Sam Rowlands

Repeated use of hormonal emergency contraception by younger women in the UK

A cohort of women aged 14–29 in 1993 was identified from the General Practice Research Database and followed up for a period of 4 years. Patient files were searched for evidence of use of emergency contraception and regular contraception. Of the 95 007 women, 15 105 (16%) had received emergency contraception during the study period (an average of 5% per annum). There was a small year on year increase in uptake of emergency contraception between 1994 and 1997. Only 4% of emergency contraception users received emergency contraception more than twice in any year. More than 70% of those who had no previous record of use of regular contraception had used regular contraception within 1 year of using emergency contraception. Teenagers were more likely than other age groups to use emergency contraception, to be repeat users of emergency contraception and to fail to start regular contraception after first use of emergency contraception until later in the study period. These results disprove the notion of widespread repeated use of emergency contraception. They show that provision of an emergency contraception service does not result in failure to initiate regular contraception or abandonment of regular contraception; rather they show many women using regular contraception for the first time after use of emergency contraception.

A possible mechanism of action of danazol and an ethinylestradiol/ norgestrel combination used as postcoital contraceptive agents

Twenty-seven women requesting postcoital contraception were randomly allocated to take an ethinylestradiol/dl-norgestrel combination or danazol. Urine specimens were assayed for luteinising hormone (LH) and pregnanediol-3-glucuronide (P3G) levels from the day of the postcoital treatment to the next period. In addition, the urine samples of these recruits and 12 additional women were assayed for the Beta-subunit of human chorionic gonadotropin (B-hCG). A consistent pattern of alteration in urinary steroids was lacking, indicating a heterogeneous effect on ovarian function. There was no evidence of early pregnancy in successfully treated cases. We suggest that the main mechanism of action of these drugs is at the endometrial level.

Side effects of danazol compared with an ethinyloestradiol/norgestrel combination when used for postcoital contraception.

A postcoital contraceptive with a lower incidence of nausea and vomiting than oestrogen-progestogen combinations would be a significant advance. During a nine-month period, 101 women were treated at the Margaret Pyke Centre in London with either an oestrogen-progestogen combination or with danazol. A comparison of the side effects of each drug is reported. Those treated with danazol were six times less likely to experience nausea and none vomited. With the exception of breast symptoms, other side effects were five times less common in women receiving danazol. These differences give danazol a clear advantage in terms of patient acceptability. Further experience will enable the efficacy of danazol to be evaluated and so determine whether this drug should become the preferred hormonal postcoital treatment.

The incidence of sterilisation in the UK

Objective To estimate incidence rates for tubal occlusion and vasectomy, and to examine how these vary with age, geographical area and time.

Social predictors of repeat adolescent pregnancy and focussed strategies

This article begins with an overview of teenage pregnancy within a social context. Data are then presented on conceptions and repeat conceptions in teenagers. Social predictors of repeat teenage pregnancy are grouped according to social ecological theory. A brief summary of prevention of teenage pregnancy in general is followed by a detailed analysis of studies of interventions designed to prevent repeat pregnancy that reached specific quality criteria. The results of some systematic reviews show no significant overall effect on repeat pregnancy, whereas others show an overall significant reduction. Youth development programmes are shown in some cases to lower pregnancy rates but in other cases to have no effect or even to increase them. Features of secondary prevention programmes more likely to be successful are highlighted.

Misinformation on abortion

ABSTRACT Objective To find the latest and most accurate information on aspects of induced abortion. Methods A literature survey was carried out in which five aspects of abortion were scrutinised: risk to life, risk of breast cancer, risk to mental health, risk to future fertility, and fetal pain. Findings Abortion is clearly safer than childbirth. There is no evidence of an association between abortion and breast cancer. Women who have abortions are not at increased risk of mental health problems over and above women who deliver an unwanted pregnancy. There is no negative effect of abortion on a womans subsequent fertility. It is not possible for a fetus to perceive pain before 24 weeks’ gestation. Misinformation on abortion is widespread. Literature and websites are cited to demonstrate how data have been manipulated and misquoted or just ignored. Citation of non-peer reviewed articles is also common. Mandates insisting on provision of inaccurate information in some US State laws are presented. Attention is drawn to how women can be misled by Crisis Pregnancy Centres. Conclusion There is extensive promulgation of misinformation on abortion by those who oppose abortion. Much of this misinformation is based on distorted interpretation of the scientific literature.

Legal aspects of contraceptive implants

Key message points - There has been litigation in relation to the three types of harm associated with contraceptive implants: non-insertion, deep insertion and nerve injury. - Recommendations for safe clinical practice can be derived from analysis of legal cases and published case reports. - Nerve injury has invariably been caused by clinicians without upper limb surgical skills attempting difficult removals. - The launch of the updated single-rod implant (Nexplanon®) may hold the best possibility for harm reduction. - Litigation in relation to side effects can lead to the withdrawal of safe and effective contraceptive products, so reducing choice for women

More than one abortion.

Key message points - Categorising women undergoing abortion into groups according to number of previous abortions has little scientific merit. - Women undergoing their first abortion and women undergoing subsequent abortions should be treated no differently. - Future research on abortion should focus more on psychosocial antecedents to unintended pregnancy

New technologies in contraception.

New technologies in both reversible contraception and sterilisation are described. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception, intrauterine devices, spermicides and barrier methods. It also covers methods of transcervical female sterilisation and more easily reversible male sterilisation. The emphasis is on the technology and its safety and effectiveness. Hormonal delivery systems are described in some detail. Mention is also made of research into vaccines and male hormonal methods, where progress has been disappointing.

Post-Coital Contraception with Danazol, Compared with an Ethinyloestradiol—Norgestrel Combination or Insertion of an Intra-Uterine Device

SummaryAn early specialist in this subject, the Persian physician Al-Razi who died about 924, wrote ‘first, immediately after ejaculation, let the two come apart and let the woman arise roughly, sneeze and blow her nose several times, and call out in a loud voice. She should jump violently backwards seven to nine times’ (Rinehart, 1976). Earlier still, the Egyptians in 1500 bc described a post-coital douche of wine and garlic with fennel, used in conjunction with pre-coital fumigation of the vagina. In some developing countries at the present time, Coca-Cola is in favour as a douche (Rinehart, 1976). With or without gymnastics, incantations or incense, douching may be unsuccessful; spermatozoa can reach the endocervix within 90 seconds of ejaculation (Sobrero and Macleod, 1962).