Use Of Injectable Contraceptives Research Articles

Injectable long-acting contraceptives.

This paper reviews the pharmacologic and epidemiologic data on injectable contraceptives and provides clinicians with clinical insights pertaining to counseling selection initiation and maintenance to facilitate successful use of injectable contraceptives. In the US women have two available options: Depo-Provera (DMPA) a 3-month progestin-only formulation containing 150 mg medroxyprogesterone acetate per injection and Lunelle (MPA/E2C) a 1-month combination containing 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate per injection. Both DMPA and MPA/E2C offer users effective convenient and reversible birth control choices. In particular DMPA is characteristically associated with amenorrhea. This progestin-only control method can be used by lactating women and by others for whom contraceptive doses of estrogen are contraindicated. However return of fertility can be delayed in women discontinuing DMPA to become pregnant. In some cases use of DMPA also confers important noncontraceptive and therapeutic benefits. On the other hand MPA/E2C is more beneficial to women who are concerned with daily pill taking who prefer regular cycles to amenorrhea and who find monthly injections acceptable and accessible. Like oral contraceptives MPA/E2C also represents an appropriate choice for women who prefer a rapidly reversible contraceptive method. Its contraindications are parallel to those for combined oral contraceptives.

Contraceptive practices of women after abortion in Turkey

Objectives The aim of this study was to determine the postabortion contraception choices of women and the subsequent reduction in pregnancy rate. The changes in method of contraception during the1-year follow-up period were also assessed.Methods Ninety women decided to practice family planning methods following an abortion procedure. The family planning choices of the postabortion familyplanning group were determined by active immediate family planning counselling. The control group, which consisted of 23 women who had had an abortion and wanted to become pregnant again, were followed-upfor 1 year to determine their pregnancy rate. The pregnancy rates and methods used were determined during a 12-month follow-up period.Results Following counselling, 79.64% of the patients signedfor immediate family planning practice. In the postabortion family planning group, one out of 90 patients (1.1%, Pearl index 1.29) practising contraception with a condom became pregnant. However, ten outof 23 (43.5%, Pearl index 54.2) patients in the control group became pregnant during the 1-year follow-up period (p < 0.05). In the postabortion family planning group, intrauterine devices (IUDs)(n = 43), injectable monthly contraceptives (n = 24) and tubal ligation (n = 9) were the most commonly preferred methods, with 47%, 27% and 10% of the women using these methods, respectively.At the end of the 12-month period, the drop-out rate among women using the injectable monthly contraceptives was significantly higher (13 patients, 54%) compared to other methods (p < 0.05). Inone case out of 43 using an IUD (2.38%), the IUD was expelled during follow-up.Conclusion The use of postabortion family planning significantly decreased the postabortion pregnancy rate. Theuse of an IUD was the preferred immediate method of choice. Use of injectable monthly contraceptives was the method with the highest drop-out rate. The expulsion rate of postabortion IUDs was acceptablein our practice. The pregnancy rate in the control group was lower than the physiological fecundity would predict. This may suggest that, although couples plan to get pregnant, they do not concentrate onthe ideal conditions for conception or they do, in fact, practice some form of family planning.

Risk of breast cancer in relation to the use of injectable progestogen contraceptives and combined estrogen/progestogen contraceptives.

Recent studies have suggested that progestogen-only contraceptives and combined estrogen/progestogen oral contraceptives (COCs) may increase the risk of breast cancer among women less than 35 years of age or among recent users. The authors conducted a case-control study, in which cases of breast cancer (n = 484) [corrected] and controls (n = 1,625) hospitalized for conditions unrelated to contraceptive use were interviewed from 1994 to 1997 in hospitals in greater Cape Town, South Africa. The women were aged 20-54 years, resided in a defined area around Cape Town, and were Black or of mixed racial descent. The relative risk for exposure to injectable progestogen contraceptives (IPCs), mostly depot medroxyprogesterone acetate, was 0.9 (95% confidence interval (CI) 0.7, 1.2). There were no consistent associations within categories of age or recency or duration of use. For exposure to COCs, the overall relative risk was 1.2 (95% CI 1.0, 1.5). Among women below age 35 years, the relative risk was 1.7 (95% CI 1.0, 3.0), and it was unrelated to the duration or recency of use. The findings suggest that IPCs do not increase the risk of breast cancer, and that COCs may increase the risk among women below age 35 years, although bias cannot be excluded.

Cardiovascular disease and use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives: Results of an international, multicenter, case-control study

This report describes the first study to evaluate the risks of cardiovascular disease (CVD) associated with the use of oral and injectable progestogen-only and combined injectable contraceptives. Based on combined data from Africa, Asia, Europe, and Latin America collected in the World Health Organization (WHO) Collaborative Study, odds ratios (OR) for CVD combined, strokes, venous thromboembolism (VTE), and acute myocardial infarction (AMI) were calculated. Among 3697 CVD cases (59% stroke, 31% VTE, and 10% AMI), 53, 37, and 13 women, respectively, were current users of oral and injectable progestogen-only and combined injectable contraceptives. Overall, the adjusted OR for all CVD combined compared with nonusers of any type of steroid hormone contraceptive (SHC) associated with current use of oral and injectable progestogen-only contraceptives and combined injectable contraceptives, respectively, were 1.14 (95%CI: 0.79–1.63), 1.02 (0.68–1.54), and 0.95 (0.49–1.86). No significant changes in OR were apparent for strokes, VTE, or AMI in association with any of these types of contraception. However, a small, nonsignificant increase in OR for VTE was apparent in association with oral and injectable progestogen-only contraceptives. Among women with a history of hypertension, OR for stroke, as compared with that for nonusers of any type of SHC with no history of hypertension, rose from 7.2 (6.1–8.5) among nonusers of any type of SHC to 12.4 (4.1–37.6) among current users of all oral progestogens. Although limited by the small number of cases and control subjects using the types of contraceptives under investigation, these data suggest that there is little or no increased risk of stroke, VTE, or AMI associated with the use of oral or injectable progestogen-only or combined injectable contraceptives. However, further investigation into a possible adverse effect on stroke risk of progestogen-only contraceptives used by women with a history of high blood pressure are indicated.

Current status of injectable hormonal contraception, with special reference to the monthly method.

Injectable contraceptives are a valid option in every family planning program. Contraceptives which are administered every 2 or 3 months, containing only progestogen agents (DepoProvera, Noristerat) have proven efficacious and do not show long-term safety problems. They differ from other contraceptives in their long lasting action and by not presenting the contraindications of the estrogens. Their most prominent side-effect is the irregularity of cyclic bleeding. Although bleeding irregularities are not life threatening, many users stop the treatment for that reason. Monthly contraceptives comprising progestogens and estrogens, maintain or improve the high efficacy of the earlier forms and have the added benefit of allowing bleeding to resemble the physiologic one. This increases acceptability and the continuation rate. There is no long-term inconvenience. At this point, the greatest experience is with the formulation known as Topasel or Perlutal. Other formulations (Cyclofem, Mesigyna) are beginning to be commercialized and their characteristics must still be confirmed through daily use. Indications, contraindications, precautions and warnings for the use of monthly injectable contraceptives are basically identical to those of the combined oral contraceptives, as are the side-effects. Efficacy, though, proves to be superior, which can be correlated to a simpler method of use and less risk of error when using it. Main motivation factors are: efficacy, simplicity in usage, reversibility and confidentiality.

Determinants of HIV Infection among Female Commercial Sex Workers in Northeastern Thailand: Results from a Longitudinal Study

Our objective was to estimate HIV seroconversion rates among commercial sex workers (CSWs) between 1990 and 1991 and to identify the behavioral, demographic, and reproductive determinants of these rates. This study has a prospective (n = 240 with 15 cases) and a cross-sectional component (n = 271 with 34 cases). In November 1990, HIV-negative female CSWs from 24 brothels in Khon Kaen city were interviewed and were followed prospectively for up to 1 year. In March, June, and September 1991, additional HIV-negative CSWs were enrolled and prospectively followed. HIV seroconversion rates were calculated, and the Cox regression model was used to estimate the relative risks of HIV seroconversion from demographic, sexual practice, and reproductive factors, adjusted for the effects of the others, among 232 of the 240 without missing data. Seroprevalence rates were also calculated for the 271 participants enrolled between March and December 1991, and relative risks of HIV seroprevalence were calculated for demographic, sexual practice, and reproductive risk factors among 184 of the 271 without missing data. The average seroprevalence was 12.5% (95% confidence interval 9.6-15.4%). With 1,947 person-months of observation obtained from 240 participants who were uninfected at baseline and seen at least twice during the course of the study, the cumulative incidence of HIV seroconversion between November 1990 and December 1991 was 9.4% (95% confidence interval 5.4-13.4%), and the average incidence rate of HIV seroconversion was 9.2 per 100 person-years (95% confidence interval 4.6-13.9 per 100 person-years). In the multivariate analysis, later date of enrollment into the study, having < 3 months experience as a CSW, and use of injectable contraceptives were the only risk factors that remained significant, with relative risks of 2.1 (95% confidence interval 1.2-3.7) for enrollment 3 months later, 3.8 (95% confidence interval 1.0-14.4) for < 3 months experience as a CSW versus > 3 months experience, and 3.9 (95% confidence interval 1.3-11.8) [corrected] for use of injectable contraceptives. In multivariate analysis of the cross-sectional data with 184 participants, of whom 21 were HIV seropositive, risk of HIV seropositivity increased significantly with current syphilis infection (odds ratio 5.8, 95% confidence interval 1.1-31.0). The results of this study will contribute to a better understanding of the risk factors of infection with HIV and thus allow for better targeting of group-specific interventions, particularly for CSWs and their clients. Further investigation of a possible association between injectable contraceptive use and HIV infection is needed.

Adolescent knowledge and use of injectable contraceptives in developing countries

To review recent survey data on knowledge and use of injectable contraceptives among adolescents and young women in developing countries. The proportion of adolescents who are aware of this method, who have ever used it, and who are currently using the method, are described. Use of the injection is compared to overall use of any method, as well as to use of two other specific methods, the contraceptive pill and the condom. The data reported here come from a series of nationally representative surveys carried out in 25 developing countries, in the mid to late 1980s, as part of the Demographic and Health Surveys (DHS) project. These are surveys of 5,000-10,000 women aged 15-49 years that obtain information on whether women have heard about each specific method, as well as on ever-use and current use of contraception. The data presented here are compiled from published sources, and focus on currently married young women (15-24 year olds), and adolescents (15-19 year olds). Although the injection is recognized by a moderately high proportion of young women and adolescents (40-70% in most countries), use of this method is extremely low in almost all countries. The exceptions, based on DHS data, are 3 Asian countries (Indonesia, Sri Lanka and Thailand) and to a lesser extent, two Latin American countries (Colombia and Mexico). Other countries with moderately high levels of use of Depo-Provera, based on other sources, are China, Jamaica and New Zealand. However, apart from these few countries, when adolescents and young women do choose to use contraception, it is the pill that they are much more likely to choose. Problems of availability of supplies of the injection may explain some of the observed variation in levels of use of this method. Supplies are mostly provided by international donor agencies such as United Nations Fund for Population Activities and International Planned Parenthood Federation. The lack of approval of the method by the United States until recently also probably had a negative effect on the likelihood of some other governments approving this method or promoting it. Now, with the approval of the United States, supplies may become more available and there may be a greater willingness to use Depo-Provera and other injectables in the developing countries.

Risk factors of HIV-1 infection among female prostitutes in Khon Kaen, Northeast Thailand.

HIV infection has increased to epidemic proportions in Thailand since 1987. There have been separate epidemics among population groups at high risk of infection and significant increases in different localities. The northeast region of Thailand has been affected by the epidemic since early 1989. The purpose of this study was to identify factors associated with HIV transmission among prostitutes during an early phase of the epidemic in the regional center of Khon Kaen. Three hundred and fifty-six prostitutes known to work in the urban area of Khon Kaen (Ampur Muang) in November 1990 were included in the study. Prostitutes were divided into two groups according to the type of place where they worked: direct prostitutes (in brothels, n = 217) and indirect prostitutes (in massage parlors, n = 139). The prevalence of HIV infection was found to be 12% among direct prostitutes and 2% among indirect prostitutes. Four variables were significantly associated with HIV infection after adjusting for confounders by logistic regression analysis: previous work in an area of high HIV prevalence, working in Khon Kaen less than one month, a low price charged for sex and using injectable contraceptives. Follow-up investigations are currently being carried out to explore in detail the association between the use of injectable contraceptives and HIV infection.

Contraceptive Prescribing Practices of Family Planning Centers in Ile-de-France

A study of the prescription of three medical contraceptive methods (the pill, the intrauterine device and injectable contraceptives) was carried out between 1986 and 1988 on 1,035 women in 13 family planning centers and a maternity hospital in a département of the Paris region. Analysis of sociodemographic and economic factors, medical criteria for prescription, and circumstances in which a method was prescribed revealed the major characteristics of contraceptive use in one region of France: massive use of the pill and the IUD, especially of the pill among very young women, and low but not negligible use of injectable contraceptives, especially among immigrant women.

Return to ovulation following the use of long-acting injectable contraceptives: A comparative study

A comparative study was undertaken in twenty-four Mexican women who discontinued the use of depo-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) to assess the time required for the return to menses and ovulation. All subjects were exposed to long-acting injectable contraceptives for at least one year, and were followed prospectively. Serum progesterone levels were determined weekly in all subjects beginning 3 months after the last progestogen injection. Mean time to return to ovulation occurred significantly earlier (p < 0.001) after NET-EN (2.6 months) as compared with DMPA (5.5 months). No correlation between the return to ovarian function and the duration of steroid exposure was found. The overall data was interpreted as demonstrating a clear-cut difference between the two long-acting progestogens in terms of ovulation suppression.

Thailand's Reproductive Revolution: An Update

A comparison of the results of the 1981 Contraceptive Prevalence Survey with those of a similar survey carried out in 1978-1979 shows that the proportion of currently married Thai women who are practicing contraception has continued to rise and is now approaching 60%. Nearly all segments of Thai society have participated in this increase; rural/urban and educational differentials are modest and even among rural women with fewer than 4 years of education more than half report that they are currently using contraceptives. Important regional differences remain however; southern Thailand particularly lags behind the other regions. Increases in contraceptive prevalence have resulted largely from greater use of female sterilization and to a lesser extent from increased use of injectable contraceptives. The pill remains the method most commonly employed but by 1981 it was only slightly more popular than female sterilization. Pill users represent slightly more than 33% of all women using contraceptives; sterilized women constitute slightly less than 33%. Government outlets of the Ministry of Public Health are by far the most important suppliers of contraceptive services. Fertility rates among currently married women in the year prior to the survey were slightly higher among 1981 respondents than among those interviewed in 1978-1979. However the proportion of respondents reporting that they were currently pregnant declined between surveys; the average length of the interval since a womens last live birth increased. Both of these findings suggest that Thai fertility may have actually declined between surveys and that regional fertility differences are diminishing. The average expected family size has decreased to 3.3 children. Among women married less than 5 years only 2.4 children are wanted. A 2-child family appears to represent a lower limit on any further decline in fertility that might occur in the immediate future. Family size preferences vary with the sex distribution of children already born. (authors modified) (summaries in ENG FRE)

The clinical use of monthly injectable contraceptive preparations.

The clinical use of monthly injectable contraceptive preparations is reviewed. The preparations include estrogen-progestogen combinations progestogen only and estrogen only. Clinical trials of monthly injectables were done with: 1) Deladroxate - 150 mg dihydroxyprogesterone (Algestone) acetophenide (DHPA) + 10 mg estradiol enanthate (EE) in 1 ml oil: 2) Cycle-Provera - depot medroxyprogesterone acetophenide + 10 mg estradiol-3- Benzoate 17beta butyrate; acetate (DMPA) + estradiol cypionate; 3) Unimens - 150 mg 16-17 dihydroxyprogesterone 4) Gravibinon - 250 mg 17alpha-OH progesterone (250 mg) caproate + 5 mg estradiol valerate; 5) 50-70 norethisterone enanthate (Net En) and 5-10 mg estradiol unducelate; 6) 25 mg norgestrel and 5 mg estradiol hexahydrobenzoate; 7) Czechoslovakian injectables; 8) progestogen-only preparations; and 9) estrogen only. The rate of continuation with the use of injectable contraceptives compares favorably with that of IUDs and pills. Most studies show a carryover cumulative effect to subsequent cycles. There is a tendency toward a significant dropout rate following 12 months of use and a delay in return to fertility. The main advantage of monthly injectables is a better cycle control that with the ones used for longer periods.

Antifertility agents.

Studies of the toxicity of oral contraceptives are continually going on. Areas of special note include liver function, neurological syndromes, impaired subsequent fertility following discontinuance of use, cerebral artery occlusion, erythema nodosum and vulvo-vaginal candidiasis. At the time of this report, none of these relationships had been proven. Studies of the mechanism of action, acceptability of oral contraceptives and lowered dosage forms are briefly mentioned. A potential exists for the use of injectable contraceptives. The continued usefulness of IUDs is noted by a variety of published papers.