Term Contraception Research Articles

SATISFACCIÓN DE LAS USUARIAS DE IMPLANTES DE LEVONORGESTREL. EXPERIENCIA DEL HOSPITAL NACIONAL CAYETANO HEREDIA

OBJETIVOS:Determinar las características y el porcentaje de satisfacción de las usuarias de implante subdérmico de levonorgestrel (Norplant®)pertenecientes al Programa de Planificación Familiar del HNCH. DISEÑO: Estudio descriptivo, retrospectivo. MATERIAL Y METODOS : Del total de usuarios a quienes se les extrajo el implante entre enero 1995 y diciembre 1999, se incluyo 82. Los datos fueron obtenidos mediante una ficha de recolección de datos y una encuesta. La satisfacción fue evaluada mediante la escala de Likert. REULTADOS: El 71,9% de usuarias resulto satisfecha La tasa deembarazo fue 0%. El 70,7% de las usuarias presento algun efecto secundario, el mas frecuente fue la alteración de la mestruacion (47,6%). La principal ventaja fue la protección contra el embarazo a largo plazo (53,7%). Se registro 59% de continuidad a los 5 años y las principales causas de remoción temprana fueron deseo de embarazo (23,5%) y alteraciones mestruales (23,5%). Se encontró significancia estadística con la satisfacción evaluada en la siguientes variables: aumento de peso (p= 0,0077), dolor en zona del implante (p= 0,000055), síntomas depresivos (0,00000), nivel educativo (p =0,033), recomendación del metodo (p= 0,000) y deseo de reimplante (p= 0,0000). CONCLUSIONES: Los implantes subdérmicos de levonorgestrel resultan ser un metodo anticonceptivo muy bien aceptado por las usuarias, a pesar de los efectos secundarios que presentan, altamente efectivo y una buena alternativa para mujeres que deseen anticoncepción a largo plazo.

Contraceptive Choices amongst Antenatal Care Patients in a Tertiary Health Centre in Nigeria

Background to Study: Maternal mortality and morbidity are very high in sub-Saharan Africa as in most developing countries, Nigeria inclusive. There have been concerted efforts by Governments of these countries, Non-Governmental Organisations, International and World bodies on how to solve this problem. One of the worth able strategies employed to solve the issue of maternal mortality is to prevent unintended pregnancies, unsafe abortions, space births, plan family sizes through the use of modern contraceptive methods for women in their reproductive age. However, maternal mortality remains high in Nigeria because of the low prevalence of contraceptive patronage. We, the authors of this study decided to test the prevalence of contraceptive patronage amongst our antenatal patients and compare our results nationally and globally. Objective: To determine the pattern of contraceptive choices among antenatal patients attending the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, South-South Nigeria. Methodology: This was a descriptive cross sectional study conducted at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, South-South Nigeria, between October 2014 to January 2015. It consisted of a set of structured, pretested questionnaires that were administered to consecutive antenatal attendees. Original Research Article Addah et al.; BJMMR, 9(6): 1-10, 2015; Article no.BJMMR.18276 2 Results: Fifty-one (57.3%) of subjects in the study have used contraceptives in the past. The most commonly used modern contraceptive method among the study population was the male condom – 25 (28.1%). Injectables were used by 12 (13.5%) of those who have used contraceptives before the advent of present pregnancy. Information on contraceptionSeventy three (82%) of respondents learnt of family planning services in the hospital through Doctors and Nurses. Conclusion: Previous contraceptive usage before the pregnancy by the study group was encouraging. However more advocacies by contraceptive providers are needed in the areas of emergency contraception and long term contraceptive methods for increase uptake.

Cost-Effectiveness of Introducing the SILCS Diaphragm in South Africa

BACKGROUND: Though South Africa has high contraceptive use unintended pregnancies are still widespread. The SILCS diaphragm could reduce the number of women with unmet need by introducing a discreet woman-initiated non-hormonal barrier method to the contraceptive method mix. METHODS: A decision model was built to estimate the impact and cost-effectiveness of the introduction of the SILCS diaphragm in Gauteng among women with unmet need for contraception in terms of unintended and mistimed pregnancies averted assuming that the available contraceptives on the market were not a satisfying option for those women. Full costs were estimated both from a providers and users perspective which also accounts for womens travel and opportunity cost of time assuming a 5% uptake among women with unmet contraceptive need. The incremental cost-effectiveness ratio is computed at five and 10 years after introduction to allow for a distribution of fixed costs over time. A probabilistic sensitivity analysis was conducted to incorporate decision uncertainty. RESULTS: The introduction of the SILCS diaphragm in Gauteng could prevent an estimated 8365 unintended pregnancies and 2117 abortions over five years at an annual estimated cost of US$55 per woman. This comes to a cost per pregnancy averted of US$153 and US$171 from a users and providers perspectives respectively with slightly lower unit costs at 10 years. Major cost drivers will be the price of the SILCS diaphragm and the contraceptive gel given their large contribution to total costs (around 60%). CONCLUSIONS: The introduction of the SILCS diaphragm in the public sector is likely to provide protection for some women for whom current contraceptive technologies are not an option. However to realize its potential targeting will be needed to reach women with unmet need and those with likely high adherence. Further analyses are needed among potential users to optimize the introduction strategy.

Contraceptive Method Mix Utilization and its Associated Factors among Married Women in Gedeo Zone, Southern Nations, Nationality and People Region-Ethiopia: A Community based Cross Sectional Study

Background: Ethiopia is one of the most notable family planning success stories in sub-Sahara Africa. In last fifteen year, there is a fivefold increase in the use contraceptive method. Much of this increase is attributable to the increase in the use of short term methods. This study was to assess the contraceptive method mix, utilization and factors associated with contraceptive use. Methods: A community based cross-sectional study was conducted among married women aged 15-49 years in the Gedeo zone in 2015. Multistage sampling technique was used to select a total of 1056 study participants. A pre-tested structured questionnaire was used for gathering data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 20.0 statistical package to identify factors associated with contraceptive use. Results: Current contraceptive use among the study subjects was 395 (74.8%) among urban and 339 (64.2%) among rural women. Urban women were two times more likely to use contraceptive methods [OR 2.23, 95% CI (1.55, 3.21)] compared with rural women. The overall current prevalence of contraception was 734 (69.5%). The most preferred method among short term contraceptive method was injectable 433 (57.0%) followed by pills 62 (8.2%), whereas among long acting and permanent contraceptive methods, implants, 201 (26.1%) and intrauterine devices (IUD), 50 (6.6%) were the most preferable methods. The result of multiple logistic regressions revealed that participant’s residence, participants’ education, number of a live child, women’s desire to have a child, knowledge of contraceptive methods and women’s attitude toward contraceptive method were found significantly associated with contraceptive use. Conclusion: Based on the study finding the contraceptive method mixe were highly dominated by short term contraceptives. Thus women’s contraception needs change during the course of their life; therefore healthcare professionals need to inform women’s about the benefits and risks of all available contraceptive methods.

Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception

ObjectiveSurgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women. Study designProspective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs. ResultsOne thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method. ConclusionCultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved.

Factors affecting women's intention to use long acting and permanent contraceptive methods in Wolaita Zone, Southern Ethiopia: a cross-sectional study.

BackgroundThe use of long acting and permanent contraceptive methods (LAPMs) has not kept step with that of short-acting methods such as oral pills and injectable in Africa. This study explores the association between women’s awareness, attitude and barriers with their intention to use LAPMs among users of short term methods, in Southern Ethiopia.MethodsA cross-sectional study design of mixed methods was conducted in the public health facilities of Wolaita zone, Southern Ethiopia, in January 2013. Women who were using short term contraceptive methods were the study population (n = 416). Moreover, 12 in-depth interviews were conducted among family planning providers and women who have been using short term methods. Data were entered into EPI Info version 3.5.3 and exported to SPSS version 16.0 for analysis. The odds ratios in the binary logistic regression model along with 95% confidence interval were used.ResultsOne hundred fifty six (38%) of women had the intention to use LAPMs while nearly half of them (n = 216) had a negative attitude to use such methods. Moreover, two-third of study participants (n = 276) held myths and misconceptions about such methods. The women who had a positive attitude were found to be 2.5 times more intention to use LAPMs compared to women who had a negative attitude (AOR =2. 47; 95% CI: 1.48- 4.11). Women who had no myths and misconceptions on LAPMs were found to be 1.7 times more intention to use LAPMs compared to women who had myths and misconceptions (AOR = 1.71; 95% CI: 1.08- 2.72). Likewise, women who attained secondary and higher level of education were found to be 2 and 2.8 times more intention to use LAPMs compared to women with no education, respectively (AOR = 2. 10; 95% CI: 1.11- 3.98) and AOR = 2. 80; 95% CI: 1.15- 6.77).ConclusionsIntention to use LAPMs was low and nearly half of women had a negative attitude to use such methods. Positive attitude, absence of myths and misconceptions on LAPMs and secondary and plus level of education predicts intention to use LAPMs. Educating communities to change the attitude, myths and misconceptions on LAPMs should be aggressively done.

Injectable Contraceptive Continuation among Female Exotic Dancers Seeking Mobile Reproductive Health Services.

We describe depot medroxyprogesterone acetate (DMPA) continuation patterns among female exotic dancers receiving reproductive health services at a mobile syringe exchange. Clients initiating DMPA between November 2009 and August 2012 were identified retrospectively via chart review. Life table analysis measured continuation. Client characteristics were compared using chi-square tests. Sixty nine clients were identified; 72% were African American and 63% were younger than 25. At three months, 36% of the study sample continued DMPA; those continuing were more likely to be White (p=0.01) and receive other services (p=.01). The 12-month cumulative continuation probability was 0.09. Considering those who had received an injection, continuation proportions were higher (46% at 6; 71% at 12 months). A subset of female exotic dancers may favor DMPA as a long term contraceptive. Integrating mobile reproductive health services into public health programs can help fulfill the unique health needs of this high-risk population.

Knowledge and perception on long acting and permanent contraceptive methods in adigrat town, tigray, northern ethiopia: a qualitative study.

Background. Long acting and permanent contraceptive methods have the potential to reduce unintended pregnancies but the contraceptive choice and utilization in Ethiopia are highly dominated by short term contraceptives. Objective. To assess the knowledge and perception on long acting and permanent contraceptives of married women and men in Northern Ethiopia. Method. A qualitative method was conducted in Adigrat on January, 2012. Four focus group discussions with married women and men and six in-depth interviews with family planning providers were conducted. Content analysis was used to synthesize the data. Result. Participants' knowledge on long acting and permanent contraceptives is limited to recognizing the name of the methods. Most of the participants are not able to identify permanent methods as a method of contraception. They lack basic information on how these methods work and how they can use it. Women had fears and rumors about each of these methods. They prefer methods which do not require any procedure. Family planning providers stated as they have weakness on counseling of all contraceptive choices. Conclusion. There are personal barriers and knowledge gaps on these contraceptive methods. Improving the counseling service program can help women to increase knowledge and avoid misconceptions of each contraceptive choice.

Modern Contraceptive Method Mix and Factors Affecting Utilization of Modern Contraceptives among Married Women in Adigrat Town, Tigray, Northern Ethiopia

Background: In Ethiopia the prevalence of contraceptive use among currently married women has increased nearly six fold in the last 20 years, from 5 percent in the 1990 to 29 percent in the 2011 Ethiopia Demographic Health Survey. The contraceptive method mix is dominated by short term methods like pills and injectables. This study was conducted to assess the contraceptive method mix and factors associated with modern contraceptive use among currently married women in Adigrat town. Methods: A community based cross sectional study design was conducted in three selected Kebeles of Adigrat town. A total of 594 study subjects were interviewed. Systematic random sampling method was used to select study subjects. Factors associated with modern contraceptive use were identified using logistic regression. Results: The current modern contraceptive prevalence was 51.3% (95%CI= 47.2, 55.4). The most preferred method was Depo-Provera, 207(68.3%), followed by pills, 35(11.6%). Thirty one (10.2%), 16 (5.3%), 12 (4%) of participants have found with implants, intra uterine device (IUD), and tubal ligation, respectively. None of the participants had reported vasectomy. The main source of the current method was government health centers (71.3%) and hospital (20.8%). Various reasons were given for not using modern contraception. The main reasons stated were desire to be pregnant (38.9%) and exclusive breastfeeding (25%). The result of multiple logistic regression revealed that couples’ education status, desire to have child within two years or soon, discussion on family planning with partner and ever use of modern contraceptives were found significantly associated with modern contraceptive use. Conclusions: The magnitude of modern contraceptive use in the town is almost comparable with the national demographic health survey 2011 and other urban based studies. But the contraceptive method mix is poor, dominated by short term contraceptives. Therefore, couples discussion on family planning and husbands’ involvement in family planning programs should be encouraged.

CONTRACEPTION HAS GONE TO THE COYOTES (CANIS LATRANS)

Coyotes (Canis latrans) are predators of livestock. Current management programs, primarily lethal control, are ineffective for long-term management of predation. Controlling reproduction of coyotes may reduce depredations if territory fidelity is maintained by breeding pairs. Surgical sterilization is successful in altering predatory behaviors of coyotes but may provide a challenge for field implementation. An alternative approach is the development of a one-time non-transferable chemical contraceptive. This research is investigating the efficacy of a single high dose treatment of a sustained release gonadotropin-releasing hormone agonist, deslorelin, on coyotes as a long term contraceptive. Male coyotes were administered 47 mg deslorelin subcutaneously. Preliminary data show full suppression of the reproductive axis for over 12 mo as indicated by complete absence of sperm.

Development and characterization of levonorgestrel encapsulated injectable poly glycolic acid microspheres engineered to specific sizes for controlled longer term contraception

Research and product development resulting in a longer-acting injectable contraceptive, could significantly increase compliance, improve continuation, and reduce We are exploring novel formulations of poly (lactic-co-glycolic) acid (PLGA) microspheres to achieve a longer acting injectable contraceptive.

An all time low utilization of intrauterine contraceptive device as a birth spacing method- a qualitative descriptive study in district Rawalpindi, Pakistan

BackgroundPakistan was among the leading countries in south Asia which started the family planning program in late 50s, forecasting the need to control the population. Despite this early intervention, fertility rate has declined but slower in Pakistan as compared to most other Asian countries. Pakistan has almost a stagnant contraceptive prevalence rate for more than a decade now, perhaps owing to the inadequate performance of the family planning programs. The provision and use of long term contraceptives such as IUCD has always been low (around 2%) and associated with numerous issues. Married women who want to wait before having another child, or end childbearing altogether, are not using any long term method of contraception.MethodologyA descriptive qualitative study was conducted from May to July 2012, to explore and understand the perceptions of women regarding the use of IUCDs and to understand the challenges/issues at the service provider’s end. Six FGDs with community women and 12 in-depth interviews were conducted with family planning providers. The data was analyzed using the Qualitative Content Analysis approach.ResultsThe study revealed that the family planning clients are reluctant to use IUCDs because of a number of myths and misconceptions associated with the method. They have reservations about the provider’s capability and quality of care at the facility. Private health providers are not motivated and are reluctant to provide the IUCDs because of inadequate counseling skills, lack of competence and improper supporting infrastructure. Government programs either do not have enough supplies or trained staff to promote the IUCD utilization.ConclusionBesides a well-designed community awareness campaign, providers’ communication and counseling skills have to be enhanced, as these are major contributing factors in IUCD acceptance. Ongoing training of all family planning service providers in IUCD insertion is very important, along with strengthening of their services.

If Progesterone Is Blamed for Breast Cancer Development, Why Are We Still Using Tamoxifen?

To the Editor: Breast cancer is the most commonly seen cancer in women and rates increase with advancing age [1]. Tamoxifen was found to be an effective drug in estrogen receptor positive breast cancer and it has been shown to be associated with prolonged survival [2]. In recent long term randomized population studies, breast cancer rates were higher in women under estrogen+progesterone therapy while there was no increase in breast cancer rate in group with estrogen only therapy [3,4]. Another controversy is increase rates of breast cancer in women with long term anovulatory cycles like polycystic ovary syndrome [5]. Additive effect or potentialization may be the mechanism under this controversy. We suggest to analyze effect of progesterone only therapy on breast cancer development. And also the effect of antiprogesterone therapy in breast cancer needs to be analyzed. Although a retrospective data showed no association between previous progesterone exposure and invasive breast cancer [6], we thought that women using subdermal implants for long term contraception are the best candidates to assess role of progesterone in breast cancer development and determine duration and dosage leading to cancer in a prospective manner. Effect of mifepristone on breast cell proliferation was analyzed and study concluded that the ability of mifepristone that block breast epithelial cell proliferation in premenopausal women may be beneficial [7]. Therefore tamoxifen may be combined with a safe drug mifepristone, a progesterone receptor antagonist, as an adjunctive therapy in hysterectomized women to determine efficacy of antiprogesterone therapy in breast cancer.

M130 IMPORTANCE OF THE CONTEXT OF DECISION MAKING IN SUCCESSFUL CONTINUATION OF THE LONG TERM CONTRACEPTIVE METHOD NORPLANT IN A DISTRICT OF NORTHERN BANGLADESH

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S573-S574 Poster presentations M130 IMPORTANCE OF THE CONTEXT OF DECISION MAKING IN SUCCESSFUL CONTINUATION OF THE LONG TERM CONTRACEPTIVE METHOD NORPLANT IN A DISTRICT OF NORTHERN BANGLADESH F.A. Huda, F.A. HudaSearch for more papers by this authorF.R. Sirajuddin, F.R. SirajuddinSearch for more papers by this author F.A. Huda, F.A. HudaSearch for more papers by this authorF.R. Sirajuddin, F.R. SirajuddinSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61325-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S573-S574 RelatedInformation

Reproductive health algorithm.

263 Background: About 692,000 women are newly diagnosed with various cancers yearly in the US, with breast being the most common, and 10% within reproductive age group. When concerned about survival, reproductive health is overlooked. The objective of this study was to incorporate a reproductive health algorithm into oncologic care of reproductive aged women. Methods: This prospective observational study was conducted at John H. Stroger, Jr. Hospital of Cook County. Eleven newly diagnosed patients were recruited. The algorithm was implemented for each participant and they were surveyed quarterly for 2 years. Results: The mean age of participants was 39 and mean living children was 1.9. Of the 11 women, two (18%) were pregnant at the time of recruitment and nine were not. Both pregnant subjects had an obstetric consultation and chose to continue the pregnancies. They delivered without complications. One began chemotherapy in the second trimester, the other began postpartum. After completion of the pregnancies, these women went into the “not pregnant” cohort. Of the now 11 women in the “not pregnant” cohort, one (9%) had not completed childbearing and 10 (91%) had. The one woman interested in childbearing underwent REI consultation and fertility preservation counseling. Of the women who had completed childbearing, 70% had adopted a long term contraceptive method, 10% a short term method and 20% were abstinent. All 11 women had a family planning consultation. Eighteen percent had already undergone permanent sterilization and 27% had an IUD in place at the time of diagnosis. An additional 27% selected an IUD. Seventy-two percent continued or began long term contraception. Eighteen percent remained abstinent throughout study period. Conclusions: Conclusions from this study demonstrate that with the intervention of the algorithm and referral system, 100% of patients had a basic management plan consistent with reproductive health goals. Most selected a form of long term contraception prior to or on study. All sexually active women had a contraceptive plan in place post diagnosis and during treatment of cancer consistent with long term reproductive health goals. A cluster-design, multicenter, randomized controlled trial has been developed to further investigate and validate our findings.

Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period

To analyse the compliance of patients and side effects of Implanon® during breast feeding. Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.

Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device.

The intrauterine device (IUD), primarily in the form of the copper IUD, is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. With a remarkably low failure rate of less than 1 per 100 women in the first year of use, the Copper T-380A is in the top tier of contraceptives in terms of efficacy. Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion. Overall, the number of adverse events is low, making the Copper T-380A a very safe contraceptive method. The most common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. However, cumulative discontinuation rates of Copper T-380A are lower than that have been reported for other methods, indicating that the Copper T-380A is highly acceptable to women. After 5 years, approximately 50% of all women, who have a Copper T-380A inserted, will continue to use this highly effective contraceptive method.

Integrated community-based sexual health services for young people in urban areas: are we meeting the needs of the local community?

Community-based sexual health services (SHS) are intended to improve access for people who may have difficulty attending traditional genitourinary medicine clinics. The objective of this study was to review uptake of sexually transmitted infection (STI) testing in an outreach clinic for those under 25 in an area where Black and minority ethnic groups comprise the majority of the local population. A retrospective case-notes review was undertaken of those attending. Standards were that Fraser guidelines should be completed in all under 16-year-old and all clients should be offered STI testing, HIV testing and contraception (if applicable) in accordance with local standards. One hundred and seventeen clients attended. Ten percent self-reported ethnicity was Asian. Thirty-six (31%) clients tested for chlamydia. Thirty (26%) had an HIV test. Five (14% of those tested) had a positive nucleic acid amplification test for chlamydia. Five (13%) of those requesting long term contraception had STI testing. This service has successfully improved access to STI screening. However, there may have been missed opportunities to offer tests in those requesting contraception. Under-representation of those of non-white ethnicity suggests access to SHS may be a particular problem and further work is required to improve the sexual health of the local community.

Biphasic versus monophasic oral contraceptives for contraception

Side effects caused by oral contraceptives discourage compliance with, and continuation of, oral contraceptives. Three approaches have been used to decrease these adverse effects: reduction of steroid dose, development of new steroids, and new formulas and schedules of administration. The third strategy led to the biphasic oral contraceptive pill. To compare biphasic with monophasic oral contraceptives in terms of efficacy, cycle control, and discontinuation due to side effects. Our a priori hypotheses were: (a) biphasic oral contraceptives are less effective than monophasic oral contraceptives in preventing pregnancy; (b) biphasic oral contraceptives cause more side effects, give poorer cycle control, and have lower continuation rates. We searched the computerized databases MEDLINE, EMBASE, POPLINE, LILACS and CENTRAL. In addition, we searched the reference lists of all potentially relevant articles and book chapters. We also contacted the authors of relevant studies and pharmaceutical companies in Europe and the USA. We included randomized controlled trials comparing any biphasic with any monophasic oral contraceptive when used to prevent pregnancy. We examined the studies found during the various literature searches for possible inclusion and assessed their methodology using Cochrane guidelines. We contacted the authors of all included studies and possibly randomized studies for supplemental information about methodology and outcome. We entered the data into RevMan, and calculated Peto odds ratios for the incidence of intermenstrual bleeding, absence of withdrawal bleeding, and study discontinuation due to intermenstrual bleeding. Only one trial of limited quality compared a biphasic and monophasic preparation. Percival-Smith 1990 examined 533 user cycles of a biphasic pill (500 microg norethindrone/35 microg ethinyl estradiol for 10 days, followed by 1000 microg norethindrone/35 microg ethinyl estradiol for 11 days; Ortho 10/11) and 481 user cycles of a monophasic contraceptive pill (1500 microg norethindrone acetate/30 microg ethinyl estradiol daily; Loestrin). The study found no significant differences in intermenstrual bleeding, amenorrhea and study discontinuation due to intermenstrual bleeding between the biphasic and monophasic oral contraceptive pills. Conclusions are limited by the identification of only one trial, the methodological shortcomings of that trial, and the absence of data on accidental pregnancies. However, the trial found no important differences in bleeding patterns between the biphasic and monophasic preparations studied. Since no clear rationale exists for biphasic pills and since extensive evidence is available for monophasic pills, the latter are preferred.

Biphasic versus triphasic oral contraceptives for contraception

Side effects caused by oral contraceptives discourage compliance with, and continuation of, oral contraceptives. A suggested disadvantage of biphasic compared to triphasic oral contraceptive pills is an increase in breakthrough bleeding. We conducted this systematic review to examine this potential disadvantage. To compare biphasic with triphasic oral contraceptives in terms of efficacy, cycle control, and discontinuation due to side effects. We searched MEDLINE, EMBASE, POPLINE, LILACS and CENTRAL. We searched the reference lists of relevant articles and book chapters. We also contacted the authors of relevant studies and pharmaceutical companies in Europe and the USA. We included randomized controlled trials comparing any biphasic with any triphasic oral contraceptive when used to prevent pregnancy. We examined the studies found during the searches for possible inclusion and assessed methodological quality using Cochrane guidelines. We contacted the authors of included studies and of possibly randomized studies for supplemental information about the methods and outcomes. We entered the data into RevMan. We calculated Peto odds ratios for incidence of discontinuation due to medical reasons, intermenstrual bleeding, and absence of withdrawal bleeding. Only two trials of limited quality met our inclusion criteria. Larranaga 1978 compared two biphasic pills and one triphasic pill, each containing levonorgestrel and ethinyl estradiol. No important differences emerged, and the frequency of discontinuation due to medical problems was similar with all three pills. Percival-Smith 1990 compared a biphasic pill containing norethindrone (Ortho 10/11) with a triphasic pill containing levonorgestrel (Triphasil) and with another triphasic containing norethindrone (Ortho 7/7/7). The biphasic pill had inferior cycle control compared with the levonorgestrel triphasic. The odds ratio of cycles with intermenstrual bleeding was 1.7 (95% CI 1.3 to 2.2) for the biphasic compared with the triphasic levonorgestrel pill. The odds ratio of cycles without withdrawal bleeding was 6.5 (95% CI 3.1 to 13). In contrast, cycle control with the biphasic pill was comparable to that of the triphasic containing the same progestin (norethindrone). The available evidence is limited and the internal validity of these trials is questionable. Given the high losses to follow up, these reports may even be considered observational. Given that caveat, the biphasic pill containing norethindrone was associated with inferior cycle control compared with the triphasic pill containing levonorgestrel. The choice of progestin may be more important than the phasic regimen in determining bleeding patterns.