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Teaima MH, Eltabeeb MA, El-Nabarawi MA, Abdellatif MM. Utilization of propranolol hydrochloride mucoadhesive invasomes as a locally acting contraceptive: in-vitro, ex-vivo, and in-vivo evaluation. Drug Deliv 2022; 29:2549-2560. [PMID: 35912869 PMCID: PMC9347470 DOI: 10.1080/10717544.2022.2100514] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
It was found that propranolol hydrochloride (PNL), which is a beta-blocker used for hypertension treatment, has a potent spermicidal activity through local anesthetic activity or beta-blocking effect on sperm cells subsequently it could be used as a contraceptive remedy. This study aimed to entrap PNL into invasomes (INVs) and then formulate it as a locally acting contraceptive gel. PNL-loaded mucoadhesive INVs were prepared via the thin-film hydration technique. The D-optimal design was utilized to fabricate INVs employing lipid concentration (X1), terpenes concentration (X2), terpenes type (X3), and chitosan concentration (X4) as independent variables, while their impact was observed for entrapment efficiency percent (Y1; EE%), particle size (Y2; PS), zeta potential (Y3; ZP), and amount of drug released after 6 h (Y4; Q6h). Design Expert® was bestowed to nominate the desired formula. The selected INV was subjected to further studies and formulated into a mucoadhesive gel for ex-vivo and in-vivo investigations. The optimum INV showed a spherical shape with EE% of 65.01 ± 1.24%, PS of 243.75 ± 8.13 nm, PDI of 0.203 ± 0.01, ZP of 49.80 ± 0.42 mV, and Q6h of 53.16 ± 0.73%. Differential scanning calorimetry study asserted the capability of INVs to entrap PNL. Permeation studies confirmed the desired sustained effect of PNL-loaded INVs-gel compared to PNL-gel, INVs, and PNL solution. Sperm motility assay proved the potency of INVs-gel to inhibit sperm motility. Besides, the histopathological investigation verified the tolerability of the prepared INVs-gel. Taken together, the gained data justified the efficacy of PNL-loaded INVs-gel as a potential locally acting contraceptive.
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Affiliation(s)
- Mahmoud H Teaima
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo, Egypt
| | - Moaz A Eltabeeb
- Department of Industrial Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt
| | - Mohamed A El-Nabarawi
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo, Egypt
| | - Menna M Abdellatif
- Department of Industrial Pharmacy, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, Giza, Egypt
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Rafferty J. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics 2018; 142:e20182162. [PMID: 30224363 DOI: 10.1542/peds.2018-2162] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.
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Contraceptive, condom and dual method use at last coitus among perinatally and horizontally HIV-infected young women in Atlanta, Georgia. PLoS One 2018; 13:e0202946. [PMID: 30208062 PMCID: PMC6135381 DOI: 10.1371/journal.pone.0202946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 08/13/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate factors within the social-ecological framework associated with most or moderately effective contraception, condom and dual method use at last coitus among young, HIV-infected women in Atlanta. Methods This is a cross-sectional study conducted from November, 2013 until August, 2015 at the Grady Infectious Disease Clinic in Atlanta, Georgia. We recruited perinatally and horizontally HIV-infected women of ages 14–30 years to complete an audio computer-assisted self-interview. We evaluated factors within a social-ecological framework associated with most or moderately effective contraceptive use (hormonal contraception or an IUD), condom use, and dual method use (use of condom and most or moderately effective contraceptive) at last coitus. Results Of 103 women enrolled, 74 reported a history of sexual activity. The average age was 22.1; 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At last coitus, 46% reported most or moderately effective contraception, 62% reported condom use and 27% reporting dual-method use. The odds of most or moderately effective contraceptive use was significantly reduced among those with detectable viral loads (versus undetectable viral loads; aOR 0.13 [0.04, 0.38]). Older age (aOR 0.85 [0.74, 0.98] and more frequent coitus (>once/week versus < = once/week; aOR 0.24 [0.08, 0.72]) was significantly associated with reduced condom use. Having a detectable viral load (versus undetectable viral loads; aOR 0.13 [0.03, 0.69]) and more frequent coitus (>once/week versus < = once/week; aOR 0.14 [0.03,0.82]), was associated with reduced dual method use, while being enrolled in school (aOR 5.63 [1.53, 20.71]) was significantly associated with increased dual method use. Conclusions Most or moderately effective contraception, condom and dual method use remained inadequate in this cohort of young HIV-infected women. Individual-level interventions are needed to increase the uptake of dual methods with user-independent contraceptives.
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Haddad LB, Polis CB, Sheth AN, Brown J, Kourtis AP, King C, Chakraborty R, Ofotokun I. Contraceptive methods and risk of HIV acquisition or female-to-male transmission. Curr HIV/AIDS Rep 2014; 11:447-58. [PMID: 25297973 PMCID: PMC4310558 DOI: 10.1007/s11904-014-0236-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.
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Affiliation(s)
- Lisa B Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA,
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Rashed AN, Hsia Y, Wilton L, Ziller M, Kostev K, Tomlin S. Trends and patterns of hormonal contraceptive prescribing for adolescents in primary care in the U.K. ACTA ACUST UNITED AC 2014; 41:216-22. [PMID: 25398724 DOI: 10.1136/jfprhc-2013-100724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hormonal contraceptives are the most common method used worldwide by teenagers to prevent unwanted pregnancies. To date there are limited data about such use by teenagers in the UK. This study investigated trends and patterns of hormonal contraceptive prescribing to adolescents aged 12-18 years in UK primary care between 2002 and 2011. METHODS A retrospective cohort study using the IMS Disease Analyzer database was conducted. All females aged 12-18 years with ≥1 prescription for a contraceptive drug between 1 January 2002 and 31 December 2011 were included. Annual prevalence of contraceptive drug prescribing was calculated, and indications for prescribing, and types of contraceptive drug prescribed, were examined. RESULTS In 2002, 13.7% (6135/44 532) of female adolescents received prescriptions for hormonal contraceptives, compared to 19.0% (6597/34 676) in 2011. The majority of female adolescents [2002: 76.2% (4676/6135); 2011: 65.7% (4334/6597)] received a contraceptive drug for 'contraceptive management'. The combined oral contraceptive (COC), 'progestogen+estrogen', was the most commonly prescribed. Although use of progestogen-only contraceptives was lower than COCs, the number of patients who received desogestrel pills and etonogestrel implants increased during the study period; levonorgestrel pill use declined. Only one injectable progestogen, long-acting depot medroxyprogesterone acetate, was prescribed. CONCLUSIONS Use of hormonal contraceptives among adolescents increased between 2002 and 2011, and COC usage was dominant. The increasing use of hormonal contraceptives in adolescents, especially in younger adolescents, warrants further investigation, including research into the long-term safety of these medicines in this age group.
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Affiliation(s)
- Asia N Rashed
- Research Associate, Institute of Pharmaceutical Science, King's College London, King's Health Partners, London and Honorary Research Pharmacist, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Yingfen Hsia
- Research Fellow, University College London, School of Pharmacy, London, UK and Research Fellow, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Lynda Wilton
- Honorary Research Consultant, University College London, School of Pharmacy, London, UK
| | - May Ziller
- Gynaecologist, Department of Gynaecology, University Hospital of Giessen and Marburg GmbH, Marburg, Germany
| | - Karel Kostev
- Research Consultant, IMS HEALTH Epidemiology, Frankfurt, Germany
| | - Stephen Tomlin
- Honorary Clinical Reader, Institute of Pharmaceutical Science, King's College London, King's Health Partners, London and Consultant Pharmacist, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Ziller M, Rashed AN, Ziller V, Kostev K. The prescribing of contraceptives for adolescents in German gynecologic practices in 2007 and 2011: a retrospective database analysis. J Pediatr Adolesc Gynecol 2013; 26:261-4. [PMID: 24012127 DOI: 10.1016/j.jpag.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/29/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the prescribing trend of contraceptives in adolescent girls aged 12-18 years and to compare prescribing patterns of the most frequently used contraceptives among this population in Germany in 2007 and 2011. METHODS A retrospective cohort study was conducted to analyze contraceptive prescriptions written by gynecologists in 2007 and 2011 in Germany by using the IMS Disease Analyzer database (IMS HEALTH). All adolescent girls aged 12-18 years with at least 1 prescription of a contraceptive drug in 2007 or 2011 were identified. The prevalence of contraceptive prescriptions was calculated and the types of contraceptive substances prescribed were examined. RESULTS A total of 21,026 teenage girls in 2007 and 18,969 in 2011 received contraceptive prescriptions. The prevalence of contraceptive prescribing rose significantly between 2007 and 2011 (P < .001). The percentage of teen girls who received prescriptions of levonorgestrel and chlormadinone pills was significantly higher in 2011 compared to 2007 (P < .001). However, the portion of contraceptive pills containing drospirenone or desogestrel significantly decreased in 2011 compared to 2007 (P < .01). CONCLUSION There was a significant increase in contraceptive prescription usage among adolescent girls between 2007 and 2011 in Germany. However, the prescription behavior of doctors also changed; they consequently prescribed contraceptives with more evidence. Further research is needed to better understand the various factors associated with contraceptive use among this population.
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Affiliation(s)
- M Ziller
- Gyn. Praxis Eichler/Ziller Medizin Marburg Mitte, Marburg, Germany
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7
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Laurence V, Rousset-Jablonski C. Contraception and Cancer Treatment in Young Persons. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:41-60. [DOI: 10.1007/978-94-007-2492-1_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Multiple method contraception use among African American adolescents in four US cities. Infect Dis Obstet Gynecol 2011; 2011:765917. [PMID: 21785557 PMCID: PMC3139861 DOI: 10.1155/2011/765917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 06/10/2011] [Indexed: 11/18/2022] Open
Abstract
We report on African American adolescents' (N = 850; M age = 15.4) contraceptive practices and type of contraception utilized during their last sexual encounter. Respondents completed measures of demographics, contraceptive use, sexual partner type, and ability to select "safe" sexual partners. 40% endorsed use of dual or multiple contraceptive methods; a total of 35 different contraceptive combinations were reported. Perceived ability to select "safe" partners was associated with not using contraception (OR = 1.25), using less effective contraceptive methods (OR = 1.23), or hormonal birth control (OR = 1.50). Female gender predicted hormonal birth control use (OR = 2.33), use of less effective contraceptive methods (e.g., withdrawal; OR = 2.47), and using no contraception (OR = 2.37). Respondents' age and partner type did not predict contraception use. Adolescents used contraceptive methods with limited ability to prevent both unintended pregnancies and STD/HIV. Adolescents who believed their partners posed low risk were more likely to use contraceptive practices other than condoms or no contraception. Reproductive health practitioners are encouraged to help youth negotiate contraceptive use with partners, regardless of the partner's perceived riskiness.
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Greydanus DE, Omar H, Pratt HD. The adolescent female athlete: current concepts and conundrums. Pediatr Clin North Am 2010; 57:697-718. [PMID: 20538152 DOI: 10.1016/j.pcl.2010.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The adolescent female athlete has become a common part of the sports environment at all levels from childhood play to professional adult sports. This article considers various issues common to this athlete to help clinicians care for their patients. Basic sports physiology is reviewed and then specific conditions are considered, including iron deficiency anemia, stress urinary incontinence, breast issues (ie, pain, asymmetry, galactorrhea, injury), the female athlete triad (ie, menstrual dysfunction, abnormal eating patterns, and osteopenia or osteoporosis), and injuries. Clinical conundrums are considered including the difficulty in caring for a dedicated athlete whose intense love of her sport may lead to menstrual and bone loss complications. The knowledgeable clinician in the twenty-first century can be of considerable help to the female athlete who is at and beyond puberty.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatrics & Human Development, Michigan State University College of Human Medicine, Kalamazoo, MI 49008-1284, USA.
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10
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Abstract
Introduction. Because of their safety and efficacy, oral contraceptives are
available without prescription in many countries. Monophasic combined oral
contraceptives are a combination of estrogen and progestin taken in constant
amounts. Venous thromboembolism. Combined oral contraceptives slightly
increase the risk of venous thromboemolism, but this event is very rare among
non-pregnant women of reproductive age. The absolute risk rises with age,
obesity, recent surgery and certain forms of thrombophilia. The estrogen
component of combined oral contraceptives increases the synthesis of several
coagulation factors in a dose-dependent manner. Changes of most of these
parameters are very small and there is no evidence that they have any effect
upon the clinical risk of developing venous thrombosis. If a woman has an
inherited coagulation disorder that increases her risk of developing
thrombosis, the risk is increased several fold if she ingests estrogen
containing oral contraception. Conclusion. The increased risk of venous
thromboembolism associated with combined oral contraceptives should have
little impact on healthy women, but may have substantial impact on women with
a history of thromboembolism. Combined oral contraceptive use increases the
risk of venous thromboembolosm in a dose-dependent manner. The absolute risk
of venous thromboembolism rises with age, obesity, recent surgery and certain
forms of thrombophilia, as well.
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Sousa MCRD, Gomes KRO. Conhecimento objetivo e percebido sobre contraceptivos hormonais orais entre adolescentes com antecedentes gestacionais. CAD SAUDE PUBLICA 2009; 25:645-54. [DOI: 10.1590/s0102-311x2009000300019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022] Open
Abstract
A elevada freqüência de gestação precoce no Brasil e, particularmente, em Teresina (21,5%), Piauí, motivou o presente estudo, cuja meta foi identificar os níveis de conhecimento objetivo e percebido sobre contraceptivos hormonais orais, bem como variáveis reprodutivas e sócio-demográficas preditoras de elevado conhecimento. Realizou-se estudo transversal com 278 adolescentes com idade de 15 a 19 anos de idade, com antecedentes reprodutivos, internadas em quatro maternidades de Teresina, em 2006. Regressão logística foi a base da análise estatística. Quase 98% das adolescentes apresentaram baixo conhecimento tanto objetivo quanto percebido. Apenas o maior número de gestações foi preditor de elevado conhecimento objetivo para anticoncepcionais orais. Os baixos níveis de conhecimento objetivo e percebido das adolescentes sobre o uso de anticoncepcionais orais revelam a suscetibilidade das jovens ao comportamento sexual de risco. Sugere-se a utilização de abordagem mais interativa com os adolescentes para elevar o nível de conhecimento tanto objetivo quanto percebido deles, e assim reduzir a incidência e reincidência da gravidez indesejada na adolescência e suas conseqüências negativas na vida destas jovens e de sua prole.
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Heavey EJ, Moysich KB, Hyland A, Druschel CM, Sill MW. Differences in contraceptive choice among female adolescents at a state-funded family planning clinic. J Midwifery Womens Health 2008; 53:45-52. [PMID: 18164433 DOI: 10.1016/j.jmwh.2007.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Our objective was to examine differences in contraceptive choice among female adolescents from low socioeconomic backgrounds both before and after an appointment for reproductive health care at a community-based, state-funded, family planning clinic. This study utilized data collected from 4237 charts from young women attending a family planning clinic. Logistic regression was utilized to examine variables associated with the following main questions: (1) the selection of use or nonuse of contraception; (2) the selection of barrier versus hormonal contraception; and (3) within those who selected hormonal contraception, the preference for injectable versus oral hormonal methods. We found that race, age, school status, and type of health insurance were all associated with contraceptive decision-making among female adolescents. Some but not all of these associations remained after the clinic visit, which included no-cost contraception.
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Affiliation(s)
- Erica Monasterio
- Division of Adolescent Medicine, Department of Pediatrics, University of California, San Francisco, California, USA
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14
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Contracepción en la adolescencia. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73888-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Adolescents, due to the lack of knowledge, experience, and counseling, may confront serious social and health-related problems, such as out-of-wedlock pregnancies and sexually transmitted diseases (STDs). The age of the first sexual intercourse has declined recently. Unintended pregnancies often force adolescents into unwanted marriage or limit their opportunities to further education or employment while predisposing them to long-term welfare dependence. To be most effective, sex education programs should be developed through a process of collaboration between families, health care professionals, educators, government officials, and youth themselves. The contraceptive choices during adolescence are the male condom, the use of spermicides, combined oral contraceptives (COCs), the depomedroxyprogesterone acetate (DMPA), the female condom, the vaginal sponge, implants and patches, male hormonal contraception, and others. Issues of emergency contraception (EC) are also discussed.
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Affiliation(s)
- Efthimios Deligeoroglou
- 2nd Department of Obstetrics and Gynecology, University of Athens, Medical School, Aretaieion Hospital, Athens, Greece
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Abstract
With the rates of unintended pregnancies in teenagers remaining high, it is crucial to present adolescents with all of the contraceptive options available to them. While barrier methods, for example, male condoms, are easily accessible and do not have adverse effects, their use must be consistent and correct with each act of intercourse. Hormonal contraception affords much better efficacy in preventing pregnancy when used with full compliance. Oral contraceptives are a popular method of contraception among adolescents and offer many non-contraceptive benefits along with the prevention of pregnancy. They have very few significant adverse effects, which are outweighed by the significant morbidity associated with teenage pregnancies, and can be used by most adolescent females. However, their minor bothersome effects do contribute to the high discontinuation rates seen. In addition, many girls find it difficult to remember to take a pill every day, leading to higher failure rates in teenagers than in adult women. The advent of long-acting, progestogen (progestin)-only methods, such as injectables and implantables, has been generally accepted by adolescents and these methods have proven to be more efficacious by avoiding the need for daily compliance. However, progestogen-only methods cause irregular bleeding and amenorrhea, which is not acceptable to many teenagers. In addition, the most widely used implant was taken off the market a few years ago and newer forms are not yet widely accessible. Other novel methods are currently available, including the transdermal patch and the vaginal ring. Both are combinations of estrogen and progestogen and have similar efficacy and adverse effect profiles to oral contraceptives. Their use may be associated with greater compliance by adolescents because they also do not require adherence to a daily regimen. However, there may be some drawbacks with these newer methods, for example, visibility of the patch and difficulty with insertion of the vaginal ring. When regular contraceptive modalities fail, emergency contraception is available. Choices include combination oral contraceptives, progestogen-only pills, mifepristone, or placement of a copper-releasing intrauterine device. These methods can be very useful for preventing pregnancy in adolescents as long as adolescents are aware of their existence and have easy access to them.
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Affiliation(s)
- Rollyn M Ornstein
- Division of Adolescent Medicine, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
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Abstract
Despite recent improvements in rates of teen pregnancy, abortion, birth,and contraceptive use, effective contraceptive counseling for adolescents should be a high priority for the primary care provider in the office setting. Adolescent psychosocial risk screening and appropriate counseling about sexual decision-making is necessary. Contraceptive services visits include, relevant history, limited physical examination, provision of information, anticipatory guidance about sexual behaviors, and the provision of contraceptive methods. Teens should always be encouraged to use a male condom during sex to reduce STI risk. A variety of barrier and hormonal contraceptive methods are available for the adolescent population. Education about and provision of EC is effective in reducing the rate of unintended pregnancy and abortion in the United States. Contraceptive care for adolescents is a rewarding experience for primary care providers.
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Affiliation(s)
- Elizabeth Feldman
- Department of Family Medicine, University of Illinois at Chicago, USA.
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Laurence V, Gbolade BA, Morgan SJ, Glaser A. Contraception for teenagers and young adults with cancer. Eur J Cancer 2005; 40:2705-16. [PMID: 15571952 DOI: 10.1016/j.ejca.2004.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 08/20/2004] [Accepted: 09/02/2004] [Indexed: 11/16/2022]
Abstract
Adolescence can be an extremely stressful time for all concerned. When this period is then compounded by the development of cancer, formidable and seemingly insurmountable problems may be perceived. Cancer in adolescence is relatively uncommon, with an annual incidence rate in western populations of approximately 150-200 per million. Five-year survival of patients diagnosed around 1990 exceeded 70% in the United Kingdom (UK) and United States of America (USA), and adolescents with cancer are likely to remain fertile. Further advances in therapeutic modalities are creating a generation of adolescents and young adults with cancer who can now aspire to the same sexual and reproductive activities as their healthy peers. This then raises the issue of avoidance of undesired pregnancy during and after treatment. This article aims to address the contraceptive needs of adolescents and young adults undergoing treatment for cancer.
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Affiliation(s)
- V Laurence
- Yorkshire Regional Centre for Paediatric Oncology & Haematology, St. James's University Hospital, Leeds, UK.
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Abstract
An important issue for human beings is the acquisition of normal sexual health, including the understanding and application of reproductive health when needed. Comprehensive sexuality education is not a topic provided to many children, adolescents, or college students in the United States, however. Students who were sexually active in high school may continue to be at risk for unwanted pregnancies and sexually transmitted diseases in their college life; those who chose abstinence in high school may abandon this concept in college, choosing coital behavior at all levels of university life-freshman through graduate levels. Most American college students are sexually active and many have multiple partners. This article reviews current contraceptive methods available to college students. College health providers and pediatricians are urged to be vigilant about the reproductive health needs of the college students they serve.
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Affiliation(s)
- Donald E Greydanus
- Sindecuse Health Center, Western Michigan University, Kalamazoo, MI, USA.
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Koubovec D, Vanden Berghe W, Vermeulen L, Haegeman G, Hapgood JP. Medroxyprogesterone acetate downregulates cytokine gene expression in mouse fibroblast cells. Mol Cell Endocrinol 2004; 221:75-85. [PMID: 15223134 DOI: 10.1016/j.mce.2004.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2003] [Revised: 02/25/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022]
Abstract
Although medroxyprogesterone acetate (MPA) is used as an injectable contraceptive, in hormone replacement therapy (HRT) and in treatment of certain cancers, the steroid receptors and their target genes involved in the actions of MPA are not well understood. We show that MPA, like dexamethasone (dex), significantly represses tumour necrosis factor (TNF)-stimulated interleukin-6 (IL-6) protein production in mouse fibroblast (L929sA) cells. In addition, MPA repressed IL-6 and IL-8 promoter-reporter constructs at the transcriptional level, via interference with nuclear factor kappaB (NFkappaB) and activator protein-1 (AP-1). Furthermore, like dex, MPA does not affect NFkappaB DNA-binding activity. We also observed significant transactivation by MPA of a glucocorticoid response element (GRE)-driven promoter-reporter construct in both L929sA and COS-1 cells. The MPA-induced nuclear translocation of the glucocorticoid receptor (GR), as well as the antagonistic effects of RU486, strongly suggest that the actions of MPA in these cells are mediated at least in part via the GR.
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Affiliation(s)
- Dominique Koubovec
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa
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Black A, Francoeur D, Rowe T, Collins J, Miller D, Brown T, David M, Dunn S, Fisher WA, Fleming N, Fortin CA, Guilbert E, Hanvey L, Lalonde A, Miller R, Morris M, O'Grady T, Pymar H, Smith T, Henneberg E. Canadian Contraception Consensus. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:347-87, 389-436. [PMID: 15115624 DOI: 10.1016/s1701-2163(16)30363-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Archivée: Consensus Canadien sur la Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li CFI, Lee SSN, Pun TC. A pilot study on the acceptability of levonorgestrel-releasing intrauterine device by young, single, nulliparous Chinese females following surgical abortion. Contraception 2004; 69:247-50. [PMID: 14969674 DOI: 10.1016/j.contraception.2003.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 10/13/2003] [Indexed: 11/26/2022]
Abstract
This study investigated the acceptability of the levonorgestrel-releasing intrauterine device (LNG-IUS) as contraception among young, single women after termination of pregnancy. Twenty subjects, with a median age of 21 years, had LNG-IUS inserted immediately after suction termination of first-trimester pregnancy. The subjects were followed-up at 6 weeks, 3 months, 6 months and 12 months. Fifteen subjects (75%) had other pregnancies terminated in the past. There were no serious complications or pregnancies. The acceptability of the LNG-IUS was generally above 86% during each follow-up visit. A total of seven (35%) subjects were lost to follow-up at different periods of the study. Overall, four subjects (22%) had the LNG-IUS removed. Nine subjects were seen at the end of the 1-year study period and all continued with the LNG-IUS for contraception. Side effects were commonly observed and irregular vaginal bleeding was the most common. We conclude that the LNG-IUS may be an acceptable method among selective young, single, nulliparous clients after termination of pregnancy and could be offered as an option of contraception to them. However, the small sample size and the high lost-to-follow-up rate are the major limitations of this study.
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Affiliation(s)
- Chiu-fai Ivy Li
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, No. 102 Pokfulum Road, Hong Kong, China.
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Abstract
PURPOSE OF REVIEW Unintended pregnancy continues to exact a considerable economic, social and personal cost in industrialized nations despite the ready availability of safe, reliable and highly effective methods of contraception. Adolescents still demonstrate some of the highest rates of unintended pregnancy and thus may benefit from considering new contraceptive options that provide unique side effect profiles or delivery systems that could facilitate and improve compliance of contraceptive methods. RECENT FINDINGS The recent launch of several new combination oral contraceptive pills with novel side effect profiles has expanded the choices for teenagers who choose to use a daily oral contraceptive. Of potentially greater interest is the recent availability of several nondaily contraceptives, as compliance remains a critical issue with successful contraceptive use in adolescents. SUMMARY New contraceptive methods bring unique side effect profiles and delivery systems that may improve overall contraceptive compliance, especially among teenagers who are more prone to misuse from a wide array of side effect and compliance issues. Even the most accepted method, however, will not provide effective contraception if the process by which contraception is provided fails to address the unique concerns and lifestyle issues of each individual adolescent.
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Affiliation(s)
- Nikki B Zite
- Family Planning, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois 60611, USA
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Diekema DS. Involuntary sterilization of persons with mental retardation: an ethical analysis. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2003; 9:21-6. [PMID: 12587134 DOI: 10.1002/mrdd.10053] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.
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Affiliation(s)
- Douglas S Diekema
- Department of Pediatrics & Medical History and Ethics, University of Washington, Seattle, Washington, USA.
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Abstract
As the twentieth century progressed, the female athlete became an accepted participant of sports at all levels. This article reviews various aspects of female sports participation. After an historical perspective, selected comments are provided on psychologic and physiologic aspects. Concepts of adolescent gynecology are reviewed, including breast and menstrual problems and pregnancy. Other areas reviewed include iron deficiency anemia, stress urinary incontinence, and sports injuries in female athletes.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Kalamazoo, MI, USA.
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