contraception Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2013;35(8):373-378
DOI 10.1590/S0100-72032013000800007
PURPOSE: To compare by transvaginal ultrasound the position of the intrauterine device (IUD) inside the uterine cavity, depending on the time of insertion, postpartum and post-abortion, and during the menstrual cycle. METHODS: Epidemiologic, observational and cross-sectional study carried out between February and July, 2013. A total of 290 women were included, 205 of them with insertion during the menstrual cycle and 85 during the postpartum and post-abortion periods. The independent variables were: age, parity, time of use, insertion time, number of returns to family planning, satisfaction with the method, wish to continue using the device, symptoms and complications. The dependent variable was the adequate position of the IUD inside the uterine cavity. The χ² test with Pearson's correction and the Fisher exact test were used for statistical analysis, with the level of significance set at 5%. RESULTS: The average age was 29.4 years and the average time of IUD use was 2.7 years; 39.3% of the women had symptoms associated with the method, the most frequent being menorrhagia (44.7%). The degree of satisfaction was 85% and 61.4% of the women returned two or more times for consultation about family planning. Age, parity and the position of the uterus in the pelvic cavity was not associated with a poor position of the IUD inside the uterine cavity (p>0.05). Insertion during the menstrual cycle was significantly more associated with a correct position of the IUD than postpartum and post-abortion insertion (p<0.028). CONCLUSION: Postpartum and post-abortion insertion showed worse results regarding the adequacy of IUD position, a fact that was not observed regarding age, parity or position of the uterus in the pelvic cavity.
Summary
Rev Bras Ginecol Obstet. 2013;35(8):373-378
DOI 10.1590/S0100-72032013000800007
PURPOSE: To compare by transvaginal ultrasound the position of the intrauterine device (IUD) inside the uterine cavity, depending on the time of insertion, postpartum and post-abortion, and during the menstrual cycle. METHODS: Epidemiologic, observational and cross-sectional study carried out between February and July, 2013. A total of 290 women were included, 205 of them with insertion during the menstrual cycle and 85 during the postpartum and post-abortion periods. The independent variables were: age, parity, time of use, insertion time, number of returns to family planning, satisfaction with the method, wish to continue using the device, symptoms and complications. The dependent variable was the adequate position of the IUD inside the uterine cavity. The χ² test with Pearson's correction and the Fisher exact test were used for statistical analysis, with the level of significance set at 5%. RESULTS: The average age was 29.4 years and the average time of IUD use was 2.7 years; 39.3% of the women had symptoms associated with the method, the most frequent being menorrhagia (44.7%). The degree of satisfaction was 85% and 61.4% of the women returned two or more times for consultation about family planning. Age, parity and the position of the uterus in the pelvic cavity was not associated with a poor position of the IUD inside the uterine cavity (p>0.05). Insertion during the menstrual cycle was significantly more associated with a correct position of the IUD than postpartum and post-abortion insertion (p<0.028). CONCLUSION: Postpartum and post-abortion insertion showed worse results regarding the adequacy of IUD position, a fact that was not observed regarding age, parity or position of the uterus in the pelvic cavity.
Summary
Rev Bras Ginecol Obstet. 2011;33(7):143-149
DOI 10.1590/S0100-72032011000700005
PURPOSE: To determine the main contraceptive methods adopted by users of the public and private health sectors in the city of Aracaju (SE), Brazil, with a secondary focus on orientations for their use and reasons for interruption. METHODS: A cross-sectional study was conducted on 210 women, 110 from the public service and 100 from the private sector. The data were collected by applying a questionnaire to sexually active patients who agreed to sign a consent form. The software Statistical Package for Social Sciences (SPSS) version 15.0 was used for statistical analysis, with the 
test for categorical variables and the Student's t-test for independent samples. RESULTS: The overall prevalence of contraceptive use in this study was 83.3%. The main methods used in the public and private sectors, were the hormonal (41 and 24%, p=0.008) and permanent (20 and 26%, p=0.1) ones, respectively. The rate of condom use was 17.3% in the public sector and 12% in the private sector, with no significant difference (p=0.12). Medical orientation about the correct use of the method chosen and/or indicated was provided to 37.3% of users from the public sector and to 48% of users from the private sector. Discontinuation of the use of contraceptive methods was 14.5% in the public sector and 12.0% in the private sector, mainly because of side effects and the desire to become pregnant. CONCLUSIONS: The main contraceptive methods adopted by users of the public and private sectors were hormonal contraception and permanent contraception. It is important to highlights the low frequency of use of male condoms in the two groups studied.
Summary
Rev Bras Ginecol Obstet. 2011;33(7):143-149
DOI 10.1590/S0100-72032011000700005
PURPOSE: To determine the main contraceptive methods adopted by users of the public and private health sectors in the city of Aracaju (SE), Brazil, with a secondary focus on orientations for their use and reasons for interruption. METHODS: A cross-sectional study was conducted on 210 women, 110 from the public service and 100 from the private sector. The data were collected by applying a questionnaire to sexually active patients who agreed to sign a consent form. The software Statistical Package for Social Sciences (SPSS) version 15.0 was used for statistical analysis, with the test for categorical variables and the Student's t-test for independent samples. RESULTS: The overall prevalence of contraceptive use in this study was 83.3%. The main methods used in the public and private sectors, were the hormonal (41 and 24%, p=0.008) and permanent (20 and 26%, p=0.1) ones, respectively. The rate of condom use was 17.3% in the public sector and 12% in the private sector, with no significant difference (p=0.12). Medical orientation about the correct use of the method chosen and/or indicated was provided to 37.3% of users from the public sector and to 48% of users from the private sector. Discontinuation of the use of contraceptive methods was 14.5% in the public sector and 12.0% in the private sector, mainly because of side effects and the desire to become pregnant. CONCLUSIONS: The main contraceptive methods adopted by users of the public and private sectors were hormonal contraception and permanent contraception. It is important to highlights the low frequency of use of male condoms in the two groups studied.
Summary
Rev Bras Ginecol Obstet. 2011;33(6):303-309
DOI 10.1590/S0100-72032011000600007
PURPOSE: Due to the scarce information available in Brazil in relation to the number of women who initiated the use of combined oral contraceptives and prematurely discontinued, the objective was to assess the reasons for discontinuation of the use of several combined oral contraceptives among Brazilian women living in urban areas. METHODS: A cross-sectional study with 400 gynecologists registered withy the Brazilian Federation of Obstetricians and Gynecologists. Each physician interviewed 10 non-pregnant, not breastfeeding, not amenorrheic women aged 18 to 39 years who consulted requesting combined oral contraceptive (COC) with a questionnaire at the beginning of use and at six months later. The questionnaire included sociodemographic data, type of COC chosen or prescribed and reasons for discontinuation when it occurred during follow-up. The strategy of selection allowed the inclusion of women from different socioeconomic strata, however, only those attended at private or insurance offices. The sample size was estimated at 1,427 women. RESULTS: A total of 3,465 interviews were conducted at the first visit and 1,699 six months later. The women were 20 to 29 years old, 57.3% were single and an equal proportion of 45.0% attended high school or college. Most (60.7%) were nulligravidas and among those who had used some contraceptive before, 71.8% had used a COC. Among the more prescribed or chosen COC the most prevalent were monophasic with ethynil estradiol (20 µg) and regarding progestin the most prevalent was with gestodene (36.5%) followed by a COC with drosperinone (22.0%). At six months 63.5% still used COC. Among those who discontinued the main reasons were wishing to become pregnant (36.5%) and side effects (57.3%) and the most prevalent were headache (37.6%), weight gain (16.6%) and irregular bleeding (23.6%). CONCLUSIONS: The continuation rate of COC was low at six months and this study could contribute to a better counseling on the part of physicians of patients who initiate COC about side-events that are rare, minimal and temporary and about the benefits of COC use.
Summary
Rev Bras Ginecol Obstet. 2011;33(6):303-309
DOI 10.1590/S0100-72032011000600007
PURPOSE: Due to the scarce information available in Brazil in relation to the number of women who initiated the use of combined oral contraceptives and prematurely discontinued, the objective was to assess the reasons for discontinuation of the use of several combined oral contraceptives among Brazilian women living in urban areas. METHODS: A cross-sectional study with 400 gynecologists registered withy the Brazilian Federation of Obstetricians and Gynecologists. Each physician interviewed 10 non-pregnant, not breastfeeding, not amenorrheic women aged 18 to 39 years who consulted requesting combined oral contraceptive (COC) with a questionnaire at the beginning of use and at six months later. The questionnaire included sociodemographic data, type of COC chosen or prescribed and reasons for discontinuation when it occurred during follow-up. The strategy of selection allowed the inclusion of women from different socioeconomic strata, however, only those attended at private or insurance offices. The sample size was estimated at 1,427 women. RESULTS: A total of 3,465 interviews were conducted at the first visit and 1,699 six months later. The women were 20 to 29 years old, 57.3% were single and an equal proportion of 45.0% attended high school or college. Most (60.7%) were nulligravidas and among those who had used some contraceptive before, 71.8% had used a COC. Among the more prescribed or chosen COC the most prevalent were monophasic with ethynil estradiol (20 µg) and regarding progestin the most prevalent was with gestodene (36.5%) followed by a COC with drosperinone (22.0%). At six months 63.5% still used COC. Among those who discontinued the main reasons were wishing to become pregnant (36.5%) and side effects (57.3%) and the most prevalent were headache (37.6%), weight gain (16.6%) and irregular bleeding (23.6%). CONCLUSIONS: The continuation rate of COC was low at six months and this study could contribute to a better counseling on the part of physicians of patients who initiate COC about side-events that are rare, minimal and temporary and about the benefits of COC use.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):404-410
DOI 10.1590/S0100-72032009000800006
PURPOSE: to identify factors associated with gestation in adolescence in a State of the northeast of Brazil. METHODS: 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. RESULTS: 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; CI95%=1.3-3.8), age at the first intercourse lower than 15 years old (OR=3.6; CI95%=2.2-5.7), history of maternal pregnancy at adolescence (OR=2.6; CI95%=1.7-3.4). The history of previous gynecological appointments (OR=0.3; CI95%=0.2-0.4) and the use of hormonal methods (OR=0.6; CI95%=0.4-0.9) were protecting variables. CONCLUSIONS: 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.
Summary
Rev Bras Ginecol Obstet. 2009;31(8):404-410
DOI 10.1590/S0100-72032009000800006
PURPOSE: to identify factors associated with gestation in adolescence in a State of the northeast of Brazil. METHODS: 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. RESULTS: 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; CI95%=1.3-3.8), age at the first intercourse lower than 15 years old (OR=3.6; CI95%=2.2-5.7), history of maternal pregnancy at adolescence (OR=2.6; CI95%=1.7-3.4). The history of previous gynecological appointments (OR=0.3; CI95%=0.2-0.4) and the use of hormonal methods (OR=0.6; CI95%=0.4-0.9) were protecting variables. CONCLUSIONS: 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.
Summary
Rev Bras Ginecol Obstet. 2008;30(9):470-479
DOI 10.1590/S0100-72032008000900008
Adequate postpartum contraception is recommended in order to prevent mother and infant morbidity. The mother-infant benefits of lactation are well recognized, and exclusive, regular and frequent breastfeeding is an effective contraceptive method for amenorrheic patients. However, the resumption of fertility varies among women and access to health services is not guaranteed in many regions of the world. We searched the articles in Medline (PubMed) related to the subject published between 1971 to April 2008 and selected the most relevant articles in the literature about postpartum contraception. Short interpregnancy intervals increase maternal and fetal complications and therefore effective postpartum contraception is imperative. The ideal method prescribed should be effective and safe, id est, should not interfere with lactation or alter the hemostatic system. During the postpartum period, ideally non-hormonal methods should be used because they do not alter lactation or hemostasis. However, in populations with difficult access to health or with an early start of calorie supplementation to the newborn, the option should be for progestogens-only contraceptives, ideally initiated after six weeks or earlier in special situations.
Summary
Rev Bras Ginecol Obstet. 2008;30(9):470-479
DOI 10.1590/S0100-72032008000900008
Adequate postpartum contraception is recommended in order to prevent mother and infant morbidity. The mother-infant benefits of lactation are well recognized, and exclusive, regular and frequent breastfeeding is an effective contraceptive method for amenorrheic patients. However, the resumption of fertility varies among women and access to health services is not guaranteed in many regions of the world. We searched the articles in Medline (PubMed) related to the subject published between 1971 to April 2008 and selected the most relevant articles in the literature about postpartum contraception. Short interpregnancy intervals increase maternal and fetal complications and therefore effective postpartum contraception is imperative. The ideal method prescribed should be effective and safe, id est, should not interfere with lactation or alter the hemostatic system. During the postpartum period, ideally non-hormonal methods should be used because they do not alter lactation or hemostasis. However, in populations with difficult access to health or with an early start of calorie supplementation to the newborn, the option should be for progestogens-only contraceptives, ideally initiated after six weeks or earlier in special situations.
Summary
Rev Bras Ginecol Obstet. 2008;30(2):55-60
DOI 10.1590/S0100-72032008000200002
PURPOSE: to compare two strategies of access to emergency contraception: only information and information with previous delivery of this contraceptive method, and its relationship with the use of this method and the regular use of contraceptives. METHODS: from August 2004 to January 2005, 18 to 49-year-old volunteers, attended at reproductive health clinics from six Brazilian towns were recruited. The subjects were randomly distributed in a group getting information about emergency contraception (Control Group), or in a group getting information about this method and previous delivery of the contraceptive (Medicated Group). Follow-up visits occurred into four and eight months. Person and McNemar's tests were used for the statistical analysis. RESULTS: from the 823 recruited subjects, 407 completed the 8-month-observation period and were the sample analyzed. Most of the subjects (61%) did not use the emergency contraceptive. The subjects from the Medicated Group used more emergency contraceptives (57%) than the ones from the Control Group (18%), and they did it more precociously, concerning the time since the unprotected sexual intercourse. There was a significant increase of regular use of contraceptives among the subjects who used emergency contraceptives in the Medicated Group (88% versus 97%) and a statistically nonsignificant decrease in the Control Group. CONCLUSIONS: information and previous delivery intensified the access and use of emergency contraceptives, and did not reduce the regular use of contraceptives, including condoms.
Summary
Rev Bras Ginecol Obstet. 2008;30(2):55-60
DOI 10.1590/S0100-72032008000200002
PURPOSE: to compare two strategies of access to emergency contraception: only information and information with previous delivery of this contraceptive method, and its relationship with the use of this method and the regular use of contraceptives. METHODS: from August 2004 to January 2005, 18 to 49-year-old volunteers, attended at reproductive health clinics from six Brazilian towns were recruited. The subjects were randomly distributed in a group getting information about emergency contraception (Control Group), or in a group getting information about this method and previous delivery of the contraceptive (Medicated Group). Follow-up visits occurred into four and eight months. Person and McNemar's tests were used for the statistical analysis. RESULTS: from the 823 recruited subjects, 407 completed the 8-month-observation period and were the sample analyzed. Most of the subjects (61%) did not use the emergency contraceptive. The subjects from the Medicated Group used more emergency contraceptives (57%) than the ones from the Control Group (18%), and they did it more precociously, concerning the time since the unprotected sexual intercourse. There was a significant increase of regular use of contraceptives among the subjects who used emergency contraceptives in the Medicated Group (88% versus 97%) and a statistically nonsignificant decrease in the Control Group. CONCLUSIONS: information and previous delivery intensified the access and use of emergency contraceptives, and did not reduce the regular use of contraceptives, including condoms.
Summary
Rev Bras Ginecol Obstet. 1998;20(2):105-109
DOI 10.1590/S0100-72031998000200008
The authors describe their experience with videolaparoscopic tubal anastomosis in 10 selected patients operated from June 1994 to February 1996. The time of the first surgery was 4 hours and 30 minutes and the last , 2 hours and 30 minutes. The time was different according to the change of auxiliary team. Half of the reanastomoses were isthmic- isthmic. The minimum size of the remaining tubes was 5cm on each side. We used 7-0 and 6-0 polyglycolic acid monofilament for suture. The tube patency was tested by hysterosalpingogram 3 months after surgery, and it was shown that 88.8% of the operated tubes were free. The patients considered able to become pregnant were followed up for a short period of time and 4 of them became pregnant. The hospitalization lasted 24 hours and there were no surgical or anesthetic complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(2):105-109
DOI 10.1590/S0100-72031998000200008
The authors describe their experience with videolaparoscopic tubal anastomosis in 10 selected patients operated from June 1994 to February 1996. The time of the first surgery was 4 hours and 30 minutes and the last , 2 hours and 30 minutes. The time was different according to the change of auxiliary team. Half of the reanastomoses were isthmic- isthmic. The minimum size of the remaining tubes was 5cm on each side. We used 7-0 and 6-0 polyglycolic acid monofilament for suture. The tube patency was tested by hysterosalpingogram 3 months after surgery, and it was shown that 88.8% of the operated tubes were free. The patients considered able to become pregnant were followed up for a short period of time and 4 of them became pregnant. The hospitalization lasted 24 hours and there were no surgical or anesthetic complications.
Summary
Rev Bras Ginecol Obstet. 1998;20(5):273-280
DOI 10.1590/S0100-72031998000500007
An open-label comparative study was conducted in nine centers in Brazil to evaluate the tolerability and cycle control of two low-dose oral contraceptives containing 20 mg ethynylestradiol/75 mg gestodene and 20 mg ethynylestradiol/150 mg desogestrel, during six treatment cycles. A total of 167 healthy sexually active women were enrolled (77 in the gestodene group and 90 in the desogestrel group) and 138 completed the six-cycle treatment period. A lipid and hemostatic profile was performed for a subgroup of first users. A total of 867 cycles were evaluated. Irregular bleeding did not occur in 95.4% of the cycles evaluated with gestodene and in 91.9% with desogestrel. Tolerability was good with both preparations but there was significantly more nausea in the desogestrel group. Cycle control was good with both preparations with a significantly lower incidence of irregular bleeding with gestodene when all cycles were considered. There were no clinically significant changes in the hemostatic profile. Lipid profile showed a trend to be more favorable after six cycles of treatment with both preparations. Women in the gestodene group did not present changes in the mean weight; in the desogestrel group there was a significant mean weight increase of 1 kg after six cycles of treatment. Compliance with treatment was good with both preparations. Results of this study demonstrated that low-dose preparations containing gestodene or desogestrel combined with 20 mg of ethynylestradiol are well-tolerated oral contraceptives that provide good cycle control.
Summary
Rev Bras Ginecol Obstet. 1998;20(5):273-280
DOI 10.1590/S0100-72031998000500007
An open-label comparative study was conducted in nine centers in Brazil to evaluate the tolerability and cycle control of two low-dose oral contraceptives containing 20 mg ethynylestradiol/75 mg gestodene and 20 mg ethynylestradiol/150 mg desogestrel, during six treatment cycles. A total of 167 healthy sexually active women were enrolled (77 in the gestodene group and 90 in the desogestrel group) and 138 completed the six-cycle treatment period. A lipid and hemostatic profile was performed for a subgroup of first users. A total of 867 cycles were evaluated. Irregular bleeding did not occur in 95.4% of the cycles evaluated with gestodene and in 91.9% with desogestrel. Tolerability was good with both preparations but there was significantly more nausea in the desogestrel group. Cycle control was good with both preparations with a significantly lower incidence of irregular bleeding with gestodene when all cycles were considered. There were no clinically significant changes in the hemostatic profile. Lipid profile showed a trend to be more favorable after six cycles of treatment with both preparations. Women in the gestodene group did not present changes in the mean weight; in the desogestrel group there was a significant mean weight increase of 1 kg after six cycles of treatment. Compliance with treatment was good with both preparations. Results of this study demonstrated that low-dose preparations containing gestodene or desogestrel combined with 20 mg of ethynylestradiol are well-tolerated oral contraceptives that provide good cycle control.
