Importância. Anticoncepcionais hormonais combinados orais (AHCO) podem levar ao aumento do risco da doença cardiovascular, que pode estar associado a alterações na pressão arterial e na função endotelial. Objetivos. O objetivo deste estudo foi avaliar o impacto do uso de AHCO contendo 20 mg de etinilestradiol (EE) e 3 mg de drospirenona (DRSP) por mulheres jovens normotensas sobre a função endotelial arterial, pressão arterial sistólica (PAS, mmHg) e diástólica (PAD, mmHg), frequência cardíaca (FC, bpm), débito cardíaco (DC, L/min), e sobre a resistência periférica total (RPT, NU). Métodos. Setenta e uma mulheres jovens saudáveis com idade média de 29 ± 1 ano foram avaliadas. Quarenta e três foram analisadas antes da introdução do AHCO e ao final de 6 meses de uso (grupo-caso) e vinte e oito, não usuárias de nenhum método hormonal de contracepção, foram avaliadas quanto aos mesmos parâmetros no mesmo intervalo de tempo (grupo-controle). Resultados. Não se observaram mudanças significantes na função endotélio-dependente (VMF%) e independente (VIE%) e nas medidas de PAS, PAD, FC, DC e da RPT com o uso do AHCO (p> 0,05 para todas as variáveis). Não houve variações significantes nestes parâmetros no grupo-controle. Conclusão: O uso desta formulação de AHCO não causou alterações deletérias na reatividade vascular, e nas variáveis hemodinâmicas em mulheres jovens normotensas. / Background: Combined oral contraceptives (COCs) may lead to a rise in cardiovascular disease risk, possibly associated with changes in blood pressure and endothelial function. Objective: The objective was to evaluate the impact of COC containing 20 mcg of ethinyl estradiol (EE) and 3 mg of drospirenone (DRSP) on the arterial endothelial function, systolic and diastolic blood pressure (SBP and DBP), heart rate (HR), cardiac output (CO), and total peripheral resistance (TPR) of normotensive young women. Methods: Of the 71 women in the study, 43 were evaluated before the introduction of COC and after 6 months of its use (case group) and 28, COC nonusers, were assessed for the same parameters at the same time interval (control group). Results: No significant changes in endothelium-dependent and -independent functions or in measures of SBP, DBP, HR, CO, and TPR caused by COC use were observed in the case group (P> 0.05 for all variables) or in the control group. Conclusion: These data suggest COC with 20 mcg EE and 3 mg DRSP does not alter arterial endothelial function or hemodynamic parameters in normotensive young women

Durante as diferentes fases da vida, ocorrem alterações nos níveis dos hormônios sexuais no organismo. Estes períodos estão diretamente associados com episódios de inflamação periodontal exacerbada. Por isso, a relação entre níveis alterados dos hormônios sexuais e variações no grau de inflamação gengival tem sido estudada. Como os contraceptivos orais alteram artificialmente os níveis dos hormônios sexuais, o objetivo deste estudo é avaliar a influência de contraceptivos orais combinados atuais na condição periodontal de 25 mulheres entre 19 e 35 anos de idade que fazem uso deste medicamento pelo período mínimo de 12 meses em comparação ao grupo controle de 25 mulheres, dentro do mesmo limite de idade, que não fazem uso de contraceptivos orais. As pacientes foram avaliadas por examinador único, previamente treinado, cego em relação ao uso do contraceptivo, quanto às medidas de profundidade de sondagem, nível de inserção clínica, índice de sangramento do sulco e índice de placa. Os dados obtidos foram analisados estatisticamente segundo o teste t não pareado, teste de correlação de Pearson e teste de correlação de Spearman. Os resultados obtidos indicaram que mulheres que fazem uso de contraceptivos orais há mais de um ano apresentam maior profundidade de sondagem (2,228±0,011 x 2,154±0,012; p<0.0001), perda de inserção (0,435±0,01 x 0,412±0,01; p=0.11) e índice de sangramento do sulco (0,229±0,006 x 0,148±0,005, p<0.0001) do que o grupo controle, embora o índice de placa tenha sido menor no grupo teste do que no controle (0,206±0,007 x 0,303±0,008; p<0.0001). Não houve correlação entre o tempo de uso do medicamento, idade e nenhum dos parâmetros periodontais clínicos. Esses achados sugerem que o uso de contraceptivos orais combinados disponíveis atualmente no mercado pode influenciar a condição periodontal das pacientes, independentemente da quantidade de placa presente e do tempo de uso dos contraceptivos, resultando em maior inflamação da gengiva marginal. / During the different life phases, sexual hormones levels can be altered. These periods are directly associated to episodes of increased periodontal inflammation. Because of this, the relation between altered levels of sexual hormones and degree of gingival inflammation has been studied. As oral contraceptives artificially modify sexual hormones levels, the aim of this study is to evaluate the effects of this drug in the periodontal condition of 25 women aged 19-35 years old that have been taking oral contraceptives for at least one year compared to a control group composed of 25 patients at the same age range that do not report the use of oral contraceptives. Patients were evaluated by a previously trained, single blinded examiner according to pocket probing depth, clinical attachment level, bleeding on probing and plaque index. Data was statistically evaluated by unpaired t test, Pearsons correlation test and Spearmans correlation test. The results obtained indicated that women taking oral contraceptives for at least one year show increased probing pocket depth (2.228±0.011 x 2.154±0.012; p<0.0001), attachment loss (0.435±0.01 x 0.412±0.01; p=0.11) and bleeding on probing (0.229±0.006 x 0.148±0.005, p<0.0001) than the control, although plaque index was slightly inferior in test than in control group (0.206±0.007 x 0.303±0.008; p<0.0001). No correlation between the duration of oral contraceptives intake, age and periodontal parameters was observed. These findings suggest that the use of currently available combined oral contraceptives can influence the periodontal condition of the patients, independent from plaque accumulation and the duration of use of the medication, resulting in increased gingival inflammation.

This systematic review consolidates and discusses all the advantages and disadvantages of each contraceptive method, organized by mammalian species, with emphasis on reversible immune-contraception, obtained from the international scientific literature. The objective is to deepen the knowledge and elucidate adequate solutions to a serious global problem of wildlife population control. Furthermore, serving as pre-project to the next stage of development of a contraceptive method, economically viable, with better attributes, high effectiveness of the action, better and safer techniques of application, and more importantly, ensure overall health and population genetics. Finalizing this review by offering in a brief and concise manner, an updated understanding of reversible contraceptive methods, organized by methods, taxon, drugs, and associated risks / Esta revisão sistemática, consolida e discuti todas as vantagens e desvantagens de cada método contraceptivo, organizada por espécies de mamíferos, com ênfase em imunocontracepção reversível, obtidos em literatura científica internacional. O objetivo é aprofundar os conhecimentos e elucidar soluções adequadas para o grande problema mundial do controle das populações de animais silvestres. Além disto, pode servir como pré-projeto para a próxima fase de desenvolvimento de um método contraceptivo economicamente viável, com melhores atributos, alta eficácia da ação, técnicas de aplicação melhores e mais seguras, e mais importante, garantir saúde geral e genética das populações. Finalizando, esta revisão oferecer de forma breve e concisa, uma atualização sobre o conhecimento de métodos contraceptivos reversíveis, organizada por métodos, táxon, fármacos, e riscos associados

Orientador: Luis Guillermo Bahamondes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T11:48:13Z (GMT). No. of bitstreams: 1 Sanches_Luciana_M.pdf: 2162409 bytes, checksum: b3edab8c6bcc59cc639d9b6b5d09e971 (MD5) Previous issue date: 2008 / Resumo: Introdução: Diante da relevância da contracepção na saúde reprodutiva, muitos estudos sobre segurança e eficácia contraceptiva são realizados a cada ano. O contraceptivo injetável com acetato de medroxiprogesterona de depósito (AMP-D) é um método reversível e eficaz. Entretanto, seu uso provoca hipoestrogenismo e pode afetar a densidade mineral óssea (DMO) durante seu uso ou após a descontinuação, levando à osteopenia e osteoporose. A osteoporose é uma doença caracterizada pela diminuição absoluta da quantidade de osso, tornando-o frágil, sendo um dos maiores problemas de saúde, pois está associada com o aumento no risco de fraturas. O efeito do uso do AMP-D durante a vida reprodutiva sobre a DMO na pós-menopausa ainda é controverso. Objetivo: Avaliar a DMO em mulheres na pós-menopausa que usaram o AMP-D como contraceptivo até a menopausa e comparar com mulheres na pós-menopausa que usaram o dispositivo intra-uterino (DIU) com cobre. Sujeitos e métodos: Estudo com 135 mulheres na pós-menopausa, com idade entre 43 e 58 anos, compreendendo 36 usuárias de AMP-D e 99 usuárias de DIU com cobre como grupo comparativo. A DMO foi avaliada nas porções distal e ultradistal do rádio do antebraço não dominante, usando a técnica da energia dupla de Raios-X, até 3 anos após a menopausa. Todos os valores foram expressos em média ± erro-padrão da média (EPM). Resultados: O tempo de uso de ambos os contraceptivos foi de 9,4 ± 3,8 e 14,7 ± 6,2 anos para o AMP-D e DIU, respectivamente. As DMO na seção distal nos anos 1 e 2-3 após a menopausa foram 0,435 e 0,449 e 0,426 e 0,447 nas usuárias de AMP-D e DIU, respectivamente. Na seção ultradistal os valores foram: 0,369 e 0,384 e 0,340 e 0,383, respectivamente. Todos sem significância estatística. Conclusões: Mulheres com idade entre 43 e 58 anos, na pós-menopausa, ex-usuárias de AMP-D, apresentaram DMO, no ano 1 ou 2-3 após a menopausa, similar ao grupo de controle. / Abstract: Objetive: The aim of the study was to compare bone mineral density (BMD) in post menopausal women who were users of depot-medroxyprogesterone acetate (DMPA) or copper intrauterine device (IUD) up to the menopause. Volunteers and methods: This study included 135 postmenopausal women, aged 43 to 58 year divided on a group of formers users of DMPA (36 women) and the control group of formers users of the copper IUD (99 women). BMD was measured at the nondominant forearm using double X-ray absorptiometry up to 3 years after the menopause. Results: The mean time of previous use of both contraceptives was (Mean ± SEM) 9.4 ± 3.8 and 14.7 ± 6.2 years for DMPA and IUD, respectively. The mean BMD at the distal section at years 1 and 2-3 after the menopause among DMPA and IUD users were 0.435 and 0.449 and 0.426 and 0.447, respectively. At the ultradistal section the values were 0.369 and 0.384 and 0.340 and 0.383, respectively, without statistically significance. Conclusions: Postmenopausal women aged 43 to 58 former users of either DMPA or copper IUD up to the onset of menopause presented similar BMD at 1 or 2-3 years after the menopause. / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background. Unintended pregnancy is a major global challenge among sexually active women of childbearing age. Non-use of modern contraception and inconsistent use of short term contraceptive methods are the main reasons associated with unintended pregnancy. Long acting reversible contraceptives (LARCs) have proven to be highly effective with good continuation rates, and are cost-effective compared to other methods, when used more than one year. However, there is low uptake of LARC methods globally and in South Africa. Aim of the study. The aim of the study was to determine factors influencing the uptake of LARC methods among women at the primary health care (PHC) clinics in eThekwini District. Methodology. A quantitative, descriptive survey was used in this study. Purposive sampling of six fixed PHC clinics from the three sub-districts was done. Convenience sampling resulted in 371 participants. A survey questionnaire in English and isiZulu was used to collect data. Data was analysed using SPSS version 23.0. Inferential statistics were used to determine the relationship between the variables. Results. The results of this study revealed that the contraceptive injection was most common LARC used, and the least used method was the intrauterine contraceptive device. The side effects were the main reasons for discontinuation with LARCs and all other contraceptive methods. Irregular vaginal bleeding was the main side effect cited by respondents associated with contraceptive implant usage. The respondents had positive attitudes and perceptions towards LARCs; however, the majority of respondents were not interested in using LARC methods. Common myths and misconceptions were not negatively associated with LARCs, since respondents disagreed with them all. / M

Objectives This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. Methods/Principal findings A cross-sectional study enrolling women aged 18–25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%–49.3%), and 17.4% (95%CI: 13.1%–21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81–3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14–3.30) after controlling for confounders. Conclusions There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.

Background: Women's empowerment is hypothesized as a predictor of reproductive health outcomes. It is believed that empowered girls and women are more likely to delay marriage, plan their pregnancies, receive prenatal care, and have their childbirth attended by a skilled health provider. The objective of this study was to assess the association between women's empowerment and use of modern contraception among a representative sample of Nigerian women. Methods: This study used the 2003, 2008, and 2013 Nigeria Demographic and Health Survey data. The analytic sample was restricted to 35,633 women who expressed no desire to have children within 2 years following each survey, were undecided about timing for children, and who reported no desire for more children. Measures of women's empowerment included their ability to partake in decisions pertaining to their healthcare, large household purchases, and visit to their family or relatives. Multivariable regression models adjusting for respondent's age at first birth, religion, education, wealth status, number of children, and geopolitical region were used to measure the association between empowerment and use of modern contraceptives. Results: The proportion of women who participated in decisions to visit their relatives increased from 42.5% in 2003 to 50.6% in 2013. The prevalence of women involved in decision-making related to large household purchases increased from 24.3% in 2003 to 41.1% in 2013, while the proportion of those who partook in decision related to their health care increased from 28.4% in 2003 to 41.9% in 2013. Use of modern contraception was positively associated with women's participation in decisions related to large household purchases [2008: adjusted OR (aOR) = 1.15; 95% CI = 1.01-1.31] and (2013; aOR = 1.60; 1.40-1.83), health care [2008: (aOR = 1.20; 1.04-1.39) and (2013; aOR = 1.39; 1.22-1.59)], and visiting family or relatives [2013; aOR = 1.58; 1.36-1.83]. The prevalence of modern contraceptive use among women with need for contraception increased marginally from 11.1% in 2003 to 12.8% in 2013.

Magister Public Health - MPH / Dual protection is protection against unwanted pregnancy, HIV and other sexually transmitted infections and a means of achieving safer sex and birth control (WHO, 2012). It is one of the essential tools promoted by the WHO for preventing unintended pregnancies and sexual transmitted infections among HIV-positive women to reduce dual risk of unintended pregnancies, re-infections and transmission of HIV in the cases of sero-discordant couples. However, the use of dual method use among HIV-positive women in Zimbabwe is poorly described. Hence to fill in the existing research gap, this study aims to explore the factors influencing dual protection use by HIV- positive women participating in a prevention of mother-to-child transmission (PMTCT) program in an urban setting in Zimbabwe. Methodology: A qualitative exploratory study design with a combination of qualitative research methods including interviews and focus group discussions was conducted. A total of five focus group discussions (FGDs) each consisting of 8-12 participants was conducted with a total of 51 women. Five in-depth interviews were conducted with key informants. All interviews and FGDs were audio recorded using a digital voice recorder. The interviews were conducted in Shona and translated into English. Data analysis was done manually using thematic coding. Codes emerged from the data using an inductive approach. Ethical principles of research and rigour were observed throughout the study. Results: Dual protection use was low among the HIV-positive women. Absolutely non-use of contraceptive was reported by some women. The main methods of contraceptives were the pill, depo provera and condoms. Inconsistent condom use was mentioned among the few women who reported using condoms. Many barriers to contraceptives use among HIV-positive women in Zimbabwe were identified. However there were a few facilitating factors too. Health system factors associated with health care workers (HCWs) related factors and service delivery processes were reported as major barriers to contraceptive use. Women expressed negative attitude towards condom use associating them with unfaithfulness. Facilitators of contraceptive use identified were couples' HIV testing and counselling, women's increase in CD4 count result, fear of vertical transmission and HIV sero-discordance between couples. Conclusion and Recommendations: In conclusion, dual protection use among HIV-positive women in this community was low. Health system factors were the main barriers to contraceptives use whilst health related factors were the main facilitators. HIV-positive women still face challenges in accessing and utilisation of contraceptives. Hence the barriers to contraceptive use needs to be addressed at the same time promoting the facilitators.

The present study examines social, demographic and behavioural factors that influence contraceptive use and method choice among young Namibian women. The study also explores ways to improve the accessibility of health facilities and family planning services for young women. The research is based on both quantitative and qualitative data provided by the 2000 Namibian Demographic and Health Survey and focus group discussions with young women (15-24 years) respectively. The data have been used to analyse the factors affecting contraceptive use and method choice among young women in Namibia. The logistic regression method has been applied to examine the determinants of contraceptive use and method choice. The study examines knowledge of contraceptive methods and sources of supply, decisions leading to contraceptive use and views about service delivery and the availability of contraceptive methods. The study reveals that whilst there is provision, the accessibility of existing reproductive health services for young women is poor in rural areas. There is a lack of support from parents, nurses, and the broader community. Part of the problem here is that older people are not fully aware of the sexual rights of young women, which leads to misunderstandings with regard to sexual and reproductive health issues. Nurses, especially in rural areas, are deemed to be judgmental and reluctant to provide contraceptives to young female scholars. Health facilities are also ranked by young women as user-unfriendly as most of them, as public spaces, lack confidentiality and privacy. These negative experiences of young women impact on their utilization of reproductive and health services and their use of contraceptives. Levels of contraceptive use among all age groups, including young women, in Namibia are still low. The choice of contraceptive method is restricted to injectables and to some extent, condoms. Uninformed and unsupportive parents are identified as major barriers to young women’s sexual health and their ability to use contraception consistently. Apart from this, individual use of contraception is greatly influenced by individual and community characteristics. The education level, marital status, number of children and work status are important individual factors affecting whether and what kind of contraception young women will use. Other issues related to the individual women concern whether she discusses family planning with her partner or parent, and whether she has access to the media and to health facilities. For example, findings from the multivariate analysis showed that increased education was significantly associated with a greater likelihood of using contraception. Unmarried young women were more likely to use condoms than married women. Higher condom use was also reported among young women of 15-19 years old than among 20-24 year olds. Furthermore, young women in urban areas had more positive attitudes towards using contraceptives, as well as more forthcoming friends and parents than those in the rural areas. The findings thus suggest that government strategies, which aim to increase the use of contraceptives amongst young women in Namibia, ought to enhance and improve parent-child communication, engage young women’s social networks, and seek to counteract negative assumptions of service providers who could potentially cater for a growing number of young women users and also make a range of choices available. / Thesis (DPhil(Sociology))--University of Pretoria, 2008. / Sociology / DPhil / unrestricted

Background: There is an increased awareness among women of child bearing age on the forms of contraceptives in South Africa. Despite this, there has been a steady rise in the number of induced abortions conducted in the country. The aim and objectives of this study was to understand the contraceptive choices of the women requesting termination of pregnancy as well as their knowledge, attitude and practice toward contraceptives in one of the District Hospitals in Western Cape, South Africa. Methods: This was a cross sectional descriptive study which was conducted in Mitchell's Plain District Hospital, among women seeking induced abortion. Women aged 18 years and older seeking elective Termination of Pregnancy were included in the study. Convenience sampling method was used to select the participants women attending the clinic and who were willing to participate. Researcher-administered questionnaires were used as a data collection tool, and the data analyzed using SPSS version 25. Correlation between socio-demographic factors and contraceptive uptake was made using chi-square and Fisher's tests. Results: Most of the participants were between the ages of 26-39 years, single, unemployed and did not have matric education. There was an acceptable knowledge on contraceptives in terms of types, sources and side effects. However, there was low uptake of contraceptives (17%) prior to falling pregnant. The most common barriers to contraceptives use were side effects, no time to visit the clinic and low level of education. Conclusion: Findings from this study showed that awareness and knowledge of contraceptives does not necessarily translate to practice. In the future, it would be worthwhile to conduct a qualitative in-depth study on decision-making and behavior of all women around contraceptives.