A review of literature is used to evaluate contraceptive methods in the postpartum and postabortion periods and a strategy to be used in practice is presented. Fertility may resume as soon as the 25th day postpartum and breastfeeding is not a fail-safe contraceptive method. Postabortion, the situation is simple and the rule is to prescribe estrogen/progestin except where this is contraindicated. An IUD can also be inserted postabortion. In the postpartum, there are 2 different situations which may present themselves. If the woman is breastfeeding, the contraceptive of choice is a microprogestin pill given from the 20th day onward. If the patient does not prefer to take an oral contraceptive, oral contraception is suggested (but not a diaphragm). When the patient ceases breastfeeding, an estrogen/progestin pill or an IUD will be the choices; the IUD can be inserted as early as the 2nd month postpartum. If the woman is not breastfeeding, estrogen/progestin pills, microprogestins (on the 20th day), or local methods can all be used. An IUD can be inserted as early as the 2nd month postpartum or the 3rd month after a cesarean. (author's modified)
The efficacy and clinical acceptability of a new oral contraceptive (OC) Mercilon (20 mcg ethinyl estradiol + 150 mcg desogestrel) was investigated in 235 women during 1305 cycles in an open, noncomparative, multicenter study carried out by 37 French gynecologists. No pregnancies occurred and cycle control was good. Only 5.5% of the women studied discontinued this OC because of irregular bleeding. The incidence of subjective side effects such as breast tenderness, known to be estrogen-dependent, was very low. Total continuation rate for Mercilon was very high for a low-dose contraceptive at 86%. Because of its clinical characteristics, along with its already proven excellent metabolic acceptability, this OC can be prescribed as a 1st choice for women without contraindication against combined OCs. (author's modified)
More than 1% of sterilized women seek restoration of their fertility. The large number of tubal sterilizations performed each year has created a significant demand for reversal. Microsurgical tubal anastomosis has yielded excellent results in these cases, and the reported viable pregnancy rates vary between 55-78%. An alternative approach is in vitro fertilization which yields a viable pregnancy rate of less than 20/pickup cycle. The primary approach in this study with previously sterilized women is tubal anastomosis, especially if the length of the reconstructed tube will exceed 4 cm. Tubal anastomosis and in vitro fertilization must be viewed as complementary rather than competitive procedures since the failure of 1 will, in most cases, allow the use of the other. Preliminary investigation of fertility parameters and proper assessment of the tubes (with hysterosalpingography and frequently by laparoscopy) is necessary to determine the most appropriate therapeutic approach. (author's modified)
Currently, more than 60 million women throughout the world use oral contraceptives (OCs). Therefore, it is particularly important to study the possible effects of OCs on the risk of getting cancer. In order to understand the divergent results presented in the literature relating to breast cancer, the authors reviewed the different types of studies carried out worldwide and considered the principal problems encountered in the organization and analysis of these studies. The authors then reviewed the results of the meta-analysis performed by Prentice and Thomas in 1987 and discussed articles published since that time. 1 of the essential conclusions of the studies by Prentice and Thomas was that cancer mortality, considering all sites, was similar in OC users and nonusers (relative risk=1.0; 95% confidence interval, 0.8-1.3). A decrease in the number of OC users would therefore not produce a decrease in worldwide cancer mortality. In spite of the large fluctuations in results from the various studies on breast cancer, the overall risk evaluated by Prentice and Thomas in 1987, based on 16 case- control studies and 4 cohort studies have demonstrated a positive and significant relationship between the pill and breast cancer, while other studies, also very recent, have not demonstrated such a relationship. If a new summary of the results were to be performed at the present time, it would have little chance of producing conclusions which would differ from those obtained previously. (author's modified)
Performance of IUDs has improved greatly in the past decade. The reasons for improvement include increased copper content and prevention of copper fragmentation, flexible frames that adapt to the endometrial cavity, better evaluation of the endometrial cavity before insertion, simplified insertion, selection of acceptors, and careful follow-up. NO significant modifications in IUD design have occurred since the use of copper was begun in the 1970s except for use of systems-releasing steroids. The use of copper improved efficacy and permitted use of smaller devices, reducing some side effects especially in small uteruses. The duration of use of copper IUDs has increased, and their efficacy has improved at the same time that modifications have permitted greater local tolerance with no increase in expulsion rate. Greater selectivity of IUD users has improved performance, taking into account known risks for major complications such as extrauterine pregnancy and infection. Prior use of IUD and conditions of follow-up should also be considered in candidate selection. The major weaknesses of IUDs at present are related to the introduction of a foreign body into the uterine cavity; IUD insertion entails potential risks of infection and perforation. However, the active substance should not cause damage to the endometrial mucus or induce cycle disturbances or diminished defenses against pain and infection. Research on IUD frames is oriented toward development of a device adaptable to specific conditions such as the postpartum. 1 new device would completely eliminate plastic and the related side effects. A new miniaturized device is under investigation along with a biodegradable device and an intracervical device. New substances under study for a better contraceptive effect include spermicides, immunological substances, and synthetic progestins. An intracervical device emitting a battery-driven weak electric field is intended to immobilize sperm. Most current research has as its goal the reduction of secondary effects of bleeding, pain, or risk of infection. Among the numerous substances utilized have been antifibrinolytics, prostaglandin inhibitors, sexual steroids, and antibiotics. These systems should provide constant release over a prolonged period, a goal not yet attainable for all these substances.
