Reason, myths and fantasies: preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea

Influence of culture on contraceptive utilization among HIV-positive women in Brazil, Kenya, and South Africa

Contraceptive choice and discontinuation are poorly understood among HIV-positive women, and HIV disease and culture may influence decisions. We assessed factors influencing contraceptive decision-making among HIV-positive women in three countries. This qualitative assessment of 108 HIV-positive women (36/site, selected by age and parity strata) was conducted in Rio de Janeiro, Brazil; Kericho, Kenya; and Soweto, South Africa. Freelist interviews assessed knowledge and attitudes towards contraception and were analyzed enumerating frequency and saliency of mentions. There was intersite consensus around list items but priority and themes varied. Site-specific factors influencing contraceptive choice were male partner wishes and fertility desire (Brazil), side-effects (South Africa), and impact on health and HIV progression (Kenya). Age, parity, and taking antiretroviral therapy (ART) impacted some themes. Contraceptive use among HIV-positive women is substantially influenced by culture and other factors. Counseling efforts should consider individual factors in method selection and offer method variety to accommodate changing needs.

Levonorgestrel-releasing intrauterine system for treating menstrual disorders: A patient satisfaction questionnaire

AIMS

To establish the continuation and satisfaction rates and the reasons for removal of the levonorgestrel-releasing intrauterine system (LNG-IUS) in Palmerston North Hospital (PNH), New Zealand.

SAMPLE AND SETTING

All women (120) who had a LNG-IUS inserted at PNH between June 1998 and June 2002 were included in the study.

METHODS

A survey questionnaire regarding bleeding patterns, side-effects and satisfaction rates relating to the device as well as reasons for premature removal, current treatment for dysfunctional uterine bleeding (DUB) and contraception was sent to all 120 women. Seventy-eight of the 85 women who received the questionnaire (91%) responded to it. Thirty-five women were lost to follow-up and the overall response rate was 65%.

RESULTS

The LNG-IUS was prematurely removed from nine women and expulsion occurred in one case. The overall continuation rate was 87%. No women had LNG-IUS removed as a result of hormonal side-effects except for bleeding abnormalities. The overall satisfaction rate was 76%.

CONCLUSION

Levonorgestrel-releasing intrauterine system is a well-accepted and efficacious therapy for heavy menstrual bleeding. These satisfaction and premature removal rates compare favourably with international figures. The response rate to the questionnaire was reasonably high given the highly mobile nature of the studied population.