29.99% giving verbal consent for its insertion. About 60.01% women refused for various reasons. Conclusion: This study shows that PPIUCD insertion is a safe and convenient method which requires more population awareness, counseling, and usage.

Applicability of Lipid Ratios in the Prediction of Atherogenic Risks of Women on Combined Oral Contraceptives in North-Central Nigeria

Background: Combined Oral Contraceptive (COC) pill is associated with atherogenic and cardiovascular changes. Some service providers use individual lipid parameters to assess these changes unlike objective calculation using standard formulae. Objective: To determine and compare the atherogenic changes in women on COCs using six lipid ratios; coronary heart disease risk ratio, atherogenic index of plasma, atherogenic co-efficient, Cholesterol index, Castelli risk index I, and Castelli risk index II. Materials and Methods: A prospective, comparative study among new acceptors of contraceptives at four family planning clinics in Ilorin, North-Central Nigeria. Participants were categorized into COCs acceptors (group I, n=120) and acceptors of non-hormonal contraceptives (group II, n=120). Participants were followed up with serial lipid profiles at 0, 3 and 6 months after uptake. Atherogenic risks were calculated using six standard formulae; statistical analysis was with SPSS version 21.0 and Analysis of variance (ANOVA) was used to compare the differences of more than two means, Bonferroni Post Hoc test was used to test for specific significance within the group and p-value &lt;0.05 was considered significant. Results: A total of 225 participants (111 COC users, 114 non-COC users) aged 19 to 48 years completed the study. Serum levels of Low-Density Lipoprotein showed a statistically significant rise among the COC users over the study period (p=0.038), especially between the third and sixth months. The lipid ratios were statistically increased using all six methods despite apparently normal lipid parameters. Conclusion: Atherogenic changes may occur in the presence of apparently normal lipid parameters among COC users; therefore, serial lipid ratio using standard method formulae is recommended.

Contraception in Women at Risk

Contraception in Women at Risk Abstract. Healthy non-obese non-smokers without personal contraindications may use all hormonal and non-hormonal contraceptive methods up to the normal menopausal age. However, underlying diseases or an unfavourable lifestyle may change this liberty of choice. Vascular risks are potentiated by age, obesity, smoking, arterial hypertension, and diabetes. The presence of any arterial disease is an absolute contraindication against combined oral contraceptive (CHC). In regard of internal diseases, CHC possess the highest risk for serious complications among the methods known to be safe, whereas the lowest risk is seen in users of Cu-IUDs. The hormonal alternatives to CHC are gestagen-only preparations including levonorgestrel-releasing IUS. If no further pregnancies are intended, sterilisation of one of the partners is also a valid alternative. Because of their lack of reliability, barrier methods and natural family planning should be strongly discouraged in women with an underlying disease. Any unplanned pregnancy may present a high risk for mother and child. In presence of an underlying disease, it is strongly recommended to consult the treating specialist before a hormonal method is chosen. Independently of the method used, all women at risk for sexually transmitted diseases should also use a barrier method.