Non-hormonal Methods Research Articles

Effect of Vaginal Laser and Topical Therapies on Vulvovaginal Atrophy Symptoms in Breast Cancer Patients: A Systematic Review and Meta-Analysis.

Background: Vulvovaginal atrophy (VVA) significantly impacts the quality of life in breast cancer patients leading to symptoms like vaginal dryness, dyspareunia, and genital discomfort. Quality of life in this context is measured using validated scales like the Vaginal Health Index, Visual Analog Scale (VAS), and the Female Sexual Function Index (FSFI). Methods: We performed a systematic review and meta-analysis to identify effective treatment options for VVA, including topical estrogen, systemic hormone therapy, vaginal DHEA, ospemifene, and non-hormonal methods like intravaginal laser therapy, moisturizers, and lubricants. A systematic search of four databases (MEDLINE, Scopus, CENTRAL, Embase) identified studies on VVA treatment efficacy in breast cancer patients, yielding 13,039 records, with 32 eligible studies and 8 included in the meta-analysis. Results: Significant improvements were found with intravaginal laser therapy, showing notable differences in the Vaginal Health Index (MD = 8.24, p < 0.01), dyspareunia (MD = -4.82, p = 0.05), and dryness (MD = -5.05, p = 0.01). However, no significant changes were observed in FSFI and vaginal pH. Notably only intravaginal laser therapy was included in the meta-analysis, as other treatment options lacked comparable data. Both hormonal and non-hormonal treatments improved quality of life, with laser therapy showing the most substantial effects. Conclusions: Intravaginal laser therapy is an effective treatment for VVA symptoms in breast cancer survivors, particularly in improving the Vaginal Health Index and reducing dyspareunia. Despite the strengths of the study, variability among studies, lack of RCT-s and data limitations, especially on long-term effects, present challenges.

Sexual function, quality of life, anxiety, and depression in women of reproductive age using hormonal, nonhormonal, and no contraceptive methods.

Hormonal contraceptive use has been related to adverse effects, including impacts on sexual function and sexual satisfaction, although the difference in the effects on sexual function with the use of hormonal vs nonhormonal contraceptive methods remains controversial. In this study we sought to compare the prevalence of dyspareunia, sexual function, sexual satisfaction, quality of life, anxiety, and depression between women using hormonal, nonhormonal, or no contraceptive methods and to compare these outcomes between the most frequently used contraceptive methods. This cross-sectional study included sexually active women of reproductive age who were stratified into 3 groups: women using hormonal, nonhormonal, or no contraceptive methods. Based on the use of questionnaires administered to the study participants, we compared sexual function in the 3 groups and more specifically among users of oral contraceptives, copper and hormonal intrauterine devices, and barrier methods. Participants completed 4 questionnaires to assess sexual function (Female Sexual Function Index), sexual satisfaction (Sexual Quotient-Feminine Version), quality of life (12-item Medical Outcomes Short Form Health Survey), and anxiety and depression (Hospital Anxiety and Depression Scale). This study included 315 women classified into 3 groups on the basis of contraceptive use: 161 in the hormonal contraceptives group (median [interquartile range] age, 24 [23-28] years), 97 in the nonhormonal contraceptives group (age 26 [23-30] years), and 57 in the no contraceptive methods group (age 28 [24-35] years). Dyspareunia prevalence showed no difference between the groups. In the quality of life domain, compared with women in the nonhormonal contraceptive group, women in the hormonal contraceptive group were younger and had lower sexual function satisfaction, reduced arousal, and heightened pain (P< .05), as well as higher anxiety and depression levels (P= .03, for both), increased pain (P= .01), and poorer overall health (P= .01). No difference was found between these groups in other quality of life domains. Regarding contraceptive methods, women using copper intrauterine devices had better sexual function, including higher rates of arousal and lower anxiety, than women using oral contraceptives (P< .05). The results of this study highlight worse sexual function and sexual satisfaction and higher levels of anxiety and depression in women using hormonal contraceptive methods than in women using nonhormonal methods. The findings of this study strengthen the evidence of differences in sexual function between women using oral contraceptives and those using copper intrauterine devices. Sexual function was also compared among users of oral contraceptives, copper and hormonal intrauterine devices, and barrier methods. However, less frequently used contraceptive methods, such as hormonal injections and vaginal rings, could not be compared in this sample. Women using hormonal contraceptive methods were younger, had lower sexual function and satisfaction, and experienced higher anxiety and depression levels than women using nonhormonal contraceptive methods.

Pre-clinical and early clinical considerations for the development of non-hormonal contraceptives for men.

This manuscript presents non-hormonal male contraceptive development in the context of mitigating risk to investigators and investors. The manuscript uses examples to illustrate drug development principles to move a project from discovery to development. The content is intended for those with reproductive biology backgrounds without significant exposure to drug development-particularly early-stage targeted drug development-and those with general interest in developing non-hormonal methods of contraception. The goal of issues addressed in this manuscript is to facilitate the advancement of innovative male contraceptives into late-stage clinical trials, while keeping in mind early recognition of program deficiencies and development of mitigation strategies, or reassignment of limited, valuable resources.

Alternative non-hormonal methods for correcting menopausal disorders

Alternative non-hormonal methods for correcting menopausal disorders

Recent Developments in Promising Hormonal and Non- Hormonal Male Contraceptives: A Review

New male contraceptive methods would expand male and female contraceptive alternatives and enhance male contraceptive agency. Since 1969, a program for developing contraceptives has been financed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which also continues to fund the majority of hormonal male contraceptive development today. Also, the early stages of non-hormonal techniques start to develop. The hormonal male contraceptive methods, include testosterone undecanoate injection plus norethisterone enanthate injection, implants of testosterone plus depo-medroxyprogesterone acetate injection, testosterone enanthate injection, and other testosterone-based methods. The non-hormonal methods, include novel hormone-free substances such as retinoic acid inhibitors, sperm ion channel blockers, and vasal peristalsis blockers. The review provides insights into the efficacy, safety, and potential side effects of each method, and highlights the current state of research and development in the field of male contraception.

Use of Short-Term CIDR-Based Protocols for Oestrus Synchronisation in Goats at Tropical and Subtropical Latitudes.

This review aims to provide an insight into the application and efficiency of CIDR-based protocols for ES in goats raised under tropical and subtropical environments. In temperate regions, short-term CIDR treatments are replacing long-term treatments and sponges used in earlier decades. In addition, the use of co-treatments for the induction of ovulation is gradually changing from hormonal to non-hormonal methods, given the drive towards clean, green, and ethical techniques for reproductive management. Whereas the subtropical region registers ongoing research in the development of new ES protocols, there are few reports from the tropics, particularly Africa, one of the regions with the highest population of goats. Therefore, this calls for research to develop the most appropriate protocols for these regions, since the protocols currently used are largely hormonal based, as they were developed for goats at higher latitudes. Management and environmental factors determine the breeding pattern of goats at tropical latitudes rather than photoperiods, and they are the main causes of reproductive seasonality. The use of ES methods, particularly short-term CIDR-based protocols, along with artificial insemination, may have a significant impact on the productivity of goats in these regions when these factors are controlled.

Procjena reproduktivne uspješnosti u koza – pregled odabranih čimbenika koji na to utječu

Dairy goats are a very successful form of livestock farming in developing countries, with functional products for human consumption, which makes their breeding attractive. Breeding efficiency is determined by successful reproductive parameters. Several parameters can be used as indicators of reproductive success, such as the number of kids born, age at first kidding, kidding interval, percentage of kids born and weaned, abortion rate, body weight of kids at birth and at weaning, and the length of the goat's reproductive life. Due to the seasonality of reproduction and multiple possibilities of controlling the sexual cycle in goats (hormonal and non-hormonal methods), it is difficult to standardise parameters that could be systematically used to detect suboptimal production, and whose improvement would increase reproductive success. Adequate housing conditions and feeding are inseparable from good breeding and productivity of animals. By meeting these measures with constant observation of reproductive success parameters, high fertility, large litters (2 kids per pregnancy) with a survival rate of 90% until weaning can be expected in goat breeding.

Leveraging web search data in Germany to identify unmet needs of contraceptives on a population-based level: A longitudinal retrospective study.

There are a variety of possible contraceptives available. While medical advice is an important resource for selecting the individual contraceptive, previous research has shown that the Internet has become an increasingly important source of health care information. This study aims to identify key trends in contraception-related web searches in Germany and thus allows conclusions about preferences and unmet needs with regard to pregnancy prevention. Longitudinal retrospective study. Google Ads Keyword Planner was used to identify contraception-related keywords and their search volume in Germany and all federal states between 2018 and 2021. The keywords were categorized based on gender, hormonal/non-hormonal, and different contraceptive methods. Search volume and categories were analyzed for temporal trends, regional differences, and underlying socioeconomic variables. The 1481 contraception-related keywords corresponded to 15,081,760 searches. In total, a 56% increase in searches/100,000 inhabitants was observed. Highest mean search volume was observed in categories "woman," "woman/non-hormonal" and "woman/non-hormonal/barrier," respectively, and in the federal state Hamburg, while the lowest was seen in North Rhine-Westphalia. The increase in search volume reflects a high interest in contraception, particularly in non-hormonal female methods. This stands in contrast to the limited number of effective non-hormonal contraceptives available and points to an unmet need. In addition, the low search volume for male contraceptives demonstrates gender-specific responsibilities regarding family planning in German society.

Impact of Various Contraceptive Methods on Immunological Profiles in Women: A Serological Analysis in Diyala Governorate

Introduction: Both hormonal and non-hormonal contraception methods are highly effective and used globally. Our study aimed to examine the immune factors in women using contraceptives, providing insights into the complexities involved. Ninety women participated, with 50 using contraceptives (study group) and 40 not using any (control group), all considered healthy individuals. Venous blood samples, drawn using sterile single-use medical syringes, were 5 ml each. Methods: The study used an inclusive approach, employing techniques like Indirect Sandawish ELISA to assess CD4, CD8, IL16, and IL27 levels, and Single Immunodiffusion (SRID) for IgG, IgM, and IgA determination. Results: Analysis revealed significantly higher levels of IgG, IgM, IgA, and IL16 in contraceptive users compared to non-users. However, CD4 and IL27 levels showed a marked reduction in patients compared to healthy controls. Notably, there were no statistically significant differences (P&gt;0.05) in immune variables between different contraceptive types, except for IgA, which was highest in injection users and lowest in oral contraceptive users. Further scrutiny found no significant variations (P&gt;0.05) between immune variable levels and hormonal/non-hormonal contraceptives, except for IL16 (P&gt;0.01). Conclusions: The study concludes that various contraceptive methods (tablets, injections, copper IUDs) lead to increased levels of immunoglobulins (IgG, IgM, IgA). Importantly, changes in contraceptive type (tablets, injections, IUDs) had minimal impact on immune variables, except for increased IgA in injection users. Hormonal or non-hormonal contraceptives showed no noticeable influence on immune indicators, except for IL16, which exhibited a significant increase.

Non-hormonal methods of treating premature ovarian insufficiency (POI)

Non-hormonal methods of treating premature ovarian insufficiency (POI)

Innovation and Challenges in Male Contraception

The unwanted cases of pregnancy have increased resulting in improper family planning and cases of depression or stillbirth. The decision regarding reproduction is shared equivalently by men and women. Although the contraception methods result in effectiveness, they have more complications than effective results. Hormonal disbalance and endometriosis are a few such examples. Contraception for males is limited, yet has more effective results and fewer complications. The development of male contraception is vastly researched over the past few decades. Various hormonal and non-hormonal methods are being developed to provide better contraception with minimum or no disadvantage. The basic advantage of developing a male contraceptive includes its availability, low cost, no side effects, and ease of use.

Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study.

People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user's fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users' preferences and needs. We examined the user experience offered by Natural Cycles-the first digital contraceptive-through an analysis of app reviews written by its users worldwide. We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. Digital contraception is experienced by users as a tamed natural approach-a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as "natural," which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception.

Fraxetin reduces endometriotic lesions through activation of ER stress, induction of mitochondria-mediated apoptosis, and generation of ROS

BackgroundFraxetin, a phytochemical obtained from Fraxinus rhynchophylla, is well known for its anti-inflammatory and anti-fibrotic properties. However, fraxetin regulates the progression of endometriosis, which is a benign reproductive disease that results in low quality of life and infertility. Hypothesis/purposeWe hypothesized that fraxetin may have therapeutic effects on endometriosis and aimed to elucidate the underlying mechanisms of mitochondrial function and tiRNA regulation. Study designEndometriotic animal models and cells (End1/E6E7 and VK2/E6E7) were used to identify the mode of action of fraxetin. MethodsAn auto-implanted endometriosis animal model was established and the effects of fraxetin on lesion size reduction were analyzed. Cell-based assays including proliferation, cell cycle, migration, apoptosis, mitochondrial function, calcium efflux, and reactive oxygen species (ROS) were performed. Moreover, fraxetin signal transduction was demonstrated by western blotting and qPCR analyses. ResultsFraxetin inhibited proliferation and migration by inactivating the P38/JNK/ERK mitogen-activated protein kinase (MAPK) and AKT/S6 pathways. Fraxetin dissipates mitochondrial membrane potential, downregulates oxidative phosphorylation (OXPHOS), and disrupts redox and calcium homeostasis. Moreover, it triggered endoplasmic reticulum stress and intrinsic apoptosis. Furthermore, we elucidated the functional role of tiRNAHisGTG in endometriosis by transfection with its inhibitor. Finally, we established an endometriosis mouse model and verified endometriotic lesion regression and downregulation of adhesion molecules with inflammation. ConclusionThis study suggests that fraxetin is a novel therapeutic agent that targets mitochondria and tiRNAs. This is the first study to demonstrate the mechanisms of tiRNAHisGTG with mitochondrial function and cell fates and can be applied as a non-hormonal method against the progression of endometriosis.

Practice and development of male contraception: European Academy of Andrology and American Society of Andrology guidelines.

Despite a wide spectrum of contraceptive methods for women, the unintended pregnancy rate remains high (45% in the US), with 50% resulting in abortion. Currently, 20% of global contraceptive use is male-directed, with a wide variation among countries due to limited availability and lack of efficacy. Worldwide studies indicate that >50% of men would opt to use a reversible method, and 90% of women would rely on their partner to use a contraceptive. Additional reasons for novel male contraceptive methods to be available include the increased life expectancy, sharing the reproductive risks among partners, social issues, the lack of pharma industry involvement and the lack of opinion makers advocating for male contraception. The present guidelines aim to review the status regarding male contraception, the current state of the art to support the clinical practice, recommend minimal requirements for new male contraceptive development and provide and grade updated, evidence-based recommendations from the European Society of Andrology (EAA) and the American Society of Andrology (ASA). An expert panel of academicians appointed by the EAA and the ASA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. Sixty evidence-based and graded recommendations were produced on couple-centered communication, behaviors, barrier methods, semen analysis and contraceptive efficacy, physical agents, surgical methods, actions before initiating male contraception, hormonal methods, non-hormonal methods, vaccines, and social and ethical considerations. As gender roles transform and gender equity is established in relationships, the male contribution to family planning must be facilitated. Efficient and safe male-directed methods must be evaluated and introduced into clinical practice, preferably reversible, either hormonal or non-hormonal. From a future perspective, identifying new hormonal combinations, suitable testicular targets, and emerging vas occlusion methods will produce novel molecules and products for male contraception.

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.

The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche.

We sought to evaluate the impact of estrogen-containing treatment for heavy menstrual bleeding (HMB) on subsequent height compared to progesterone-only or non-hormonal treatment when initiated at menarche. We performed a retrospective chart review of adolescent females aged 10-15 years who presented to an institution-affiliated outpatient, inpatient, or emergency setting for management of HMB within three months of menarche. Growth records over a 2 year period starting at menarche were recorded, and comparisons made among patients treated with 1) estrogen, 2) progesterone, and 3) non-hormonal methods (controls). Groups were compared using bivariate analysis with Chi-square or Fisher's exact test and linear regression. In an analysis of 80 patients at 24months, the mean increase in height from menarche was 6.4cm among controls (n=54), 7.2cm among the progesterone-only group (n=10), and 3.8cm among the estrogen group (n=16). The estrogen group's increase in height was significantly lower than the control group's, by a mean of 1.8cm (p=0.04). Change in height did not differ significantly between the progesterone and control groups (p=0.87). Additionally, for every year younger at menarche, there was 1 fewer cm of growth (change in height) at 24months after menarche (p<0.002). Estrogen-containing treatment for HMB initiated within three months of menarche was associated with reduced growth at 24months compared to progesterone-only or non-hormonal methods. The clinical applicability of the estrogen group's 1.8cm absolute reduction in height may have considerable significance for those who are shorter at baseline.

The relationship between sexual self-concept and contraception sexual behavior in 15 to 49 years old women covered by community health centers.

One of the most important goals of sexual intercourse is to arouse the psychological effects of intercourse and to increase sexual self-concept, which changes following sexual behaviors such as the use of contraception methods. This study was performed to investigate the relationship between sexual self-concept and contraception sexual behavior in 15-49-year-old women covered by community health centers. The present descriptive correlational study was performed on 297 married women referring to Isfahan community health centers in 2020 who were selected as cluster that randomly classified. The tools included demographic information and the Snell's Multidimensional Sexual Self-Concept Questionnaire, the data of which were analyzed via SPSS version 22 software by Mann-Whitney U test and Pearson correlation. Among a total of 297 women, 5.4% of the samples used hormonal methods and 94.6% used non-hormonal methods, which was the most common intermittent method. The results also showed that the mean score of negative sexual self-concept in women using the hormonal level method was significantly higher (P = 0.012). Positive and positive sexual self-concept score was significantly higher in women using non-hormonal methods (P = 0.048 and P = 0.002). Therefore, there was a significant relationship between sexual self-concept and contraception method. Due to the relationship between contraception and sexual self-concept, it is recommended to pay attention to the aspects of sexual self-concept and contraception during reproductive health counselling sessions so that if there is a disorder, useful advice can be provided or referred, if necessary.

Perception and use of reversible contraceptive methods in Germany: A social listening analysis.

With an increasing array of contraceptives in the market, it is important to understand how users perceive them and how their interests evolve over time. In this analysis, we aimed to examine the contraceptive interests of women and couples in Germany using data derived from social media posts. Social listening analysis. Posts from Urbia-a German Internet community-mentioning at least one reversible contraceptive method between April 2006 and April 2021 were carefully selected by searching for a defined set of keywords and phrases. The frequency of mention of each method was studied and their trend over the last 5 years was analyzed. The significance of trends was evaluated using Mann-Kendall test. Additionally, 656 random posts were individually assessed for method transitions and problems associated with specific contraceptives. The contraceptive pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Although general interest in hormonal contraception was higher compared to non-hormonal, interest in the pill decreased and interest in natural family planning and copper/gold coil increased. Most women switched from the pill to non-hormonal methods, almost half of them using a condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The common problem associated with most contraceptives was side effects. Social media provides valuable information about contraceptive experiences that can be used to monitor contraceptive prevalence patterns and attitudes within a large population in a very short span of time. A good understanding of how various contraceptives are currently perceived helps in identifying strategies for improving existing family planning policies. Currently, there are a variety of contraceptive products available in the market. To understand how users perceive them and how their interest evolves over time, we analyzed social media posts from Urbia, a German Internet platform. We scraped posts between 2016 and 2021 from the "child-desire" and "contraception" forums and analyzed the relative frequency of mentions of different contraceptive methods. We also looked at 1000 individual posts from 1000 different users, analyzed method switches and the problems associated with individual methods of use. The oral pill was the most frequently mentioned method of contraception followed by natural family planning methods, condom, hormonal coil, and copper/gold coil. Over the last 5 years however, the mention of the pill dropped, whereas the mentions of natural family planning and copper or gold coil increased. Further analysis of individual posts showed most women migrating from the pill to other non-hormonal methods such as natural family planning and condom. Almost all migrations to natural family planning were from the pill and most migrations to non-hormonal intrauterine devices such as the coil were from hormonal methods. The most common problem associated with the pill and non-hormonal intrauterine devices was side effects. Through this analysis we show that social media serves as a useful tool to monitor contraceptive prevalence and attitudes within a large population in a very short span of time. Our findings give policy makers an idea on the topics where more counseling and education may be required to help women and couples find their best suited method of contraception.

Reproductive Management in Goat Breeding

Goats belong to the „short day breeders“ group of seasonal polyoestrous animals. In the temperate climate zone, their season lasts from mid-summer till mid-autumn, being regulated by epiphysis’ melatonine secretion, as well as by genetics and environment factors. Therefore, the presence of goat milk and dairy products, as well as goat meat, at the food market, is exclusively seasonal. In order to provide goat food products throughout the whole year, reproductive herd management should be established. This paper presents a brief overview of the methods of reproductive management in dairy goat herds (natural mating and artificial insemination, hormonal and nonhormonal synchronization methods and embryo production and transfer). Proposed protocols are consisted of light treatment, male effect and timed artificial insemination which could be combined with or without injection of prostaglandin. Application of reproductive and breeding programs allow efficient diffusion of desirable genetic traits in a selection program.

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.