Use Of Hormonal Methods Research Articles

Bacteriuria in Pregnant Adolescents and Behavioral Risk Factors: A Cross-Sectional Study at a Brazilian Teaching Hospital

Bacteriuria during pregnancy is a frequent and important cause of morbidity and complications. Data on its occurrence in pregnant adolescents are still scarce. A cross-sectional study was conducted at a tertiary teaching hospital in São Paulo, Brazil. All adolescents (≤18 years) who came for prenatal care between January 2010 and January 2016 were included. Sociodemographic characteristics, medical history, obstetric history, and the results of laboratory tests were selected. A urine sample was aseptically collected from each patient to undergo microscopic and culture analysis. A total of 388 pregnant adolescents averaging 15.30±1.24 years of age were included. The frequency of bacteriuria in this group was 17.01% (66/388). The lack of sports practice (OR=8.65; 95% CI, 1.09-68.39), the fact that pregnancy was desired (OR=2.17; 95% CI, 1.08-4.34), and the use of hormonal methods of contraception (OR=2.46; 95% CI, 1.04-5.84) turned out to be independent risk factors for bacteriuria. Protective factors were identified as late coitarche (OR=0.75; 95% CI, 0.57-0.98) and a urine culture analysis at a later gestational age (OR=0.94; 95% CI, 0.90-0.98). The most often isolated pathogens were Escherichia coli (49%) and Streptococcus agalactiae (18%). Bacteriuria among pregnant adolescents is a relatively common condition. The infection risk of the urinary tract was increased by physical inactivity and seemingly by the influence of behavioral and sexual factors. Such results can help to identify patients at risk, favoring the early diagnosis of urinary tract infections and optimizing prenatal care.

Return to pregnancy after contraceptive discontinuation to become pregnant: a pooled analysis of West and East African populations

BackgroundThe fear of infertility or delayed return to fertility is a common barrier to contraceptive use in sub-Saharan Africa, particularly among young or nulliparous women. Global evidence on return to pregnancy after method discontinuation suggests these fears may be misplaced; yet the topic has not been widely studied in sub-Saharan Africa nor by age and parity group.MethodsReproductive calendar data from recent Demographic and Health Surveys of 15 sub-Saharan African countries were used to analyze time-to-pregnancy following discontinuation of a contraceptive method with the reason to become pregnant. The probability of pregnancy at 12 months was estimated using single-decrement life tables run by type of method discontinued, age and parity. Results are presented by region: francophone West Africa, anglophone West Africa and East Africa.ResultsThe 12-month probability of pregnancy after discontinuation of contraception to become pregnant was 73.0% in francophone West Africa, 78.8% in anglophone West Africa, and 82.0% in East Africa. Our results showed significant regional differences in return to pregnancy by 12 months, with probabilities in francophone West Africa being significantly lower than in anglophone West Africa or East Africa. A lower return to pregnancy by 12 months was seen among women ages 35–49 years and was lowest after discontinuation of a hormonal method for all age groups. Differences by parity group were only evident after discontinuation of hormonal methods in francophone West Africa.ConclusionsSustainable gains in increasing contraceptive uptake, especially among youth, may be difficult to achieve without information and counseling that address concerns about infertility and potential delays in return to pregnancy following use of hormonal methods.

Medroxyprogesterone Acetate Impairs Amyloid Beta Degradation in a Matrix Metalloproteinase-9 Dependent Manner.

Despite the extensive use of hormonal methods as either contraception or menopausal hormone therapy (HT), there is very little known about the potential effects of these compounds on the cellular processes of the brain. Medroxyprogesterone Acetate (MPA) is a progestogen used globally in the hormonal contraceptive, Depo Provera, by women in their reproductive prime and is a major compound found in HT formulations used by menopausal women. MPA promotes changes in the circulating levels of matrix metalloproteinases (MMPs), such as MMP-9, in the endometrium, yet limited literature studying the effects of MPA on neurons and astroglia cells has been conducted. Additionally, the dysregulation of MMPs has been implicated in the pathology of Alzheimer’s disease (AD), where inhibiting the secretion of MMP-9 from astroglia reduces the proteolytic degradation of amyloid-beta. Thus, we hypothesize that exposure to MPA disrupts proteolytic degradation of amyloid-beta through the downregulation of MMP-9 expression and subsequent secretion. To assess the effect of progestins on MMP-9 and amyloid-beta, in vitro, C6 rat glial cells were exposed to MPA for 48 h and then the enzymatic, secretory, and amyloid-beta degrading capacity of MMP-9 was assessed from the conditioned culture medium. We found that MPA treatment inhibited transcription of MMP-9, which resulted in a subsequent decrease in the production and secretion of MMP-9 protein, in part through the glucocorticoid receptor. Additionally, we investigated the consequences of amyloid beta-degrading activity and found that MPA treatment decreased proteolytic degradation of amyloid-beta. Our results suggest MPA suppresses amyloid-beta degradation in an MMP-9-dependent manner, in vitro, and potentially compromises the clearance of amyloid-beta in vivo.

Comparison of body weight among hormonal and non-hormonal users in a Malaysian cohort.

ObjectivesWeight gain remains an issue for contraceptive users due to the high prevalence of obesity. This retrospective study compares the weight gain between hormonal and non-hormonal contraceptive users in government health clinics in Kota Bharu, Kelantan, Malaysia.MethodsA total of 380 women who had used the same contraceptive method for at least twelve months were recruited in this study. Covariance analysis was done to compare the weight gain between hormonal and non-hormonal contraceptive users, while studying the same confounders [age, household income, number of pregnancies, and baseline body mass index (BMI)].ResultsHormonal methods were more commonly used. The mean weight gain among hormonal users (adjusted mean 2.85, 95% CI 2.45, 3.24) was significantly higher than non-hormonal users (adjusted mean 0.46, 95% CI -0.73, 1.65; p-value <0.001), after controlling for age, household income, number of pregnancies, and baseline BMI.ConclusionThe possibility of weight gain following the use of hormonal methods should be investigated and non-hormonal methods should be considered to prevent weight gain.

Varicose veins of the small pelvis and pelvic congestion syndrome. A differentiated approach: the choice of method of contraception, treatment, prevention

The article considers the main points that affect the quality of life of women with varicose veins of small pelvis with congestion and without it, in particular the use of hormonal methods of contraception, and also discussed the issues of diagnostics, prevention and treatment of these diseases. Algorithms of clinical tactics for conducting such patients are presented. Particular attention is focused on the features of the appointment of hormonal drugs in this category of women. You can determine the methods of treatment and avoid long-term unreasonable prescription of various medicine (especially hormones that will mask or worsen the course of the disease) if you select groups of women with varicose veins of the small pelvis without congestion and with it (reflux).Varicose veins of the small pelvis and pelvic congestion syndrome are conditions that require an interdisciplinary and differentiated approach. Symptoms of these conditions can be put on a mask of various gynecological, urological, traumatological diseases. Anatomical and physiological features of the structure of the veins and the regulation of their venous tone explain the possibility of forming a venous congestive syndrome in women. This can be due to two reasons: due to the violation of the outflow of venous blood or due to the obstruction of any vein of the ovary, any increase in intravascular pressure not controlled by the venous tone at the level of the pelvis.Varicose veins of the small pelvis and pelvic congestion syndrome remain unexplored until the end. There are no uniform standards for their diagnostics. Varicose veins of the small pelvis and pelvic congestion syndrome are different diseases which requiring an understanding of the mechanisms of their development and consequences. If a pelvic varicose veins are suspected, the first diagnostic test is usually ultrasound. Modern ultrasound technique can evaluate blood flow in various veins. To study the blood flow in the veins, laparoscopy, venography in combination with CT or MRI can also be performed.

HIV/AIDS and Contraceptive Method Choice: Demographic and Socio-Economic Correlates of Contraceptive Method Choice among HIV-Positive Women Practising Family Planning In Kenya

Introduction: As the generalized HIV epidemic in specific settings of sub-Saharan Africa continues to evolve, there is need for evidence-based response to address emerging challenges, which include enabling the large number of women living with HIV make informed choices to achieve their reproductive goals. Objectives: This paper seeks to (i) examine the effect of HIV/AIDS on contraceptive method choice among women using contraceptives in Kenya; and (ii) identify correlates of contraceptive method choice among HIV-positive women practising family planning. Material and Methods: We apply multinomial Logistic regression models to a sample of 3190 sexually-active women of reproductive age using contraceptives from the 2003 and 2008 Kenya Demographic and Health Surveys to examine the effect of HIV/AIDS on contraceptive method choice. The analysis of correlates of method choice among HIV-positive women is based on a sample of 255 HIV-positive women using contraceptives and involves bivariate cross-tabulations with Chi-Square tests. Result: Overall association between HIV status and contraceptive method choice is consistent with expected patterns, with women who are HIV-positive being more than twice as likely to use condoms rather than hormonal contraceptives, compared to their counterparts of similar characteristics who are HIV-negative (p<0.05). Among women infected with HIV, those who were previously tested for HIV were more likely to use condoms and less likely to use hormonal methods (p<0.05) than those who had never been tested. The higher use of condoms by HIV-positive women is only evident among those who had previously been tested for HIV. Significant correlates of contraceptive method choice among HIV-positive women include parity, marital status, age group, education and ethnicity. Overall trends suggest a notable shift from use of hormonal methods to condoms by HIV-positive women, but predominant use of hormonal methods (60%) and low use of condoms (23%) by HIV-positive young women aged 15-24 practising family planning is of potential concern. Conclusion: The findings have important implications for family planning policies/programs targeting young women living with HIV and underscore the need to intensify efforts towards improved HIV testing coverage to enable HIV-positive women make informed reproductive choices.

Contraceptive use among young women in Estonia: Association with contraceptive services

Objectives Our study aimed to explore the association between the use of effective contraceptive methods and access to different contraceptive services, as well as to describe accessibility-related obstacles when using contraceptive services and satisfaction with those services.Methods From a population-based cross-sectional study carried out in 2004 (response rate 53.8%), the data of 16- to 24-year-old women requiring contraception (N = 868) were analysed. Factors associated with the use of effective contraceptive methods and, specifically, hormonal methods, were explored using multiple logistic regression analysis.Results Effective contraception was used by 75.1% of the respondents. The use of effective contraceptive methods was associated with school-based sexuality education (adjusted prevalence odds ratio 2.69; 95% confidence interval 1.32 − 5.50), visiting a youth-friendly clinic (YFC) (1.82; 1.03–3.23) or a private gynaecologist (2.08; 1.11–3.92). The use of hormonal methods was additionally associated with being a native Estonian speaker and visiting a family doctor. More than half of the respondents reported some obstacle in accessing contraceptive services. The highest satisfaction ratings were given to YFCs.Conclusions Steps to promote the use of services that are youth-friendly and associated with better uptake of effective contraceptive methods are needed among all 16- to 24-year-old women.

Pull and pray or extra protection? Contraceptive strategies involving withdrawal among US adult women

ObjectiveResearch assessing contraceptive use often focuses on the most effective method used and suggests that very few women rely on withdrawal. We adopted a new measurement strategy in an attempt to measure contraceptive practices and withdrawal in particular. Study designWe collected data from a national sample of 4634 US women aged 18–39; the survey was administered online in November and December 2012. We obtained information about recent use of hormonal methods and coital methods using two separate items, and we placed withdrawal first on the list of coital methods. The analysis examines several measures of withdrawal use in the last 30 days: most effective method used, any use, use with other methods and withdrawal “method mix.” ResultsAmong women at risk of unintended pregnancy, 13% reported that withdrawal was the most effective method used in the last 30 days, but 33% had used withdrawal at least once. Most women who used withdrawal had also used a hormonal or long-acting method (13% of the sample) or condoms (11%) in the last 30 days, and a minority reported using only withdrawal (12%). Younger women, women in dating relationships and women strongly motivated to avoid pregnancy had some of the highest levels of “dual” use of withdrawal with condoms or highly effective methods. ConclusionMany women and couples in our sample used withdrawal in combination, or rotation, with condoms and highly effective methods. Findings suggest that some people who use withdrawal may be more versus less vigilant about pregnancy prevention. ImplicationsHealth care providers who discuss contraception should include withdrawal in these conversations. A substantial minority of individuals has used it recently, and many appear to be using it as a backup or secondary method. If dual use were more widespread, it could help reduce the incidence of unintended pregnancy.

Unintended Pregnancy and Contraceptive Use Among Women in the U.S. Military: A Systematic Literature Review

U.S. servicewomen's ability to plan pregnancies is of concern to the military in terms of troop readiness and cost and is an important public health issue. Contraception access and use are crucial, particularly given the high prevalence of sexual assault in the military and the benefits of menstrual suppression for deployment. We systematically searched for publications on contraception, unintended pregnancy, and abortion in the military. Pregnancy and unintended pregnancy rates are higher among servicewomen than the general U.S. population. Contraceptive use may be somewhat higher than the nonmilitary population, although use decreases during deployment. Reported use of hormonal methods for menstrual suppression is lower than interest. There are limited data on these topics; more large, representative studies and longitudinal data from all branches are needed, along with qualitative research to explore findings more deeply. Emergency contraception and abortion are particularly underresearched.

The Impact of Contraceptive Counseling in Primary Care on Contraceptive Use

Whether contraceptive counseling improves contraceptive use is unknown. To evaluate the association between contraceptive counseling provided by primary care physicians and patients' contraceptive use. All women aged 18-50 who visited one of four primary care clinics between October 2008 and April 2010 were invited to complete surveys about their visit. Seven to 30 days post visit, participants completed a survey assessing pregnancy intentions, receipt of contraceptive counseling, and use of contraception at last sexual intercourse. Survey data were linked to medical record data regarding contraceptive prescriptions prior to and during the clinic visit. Women were classified as in need of contraceptive counseling if they were sexually active, were not pregnant or trying to get pregnant, and had no evidence of contraceptive use prior to their index clinic visit. Fifty percent (n = 386) of women were in need of contraceptive counseling at the time of their visit. Those who received contraceptive counseling from a primary care provider were more likely to report use of hormonal contraception when they last had sex (unadjusted OR: 3.83, CI: 2.25-6.52), even after adjusting for age, race, education, income, marital status, pregnancy intentions, and prior pregnancy (adjusted OR: 2.68, CI: 1.48-4.87). Counseling regarding specific types of contraception was associated with an increased use of those methods. For example, counseling regarding hormonal contraceptives was associated with a greater likelihood of use of hormonal methods (adjusted OR: 4.78, CI: 2.51-9.12) and counseling regarding highly effective reversible methods was highly associated with use of those methods (adjusted OR: 18.45, CI: 4.88-69.84). These same relationships were observed for women with prior evidence of contraceptive use. Contraceptive counseling in primary care settings is associated with increased hormonal contraceptive use at last intercourse. Increasing provision of contraceptive counseling in primary care may reduce unintended pregnancy.

Fatores de risco para a gravidez na adolescência em uma maternidade-escola da Paraíba: estudo caso-controle

To identify factors associated with gestation in adolescence in a State of the northeast of Brazil. A case-control study in the ratio of one 10 to 19-year-old adolescent (case) for two 20 to 35-year-old women (controls), with a total of 168 cases and 337 controls. The variables analyzed were: schooling, marital status, origin, family income per capita in Brazilian currency, paid job, mother's schooling, and presence of adolescent's father at home. Reproductive variables such as age at the first intercourse, mother's history of adolescence pregnancy, gynecological appointments before the pregnancy, knowledge, access and use of contraceptive methods were also included in the analysis. The following variables were associated with gestation in adolescence: schooling lower than eight years, lack of a regular mate, and maternal history of adolescence gestation. Also, the age at the first intercourse was significantly lower among the adolescents and that they had a lower rate of gynecological appointments. Knowledge of hormonal methods and access to contraceptive methods were also less frequent among the adolescents. After the multiple logistic regression analysis, risk factors for pregnancy at adolescence were: low schooling (OR=2.3; CI 95%=1.3-3.8), age at the first intercourse lower than 15 years old (OR=3.6; CI 95%=2.2-5.7), history of maternal pregnancy at adolescence (OR=2.6; CI 95%=1.7-3.4). The history of previous gynecological appointments (OR=0.3; CI 95%=0.2-0.4) and the use of hormonal methods (OR=0.6; CI 95%=0.4-0.9) were protecting variables. The main factors associated with pregnancy in adolescence were: the adolescent's low schooling, maternal history of adolescence gestation, lack of previous gynecological appointments and lack of access to contraceptive methods.

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

BackgroundImproving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses.MethodsLiterature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data.ResultsOf the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health.ConclusionIncreasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved.

The relationship among demographics, reproductive characteristics, and intimate partner violence

Objective: Our purpose was to examine the associations between demographics and reproductive characteristics on the occurrence of intimate partner violence (IPV) in young women. Study Design: An anonymous questionnaire was completed by 727 women between 14 and 26 years old who were seen in the family planning clinics in southeast Texas between March 1997 and February 1998 and who reported a current spouse or partner. Subjects completed a standardized measure of violence perpetrated by a partner and provided information on demographics and reproductive characteristics. Separate logistic regression analyses were used to analyze factors associated with physical and verbal violence. Results: Significant and positive associations with physical violence were found for race, employment, and parity (≥1); risk of verbal abuse included employment, history of sexual abuse, and inconsistent condom and prescription contraceptive use. Protective factors for physical violence included education level, use of hormonal methods of contraception or condoms at last intercourse, and older age at first intercourse and at first childbirth; protection from verbal assault included dual contraceptive use, as well as barrier and hormonal contraception at last intercourse. Conclusion: Different patterns of risk emerge between physical and verbal assault among young women seen in a publicly funded family planning clinic. Minority parous women with limited education, early onset of sexual activity, and who report no contraception use at last intercourse appear to be at highest risk for reporting physical violence, whereas history of sexual victimization, early sexual activity, and younger age at first child birth elevates risk for verbal abuse. (Am J Obstet Gynecol 2002;187:1002-7.)

Changes in Bone Density Associated with the Use of Hormonal Methods are Small and Temporary

A multicenter study was conducted in Africa Asia and Latin America to examine the changes in bone density associated with the use of hormonal methods. Data were collected by interviewing 2474 women aged 30-34 between 1994 and 1997 at family planning clinics in Bangladesh Brazil China Egypt Mexico Thailand and Zimbabwe. A total of 33% of these women were classified as pill users 14% as depot-medoxyprogesterone acetate (DMPA) users and 25% as implant users while 28% were considered never-users. To determine bone density the radius was measured near the wrist and the ulna was measured at mid-shaft. It is noted that bone density at both sites was associated with hormonal method use. Overall the study showed that hormonal contraceptives have only small reversible effects on bone density. Compared with women who do not use hormonal methods women who use combined oral contraceptives experience a significant increase in bone density while those who use the injectable DMPA or the levonorgestrel implant Norplant experience a significant decrease. However these changes disappear after the first 2-3 years of current use and appear to be clinically insignificant.

Use of Hormonal Methods of Birth Control Among Sexually Active Adolescent Girls

ObjectiveTo identify factors associated with the use of vmious birth control methods among sexually active adolescent girls. DesignA survey distributed as part of a larger study measuring compliance with hepatitis B vaccination. SettingA hospital-based and a school-based clinic. MeasuresDemographic and health behavior data including sexual activity, contraceptive method, substance use, condom use, and history of sexually transmitted diseases (STDs) were collected. Birth control method was confirmed by medical record review. Associations with the outcome variable of birth control method were analyzed using chi square, Kruskal-Wallis analyses of variance, and t-tests, followed by logistic regression analysis. ResultsAmong sexually experienced girls, 39% (n = 123) reported using oral contraceptive pills (OCPs), 5.4% (n = 17) used Depo-Provera (medroxyprogesterone acetate) or Norplant (levonorgestrel), and 55.6% (n = 175) used no hormonal method. Logistic regression analysis revealed that the factors most significantly associated with the use of hormonal methods were older age (odds ratio [OR] = 1.19; 95% confidence interval [CI], 1.07–1.33), not using a condom at last intercourse (OR = 0.55; CI, 0.34–0.90), and having had a well visit within 1 year (OR = 2.11; CI, 1.12–3.70). OCP users were less likely than Depo-Provera or Norplant users to have used alcohol (p = 0.041), cigarettes (p = 0.002), or marijuana (p = 0.018) in the past 30 days. OCP users were less likely than nonusers of hormonal methods to have smoked cigarettes (p = 0.034) or marijuana (p = 0.052). The school-based clinic had a greater proportion of subjects using long-acting progestins (p < 0.001). ConclusionsThe decreased rate of condom use among those who used hormonal birth control methods and the different rates of health risk behaviors among users of various methods require targeted counseling efforts to decrease pregnancy and STD rates among young women.