Postabortion Contraception Research Articles

Immediate postabortal contraception with a microdose combined preparation: Gonadotropin, estradiol and progesterone levels during the last treatment cycle and after discontinuation of oral contraceptives

The concentrations of plasma LH, FSH, estradiol, and progesterone, as well as urinary LH, were measured during the last treatment cycle and during the recovery cycle in women who, immediately after abortion, had started microdose combined oral contraceptives containing 30 μg of ethinylestradiol and 150 μg of d-norgestrel. During the treatment, cyclic variations were found in LH, FSH, and estradiol concentrations. FSH levels were highest during the first treatment week as well as the treatment-free week. LH concentrations were highest during the first treatment week. Estradiol concentrations showed a significant increase during the treatment-free week and during the first treatment week suggesting a follicle stimulation. The recovery of ovulation occurred rapidly, in a great majority of the subjects, after discontinuation of the treatment. The first midcycle LH peak was observed thirteen days after the intake of the last pill, and 50% of the subjects had ovulated within 22 days. In 91% of the subjects, plasma progesterone concentration during the luteal phase was higher than 5 ng/ml.

Immediate postabortal contraception with a microdose combined preparation: Suppression of pituitary and ovarian function and elimination of HCG

The effect of an oral contraceptive on the pituitary and ovarian function as well as on the elimination of HCG was studied in women volunteers who had had a first-trimester abortion. The contraceptive regimen was a combined preparation containing 30 micrograms of ethinylestradiol and 150 micrograms of d-norgestrel. The treatment was started on the day of abortion. Plasma concentrations of LH, FSH, HCG, estradiol and progesterone were measured by radioimmunoassay. The contraception was well tolerated and no objective side-effects were found. There were no ovulations during the 32-day observation period following the abortion, as indicated by the suppression of LH and FSH, and low plasma levels of progesterone. Plasma FSH concentrations were the best indicators of pituitary suppression during the treatment. However, individual variations in the degree of suppression were found. In each case, the FSH concentrations rose to follicular phase levels during the treatment-free week, indicating the recovery of pituitary function. Plasma estradiol concentrations remained at the low, prefollicular level throughout the observation period, except in one subject during the treatment-free week. Plasma progesterone concentrations were low except for a transient elevation between days 7 to 12 after the abortion when there were high levels of HCG. The treatment did not affect the elimination of HCG; an estimate of 36.7 days for the complete elimination was calculated from the results obtained with the specific RIA for the beta subunit of HCG.

Return of ovarian function after abortion.

The first menstrual cycle after a therapeutic abortion was studied in eighteen women by measuring plasma oestradiol and progesterone concentrations and the urinary excretion of LH until the first menstruation. The plasma concentrations of oestradiol and progesterone declined rapidly, reaching low values as early as the second day after the abortion. An increase in plasma oestradiol levels was observed from the seventh post-abortal day onwards. P peak of short duration in the plasma progesterone concentrations occurred during the increased oestradiol synthesis. The concentration of progesterone during the luteal phase of the cycle was lower than in a normal cycle, indicating an inadequate luteal function. Return of ovulation was observed in 83% of patients during the first cycle; as judged by a biphasic oestradiol profile in plasma, a mid-cycle LH peak, and subsequent elevation of progesterone. The first LH peak was observed 16 days after the abortion. The rapid return of the ovulatory function makes immediate post-abortal contraception a necessity.

Abortion views and practices among Danish family physicians

SummarySixty-seven GPs from a suburb of Copenhagen were interviewed regarding their experience with and opinion of induced abortion. The younger physicians in the sample were (a) significantly more experienced in areas of medical practice relating to abortion care, (b) significantly more positive in their attitude towards abortion, and (c) significantly more likely to emphasize the provision of contraceptive services to women undergoing pregnancy termination. Independent of the influence of age, a significant positive correlation was found between abortion attitude and the emphasis placed on providing contraception. A physician's self-perceived success in providing post-abortion contraception was found to relate in part to his/her view of the proper role to be played by a GP in abortion cases.

Abortion counseling.

Abortion counseling has 3 purposes: 1) to aid the applicant in making a decision about the unwanted pregnancy, 2) to help her implement the decision, and 3) to assist her in controlling her future fertility. To accomplish the 1st objective, the compulsory use of psychiatrists to prove emotional disorders has been unsatisfactory. Counseling needs to be supportive and nonjudgmental regardless of circumstances. Hostile feelings of the counselor must be suppressed. The applicant should be informed regarding the physical and emotional aspects of the abortion procedure. Also, good counseling should aim at future prevention by determining the reasons for failure that caused the unwanted pregnancy. Of importance in selecting abortion counselors are qualities described as personality traits. These include empathy, nonpossessive warmth, and genuineness. Also, maturity and flexibility are needed in allowing the woman to make the decision, particularly in cases of ambivalence and uncertainty. A program in New York City has used women counselors who themselves have had abortions. This experience alone is not sufficient, but may be significant. The counselor needs basic knowledge of sexual physiology, psychology, and contraceptive technology. Also, the counselor should be able to recognize prodromal psychiatric signs of an imminent crisis, and be able to initiate steps of prevention. Training programs vary widely. Flexibility is needed. Experience in counseling couples is important. Assistance by an experienced counselor is helpful on a continuing basis, particularly for the new counselor. Group sessions and didactic presentations are needed. To obtain acceptance of postabortal contraception may pose special problems. A history of previous psychiatric disturbance may require referral to a trained consultant. Strong religious or ethical feelings modify attitudes. The woman must not feel coerced. She should be able to integrate the experience in such a way as to prevent a recurrence.