Topic 1: Abortion
P001
Legal abortion in Hospital Santa Maria: Contraceptive methods prior to abortion and methods failure
J. Neves, A. Candeias, H. Ferreira, M. Manuela Carmo, and L. Mendes Graca
Department of Obstetrics, Gynecology and Reproductive Medicine, Lisbon, Portugal
Objective To find the contraceptive methods used prior to the legal abortion and the reason for contraceptive method failure.
Design and methods We have studied 139 cases of legal abortion; we looked for the contraceptive method prior to the abortion and if there is or not failure from the method; results are presented in absolute and relative values.
Results 139 women had completed the process for legal abortion in our Department, since the first visit to the discharge. The clinical and demographic data are the following (mean±sd) – age 28.3±7.66 (years) and gestation duration 56.9±8.26 (days); 41 (29.4%) were nuliparous, 38 (27.3%), primiparous and 60 (43.1%), multiparous. Regarding the contraceptive methods used prior to the abortion, 68 (48.9%) had preferred OCs, 42 (30.2%) had used condoms, other methods were appointed in 4 (2.8%) and 25 (17.9%) did not use any contraceptive methods. In 110 cases, there was an identified cause of contraceptive method failure – missed tablets in OCs (59, 42.1%), condom rupture (42, 30.2%) and use of concomitant medication with OCs (9, 6.4%).
Conclusions In this sample of population requesting legal abortion, the main contraceptive method was OCs; there was a significant proportion in this sub-population (25 in 139) that not use any contraceptive method, enhancing one of the milestones for legal abortion, the education for an appropriate contraceptive method; missed tablets were a dominant cause for contraceptive method failure, enforcing the necessity to manage good family planning for women or couples who do not want a pregnancy in a short period, looking more for longer acting contraceptive methods.
P002
A complex procedure for home abortion: Are we going backwards?
P. Roblin1, R. Shojai2, and L. Boubli2
1La Plaine Santé, Marseille, and 2Hopital Nord, Marseille, France
Objective Medical abortion in an ambulatory setting has been possible in France since 2004. However, many physicians have been reluctant to use this new option at the office because of a complex legislation and fear of complications. Our aim was to evaluate the feasibility of this procedure in a private practice.
Patients and methods A prospective study was realized among 120 consecutive women choosing a medical abortion at the office. The conditions required for the patient were: pregnancy less than 49 days and distance from patient's home to the hospital less than one hour. Patients had to undergo five supervised visits (V) at the office. The first visit (V1) was to inform patients on the procedure and proposition to encounter a social worker for alternatives to abortion. V2 was for medical examination, cervical cytology, screening for IST and counselling on contraception. After a reflection period of 7 days, the third visit was for administration of 600 mg of Mifepristone®. The fourth visit was for administration of 400 μg of oral Misoprostol®. V5 was for post-abortion control at 10 days.
Results Among the 120 patients, 5 (4.2%) were lost at follow-up. The rate of complete abortion with no major complications among the 115 patients with a known outcome was 96.5%. Four patients (3.5%) required surgical aspiration: 2 for haemorrhage, 1 for incomplete abortion and 1 for continuation of pregnancy. Seventy-six women (63%) fully adhered to the protocol and came to the 5 scheduled visits. The mean number of visits at the office was 4.1. An unscheduled visit was required in 7 cases (6%) and 19 patients (16%) phoned for advice. The reflection period of 7 days was not possible to respect in 55% of cases because of the time limit of 49 days but all patients had at least 48 hours to confirm their decision. None of our patients requested an encounter with a social worker. At the control visit, 38% opted for a long term reversible method (IUD or implant). Overall rate of satisfaction for the method was 78%.
Conclusions Our preliminary findings confirm that medical abortion in a general solo practice is a safe and acceptable procedure. A complex procedure based on five visits at the office may be a shortcoming and considered as a setback in the era of increased patient autonomy. In our view however, it improves the patient-doctor relationship which is essential for counselling in post-abortion contraception.
P003
Greece: the role of family planning in the decline of abortion rates
N. Salakos, K. Bakalianou, C. Iavazzo, G. Paltoglou, and K. Papadias
Division of Family Planning, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
Aim Due to lack of consistent evidence, it is widely believed that Greece holds one of the higher abortion rates in Europe. Sexual education in Greece is not included as a part of the main school program. The Ministry of Education organizes extra 25-hour teaching programmes on Health Education for adolescents which include topics on sexual education. These programmes are hosted in schools and other organizations, such as athletic clubs. It should be noted that similar programmes are organized by non governmental organizations, such as the Greek Society of Family Planning, after request from the local authorities or the school itself. All the above programmes are approved by the Ministry of Education. The Greek Society of Obstetrics and Gynecology collected data demonstrating that these rates seem to be declining.
Method In the year 2004–2005 the Greek Society of Obstetrics and Gynecology commenced a thorough survey and managed to collect the evidence demonstrated in the present study. Collecting data from the major public hospitals of Greece was relatively uncomplicated. The obstetrics department of each hospital was contacted and if the department performed abortions the following data were requested from the responsible doctor: the exact number of abortions, the mean age of the women subjected to an abortion and the mean gestation age of the fetus. The same method was used in the private sector but the collected data remain a question regarding the total or partial registration.
Results The total number of abortions in Greece was 69,960. The mean age of women was 25.4 years, while the mean gestation age was 7.7 weeks. It is revealed that the vast majority of abortions were completed in private clinics (6% vs 94% in public and private hospitals respectively). Furthermore, 61% vs 39% were the rates between urban and rural Greece respectively.
Conclusion The decline in the number of abortions in Greece, evident in the last decade can mainly be attributed to the positive outcomes of the spread of the extra-curriculum teaching programmes implemented by the ministry of education. It is characteristic that through the programmes organized by the Greek Society of Family Planning under the guidance of the University of Athens and the approval of the Ministry of Education, 150,000 adolescents aged 14 to 18 years and their parents, received full, concise, up-to-date education and counseling on contraception, sexually transmitted diseases, emergency contraception and abortions.
P005
Introducing a reduced 200 mg dose of Mifepristone® followed by Misoprostol® for medical abortion through 56 days gestation
S. Raghavan1, V. Lishchuk2, S. Zhuk3, S. Posohova4, G. Maistruk5, V. Bannikov5, and B. Winikoff1
1Gynuity Health Projects, New York, NY, USA, 2Central Military Hospital, Kiev, Ukraine, 3Academy for Postgraduate Education, Kiev, Ukraine, 4Central District Maternity House, Odessa, Ukraine, and 5Women Health and Family Planning, Kiev, Ukraine
Objectives The aim of the study was to assess the efficacy of a 200 mg dose of Mifepristone® followed by 400 mcg of Misoprostol® taken orally for early abortion. In this former Soviet republic, 600 mg of Mifepristone® was part of the standard regimen until recently and its high cost has inhibited widespread use of the method. A lower dose of Mifepristone®, showing similar efficacy, can greatly reduce the cost and increase accessibility to women.
Materials and methods Three hundred and fifty women presenting for termination of pregnancy with gestational ages ≤56 days were enrolled at three sites and received 200 mg Mifepristone® orally in the clinic. Women were offered the choice to take 400 mcg Misoprostol® orally at home or in the clinic 48 hours following Mifepristone® administration. Participants returned to the clinic two weeks after initial visit for an assesment of abortion status. Women with ongoing, viable pregnancies were offered surgical abortions. Women with non-viable pregnancies or incomplete abortions were offered the option of waiting another week before surgical intervention.
Results Ninety-seven percent of women had successful abortions without recourse to surgical intervention. Around 95% of women opted to take the Misoprostol® at home. More than 94% of women reported being either satisfied or very satisfied with the method and 96% indicated that the experience was not difficult. The side effects profile was as expected with two-thirds of women reporting either nausea or vomiting. Pain was rated as tolerable by 91% of women. Ultrasonography was used in half the cases to confirm abortion at the follow up visit.
Conclusions 400 mcg of oral Misoprostol® after 200 mg Mifepristone® is effective and acceptable in inducing abortion in women up to 56 days gestation. Some site variation was found related to women's satisfaction and expectations with the method. These differences are likely due to the quality of counseling offerred at the clinics which can improve with further training and experience. In 2006, based on the study results, the Ministry of Health incorporated the reduced dose Mifepristone® medical abortion regimen into its national guidelines.
P006
Ibuprofen does not reduce the effectiveness of Mifepristone® and Misoprostol® induced medical abortion: A double-blind randomized controlled study
A. Livshitz2, R. Machtinger1, G. Yerushalmi1, Y. Ben David1, M. Spira1, A. Moshe-Zahav1, L. Lerner Geva3, E. Schiff1, and D. Seidman1
1Sheba Medical Center, Tel-Hasomer, Israel, 2Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, and 3Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hasomer, Israel
Objective(s) To determine whether the use of ibuprofen for pain relief can adversely affect the outcome of medical termination.
Design and methods We randomized, in a prospective double-blind controlled study, 120 women undergoing medical abortion with 600 mg oral Mifepristone® and 400 mcg oral Misoprostol® to receive ibuprofen or paracetamol when pain relief was necessary. Outcome variables included treatment success (defined as an empty uterus on ultrasound follow-up examination 10–14 days after medical abortion), self-reported pain relief and side effects.
Results There was no statistically significant difference in the failure rate of medical abortion after ingestion of ibuprofen, and the frequency of surgical intervention was slightly higher in the group that received paracetamol (16.3% versus 8.5%). Ibuprofen was found significantly more effective (p < 0.0001) for pain relief after medical abortion compared with paracetamol. We also showed that a past history of a surgical or medical abortion and the pain score before the analgesia were predictive for high pain scores.
Conclusions We found that, despite its anti-prostaglandin effects, ibuprofen use did not interfere with the action of Misoprostol® and was not associated with an increase in the rate of surgical interventions. Ibuprofen, however, was found to be highly efficient for pain reduction during medical abortion and more effective than paracetamol. There seems to be no need to avoid Non-steroidal anti-inflammatory drugs (NSAIDs) in protocols for medical abortion, because they offer effective pain relief, and concern over their potential inhibition of prostaglandin induced uterine contractions is apparently not justified.
P007
Efficacy of Mifepristone® and oral Misoprostol® for induced abortion on woman's request until 69 days of gestation
S. Carvalho, A. Lebre, A. Rita Pinto, M. Brandão, M. Fernandes, H. Bachu, T. Oliveira, R. Magarinho, and P. Sarmento
Maternidade Julio Dinis, Porto, Portugal
Introduction In Portugal abortion as an option on woman's request became legalized up to 69 days of gestation, according to law 16/2007 of 17 April. Mifepristone® and Misoprostol® are typically used for medical abortion. The best therapeutic medical regimen is still under discussion. Since October we are using in our institution Mifepristone® 600 mg oral followed 36–48 hours after by oral 800 mcg Misoprostol® for medically induced abortion.
Objective To analyse the efficacy of Mifepristone® 600 mg oral followed 36–48 hours later by oral 800 mcg Misoprostol® for induced abortion, up to 69 days of gestation.
Methods Retrospective study of 131 women who received Mifepristone® 600 mg oral followed by oral 800 mcg Misoprostol® 36–48 hours after, for induced abortion up to 69 days of gestation, from October to December 2007.
Results 131 women were submitted to medical treatment in our institutiuon with 600 mg of oral Mifepristone® followed by 800 mcg of oral Misoprostol® 36–48 hours afterwards, in order to proceed with abortion on request. All attended a pelvic ultrasound scan with 14(+/−1) days following Misoprostol®. Women with continuing pregnancy repeated the therapeutic regimen. Women in whom non viable products of conception were found were offered a further dose of Misoprostol®. We considered two groups: group 1: under 49 days of gestation (n = 71); group 2 from 50–69 days of gestation (n = 64). Successful medical abortion defined as no requirement for repeating medical or surgical intervention was 94.3% (n = 67) in group 1 and 84.4% (n = 54) in group 2. The complete abortion rate with medical treatment was 95.4% (six women had to undergo curettage).
Discussion Mifepristone® 600 mg orally followed by oral Misoprostol® 800 mcg 36–48 hours after is acceptable and effective in early termination of pregnancy, in particular those under 49 days of gestation. Other therapeutic regimen options need to be analysed for abortion pregnancy from 50 to 69 days of gestation due to a high percentage of treatment failure in this group (15.6%).
P008
Development of contraceptive methods in rural areas can effectively prevent induced abortion in north western Iran
R. Ahmadi
Islamic Azad University, Hamedan Branch, Hamedan, Islamic Republic of Iran
Objectives The extensive education on contraceptive methods, particularly in rural areas of developing countries, plays a pivotal role in the prevention of induced abortion. The main purpose of this study was to determine the major cause of induced abortion in women in western areas of Iran.
Materials and methods The hospital documentary of 848 women encountering medical examinations due to abortion during recent 2 years was studied. Subsequently, by using a standard questionnaire, the major causes of induced abortions were investigated and statistically analyzed.
Results Our findings indicated that the frequency of induced abortion leading to infectious abortion was very remarkable (480 cases) and most of them (over 60%) were inhabitants of rural areas who did not have much knowledge about contraceptive methods. The used devices and tools for induced abortion were urethral sound or Foley catheter (56%), hook, clarinet key or feather (27%), plant extractions, Mg sulfate or Permanganate (9%), and fork or spoon (8%). In most cases (over 50%) the mean age range was 24–38 years old.
Conclusion Based on our results, the frequency of induced abortion was remarkable among the female population in rural western areas of Iran. Since the major cause of induced abortion was the lack of contraceptive methods and poor knowledge on contraceptive methods, the encouragement and education on contraceptive methods application is necessarily required in developing countries and particularly in rural areas.
P009
Protocol for termination of pregnancies in a maternity hospital
S. L. Goh
KK Women's and Children's Hospital, Singapore, Singapore
Termination of pregnancy is a commonly requested procedure in our maternity hospital. Large numbers of staff are involved in a care of a patient from the outpatient setting to the actual surgical procedure. Our hospital initiated a protocol for abortions, in order to standardize care for these patients.
We examine how this protocol eases the flow of care from one healthcare provider to another within the hospital. The clinical pathway charts the necessary information and abortion counselling at the first visit and is used throughout the patient's care for the abortion.
Using a well-defined protocol reduces the risks of medical mishaps through human errors or ill medical judgements, and streamlines medical care. It also serves to cover different aspects of an abortion, including non-medical facets such as counselling by trained counsellors and social workers.
P010
Analysis of pain risk factors during non-surgical induced abortions
D. Marinoushkine
CH de Carhaix, Carhaix, France
Pain stays a known inconvenience and has not yet been controlled in the case of non-surgical induced abortions (NSIA). We have tried to analyse the factors that could influence the intensity of the pain induced by this procedure.
We asked 310 patients to evaluate on a visual analogue scale (VAS) the intensity of their menstrual pain and the intensity of the pain occurred by NSIA. Each of those patients gave their consent to take part in this study. For each, we registered their age, the term of the pregnancy, the obstetric, gynaecology and surgical history, the birth control used before and after the abortion, the intensity of the blood loss and the post-abortion scan results, etc. – 65 criteria in total.
In our research, the average menstrual pain was rated 34.2±16.1. For this reason, we decided to break up our group in two separate groups:
the ones (n1 = 64) with an average abortion-pain <35 (therefore less or equivalent to menstrual pain);
and the ones (n2 = 246) with an average abortion-pain >35.
So, the psychosomatic factor was predominant in the case of the pain occurred by NSIA. And that is probably why the classic pain-killers do not always work.
P011
Social and hygienic aspects of artificial termination of pregnancy
A. Chavchidze, G. Shelia, and N. Tsuleiskiri
Akaki Tsereteli State University, Kutaisi, Imereti, Georgia
Objective Study of the influence of social and hygienic parameters on the motivation of demographic behaviour of the women of the fertile age, residing in the region of Imereti (Georgia).
Design and methods A questionnaire interview of 1230 women with the term of pregnancy up to 12 weeks before their direction to the procedure of artificial abortion. Statistical processing of the material with Excel 7.0 et Statgafics 5.0 programs.
Results 62.7% of the investigated women had undergone the procedure of first abortion, for 26.7% it was the second, for the rest (10.6%) it was the third abortion. From them 43.7% were within the age range of 14–20 years (first abortion). Most of the respondents (71.8%) were married and the age of their children ranged from 1–4 years (63.4%). At the same time, almost 2/3 of the women were engaged or married for 5 and more years (in other words, they had a lot of time and opportunity for having more than two children). More than half of the questioned contingent believed two children to be the ideal number of children in the family, and 24.3% believed this number to be one. As factors hindering birth of the children in the desired number 67.8% of the respondents were citing social and economic difficulties, poor living conditions (22.4% of the women didn't own their own living houses) as well as low incomes (42.9%). At the same time, 41.7% of them believed that for the perfect family it is necessary to have children. The investigation has shown that a third of the women (31.2%) had received higher education, 25.7% had secondary special and 43.1% had only secondary education. A quarter of the women who had undergone abortion, had her own source of income, 18.7% were students.
Conclusion The artificial termination of pregnancy by the interviewed women is socially conditioned: the low level of life, poor living conditions, low salaries, unemployment, lack of the faith in the future, etc. all influence the reproduction plans of a family. Social composition of the women, who have decided to undergo abortion, reflects difficulties of the transient period in Georgia, which is more acutely expressed in the regions. Imereti belongs to the number of such regions.
P012
The effect of education on the pain during and after the abortion
T. Ozkan, E. Albayrak, and M. Baser
University of Erciyes Atatürk School of Health, Kayseri, Turkey
Aim This study was conducted in order to determine the effect of planned education on the pain during and after the abortion.
Methods This study includes women who have abortion at Maternity Hospital, Kayseri, Türkiye between 1 July 2007 and 1 September 2007. The study was composed of volunteers (n = 60) and residents in the city center who were having abortion at hospital during the research. The first 30 women of 60 women who attended family planning clinic were given education by the researchers during these periods. The data were collected with a questionnaire and Visual Analog Scale. Narcotic agents are not used for the abortions carried out by the physicians at the clinic. Therefore, the pain scale was marked by the statements of the woman during the abortion and after 15 minutes and 30 minutes later the abortion procedure. Also three months after the abortion, it was asked for what kind of contraceptive methods were used by the women by phoning them. Chi-square test, Mc Nemar chi-square test and t test were used in order to evaluate the data.
Results The average age of the women was 31.9 ± 5.7 and 56.7% of them had primary school education. It was found out that the women who were educated showed a lower pain scale after 30 minutes later the abortion than those who were not educated (p < 0.05). It was observed that women in the 32–43 age group had a lower scale for the pain occurring 15 minutes after the abortion procedure compared to the younger women (p < 0.05). Twenty two point four percent (22.4%) of the women used modern family planning methods before the abortion whereas it was 81.5% 3 months after the abortion (p < 0.001).
Conclusion The pain levels were found to be lower for the women who were educated before the abortion. Also use of modern family planning methods increased for all women after the abortion.
P013
The wide acces to contraception is the best way to downregulation of abortion rate
T. Fait1, L. Sulova4, J. Jenicek3, and R. Uzel2
1General Faculty Hospital, Prague, 2Czech Family Planning Association, Prague, 33rd Faculty of Medicine Charles University, Prague, and 4Department of Psychology Charles University, Prague, Czech Republic
Objective To verify how demography changes influence of contraceptive's possibilities on the abortion rate.
Design Demography study.
Results The 1990s represent a radical transition from the socialist era in Czech republic, when induced abortions was a common method of unwanted pregnancy additional prevention. Abortion was legalised according the § 68/1957 law many years before hormonal contraception was widespread. The Government tried to reduce the number of induced abortions by so called abortion boards from 1962 to 1987 and by abortion fees until 1993. But restriction was not successful. During the last 17 years the magnificant lowering of abortion rate by 76% from 107,131 (1990) to 25,342 (2006) were connected with the increasing of hormone contraception users by 825% from 110,147 to 908,285. Whereas in 1990 only 17% use medically prescribed contraception, today it is 39% of childbearing. There are still some problems. First order abortion percentage grew merely from 50 to 54%. In 2000 94% of women who underwent abortion did not use any contraception. The most important group undergoing induced abortion remains mothers of two children (38%).
Conclusions The women's right to decide about their pregnancy could be broken by legal restrictions of abortion. The reduction of the abortion rate is closely connected with the modern contraception widespread. It is also more successful than any pro-natality political climate. Dates from Czech republic are the best confirmation of it.
P014
Sociologic aspects of abortion
M. Moreira, R. Coimbra, T. Bombas, T. Sousa Fernandes, and P. Moura
Obstetric Service - Coimbra's University Hospitals, Coimbra, Portugal
Introduction According to the United Nations, about 13% of maternal deaths in the world were attributed to complications from unsafe abortions. In our country, in last decades, for every ten maternal deaths occurring per year, one of them is due to complications of illegal abortion. Since 16 July 2007 abortion is legal before ten weeks.
Objectives To characterize the female population that came to our Service for abortion.
Material and methods We analysed 144 clinical records of medical abortion appointments. We studied: age, nationality, marital status, educational level, profession, parity, historical of abortions, use of Family Planning appointment and reason to ask for abortion.
Results We included 144 females. Average age: 28.2 ± 7.6 (11.8% were adolescents and 20.1% had more than 35 years). From our population, 88.9% women were Portuguese and 63.9% married or living together. About educational level: 40.9% didn't finish basic school, only 20.2% with basic level, 18.8% finished high school and 20.1% had academic education. The majority of women, 36.1%, hadn't a qualified job, 21.5% were students, 11.1% were unemployed and 5.5% had an high qualified profession. It was a first pregnancy in 43.8% and 10.4% had past history of illegal abortion. In our population, 61.8% of women didn't have any Family Planning appointment in the last year. The main reasons for requesting an abortion were: economical, 36.8%; sporadic sexual intercourse, 24.3%; family completed, 16.7%; professional, 8.3%.
Conclusions The majority of women that came for abortion weren't adolescents, as we could expect. Most of them were Portuguese and lived with their partner. The incidence of education underachievement and unqualified professions was high. A great number of women weren't users of Family Planning Services.
P015
Doctors' attitudes to prenatal screening and selective abortion
A. Linca and T. Kulik
Pedagogy, Lublin, Poland
The main aim of the survey was recognition of doctors' attitudes towards prenatal diagnostics as well as selective abortion. We were looking for any connection between attitudes towards prenatal diagnostics and such variables as opinions about the beginning of human being's life, reliability of knowledge about prenatal development of a child, hierarchy of values and religiosity. The survey were conducted by means of the Questionnaire of Attitudes towards Prenatal Diagnostics and Personal Care. Fifty three doctors, who took part in a training in the field of genetic guidance conducted by Instytut Matki Zdrowia i Dziecka Warszawie in 2006 within the framework of first degree specialization in gynaecology, were surveyed. Doctors' attitudes towards abortion were the following: 13.5% of doctors were in favour of abortion, 21.2% were definitely against abortion, 44.2% were willing to permit abortion in many situations, and 21.2% would allow abortion in extreme situations. The huge majority of doctors (96.2%) expressed an opinion that, if there is a possibility of prenatal examinations during gestation, which may reveal an illness or abnormalities of foetus, then one should undergo such examination even if the illness is impossible to cure. A total of 83% of those questioned would allow abortion for this reason. The analysis of data shows the dependence of the attitude towards abortion on the level of variables: hierarchy of values and religiosity of respondents.
P016
Legal interruption of pregnancy between weeks 12 to 22: our protocol
M. Sosa Marrero, L. Estevez Suarez, and C. Delgado Godoy
Hospiyal Universitario Materno-Infantil de Canarias, Las Palmas-Canary Islands, Spain
Introduction The University Hospital Materno Infantil of Canary is a III reference level for the province of Las Palmas. Every year, about 80 legal abortions are performed between weeks 12 to 22 cases within statutory Spanish legislation.
Objectives To report our performance protocol in these processes: Results of fetal expulsion with vaginal misoprostol administered by nurses or patients vaginally according to the gestational age, and acting foeticide in pregnancies over 18 weeks with intracardiac CLK, Protocol analgesia with morphine pump self-managed protocol and psychological support in these patients by health care professionals.
Results The administration of misoprostol vaginally 400 mg every 3 hours in 5 rounds of government is revealed as appropriate dose-balancing effectiveness absence side effects in all cases. Have an analgesic proper protocol has helped to avoid pain in these patients. Doing foeticide to fetuses older than 18 weeks has contributed to the psychological comfort of these patients. Have a protocol of psychological help and preparing the workforce involved in the process has been very helpful both for patients and for their own health personnel.
Discussion ILE is a traumatic process for pregnant women: establishing protocols and preparing the workforce contributes to the goal of shortening stays and help from a gynaecological and psychological care.
Conclusion It is proposed this protocol as a basis for those centers that do not have them and want to take this as a reference.
P017
Legal abortion in hospital Santa Maria: medical abortion techniques efficacy
J. Neves, A. Candeias, H. Ferreira, M. Manuela Carmo, and L. Mendes Graca
Department of Obstetrics, Gynecology and Reprodutive Medicine, Lisbon, Portugal
Objective The evaluation of medical abortion technique efficacy.
Design and methods We had studied 139 cases of legal abortion. All cases were submitted to medical abortion techniques – Mifepristone® (200 mg oral) plus Misoprostol® (800 ug vaginal) at the same time is Protocol 1 (P1); Mifepristone® (200 mg oral) and Misoprostol® (800 ug vaginal) at the same time and 24 hours after, Misoprostol® oral (1600 ug – 1 tablet/hour till completed 8 tablets), the Protocol 2 (P2). Protocol 1 was used for gestation duration less than 49 days and Protocol 2 was used for gestation duration with or more than 49 days till 70 days. Lack of efficacy was defined as need for surgical curettage.
Results 139 women had completed the process for legal abortion in our Department, since the first visit to the discharge. The clinical and demographic data are the following (mean±sd) – age 28.3±7.66 (years) and gestation duration 56.9±8.26 (days); 41 (29.4%) were nuliparous, 38 (27.3%) primiparous and 60 (43.1%) multiparous. P1 was used in 67 cases (48.3%) and P2 was used in 72 cases (51.7%). In 129 cases (92.8%) there were a complete uterine evacuation and 10 cases (9.28%) had needed surgical curettage. From those surgical cases, in two of them, the histological features had not found any embryonic tissue, so the uterine evacuation was not completed in 8 cases (5.7%). No reports of infection.
Conclusions In this sample of population enrolled for legal abortion, the medical techniques using Mifepristone® and Misoprostol®, have a high efficacy for uterine evacuation.
P018
Six years results of mid-trimester medical abortions
O. Šottner1, D. Driák1, B. Sehnal1, K. Hurt1, M. Dvorák1, J. Záhumenský1, M. Halaška1, and D. Stejskal2
1Department of Gynaecology and Obstetrics, Charles University in Prague, First Faculty of Medicine and University Hospital Na Bulovce, Prague, Czech Republic, and 2Gennet, s.r.o., Prague, Czech Republic
Introduction The spontaneous miscarriage rate of clinically confirmed pregnancies varies between 10–15% and generally falls into the first trimester. The early pregnancy loss rate in preclinical phase seems to be even higher and estimates about 50%. In the second trimester spontaneous miscarriage rate is 1–3%. In general about 70% of human conceptions for various reasons do not reach the stage of viability.
Objectives The purpose of our study was to analyse the effectiveness and safety of different methods of mid-trimester medical abortion.
Design and methods Within 6 years, 2002–2007, a total of 131 mid-trimester medical abortions were performed in our clinic. The parameters of indication, induction-to-abortion intervals, blood loss, other complications, and lenght of hospitalization were evaluated.
Results The most frequent indication for termination of second trimester pregnancy was genetic, 83 (63.4%). The most common method of mid-trimester abortion was induction by means of intracervical application of Dilapan followed with intraamniotic injection of PGF2α, 59 (45%). In those cases the mean induction-to-abortion interval was 15 hours and 25 minutes, the mean blood loss was 144 ml. Total time of hospitalization on average was 4 days, and time from abortion to dimission on average was 2.7 days.
Conclusion According to the results of our trial, the pretreatment with mechanical-chemical dilatation of the cervix followed with intraamniotic injection of PGF2α is a very effective and safe method of termination of second trimester pregnancy.
Topic 2: Adolescence
P019
Etonogestrel-releasing contraceptive implant (Implanon®) in adolescents – 6 years experience
M. Durão, R. Martins, T. Bombas, T. Sousa Fernandes, and P. Moura
Department of Obstetrics, Human Reproduction and Foetal-Maternal Medicine, Coimbra University Hospital, Coimbra, Portugal
Introduction Portugal has one of the highest rates of adolescent pregnancy in Europe. In an adolescent population requiring an effective, long-acting, contraceptive method that avoids the need for daily compliance, subdermal etonogestrel-releasing implants (Implanon®) are an often-used option. A study was conducted in our institution regarding our experience with its use.
Material and methods A total of 210 Implanon® devices were applied in 196 adolescents from June 2001 until June 2007, twice in 14 of them. Among others, the following variables were assessed by retrospective analysis: age, parity, moment of insertion of the implant, reasons for choosing it, previous contraceptive method utilized (if any), side effects, degree of satisfaction with Implanon® and reasons for its eventual removal.
Results The median age of our population was 16.5 years (SD 1.39 years, range 12–18 years). Only 21.4% had never been pregnant; 66.8% had already one child and 7.1% had two. The main reason for choosing Implanon® was the need for an effective contraceptive method (89.3%), followed by medical contraindication to combination hormonal contraceptives (6.1%). A significant percentage of the adolescents (76%) had no previous experience with a contraceptive method; 18.4% had used an oral hormonal contraceptive. Of those with previous contraceptive experience, 59.6% mentioned a defective compliance. Implanon® insertion occurred in the first half of the menstrual cycle in 25% of the adolescents and in 70.4% in the immediate postpartum period. There were no pregnancies in the adolescents with Implanon®. Persistent side effects (weight gain, heavy or irregular bleeding) were described by 10.2% of the adolescents. In 6.6%; the implant was removed before 3 years - in 5.1% because of its adverse side effects. 93.9% of the adolescents were satisfied with the method.
Comments In a population of young girls at risk of a teenage pregnancy (or following one), Implanon® can be seen as a first option contraceptive method because of its long lasting efficacy, easy compliance requirements and favourable side effects pattern.
P020
The experience of the reduction of the number of abortions and level of maternal death-rate of women-teenagers
M. Khamoshina1, L. Kaygorodova2, L. Nesvyachenaya3, and G. Pogorelova4
1Vladivostok State Medical University, Vladivostok, Russian Federation, 2Vladivostok State Medical University, Vladivostok, Russian Federation, 3The Public Health Care Department of the Administration of the Primorsky region of Russian Federation, Vladivostok, Russian Federation, 4Primorsky region clinical hospital No 1, Vladivostok, Russian Federation
Objective To reduce the number of abortions and the level of maternal deaths of women-teenagers in Primorsky region.
Design and methods In the course of our investigation we studied the reproductive behaviour and contraceptive needs of girl teenagers and pregnant women 15–19 years (n = 6195), and also the structure and reasons of maternal death-rate of the women 15–19 years (n = 19). The study was conducted from 1998–2004. The methods of anonymous interview, analysis of data from medical documentation, correlative and multivariate exploratory techniques were used. For statistical data processing the STATISTICA (StatSoft Inc., USA) was used. Verification of the qualitative signs change was performed by univariate analysis of variance. Vilkoksona-Manna-Uitni criterions for unbounded collections and the methods of the variational statistics with use the criterion χ2 were used too. The difference declared significant was p < 0.05.
Results It was installed that the breaches of the reproductive behaviour of the young women are defined by low level of knowledge about contraception (r = 0.87). The longing to choose the method of contraception for themselves is the particularity of the teenagers. The share of abortions in structure of maternal death-rate of the women-teenagers was 33.3%, the main reasons of maternal death-rate were preeclampsia (35.3%) and complications of abortions (29.4%). This has given us the motivation for the main trends of activity to reduce the number of abortions and undesirable pregnancy of the teenagers: (1) increasing of the level of knowledge about contraception and consequences of abortion and undesirable pregnancy; (2) the personalization of contraceptive choice; (3) improvement of the obstetrics care with provision for age particularities; (4) the increasing of qualification of the medical workmen in the field of the reproductive health of teenagers, teenagers pregnancy and contraception. This system of the measures was marketed in the region in 1998–2002 years under information and partner support AS ‘Gedeon Richter’ (www.g-richter.ru and www.contraceptia.ru). The educational program ‘The bases of the reproductive health’ for students of first courses was introduced in the medical university in volume of 12 academic hours as separate obligatory course. The estimation of its efficiency have shown the reduction of frequency of abortions and events of sexual- transmission infections in group of informed students (in 1.5 times, p < 0.01–0.05). The Informative module of the program was introduced in the work with teenagers in medical and educational institutions of the region, and was submitted for the websites about reproductive health and contraception. The interactive algorithm for teenagers was designed and introduced in practical activity. The interactive choice of contraceptive method was realized with provision for sexual activity, number of sexual partners, nature of the menstrual cycle, presence of the symptoms of hyperandrogenia and metabolic risk associated with long use of contraceptive pills. The preventive tactic of the prenatal care of young pregnant women was motivated and introduced in the practice of the obstetrics clinics of region. It was directed on the warning of the placenta insufficiency and preeclampsia. In medical university the obligatory lectures and seminars about the guard of reproductive health of teenagers, obstetrics and gynecologies of teenagers were introduced into the structura of postdiploma education of obstetricians and gynecologists, pediatricians and family doctors. The offered system of acts in Primorsky region in 1998–2002 has allowed us to reduce the number of procreations before 19 years to 16.5%, their share in the crude structure to 30.5%, reduce the number of abortions in 15–19 year olds by 41.0% and their share in the crude abortion structure on 32.7%, perfect the correlation a birth: abortions in this categories (1.0:0.94) and reduce maternal death-rate at age below 19 years on 40.1% (p < 0.05). Now the information-educational work with teenagers lasts within the framework of educational program ‘Your children are your future’ in support of AS ‘Gedeon Richter’ (www.love4life.ru). As from 2004, the events of maternal death-rate of the young women in Primorsky region do not take place. In period 1998–2006 the number of abortions of women 15–19 years was reduced by 51.9% (p < 0.05).
Conclusions The system of the measures for the reduction of the number of abortions and maternal death-rate of teenagers must include the actions, directed at increasing the level of reproductive education of teenagers, the personalization of choice of the contraceptive method and the increasing of qualifications of doctors in the field of obstetrics and gynecology of teenagers.
P021
Implanon® – retrospective study of 7 years (2001–2007) among young people
F. Pinto, M. Teixeira, M. Brandão, A. Lebre, A. Pinto, D. Leite, J. Santos, T. Oliveira, and P. Sarmento
Centro Hospitalar do Porto, Porto, Portugal
Implanon® is an implantable device, wich is currently being investigated for use, releasing 40 mcg of etonorgestrel per day in a single rod system. This method maintains its efficacy for 3 years. In addition to thickening of the cervical mucus and decidualization of the endometrium, it also acts by having a circulating level of progestin high enough to block the luteinising hormone surge and, hence, ovulation.
The ‘Young Space’ is a project developed by our institution in order to supply free contraception and avoid pregnancy in the first place. Created in March of 1994 for both sexes, we try to give answer to several questions in sexuality area, gynaecological problems, family planning, free provision of contraception and screening of sexually transmitted diseases, always with anonymity and without bureaucratization.
The purpose of the study is to evaluate indications, side effects, menstrual bleeding pattern, efficacy of contraception, satisfaction rate and removal causes with implantable device.
Retrospective study of 235 women, younger than 25 years old, followed in ‘young space’, of the Maternidade Júlio Dinis, over 7 years.
Two hundred thirty five cases were analysed (n = 235): 1.3% among teenagers less than 14 years old, 33.2% between 14–17, 29% between 18–20 and 36.6% among girls older than 20 years old. One hundred twenty five girls had already been pregnant. Social cases were responsible for 78 cases, forgetfulness of pills for 63 cases, cognitive deficits for 53 cases, psychiatric problems for 16 and after voluntary interruption of pregnancy responsible for 10 of the implant device. It is important to note that 52 of thess girls were institutionalized.
Relatively to previous contraception, pills were used by 94 girls, barrier method by 18 girls, Depo-provera by 13 girls and implant device by 17 girls. One hundred three girls did not use any contraceptive method before consultation.
Common side effects reported were irregular bleeding, weight increase, headaches and acne. Oligomenorrhea was the most frequent pattern of bleeding. Irregular menstrual bleeding pattern, mostly menometrorragia, and weigh increase were the main causes of dissatisfaction. In order to avoid pregnancy, implantable device demonstrated efficacy of 100%. Despite the high satisfaction rate, just 17 cases replaced a new device because the most cases will complete the term of Implanon® in the next year. We believe to be a very good method in groups with bad compliance and mainly in young people with social and psychological problems.
P022
Socio-clinical characteristics of contraceptive use among Libyan Women at Misurata Teaching Hospital
F. El Rishi and B. Elmadani
Misurata Teaching Hospital, Misurata, Libyan Arab Jamahiriya
Objective Knowledge of the wide variety of contraceptive methods is important in helping each patient make an appropriate choice, the study was conducted to investigate the influence of demographic and sociocultural factors on contraceptive use among women residing in Misurata, Libya.
Design 220 contraceptive users attending the obstetric and gynaecology out-patients clinic of the hospital and underwent a structured interview. Medical records, demographic and sociocultural factors of family planning women were reviewed.
Results The current users have a mean age of 32.7 ± 5.3 years and 62.7% of them were between 30 and 39 years. 16.4% of the women were illiterate; 47.3% had low education level and only 12% had more than 12 years of education. The average number of pregnancies was 5 and that of living children was 4.4; and none of the women interviewed had used any contraceptive prior to her first pregnancy. The average birth interval was 2.8 years. Illiterate women had an average of 6.8 pregnancies compared with 2.5 for those had more than 12 years of school; 75.5% were housewives and 2% are students. 31.8% of the users had poor income and had average family members of 7.5. Of the total contraceptive users; 26.4% have medical problems. Only 36.4% had some sort of awareness regarding contraception; the main source of information was relatives (21%), and none of the users is aware of options for emergency contraception neither of new modern contraceptions. Of the total users; 32% the patient is the one who decided on the method of contraception based on the patient's personal beliefs and preferences; and in 41% husband shared in the decisions while in 16% of the cases husband is the one who decided. 45.5% had contraceptive counseling. More than 50% of the women used either IUDs (27.3%) or oral contraceptives (24.5%). 60% of the IUDs users were grandmultiparae. Tubal sterilization is the least popular method of contraception among our patients (1.8%). The other options of contraceptives were calendar methods (22.7%), lactational amenorrhea (6.4%) withdrawal (3.6%), condoms (6.4%), and injectable (7.3%).
Conclusion No woman surveyed had used any contraception before her first pregnancy. Husbands have a major role in decision on the method of contraception. There is a knowledge-practice gap concerning family planning methods among our patients indicating a family planning program to be effective and strategic planning should be target the grandmultiparae.
P023
Contraception practices following termination of pregnancy in adolescents
G. Amountza1 and P. Anastasopoulos2
1Department of Paediatrics, and 2Department of Obstetrics & Gynaecology, University of Dundee, Dundee, UK
Objectives The purpose of the study was the analysis of contraception practices immediately after a termination of pregnancy in adolescents.
Introduction This is a population study using the cases of our tertiary hospital which acts as a referral centre for the area. In the above population and consistently with the national reports Termination Of Pregnancy (TOP) is the most common gynaecological operation, with approximately one third of the women in reproductive age reporting at least one in their medical history. Adolescents consist the most vulnerable 25% of them.
Design and methods The study included as reference population all those referred for TOP over a two year period (2004–2005) to the University Hospital, where 99.8% of those procedures takes place. Adolescent girls were studied with regards to their exact age, the method of TOP, the contraception used (if any) at the time of pregnancy and the one practised after the TOP. According to the guidelines, our hospital offers surgical TOP for pregnancies between 9–12 weeks while medical TOP (using Mifepristone®) is offered up to 18 weeks.
Results Out of the 922 cases, 212 (23%) were in adolescence, with an average age of 16.42 years. 165 (78%) proceeded to a first trimester medical TOP, 25 (12%) to a surgical TOP and 21 (10%) to a second trimester TOP. 93 (44%) reported using no contraception, 91 (43%) reported using prophylactic, while 21 (10%) used progesterone only or combined contraceptive pill; only 6(3%) used progestogens of any form. After the TOP the suggested and immediately followed contraceptive practice was the pill in 119(56%), the injectable progestogens in 66 (31%), progestogen implants in 17(8%) and Intra-Uterine Contraceptive Devices is 11 (5%). The exclusive use of condoms is not included among the recommended methods by the hospital. 23 (11%) reported one and 2 (1%) two previous TOPs.
Conclusions The adolescent girls' contribution to the referrals for TOP remains unacceptably high, albeit consistent with the national statistics. This dictates the immediate need for further contraception education from very early on within the formal school education system. The percentages of the medical TOPs are fortunately among the highest both nationally as well as internationally. Adolescents after the TOP choose some form of contraception or improved the one already used, implying that it was its absence or unreliability leading them to TOP. The overwhelming preference for ‘female controlled’ methods further enhances the above.
P024
At-risk adolescents: pregnancy and contraceptive use
W. Hellerstedt
University of Minnesota, Minneapolis, MN, USA
Objective Compared with adolescents in the US overall, Native American youth are at twice the risk of unintended pregnancy and sexually transmitted infections (STIs). The purpose of this study was to examine the risk and protective factors associated with the use of contraceptives among Native adolescents in order to develop effective pregnancy and STI interventions.
Design and methods A sample of 148 13–18 year-old Native females and males in Minnesota, USA, completed a written survey about their sexual experiences, use of contraceptives, and pregnancy involvement. Risk and protective factors on the survey included household structure, neighborhood characteristics, school involvement, and future plans. Separate multivariable logistic regression analyses were conducted to examine variables associated with (1) usually or always using contraceptives and (2) pregnancy involvement, for young (13–15-year-olds) and older (16–18-year-old) females and males.
Results About 40% of the 13–15-year-olds were sexually experienced and the majority of the 16–18-year-olds were sexually experienced (63% females; 74% males). The correlates of contraceptive use varied by sex and age group. For example, for 16–18-year-old males, the variable most strongly associated with usual/always using contraceptives was intention to go to college (odds ratio 2.4; 95% confidence interval 1.6–2.9). The most significant risk factors for not usually/always using contraceptives for both female and male 16–18 year-olds was personal experience of violence. The strongest risk factors for pregnancy involvement for 16–18-year-old females and males was having experienced violence; for females only, feeling safe in one's neighborhood was negatively associated with pregnancy.
Conclusions We found that risk and protective factors for not usually/always using contraceptives and pregnancy involvement for adolescents were associated with larger social concerns: experiences of violence, perceived neighborhood safety, and future plans for education. It may not be enough to incorporate these findings into individual interventions, but rather to consider further examination of these findings as policies and funding priorities for youth are set.
P025
Teenagers, unplanned pregnancies and contraceptive use
G. Falk1, J. Brynhildsen1, and A.-B. Ivarsson2
1Department of Obstetrics and Gynecology Linköping University Hospital, Linköping, and 2Department of Public Health and Caring Sciences Örebro University, Örebro, Sweden
Background Preventing unplanned pregnancies, especially among teenagers, is an important goal for all health promoting programs in many countries worldwide. In Sweden contraceptives are easily available for teenagers and preventive programs exist as well as sex education within the school system. Despite this the abortion rates increases as well as the repeat abortion rates among teenagers.
The aim of this study was to examine and analyse the contents of medical records of teenagers who were seeking abortion on account of unplanned pregnancies. The focus was on contraceptive counselling.
Methods A consecutive selection of 30 medical records, from 1 January 2006, concerning teenagers seeking for abortion on account of unplanned pregnancies, was done. The documentation was analysed with a retrospective content analyse method. This qualitative research method was used because it can generate new knowledge about the contraceptive counselling, that should be a part of the discussion between the doctor and the teenager at this visit. The research question was what was documented about contraceptive use before the unplanned pregnancy and what contraceptive method was suggested for the future as a way to avoid a new unplanned pregnancy. The text areas were transcribed by the researcher in several stages and the themes that emerged were analysed.
Result Documentation within the medical records covered themes about barriers to contraceptive use such as; not having started contraceptive use despite having it at home, not having used contraceptives at all, having been advised against contraceptive use, having problems with remembering to use contraceptives, having experienced negative side-effects of contraceptives leading to cessation. The themes that emerged about recommendation of future contraceptive use were: not recommending any method, referring to another contraceptive adviser, giving a long-acting method, giving a short-acting method, informing of different contraceptive methods, stating that it was not possible to discuss contraceptives at the visit.
Conclusion The result of this study showed that the documentation about contraceptive use and advice about future use at the visit when teenager request abortion, reveals that contraceptive counselling should be improved and that a second visit for contraceptive counselling might enhance the chances for successful contraceptive use in the future.
P026
Reducing the intention-behaviour gap for contraceptive use: findings from a user-engagement study
K. Brown1, C. Abraham2, P. Joshi3, and L. Wallace1
1Coventry University, Coventry, 2University of Sussex, Brighton, and 3Aston University, Birmingham, UK
Britain has high rates of teenage pregnancy and STI transmission and although the Government has set targets to address this issue, they are unlikely to be met1. Evidence from previous research suggests teenagers often intend to use contraception but fail to translate their intentions into action2. Theory-driven interventions which help people plan effectively to translate their intentions into action have been effective in relation to other health-related behaviours (e.g., Orbell & Sheeran, 2000)3. No research to date has applied such theory to contraceptive use. A prototype computer-based intervention using this psychological theory was therefore designed to help teenagers form effective plans to use their chosen contraceptive method effectively. The purpose of the project reported here was to increase real-world usability of this theory-based tool, by consulting teenagers and sexual health professionals about the prototype. Interviews with 22 teenagers and 10 sexual health professionals who had interacted with the intervention prototype yielded rich data which was transcribed and subjected to thematic analysis4. Findings have provided specific detail about further development of the intervention programme and have revealed important issues with implications for the approach taken for delivery of sexual health services and education in Britain.
P028
Tendency of sexual and contraceptive behavior among Greek youngsters: A comparison between 2003 and 2007 studies
P. Christopoulos, E. Deligeoroglou, N. Salakos, C. Bakalianou, C. Papadias, and G. Creatsas
Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery, Athens, Greece
Introduction The reported age of menarche has declined in our days, with a mean age of 12.5 years old when 150 years ago the mean age was around 17.5 years old. Adolescent pregnancies are considered to be high-risk pregnancies because of their increased perinatal and maternal morbidity, due to frequent obstetric complications. In developed countries, 7.5–10% of adolescent women get pregnant, while half of these cases end in technical abortion with all possible complications. The purpose of this study was to investigate the tendency of the sexual behavior, concerning age at first intercourse, as well as contraceptive issues, during the last few years, in Greece.
Material and methods We confronted the results of two surveys, conducted the first one during 2003 and repeated in 2007, regarding sexual behavior, age at first intercourse and contraceptive methods used during adolescence.
Results Our study revealed an increase of sexual activity, up to the age of 18 years old, from 30% to 40% of teenagers being sexually active. At the time of their first sexual intercourse, 11.25% of them (4.5%) aged between 12–14 years old, compared to the 16.7% (5.0%) of the previous study, for the same age group. Another 21.25% (8.5%) of those teenagers, compared to the 14% (4.2%) of the previous study, had their first sexual intercourse between the age of 14–16 years old. The remaining 67.5% approximately (27%), aged between 16–18 years old, compared to the 69.3% (20.8%) of them in the 2003 study. A large percentage of adolescents uses none (27% compared to the previous 30%) or ineffective contraceptive methods such as withdrawal (25% compared to the 30% of the 2003 study).
Conclusions It is noted that teenagers tend to become sexually active at younger ages. Despite all the initiatives on educational programs concerning sexuality and contraceptive issues, they demonstrate still low compliance to contraceptive methods, even though things tend to improve. Specialized sexual health-counseling programs for youngsters and extended follow up for their support, in adequate Departments, such as Pediatric and Adolescent Gynecology's, are necessary.
P029
Postnatal contraception practices in adolescents
G. Amountza2 and P. Anastasopoulos1
1Department of Obstetrics & Gynaecology, University of Dundee, and 2Department of Paediatrics, University of Dundee, Dundee, UK
Objective Purpose of the study is the analysis of contraception practices immediately after a pregnancy in adolescence.
Introduction Contraception during the puerperium and generally soon after a pregnancy is one of the neglected areas of care provision internationally, with the involvement of a variety of healthcare professionals. This is the case even more so for the extremely vulnerable group of the adolescent girls.
Design and methods Data about the contraceptive practices up to 6 months postnatally were collected for the adolescent girls delivered in our University Hospital for the year 2005. The cases were studied with regards to the mode of delivery the type of contraception used (if any) before and after the pregnancy, the practice or not of lactation, the capacity of the caregiver providing the contraception advice and the quality of the contraceptive advice evaluated by the girls themselves.
Results We studied 89 cases withan average age of 17.2 years at conception. Only 13% (12) reported a provision of contraceptive advice for the first time during the pregnancy, while 72%(64) reported this to have taken place in the postnatal wards. The vast majority of those girls (59, 92%) obtained this information by their named midwives or by the breastfeeding promotion specialist midwife. Only 8% received this information exclusively from medical practitioners.
About 50% (45) were formally discharged with a contraceptive medication prescription: The contraceptive pill (35, 39%), injectable progestogens (5, 6%) or subcutaneous implants (5, 6%). The hospital's Department of Paediatrics had an informal input. However, with their contribution, further analysis revealed an increased rate of contraceptive advice in the cases where delivery was premature and in cases with the baby's been admitted to special care baby unit or neonatal intensive care unit.
Conclusions Our data are not dissimilar to the national reports about the overall contraception rates. It is however of great importance the finding of significant preference of this age group for female controlled contraception. This comes along with the need for an INTEGRATED information provision at the time of the puerperium: Concurrent education for lactation, contraception, as well as specialist paediatric input if necessary should be emphasised. Finally, the efforts during stay in the postnatal wards are probably not enough to address the issue.
P030
Use of etonogestrel implant in adolescent mothers
Flaviano Queiroz, Cristina Guazzelli, and Marcia Barbieri
UNIFESP, Sao Pulo, Sao Paulo, Brazil
The incessant quest to find ways to reduce the incidence of pregnancy in adolescence is based on increasing rates found not only in our country, but all over the world. Currently, we found that about 20% of the deliveries made by the WHO of patients are less than 19 years old, and because of the annual increase of this rate, we need new projects for a better approach for these pacients.We found few studies in the literature with the use of progesterone implants in patients adolescents. The implant of progesterone is an efficient method and safe with good applicability in this group of patients.
Methodology We selected 26 adolescent patients (14–19 years) in puerperal period (after the second month of birth and up to the sixth month), who sought the service of family planning, UNIFESP, during the period June 2005 to June 2006. It was established as criteria for excluding those suggested by the WHO (2004) in categories 3 and 4. Twenty six patients were evaluated with respect to body weight, vaginal bleeding and blood pressure.
Results No problems were found for the placement of the implant. The time of allotment averaged about 30 seconds. The reasons for the greatest feedback from the patients were changes in weight – a decrease in weight of 2.4% in overall average of patients. The greatest weight loss occurred in a patient who lost 11.8 kg. Three patients had weight gain, and the maximum weight gain was 3.3 kg. Every month the patients had their blood pressure measured at each visit. The initial average blood pressure was 86.7 and the end of 87.6%. Four of the 26 patients in the study progressed with amenorrhea after delivery (19.2%). In the remaining patients the standard was irregular bleeding, but no patient developed anemia.
Discussion The adoption of the use of implantation of progesterone in patients who were adolescent mothers was adopted because of the need to increase the range interpartal the first to the second pregnancy in adolescents of our service through a safe and efficient method. We also believe that the lack of work to implant in adolescents has been a great stimulus for this study. Urbancsek, in 1998, found an increase of 6.4% in weight in adult users of etonogestrel implant, after 3 years of monitoring. A gradual increase in weight from 1.5 to 2.0% after one year is expected in users of implant patients. We believe that the weight loss found in our patients is predominantly due to the fact of them are in puerperal stage, and not to use the method. The incidence of clinical elevation of blood pressure is very low in users of implant. Studies evaluating the blood pressure in adult users of implantation of etonogestrel found increase in systolic pressure by 0.4% and 0.7% in diastolic pressure on users to implant the end of a year of use. The average systolic and diastolic pressures have not changed in these groups. In our study we found an increase in the mean systolic blood pressure of 0.99% and diastolic of 98%. A retrospective study was performed in the UK with adult users of implant patients found that 12% of patients requested early withdrawal of the implant with complaint of menstrual irregularity. The same study found a rate of amenorrhea in 27% of users of implantation of etonogestrel.
Conclusions No pregnancy was diagnosed in clinical studies using implantation of progesterone. The patients should be advised that the rate of pregnancy associated with the use of implantation of progesterone is less than 1 in 1000 by 3 years of use. The use of etonogestrel implant is not associated with severe adverse effects. Approximately 20% of patients with amenorrhea evolve, while 50% of patients will have infrequent bleeding, frequent or prolonged. There is no evidence to support a causal association between the use of the implant of progesterone and changes in weight.
P031
Oral contraceptive use in relation to bone mineral density and bone turnover in adolescent women
M. Lattakova1, M. Borovsky1, J. Payer2, and Z. Killinger2
11st Department of Gynecology and Obstetrics, School of Medicine, Comenius University, Bratislava, Slovakia, and25th Department of Internal Medicine, School of Medicine, Comenius University, Bratislava, Slovakia
The accrual of peak bone mass during childhood and adolescence is influenced by genetic variability, physical activity, nutrition and after puberty by sex steroids. Although it is well established that oral contraceptives (OCs) have positive effects on bone mass and fracture risk in estrogen-deficient postmenopausal women, the effect of low-dose OCs on bone mass in adolescent women is not clear. The decrease in both estrogen and progestin content in OCs over the past decade has led to a reduction in both side effects and cardiovascular complications and potentially to lower serum estrogen concentrations. Therefore, the peak bone mass can be affected in adolescent girls using low-dose and ultra-low-dose OCs. The aim of the study was to compare the effect of low-dose OCs containing 30 μg of ethinylestradiol and ultra-low-dose OCs containing 15 μg of ethinylestradiol on bone turnover and bone mineral density (BMD) in healthy adolescent women.
Ninety two healthy girls between 16 and 19 years of age participated in the study. After gynecological examination, the life style data were obtained and bone mineral density at the lumbar spine and total hip were measured by dual-energy X-ray absorptiometry, and serum osteocalcin and C-telopeptide were measured. Subsequently, the girls were divided into three groups. In the first group the girls started using hormonal contraception containing 30 μg ethinylestradiol/3 mg drospirenon, in the second group hormonal contraception containing 15 μg ethinylestradiol/0.06 mg gestoden and in the third group no contraception was used. BMD and markers of bone turneover will be measured 12 month after the first measurement. The measurement will be accomplished in March 2008.
This study has been supported by the Slovak Republic Ministry of Health Government Grant No. 2005/7-FNsPBA-02.
P032
Sexual behaviour of adolescent females using different contraceptive methods
K. Sedlecky, S. Perovic, I. Mazibrada, and Z. Stankovic
Mother and Child Health Care Institute of Serbia, Belgrade, Serbia
Objective It was hypothesized that, apart from lack of knowledge regarding contraceptive use, the psychological characteristics of adolescents, like being passive and perceiving sexual intercourse as something that happens to them, emotional and/or sexual immaturity, being impulsive could be the reason why girls don't rely on efficient contraception in pregnancy prevention. The aim of this study was to explore the differences in sexual behavior and quality of sexual life of young women using withdrawal (W), condom (C) and combined oral contraception (COC).
Design and methods The study group consisted of 180 sexually active women aged 16–25 who were using either W (n = 60), C (n = 50) or COC (n = 70). The investigated women were attending the Youth Reproductive Health Service in The Mother and Child Health Care Institute of Serbia in the period from 1 October–28 December 2007. The participants of this study were interviewed about their sexual behaviour and contraceptive use, with particular attention paid to the relevant variables in the year preceding the investigation. The data were analysed using the statistical programme for social sciences (SPSS) computer software package with Chi-square to assess the association between variables.
Results The groups of women using different contraceptive methods were matched according to age. The first sexual intercourse was experienced earlier in the group of women using W (17.18), in comparison with the groups using C (17.98) and COC (18.01). The average number of sexual partners was the highest in the same, W group (3.37 vs. 3.26 in COC and 1.76 in C groups). Two or more sexual intercourses per week had 76.6% of the investigated women in W group, 74.3% among COC users and 56.0% in C group. There were no significant differences in the frequency of vaginal, oral and anal sexual intercourses among investigated groups. The big proportion of women reported never experienced orgasm during sexual intercourse (total 23.3%; W 33.3%; COC 20.0%; C 16.0%). The ratio of women satisfied with their sexual life was significantly higher (p>0.005) in the COC group (36.0%) and C group (36.0%) in comparison with W group (23.3%). A sexual intercourse was most often initiated by a boyfriend in the W group (43.3%), and by both partners in the COC users (48.6%) and C group (44.0%).
Conclusion Although certain methodological limitations exist, this study indicates that women who rely on withdrawal as their birth control choice have weaker control over their sexual life and poorer sexual fulfillment.
P033
Contraceptive methods awareness and knowledge of adolescents in the Georgian Capital, Tbilisi
J. Kristesashvili, M. Jorbenadze, and L. Nadareishvili
Zhordania Institute of Human Reproduction, Tbilisi, Georgia
Objectives The aim of the study was detection of level of awareness and knowledge in contraceptive methods of the adolescents in Tbilisi.
Design and methods Qualitative survey among 753 adolescents (378 boys and 375 girls) aged 15–17 in Tbilisi schools with the use of in-depth and key-informant interviews were carried out.
Results 95% of respondents were aware about pregnancy, negative results of abortion as well as the possibilities of avoiding unwanted pregnancy. Awareness on particular methods of contraception was varying in wide range (0.4–83.1%). Even for the most popular methods of contraception knowledge of correct usage was significantly lower than awareness (by 50%, excluding condom). The use of condom seems to be familiar for the majority of both boys and girls (90.6% and 62.4% respectively), while about IUD girls know much better (31.0% for girls against 18.6% for boys). The knowledge about the hormonal pills turned out to be similar. A share of those informed about other means of contraception and aware of their application order is very small (about 2%). Among these, awareness about the traditional and the postcoital contraceptives tends to grow with the years. 87.6% of respondents consider casual sexual contracts as dangerous. Majority of respondents think that both sexual partners have to take care to avoid the unwanted pregnancy.
Conclusions The results above should be taken into consideration during elaboration of educational and health programs of adolescent reproductive health.
P034
Reproductive behaviour of the adolescent girls residing in the region and choice of contraception
G. Shelia, A. Chavchidze, and N. Tsuleiskiri
Akaki Tsereteli State University, Kutaisi, Imerety, Georgia
Objective To reduce the number of abortions in adolescents in Imereti region (Georgia) on the basis of the development and introduction of a system of regional measures.
Design and methods A prospective study; a group 962 studying adolescent girls aged 14–18 years; volunteer anonymous guestionnaire survey, descriptive statistics, one-way layout variance analysis.
Results From the total number of the adolescent girls 59.3% were sexually active. 72.1% believed that sexual début in the age of 17 and above was optimal. Study of the reproductive disposition has shown that most of them were inclined to have 1 or 2 children. The average age of occurrence of pregnancy amounted to 16.7 ± 0.04 years; in 3.9% its outcome was spontaneous abortion in early terms of pregnancy; 37.8% have undergone artificial abortion according to their own will or by special indication. Almost half of the interviewed have remarked that they had not received sufficient sexual education. Though they were aware of several methods of contraception, amongst which they have named: condoms (98%), hormonal pills (54.3%), spirals (59.1%). Respondents believed that the use of condoms was the safest method. Each fourth girl stated that there were no safe methods. Analysis of the sources on the methods of contraception have shown that they have discussed this theme with friends (62.1%), mother and relatives (20.3%), a medical worker (7.9%), or retrieved it from the special literature (9.4%). This points to the fact that they have quite insufficient sexual education and are inadequately informed, or do not use the methods of contraception in the life. Accordingly, they represent the group of high risk of occurrence of non-desired pregnancy and in respect of possible abortion.
Conclusion Perspective direction towards diminution of abortions amongst adolescent girls is to bring nearer to them qualified consultative services, supply more information of the methods of contraception, so that there could be made well-cognized and adequate contraceptive choice in the created situation elaboration of the systemic measures on the regional level and their inculcation have shown that the number of abortions have diminished by 1.6–1.9 times amongst informed adolescents.
P035
HPV vaccination: what do Greek adolescents know?
N. Salakos, C. Iavazzo, K. Bakalianou, E. Deligeoroglou, K. Papadias, and A. Kondi-Pafiti
2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
Aim The newly developed HPV vaccine could become an important mean of prevention against cervical carcinoma. The objective of our study was to investigate the knowledge of Greek adolescents regarding the HPV vaccination, the need for education material and the acceptance among them.
Method We organized a survey among students of 3rd class in 5 High Schools of Athens. We offered an educational leaflet and we asked them to reply to specific questions regarding their knowledge relating to cervical cancer, the role of HPV and their attitude towards the use of vaccine before and after reading the educational material.
Results 479 students aged between 14 and 15 years old participated in the survey. 367/479, 405/479 and 389/479 respectively did not know any information regarding cervical carcinoma, HPV and HPV vaccination. After our offered educational programme, 406/479 answered correctly the survey questions. The most important result was the fact that 371/479 (219/257 girls and 152/222 boys) supported the vaccination use in early adolescence, whereas only 24/479 (9/257 girls and 15/222 boys) rejected the idea. The rest of the adolescents did not express any opinion.
Conclusion The major obstacle of accepting HPV vaccine is lack of knowledge. Organization of such programmes in Greece is going to offer sufficient information on the field and increase the acceptance rates of vaccination among adolescents.
P036
Dysmenorrhea is decreasing school performance
Z. Korkmaz, M. Baser, and S. Mucuk
University of Erciyes, Atatürk School of Health, Kayseri, Turkey
Aim This study was conducted descriptively in order to determine the effect of dysmenorrhea on school performance of the students at Atatürk School of Health, University of Erciyes.
Material and method The study was carried out with the girl-students at Atatürk School of Health, University of Erciyes. The total number of the students was 586 and 33 of them are boys. Three hundred seventy eight girl-students were involved in the study. Questionnaire forms and Visual Analog Pain Scale were used in order to collect the data. The data were evaluated with chi-square test and t-test.
Findings The average age of the students involved in the study was 21.4±1.6 and the average menarche age was 13.3 years. Sixty three point eight percent of the students stated that they had dysmenorrhea. It was found out that 63.6% of the students had dysmenorrhea during each menstrual cycle after menarche and 83.4% of them had dysmenorrhea on the first day of menstruation. Fifty one point nine percent of the students with dysmenorrhea stated that they were absent from the school during their menstrual period. It was observed that dysmenorrhea affected negatively their study-performance (79.9%), active participation during lessons (82.9%), concentration (81.5%), exam-performance (80.3%), training performance (88.3%), communication (62.0%) and social activities (66.0%).
Conclusion It was concluded that more than half of the students had dysmenorrhea and dysmenorrhea affected negatively their school performance and training performance.
P037
Review of Implanon® use in adolescents in a community service setting
C. Lipetz and C. Fleming
Gwent Healthcare NHS Trust, Torfaen, Gwent, UK
Objectives To audit the duration of use of Implanon® in teenagers over a 36 month period from insertion to end of prescribed use. Outcome measures: duration of use, reasons for removal and pregnancy rates over the same period.
Design and methods A retrospective audit of all users of Implanon® in our service in 2003 was conducted. A total of 521 patients were identified. 94% notes were retrieved and complete data sets were obtained for duration of use in 85%. Data was collected from clinic notes, patient questionnaires and general practitioner questionnaires. Thirteen patients did not consent to contact for questionnaires. Data was stored anonymously and password protected. Statistical analysis was conducted with SPSS 15.
Results 146 teenagers were identified with an age range of 14–19 (mean 17.5), of whom 47% had had a previous pregnancy, 37% had had a previous unplanned pregnancy and 12% had had a termination of pregnancy. Previous pregnancy was not a predictor for continued use of Implanon®. 5% had used Implanon® as a previous method. Average duration of use was 1.66 years (19.95 months). Despite 49% experiencing irregular bleeding as a side effect, 23% continued with the Implanon® as their next method. Of those that had early removal, 20 had an unplanned pregnancy within the 36 month follow up. Comparison with non-adolescent users showed no difference in duration of use with age or previous unplanned pregnancy. Teenagers who had their implant removed prematurely had twice the pregnancy rate of older users (relative risk 2.03) who also had premature removal within the 36 month period the implant was prescribed. There were no failures of the method.
Conclusion Adolescents who have had Implanon® prescribed will remain high risk for unplanned pregnancy when no longer using the method. Other LARC methods should be considered in this group as replacement contraception if Implanon® is no longer accepted. Cost effectiveness may be improved with increased duration of use of the method. Protocols for treatment of side effects and duration of use need to be audited. Cost effectiveness at a service level is being compared for Implanon® and oral contraceptive users.
P038
Efficacy of oral contraceptives with Metformin®-Orlistat® in treatment of obese or overweight adolescents with menstrual irregularities
I. V. Kuznetsova and D. Santamaria Fernandez
Russian Medical Academy of Postgraduate Education, Moscow, Russian Federation
Aim To investigate the efficacy of desogestrel or drospirenone-containing oral contraceptive and drag improvement the metabolic parameters for the treatment of obese or overweight adolescents with menstrual irregularity.
Methods Twenty six patients aged 14–18 years with a mean body mass index (BMI) 32.1±2.72 kg/m2 and menstrual irregularities were examined. Body weight, insulin resistance by the homeostasis model assessment (HOMA-IR), fasting lipids, and hormonal profile was measured before and after 6 month treatment with desogestrel® or drospirenone-containing oral contraceptive, metformin® (500 mg/day) and/or orlistat® (360 mg/day). All statistical calculations were made by using SPSS version 15.0 software. A P value of <0.05 was considered significant.
Results After therapy the mean weight loss in patients was 11.9±2.84 kg, i.e., 12.82±2.65%, of initials data. Significant decrease HOMA-IR from 4.17±2.11 to 2.39±1.18 (p < 0.001) was observed. Also in all patients parameters of total cholesterol, triglycerides, and low- and high density lipids were improved. In hormonal profile significant decrease concentration of testosterone (p < 0.001), androstenedione (p < 0.001), and increased concentration of sex-steroid globulin binding (p < 0.001) was observed. Free androgen index was decrease in all patients.
Conclusion Use the oral contraceptives in combination with orlistat® and metformin® decrease hyperandrogenism without disturbances in carbohydrate and lipid metabolism at the obese or overweight adolescents.
P039
The emergency contraception in adolescent girls in rural and urban Greece
K. Bakalianou, C. Iavazzo, N. Salakos, G. Paltoglou, and K. Papadias
Division of Family Planning, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
Aim The objective of our study is to clarify the knowledge of emergency contraception regarding its role and side effects among adolescents in rural and urban Greece.
Method During the period September 2006–June 2007 the Division of Family Planning of 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital conducted a survey regarding the knowledge of emergency contraception. This survey was made by using anonymous questionaries during the offered programmes on the field in different Greek schools.
Results 1293 students (769 females and 524 males) aged from 16–18 years old were included in the study regarding the role of emergency contraception. 709 studied in schools of rural and 584 in schools of urban Greece. 310/1293 ((196/709 and 114/584 respectively) had ever heard about emergency contraceptive pills and even less knew their role or side effects or the correct method of use 107/1293, 69/709 and 38/584 respectively. It should be mentioned that more informed were the girls, the older students and the students from rural Greece. 23/1293, 16/709 and 7/584 had ever used emergency contraceptive pills. According to our survey Greek adolescents were informed on the field by books or magazines (163/310), by television or radio programmes (87/310) and by friends (54/310) or parents (6/310).
Conclusion Greater effort should be made in informing Greek adolescents regarding the role of emergency contraception. The Greek Family Planning Association is trying to organize such programmes in order to succeed a decline in abortion rates.
P040
Does medical education affect students' point of view on reproductive health? Are prospective physicians ready for counseling?
S. Ozalp, O. Elcioglu, A. Uludag, and I. Unluoglu
Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
Objective In this study, we aimed to evaluate students' level of knowledge, about changes in their attitudes, and how they perceive themselves about couselling about reproductive health within during 5 year of medical education.
Desing and methods To fulfill the abovementioned objective, questionnaire with 54-items were distributed to the students before they started medical education, and once again, in the fifth year (before they began their internship). In the first year 142 students (81.1% of all students) and in the fifth year 124 students (70.8% of all students) participated in this study. For the analysis of the data, x2 test, arithmetic mean, standard deviation, frequency and percentages were used
Results Within 5 years students' preference for the age of marriage increased both for male and female. Also within five years students' preference for the gender of their prospective child/children increased from 14.0% to 24.2% (+10.2%). Another change within five years was the decrease in the number of children they wanted (67.6% to 74.3%, +6.7%). At the beginning of the study while most of the students wanted to receive information of reproductive health for their friends (75.5%), before internship they wanted to get the information from health institutions (53.2%). Only 29% of the students think, before their internship, that they are competent enough to provide counseling on reproductive health.
Conclusion During medical education students' attitudes about reproductive health may change. This must be recognized in the medical curriculum and future planning should be realised. And also students' counselling skills should be improved.
P041
Family and social conditions of village girls-adolescents and their reproductive plans
A. Labigina, O. Leshenko, L. Suturina, and O. Kravtsova
East-Sibirian Scientific Center of Medical Ecology, Irkutsk, Russian Federation
Objectives This study was performed to investigate the reproductive plans of village adolescents.
Design and methods This study was performed among 68 female adolescents aged 15–16 years, who attended village secondary school, with the help of questionnaire HBSC (Health Behavior among School-aged Children, Norway, 2002), which was adapted and elaborated. The questions of the questionnaire were grouped in: family data, regimen and character of nutrition, sleep, motor activity, harmful habits, awareness of their health state, attitude to family-marriage relations and reproductive plans.
Results 72.6% of village girls have complete families, 58% live in families with 2 children; 21% with 3 and more children, 12.9% with one child. To the question ‘What social status do you have?’ the girls gave the following answers: my family is with high income 3.3%, well-to-do 85%, with low income 10%. The majority of village girls (74.6%) considered good interrelations in a family as a top-priority of life. The fact of interest is that other life-priorities (education, love, friendship, career, health, money) were not so significant for them. 93.3% plan to have a family in the future, 13.3% of them plan to have one child, 78.4% two children, and 3.3% three children. But if their life conditions are better they will plan to have three and more children more often.
Conclusions The reproductive plans of village school girls depend significantly on their life conditions.
P042
The attitudes towards and behaviors about sexual and reproductive health in university students
E. Ege, B. Akin, R. Kültür Can, and A. Ariöz
University of Selcuk School of Health Nursing Department, Konya, Turkey
Objective Concern about the sexual and reproductive health of young people has been mounting in Turkey. This study aimed to assess the attitudes and behaviors of university students on sexual and reproductive health.
Method The study was a cross-sectional design. A total of 1112 students (567 female and 545 male) of the Selcuk University made up the sample of the study. The data were collected with a questionnaire form designed by the researchers. Data was analyzed using SPSS 10.0.
Results The average age of the study group was 21.1±2.0. Sexual intercourse experiences of students were 17.7%. Of the sexually active students 8.1% was female and 91.9% male students. It was found that the average age of first sexual intercourse of the students was 17.8±1.8. Of the students 53.5% reported that they use any contraceptive method during their last intercourse and contraceptive method they used was condom (82.9%). 69.7% of the students demanded a youth center in the university.
Conclusion Findings showed there was a need for a youth center in the university district that informs youth in non-threatening, non-judgmental and confidential ways.
P043
Information for contraception: a basic measure for the avoidance of the teenage pregnancy
S. Dimitrakopoulos, S. Koliantzaki, A. Sidiropoulou, M. Anastasopoulou, D. Tassopoulos, G. Allagiannis, E. Mpraxna-kontelli, E. Papageorgiou, A. Saltamavros, K. Sorras, and N. Sidiropoulos
General Hospital of Pyrgos, Obstetric-Gynecologic Department, Pyrgos, Greece
Aim Our purpose was to see how informed nowadays high school children are about the matters of contraception and abortion.
Material and methods Our material was 870 high school students, aged between 16–17 years, who attended schools in Ileia district.
Results 97% of students responded that they were familiar with the subjects of contraception and abortion, but only 5% said they had a wide and accurate knowledge for both subjects. 84% knew more than one method of contraception, but without knowing all the details about the advantages and the disadvantages of the methods. Only 16 knew the possible dangers of an abortion, while 2.8% claim to have had an abortion in the past, 88% said that media such as television, magazines and newspapers are a basic source of information, 57% said that information about both matters were given in their family environment, while school has been a source of information for only 27%. The majority (96%) were unsatisfied with the quality of sexual education provided by the schools and agreed that this is a matter that needs to be improved in the future. Risk taking behaviors such as negligence in contraceptive use and intercourse under the influence of alcohol were suggested as main reasons behind the number of abortions. Only 59% use a condom as a measure of precaution for both unwanted pregnancies and sexually transmitted diseases.
Conclusions We see that nowadays, high school students are quite well informed about contraception and abortion, but their knowledge is insufficient. It is obvious that sex education should be included in the school curriculum and accurate information on contraception and prevention of unwanted pregnancy should be provided, especially in adolescents, by every possible source of information, including their family.
P044
Dysmenorrhea and related factors in Kashan university students
M. Abedzadeh and M. Taebi
Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
Objective Dysmenorrhea is a common problem in gynecology that can cause to disability. The aim of this study was determined the prevalence of dysmenorrhea and related factors in Kashan university students.
Material and methods This cross-sectional study performed on 200 students with randomized sampling. Then data including age, residency status, marital status, menarche age, dysmenorrheal age dysmenorrheal characteristics (severity, nature, frequency, and symptoms) and PMS were collected and analyzed with t-test and χ2 test.
Results The mean and SD of age was 21.8 ±1.48 years. 49.5% of students were resident in a dormitory. The mean and SD of menarche age and dysmenorrheal age was respectively 13.7 ± 1.4 and 15.3 ± 2.1 years. 81.5% had dysmenorrhea that 22.1% experience pain during all of their cycles. 35.6% had severe pain. 76% had intermittent pain. The most common site for pain was lower abdominal area (53.1%). The most common sign with pain was fatigue (50.4%). 85% had PMS. Pain history in mother and sister was respectively 55.5% and 73.5%. there was a significant correlation between dysmenorrhea and marital status (p = 0.03), pain history in mother (p = 0.04) and sister (p = 0.003).
Conclusion The incidence of dysmenorrhea and PMS in students is high; therefore it's necessary to inform adolescents about this problem and its management.
P045
Outcome of pregnancy in school girls
S. Dimitrakopoulos, S. Koliantzaki, A. Sidiropoulou, M. Anastasopoulou, D. Tassopoulos, G. Allagiannis, A. Saltamavros, K. Sorras, and N. Sidiropoulos
General Hospital of Pyrgos, Obstetric-Gynecologic Department, Pyrgos, Greece
Aim Our purpose is the study of the incidence and complications of adolescent pregnancies.
Material and methods The medical records of 166 adolescent mothers that delivered in the Obstetrics and Gynecology Department between the years 1999–2007.
Results In a total of 3280 women, 166 were adolescent girls aged between 14–18 years. Among them 66% resulted in birth, 23% in abortion and 11% in miscarriage. The mean gestational age at delivery was 38 weeks and 5 days and the mean birth weight was 2.820 gr. The mode of delivery was normal in 62% of cases, while 11% were delivered by vacuum extraction and 27% by caesarean section. 13% of the deliveries were premature and 22 ectopic pregnancies were seen. Only 32% have had a constant follow-up during pregnancy. In 14% of births, the neonates had low Apgar score, while there has not been any death of mother or child.
Conclusion The majority of the pregnancies were unwanted. Adolescent pregnancies are a social problem. Information about contraception and the sexual education of teenagers is the most critical step that could help in the direction of precaution of the unwanted pregnancies in school girls.
P046
Thyroid status, physical and sexual development of village school-girls
O. Leshenko, O. Kravtsova, and L. Suturina
East-Sibirian Scientific Center of Medical Ecology, Irkutsk, Russian Federation
Objectives This study was performed to investigate the status of physical and sexual development of school-girls in the village region of Eastern Sibiria.
Materials and methods 263 village school-girls aged 10–18 years were examined, including evaluation of physical and sexual development and morphofunctional status of the thyroid gland. Value of the thyroid gland volume higher 97% percentile is considered as goiter (WHO, 2001). Also we determined TTH, T3 free, T3, T4 free, T4, FSH, LH and prolactin levels.
Results Among all examined subjects 98 (37.2%) have been detected as absolutely healthy. According to the data of ultrasonic scanning and thyroid profile in 111 girls (42.4%) we diagnosed thyroid pathology: endemic goiter in 106 children (40.1%), diffuse-nodular goiter in 3 adolescents (1.14%), and thyroid hypoplasia in 2 subjects (0.76%). Hypothyroidism, including subclinical, that was combined in 82% of cases with endemic goiter, was diagnosed in 17 adolescents (6.46%). The 93.54% of the subjects were diagnosed as euthyroid. Analysing the physical development of school-girls we observed the harmonious type of development in 83.6%. Disharmonious development and delayed physical development are much more spread among girls with endemic goiter. In the group of girls with disharmonious development we observed considerably larger part of adolescents with overweight, body weight deficit was marked in 1.9% of examined girls. Height lower 3 percentile was marked in 11.78% of girls and girls-adolescents. Normal sexual development was observed in 70% of girls and girls-adolescents. In the structure of reproductive disorders we diagnosed syndrome of delayed pubertal development (10.26%), dysmenorrhea (10.06%) and hypohonadism (8.36%).
Conclusion Delayed physical development and reproductive disorders are often combined with endemic goiter and hypothyroidism in examined village girls and female adolescents.
Topic 3: Counselling
P048
Counseling and use of contraceptive methods by 210 female graft recipients
C. Guazzelli, T. Sanches, M. Torloni, M. Barbieri, and J. Pestana
São Paulo Federal University- Paulista Medical School, São Paulo/São Paulo, Brazil
Background The increasing survival of female graft recipients has brought new concerns about the quality of life of these women, including their sexual and reproductive health. Although menstrual irregularity and infertility are common in patients with serious diseases, most of these women regain their reproductive function soon after transplantation. This should prompt medical professionals to consistently advise these women about the necessity of using effective contraceptive methods, since an unplanned pregnancy soon after the transplant can expose both the mother and fetus to considerable risk. Therefore, we decided to interview female graft recipients and inquire if they had been advised by a health professional about the need to avoid pregnancy and their actual use of contraceptive methods, before and after transplantation.
Methods A total of 210 transplanted reproductive age women (197 kidney, 9 liver and 4 heart) attending a transplantation clinic were interviewed by a single investigator. They were asked about menstrual pattern, sexual activity, counseling and use of contraceptive methods both before and after the transplant.
Results Before transplantation 70.5% of the participants reported menstrual irregularity, 90.5% of them were sexually active, 72.9% were advised about the need for contraception and 84.3% used some contraceptive method. After the graft, menstrual irregularity was reported by 50%, 78.1% were sexually active, 49.5% were advised to use contraceptives and 70.5% were using a contraceptive method. After transplantation, there were 15 pregnancies in 12 women and 93.3% (14/15) of these were unplanned.
Conclusions Although the vast majority of female graft recipients were sexually active both before and after transplantation, a significant proportion of them were not counseled about the need for contraception and many did not use any birth control method. Health professionals involved in the care of these patients need to include contraceptive counseling as part of the routine management of these women.
P049
Contraception for women over 40 years
H. Gonçalves, R. Lagarto, F. Mota, and C. de Oliveira
Department of Gynaecology - University Hospital of Coimbra, Coimbra, Portugal
Objective The aim of this study was to evaluate the contraceptive options for women over 40 years of age, the reasons for choosing a new method, compliance and side effects.
Material and methods This is a retrospective descriptive assessment based on medical records revision, evaluating patients over 40 years of age, referred to our Family Planning Unit, during a period of 12 months (1.1.2006/31.12.2006).
Results The study included 244 women above 40 years of age (minimum: 40; maximum: 54; median ± standard deviation: 45.3±3.5). Those women were divided in to 3 groups according to their age - Group A: 40 to 44 years (99 women); Group B: 45 to 49 years (113 women); Group C: 50 to 54 years (32 women). 95% of the study population were multiparous and 5% were nulliparous. The results showed that intrauterine cooper-bearing device (IUD) was the first choice (122 women – 50%); followed by the intrauterine system releasing levonorgestrel - IUS (41 women – 16.8%), female sterilization (40 women – 16.4%), oral contraceptives - OCs (26 women – 10.7%), barrier methods (11 women – 4.5%) and other methods (4 women – 1.6%). When we stratified the contraceptive options, the ranking of preferences was the same in the 3 groups considered. The contraceptive method was changed in 65.7% women in group A, 50% in group B and 28% in group C. The main reasons for this were the associated medical problems as obesity, hypertension, vascular disease or migraine, menstrual disorders and desire of definite contraception. No pregnancies occurred among these women.
Discussion Results showed that women over 40 years of age tend to change their contraceptive methods, most of the time because of medical problems. They usually have their families complete and want a method that will last to the menopause. IUD seems to be a good option providing continuing contraception without the need of frequent replacement. The IUS has very good acceptance, especially among women suffering from menorrhagia or dysmenorrhoea. The female sterilization is an option when other methods are contraindicated. The OCs are not contraindicated in this population and may be a good option for healthy non-smoking women suffering from irregular bleeding. Other contraceptive options do not have good acceptance among these women.
P050
Knowledge, attitudes and practice in contraceptive use in women before and after delivery
P. Krepelka and J. Hanacek
Institute for the Care of Mother and Child, Prague, Czech Republic
Objectives To inform about knowledge, attitudes and behaviour related to methods of contraception among women and analyse the changes in attitudes regarding contraception during a fertility period.
Design A cross-sectional, questionnaire-based survey administered to women immediately and six months after the delivery. The sample consisted of 2450 women who gave birth within a year in our hospital from 15 November 2006–15 November 2007.
Methods Self-administered questionnaire. Multiple logistic regression analysis was applied in order to compare determinants of age, education, personal characteristics, knowledge, attitudes and practise in use of contraceptive.
Results Group: N = 2450. Age: 85% of respondents 26–35 years. Parity: I 61.3%, II 32.3%, III 5.4%. Contraception use before pregnancy: combined oral contraception (COC) 59.7%, condom 11.1%, intrauterine device (IUDs) 1%, no method 20.6%. In COC group the most popular type of contraception was 20 μg ethinylestradiol (EE)/150 μg desogestrel 12.8%, 35 μg EE/250 μg norgestimate 9% and 35 μg EE/200 μg cyproteronacetate 7.6%. The average time of COC use was 8 years and 1 month. Contraception use in the multipara's group during breast feeding: hormonal oral contraception 19.6% (COC 9.9%, 500 μg lynestrenol 20.3%, 75 μ desogestrel 16.1%), condom 17.1%, IUDs 1.3%, no method 54.5%. Contraception planned after delivery: hormonal contraception 36.6%, condom 18.8%, IUDs 5.4%, no method 20.1%. 69.5% of respondents did not know any hormonal contraception that can be used during breast feeding, 8.1% assumed that none is useful, 11% identified incorrect type of hormonal contraception for lactating period. 61.6% of respondents considered themselves to have a good knowledge on the subject of family planning. Main information source for 80.7% of women is the gynaecologist.
Conclusions Combined oral contraception is the most common contraceptive method in general. Women after delivery and during breast feeding period prefer progestine-only pills. Women more often plan use of contraception after the second delivery. The role of gynaecologist in providing of information regarding contraceptive methods is the most important for the majority of patients.
P051
Use and preferences of contraceptive methods in Spanish women aged 18–49 years
C. Lopez-delBurgo, C. Marina Lopez-deFez, J. Lopez-Guzman, and J. de Irala
University of Navarra, Pamplona, Navarra, Spain
Objective To identify Spanish women's use of FP methods and to explore what characteristics are considered by the women when choosing a FP method.
Methods Cross-sectional survey in a Spanish representative sample of 848 potentially fertile women, aged 18–49. Data were collected between March and September of 2005 by female research assistants from the GFK-Emer Market Research Company. Computer-Assisted Personal Interviewing (CAPI) method was used to administer an anonymous, 30-item questionnaire about FP. Univariate and multivariate logistic regression analyses were performed.
Results The majority of women were married, held an academic degree and had at least one child. There were 23.6% of 18–24-year-old women, 39% of 25–34, 28.8% of 35–44 and 8.6% of 45–49. The most common methods of FP used by participants were condoms (38.3%) and oral contraceptives (29.9%). While condoms are more used among the youngest group, the pill is more frequently used by 25–34 year-old women and the intrauterine device (IUD) by 35–44 year-old women. Among women aged 18–24, 5% referred having ever used the IUD, 3% had used the emergency contraception pill and 2% referred having had an elective abortion. Eighteen point four percent of the women were not using a FP method at the moment of the survey. Efficacy, convenience and having no side effects were the three most important characteristics considered by the women when choosing a FP method (they were named by 60.7%, 44.3% and 32.1% of the surveyed women respectively). Efficacy was a more important characteristic among the youngest and the eldest group, while convenience was more important among 25–34 year-old women. Having no side effects was more important for the eldest women. Other characteristics mentioned by women were: ‘easy to use’ (12.5%), ‘low cost’ (11.4%), ‘beneficial health effects’ (like cycle control or protection against sexually transmitted infections) (9.6%), ‘easy access’ (3.2%) and ‘natural’ (1.7%).
Conclusion There are different patterns of use of FP methods among Spanish potentially fertile women according to their age. Condoms and oral contraceptives are the most used FP methods among Spanish potentially fertile women, especially during their twenties and thirties. Efficacy, convenience and having no side effects are the three most important characteristics considered by the women when choosing an FP method. The percentage of young women that have ever used the IUD and the emergency contraception pill and that have had an elective abortion is noteworthy.
P052
University Students Contraceptive Survey
R. Martins1, R. Fernandes1, M. Durao2, and T. Bombas2
1Coimbra's University Health Care Center, Coimbra, Portugal, and 2Genetics, Reproduction and Fetal Maternal Medicine Departement, Coimbra, Portugal
Backround The purpose of this study was to examine knowledge, attitudes, and behaviors regarding contraception in university women.
Materials and methods For this purpose, a survey was conducted with the voluntary participation of 220 students enrolled in the University Health consults. A survey form containing 10 questions designed to elicit demographic and sexual behavior data was self-administered anonymously to the participating students.
Results From the initial 220 queries we had a positive response of 200 (90% rate). The mean age of this group was 21.8 years. A total of 84.5% had active sexual relations, 41% used oral contraceptives, 32% the combination of oral contraceptives associated with condom, and 7% only used condom. The remaining used other contraceptive methods. The majority of these women obtained contraceptive information through their physician or among the general group of friends. Almost 65% had regular planning consults. From the ones that used oral contraceptives, only 34% refer never to have forgotten the intake. Almost 40% had a history of emergency contraception use, and many of which in the context of condom accidents, or unprotected sexual intercourse.
Discussion Approval of the contraceptive method is widespread among female students. Many of their concerns stem from incomplete information about how the regimen works. Students noted how rarely emergency contraceptive pills are discussed, and were curious to know more. They asked for routine education, as well as more general discussion.
P053
Family planning methods preferred by women applied for curettage
N. Demirci, Z. Bilgin, and F. Engin Yigit
Marmara University, Istanbul, Turkey
Introduction and objectives Family planning methods play a major role in prevention of unwanted pregnancy and curettages. Purpose of family planning efforts is to preserve mother and child's health and to create a healthy society by preventing excess fertility. High population growth rate in Turkey requires family planning to be a top priority. Prevention of unwanted pregnancies is one of the main purposes of spreading family planning. More than half of the pregnancies in Turkey are unwanted or unplanned pregnancies. In this study, family planning methods preferred by women between ages 15–49 who have applied to a family planning clinic for curettage are surveyed. The purpose of the study was to determine the family planning methods considered by women who applied for a curettage operation, before and after consultancy.
Design and methodology 273 women who had applied to family planning clinics for an abortion between April 2007 and June 2007 have been interviewed for this study. All 273 women were provided with general pre-curettage family planning consultancy. 184 women of these 273 women accepted to participate to the study and constitute the scope of this study. Before the consultancy session, participants were given a 25-question survey related to their family planning method preferences for future. All participants were given another survey on same topic after the consultancy and the completion of curettage. Data obtained were statistically analyzed later.
Results and conclusion When asked before consultancy, 40.8% of the participants said they would prefer intrauterine devices, 20.1% would prefer condoms, 13% would prefer combined oral contraceptive, 11.4% would prefer coitus interruptus, 9.2% would prefer hormonal injection (depo-provera). Participants' responses after consultancy were as such: 47.3% intrauterine devices, 20.7% condoms, 15.2% hormonal injection (depo-provera), 9.8% combined oral contraceptive, 1.6% coitus interruptus. 21% of the participants changed their mind after the consultancy. The most dramatic change was the decrease on the percentage of women that prefer coitus interruptus method.
P054
Contraceptive consultation – the five step approach
B. Frey Tirri and J. Bitzer
University Women's Hospital, Basel, Switzerland
Objective From a quality management point of view the objectives of contraceptive counselling are (MMORA): Maximize contraceptive efficiency, Minimize health risks, Optimize tolerance, Realize health benefits, Avoid unnecessary costs. Although contraceptive technology offers a large variety of options these objectives are still far from being fully reached. It seems therefore necessary to qualify and standardize the counselling process.
Design and methods Review of the literature and analysis of video consultations and of case discussions in the family planning unit of our university hospital.
Results Contraceptive counselling aims to obtain the best possible fit between 3 groups of variables: Patient profile, Situation profile and Method Profile (Contraceptive Triangle). Counsellor and client are involved in an interactive process going through 5 steps: (1) Assess expectations, aims and values of the woman. (2) Assess the biopsychopsychocial profile of the woman. (3) Inform and educate the client about the contraceptive methods according to EBM. (4) Help to arrive at a transparent and shared decision (Exlusion of methods according to patient's preference and medical eligibility; Positive choice according to values and additional health benefits). (5) Evaluation.
Conclusion Contraceptive counselling is a skilful acitivity with a high bioethical impact. We have developed a model integrating biomedical knowledge, communication skills and bioethical principles.
P055
Age-related infertility – non-contraceptive impact of contraception
H. Konecna
University of South Bohemia, Ceske Budejovice, Czech Republic
Objective The available and reliable contraception means revolution in the reproduction behaviour of people. What influence does it have on family planning?
Design and methods Qualitative secondary data analysis.
Results People have children at higher age and have less of them. The average age of the woman at childbirth is more than 30 years in a number of European countries, and the ascending trend continues. The drop of number of miscarriages and abortions has stopped in some countries – the number of abortions keeps dropping, but the number has been evened out by spontaneous miscarriages. The interest in therapy of fertility disorders has been markedly increasing, the age of people requiring therapy by assisted reproduction has been rising and there is more and more interest in donor egg cells – which is therapy strategy used particularly for older women. The involuntary childlessness and the therapy by assisted reproduction has health and psycho-social consequences, is financially demanding and ethically problematic. Researches from different parts of the world show poor knowledge of people in the sphere of the actual fertility: underestimation of biological limits, underestimation of the importance of male fertility and overestimation of the possibilities of assisted reproduction. There is lack of educational literature: 148 titles concerning reproductive health, in comparison with 13,565 titles concerning contraception, ratio 1:99. WHO materials are focused almost exclusively on the information level of contraception.
Conclusions Reliable and available contraception has brought liberty in decision making when not to become a parent. But that does not imply liberty in decision making when to become a parent. Age-related infertility is a serious problem of developed countries. Research shows poor knowledge of people in this sphere. Assisted reproduction has brought distinct chances to a lot of people, but at the same time false hope to others who overestimate its possibilities. Europe spends high amounts on therapy of infertility, but it engages minimally in prevention in the sphere of reproduction health, information on biological limits and risks related with the effort to get pregnant at higher age. The educational literature and consulting is focused only on contraception, not on help to people in decision making how to be a parent. Does the term ‘family planning’ really means only measures focused on how not to have a family?
P056
The perception of contraception by French women in 2007
P. Panel, C. Czernichow, A. Le Tohic, I. Grosdemouge, C. Chis, and P. This
Gynaecology-Obstetric Department, Le Chesnay, France
Objective To understand the perception of contraception by French women in order to adapt medical prescription.
Design and method A cohort study was made upon a representative sample of the French population by an independent polling organization (panel metascope TNS SOFRES). A total of 10,000 women aged 15–45 were posted a self-report questionnaire and 5963 completed it. They were asked about their vision of birth control.
Results 79% thought that choosing a contraception method was a very or an extremely important decision in their life. 80% thought they were well informed about different methods. Depending on their age, they had different perceptions. The older (aged more than 25) perceived it more as a factor of freedom or progress than the younger. Negative feeling about contraception seemed unrelated to age, 11% viewed it as a danger for health and 9% judged there was social pressure for using contraception even if they didn't want any. The first things they expect of contraception are safety and tolerance. Those facts are correlated to the contraception method they use. It appears that women experience oral contraception as a constraint. Another question about the influence of contraception on sexuality underscored the freedom it provides and the lack of correlation with libido.
Conclusion General ideas about contraception influence the use that is made of it. A better understanding of the perceptions of patients could enhance communication on this public health concern.
P057
The satisfaction of French women with their contraception
P. Panel, C. Czernichow, A. Le Tohic, I. Grosdemouge, C. Chis, and P. This
Gynaecology-Obstetric Department Centre Hospitalier de Versailles, Le Chesnay, France
Objective To investigate the satisfaction of French women with their contraception in order to better answer their expectations with medical counselling and prescription.
Design and methods A cohort study was made upon a representative sample of the French population by an independent polling organization (panel metascope TNS SOFRES). A total of 10,000 women aged 15–45 were posted a self-report questionnaire and 5963 completed it. Age, marital status and will of pregnancy were consigned. Women were asked about their contraception.
Results 46% used oral contraception, 15% an intrauterine device and 6% condoms. When asked about their will to continue using the same method, positive answers represented 96% for intrauterine device (IUD) users, 90% for oral contraception (OC) users, 86% for contraceptive implant users and 74% for condom users. Women were asked to give a score from 1 to 10 to their contraceptive method. IUD got a score of 8.89, OC 8.46, new contraceptive devices (implant, ring and patch) 8.38 and condom 7.31. The best score was for tubal sterilization which is not contraception. This allows us to think that efficiency, easy use and personal choice guarantee a good acceptance.
Conclusion Most contraception users are satisfied with their choice, the reasons for changing are mainly related to a change in their life. Thus a greater attention to those changes should lead to more efficient prescriptions.
P058
History of cesarean throughout centuries
S. Dimitrakopoulos, V. Karmi, A. Bonas, A. Saltamavros, A. Sidiropoulou, K. Sorras, S. Koliantzaki, A. Palaiotheodorou, and N. Sidiropoulos
General Hospital of Pyrgos, Obstetric-Gynecologic Department, Pyrgos, Greece
Aim It comes from the Latin word caedere (cut/intersect). With the present study we would like to present an old but at the same time contemporary obstetric operation.
Material and methods After the collection of data from passages of the antiquity, the tracing back in historical sources and the choice of the material cautious reading and analysis followed.
Results There is reference to the cesarean in the Persians and in Hindi. Buddha was born from his mother rib, Brahma from her navel/umbilical patterns of cesarean in Egyptians and in Chinese. Jews use the cesarean not only in live but in dead women too. The Incas and Aztecs describe it as following: cutting of the abdominal wall and the uterus, delivery of newborn, manner of hemostasis, stitching of the walls. In mythology, Dionysos, Athena and Asklipius were all born with a pattern/form of cesarean. In Romans, Iex Regia, forbade the burial of a pregnant woman and commanded the opening of the abdomen and deliverance/release of the baby. Julius Caesar was named as such because he was born with a cesarean. Under the impact of christianism the appeal to the posthumous cesarean is expanded. In 1500s cesarean was successfully practiced/performed/applied in an alive woman. However, three centuries later the method got to be considered as lethal due to the high levels of mortality. Amendment of the method by E. Porro reduced the levels of mortality from 75% to 25%.
Conclusion We realized that cesarean is an ancient method of artificial delivery.
P059
Gender inequalities, health rights and STIs/HIV
H. Ahmed, G. Ahmad, and R. Ahmad
Plus Development Foundation, Multan, Pakistan
Issue Poverty and maltreatment of vulnerable women and children particularly young girls in Pakistan continues to rise at an alarming rate, thus demanding for greater action than presently able to be offered. Urbanization, natural catastrophe, inter cultural/sectarian conflicts, illiteracy, disease, war or internal conflict and economic breakdown are the many causes of unemployment and homelessness. These situations often times force families to go in search for a better way of life, which more than often puts women and girls at greater risks of abuse and exploitation and reasons for vulnerability to HIV/AIDS.
Description and results Poverty, unemployment, physical violence and attitude of family, split/broken families, forced labor, load of domestic work, drug addiction are the major reasons for being in streets, on road or domestic workers. Quetta city also host a great number of Afghan refugee population particularly young women with no business, no job opportunity, no local linkages which increases their vulnerability to health, prostitution, sexual abuse and HIV/AIDS.
Research data shows that Gender inequalities play a facilitating role in the spread of STIs/HIV/AIDS in Pakistan. Pakistani women particularly young girls in general have lower socioeconomic status, less mobility and less decision making power than do men, all of which contributes to their STIs/HIV vulnerability. Because of gender disparities in educational enrolment, female literacy is much lower than males. Thus literacy presents an obstacle for HIV/AIDS prevention efforts in general; it is much harder to reach women than men with information about how they can protect themselves from HIV infection. Women also are under-represented in the formal labor force, which combined with their lower literacy rate and educational levels, reinforces their economic and social dependency on men. Additionally restrictions on mobility often make it difficult for women to obtain access to health and social services, including access to basic reproductive health rights and care. Finally in situation where their decision making power is restricted, it is unlikely that all women are equipped with the skills necessary to negotiate with their partners for safer sexual practices.
In Quetta, the issue of domestic gender, discrimination, women empowerment and working girls has not been considered important or considerable enough for a check on magnitude to be drawn and needed to make this a very high priority area on the humanitarian agenda.
Lessons learned/recommendations Training of adolescent/young girls as peer educators/agents of change is recommended. The fundamental human rights of all women and girls infected or affected by STIs/HIV/AIDS must underpin all responses to the epidemic. Education and awareness programs based on cultural/religious norms can stop the risk of STIs/HIV/AIDS. Religious leaders can play an important role to sensitize community stakeholders to raise voice in favor of women and girls rights in their Friday and general talks.
Topic 4: Demography
P060
New challenges for the sexual and reproductive health agenda in Spain: Contraceptive patterns of immigrants
T. Castro-Martin, T. Martin-Garcia, and L. Lorenzo
CSIC, Madrid, Spain
Objectives This study aims at examining similarities and differentials in several sexual and reproductive health indicators between the Spanish and the immigrant population. In particular, we examine contraceptive use prevalence and contraceptive method choice; condom use as prevention against HIV infection; adolescent fertility and abortion.
Design and methods Contraceptive patterns are examined using the Fertility and Values Survey 2006, a nationally representative survey with a sample of 10,000 women of reproductive age. HIV risk perceptions and preventive behaviours are examined using the National Survey on Health and Sexual Behaviour 2003, conducted by the National Institute of Statistics. The examination of abortion rates by nationality is based on the abortion registry of the Ministry of Health. In order to take into account compositional differences, binomial and multinomial logistic regression models are used, controlling for socio-demographic characteristics, such as age, marital status, partnership history, parity and household composition, and socio-economic factors, such as educational level, labour force participation and type of occupation. The influence of duration of residence in Spain is also examined, in order to explore whether a gradual adaptation process is taking place.
Results The analysis shows that the contraceptive prevalence rate is significantly lower among sexually active foreign women than among their Spanish counterparts. The choice of contraceptive methods also varies notably according to region of origin, even after age, marital status and parity are controlled in the models. In relation to HIV risks, the foreign population is well informed regarding HIV transmission and preventive mechanisms; yet, their rate of condom use is lower than the Spanish population. Adolescent pregnancy rates and abortion rates are also significantly higher among foreign women.
Conclusions Spain, a country of emigration during centuries has recently become a country of immigration. Immigration flows have been particularly intense in the last decade and nowadays the foreign population makes up 10% of the overall population. This new scenario is having visible effects on demographic trends: population growth has resumed; crude birth rates and fertility rates have gradually increased; cohabitation, mixed nationality marriages and nonmarital childbearing are on rise. Sexual and reproductive health patterns have also been influenced by the recent increase of immigrants. Contraceptive patterns, HIV preventive behaviour and abortion rates differ among the Spanish and the immigrant population. Sexual and reproductive health programmes should take into account the observed differentials as well as their underlying causes – whether based on educational, socioeconomic or cultural grounds – in order to adapt adequately their campaigns and services.
P061
Survey of contraception in France in 2007
P. Panel, C. Czernichow, A. Le Tohic, I. Grosdemouge, C. Chis, and P. This
Centre Hospitalier de Versailles, Le Chesnay, France
Objective To review the uses of contraception in France in order to better understand the needs of women concerning birth control.
Design and method A cohort study was made upon a representative sample of the French population by an independent polling organization (panel metascope TNS SOFRES). A total of 10,000 women aged 15–45 were posted a self-report questionnaire and 5963 completed it. Women were asked about contraception in general.
Results 34% had already had sexual relations before their first use of contraception. 24.5% didn't use any contraception. On average they had first used contraception at 22 while they had started their sexual activity at 17.8. Women aged less than 30 had mainly used condoms as their first contraceptive method, whereas women aged more than 35 had used oral contraception. 93% had already used oral contraception. Only 64% had used condoms. 46% currently used a contraceptive pill, 15% an intrauterine device, 6% condoms. The contraceptive method used depends on age, marital situation and pregnancy plans. Better counselling and information on contraception could help prevent undesired pregnancy. New types of contraceptives such as rings, implants and patches remain widely unused.
Conclusion A better knowledge of today's uses of contraception and of women's needs could lead to better practices.
P062
Social impact of contraception and fertility decline in India
P. Datta
International Institute for Population Sciences, Mumbai, Maharashtra, India
It is a well known fact that, fertility is declining over the years. Almost half the married couples in developing nations now use contraception. Consequently, desired family sizes are found to be remarkably decreasing. Literatures show that in India, literacy level is increasing with the introduction promoting universal primary education for all. Therefore, educational planning and population planning are bound to be together in any Government set up. The main contribution of education-fertility research so far had revealed how education influences the process of fertility decline. With declining fertility trends in the process of demographic transition, it becomes imperative to find out what social benefits we are getting when fertility declines. This paper is an attempt to observe the impact of family planning and fertility decline on the improvement of educational attainment on the society as a whole and families in particular. On this given background, the present paper investigates effects of family size and contraceptive use of parents on child schooling of illiterate parents in India using NFHS dataset. Additionally, to detect family-level discrimination, the paper examines how siblings’ sex composition and birth order affect school attendance of children. Results show that child schooling is negatively affected by family size and it increases considerably in smaller family among contraceptives users compared to non-users. Contraceptive use has significant impact on child schooling separately, apart from its influence through reducing the family size. Sex and birth order differential in school enrolment and attendance is statistically significant. Earlier-born children, especially, girl children are expected to be benefited more in terms of schooling when family size declines. Thus, small family provides more education to children, reversing the general notion – ‘the more the education, the smaller the family’.
P063
The prevalence of covert use of contraceptives in Nazareth/Adama town
B. Tensou Tessema, T. Araya GebreKidan, G. Reniers, and T. Kebebew
Addis Ababa University, Addis Ababa, Ethiopia
Background Reproductive Health in its broader sense should be a concern of all, not just only for women. In Sub Saharan Africa and in the more patriarchal societies like Ethiopia decisions related to reproductive health are made by men. Improving joint decisions of couples and husband approval on women's decisions of reproductive health predominantly decision regarding family size limitation, is not a simple fact. In a society where there is low prevalence of contraceptive, clandestine use of contraceptive is high, mainly in Sub Saharan Africa where women have low autonomy.
Methods This study was conducted with an objective of estimating prevalence of secret use of contraceptives on a sample of 578 currently married women in Adama town 100 km south of Addis Ababa, capital of Ethiopia. Currently married women aged 15–49 and a sub-sample of their husbands were the study unit. Both quantitative and qualitative data were used. The prevalence of covert use is estimated using direct questions and discordant responses of couples.
Results The study has found out that the Contraceptive Prevalence Rate among currently married women is 47% and 8.7% of them admitted use of contraceptives with out the knowledge of their husbands. Almost 23% of women practiced use of contraceptives with a complete or partial lack of knowledge of their husbands. Of all the modern methods, 15.7% of the covert users practice Injectables. Roughly 64% and 52% of covert users reported that their husband's are more pronatalist and had difficult spousal communication about family planning, respectively. Likewise, 78% of the covert users reported that their husband opposes use of contraceptives.
Conclusion The findings support the literatures in low contraceptive settings secret use of contraceptive is high. Women should be authorized to exercise their rights in making decisions that affect their reproductive health. The involvement of Men in reproductive health issues should be encouraged. Also, reproductive health service providers should inflate the choices available to their clients. The lack of women autonomy is the main factor that determines clandestine use of family planning services. Access to services, knowledge to specific methods, traditional and cultural barriers do have interplay to improve the role of men in reproductive health. With increasing involvement of men it might be possible to bring change in contraceptive use, which is the main challenge in the past several years. Since reproductive health matters are one indicators of poverty, men involvement and women autonomy will bring a new and short route to achieve the Millennium Development Goals.
P064
Statistical analysis of abortions in Belgrade (Serbia) during 2006
L. Tasic, M. Vasiljevic, M. Dzinic, and D. Tasic
Gynecology-Obstetric Clinic Narodni Front, Belgrade, Serbia
Objective To show the number and the structure of women who had decided to interrupt the unwanted pregnancy during the period of one year (2006) in Belgrade (capital of Serbia, with nearly 2 million people).
Method Results are based on statistical analyses of Institute of Public Health in Belgrade.
Results In 2006 there were reported 7628 interruptions of unwanted pregnancies in Belgrade. 97.6% of all abortions were performed in four clinics and the rest of them in private ambulances. The most abortions (91.9%) were performed in legally predicted term of 10 gestations weeks. The average age of women was 31 years (range 14–45 years). Intended abortion was the most commonly performed in women ranging from 25–34 years old (49.7%), closely followed by women ranging from 35–44 (29.7%). Women under 20 were represented with 3.8% and this percentage have not been changed for years. Under-aged females (under 18) made 0.9% of a whole number. 36.2% of women who decided to make abortion had no children at all. On the second place were women with two children (32.4%). 31.1% of women interrupt their first pregnancy, while 20.2% had one or more abortions in the past.
Conclusions The number of abortions in Belgrade is in constant fall: during 1991 32,215 legal abortions were done, while in 2006 there were 7,628 (index 1991/2006 is 23.7). In 1991 for every live-born baby two abortions were performed; in recent years for every two live-born babies one abortion was executed. The falling number of abortions (in spite of the still large number) reflects to more adequate family planning and a usage of contemporary contraceptive methods. In our country family planning has not revelled its goal yet and intended abortion is still the most common way of family planning.
P065
Attitudes towards sex education, marital roles, therapeutic abortions and modes of contraception among five distinct societies in Israel
G. Ben-David, L. Harel, B. Chayen, and I. Ben-Shlomo
Maayanei Ha Yeshua Hospital, Bnei Brak, Israel
Physician-patient interaction relies primarily on the efficiency of communication. Herein we describe comprehensively the main subjects that have relevance to the consultation of obstetricians/gynecologists to five distinct patient populations in Israel: Jewish Ultra-Orthodox (Hassidi), Jewish modern Orthodox, Non-observant Jewish, Urban Arab, Nomad Arab (Bedouin). In order to capture the full scope of the attitudes and practices, we interviewed leadership and representative figures from each of the five distinct social groups.
The issues that were discussed were: exposure to sex issues in general and through the various communication media, premarital sex, preferred age for marriage, consanguineous marriage, intercourse in relation to menstrual bleeding, preferred mode(s) of contraception, desired family size, specific diagnostic techniques during pregnancy and the place of therapeutic abortions.
As expected, the various attitudes towards these issues differ significantly, based on tradition as well as religious or non-religious ideology. This varies from Jewish Ultra-Orthodox who seldom use contraception other than breast feeding, hardly use antenatal screening for fetal malformation and rarely terminate a pregnancy; through the urban and nomad Arabs who use contraception more freely, partially use prenantal screening and accept termination of pregnancies until 120 days of conception; and up to the Non-observant Jewish, who freely use contraception, use thorough prenatal diagnosis and usually would elect termination of pregnancy at any gestational age if a mentally or physically challenged newborn is suspected. Since in the Middle East the mode of dressing and looks disclose much information on religious nomination, obstetricians/gynecologists can form a general framework of consultation for their patients, provided they recognize their group's attitudes.
P066
The use of contraceptive methods in Spain
I. Lete and E. Daphne
Hospital Santiago Apóstol, Vitoria-Gasteiz, Spain
Objective To study the use of contraceptive methods among Spanish women, their preferences between the different types of methods available and the evolution of this behaviour in the last 10 years.
Study design Personal interviews were conducted to Spanish women of childbearing age, from 15 to 49 years. A probabilistic, stratified random sampling was performed to select the women to be interviewed.
Results In 2007, 2105 women were interviewed, with a mean age of 32.8 years. 54% were married or living as a couple, 67.6% worked outside home and 12% were students. A total of 79.8% declared they used a contraceptive method. The most used methods were the condom (38.8%) and the pill (20.3%). Among women who declared not using any method (20.1%), 53% pointed out the absence of sexual intercourse as the main reason followed by the 18% who wished to get pregnant. 8.4% of women were estimated to be at risk of unwanted pregnancy due to the lack of use of contraceptive methods and the use of non-effective ones. The use of contraceptive methods progressively increased (from 49% in 1997 to 79.8% in 2007). The condom remained as the most used method (from 21% in 1997 to 38.8% in 2007) followed by the pill (from 14.3% in 1997 to 20.3% in 2007).
Conclusions The use of contraceptive methods has increased in the last decade in Spain and is approaching the pattern found in other European countries. Nevertheless, a far from negligible percentage of women are still at risk of unexpected pregnancy.
Topic 5: Emergency Contraception
P067
Emergency contraception in young women from the region of Gdansk, Poland
J. Olszewski1, H. Olszewska2, A. Abacjew-Chmylko2, and L. Chmylko3
1Department of Nursing, Medical University of Gdansk, Gdansk, Poland, 2Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Gdansk, Poland, and 3F. Ceynowa Hospital, Wejherowo, Poland
Objective Despite the increasing level of knowledge about contraception, emergency contraception (EC) is still considered a controversial method. The aim of this research was to investigate the characteristics of young women using EC, their sexual behaviour, the circumstances of receiving the medication as well as their knowledge about it as a method of contraception, especially in countries such as Poland with deep-rooted Catholic traditions.
Design and methods The research was conducted among students from the region of Gdansk, Poland, aged between 18 and 29. The selected group of EC users was later analysed.
Results Of the 1067 young women investigated, 65.8% were after sexual initiation, of which only 15.1% used EC. The majority received the medication once (70.1%). The main reason for practising EC was: condom breakage (38.3%) and not using any contraception (23.4%). More than half respondents used the EC within 12 hours of the intercourse although nearly all were aware of the 72-hour time limit. 79.4% had good access to the EC; however, a few women met with refusal from physicians or pharmacists to prescribe EC. Statistically speaking, those with condom problems had better access to EC. 26.7% respondents treated it as a contraceptive drug while 69.5% as an early abortive. Of the latter 29.5% never considered having an abortion. The most common sources of information about contraception were: physicians (40.2%), medical literature (31.8%) and magazines (23.4%); the least common were: family (0.9%) and church lectures (0%). The mean age of sexual initiation was 18.5 years (±1.87), during which the majority of respondents used condoms (67%) while 14.2% used oral contraceptives. Currently, the most popular method was oral contraception (50.9%), which reflected women's trust in contraceptive methods: hormonal contraception (93.5%), intrauterine devices (72%), condoms (45.8%) and EC (39.3%). The large majority (87.2%) were currently sexually active, 63.1% had 2 or more sexual partners and 45.3% had at least a few unprotected intercourses.
Conclusions Every sixth young woman used EC after initiation, most commonly due to condom failure. During an active sexual life the use of and trust for condoms decreased in favour of oral contraceptives. The EC was used correctly, however, the majority of young women treated the EC as an early abortive drug.
P068
Advance provision of emergency contraceptive pills reduces treatment delay – a randomized controlled trial among Swedish teenage girls
M. Ekstrand1, M. Larsson1, E. Darj1, and T. Tydén2
1Department of Women's and Children's Health, Uppsala University, and 2Department of Public Health and Caring Sciences, Uppsala university, Uppsala, Sweden
Objective To evaluate an intervention involving advance provision of emergency contraceptive pills (ECP) to Swedish teenage girls.
Design and methods A randomized controlled trial was performed among 420 girls aged 15–19 requesting emergency contraception at a local youth clinic. Participants were randomly assigned to intervention group (IG) (n = 214) or control group (CG) (n = 206). Both groups received ECP on request. In addition, the IG received one extra dose of ECP, condoms and an information leaflet regarding ECP and condom use. Main outcome measures were differences between IG and CG regarding ECP use, time span between unprotected intercourse and ECP intake, contraceptive use, and sexual risk taking. Questionnaires were completed at the initial visit, and the girls were followed up by structured telephone interviews three and six months later.
Results At the three-month follow-up, girls in the IG were almost twice as likely to have used ECP compared to girls in the CG (IG: 24.0%, CG: 13%, p = 0.02), and they used it sooner after unprotected intercourse (mean time IG: 13.61 h, CG: 25.47 h, p = 0.007). Significant differences persisted six months after the intervention (ECP use IG: 31%, CG: 19%, p = 0.01; and mean time IG: 15.59 h, CG: 26.38 h, p = 0.006). No significant differences were found in the use of regular hormonal contraceptives or condoms at either follow-up. About 40% of the girls in both groups had risked pregnancy at least once during the six month period. Only half of these had used ECP afterwards, however, girls in the IG had used ECP to a greater extent than controls (IG: 58%, CG: 37%, p = 0.02).
Conclusions This intervention increased the ECP-use and shortened the time interval from unprotected intercourse to pill intake without jeopardizing regular contraceptive use and without increasing sexual risk taking.
P069
Knowledge about contraception and sexual behaviour of young women using emergency contraception and not using emergency contraception
J. Olszewski1, H. Olszewska2, A. Abacjew-Chmylko2, and L. Chmylko3
1Department of Nursing, Medical University of Gdansk, Gdansk, Poland, 2Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Gdansk, Poland, and 3F. Ceynowa Hospital, Wejherowo, Poland
Objective Emergency Contraception (EC) is used when birth control methods fail or after an unprotected intercourse. Young women choose this method of contraception only if they have good information and easy access to it. The aim of the research was to compare the knowledge about contraception and the sexual behaviour of young women using EC and of those using other methods.
Design and methods The research was conducted among 703 sexually active women from Gdansk, Poland. It included high school and university students aged between 18 and 29. A group of EC users and non-EC users were distinguished. Data received by the use of an anonymous questionnaire was statistically analysed with chi-square and t-student tests.
Results Of 703 sexually active women investigated 15.2% used EC. The mean age of the EC users turned out to be higher (22.5 ± 2.00 years) than that of the non-EC users (19.5 ± 0.52 years). A majority of students were aware of the emergency indications of the EC and that it must be started within 72 hours. Simultaneously, the non-EC users had statistically less knowledge about the rules of using the drug, while 11.1% never heard about this medication. Nearly 70% in both groups treated the EC as an early abortive drug, whereas only every fifth as a contraceptive. The mean age of the first intercourse was higher in EC users (18.5 ± 1.87 years) than in non-EC users (17.5 ± 0.97 years). In the opinion of all students the most effective method of contraception were oral contraceptives (OC), followed by intrauterine devices, condoms and EC. Despite that, the EC users compared to non-EC users had statistically less trust in natural methods (0.9% vs. 6.2%) and in condoms (45.8% vs. 62.1%). Currently, the most frequently used method of contraception was: OC (50.9%) in EC users and the condom (49.1%) in non-EC users (in the last group OC was used by only 39.1%). The largest number of sexual partners had EC users, 63.1% declared having at least 2 partners compared to 33.7% in non-EC users. Unprotected intercourses were more common in EC users (60.4%) than in the other group (47.5%). Statistically speaking, the EC users considered having an abortion more frequently (16.8% vs. 7.3%).
Conclusions The young women who chose EC turned out to be older, with a longer and more active sexual life. They had more knowledge about the medication, which was drawn from more trustworthy sources. The students who did not reach for EC used less effective contraceptive methods during sexual intercourses.
P070
Postcoital intrauterine device for emergency contraception
D. Janga1 and S. Gupta2
1Homerton University Hospital, London, and 2Waltham Forest PCT Leyton, London, UK
Aims/Objectives To evaluate the uptake and outcome of postcoital IUD's in a family planning clinic and assess trends in the uptake during the study period.
Background Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse (UPSI) or potential contraceptive failure. The Faculty of Sexual & Reproductive health care guidance states that all women attending for EC should be offered an IUD even if presenting within 72 hours of UPSI.
Materials and methods We performed a retrospective case note audit of uptake and outcome of postcoital IUD's from the years 2000 to 2006. A total of 2091 IUD's were fitted, of which 146 (6.9%) were postcoital. Trends in uptake during the study period were studied.
Results During the study period, 146 women were fitted with postcoital IUD's, of these 101 notes (69%) could be retrieved. The age range was 15 to 42 years and 78 (77.2%) were nulliparous. A large proportion of women 57(56.4%) requested EC due to unprotected sexual intercourse and contraceptive failure (condom accidents 35 (34.6%), pill problems 5(4.9%), late depo-provera 4 (3.9%). The time of presentation to the clinic after the accident varied from 3 to 384 hours, but 85% women presented within 120 hours. Two women assumed low risk for sexually transmitted infections (STI) had positive Chlamydia swabs and not given antibiotic prophylaxis. 89 (88.1%) women wished to use the IUD for long term contraception, though only 80 (79.2%) came back for further follow up. There were no failures and uterine perforations, one woman had mild PID after insertion and there was one spontaneous IUD expulsion.
Discussion Despite guidance that all women attending for emergency IUD shoud be offered an emergency IUD, we have not seen an increase in uptake from 2000 to 2006. Possible reasons could be health professionals’ views determining the way it is presented to the user, nulliparous women who may favour the emergency pill over the IUD, anxiety by the user about it being invasive and time constraints in understaffed walk-in clinics.
Conclusion Postcoital IUD is a very effective and safe method for EC.
P071
Emergency hormonal contraception – knowledge and attitudes among university students
S. Saleiro, M. Moreira, T. Bombas, and T. Sousa Fernandes
1University Hospital of Coimbra, 2University Hospital of Coimbra, 3University Hospital of Coimbra, and 4University Hospital of Coimbra, Coimbra, Portugal
Introduction Emergency contraception pills (ECPs) prevents pregnancy after unprotected sexual intercourse or potencial contraceptive failure and has the potential to significantly reduce the incidence of unintended pregnancy and consequent need for abortion. ECPs consist of high doses of hormonal contraceptives taken within 72 hours of unprotected sexual intercourse. Strategies to reduce unplanned pregnancies should include improving knowledge, accessibility and availability of contraceptive services, including emergency contraception.
Objectives To access knowledge and attitudes about ECPs and issues of access and availabilty among university students.
Material and methods An anonymous questionnaire was conducted among 182 university students.
Results One hundred and eighty two participants completed the questionnaire. Average age of the students was 22.0 years (17–36), 66% were female and 34% were male students. Ninety nine percent of the students knew ECPs, but only 32% knew that ECPs prevents pregnancy. The majority of the students heard about ECPs in newspapers, at school and by friends. Ninety seven percent answered correctly to the question ‘When should ECPs be taken?’ as ‘within 72 hours after sexual intercourse’. Only 7 students (4%) didn't know the side effects of ECPs. 75% of the students knew that ECPs could be taken more than once, 15% answered that ECPs couldn't be taken more than once and 10% didn't know. However, only 31% knew that ECPs have no influence in future fertility, 47% thought it had influence and 22% didn't know. 177 students (97%) knew that ECPs could be bought at pharmacies and 87% knew ECPs were available without prescription. From the 121 female students 15% had already taken ECPs.
Conclusions The university students we accessed have good basic information of ECPs. Otherwise more detailed information and education should be given at school and in the media since these are the major sources of information about ECPs.
P072
Is emergency contraception as effective as regular combined oral contraception method?
L. Ostrowska2 and M. Lech1
1Fertility and Sterility Research Centre, Warsaw, Poland, and 2Medical University of Bialystok, Department of Hygiene and Epidemiology, Bialystok, Poland
Background Poland is the country with very restrictive abortion law. Due to this fact the contraception, and especially emergency contraception, plays a very important role in life of contemporary women living in the Country. Emergency contraception (EC) products are only available on prescription, but the prescriptions are not easily obtainable in the family doctors clinics, public hospitals etc. Due to this fact, in some setings – out of the public health services - there were created contraceptive clinics (with 24-hours services available).
Objective The aim of the study was to establish the reasons for needing EC, efficiency of the method, and unwanted effects occurred in women after consumption of two tablets containing 750 μg of levonorgestrel each (with the breake of 12 hours between them). The first dose of levonorgestrel was taken within the period of 72 hours after unsecured intercourse.
Stydy design The review and follow-up of the patients reported to one of the most prominent contraception clinics in Warsaw (the capital of Poland).
Results During the period 1 January 2004–31 May 2007, 3470 women seeking EC were seen in the Contraceptive Clinic of Fertility and Sterility Research Centre in Warsaw. 65.3% of them were below 25 years. 13.1% of women reported themselves for EC, were in the age below 18 years. During the follow-up period, it was found that only in less than 0.5% of the patients, the method was not effective and pregnancy occurred. But app. 21.0% (out of 3,470) patients were not available for the follow-up. The side effects of the hormonal EC were rare and mild. The most common reason for needing of EC was the condom's failure (54.9%).
Conclusion In the view of this study, the hormonal EC is the very effective and safe method of prevention of unwanted pregnancy, and could be used with a very high effectiveness, even in cases of failure of the other methods of contraception.
Topic 6: Endocrinology and Metabolism
P073
Comparison of corticoid substitution versus combined oral contraception administration in the treatment of nonclassic adrenal hyperplasia (NCAH)
M. Fanta, D. Cibula, J. Belacek, and J. Vrbikova
Department of Gynecology and Obstetrics of 1st Medical Faculty of Charles University and General Faculty Hospital, Prague, Czech Republic
Objective The clinical symptoms of nonclassic adrenal hyperplasia (NCAH) are the same as those in patients with polycystic ovary syndrome (PCOS). The aim of our study was to compare classic corticoid treatment of NCAH with effect of combined oral contraception (COC) administration (used in treatment of PCOS) on clinical and laboratory parameters of NCAH.
Design A prospective clinical study, cross-over design.
Material and methods Since 1999 were identified from 298 hyperandrogenic women eight patients as having 21-hydroxylase deficient NCAH. They were divided equally into two groups according to order of application treatment modality(hydrocortison vs. COC). Effect of treatment of both modalities on clinical symptoms (hirsutism – FG score, acne, menstrual cycle) and laboratory parameters (testosterone, androstenedione, DHEA, DHEAS, SHBG) were followed.
ResultsWe observed decrease of plasma androgens in both groups, which did not significantly differ. But we documented significant increase of SHBG (i.e., decrease of free androgens) in each period with COC administration. Not surprisingly, improvement of the most frequent clinical symptom of NCAH in our study group, oligomenorrhea, was also more effective in COC. Hirsutism was only minor problem in our group, that did not allow to evaluate treatment effect of both modalities.
Conclusion Our results indicate that also ovarian supression by COC administration can be used for the treatment of NCAH, at least under basal conditions. Whether corticosteroid substitution can be limited to patients with inadequate response to COC on plasma androgen levels or with signs of adrenal insufficiency will require further data.
P074
Prevalence of nonclassic adrenal hyperplasia (NCAH) in hyperandrogenic women
M. Fanta, D. Cibula, and J. Vrbikova
Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and General Faculty Hospital, Prague, Czech Republic
Objective The clinical symptoms of nonclassic adrenal hyperplasia (NCAH) are identical with polycystic ovary syndrome (PCOS). The aim of our study was to determine the prevalence of nonclassic adrenal hyperplasia (21-hydroxylase-deficiency) in hyperandrogenic women, its biochemical, endocrine and clinical characteristics and to compare them with parameters of patients with ovarian hyperandrogenism.
Methods Since 1999, 298 patients with elevation of at least one androgen and manifestation of one of the clinical androgenic symptoms (oligo/amenorrhea, hirsutism or acne) have been identified in our database. A diagnosis of NCAH was considered when the basal or stimulated 17-hydroxyprogesterone was elevated.
Results Only eight patients were identified as having 21- hydroxylase deficient NCAH in the whole group of 298 hyperandrogenic women. Hirsutism and acne were found only in three, two patients, five of them had oligo/amenorrhea.Seven patients had both elevated basal and stimulated 17-hydroxyprogesterone, while in one case only elevation of stimulated level was found. All of the NCAH patients had elevated concentrations of testosterone, six DHEA, lower SHBG was found in four patients. Surprisingly, none of the NCAH patients had increased DHEAS.
Conclusion In our study, the prevalence of NCAH in hyperandrogenic women was 2.68%. Their leading symptom was oligomenorrhea and skin androgenic disorders were a minor clinical problem. None of the NCAH patients had an elevated DHEAS, the androgen dominantly produced by the adrenal glands.
P075
Changes in body weight and waist circumference during 13 usage cycles of 30 μg of Ethinylestradiol® and 3000 μg of Drospirenone
D. Driák1, K. Hurt1, O. Šottner1, J. Záhumenský1, and V. Kacer2
1Department of Gynaecology and Obstetrics, Charles' University in Prague, First Faculty of Medicine and University Hospital Na Bulovce, Prague, Czech Republic, and 2GynCentrum, spol. s r.o., Prague, Czech Republic
Introduction Despite the clinical trials documenting that the average weight gain of about 0.5 kg per year in the female population was observed both with and without hormonal contraception, most of young women accuse the oral contraception (OC) of the weight increase. While not proved by evidence, this side-effect remains a rather subjective menace, but one of the most frequent reasons for discontinuing.
Objectives The purpose of this study was to observe the changes in body weight, body mass index (BMI), and waist circumference during 13 usage months of the OC containing 30 μg of ethinylestradiol (EE) and 3000 μg of drospirenone (DRSP) in one tablet (Yadine®).
Design and methods Within 4.5 years, from 2003 to 2007, in 132 women between 15 and 47, taking Yadine®, body weight, BMI and waist circumference were measured. Side effects and reasons for discontinuation were registered.
Results During 13 usage cycles of Yadine®, the mean body weight dropped non-significantly from 63.2 to 62.6 kg, the mean BMI decreased very slightly from 22.5 to 22.3 kg/m2 and the mean waist circumference decreased non-significantly from 62.5 to 61.8 cm. The contraceptive's reliability was absolute. Breakthrough bleeding of mild intensity (spotting) occured in 9 cases (6.8%) in the first 3 months and, afterwards, disappeared spontaneously.
Conclusion According to the results of our prospective study, in 1274 cycles the OC containing 30 μg of EE and 3000 μg of DRPS was tolerated well. Body weight, BMI and waist circumference remained stable or non-significantly decreased.
P076
Fate of uterine fibroids under oral contraceptives
D. Driák, O. Šottner, K. Hurt, and J. Záhumenský
Department of Gynaecology and Obstetrics, Charles' University in Prague, First Faculty of Medicine and University Hospital Na Bulovce, Prague, Czech Republic
Introduction Oral contraception (OC) blocks the endogenous ovarian steroid secretion that stabilises the hormonal concentrations. Monophasic, progestin-dominant pills may lead to regression of estrogen-dependent diseases, e.g. myoma and endometriosis.
Objective The purpose of this study was to observe the fate of uterine fibroids that were exposed to the influence of various monophasic OC with progestin dominancy.
Design and methods During the 6 years 2002–2007, a total of 30 women with one or multiple myomas were treated conservatively with hormonal contraception. The changes in myomas' growth and clinical presentation were observed.
Results During the period from 6 months to 5 years one or multiple myomas of 8–61 mm in diameter and various localisations were evaluated. In 14 patients, regression or stationary stage was registered and they continued in follow-up. In 8 patients, regression or stationary stage was registered; however, they were lost from our further evidence. Five patients underwent operation removing the whole uterus or myoma. In 3 patients, we registered progression; however, these women refused operation.
Conclusions In women from various causes refusing ultimate operation, the OC therapy stabilizes the hormonal levels. In most of cases, that may lead to diminishment of the myoma and may alleviate clinical disorders associated with uterine fibroids.
P077
Study of PMSG and HCG effects on mice uterus morphology in preimplantation period
Y. Dezhkam and R. Ali Sadrkhanlou
1Urmia Islamic Azad University, Urmia/West Azarbijan, Islamic Republic of Iran, and 2Urmia university, Urmia/West Azarbijan, Islamic Republic of Iran
The purpose of this research was to survey morphological and biometrial changes of mice ovaries and uterus in the preimplantation period. to achieve this purpose, 20 Healthy female Mice (age 6 weeks) and 15 male mice (age 10 weeks) were selected, female mice were divided into four groups and kept in ideal conditions(14 h light, 10 h dark 22–23°C temperature and 40–50% moisture) for a month and with available water and food, also the male mice. After a month, we divided the mice into one SHAM group and three treatment groups. After the vaginal extension, the mice that showed proestrus and diestrus were used for the injection of ovarian follicular stimulating hormones. 200 ul/mouse normal saline (IP) was injected in the control group and in the other groups, 200 Ul/mouse normal saline which contains 5IU/mouse PMSG was injected. After 48 h, 5IU/mouse HCG was injected in the treatment groups. 24 h after injecting the normal saline, animals were killed by cervical dislocation and their ovaries and uterus placed in boan solution, 12 h after HCG injection a male mouse was placed in each cage to fertilize female mice, 12 h after mating vaginal plague was checked, and if the vaginal plague were observed, this day was appointed as the first day, for studying ovaries and uterus changes, treatment groups were divided into three groups: day-1, day-3 and day-6, 24 h after mating 5 mice were killed by cervical dislocation and their ovaries and uterus placed in boan solution for microscopic studies. This exploit were done to group 2 after 72 h and to group 3 after 144 h of mating. After one or two days of fixation, passage process, tissue cutting and staining, morphological and biometrial studies were done. SHAM group survey shows the growth of ovarian follicles in different stages. In group I follicular dispersion decreased and some of follicular structures were changing into corpus luteum. In group II corpus luteum size and structure were apparent and in group three dispersion of corpus luteum was the main structure of the ovary. In uterus structure enhancement of endometrium epithelial cells and dispersion of vessels gemma and enhancement of glandular branches were observed myometrium diameter was increased. In day-6 group cellular changes were appear in the site of implantation in the endometrium.
P078
Treatment of chronic pelvic pain related to endometriosis: LNG-IUS versus gonadotrophin releasing hormone analogue
B. Dilbaz, Y. Bayoglu Tekin, S. Dilbaz, and A. Haberal
Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
Objective To compare the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS-Mirena®) and a depot- gonadotrophin releasing hormone (GnRH)-analogue (Zoladex®) on endometriosis-related chronic pelvic pain(CPP) over a period of12 months.
Design and methods Forty women with CPP who had no desire for further pregnancy were randomized using a computer-generated system of sealed envelopes into either LNG-IUS (n = 20) or GnRH analogue (n = 20) treatment groups. Within three days after conservative laparoscopic surgery for endometriosis a LNG-IUS was inserted or depot GnRH analogue was applied. GnRH analogue dose was repeated every two months. Scores of endometriosis-associated with CPP were evaluated using the Visual Analogue Scale (VAS) and Total endometriosis severity profile (TESP). Pain score was evaluated prior to surgery and every three months for a year in both groups.
Results In LNG-IUS group VAS score had no significant alteration in one year period, GnRH analogue group had shown a significant decrease in the VAS score at the end of the follow-up period. TESP score decreased in the LNG-IUS group at the first, third and 6th months whilst at the 12th month of follow-up TESP scores elevated up to values similar to the pre-treatment values. GnRH analogue group had shown significant decrease of the TESP score at the end of the follow-up period.
Conclusion Both, the LNG-IUS and the GnRH-analogue were effective in the treatment of CPP-associated endometriosis. Because of the side effects as the functional cysts and intermenstrual bleeding induced in most women, a LNG-IUS reduced patient satisfaction.
P079
Contraceptive use in obese women and the risks of unintended pregnancy
O. Caramelo, S. Custódio, A. Lobo, E. Marta, and P. Moura
Obstetrics Department - Coimbra University Hospital, Coimbra, Portugal
Introduction The prevalence of obesity in women of reproductive age continues to increase and is associated with pregnancy related complications and adverse outcomes. Proper contraceptive use and unintended pregnancy avoidance is a priority.
Objectives The purpose of this study was to describe contraceptive use by obese women before (and after) an intended/unintended conception. In parallel we have evaluated the failure of contraceptive methods and analyze the differences in pregnancy outcomes in these two groups.
Design and methods Data was collected retrospectively for 40 women with obesity managed in our institution between January 2005 and December 2007.
Results Mean maternal age was 29 ± 6.35 years old. Pregnancy was unintended in 60% of cases, with a reported failure of contraceptive methods described in 22.7% (mainly oral contraceptives). In planned pregnancies, 13.3% used barrier contraception, 80% oral contraception and 6.6% intrauterine devices. Prepregnancy BMI in unintended pregnancies was 36.6 kg/m2 vs 37.7 kg/m2 (p = n.s.) for planned pregnancies, with mean weight pregnancy gain of 9.25 kg vs 11.66 kg (p = n.s.) respectively. Pregnancy related complications like gestational diabetes, gestational hypertension, pre-eclampsia occurred in unintended pregnancy in 63,3% vs 43,2% in intended pregnancy (p < 0.05). Birth occurred on average at 38.6 weeks vs 38.9 weeks (p = n.s.) respectively, with cesarean rates of 45.5% vs 40.1% (p < 0.05). In unintended pregnancy, contraceptive use after pregnancy was: oral contraceptives in 53.2% of women (with 26.6% using progestative contraceptive); barrier methods and tubal sterilization in 6.6% each. In the case of indented pregnancy the postpartum contraceptive methods chosen were: oral contraceptives in 36.4% of women, tubal sterilization in 13.6%, intrauterine devices in 9.1% and subdermal hormonal implants in 4.5%.
Conclusions Reducing the rate of unintended pregnancies among obese women is a critical step towards the goal of improving pregnancy outcomes, with a decrease of gestational diabetes, gestational hypertension, pre-eclampsia, and caesarean deliveries. Because unplanned pregnancies carry risks for obese women, family planning is a high priority.
P080
Reasons for infertile women and men to discontinue in vitro fertilization (IVF)
A. Akyuz and N. Sever
Gulhane Military Medical Academy School of Nursing, Ankara, Turkey
Objectives The pregnancy chance increases with an increased number of treatment cycles in IVF-ET. The couples, starting treatment with great willingness, are therefore expected to comply with the treatment and complete all treatment cycles to achieve pregnancy. Studies in recent years have shown that a great majority of couples discontinue treatment before the recommended number of cycles is completed and pregnancy is achieved. The aim of this study was to determine the ‘reason for treatment discontinuation’ for couples who had received at least one IVF-ET treatment at the IVF center of a university hospital in Turkey. Many studies on this subject have defined discontinuing IVF treatment as ‘discontinuing the center of treatment without achieving pregnancy or without a suggestion by the medical staff to discontinue treatment for medical reasons’. We defined ‘discontinuing treatment’ in two separate categories in this study as ‘changing the treatment center’ and ‘discontinuing treatment completely’, believing that the reasons could be different and to obtain more detailed data.
Design and methods This study was performed by making use of the records of an assisted reproductive treatment center of a university hospital. The archive research revealed 758 couples that had received treatment during this period. The address and telephone information of the couples were obtained from the records and all couples were called to confirm the address information. The investigator introduced herself to one of the partners that could be reached by telephone, explained the reason for the call and obtained information about their status regarding current IVF-ET treatment. According to the result of this conversation, those who were found to have discontinued the treatment were asked whether they would like to participate in the research after the aim of the study was explained.
The SPSS 11.0 package software was used to analyze the study data. The percentiles were calculated to show the total distribution of the data and the chi square test was used for the statistical comparison of descriptive data.
Results The unsuccessful result period, the most difficult period for the women during treatment, was also effective in the discontinuation of treatment. Another important reason for discontinuing treatment is inadequate financial resources. The most important factors for the men to make a decision to discontinue treatment were ‘depletion of financial resources’, ‘unsuccessful treatments and fear of coping’ and ‘psychological exhaustion due to treatment’. The most important reason for women making the decision to discontinue the center was ‘dissatisfaction with the center and its staff’. The second most important factor for the women deciding to continue their treatment at another center was hearing that the other center had a high rate of success and the third factor was wanting to try their chance at another center. The most important factor for men in deciding to discontinue the center was unsuccessful treatments while the second and third reasons were hearing that another center had a higher rate of success.
Conclusions In our study, only 26.4% of the women and 27.8% of the men who stated they had discontinued treatment completely were certain they would never start another treatment cycle. This result indicates that most of the women and men who have discontinued treatment still want to have a child and will continue treatment if their psychological and financial status allows. We feel that the most important finding of this study is the drive felt by the couples who state they have discontinued treatment completely to continue. This result shows that couples never really stop wanting to have children and are forced to give up due to the difficulties during treatment.
P081
The effects of the LNG-IUS on lipoprotein metabolism and various parameters
Ö. Güldem Öncü, E. Zeynep Tuzcular Vural, I. Gönenç, G. Köse, and N. Aka
Haydarpasa Numune Training and Research Hospital, Family Planning Unit, Istanbul, Turkey
Objective The levonorgestrel intrauterine system (LNG IUS) is offered as a contraceptive option at the Family Planning Unit (FPU) of Haydarpaşa Numune Training and Research Hospital, Istanbul. In this study we aimed to investigate the effect of the LNG IUS on various lipoprotein parameters.
Design and methods 102 women between ages 23–48 who presented to the FPU of Haydarpaşa Numune Education and Research Hospital and chose the LNG IUS as a contraceptive method were included in the study group. Patients were informed about the study and asked if they would consent to participate Baseline lipoprotein values were evaluated for all cases. Results were analyzed using the SPSS for Windows 10.0 using the paired samples test.
Results The mean age of the women was 34.34 ± 4.43. When compared to baseline values, there were no statistically significant changes in fasting glucose, AST, ALT, total cholesterol (TC), triglyceride (TG) and HDL cholesterol levels. Coagulation tests (APTT, PT, INR) also remained unchanged. A statistically significant increase was present in LDL and VLDL cholesterol values (p < 0.05). However, both remained in the normal range. Increases in both hemoglobin and hematocrit levels were extremely significant (p = 0.001).
Conclusion The LNG IUS was well tolerated and can be considered as a useful contraceptive option for especially women with low hemoglobin and hematocrit levels. Women should be evaluated for history of long periods and blood loss and be offered the LNG-IUS during counseling.
P082
Treatment with Yasmin® for poly cystic ovary syndrome
C. Trifan and M. Tîrnovanu
Cuza Voda, Hospital, Iasi, Romania
Objectives To emphasize the endocrine profile after 6 months treatment and clinical effects at women with poly cystic ovary syndrome (PCOS).
Material and methods The patients underwent clinical, metabolically, hormonal and ultrasound imaging at presentation and every 3 months there after. We compared the tolerance for Yasmin and for other types of drugs.
Results In the period 2005–2007 we had 176 patients aged between 17 and 41 years who took Yasmin® birth control pill. From these, 41 had PCOS. We gave them Yasmin® because it contains drospirenone, which is an antiandrogen. After 3 months the plasmatic testosterone showed a statistical significant decrease at 36 patients. SHBG showed a marked increase in 38 out of 41 patients, Therefore the free androgen index statistically decreased in 100% of cases.
Yasmin® correct irregular menstrual bleeding or absent menstrual cycles after 3 months. The treatment improves androgen-related acne problems, hair loss and abnormal hair growth on face and body after 6 months for 12 women and after 9–12 months for the other 29. Ultrasound imaging showed a decrease of more than 50% of ovarian volume in 73% of cases.
An important effect is avoiding fluid retention. The treatment was well tolerated, the side effects being negligible: masthodynia, spotting, increase of liver enzymes and cholesterol.
Conclusions Yasmin® is a good choice for patients with PCOS with medium hirsutism. It is an alternative for Diane 35 which at some patients has side effects (severe headache, increase of body weight) which women with PCOS do not need to contend with on top of symptoms they already have. Tolerance for Yasmin® is better than for Spironolactone which may give side effects include nausea, menstrual irregularities and increase breast size.
P083
The impact of preconceptional counseling before pregnancy in women with type 1 diabetes
O. Caramelo, S. Custódio, A. Lobo, E. Marta, and P. Moura
Obstetrics Department – Coimbra University Hospital, Coimbra, Portugal
Introduction Preconception metabolic optimization has been shown to improve pregnancy outcomes in type 1 diabetic women, emphasizing the importance of avoiding unintended pregnancy and promoting pregnancy planning.
Objectives To determine the importance of preconceptional evaluation and counseling of women with diabetes mellitus type 1 on pregnancy outcomes.
Design and methods Retrospective assessment of 50 women with type 1 diabetes mellitus managed in our institution between January 2005 and December 2007.
ResultsMean maternal age was 30.7 ± 5.39 years. The pregnancies were divided in two groups according the existence (group A) or not (group B) of preconceptional counseling. In the first group 54,5% of the total were included. Multiparity rate was 31.8% vs 54.2% (p < 0.05). Before pregnancy BMI were 25.9 kg/m2 vs 24.7 kg/m2 (p = n.s.). The average of hemoglobin A1c in the early pregnancy was 7.01 g/dl vs 7.78 g/dl (p < 0.05) and the average of hemoglobin A1c in late pregnancy was 6.60 g/dl vs 7.30 g/dl (p < 0.05). Microvascular complications such as retinopathy were present in 13.6% vs 20.8%, nephropathy in 9.1% vs 12.5%, and chronic hypertension in 18.2% vs 12.5%. In planned pregnancies (group A), 13.3% of the women used barrier contraception, 75.1% used combined oral contraceptive and 11.6% used combined patch. In group B we found that 44.4% of women used combined oral contraceptive, 33.3% didn't used any contraception and 22.2% used intrauterine devices. Regarding pregnancy outcome we found 4.5% vs 16.7% (p < 0.001) of spontaneous abortions, with one case of stillbirth and two cases of fetus with cardiac malformations in group B. The rate of cesarean section was 82.3% vs 66.3% (p = 0.05) with a birthweigth mean of 3510 ± 423 g vs 3875 ± 409 g (p = n.s.). Contraception during the postpartum period was: combined oral contraceptive 43.7% vs 30% and progestin oral contraceptive 12.5% vs 15%.
Conclusion Safe and effective contraceptive methods are essential for these women in order to get a planned pregnancy under optimal conditions. The main contraception methods used by women with diabetes type 1 are hormonal contraception (low dose), intrauterine devices and barrier contraceptive. Optimal metabolic control at conception and early pregnancy by an endocrinologist and obstetrician is necessary to reduce the risk of early miscarriage and congenital malformations.
P084
Study of PMSG and HCG effects on mice ovaries morphology in preimplantation period
Y. Dezhkam and R. Ali Sadrkhanlou
1Urmia Islamic Azad University, Urmia/West Azarbijan, and 2Urmia University, Urmia/West Azarbijan, Islamic Republic of Iran
The purpose of this research was to survey morphological and biometrial changes of mice ovaries in the preimplantation period. to achieve this purpose, 20 healthy female mice (age 6 weeks) and 15 male mice (age 10 weeks) were selected. The female mice were divided into four groups and kept in ideal conditions(14 h light, 10 h dark 22–23°C temperature and 40–50% moisture) for a month and with available water and food, so the male mice. After a month, we divided the mice into one SHAM group and three treatment groups. After the vaginal extension, the mice that show proestrus and diestrus were used for injecting of ovarian follicular stimulating hormones. 200ul/mouse normal saline (IP) was injected in control group and in the other groups, 200Ul/mouse normal saline which contain 5IU/mouse PMSG was injected, after 48 h, 5IU/mouse HCG was injected in the treatment groups. 24 h after injecting the normal saline, animals were killed by cervical dislocation and their ovaries placed in boan solution, 12 h after HCG injection a male mouse was placed in each cage to fertilize female mice, 12 h after mating vaginal plague was checked, and if the vaginal plague were observed, this day was appointed as the first day, for studying ovaries changes, treatment groups were divided into three groups: day-1, day-3 and day-6, 24 h after mating 5 mice were killed by cervical dislocation and their ovaries placed in boan solution for microscopic studies. This exploit were done to group 2 after 72 h and to group 3 after 144 h of mating. After one or two days of fixation, passage process, tissue cutting and staining, morphological and biometrial studies were done. SHAM group survey shows the growth of ovarian follicles in different stages. In group I follicular dispersion decreased and some of follicular structures were changing into corpus luteum. In group II corpus luteum size and structure were apparent and in group three dispersion of corpus luteum was the main structure of the ovary.
Topic 7: Ethics and Legislation
P085
Conscientious objections and emergency contraception
M. Kliment and V. Cupaník
1Slovak Medical University, Bratislava, Slovakia, and 2GPN, Bratislava, Slovakia
Authors stress the importance of contraception in prevention of unwanted pregnancy. They define emergency contraception and emphasize its irreplaceable place in prevention of unwanted pregnancy in specific situations in life. In spite of more than 30 years of experience with positive impact of emergency contraception in prevention of unwanted pregnancy there still exist barriers against its wider use. Among them conscientious objections of some pharmacists or physicians play an important role. Authors also mention conflict between freedom of conscience on one hand and quality and accessibility of health services on another, as well as attitudes of the WHO and FIGO which should be respected in solving of this conflict and keeping balance. They mention also a myth regarding abortive influence of emergency contraception and accentuate the fact that obstructions against accessibility of emergency contraception should be found unethical.
Topic 8: Hormonal Contraception
P086
Intermittent vs. continuous proliferative effects of ethinylestradiol on breast cancer cells simulating conventional vs. long-cycle regimens of contraception
G. S. Merki-Feld1, H. Seeger2, and A. O. Mueck2
1Clinic of Endocrinology, Department of Gynecology and Obstetrics,University Hospital, Zurich, Switzerland, and 2University Women's Hospital of Tuebingen, Center of Endocrinology and Menopause, Tuebingen, Germany
Objectives Long-cycle regimens with continuous use of oral contraceptives (OC) for 3–6 months followed by a hormone-free interval of 7 days may reduce or prevent cycle-dependent and menses-related complaints and may offer advantages regarding the use for women with special cycle-dependent diseases. However, it remains unknown whether this long-term treatment is associated with an increased breast cancer risk as compared to the usual cyclic treatment. Therefore we compared the effect of different time-dependent expositions with respect to the estrogen component of OC, i.e. ethinylestradiol (EE), to two lines of human hormone-receptor positive breast cancer cells simulating the extended vs. conventional regimen in in-vitro experiments.
Design and methods MCF-7/HCC1500 cells (human metastatic/primary breast cancer cells) cells were incubated with physiologic concentrations of EE. To simulate normal vs. long-cycle conditions, for intermittent incubation the cells were incubated for 3 days with the steroid for 18 h and then steroid-free medium was used for 6 h; for imitating continuous therapy the cells were incubated with EE for 24 h for 3 consecutive days. Proliferation measured by the MTT-assay.
Results In MCF-7 cells the proliferation values were 49 and 54% at the concentration of 0.1 nM and 28 and 39% at the concentration of 1 nM for the intermittent and continuous incubation time, respectively. There was no significant difference between both schemes. In HCC 1500 cells, similarly to the MCF-7 cells, both incubation modes elicited a significant stimulation of the proliferation. The corresponding values were 31.5 and 38.2% for 0.1 nM and 29.4 and 33.6% for 1 nM. Accordingly to the MCF-7 cells no significant difference was found between the two incubation modes.
Conclusions Ethinylestradiol can stimulate breast cancer cells which we were able to demonstrate not only with MCF-7 cells – mostly used for research on this topic – but to our knowledge for the first time also with primary breast cancer cells which have the advantage to better reflect clinical conditions compared to metastatic cells. Our results further suggest that continuously administered ethinylestradiol may not increase breast cell proliferation to a greater extend compared to intermittent application simulating extended vs conventional regimens. Ongoing research has to demonstrate the effects of the progestogen component, and of course clinical studies are necessary to prove these in vitro results.
P087
Bleeding patterns and cycle control with a novel four-phasic combined oral contraceptive containing estradiol valerate and dienogest
S. Parke1, D. Makalova2, H.-J. Ahrendt3, and D. Mansour4
1Global Clinical Development, Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany, 2Gynekologicka a Porodnicka Ambulance, Prague, Czech Republic, 3Halberstadter Strasse 122, Magdeburg, Germany, and 4Newcastle General Hospital, Newcastle upon Tyne, UK
Objective Historically, attempts to use 17β-estradiol (E2) as the estrogen component in combined oral contraceptives (COCs) have proved unsatisfactory in terms of cycle control when administered as part of monophasic or biphasic regimens. To address this issue, a unique preparation was developed in which estradiol valerate (E2V; 1mg of E2V contains 0.76 mg of E2) was combined with the progestogen dienogest (DNG) in a novel four-phasic regimen. The objective of the current study was to compare the bleeding pattern, cycle control and safety of this new E2-containing preparation to a conventional COC containing ethinylestradiol (EE).
Methods A multicenter, randomized, double-blind study of healthy women aged 18–50 years was conducted using E2V/DNG [2 days E2V 3 mg, 5 days E2V 2 mg/DNG 2 mg, 17 days E2V 2 mg/DNG 3 mg, 2 days E2V 1 mg, then 2 days placebo] or monophasic EE 0.02 mg/levonorgestrel (LNG) 0.10 mg for 7 cycles.
Results A total of 798 women were randomized (399 per group) and received study medication. Both the duration and intensity of withdrawal bleeding was reduced with E2V/DNG, compared with EE/LNG. Through cycles 1–7, the occurrence of withdrawal bleeding ranged from 77.7–83.2% in women receiving E2V/DNG compared with 89.5–93.8% in women receiving EE/LNG. The incidence of intracyclic bleeding over 7 cycles of treatment was similar with both treatments, ranging from 10.5–18.6% for E2V/DNG and 9.9–17.1% for EE/LNG. No unintended pregnancies occurred during treatment with E2V/DNG. The safety profile of E2V/DNG was generally comparable to that of EE/LNG. The frequency of adverse drug reactions was 10.0% in women who received E2V/DNG, compared to 8.5% with EE/LNG. All assessments of general, psychological and sexual well-being concurred to indicate that E2V/DNG was as favourable as EE/LNG. The overall rate of satisfaction with E2V/DNG was 79.4%, which was comparable to that for EE/LNG (79.9%).
Conclusions A novel four-phasic COC composed of E2V/DNG is associated with a good bleeding profile and fewer bleeding/spotting days than EE/LNG. This new formulation is expected to be the first E2-providing COC to achieve good cycle control.
P088
Efficacy and tolerability of an innovative four-phasic combined oral contraceptive containing estradiol valerate and dienogest
S. Parke1, L. Wildt2, S. Palacios3, T. Romer4, and J. Bitzer5
1Global Clinical Development, Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany, 2Univ. Klinik fur Frauenheilkunde, Innsbruck, Austria, 3Instituto Palacios de Salud y Medicina de la Mujer, Madrid, Spain, 4Hospital Cologne-Weyertal, Cologne, Germany, 5University of Basel, Basel, Switzerland
Objective A unique combined oral contraceptive (COC) has been developed in which estradiol valerate (E2V; 1 mg of E2V contains 0.76 mg of E2) has been combined with the progestogen dienogest (DNG) in a novel four-phasic regimen. The preparation was designed to overcome the suboptimal cycle control observed with previous attempts to use E2 in COCs. The objective of the current study was to assess the efficacy and tolerability of this new preparation.
Methods A multicenter, open-label study of women aged 18–50 years was conducted using twenty 28-day cycles of E2V/DNG (2 days E2V 3 mg, 5 days E2V 2 mg/DNG 2 mg, 17 days E2V 2 mg/DNG 3 mg, 2 days E2V 1 mg, 2 days placebo). The primary endpoint was the number of unintended pregnancies during study treatment. Bleeding pattern and cycle control parameters were also analysed. Various safety parameters were monitored.
Results 1,377 women received the study medication. In women aged 18–35 years (n = 998), 12 pregnancies occurred over an exposure of 16,608 cycles (Pearl Index [PI] = 0.94 [upper limit of two-sided 95% CI = 1.65]). Only 5 of these pregnancies were attributed to method failure (adjusted PI = 0.40 [upper limit of the 95% CI = 0.92]). In the entire sample of women aged 18–50 years, 13 pregnancies occurred over an exposure time of 23,368 cycles (PI=0.73 [upper limit of 95% CI=1.24]) and only 6 of these pregnancies were attributed to method failure (adjusted PI=0.34 [upper limit of 95% CI=0.73]). The Kaplan-Meier estimate of the cumulative failure rate over 20 cycles was 0.0142 (95% CI 0.0080–0.0251) in 18–35-year-old women and 0.0109 (95% CI 0.0063–0.0188) in 18–50-year-old women. An analysis of bleeding data revealed a well-controlled and regular bleeding pattern during treatment, with approximately 79% of women per cycle experiencing withdrawal bleeding. Intracyclic bleeding occurred in only a minority of volunteers, with the frequency decreasing over time. During the last 10 cycles of treatment, the incidence of intracyclic bleeding ranged from 10.2–14.1%, which is similar to the incidence of intracyclic bleeding observed with EE-containing COCs. The study medication was well tolerated, with 19.8% of women experiencing adverse events assessed as related to the study drug. Nearly 80% of women were satisfied or very satisfied with treatment. The discontinuation rate due to adverse events was 10.2%. Emotional and physical well-being remained the same or improved in 89.7% and 86.4% of women, respectively.
Conclusions The novel 4-phasic COC composed of E2V/DNG described here was found to be highly effective, well tolerated, and associated with a high level of user satisfaction. This new formulation is expected to become the first globally available E2-providing COC.
P089
Oral contraception (OC) vs hormone replacement therapy (HRT): efficacy in climacteric symptoms and bleeding pattern after switch from OC to HRT
A. O. Mueck1, V. Rakov2, R. D. Hilgers3, F.-U. Deuringer1, and H. Seeger1
1University Women's Hospital of Tuebingen, Center of Endocrinology and Menopause, Tuebingen, Germany, 2Novo Nordisk Pharma, Zurich, Switzerland, and 3Institute of Clinical Biostatistics, University of Aachen, Aachen, Germany
Objectives Data are lacking assessing efficacy in climacteric symptoms and bleeding pattern switching directly from oral contraceptives (OC) to hormone replacement therapy (HRT), the latter usually used for treatment of postmenopausal women. Moreover, data are sparse using continuous combined (instead of sequential) estrogen/progestogen therapy in perimenopausal and early-postmenopausal women. Initial irregular bleedings frequently may occur dependent on the pretreatment with OC and type of HRT.
Methods Women using pills containing ethinyl estradiol (EE) 20–50 mcg were switched to estradiol 1 mg/norethisterone acetate 0.5 mg (E2/NETA) within 0–8 weeks. Open-labelled cross-over study, retrospective regarding OC use, prospective part of study with HRT during 6 cycles. Analyses evaluating efficacy, bleedings and acceptance were performed for the Intent To Treat (ITT)- as well as for the Per Protocoll (PP)-population stratifying for preceding OC use according 1) bleeding patterns during OC (regular/irregular, intensity, duration), 2) type of OC (1-,2-,3-phase OC), and 3) dosage of EE (20, 30-40, 50 mcg), and stratifying also for duration of ‘hormonal pause’ switching from OC to HRT (wash-out 0,2,4,8 weeks).
Results ITT-Population 601 women; PP-population 576 women. Mean age 49.0 years (SD 3.1), BMI 25.1 (SD 3.8) kg/m2. During OC, 56% of the women had climacteric complaints, which were almost completely ameliorated or abolished by HRT (89%). During HRT amenorrhea rate increased from 41.3% at cycle 1 to 77.0% at cycle 6; the number of bleeding days decreased from 5.3 to 1.4 days. The bleeding pattern during HRT was not influenced by duration of switching, phase type, or dosage of EE used during OC. However, bleeding during HRT occurred significantly more often up to the 6th cycle in the 15% of women who had shown irregular bleeding during OC. The drop-out rate was 5%; 13% disapproved a further treatment after the end of this study.
Conclusion Women often may have climacteric complaints during OC which can be treated by HRT. Women, aged on average 49 years, can quickly achieve a high amenorrhea rate when switched directly from OC to low-dose continuous combined E2/NETA despite of peri- or early postmenopausal age. Since during HRT significantly more and heavier bleeding has been observed, especially in women who displayed irregular bleeding during OC, these should be clarified before treatment.
P090
Haemostatic effects of a novel four-phasic combined oral contraceptive containing estradiol valerate and dienogest
C. Klipping1, W. Junge2, U. Mellinger3, I. Duijkers1, and S. Parke4
1Dinox BV, Groningen, Netherlands, 2Laboratorium fuer Klinische Forschung, Kiel, Germany, 3Jenapharm GmbH & Co. KG, Jena, Germany, and 4Global Clinical Development, Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany
Objective A unique combined oral contraceptive (COC) has been developed in which estradiol valerate (E2V; 1 mg of E2V contains 0.76 mg of E2) has been combined with the progestogen dienogest (DNG) in a novel four-phasic regimen. The objective of the current study was to compare the haemostatic effects of this preparation with that of a monophasic COC composed of ethinylestradiol (EE) 0.03 mg/levonorgestrel (LNG) 0.15 mg.
Methods Women aged 18–50 years were randomised to receive a novel four-phasic COC containing E2V/DNG [2 days E2V 3 mg, 5 days E2V 2 mg/DNG 2 mg, 17 days E2V 2 mg/DNG 3 mg, 2 days E2V 1 mg, 2 days placebo] or a monophasic COC containing EE 0.03 mg/LNG 0.15 mg in a crossover study design. Women received each treatment for 3 cycles, with 2 washout cycles between treatments. The primary efficacy variables were the intra-individual absolute changes in prothrombin fragment 1+2 and D-dimer from baseline to cycle 3.
Results Data from 29 women were assessed. Changes in haemostatic parameters from baseline to cycle 3 were generally less pronounced with E2V/DNG than with EE/LNG (Table). The proportion of women reporting adverse events was generally similar in both treatment groups. No adverse events were rated as serious.
Conclusions A COC composed of E2V/DNG had less pronounced effects on haemostatic parameters than a monophasic COC composed of EE/LNG. These findings are consistent with those observed in a study comparing E2V/DNG with a triphasic regimen of EE/LNG, suggesting that this novel COC containing E2V/DNG has less of an effect on haemostatic parameters than EE/LNG.
P091
Impact of combined oral contraception in IVF stimulation protocols
M. Huser1, I. Crha1, J. Zakova1, P. Ventruba1, R. Hudecek1, S. Mitasova1, and J. Jarkovsky2
1Department of Obstetrics and Gynecology, Brno University Hospital and Masaryk University School of Medicine, Brno, Czech Republic, and 2Institute of Biostatistics and Analyses of the Masaryk University, Brno, Czech Republic
Objective Study objective is analysis of in vitro fertilization (IVF) stimulation cycles with combined oral contraception (COC) pre-treatment and evaluation of its impact on results and efficiency of infertility treatment. It is retrospective case-control comparison of IVF cycles programmed by COC and cycles without COC performed in Assisted Reproduction Centre CAR01 of Brno University Hospital in the years 2005–2006.
Design and methods From our IVF registry there has been chosen cycles stimulated with recombinant FSH and gonadoliberine analogues in the long protocol in which ovarian factor of infertility has been excluded (basal FSH 2.0–8.0 IU, FSH/LH ratio< 1.5). All cycles run over standardised conditions with embryo cultivation 3-5 days and transfer of 2–3 embryos. Selected cycles were divided into two groups: case group of cycles programmed with COC (A, n = 68) and set of control cycles without COC (B, n = 152). Indicators of effectiveness of ovarian stimulation, fertilisation and embryo implantation were compared in both groups. For statistical evaluation Student t-test and comparative variance analysis (ANOVA) was applied using Statistica software.
Results Both groups were considered as comparable concerning age (33.1±3.4 vs. 32.3±3.4), ovarian reserve (basal FSH 3.7±2.4 vs. 4.4±2.5), number of transferred embryos (2.4±0.2 vs. 2.6±0.2) and length of cultivation (4.1±0.9 vs. 4.0±0.8). Ovarian stimulation of women with COC pre-treatment was more successful regarding number of retrieved oocytes (19.5±5.2 vs.14.1±7.0, p < 0.01) with comparable consumption of FSH (1860±225 vs. 1930±250) and without increased risk of ovarian hyperstimulation syndrome (OHS). There was no significant difference in fertilization rate (71.1% vs. 73.6%) observed. In the COC group there was slightly better clinical pregnancy rate (30.1% vs. 28.7%), but the difference was not statistically significant.
Conclusion IVF cycle pre-treatment with COC increases number of oocytes retrieved together with unchanged depletion of gonadotrophins and without increased risk of OHS. The potential of oocyte fertilisation and embryo implantation was not influenced by COC administration. In indicated cases usage of COC in ovarian stimulation protocols can increase the success rate of infertility treatment and precisely time the start day of stimulation whereby the daily workflow of infertility clinic can be markedly optimised. Cycle pre-treatment with COC prolongs treatment time and slightly increases treatment expenses.
P092
Influence of progestogen-only pill Cerazette on humoral immunity of women with autoimmune thyroiditis
E. Mejevitinova, A. Hakopian, and I. Menjinskaya
Research for Obstetrics, Gynaecology and Perinatology, Moscow, Russian Federation
Hormonal contraception is the most effective and widespread method of contraception both for healthy women and women with extragenital pathology. It is known that autoimmune thyroiditis is most frequent autoimmune disease at women of reproductive age. Possible humoral immunity changes during use of hormonal contraception attract interest of researchers.
Study purpose To study the occurrence and level of antiphospholipid antibodies (phosphatidyl serine antibodies, cardiolipin antibodies, β-2 glycoprotein – I antibodies, annexine V antibodies, prothrombine antibodies), thyroperoxidase antibodies (AT to TPO), thyroglobulin antibodies (AT to TG), DNA antibodies (ds and ss), antinuclear factor (ANA) during the use of progestogen-only pill Cerazette at women with autoimmune thyreoditis.
Design and methods A total 36 women of 18-49 years with high level AT to TPO and to TG using L-thyroxin therapy and 10 women without antithyroid antibodies were screened. Laboratory assessments included blood examination, study of hemostasis and lipid profile, evaluation of thyrotrophic hormone and free T4(FT4) level. We quantified thyroperoxidase antibodies, thyroglobulin antibodies, DNA antibodies, antinuclear factor (ANA). Gynecological examinations included colposcopy, cytology of cervical smear, ultrasonography of mammary glands, thyroid gland and pelvic organs. Blood samples for analysis of hemostasis and lipid profile, level of TSH and FT4 were taken at 9 a.m. Food and beverage weren't allowed before the assessment. All assessments were made at baseline, in 3 and 6 months of treatment.
Results 28 women with TPO antibodies and thyroglobulin antibodies and 10 healthy women were enrolled to the study and used Cerazette for contraception during 6 months. Mean age of women was 31±0.6 years. At baseline characteristics of humoral immunity of both group were in normal value: phosphatidyl serine antibodies (IgM and IgG) <10 Ed/ml, cardiolipin antibodies – IgM <7 Ed/ml and IgG <10 Ed/ml, β-2 glycoprotein antibodies-I – IgM<5 Ed/ml and IgG<5 Ed/ml), annexine V antibodies – IgM<5 Ed/ml and IgG<5 Ed/ml), protrombine antibodies – IgM and IgG <10 Ed/ml, antibodies to ss-DNA (up to 20 Ed/ml), to ds-DNA (up to 25 Ed/ml), antinuclear factor.
There were no significant changes of antiphospholipid antibodies, DNA antibodies and antinuclear factor during the study. Reduction of At TPO and TG in two times was noted in 53% and 32% women of base group after 3 and 6 months accordingly.
Conclusions Thus progestogen-only pill Cerazette has no significant influence on humoral immunity and contributes decrease of level thyroperoxidase and thyroglobulin antibodies at women with autoimmune thyroiditis.
P093
Cycle control of drospirenone 3 mg/ethinlyestradiol 20 mcg 24/4 compared with desogestrel 150 mcg/ethinylestradiol 20 mcg: pooled analysis
G. Bachmann1, M. Kunz2, and J. Marr2
1Women's Health Institute, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA, and 2Global Clinical Development, Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany
Objective To compare the cycle control and bleeding patterns of YAZ®, a low-dose combined oral contraceptive (COC) containing drospirenone (drsp) 3 mg/ethinylestradiol (EE) 20 mcg in a 24/4-day regimen, with Mercilon®, a conventional 21/7-day regimen containing desogestrel (DSG) 150 mcg/EE 20 mcg, over 7 cycles of treatment.
Methods Cycle control and bleeding data were analysed from 4 multinational trials. All studies recruited healthy women aged 18–35 years requesting contraception. In one study 1027 women received YAZ® for 13 cycles. In two further studies, women were randomized to receive YAZ® (n = 229 and n = 29) or Mercilon® (n = 220 and n = 30) for 7 cycles. In another study, women were randomized to receive drsp 3 mg/EE 20 mcg in a 21/7-day regimen (n = 220) or Mercilon® (n = 221) for 7 cycles. In all studies, daily diaries were used to record bleeding throughout treatment. For the purposes of the current analysis, cycle control parameters from the first 7 cycles of each study were analysed. Analyses were performed based on the full analysis set (all women who took ≥1 dose of medication and for whom ≥1 study observation was recorded). Cycle control parameters included withdrawal and intracyclic bleeding events.
Results In all cycles (i.e., cycles 1–7) the maximum intensity of withdrawal bleeding was ‘normal bleeding’ for over 50% of women in both treatment groups. In cycles 1–7, the mean length of a withdrawal bleeding episode ranged from 4.2–5.2 days in the YAZ® treatment group and 5.0–5.5 days in the Mercilon® treatment group. In cycles 2–7, the incidence of intracyclic bleeding was comparable for both treatments (10.2–14.9% in women treated with YAZ® vs. 8.6–13.8% in women treated with Mercilon®). In cycles 2–7, the maximum intensity of intracyclic bleeding was ‘spotting’ for over 50% of women treated with Yaz® versus over 47% of women treated with Mercilon®. In cycles 2–7 the mean number of intracyclic bleeding days was comparable in the two treatment groups (0.5–0.9 days in women treated with YAZ® vs. 0.3–0.8 days in women treated with Mercilon®). Overall, the two treatments provided similar cycle control.
Conclusion The low-dose COC YAZ® (drsp 3 mg/EE 20 mcg 24/4) is associated with an acceptable bleeding profile with reliable and consistent cycle control that is comparable with Mercilon® (DSG 150 mcg/EE 20 mcg 21/7), an established European COC.
P094
Changes in haemostasis using two low dose oral contraceptives containing 20 μg ethinyl estradiol in combination with desogestrel or gestoden
E. Uchikova, I. Batashki, and B. Pekchlivanov
University Hospital, Plovdiv, Bulgaria
Objective It is known that the combined oral contraceptives (COCs) induce changes in the concentration of many plasma proteins which take part in the processes of coagulation, fibrinolysis and are some of the natural inhibitors of the coagulation. In spite of the numerous researches it is still under discussion which of these changes is responsible for the eventually increased risk of venous thromboembolism.
We examined the influence of two low dosed oral contraceptives containing 20 μg ethinyl estradiol (EE) and 150 μg desogestrel (DSG) and with 20 μg ethinyl estradiol (EE) and 75 μg gestoden (GSD) on the haemostatic system.
Design and methods The study was randomized and it comprised 70 healthy, non-obese and none smoking female volunteers aged between 18 and 35, without a personal and family history of thrombotic disease. The women were randomly assigned into two groups – group A (35 women) using 20 μg EE and 150 μg DSG and group B (35 women) using 20 μg EE and 75 μg GSD within 12 months. We measured the following parameters:Factors of coagulation: fibrinogen was measured by the method of Clauss, factor VII and factor X by the deficit plasma of Biopool (Sweden). Factor of fibrinolysis: plasminogen activity and alpha 2-antiplasmin were measured by chromogenic tests, tissue-type plasminogen activator (t-PA) and D-dimers (DD) in plasma by ELISA. Natural inhibitors of coagulation: Protein C (PrC), total Protein S (TPrS), antithrombin III (AT III) and Heparin Cofactor II (HCII) were also determined. Mean and SDs were calculated for all parameters. The comparison between the groups was performed by an unpaired t-test for normally distributed data and by nonparametric Mann-Whitney test for non-normal data. Results were considered significant if p < 0.05.
Results The long-term usage of COC with 20 μg EE and 75 μg GSD in comparison with 20 μg EE and 150 μg DSG leads to significant changes in the concentrasion of fibrinogen (p < 0.023), ATIII (p < 0.058), HCII (p < 0.057), PrC (p < 0.005), TPrS (p < 0.001) and DD (p < 0.047). Besides that the values of these variables stayed in referential ranges. No statistically significant changes were observed in the values of the other examined variables.
Conclusions The low dose oral contraceptive with 20 μg EE and 75 μg GSD more significantly influences on haemostatic processes. The changes in coagulation, fibrinolysis and the system of natural inhibitors are mutually balanced.
P095
Sexuality and sexual behaviors of women using oral contraceptives containing different doses of ethinyloestradiol – the preliminary study
V. Skrzypulec, K. Nowosielski, A. Drosdzol, and O. Lindert
Women Health Chair; Medical University of Silesia, Katowice, Poland
Objective The purpose of this study was to assess the relationship between dose of ethinyloestradiol in oral contraceptive pills and the quality of sexual life and sexual behavior of women.
Design and methods 80 women aged 16-45 using oral contraceptive pills were eligible for the study. The research was based on self-prepared questionnaire ‘Sexuality of woman’ and the Mell-Krat scale.
Results Mean age of sexual initiation in the studied group was 19. Women taking high dose of ethinyloestradiol in oral contraceptive pills assessed sexual satisfaction as the best.
Conclusions Dose of ethinyloestradiol in oral contraceptive pills may influence the quality of sexual life. Sexuality of women is multfactorial. This investigation should be expanded on the larger population.
P096
Contraceptive efficacy of drospirenone 3 mg/ethinylestradiol 20 mcg 24/4: pooled analysis of clinical studies
G. Bachmann1, F. Petraglia2, M. Kunz3, and J. Marr3
1Women's Health Institute, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA, 2Department of Pediatrics Obstetrics and Reproductive Medicine, Division of Obstetrics and Gynecology, University of Siena, Siena, Italy, and 3Global Clinical Development Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany
Objective To determine the contraceptive efficacy of YAZ®, a 24/4-day low-dose combined oral contraceptive containing drospirenone 3 mg/ethinylestradiol 20 mcg based on pooled data from international studies.
Methods Healthy women aged 17–36 years at risk of pregnancy and requesting contraception were treated for 13 cycles in 2 large-scale, open-label trials conducted at 85 centers worldwide. All women received YAZ® once daily for 24 days followed by a 4-day hormone-free interval. The primary efficacy variable was the number of unintended pregnancies, calculated as an unadjusted Pearl Index (PI [number of pregnancies per 100 women-years]) and the corresponding two-sided 95% confidence interval (CI). Additionally, an adjusted PI was calculated taking intake failure into account. A life-table analysis for the 1-year pregnancy was performed by calculating the cumulative Kaplan-Meier estimate and corresponding CIs.
Results Contraceptive efficacy was assessed in 2128 women during 24,387 cycles of treatment. 16 pregnancies occurred during treatment, resulting in an unadjusted PI of 0.85 (upper limit of the 95% CI: 1.39). Of these pregnancies, 9 were attributed to compliance issues, resulting in an adjusted PI of 0.44 (upper limit of the 95% CI: 0.90). The cumulative 1-year pregnancy rate (determined using the Kaplan-Meier life-table analysis) was 0.85% (upper limit of the 95% CI: 1.38%).
Conclusions The results of this robust pooled analysis of two large-scale multinational trials show that YAZ® comprising drospirenone 3 mg/ethinylestradiol 20 mcg in a 24/4 regimen provides excellent contraceptive efficacy.
P097
Frequency of common adverse events associated with drospirenone 3 mg/ethinylestradiol 20 mcg 24/4 is indication dependent
G. Virginia Upton1, A. Corbin1, K. Heinemann2, and P. Korner3
1Periwinkle Associates, Biomedical Consultants, Vero Beach, FL, USA, 2Global Strategic Marketing FC, Women's Healthcare, Bayer Schering Pharma AG, Berlin, Germany, and 3Medical Affairs, Women's Healthcare, Bayer HealthCare, Wayne, NJ, USA
Objective Clinical studies supporting the approval of the low-dose combined oral contraceptive YAZ® containing drospirenone 3 mg/ethinylestradiol 20 mcg in a 24/4 regimen for three indications (contraception, PMDD and moderate acne) demonstrated adverse events (AEs) typical of combined oral contraceptives. Analyses of AEs in relation to YAZ® indications are reported.
Methods The number of YAZ® users in each study population was as follows: contraception = 1027; PMDD = 231; acne = 536. Each study had individual-specific inclusion criteria and design: contraception (13 cycles): open-label uncontrolled study; PMDD (3 cycles) and acne (6 cycles): double-blind, placebo-controlled studies. Subset analysis of the most prevalent YAZ® AEs (excluding vaginal bleeding) is presented by indication.
Results Percent of women reporting common treatment-related AEs: contraception (38.5%); PMDD (30.3%); acne (27.8%). AE-related discontinuation rates were low (OC 7.5%; PMDD 15.5%; acne 5.6%). AEs were qualitatively similar across all studies; however, subset analysis of the four most prevalent AEs (headache, nausea, breast pain and asthenia) revealed these AEs are indication-related. The PMDD population had the highest incidence (%) of each AE: 18.6, 18.6, 13.0, 8.1, respectively; contraception population: 13.4, 4.7, 6.7, 1.1, respectively; and acne population: 6.9, 4.9, 1.5, 1.3, respectively.
Conclusions The oral contraceptive YAZ®, approved for contraception as well as the emotional and physical symptoms of PMDD and moderate acne in women who elect to use an OC, is associated with a low incidence of adverse events, typical of other low-dose COCs. Frequency of some common AEs appears to be based on specific indication for use, and likely related to multiple factors including patient expectations, physician counselling, and underlying conditions.
P098
Factors determining use of the monthly contraceptive ring. Results of the Lithuanian Contraceptology Association study
V. Vanagiene and R. Cepuliene
1Department of Obstetrics and Gynaecology, Kaunas Medical University, Kaunas, Lithuania, and 2Organon, part of Schering-Plough corporation, Vilnius, Lithuania
Introduction Despite a wide choice of contraceptives and new methods entering the market, contraception usage in Lithuania stays relatively low, slightly over 9%. The contraceptive ring was introduced in QIV of 2004 and is becoming a more and more popular method. Whether or not a woman starts using a new contraceptive method depends on many different factors. Knowing these factors may help medical professionals in their daily practice.
Objective To investigate acceptance of the contraceptive ring (NuvaRing) when offered as a new contraceptive method to Lithuanian women and to determine the factors affecting continuation of use.
Design and methods This was an observational multi-centre study conducted in Lithuania. Descriptive analysis of the data is presented. The contraceptive ring was offered to 4,970 Lithuanian women who came to their doctor for contraceptive counselling or a medical check-up. Demographic details were collected of both the investigator and the woman. Women were asked about their currently used contraceptive method. The contraceptive ring was presented and it was documented if the woman wished to use the ring. Reasons for non acceptance were registered.
Results Data of 4,970 women (mean age 29.2 years) were analysed. The most popular method used at the moment of completing the questionnaire was the Pill (33.3%) and condoms (21.6%). The contraceptive ring was accepted by 2,177 women (43.8%). The reasons for not accepting the ring were related to unfamiliarity with the anatomy of the vagina (22.4%) and that the method looked unfamiliar/strange (19.5%). Tampon use had no influence on women's willingness to accept the contraceptive ring. Women with previous experience with hormonal contraception were more likely to look for convenience/a non daily method. Women using the Pill accepted the contraceptive ring in 67.7% of cases and patch users in 50.4% of cases while in condom users and IUD users the acceptance was 43.1% and 30,4%. respectively. Women under 20 years were less likely to accept the ring; the most popular method in this age group was condoms (42.1%). Women over 40 years were less likely to accept the ring; the most popular method of contraception in this age group was the IUD (29.7%). Women with a university degree were more likely to opt for the ring than women with a lower educational level, but they were also more likely to use other hormonal contraceptives. Age or clinical setting of the HCP had no influence on acceptance of the ring. It was not possible to assess whether HCP gender had an impact on ring acceptance since only one male gynaecologist participated in the study.
Conclusion Acceptance of a monthly contraceptive ring is high among Lithuanian women. Factors affecting acceptance were the currently used contraceptive method, the woman's age and her education. NuvaRing acceptance was not related to tampon use or the prescribing HCP. Non acceptance was mainly related to perceptions which can be addressed during contraceptive counselling – unfamiliarity with the anatomy of the vagina and the impression that the method looked unfamiliar/strange.
P099
Effects of Implanon® on menstrual bleeding patterns
D. Mansour1, T. Korver2, M. Marintcheva-Petrova2, and I. Fraser3
1Newcastle General Hospital, Newcastle upon Tyne, UK, 2Global Clinical Development-Organon Biosciences, Oss, Netherlands, and 3Institute for Mothers and Infants University of Sydney, Sydney, Australia
Objective To evaluate an integrated analysis of bleeding patterns associated with the use of Implanon® (etonogestrel contraceptive implant, Organon Biosciences, a part of Schering-Plough Corporation) and to provide physician guidance to optimise patient counselling.
Methods Data from 11 open-label clinical trials were reviewed. Assessments included daily bleeding-spotting records, dysmenorrhoea intensity, and patient-perceived reasons for discontinuation. Bleeding patterns were analysed via reference period (RP) analyses.
Results Of 923 treated subjects, 889 had at least 1 RP that could be evaluated. Implanon® use was associated with the following bleeding disturbances over the RPs: amenorrhoea (22.2%), infrequent (33.6%), frequent (6.7%), and/or prolonged bleeding (17.7%). In the majority of RPs (75%), the number of bleeding-spotting days was fewer than or comparable to the natural cycle but occurred at variable intervals. The bleeding pattern experienced during the initial phase may help predict the future number of bleeding-spotting days, ie, the group of women with ‘favourable’ bleeding patterns in the first RP tended to continue with this pattern throughout the first two years of use, while the group with ‘unfavourable’ patterns had at least a 50% chance that their pattern would improve. 11.3% of patients discontinued owing to bleeding disturbances, mainly because of prolonged flow and frequent irregular bleeding. Most women who had baseline dysmenorrhoea experienced complete resolution of symptoms (77%).
Conclusion Implanon® use is associated with an unpredictable bleeding pattern, which includes amenorrhoea, and infrequent, frequent, and/or prolonged bleeding. The bleeding pattern experienced during the initial phase gave an indication on the future patterns for the majority of women. Effective preinsertion counselling on the possible changes in bleeding patterns may improve continuation rates.
P100
Improvement of oestrogen-related symptoms with a desogestrel-only contraceptive among women who experienced oestrogen-related symptoms using combined oral contraceptives
H.-J. Ahrendt1 and I. Apetauer2
1Halberstädter Str. 122, Magdeburg, Germany, and2Organon s.r.o., Pobrežní 3, 18600 Praha 8, Czech Republic
Objective To evaluate the response to an estrogen-free oral contraceptive (75 ug desogestrel) in women who previously experienced estrogen-related symptoms during use of a combined oral contraceptive.
Methods Two noncomparative multicenter observational studies, 1 in the Czech Republic (N = 484) and 1 in Germany (N = 403), were conducted to assess changes in estrogen-related symptoms, body weight, and blood pressure following daily treatment with Cerazette® (75 μg desogestrel) for 3 cycles. Bleeding pattern changes were also evaluated in the German study. Patients involved in both studies previously experienced estrogen-related symptoms using combined oral contraceptives.
Results The most frequently reported estrogen-related symptoms at baseline were headache (48% Czech study, 35% German study), breast tension (42%, 40%), edema (24%, 27%), and nausea (13%, 15%). At the end of the treatment, the proportion of patients reporting these symptoms was reduced: headache (16% Czech study, 16% German study), breast tension (10%, 16%), edema (8%, 13%), and nausea (4%, 3%). Minimal changes in body weight and blood pressure were observed in both studies. In both studies, ≥89% of women were either very satisfied or satisfied with Cerazette treatment and 85–88% of women indicated that they would continue Cerazette use. Of the 12% (Czech study) and 13% (German study) of women that discontinued, spotting and irregular bleeding (41%, 32%, respectively, Czech study) and changes in bleeding patterns (46%, German study) were the most frequently cited reasons.
Conclusions Cerazette (75 μg desogestrel) treatment for 3 cycles was associated with improvement in estrogen-related symptoms experienced with combined oral contraceptives. Most women were satisfied with Cerazette and wanted to continue treatment.
P101
Contraception in Spain 2007 V Survey Bayer Schering Pharma (Daphne Team)
M. Quesada Moreno, E. Yáñez González, R. Lertxundi Barañano, E. De la Viuda, J. V. González Navarro, and M. J. Alonso Llamazares
Spanish Society of Contraception, Madrid, Spain
Objects To find out the contraceptive habits of the feminine Spanish population of fertile age, as well as the number of them who are exposed to an unwanted pregnancy. To analyze the aspects that influence in the decision making when choosing a contraceptive method and to observe the evolution in the habits and contraceptive criteria of the Spanish population.
Design and methods The data collected by means of a personal telephone interview to 2,015 women in fertile age (from 15 to 49) carried out between May and July 2007 are the sample object of the study. The selection of the sample is based on the data of the National Population Survey from the National Institute of Statistics, being this sample representative for the Spanish population respect to the distribution by age, geographic area, civil state and occupation.
Results A constant increase is observed in the use of contraceptive methods in Spain from 1997 (51%) till 2007 (80%) and the information on the contraceptive methods (MAC) is basically received through sanitary professionals (50%) and through their social surroundings. With respect to the use of methods 80% (n = 1681) of the interviewed people used some contraceptive method and within the evolution of the use of MAC by age rank its use went from 60% in women between 15–19 to reaching a tip of 86% in those between 25–29, falling back to 76% in the 45–49 age section.
About the methods used in 1997, 21.0% of the interviewed people used condoms and 14.3% the pill, reaching a frequency of use of 38.8% and 20.3% respectively in 2007. Irreversible MAC showed numbers of 4.3% vasectomy and 4.1% sterilization in 2007, the data for tubal ligation in 1997 were 5.2%, not knowing the numbers of vasectomy for that year.
The contraceptive preferences by age groups are:
Condoms: 42.4% (15–19), 46.3% (20–24) and 41.4% (25–29)
Pill: 24.1% (20–24), 31.9% (25–29) and 28.3% (30–34)
IUD: 5.6% (35–39), 7.9% (40–44) and 9.4% (45–49)
Tubal ligation and vasectomy: 14.1% and 11.3% respectively (45–49)
Interrupted sex and natural/rhythm method: 4.2% (35–39) and 1.8% (45–49)
Double method: 0.8% (20–24 and 25–29).
Among the pill users (n = 428) 65% initiate the intake only as contraception and 33% look moreover for other profits either to regulate the period cycle, or to alleviate the symptoms previous to or during the period or others, reaching these targets in 96% of the cases. The double method is known by 51% of the interviewed people with an acceptability of 80%.
The rest period for the use of the pill is a bad criterion maintained since 1997 (42% of the pill users) to 2007 (40% of the users) practically unaltered by medical recommendation in 60% of the cases and by initiative of the user in the remaining 40%. Twenty per cent of women that did not use MAC (n = 424) indicated the reason was in 53% of the cases that they did not have sex at that time and 18% referred to genesic desire. And by age sections 40.2% corresponded to women between 15–19 and 24.3% to the 45–49 section.
Survey 2007 Total Spanish women from 15–49: 11,450,030
Methods are used: 79.9% (n = 1681)
Effective method: 96.1% (n = 1615)
Ineffective method 3.9% (n = 66)
No method is used: 20.1% (n = 424)
Pregnancy risk: 25.5% (n = 108)
No pregnancy risk: 74.5% (n = 316)
Total population at risk of unwanted pregnancy: 8.4% = 961,802 women.
P102
Hormonal contraception and thyroid disfunction
C. Grigoriu1, Al. F. Anca1, C. Parau2, M. Grigoras2, A. Danilceac2, A. Lungu2, C. Cezar2, and V. Horhoianu1
1Medical University Bucharest, Bucharest, and 2University Hospital Bucharest, Bucharest, Romania
Objective The aim of our study was to establish the most adequate contraception method for patients with thyroid disfunction.
Design and methods We studied 120 patients during 30 months in four ambulatory settings. The patients requested a birth control method – hormonal contraception. The thyroid pathology was represented by: subclinical hypothyroidism (74, 62.5%), hypothyroidism (12, 10%), Graves disease (24, 20%), autoimmune thyroiditis (10, 7.5%). The patients were referred to an endocrinologist, who performed a thorough clinical and paraclinical exam and established the final diagnosis. In several cases specific therapy was prescribed. After thyroid function was therapeutically restored, a hormonal contraceptive method was choosen (combined estroprogestative with 20 or 30 mcg EE, progestative-only-pills and depot-progesteron). Patients received follow-up regarding: side effects, personal perception of well-being, convenience of the choosen contraceptive method.
Results Best results in terms of reduced incidence of side effects were obtained with estroprogestative pills with 20 mcg of EE (72%) and with progestative-only pills (65%). Minipills had also the best outcome regarding the amount of menstrual blood flow and weight gain control. Depot-contraception appeared not be a good choice in this cases due to depression and break-through bleeding.
Conclusions Correct diagnosis of thyroid disease and adequate treatment of this condition are mandatory for establishing an individualized contraceptive plan.
P103
Emotional response toward different combined hormonal contraceptive methods in women who seek medical advice
N. Parera on behalf of the Contraceptive Experts Circle
Institut Universitari Dexeus, Barcelona, Spain
Objective Evaluate the emotional response toward different combined hormonal contraceptive methods, according to the administration schedule.
Material and methods Multicentre cross-sectional population survey carried out under routine conditions of clinical practice during 2006. A total of 478 family physicians and gynecologists in public and private health care centres recruited 27,028 women, 18 to 49 years old and present users of combined hormonal contraception. This survey was designed to determine how much trust Spanish women place in their combined hormonal contraceptive method and the emotional consequences of poor compliance or concern about reduced efficacy.
Results From 27,028 recruited women, 26,250 were valid for analysis. The median age was 28.1 years (SD = 6.2) and 87.3% of women reported having a regular partner. More than 70% of pill users had forgotten or had been delayed to take the pill sometimes (71.0%). The women who reported forgetfulness or delays in patch or ring insert/retired were 32.2 and 21.6%, respectively. The fear of pregnancy was significantly more indicated by the pill or patch users than the ring users. More frequently reported than ‘fear of pregnancy’, was problems related to handling such as ‘forgetfulness’ and ‘delays’. Other reasons for doubt about the effectiveness of the method were reasons such as vomiting, diarrhea and drug interactions. These reasons were reported much less frequently.
Conclusions The main reason to fear a possible pregnancy was related to improper use of the method (ring, patch or pill). The pill users reported forgetfulness and/or delays more frequently than ring or patch users. A greater percentage of pill users reported possible failure of a method.
P104
Patient satisfaction with contraception: results from 2 surveys on NuvaRing in real world settings
I. Lete Lasa1 and A. Rieder2
1Hospital Santiago Apóstol, Vitoria-Gasteiz, Spain, and 2Medical University of Vienna, Vienna, Austria
Objective Several clinical trials have reported high patient satisfaction with NuvaRing®. Analyses of two large surveys were used to confirm these findings in a real-life setting.
Design & Methods 2 surveys were performed to assess patient satisfaction with NuvaRing®. The Metrix Lab (ML) survey included NuvaRing® users aged 16–50 years from 5 countries and the Knowledge and Awareness (KA) survey included women (n = 500/country) aged 16–40 years from 14 countries using any form of contraception. The level of satisfaction and the strengths and weaknesses of NuvaRing® were assessed by questionnaire.
Results The ML survey included 2864 NuvaRing® users (893 German [DE], 699 American [US]), and the KA survey included 84 NuvaRing® users. In the ML survey, 92% of German women and 93% of American women rated their level of satisfaction as either very positive or positive. Strengths of NuvaRing® were cited as ease of use (DE, 49%; US, 59%), less side effects (DE, 11%; US, 16%), less hormones (DE, 45%; US, 26%), and not necessary to think about everyday (DE, 73%; US, 67%). In addition, convenience (DE, 17%; US, 21%) and reliability (DE, 24%; US, 16%) were the most-cited reasons for choosing NuvaRing®. The main weaknesses varied by country, 57% of German users cited cost; 21% of American users cited this as a weakness. The main weakness cited by American users (53%) was that the ring was felt during intercourse; 32% of German users cited this weakness. As with the ML survey, high patient satisfaction was also observed in the KA survey. The level of satisfaction with NuvaRing® was rated as 8.6 out of 10. Strengths of NuvaRing® were cited as ease of use (94%), less side effects (86%), and not necessary to think about everyday (73%). The main disadvantages of NuvaRing® cited in the KA survey were nonmedical and included availability by prescription only (54%) and cost (42%).
Conclusion Patient satisfaction is high with NuvaRing®; strengths include ease of use and less side effects, and the biggest disadvantages were nonmedical.
P105
Combined oral contraceptives use and its relationship with depression among Turkish women
B. Akin1, E. Ege1, N. Aksüllü1, N. Demirören1, and H. Erdem2
1University of Selcuk, School of Health, Nursing Department, Konya, Turkey, and 2Ministry of Health, Primary Health Care Centre, Number 15, Konya, Turkey
Objective It was reported that the most important reason for discontinuation of Combined Oral Contraceptives (COC) is their side effects especially negative mood changes and depression. Much controversy exists regarding the relationship between COC use and experience of depressive symptoms and mood changes. The aim of the study is to describe the prevalence of COC use and explore the relationship between COC use and depressive symptoms in Turkish women.
Design and methods This is a descriptive study. The study group consisted of 210 married women aged between 15 and 49 years who applied two primary health care centres for free of charge family planning services in Turkey. We describe the women COC users if she has been using COC since three mounts or more time. A questionnaire and Beck Depression Inventory (BDI) (1978) were used to collect data with face-to-face interview. Percentage distribution, student t test, Mann Whitney U test and logistic regression were used for statistical analyses.
Results Of the women 23.3% use COC. There were 73 (34.8%) women who reported depressive symptoms. The women who perceived their economic status worse and not smoking preferred COC more (p < 0.05). The BDI scores were not different between the COC user (14.18±10.06) and nonuser (14.14±9.08) (p > 0.05). Logistic regression revealed that the risk factors of depression were living in extended family (OR:3.827, CI:1.565–9.357), the history of depression (OR:4.929, CI:1.828–13.289), having high number of children (OR:2.709, CI:1.283–5.720) and current smoking (OR:2.636, CI:1.040–6.683). The use of COC was not a risk factor for depression.
Conclusion The results of the study suggest that there is no effect of COC use on depressive symptoms in Turkish women.
P106
Typical OCP use in the female student population
A. Bjelica, A. Kapamadzija, V. Kopitovic, and A. Trninic Pjevic
Vojvodina Clinical Center, Department of Obstetrics and Gynecology, Novi Sad, Serbia
In Serbia, the percentage of OCP (oral contraceptive pill) users is very low. The main aim of this study was to establish the exsistence of the factors influencing usage of OCP in the female population of university students. This study is a part of a larger project of contraceptive behavior of female university students. Design of the study encompassed the potential significance of socio-demographic variables, the factors from the domain of the personal history, prejudices about contraception, as well as certain psychological variables as the potential determinants of OCP users.
The study encompassed 1598 sexually active girls, students of the University of Novi Sad, using the following measuring instruments: list of basic personal data and questionnaire on prejudices about contraception (designed for the need of this study), Externality Scale by P. Bezinovic, BSRI by S. Bem and Eysenck's EPQ. The obtained data were analyzed by applying of statistical package – Statistica for Windows and SPSS.
Only 3.9% of students use OCP. Significant determinants, among investigated variables, of OCP users were observed in respect of: religiousness, smoking, the existence of permanent sexual partner, talk with friends about contraception, knowledge about contraception, prejudices about contraception, dimension of extraversion, locus of control, and adopted sex roles.
Typical OCP user is: less religious, non smoker, has permanent sexual partner, freely talks and has good knowledge about contraception, extravert, with internal locus of control, and adopted modern sex roles. Such results could be used in creating strategies for promotion of OCP usage among female students.
P107
Role of protease-inhibitor balance in cervicovaginal and uterus lavage fluid during different variants of hormonal contraception
K. Yevgeniya and K. Anatoliy
Crimea State Medical University, Simferopol, Ukraine
Objectives Implantation of the embryo into the endometrium is a critical step in the establishment of pregnancy and the failure of embryos to implant is a major limiting factor in the success of pregnancy development. Three families of protease are involved in the matrix degradation required for implantation: the cysteine, serine and matrix metalloproteinases. Other proteases and proteinase inhibitors are required for the activation of regulatory molecules. From another side proteolytic enzymes, including acrosin, take important part in the impregnation process. In this investigation it was determine the elastase-like (ELA) and trypsine-like (TLA) activities and level of proteinase inhibitors in cervicovaginal and uterus lavage fluid in women during different variants of hormonal contraception. Also results was correlated to number of inflammatory cells in stained vaginal smears, type of predominating vaginal bacteria and changes in the endometrium.
Design and methods Fifty six women using oral hormonal contraceptives and local types of hormonal contraception (Mirena® intrauterine system) were studied. Cervicovaginal lavage fluid was collected by intravaginal injection and aspiration of saline solution. Uterine flushings were performed by slowly injecting and aspirating normal saline through a paediatric Foley catheter. The ELA, TLA and activities of acid-stable and acid-nonstable inhibitors in all women was measured.
Results In women an increased ELA and TLA was found in 56% cervicovaginal lavage fluid and 37% uterus lavage fluid. In these cases changed level of proteinase inhibitor activity. There is no correlation between the groups of women with using of oral hormonal contraceptives and Mirena® intrauterine system. Activities of proteases in vaginal secretion correlated with the number of leukocytes in vaginal smears and level of inflammatory changes. In intrauterine lavage fluid level of proteinase activities was correlated with endometrial hyperplasia.
Conclusions Local changes in the proteinse-inhibitory system in cervicovaginal and uterus lavage fluid can follow effects of hormonal contraception. The further study of proteinase-ingibitory system role in development of different variants of fertility dysfunctions will allow the perfection of approaches to increase the efficiency of contraception.
P108
Hormonal contraception and abnormal pap smear
I. Elena Blidaru1, L. Mosneagu1, M. Roman2, I. Catighera2, R. Plesca2, M. Mictariu1, and A. Luchian1
14th Department of Obstetrics and Gynecology, “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania, and 2Family Planning Unit, “Cuza-Voda” Maternity Hospital, Iasi, Romania
Objectives The aims of our study have been to estimate the risk of having an abnormal Pap smear among hormonal contraceptive users compared to contraception-free individuals and to assess the importance of some possible risk factors as: age of the subject, presence of the hormonal contraception, age of the sexual debut, socioeconomic status and existence of an associated cervical/vaginal inflammatory condition.
Design and methods Our study was conducted in the Family Planning Unit from ‘Cuza Voda’ Maternity Hospital over a period of ten months (January–October 2007). It included 200 women aged between 18 and 48, who were interviewed, examined and investigated by cytological Pap smears and cervical/vaginal bacteriological samples. 100 users of hormonal contraception, mainly pills and few injectables, have entered the test group and 100 non-users of any kind of contraceptive method have represented the controls. The women with abnormal Pap smear have been further controlled with shorter screening intervals, by repeated cytology. The relative risk (RR) was calculated for each of the considered risk factors.
Results Our study showed in the test group the existence of 10 cases with abnormal Pap smear (10%) manifested as atypical squamous cells of undetermined significance (ASCUS) in 8 cases and low grade squamous intraepithelial lesions (LSIL) in 2 cases, while in the control group there were 24 cases with epithelial cells abnormalities (24%), amongst which 10 women with ASCUS, 4 women with atypical glandular cell of undetermined significance (AGCUS) and 10 women with LSIL. The large majority of ASCUS/AGCUS and LSIL aspects were due to benign confirmed HPV infections. 28 out of the total of 34 cases with abnormal Pap smear from both groups were aged over 30. The relative risk value of the hormonal contraception use for abnormal Pap smear has confirmed it as a protection factor (RR = 0.416), as it also has been, though rather unexpectedly, the age of the sexual onset at under 20 (RR = 0.646). Surprisingly, we have found that the low socioeconomic status, assessed by woman's rural location, was demonstrated to act as a risk factor (RR = 1.326). The superimposed bacteriological infections have appeared as a rather indifferent factor (RR = 0.995), in spite of the fact that they have been put into evidence in 2/3 of the cases from the test group and half of the cases from the control group. The pathogens that have been the most frequently recovered from the cervix and vagina were Candida albicans, Staphylococci, E. coli and Enterococcus.
Conclusions The present study stresses the fact that hormonal contraception use offers a real protection against the cervical epithelial cells abnormalities, represented by ASCUS/AGCUS or LSIL, mainly after the age of 30, as it also does the early debut of the sexual life. The socioeconomic conditions might play a risk factor role. Our study has shown that in spite of the high incidence of the cervical and vaginal bacterial colonization in both groups, which co-exists with the HPV infection, it might not act as a risk factor.
P109
Extended regimens of the contraceptive vaginal ring and combined oral contraceptives: evaluation of clinical aspects
C. Guazzelli, F. Barreiro, F. Araujo, M. Barbieri, and A. Moron
Family Planning Clinic – Department of Obstetrics and Gynecology, São Paulo Federal University (UNIFESP), São Paulo/São Paulo, Brazil
This prospective observational study evaluated clinical aspects of two groups of women (aged 18 to 37) using extended regimens of two different contraceptives during one year. A total of 150 women entered the study (75 in each group).The first group (N = 75) used a vaginal ring releasing 120 μg of etonogestrel and 15 μg of ethinyl estradiol daily and the second group (N = 75) used a oral hormonal contraceptive (gestodene 75 mcg and ethinyl estradiol 0.3 mcg). Both groups used the method over a continuous period of 84 days, followed by a 7 days interval free of medication. The University's Ethics Committee approved the study and all participants signed an informed consent form. A total of 62 women in the vaginal ring group 1 and 60 women in the oral contraceptive group 2 completed the study. The rate of discontinuation was similar in both groups (17.3% in group 1 versus 20% in group 2). Among ring users, the most frequent motive for discontinuation was irregular bleeding (4.0%) and for the pill users it was gastric intolerance (8.3%). Compared to baseline symptoms, women in both groups had significantly less dysmenorrhea and irritability and there was a non-significant decrease in breast tenderness, leg pain and headaches. Dysmenorrhea was reported at the beginning of the study by 56% of the vaginal ring users and by 52% of the oral contraceptive users. At the end of one year, these symptoms were still reported by 20% of those in group 1 and 17.3% of those in group 2. Within each group, the prevalence of dysmenorrhea decreased significantly, compared to entry. There were no significant differences between the groups. The frequency of other reported symptoms (headache, breast tenderness, leg pain) did not change significantly throughout the study period within each group or between groups. Irritability decreased significantly within each group but not between groups (χ2 = 0.01 and p = 0.76). Blood pressure remained unchanged. Both groups had a significant increase in body weight at the end of one year. The mean weight of ring users at entry was 65.1 kg versus 68.1 kg at the end of one year. For COC users, these values were 67.9 versus 68.8 kg. The mean weight gain in each group (0.94 kg for vaginal ring users and 1.0 kg for oral contraceptive users) did not differ significantly (initial t test 0.25, p = 0.796 and final t test = 0.28, p = 0.78). Blood pressure remained unchanged. Although weight and body mass index increased significantly in both groups, at the end of one year this increase was within the expected biological variation range. There were no cases of pregnancy during the study period.
P110
Hormonal contraception – modern choice of community in Georgia
K. Kajaia
JSI Research & Training Institute, Kutaisi, Imereti, Georgia
Objectives Usage of modern contraceptive methods is significantly increasing through providing the population with free contraception and information on family planning (FP) by qualified primary health care (PHC) providers.
Design and methods Likewise the other post Soviet Countries mainly gynaecologists working in cities and regional canters were Family Planning service providers. Due to their way of thinking they did not provide complete consultation on hormonal methods of contraception and their services were hardly ever available for rural population. Primary healthcare providers were given right to offer family Planning services. Since the beginning of 2005 approximately 1500 health care providers of 340 PHC facilities have been trained with an evidence-based curriculum, which enabled the rural population living in remote villages to receive FP consultation. The program works almost with the half of Georgian population. Involvement of PHC party is very important to get closer to the communities; most of the doctors and nurses are local inhabitants and work closely with their community. Very often providers have to visit patients at their living place, this is one more opportunity to promote FP, especially for teenagers. Once in a quarter focus group discussions with rural population of reproductive age are held in remote villages. 30 FP clients are interviewed in each site. On the discussions satisfied clients mentioned that they effectively use FP modern methods which is a good example for community. Supportive Supervision (SS) visits are made to each site quarterly, which ensures evaluation of provider's clinical and communication skills and if necessary, conducting on-going trainings. The simple and flexible contraception and clinical data LMIS system works at central, district and PHC levels.
Results/Outcomes The average score of pre-test of trainings for PHC doctors was 33 percent. The post-test score has increased to 89%. In Imereti region 20% of women of reproductive age represent FP clients of PHC facilities. Among the women, 88 percent uses modern contraceptive methods. Correspondingly, 27% uses COC, 18% – POC, 13% – condoms, 30% – IUD, and 12% – traditional method.
Conclusion The program showed that PHC involvement in FP service provision and SS visits to providers has significantly increase accessibility to FP services of high quality. As a result of cooperation with Ministry of Labor Health and Social affaires FP service was included in the Packaged of PHC facility in 2006. SS is supposed to extend to the national level.
P111
The safety of combined oral contraceptives in young women with functional hyperprolactinaemia
L. Suturina, L. Lasareva, A. Labigina, and O. Leshenko
East-Sibirian Scientific Center of Medical Ecology, Irkutsk, Russian Federation
Objectives This study was performed to investigate prolactin, gonadotropes, sex steroid levels, and side effects of combined oral contraceptives in young women with functional hyperprolactinaemia.
Design and methods Prospective study of young women (aged 21.7±2.4, n = 46) with hyperprolactinaemia and the control group of young women (aged 20.5±2.3, n = 224) with normal prolactin levels, classified as 1–2 categories in accordance with the ‘Medical eligibility criteria for contraceptive use’ (WHO, 2002). Both groups (study and controls) were almost identical in age, anthropometric characteristics, and types of using contraceptives. All women were recruited in gynecological clinics in Irkutsk (Russia) during the period of 2003–2005. The supervision of all women included general physical and gynecological examination, monitoring of prolactin, gonadotropes and sex steroid levels before and after 1,3,6 and 12 months of combined oral contraceptive use.
Results 3 from 46 women with hyperprolactinaemia (with the prolactin levels higher than 1500 mIU/ml and microprolactinomas of pituitary gland) were excluded from the group of combined oral contraceptives users, and among the remaining 43 women the significant increase of prolactin level was observed by 12 month only in 17%, compared with baseline values. In both groups the significant difference of changes in levels of gonadotropes and sex steroids were not determined: the increasing of FSH levels by the 12 month was observed both in women with hyperprolactinaemia and in control group and this tendency did not depend on the character of prolactin dynamics. The great majority of women who used combined oral contraceptives had not serious side effects, but the PMS was observed only in patients with hyperprolactinaemia and following increase of prolactin level by 12 months.
Conclusion Combined oral contraceptives use is associated with following increase of prolactin level only in 17% of women with the functional hyperprolactinaemia without serious side effects and clinical symptoms. Combined oral contraceptives can be safely used in these young women.
P112
Bleeding patterns of women using extended regimens of the contraceptive vaginal ring and combined oral contraceptives
F. Barreiros, C. Guazzelli, M. Barbieri, F. Araujo, and A. Moron
Family Planning Clinic – Department of Obstetrics and Gynecology of Sao Paulo Federal University (UNIFESP), São Paulo/São Paulo, Brazil
This prospective observational study was of the bleeding pattern aspects of two groups of women using extended regimens of two different contraceptives during one year. The study enrolled 150 volunteers aged 18 to 39, 75 in each group. The first group (N = 75) used a vaginal ring releasing 120 μg of etonogestrel and 15 μg of ethinyl estradiol daily and the second group (N = 75) used an oral hormonal contraceptive (desogestrel 150 mcg and ethinyl estradiol 0.3 mcg). Both groups used the method over a continuous period of 84 days, followed by a 7 days interval free of medication. The University's Ethics Committee approved the study and all participants signed an informed consent form. The mean age of the women in group 1 was 24.4 years (range 18–37) and 25.5 years (range 18–39) in group 2. There were no significant differences between the two groups as to age at menarche, age at first sexual intercourse and number of previous pregnancies.
We analyzed total bleeding scheduled days and total bleeding/spotting scheduled days (total of 14.2 days for vaginal ring and 13.5 days for oral hormonal contraceptive during one year) both with decreased of bleeding over the study, with better results to the oral contraceptive. In the same way, we observed along one year diminishing of total bleeding unscheduled days and total bleeding/spotting unscheduled days for both methods, however, here, there was advantage to the vaginal ring (total of 17.8 days for vaginal ring and 18.4 days for oral hormonal contraceptive during one year). There were significant differences between the groups. The good results observed by the vaginal ring show us a new perspective in extended regimens for this new method. There were no cases of pregnancy during the study period.
P113
REMO study: the compliance of combined hormonal contraception. Retrospective analysis
E. dela Viuda on behalf of the Contraceptive Experts Circle
Hospital Genral Universitario, Guadalajara, Spain
Introduction The effectiveness rate of combined hormonal contraceptive (CHC) methods is superior to 99%, but the efficacy of CHC methods is inferior. The difference is in the compliance. We know that 68% of the pill users forget regularly to take the pill and 23% of the pill users forget at least one pill per cycle, but do not have compliance data in users of the new routes of hormonal administration.
Objective Evaluate the magnitude of the combined hormonal contraceptive methods poor compliance, according to the administration schedule.
Material and methods Multicentre cross-sectional population study carried out under routine conditions of clinical practice. A total of 27,028 women, 18 to 49 years old and present users of combined hormonal contraception participated in the study. The women filled out a self-administered survey about use and compliance problems during use of her combined hormonal method.
Results From 27,028 recruited women, 26,900 were valid for analysis. A total of 17,091 (65.1%) used the pill, 5,895 (22.8%) used the vaginal ring and, 3,174 (12.1%) used the patch. The 71% of the pill users reported poor compliance in some occasion, as opposed to 32.2% of patch users and 21.6% of ring users (p < 0.001).
Conclusions Non-daily use of combined hormonal contraception is associated with better compliance rates.
P114
Woman's attitude in the face of doubt about the combined hormonal contraceptive method's efficacy
Ma Angeles Gómez on behalf of the Contraceptive Experts Circle
Centro de Salud Sexual y Reproductiva Alicante III, Alicante, Spain
Objective Determine the woman's attitude in the face of doubt about the combined hormonal contraceptive method's efficacy, according to the administration schedule.
Material and methods Multicentre cross-sectional population survey carried out under routine conditions of clinical practice during 2006.
A total of 478 family physicians and gynecologists in public and private health care centres recruited 27,028 women, 18 to 49 years old and present users of combined hormonal contraception. This survey was designed to determine how much trust Spanish women place in their combined hormonal contraceptive method and the emotional consequences of poor compliance or concern about reduced efficacy.
Results From 27,028 recruited women, 26,250 were valid for analysis. A 65.1% of women used the pill, 22.8% used the vaginal ring and, 12.1% used the patch. The average time of use was 4.3 years for the pill, 1.3 years for the patch and, 1.3 years for the ring. For the three methods, when the patients thought that the contraceptive effectiveness could be diminished, more of 70% of the women continued with the method, more of 55% waited to the menstruation appears and, more of 40% the women visited or called to the physician. 69.9% of the women continued to have sexual relations, and 60.8% of these, used some additional contraceptive method. The pill users, followed by the patch users, had significantly more pregnancy tests and used more emergency contraceptives.
Conclusions The woman's attitude in the face of doubt about the combined hormonal contraceptive method's efficacy was similar for the three groups except for greater usage of emergency contraception and pregnancy tests among pill users, regardless to time of use of the method.
P115
Legal issues of clinical practice in gynaecology
E. Pérez Campos on behalf of the Contraceptive Experts Circle
Hospital General de Requena, Valencia, Spain
Objective Evaluate the Spanish gynaecologist preoccupation to legal issues of clinical practice.
Material and methods Spanish gynaecologists in public and private health care centres completed on line survey about legal issues of their clinical practice.
Results Representative survey of the gynaecological sector (40% of women and 60% of men). The age of 73% of participants was between 40 and more than 50 years old.
The 55% of physicians reported to have been implied in some medical-legal process. A few more than half of the participants (54%) said that there aren't models of informed consent to all medical acts that require it. The main medical processes in which the existence of models of informed consent was identified as necessary were: hysteroscopy (95%), cysts punction under ultrasonographic control (94%), hysterosalpingography (92%), endometrial biopsy (73%), cervical biopsy (71%), obstetric ultrasonography (62%) and, gynaecological ultrasonography (40%). Spontaneously, the physicians indicated more medical acts that they needed informed consent and in many cases, physicians insisted that all the medical acts need informed consent. Generally, the physicians valued very positive the scientific societies protocols about legal support of clinical practice in contraception. The 70% of participants considered that the scientific protocols were useful or very useful. More than half of physicians said that the online information or formation continued courses were the better ways to know the last news about legal issues of their clinical practice.
Conclusions The Spanish gynecologists showed an interest in receiving more information about legal issues of their clinical practice, especially, obstetrics issues, prenatal diagnostic, ultrasonography, diagnostic techniques, contraception or fertility.
P116
The characteristics of fertility of young women with functional hyperprolactinaemia after combined oral contraceptives using
L. Lasareva, L. Suturina, A. Labigina, O. Leshenko, and A. Atalian
East-Sibirian Scientific Center of Medical Ecology, Irkutsk, Russian Federation
Objectives This study was performed to investigate fertility status after combined oral contraceptives using in young women with functional hyperprolactinaemia.
Design and methods A prospective study of women, aged 21.7±2.4 years (n = 46), with hyperprolactinaemia, and the control group of women, aged 20.5±2.3 years (n = 224), with normal prolactin levels, classified as 1–2 categories in accordance with the ‘Medical eligibility criteria for contraceptive use’ (WHO, 2002), both groups were almost identical in age, anthropometric characteristics, duration and types of using contraceptives. The fertility status was estimated after 6 months since the time, when women stopped contraceptives using.
Results The rate of pregnancies in women with functional hyperprolactinaemia and following increase of prolactin level, which was associated with combined oral contraceptives using, was only 13%. In women with functional hyperprolactinaemia, who had not following increase of prolactin level during using of combined oral contraceptives, the rate of pregnancies was significantly higher – 38%. The highest pregnancies level in 6 month after combined oral contraceptives using had women with normal prolactin levels (87%).
Conclusions The fertility of women after using combined oral contraceptives is dependent on the presence of functional hyperprolactinaemia and prolactin dynamics during contraception.
P117
Acceptance of extended regimens of use of oral hormone contraception in therapeutic purpose
A. Mirjana1, K. Gordana1, and B. Artur2
1Polyclinic Perinatal, Novi Sad, Serbia, and 2Clinic for Gynecology and obstetrics, Novi Sad, Serbia
Extended regimen of oral hormone contraception (OHC) has been used in therapeutic purpose in treatment of endometriosis, endometrial polyp, anemia with metrorragia, dysmenorrhea and PMDD. During extended regimen of OHC for contraception, patients have had a menstrual suppression and time between two menstrual bleedings prolonged.
Aim Aim was to investigate the acceptance of extended regimen with OHC as a method for contraception in a group of women who have been using this regimen in therapeutic purpose.
Material and methods Retrospective study involved 41 women, users of OHC extended regimen (0.3 EE+dienogest). At the end of therapy it was sugested to women satisfied with extended regimen of OHC in therapeutc purpose (38 women) to continue extended regimen as a method of contraception. Women who accepted were invited monthly for interviews. Their experience was noted (satisfactory, having amenorrhoe, bleeding or spotting). Patients agreed for their data to be used in medical research.
Results From 41 women 38 have had therapeutic reason for use of extended regimen (TG) and 3 women had used it for contraception only (CG). Indication for TG were: endometriosis after LSC (13), endometrial polyp (18), meno-metroargia and anemia (7).
During extending regimen of OHC, 16 women (40%) have had amenorrhea,13 (32.5%) spotting (no sanitary protection needed), and 12 (28,5%) women have had uterine bleeding (sanitary protection needed). Before treatment 40 (99%) women have experienced pelvic pain, and during the 6 months treatment 35 (85%) were without pelvic pain during menstrual circles.
At the end of therapeutic regimen of OHC 35 (85%) women were satisfied with the treatment. It was suggested to these 35 women to continue with the same regimen as a method of contraception. However, only 3 (9%) women agreed to continue the extended regimen. 32 (91%) women wanted to go back to usuall menstrual periods. Most common reasons for this were falling pregnant during amenorea, uneasy feeling about bleeding as an illness symptom and beleif that 21/7 is more similar to natural cycle and hence healthier.
Conclusion Extendied regimen (24 weeks) of OHC is not widely accepted amongst women who use or would like to use OHC as a contraceptive method, but is very well accepted for therapeutic purposes.
P118
Attitude of Spanish woman to menstruation
M. A. Gómez Martínez, M. J. Alonso Llamazares, E. Pérez Campos, E. Yáñez González, M. Quesada Moreno, and E. De la Viuda
Spanish Society of Contraception, Madrid, Spain
Objectives Analyzing the attitude of the Spanish women to menstruation and their interest in eliminating the same by means of the use of combined hormonal contraceptive methods.
Material and method Descriptive study in which the results obtained from a telephone survey carried out to 588 Spanish women between 18 and 45 during the year 2006 are analyzed; it included questions related to menstruation and the acceptance of new contraceptive regimes.
Results 25% of the interviewed women did not use any contraceptive method, 32% used hormonal contraceptive methods (84% pill) and 43% used non-hormonal methods (64% condom). 35.4% of the interviewed women considered menstruation a natural physiological fact, whereas 34.5% did not associate anything positive to this phenomenon. 26% of the interviewed would be interested in eliminating the period for a certain period of time (between 1 month and 1 year 28.7% and more than one year 23%), being the young women between 18-29 the most interested (85%).
Although 90% of the women had never been informed by their gynaecologist of the possibility of suppressing menstruation for a certain period of time, 24.5% of the total of women showed an interest in the continuous use of oral contraceptive regimes to suppress periods. 49% of the women younger than 25 and those who did not use any contraceptive method but were thinking of using it in the future, showed their interest in these new criteria basically to avoid the symptoms related to menstruation.
Conclusions There is an interest on the part of the Spanish women to suppress the menstruation for a certain period of time, basically to avoid the symptoms related to the period. The new combined hormonal contraceptives, in a continuous criterion, are an acceptable option for these women.
P119
The effect of levonorgestrel-releasing intrauterine device on menorrhagia in patients under anticoagulant medication for cardiac valve replacement
S. Kilic, B. Yuksel, M. Doganay, F. Akinsu, O. Uzunlar, and L. Mollamahmutoglu
Dr.Zekai Tahir Burak Women Health Educational and Reasarch Hospital, Ankara, Turkey
Aim The aim of this study was to evaluate the effect of levonorgestrel-releasing intrauterine devices on menorrhagia in patients using anticoagulant therapy after cardiac valve replacement.
Introduction Menorrhagia is a common menstrual disorder in young patients using anticoagulant theraphy. The incidence of cardiac valve replacement in Turkey is...
Material and methods Forty patients who underwent cardiac valve replacement and used anticoagulant medication and had menorrhagia were enrolled in the study. The patients were divided into two groups. Levonorgestrel-releasing intrauterine devices were inserted in 20 patients in group 1 in the first three days of menstrual bleeding. Antibiotherapies were applied prior to the procedure. The patients in group 2 were only observed without any intervention. The prothrombin time, internal normalized ratio (INR), hematocrit, hemoglobin, ferritin values and pictorial bleeding... for the quantity of menstrual bleeding were recorded.
Results There was no difference for blood loss and coagulation parameters in 4 to 6 weeks post insertion. Starting from 3 months after insertion, blood loss significantly decreased and amenorrhea had been observed in three patients in group 1. Starting from 3 months post-insertion hemoglobin, hematocrit, ferritin values were significantly higher in group 1 but INR and protrombin values did not differ significantly between two groups.
Conclusion Levonorgestrel releasing intrauterine devices decreases menstrual bleeding in patients using anticoagulant therapy and have an additional benefit as a contraceptive method and healing the life quality.
P120
Hormonal contraceptive prescription among Italian General Practitioners
D. Giorgis, M. Lerda, and R. Michieli
SIMG, Firenze, Italy
Objective To study the prescription of hormonal contraceptives among Italian General Practitioners.
Design and methods Five hundred Italian General Practitioners (GPs) were invited to fill in two electronic forms about the prescription of hormonal contraceptives.
One form investigated the general attitude among GPs towards the prescription of hormonal contraceptives (whether independently of specialists or not, evaluation of contraindications, prescription of blood tests, side effects, up-to-date sources).
The second form, to be filled in when prescribing the medicine, evaluated which contraceptive was prescribed, the source of prescription (autonomous or not), risk factors, blood test prescription.
The aim of the study was to investigate the percentage of autonomous prescriptions in comparison with those suggested by specialists, the care taken towards contraindications (absolute and relative) and side effects. In addition, the study wanted to assess the prescription of blood tests, both upon the first prescription and during consumption.
Results According to this study, (as far as we know the first of its kind in Italy) Italian GPs make the first prescription of hormonal contraceptives in about the 50% of cases. The most important contraindications considered were: past history of thromboembolism, family history of thrombophilia, breast cancer, smoking and hypertension, although in this study some prescriptions were made to smokers.
Conclusion Even though the most of medical specialists and pharmaceutical industries seem to think the opposite, Italian GPs are responsible for about 50% of first prescription and of nearly 100% of repeated prescriptions of hormonal contraceptives. Even though guide-lines don't recommend them, too many blood tests are still being prescribed.
P121
The impact of oral contraceptive pretreatment on follicular growth and risk for OHSS – comparison of long GnRH agonist vs. GnRH antagonist protocol in randomized trial
R. Streda
CAR SANUS, Pardubice, Czech Republic
Introduction Follicular growth during ovarian stimulation may be affected by the presence of ovarian cysts, empty follicle syndrome, minimal response to hormonal treatment or the risk for ovarian hyperstimulation syndrome (OHSS). Oral contraceptive pre-treatment offers suppression of the ovary for prevention of ovarian cyst formation and may optimize ovarian response.
Objective To recognize the risk for functional ovarian cyst, empty follicle syndrome and minimal ovarian response. Secondly average estradiol level day 5 and at the day of hCG administration and estradiol level during possible OHSS comparing both protocols.
Method We conducted a randomized trial from 1 June 2006–30 October 2007. We randomized 100 patients and compared long GnRH agonist protocol triptoreline 0.1 mg daily with oral contraceptive pretreatment (EE 30 μg, desogestrel 150 μg) versus fixed GnRH antagonist protocol – ganirelix 0.25 mg, both protocols with follitropin beta- rFSH. Inclusion criteria were: BMI < 30, FSH and LH < 10 IU/l, age < 38 years. In each group we randomized 50 patients, average age was 30 years in both groups, basic characteristics of groups were without statistical differences. Initial daily dose of rFSH was 200 IU. We performed sonography examination and blood sampling of E2, LH level at day 5 and at the day of hCG administration and if necessary we used step down protocol.
Results Compared long GnRH agonist vs. GnRH antagonist protocol we treated 45 vs. 43 patients, embryotransfer was performed for 44 vs. 37 patients. We didn't observed any functional ovarian cyst. Besides of nonfertilization's cases after IVF in both protocols we proved 0 vs. 3 cases of empty follicle syndrome, resp. Average level of E2 (pg/ml) at day 5 was 361±44 vs. 429±41 and at the day of hCG administration 1868±161 vs. 1294±110, We observed 1 case of OHSS stage I at a patient treated with GnRH antagonist protocol. E2 level was 626 pg/ml at day 5 and 2602 pg/ml at the day of hCG administration.
Conclusions The study confirms contraceptive pre-treatment with long GnRH agonist protocol is the reliable protocol for IVF treatment. The disadvantage of GnRH antagonist protocol may be empty follicle syndrome. Rapid increase of E2 level and high E2 level at the day of hCG administration is statistically significant risk factor for the development of OHSS. For the first time during RCT we recognized average E2 level day 5 and at the day of hCG administration for both protocols.
P122
Etonogestrel implant in women with diabetes
L. Vicente1, D. Mendoça2, M. Dingle1, R. Duarte1, and J. Manuel Boavida1
1Portuguese Diabetic Association, Lisbon, Portugal, and 2Instituto Ciências Biomédicas Abel Salazar, Porto, Portugal
Etonogestrel contraceptive implant has shown to be a safe and effective contraceptive method in healthy women. But there are no studies addressing the use of the etonogestrel implant in women with diabetes.
Aim The primary objective of this study was to assess the effect of etonogestrel implant on glycometabolic control in women with diabetes. The secondary objective was to evaluate the acceptability of the method.
Methods This is a prospective observational study of 23 women with insulin-treated diabetes who used etonogestrel implant for at least 1 year. Evaluation was performed before implant insertion and at 3, 6, 12 and 24 months after implant insertion.
Results 23 women entered the study but 1 was lost to follow-up. The mean age was 27.59 years (range 12–37 years) and the mean duration of diabetes was 13–23 years (range 1–25 years). There were no contraceptive failures. Among users there were no increment of daily needs of insulin and no significant variation of HbA1c along the study. There were no significant changes on systolic and diastolic blood pressure along the study time. Mean body mass index showed no significant changes along the various observations. There was a significant reduction from baseline of the total cholesterol at 6 and 12 months and of triglycerides at 6, 12 and 24 months. There was also a significant reduction of HDL cholesterol at 6 and 12 months but with an increase of the HDL/total cholesterol ratio. Among women with vascular complications (18/22) there was no aggravation of the clinical parameters during the time of the study. Menstrual changes were the most common side-effect noted. One woman asked for removal of the implant at 24 months because of frequent bleeding.
Discussion In this group of women with diabetes the etonogestrel implant was a safe and well accepted contraceptive method, with little clinical impact on glycemic control and cardiovascular risk parameters. Etonogestrel implant may provide a good contraceptive choice among women with diabetes, even with coexisting vascular disease.
P123
REMO study: Poor compliance in combined hormonal contraception. A risk factor of unwanted pregnancy
J. V. González on behalf of the Contraceptive Experts Circle
Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
Introduction The effectiveness rate of combined hormonal contraceptive (CHC) methods is superior to 99%, but the efficacy of CHC methods is inferior. The difference is in the compliance. The risk factors of unwanted pregnancy are: poor use of a contraceptive method; to have sexual relations; don't use additional contraceptive protection.
Objective To evaluate the percentage of women exposed to unwanted pregnancy risk, in spite to use a combined hormonal method.
Material and methods Multicentre cross-sectional population study carried out under routine conditions of clinical practice. A total of 27,028 women, 18 to 49 years old and present users of combined hormonal contraception participated in the study. The women filled out a self-administered survey about use and compliance problems during use of her combined hormonal method and, woman's attitude in the face of poor compliance (to have sexual relations with additional protection).
Results From 27,028 recruited women, 26,900 were valid for analysis. The 71% of the pill users, 32.2% of the patch users and, 21.6% of the ring users referred poor compliance in some occasion and of them, 69.9%, 67.5% and 72.3%, respectively, it continued to have sexual relations. The 37.1% of the pill users, 43% of the patch users and, 47.7% of the ring users, didn't use additional contraceptive protection, which supposes that 18%, 6% and 7%, respectively, of the users of these combined methods were exposed, in some occasion, to unwanted pregnancy risk.
Conclusions Nondaily use of combined hormonal contraception is associated with a smaller risk of unwanted pregnancy.
P124
Oral contraceptives and intrahepatic cholestasis of pregnancy – a retrospective study
P. Kascak and M. Hlavacik
Department of Obstetrics and Gynaecology, Faculty Hospital, Trencin, Slovakia
Objective Intrahepatic cholestasis of pregnancy (ICP) is a late pregnancy associated disease that usually disappears after delivery. Intense pruritus and the risk of stillbirth and premature delivery justify the search for an effective management of the disease. It is usually recommended that all women with ICP should avoid oestrogen-containing contraceptive pills. They should also be warned that the recurrence rate in subsequent pregnancies is high.
Methods The questionnaire was sent to all patients with ICP detected at our department from January 1992 to December 2004. A part of the questionnaire was focused on the usage of oral contraceptives. Analysis on symptoms, laboratory test and side effects of the treatment was performed.
Results A total of 74 women with ICP were identified and analyzed. From Janurary 1992 to December 1996 (group A), 38 patients were treated with hepatoprotectives and antihistamines. From January 1997 to December 2004 (group B), ursodeoxycholic acid therapy was administrated to 36 women. The frequency of disease was 0.46% of all births. All patients were presented with pruritus. The data from 46 returned questionnaires were analysed (24 and 22 patients from group A and B respectively). In spite of literature recommendation, 15 patients (32.6%) have used combined oral contraceptives (COC) – 11 and 4 in the group A and B respectively. The elevation of the liver enzymes was documented in 2 cases and in one of them it was the cause of withdrawal of the COC. One patient observed pruritus as a side effect of the treatment.
Conclusions The data from returned questionnaires revealed that 33% of patients with ICP have used COC with a very low incidence of side effect. The symptoms of the disease were diagnosed in one COC user only (6.6%). According to our opinion, the contraindication of oestrogen-containing contraception in women with ICP should be reevaluated.
P125
Effects on insulin sensitivity of different hormonal contraception
A. Cagnacci, A. Tirelli, S. Ferrari, M. Generali, E. Petrella, A. Xholly, R. Zanin, and A. Volpe
Department of Obstetrics, Gynecology and Pediatrics Sciences, University of Modena and Reggio Emilia, Modena, Italy
Objective In the present randomized study we evaluated the influence of two hormonal combined contraceptives on insulin sensitivity.
Methods The study was performed in 27 women randomized to receive 6 cycles of a contraceptive treatment. Each woman received either (1) the biphasic OC containing, for the first 7 days, EE 40 mcg plus DSG 25 mcg and, for the subsequent 14 days, EE 30 mcg plus DSG 125 mcg (Gracial, n = 8); or (2) the monophasic OC containing EE 20 mcg plus DSG 150 mcg (Mercilon, n = 8) or 3) the contraceptive vaginal ring releasing EE15 mcg plus ENG 120 mcg (NuvaRing, n = 9). Insulin sensitivity (SI) and glucose utilization independent of insulin (Sg) were investigated at baseline and after 6 months by a frequently sampled intravenous glucose tolerance test (FSIGT) associated with the minimal model method.
Results Sg was not modified either by treatments while SI decreased significantly in the Gracial treatment group during the 6 months. Net SI induced by vaginal therapy was significantly greater than NET SI of the oral group (1.429 ± 1.361 vs. −1.736 ± 0.478; p < 0.05). Our results showed that EE dose was not the most important determinant on glucose metabolism. SI, in fact, did not decrease parallely to the progressive reduction of EE component of the hormonal contraceptive: net SI in the Mercilon group was similar to net SI of the Gracial group. By contrast net SI was significantly different in the NuvaRing group, where a positive trend of SI was absent.
Conclusions These results indicated that effect on insulin sensitivity is greatly influenced by the route of contraceptive administration. Vaginal route of hormonal contraceptive does not impair insulin sensitivity.
P126
Knowledge and attitudes, on therapeutic beneficial effects in combined hormonal contraception, of women who demand on contraception in gynaecological consultations. Opibel study
C. Fernández, M. Quesada Moreno, M. A. Gómez Martínez, R. Lertxundi Barañano, J. V. González Navarro, and C. Peña
Spanish Society of Contraception, Madrid, Spain
Objectives The overall goal of this study was to describe the knowledge of the additional benefits of hormonal contraception available to women who consult professionals about contraception. Specific aims were to describe the attitudes of the additional benefits of hormonal contraception, the frequency of disturbances androgenic perceived and the epidemiological profile of the woman who demand on contraception in gynaecological consultations.
Design and methods This is a cross-sectional study, multicenter, in terms of clinical practice in women who start or restart combined hormonal contraception. The information was obtained with a self-administered questionnaire. Socio-demographic data were collected and through previously defined closed questions as well the knowledge on therapeutic beneficial effects in combined hormonal contraception (rate scale in increasing order of 1 to 4). The chi-square test was used to compare qualitative variables, Logistic regression models were used to fit the observed associations, controlling by age, habitat and educational level (SPSS, v. 12.0).
Results There have been collected 4,677 surveys of users. Regarding demographics variables, the majority was high school and college, work outside the home, and lives in urban areas with more than 10,000 residents, with an average age of 28 (SD 9) years and a pregnancy. Most had used some contraceptive method previously, the latest method used by them patch/ring/pill/ in 48% and condoms in 42.6%. Most users think that hormonal contraceptives have additional benefits besides contraception: 62.3% think that they improve acne, 41.1% unknown influence on the excess fat, a 36.7% think that it diminishes excessive hair, a 52.5% unknown influence on hair loss; 81.8% thinks that improves pain associated with menstruation, 78.9% thinks that correcting the irregularities of bleeding; 71.7% know that decrease bleeding of the menstruation and 41.4% believe that improve syndrome pre-menstrual. Regarding to sexual desire, 38.2% did not think amending, 27.0% think that it diminishes, 3.8% increases and 30.9% unaware of the influence they may have. Referring to the presence of alterations androgenic, 55.7% of users believe that the combination hormonal contraceptives drugs are very safe, with few side effects. Approximately 40% of women had mild-moderate acne on face, 33.2% believe that their skin is greasy, 35.2% believe that his hair is too fatty or greasy, a 40.4% thinks that have excess hair and a 39.1% believe that is hair loss. There were found differences by age and educational level (p < 0.001).
Conclusions There is a significant ignorance on the part of users of the additional benefits of combination hormonal contraceptives. Most important therapeutic beneficial effects, in combined hormonal contraception, are the improvement of dysmenorrhoea and the decrease of bleeding.
P127
Gynaecological staff opinions and attitudes on the therapeutic and beneficial effects of combined hormonal contraception. Opibel study
E. De la Viuda García, E. Pérez Campos, M. J. Alonso Llamazares, E. Yáñez González, C. Fernández Pérez, and P. Aliseda
Spanish Society of Contraception, Madrid, Spain
Objectives In Spain, less than two million women use combined hormonal contraception being this, together with that of Italy, one of the lowest rates of the European countries in our area. However, at present, we have different combination hormonal contraceptives, with different routes of administration (oral, vaginal and transdermal), which have the same efficiency and effectiveness.It is known that combination hormonal contraceptives are not only meet the requirements of high efficacy and safety with a good cycle control, but also presented many significant beneficial effects added.
The overall aim was to describe the rating or the significance of the added benefits of hormonal contraceptive methods by gynaecological staff. The specific goals of this study were to describe the drug utilization, use of contraceptive methods recommended and benefits' assessment for contraception in the gynaecologist consultations.
Design and methods Country wide opportunity sample of gynaecological staff, public and private practice, with the application of a self-administered questionnaire, during May–July 2007. Socio-demographic and professional data were collected and through previously defined closed questions as well the opinions and attitudes on therapeutic beneficial effects in combined hormonal contraception (rate scale in increasing order of 1 to 5). The chi-square test was used to compare qualitative variables, the median test to compare quantitative variables expressed by median and interquartil range (IQR), and the Pearson correlation coefficient for analysis between pairs. Logistic regression models were used to fit the observed associations, controlling by professional profile, age, sex, habitat and training received (SPSS, v. 12.0).
Results It has been collected 578 surveys of physicians, which are considered assessable 445. As for demographics and professional profile, the number of male and female participants was similar. There are an increased number of health care professionals practicing medicine privately, mostly in urban centers with more than 100,000 residents. The average age of the health professionals was 46 (SD 8) years with an average of 19 (SD 9) years of professional practice.
When asked about contraception use, for every 10 patients who come to search for contraceptive advice, recommended six combined hormonal contraception, two IUD, only one gestagens and one barrier methods. We selected the five most commonly used combination hormonal contraceptives, in Spain, according to IMS data, and professionals were asked about the effect of these contraceptives on the control of dysmenorrhoea, control of bleeding disorders associated with the cycle, antiandrogenic effect, the effect on libido, and the improvement of premenstrual syndrome. Two of them rated the best for all these parameters: the association of 3mg Drospirenone + 30 mcg Etinilestradiol (median 4 (IQR 3–5) over 5) and 2 mg Chlormadinone acetate + 30 mcg Ethynil estradiol (median 4 (IQR 3–5) over 5) (p < 0.05). The professionals surveyed believe that the issues of most concern to women who are going to use a combined hormonal contraceptive are premenstrual syndrome and alterations of libido, (median 4 (IQR 2–5) over 5) p < 0.05, followed by dysmenorrhea and bleeding disorders associated with the cycle. When asked to professionals on the importance of the additional benefits at the time of prescribing a combined hormonal contraceptive method, agrees with his views on what matters most to women who will use it.
Conclusions Additional benefits in the professional, who thinks in terms of recommending a combined hormonal contraceptive, differ from the better known by the user. Professional recommends a combined hormonal contraceptive considering the problems that he thinks are most concerned about the user.
P128
A change of the quality of life during usage of low-dose COC
M. Havlín, T. Rohrichová, and P. Šmeral
ADC Sanatorium, Praha, Czech Republic
Objective Biological aspects of COC effect on the woman health are one of the most popular themes of recent medicine. Less attention is given to subjective feelings and opinions of COC users. Therefore we observed the influence of low-dose COC on the quality of their life.
Design and methods The standard The Quality of Life Enjoyment and Satisfaction Questionnare (Q-LES-Q-SP author J.Endicott et al., 1990) was used for the research (study). This modification of the questionnaire involves 16 questions and the patient marks the answer on the scale from 1 (very unsatisfied) to 5 (very satisfied). The patients filled in the questionnaire before the start of usage COC and again after 3 cycles of usage. We used low-dose COC Mercilon® containing 20 μg of ethinylestradiol +150 μg of desogestrel in our study.
Results 120 women aged 15–45 years (average age was 24.48) were in the study. In all aspects it improved the quality of life from 2 to 17.7% (average growth was 9.7%).
Conclusions Modern low-dose COC significantly improves the quality of life.
P129
Clinical experience programme NuvaRing® in Slovak Republic
I. Apetauer
Organon, part of Schering-Plough Corporation, Prague, Czech Republic
Introduction NuvaRing® is the vaginal contraceptive ring releasing 15 mcg of ethinylestradiol and 120 mcg of etonogestrel daily. NuvaRing® is easily inserted and removed by the women herself and 3 weeks of the ring in the vagina are followed by a ring free interval of 7 days. There is a large amount of data about this non oral contraceptive obtained from the well controlled clinical trials. However, there is only limited information about the day-to-day use of NuvaRing® in the general population of fertile women.
Objective To obtain data about women of the Slovak Republic in real-life office settings and their experience with NuvaRing®.
Design and methods Clinical Experience Programmes (CEP) are non-interventional studies using products available on the market (NuvaRing® became available on the Slovak market in April 2006). Each of the 60 gynecology centers in the Slovak Republic was asked to recruit to this project 15 women suitable for NuvaRing® with no contraindication to this contraceptive (according to the SmPC text NuvaRing®) and to fill in the forms concerning user's quality of life at the baseline, after 3–4 months and after 6 months of NuvaRing® use.
Results Data from 814 NuvaRing® users were obtained. Results are scheduled to be analysed and will be known in early 2008.
Conclusion To be added after the statistical evaluation.
P130
The approach to hormonal contraception in women with metabolic syndrome
N. Artymuk
Kemerovo State Medical Academy, Kemerovo, Russian Federation
Objective It is well-known that women with metabolic syndrome have a high rate of menstrual and reproductive disorder. However, pregnancy in this patient group is likely to take place and its courses is often complicated. From this point it is a very important to have a planned pregnancy in these women and choose an effective and safe method of contraception.
The aim of this study was researching possibility of administration of the oral contraceptive (OC) containing 30 μg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) in women with metabolic syndrome.
Design and methods 36 women with metabolic syndrome in maternity age (the mean age – 25.5±4.2 years) have been administered 30 μg EE/3 mg DRSP during 6 months. BMI of these women was 33.4±2.2 kg/m2. Arterial hypertension occurred in 33% of the women, menstrual disturbance – in 68%. Clinical examinations, anthropometrical measurements, ultrasonografic study of genital, carbohydrate and lipid metabolism were determined before OC, after 3 and 6 months.
Results The results of this study showed that the women did not become pregnant during OC administration. BMI did not have any evident changes in 3 and 6 months. There were not evident and significant levels of carbohydrate and lipid metabolism. Arterial blood pressure did not essentially increase. Side-effects were noted in 5 women that were controlled in 3 months after OC administration. Poor bleeding between periods were in 3 women and headache – in 2 patients.
Conclusions Administration of 30 μg EE/3 mg DRSP in women with metabolic syndrome for contraception is effective, safe and does not affect the metabolic profile in these women.
P131
Features of the use of modern contraceptive NovaRing® in the postabortive period
V. Dronova, V. Teterin, and V. Podolsky
State Organisation Institute of Pediatrics, Obstetrics and Gynecology Academy of Medical Sciences of Ukraine, Kiev, Ukraine
Objective Artificial interruption of pregnancy (abortion) remains the basic method of regulation of birth rate in Ukraine. It is known, that abortions are the reason of many disorders of reproductive health. Therefore wide use of effective and safe methods of contraception instead of abortions positively influences a level of gynecologic desease and complication of pregnancy. NovaRing is a modern contraceptive preparation which has positively recommended itself by many criteria. The purpose of our research became studying efficiency of use NovaRing for contraception in the postabortive period.
Design and methods 60 women of fertile age in whom pregnancy of early term (up until 6 weeks) had been interrupted artificially by vacuum, were surveyed. To all surveyed women researches of microbiocenosis of urogenital tract with use of microbiological and virologic methods, ultrasonography were carried out, thus of complications after abortion have not been revealed. For 2 day after the beginning following menstruation use NovaRing is started. During the next 12 months at patients efficiency and by-effects of application of NovaRing were estimated.
Results During supervision anybody from surveyed women has not refused use of a preparation and there were no medical indications to its cancellation. All women have estimated bearableness of a contraceptive as good – 8 (13.3%) or excellent – 52 (86.7%). It has not been marked by any not desirable pregnancy. Collateral defects it is marked at 4 (6.67%) patients: from them at 2 (50%) are marked spreading blood allocation, and at 2 (50%) – a moderate pressure of dairy glands in the first month of use of a preparation.
Conclusions NovaRing is a highly effective safe contraceptive which is well transferred by patients. Wide use of NovaRing for contraception allows the lower frequency of abortions and the complications caused by them.
P132
The knowledge and use of oral contraceptives in young Polish women
H. Olszewska1, J. Olszewski2, A. Abacjew-Chmylko1, and L. Chmylko3
1Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Gdansk, Poland, 2Department of Nursing, Medical University of Gdansk, Gdansk, Poland, and 3F. Ceynowa Hospital, Wejherowo, Poland
Objective Modern oral contraceptives (OCs) are a widely used method of contraception and have one of the highest efficiency of pregnancy prevention. They are recommended especially to young nulliparous women who are at risk of unintended pregnancies. The aim of the study was to assess the knowledge about and use of oral contraceptives in young women in the Gdansk Region, Poland.
Design and methods The study was conducted among 1067 female students of secondary schools and the largest universities of the Gdansk Region aged 18–29. The data was collected with the use of an anonymous questionnaire. Statistical analysis was performed by chi-square test.
Results A majority of respondents treated the OCs as the most effective methods of contraception. 77.1% had a correct knowledge of the mechanism of action, while 4.4% treated it as an abortive drug. 69.3% knew that using OCs does not affect future fertility, whereas, 12.8% had an opposite opinion. Of 1067 young women 48.2% had used OCs. This medication was taken by only 66.7% sexually active women and 12.9% non-sexually active women. In the second group only 5.7% took OCs as preparation for initiating sexual activity. During the first intercourse OCs were used by only 22% women while condoms by 67.0%. Only 70.8% students took OCs very regularly. The most frequently declared side effects of OCs were: breast discomfort (35.7%), mass increase (24.7%), depressive mood (17.4%), lowered libido (15.1%). The improvement of the complexion noticed 30.8%.
Conclusions The knowledge about OCs among sexually active young Polish women is rather good and consistent, however, the frequency of use is unsatisfactory. This shows that further education and promotion of the method of contraception is required.
P133
Update in hormonal contraception to midwifes
R. Lertxundi on behalf of the Contraceptive Experts Circle
Clínica Euskalduna, Bilbao, Spain
Introduction Midwifes, like the gynecologists and the family practitioners, must know the update of scientific studies carried out by the medical societies. Therefore, its participation in courses, conferences, forums of discussion, etc. on contraceptives administration routes, guidelines and compositions is fundamental.
Objective To carry out an update course in hormonal contraception to midwifes.
Material and methods Midwifes of different Spanish provinces participated in a course on update in hormonal contraception given to medical gynecologists and midwifes. The participants received write information (available at www.sec.es) about course subjects: anatomic and physiologic contraception bases, use of the contraceptive methods in Spain and surrounding countries, hormonal contraceptive methods, contraception with only progestagens methods and emergency contraception, noncontraceptive effects of the hormonal contraception, contraceptive methods during lactation and, contraceptive advice. The last part of the course was dedicated to the discussion of clinical cases. Later, midwifes completed an evaluation questionnaire and responded to a survey on the course and speakers general valuation.
Results A total of 461 midwifes participated in this course. The majority of midwifes valued the general content and speakers course like excellent or very good. Midwifes reported that the most interest subjects was: adolescence contraception, contraception during lactation, perimenopause contraception, contraceptive advice and, the discussion of clinical cases. Answer to the question ‘what subjects would you extend’, midwifes said: adolescent contraception, perimenopause contraception, legal aspects of the contraception with their corresponding legal advice and the discussion of clinical cases.
Conclusions The knowledge and conclusions from the courses on update in contraception contribute to that midwifes can offer a customized advice.
P134
The acceptability and effectiveness of oral contraceptive – Karissa
C. Trifan and M. Tîrnovanu
Cuza-Vod, Hospital 1st Clinic, Iasi, Romania
Objective The aim of the study was to evaluate the efficacy and acceptability of the use of Karissa, containing 20 micrograms of ethinylestradiol and 75 micrograms gestodene.
Materials and methods It was an observational study on the healthy women not having contra- inactions for use of hormonal contraception. The observation was carried out on 160 cases during the period of April 2006–December 2007. Basic examination was taken during the first visit. Re- examinations were taken after 3 and 6 months of usage of study drug.
Results We had 2 groups of patients: between 19–30 years 132 patients and between 31–40 years 28 patients. The indications were changes menstrual cycle more regular, primary dysmenorrhea and functional ovarian cyst for the first group and decreases menstrual bleeding in the second group. 92.5% of patients declared that oral contraception with Karissa was well accepted. At 100% of patients menses were regular. 93.3% of patients was not marked symptoms of dysmenorrhea after 6 months. Functional ovarian cysts disappeared after 3 months at 85% of cases. At all cases decreased menstrual bleeding. No serious adverse events were reported at 10% from women: spotting, nausea, tenderness of the breast, which disappeared after 2–4 cycles.
Conclusion High efficacy, good tolerance and acceptability of Karissa administration were observed.
P135
Non-contraceptive effects of combined oral contraceptive Marvelon in the prolonged regimen
V. Prilepskaya and E. Chernysheva
Research Centre for Obstetrics, Gynaecology and Perinatology, Moskow, Russian Federation
Now combined oral contraceptives are the most widespread reversible method of contraception. Non-contraceptive effects of COC are proven for dysmenorrhea and premenstrual syndrome. Extended regimens COC allows reducing menstruations frequency and as consequences decreasing or eliminating pathologic changes and patients' complaints concerned with menstruation.
Study purpose To compare the influence of prolonged regimen of Marvelon on severity of PMS and dysmenorrhea with standard regimen.
Design and methods 112 women were included to the study. The mean age of subjects was 27.5±5.6 years. All subjects were divided into 2 groups: first group – prolonged regimen COC (63-day use of active pills followed by 7-day hormone-free interval) (n = 73) and second group – standard regimen (21/7-day regimen) (n = 39). The total period of observation was 12 months. Information on cycle control, bleeding patterns, severity of PMS and dysmenorrhea was obtained by questionnaires.
Results At baseline, symptoms PMS appearing 5–10 days prior to future menstruation were observed at 48.7% of patients of the first group, 8.2% of them had PMS during 7-day interval of COC use. At baseline, 43.5% of women of the second group had PMS. Initially 26.9% and 38.4% of women of the first and second group experienced dysmenorrhea accordingly. All patients of both groups had regular hormone withdrawal bleeding during 7-days pill free interval. In 3 months 14.1% and 23.2% of women of first and second groups experienced dysmenorrhea accordingly. 5.2% women of second group had dysmenorrhea over 6 and 12 months of using standard regimen COC while there are no cases of dysmenorrhea in prolonged regimen group. In 3 months of 14.1% of women of first group and 10.3% of women of second group experienced PMS. In 6 months PMS was marked only at 1.2% of women of first group and at 5.2% of women of second groups. There are no any symptoms of PMS among women of both groups in 12 months of COC use.
Conclusions This results show that extended regimen of Marvelon decreases dysmenorrhea and PMS faster and more effective than standard regimen that as a result improves quality of women's life. Thus, prolonged regimen COC is a perspective method both contraception and treatment purposes.
P136
The TEAM-06 Spanish cross-sectional study
I. Lete Lasa, J. L. Doval Conde, E. Pérez Campos, R. Sánchez Borrego, M. Correa, E. De la Viuda, M. A. Gómez Martínez, J. V. González Navarro, R. Lertxundi Barañano, M. T. Martínez, N. Mendoza, and J. Robledo
Spanish Society of Contraception- Studie of Circle of Contraception, Madrid, Spain
Objective To know factors affecting women's selection of [Agrave]HCC.
Study design This cross-sectional multicenter study was designed to assess the reasons for selecting the contraceptive pill, the skin patch or the vaginal ring in 9700 women aged 18–49 years, who consulted their doctors for starting or re-initiating combined hormonal contraception. A self-administered questionnaire regarding the reasons for the selection made and for the refusal of the remaining two methods was completed.
Results The vaginal ring showed the greatest acceptance (46%) compared with pill (39%) and the skin patch (15%), particularly in women aged 35–39 years. The ring and the skin patch were mainly preferred because of the lower probability of inadvertent omission (62% of cases), convenience, and monthly or weekly frequency of use. The pill was preferred because of its proven efficacy (60% of cases) and ease of use. The acceptance of the skin patch increased with age and the pill was mostly accepted only by women in the youngest age groups.
Conclusions Convenience, frequency of use and lower probability of inadvertent omission were the primary determinants of contraceptive choice rather than the women's profile.
P137
Comparative study: Yasminelle® vs NuvaRing®
R. Lertxundi on behalf of the Contraceptive Experts Circle
Clínica Euskalduna, Bilbao, Spain
Objective To determine and compare the continuity rate and breakthrough bleedings or spotting of Yasminelle® and NuvaRing® at 3 cycles of use.
Materials and methods Ten members of the Contraception Basque Society recruited during 3months women who started or switched in the use of Yasminelle® (n = 182) or NuvaRing (n = 215).
Results A total of 166 women in Yasminelle® group and 203 women in NuvaRing® group completed the study. The continuity rates were high in both groups (86% for Yasminelle® and 74% for NuvaRing®). Spottings and bleedings diminished 6.5% for Yasminelle® and 18.7% for NuvaRing® to the third cycle. The main reasons to discontinuous in Yasminelle® group were bleeding problems (43%) and side effects (35%). The main reasons to discontinuous in NuvaRing® group were bleeding problems (12%), side effects (16%) and device-related events (comprising discomfort, foreign body sensation or partner rejection).
Conclusion Withdrawal rates were similar in both groups. The differences in breakthrough bleeding rates were not significant between the two routes of administration.
P138
Implanon® – clinical experience and acceptability
M. Brandão, S. Carvalho, A. Lebre, A. Rita Pinto, G. Madureira, R. Maria Rodrigues, O. Rodrigues, and R. Magarinho
Maternidade Júlio Dinis, Porto, Portugal
Introduction Implanon®, is an progestin subdermal single-rod implant, which contains 68 mg of etonorgestrel. Releasing approximately 40 μg of etonorgestrel per day, Implanon® inhibits ovulation (the primary mechanism of action), but also increases viscosity of cervical mucus leading to sperm penetration inhibition. In such a way it allows contraception over a three year period.
Objectives To evaluate indications, side effects, menstrual bleeding pattern, efficacy of contraception, satisfaction rate and removal causes in women with the implant.
Material and methods Retrospective study of 206 women, followed in family planning consultation of the Maternidade Júlio Dinis, who used implant over a year. All the patients were submitted to an evaluation questionnaire at the end.
Results 206 cases were analysed (n = 206). Mean age was 29 years (range 15–45 years) and 20 cases (10%) were nulliparous women. Prescription indications were contraception safety in 38% of the cases, oral contraceptive intolerance in 22%, psychiatric disease in 10%, comfort in 28% and in 2% of the cases were women with contraindication to estrogen intake. The efficacy was 100% and satisfaction rate was high. Common side effects reported were irregular bleeding, weight increase, headaches and acne. Oligomenorrhea was the most frequent pattern of bleeding. Irregular menstrual bleeding pattern, mostly menometrorrhagia, and weight increase were the main causes of unsatisfaction. The implant was removed only in 3 women (1%) due to excessive weight increase (>15 Kg).
Conclusions Etonogestrel subdermal contraceptive implants demonstrated high efficacy. To optimize patient success with this long-acting contraceptive, potential users of Implanon® should be well informed about the irregular bleeding pattern. Its use reveals a tendency to increase body weight. We need to continue our evaluation to give credibility to the verified conclusions.
P139
Contraception in the Family Counselling Centre: Results and data
L. Tossichetti, A. Rossi, and L. Ottavini
Family Counselling Center, Camerino (MC) Marche, Italy
Objective We have studied the womens afferent in our Family Counselling Center, in choosing contraception method.
Design and methods We carried out an epidemiologic study at our Family Counselling Centres on 120 patients sub-dividing them on the basis of their request and age. The most advice given was: (1) Hormonal contraception: is the most effective contraceptive method (99%) because it causes ovulation to cease. It is possible to personalize the method on the basis of one's own needs: (a) Monthly contraception with vaginal ring, (b) Weekly contraception with patch, (c) Daily contraception with pill; (2) Intrauterine Device: contraceptive effectiveness is good (95–98%) and it lasts from 3 to 5 years depending on the type of device.
Results The choice studied gave the following results: 40% weekly contraception, 47% monthly contraception, 13% intrauterine device. The pregnancy for unwell assumption: 2 pregnancy in weekly method and 3 in daily, none in monthly.
Conclusions The data analyzed suggested the women were confortable with the choice of monthly contraception versus unwanted pregnancy and avoid gastro-intestinal tract, thus is effective also in controlling vomiting and diarrhoea.
P140
Factors affecting satisfaction rates with the levonorgestrel intrauterine system used for contraception
E. Zeynep Tuzcular Vural, I. Gönenç, Ö. Güldem Öncü, G. Köse, and N. Aka
Haydarpasa Numune Training and Research Hospital, Family Planning Unit, Istanbul, Turkey
Objective The levonorgestrel intrauterine system (LNG IUS) is offered as a contraceptive option at the Family Planning Unit (FPU) of Haydarpaşa Numune Training and Research Hospital, Istanbul. The objective of this study was to evaluate factors affecting satisfaction rates of the LNG IUS in Turkish women.
Design and methods 102 women were accepted in the study. Inclusion criteria included a minimum of a years’ use of the LNG IUS, adequate information in records and willingness to participate in the study. Women over age 48 were excluded from the study group because perimenopausal symptoms could mimic side effects. A standardized questionnaire was used to evaluate satisfaction rates. Side effects and bleeding patterns were questioned. Results were analyzed using the SPSS for Windows 10.0 programme.
Results The mean age of the women was 34.34 ± 4.43, and the educational level was high. The reason for choosing the system was counseling in 87.4% of the women. 80.4% of the users and 84.3% of the spouses were satisfied with the method. Satisfaction with the method was positively related to spouse satisfaction (p < 0.001) and number of children (p < 0.05). Satisfaction rates weren't affected by age, number of abortions or educational status. Amenorrhea (p < 0.05), spotting (p < 0.05) and weight gain (p < 0.01) were related with unsatisfaction. Satisfaction was highest in women choosing the method after counseling and lowest in those who chose the method because a friend recommended it. Levels of satisfaction were higher in breast-feeding women, women with meno-metrorrhagia and women who were unsatisfied with their previous method of contraception. No pregnancies were reported during the study period.
Conclusions Satisfaction rates with the LNG IUS can be enhanced with careful user selection and thorough counseling of both users and spouses. Spouses’ participation in counseling services should be encouraged.
P141
Reasons of removal of the etonogestrel implant used for contraception, in a family planning unit setting, in Istanbul
E. Orhan, I. Gönenç, E. Zeynep Tuzcular Vural, G. Köse, and N. Aka
Haydarpasa Numune Training and Research Hospital, Family Planning Unit, Istanbul, Turkey
Objective The etonogestrel implant is offered as a contraceptive option at the Family Planning Unit (FPU) of Haydarpaşa Numune Training and Research Hospital, in Istanbul. The objective of this study was to evaluate the reasons of removal of the etonogestrel implant in Turkish women.
Design and methods The etonogestrel implant is offered as a contraceptive option at our FPU since 2003. Since then, 55 women who had her implant removed either in our FPU or elsewhere were enrolled in the study. The related data was collected from the patient records kept in our clinic or telephone interviews were made with those who had the implants removed in other health facilities.
Results The mean age of the women was 30.47±3.36 years. Presence of side effects was the number one reason (56.4%) for the removal of the implant. These side effects in respect with frequency consisted of menstrual disturbances (43.6%), depression (9.3%), weight gain (5.5%), acne (2.4%) headache (1.8%), decrease in libido (1.8%), ovarian cyst formation (1.8%) and edema (1.8%). Other reasons mostly observed for removal were exceeding of the expiry date (30.9%) and wishing to conceive (10 9%). Arm trauma, stated by only one woman, although did not cause any clinical manifestations, yielded to the woman's insisted request for the removal. We encountered only one implant migration which was removed after correct plotting of the implant by ultrasound.
Conclusions Full time usage of the etonogestrel implant rates can be enhanced with careful user selection and thorough counseling of users before the insertion. A detailed counseling should be given about the side effects especially about the bleeding patterns. Good counseling is the key to proper use of contraceptive methods and it gains more importance with expensive methods such as the etonogestrel implant.
P142
Hormonal contraception in patients with thrombosis and genetic mutations related with thrombophilia
M. João Carvalho, C. Oliveira, N. Melo, R. Maia, A. Teixeira, V. Rodrigues, F. Falcão, and C. F. de Olveira
1Coimbra University Hospitals - Gynaecology Department, Coimbra, Portugal, and 2Coimbra University Hospitals - Thrombosis and Hemostasis Department of Clinical Haematology Service, Coimbra, Portugal
Objectives Characterization and comparison of clinical parameters, risk factors and haemostatic disorders in women with thrombotic events and correlation with hormonal contraception (HC).
Material and methods Analysis of 255 patients with first thrombotic event in an age less than 70 years, followed in Thrombosis and Hemostasis department of Clinical Haematology Service. Precipitating factors were: HC less than 6 months, surgery, fracture, pregnancy and puerperium, abortion, immobilization, vein sclerosis, and traumatism. Predisposing factors were: Arterial Hypertension, dyslipemia, obesity, smoking, diabetes, cancer and chemotherapy, Essential Thrombocitemia and Multiple Myeloma. Relevant haemostatic disorders were the presence of genetic mutations (Factor V Leiden, Prothrombin G20210A (PT), MTHFR C677C and MTHFR A1298C) and deficiency of natural inhibitors of coagulation (Antithrombin III, Protein C, and Protein S), and Antiphospholipid Sindrome (ASS).
Results Patients (pts) were divided according with HC exposure – Group (Gp) 1 (N=29): HC exposure less than 6 months before the event (HC precipitating factor); Gp 2 (N = 112): HC exposure more than 6 months before the event; Gp 3 (N = 56): HC cessation more than 1 year before event; Gp 4 (N = 58): pts never exposed to HC. Comparing age at the first thrombotic event was: 28 (15–45) in Gp 1 vs. 34 (18–53) in Gp 2 vs. 45 (15–73) in Gp 3 vs. 43 (23–67) in group 4. The most frequent first thrombotic event was deep venous thrombosis (DVT) in Gp 1 (45%), Gp 2 (36%) and Gp 3 (40%) but in Gp 4 DVT and pulmonary thromboembolism had the same prevalence (41%). In Gp 2, Gp 3 and Gp 4 precipitating factor was mostly absent. Predisposing factors were absent in 76% pts from Gp 1, but in the remaining groups, at least 1 factor was identified in the majority. Personal antecedents of thrombotic events were present in 31% (Gp 1) vs. 27% (Gp 2) vs. 34% (Gp 3) vs. 50% (Gp 4). Family history was positive in 41% vs. 51% vs. 41% vs. 46%. Relevant haemostatic disorders were detected in 52% vs. 67% vs. 15% vs. 73%. The most frequent disorders was PT (17%) followed by ASS (14%) in Gp 1 and ASS in the remaining groups (13% vs. 17% vs. 18%), followed closely by PT (11% vs. 14% vs. 16%).
Conclusions Pts exposed to HC less than 6 months before the thrombotic event were younger and mostly without predisposing factors. In pts never exposed to HC, personal antecedents and relevant haemostatic disorders were more frequently detected. Thrombotic event, family history and the specific haemostatic disorder were not significantly different between the four groups.
P143
Evaluation and results of treatment with Diane-35 among PCO-SY adolescents and its contraceptive impact
D. Moskov and A. Ristevska
General Hospital, Strumica, Former Yugoslav Republic of Macedonia
Objective Presentation of our clinical experiences using the third generation oral contraceptive with antiandrogene progesterone component, treating adolescents with PCO-SY.
Design and methods During the period of 2006–2007, collaborating with school medicine specialists,were selected 45(10%) adolescents with PCO-SY and 30 patients aged 18–25 years examined through the gynecological ambulance. They were examined through clinical, biochemical and sonographic investigations and were classified in tree groups depending of diagnostic criterias. Consequently were treated from 6–12 months, and analysed the results with mathematical-statistical methods.
Results The adolescents in group-A were 35(47%), with sonographic stigmata for PCO-Sy, unregulated cycles, and normal hormonal profile. They were treated for six months so that regulation of cycles were achieved among 30(86%) after one month, while among 5(14%) after three months.The second group-B countering 30(40%) with sonographic symptoms, severe form of acne juvenilis, obesitas, altered cycle, and high levels of LH and testosterone, was treated one year continuously, and the cycle was regulated among 27(95%) of them, the comedones were totally closed among 21(70%), while through the others with pustulas middle effect was achieved. The LH and values of testosterone decreased among 18(65%) of them. Among the third group-C, very severe form of acne juvenilis, distinguish obesity, hirsutismus, high levels of LH and testosterone, the treatment continue, the results are among 8(80%) of them cycle regulation, middle satisfactory effects in acne treatment -3 (30%), and 2 (20%) normalizing the hormonal profile, decreasing the hirsutismus through the face and stomach.
Conclusion Optimal cicle regulation, satisfactory results of treatment the pathology associated with PCO-Sy, are reasonable condition for using DIANE-35 as contraceptive and hormonal supplement.
P144
Factors affecting satisfaction rates with the etonogestrel implant used for contraception
I. Gönenç, E. Zeynep Tuzcular Vural, E. Orhan, G. Köse, and N. Aka
Haydarpasa Numune Training and Research Hospital, Family Planning Unit, Istanbul, Turkey
Objective The etonogestrel implant is offered as a contraceptive option at the Family Planning Unit (FPU) of Haydarpaşa Numune Training and Research Hospital, in Istanbul. The objective of this study was to evaluate the side effects encountered and the factors affecting satisfaction rates of the implant in Turkish women.
Design and methods 84 women were enrolled in the study. A standardized questionnaire formed of 25 questions was used to evaluate satisfaction rates. Side effects and bleeding patterns were questioned and also the related information was gathered from the patient files. Results were analyzed with x2 and Fisher's exact tests, using the SPSS for Windows 10.01 programme. Inclusion criteria included a minimum of a six months use of the implant, adequate information in records and willingness to participate in the study.
Results The mean age of the women was 31.25±2.23, of which 41.7% were primary school graduates and the majority was housewives. The overall satisfaction rate with the method was 60.7% in the users and 84.3% in the spouses. Satisfaction with the method was positively related with the duration of the use (p < 0.000), and inversely related with the presence of side effects and spouse dissatisfaction or disapproval (p < 0.000). Menstrual disturbances were the most frequently encountered side effects. 45% of the users declared contentment despite amenorrhea, the most frequent menstrual side effect. Prolonged bleeding was significantly associated with dissatisfaction. Mastalgia was another side effect which caused statistically significant unsatisfaction.
Conclusions Satisfaction rates with the etonogestrel implant can be enhanced with careful user selection and thorough counseling of both users and spouses, especially about the bleeding patterns. Spouses’ participation in counseling services should be encouraged.
P145
Non-contraceptive impact of contraception by the levonorgestrel-releasing intrauterine system
L. Surtea1, A. Gavrila2, M. Manolea3, P. Lucian Surtea4, and D. Ciobanu4
1University of Medicine, Craiova, Romania, 2Clinical Municipal Hospital Filantropia, Craiova, Romania, 3Clinical Municipal Hospital Filantropia, Craiova, Romania, and 4University of Medicine, Craiova, Romania
Introduction The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective long-acting and rapidly reversible method of contraception and, of all the available hormonal contraceptive methods, it delivers the lowest daily concentration of hormone. But the non-contraceptive health benefits have also enjoyed considerable attention.
Objective To evaluate our results in non-contraceptive health benefits improve with use, in patients undergoing the LNG-IUS contraceptive method.
Materials and methods We performed a study on 82 women from whom the LNG-IUS represented an attractive contraceptive choice because of non-contraceptive health benefits. The selection process of patients suitable for this study includes the women with known history of: (1) heavy menstrual bleeding, (2) uterine fibroids, (3) endometrial hyperplasia, (4) hormone replacement therapy.
Results (1) During an observation period of 5 years we found a great reduction in menstrual blood loss, 54 (65,86%) of women became oligomenorrhoeic or amenorrhoeic after 12 month. (2) For women with uterine fibroids we observed a total fibroid volume decreased in 43 (52,44%) of cases. (3) The higher local concentration of levonorgestrel in the endometrium resolved endometrial hyperplasia with no further treatment in 72 (87,80%) of cases. (4) 23 (28,05%) of women (44–50 years old) received a continuous -combined LD - HRT in a period of 5 years, using LNG-IUS and a patch of 12.5 cm2 surface, with 3.8 mg 17- beta Estradiol, delivering 50 micrograms/day during 7 days, which provides sufficient blood levels of estrogens to suppress climacteric symptoms.
Discussion (1) For many women the LNG-IUS become an appropriate alternative to hysterectomy, but we found a greater incidence of progestogenic side effects and intermenstrual bleeding. (2) The mechanism of shrinkage of uterine fibroids is unknown, but it could be involved insulin-like endometrial growth factor or changes in the uterine artery blood flow. (3) Endometrial safety has been evaluated by transvaginal ultrasound examination and by endometrial biopsy before starting the method and after, for a subset of 10 women who want change/renounce this method of HRT. (4) The method is safe, well tolerated and effective in suppressing the endometrium during perimenopause.
Conclusion For women with medical conditions selected in this study, the non-contraceptive benefits of LNG-IUS have proven to be more effective than standard medical therapy.
P146
The dynamics of some electrolytes and microelements in blood serum of young women with functional hyperprolactinaemia on combined oral contraceptives
L. Lasareva, L. Suturina, O. Starostenko, M. Dolgikh, L. Grebenkina, A. Labigina, and O. Leshenko
East-Sibirian Scientific Center of Medical Ecology, Irkutsk, Russian Federation
Objectives This study was performed to investigate the potassium, sodium, calcium, magnium, chlorine, iron, copper, zinc levels before and after using of combined oral contraceptives in young women with functional hyperprolactinaemia.
Design and methods Prospective study of young women (aged 21.7±2.4, n = 46) with hyperprolactinaemia (986±248 mIU/ml), classified as 1-2 categories in accordance with the ‘Medical eligibility criteria for contraceptive use’ (WHO, 2002). All women were recruited in gynecological clinics in Irkutsk (Russia) during the period of 2003-2005 and they were using the following contraceptives: 20 mcg ethinylestradioli/150 mcg desogestreli – 7 women, 20 mcg ethinylestradioli/75 mcg gestodeni – 8, 30 mcg ethinylestradioli/150 mcg desogestreli – 6, 30 mcg ethinylestradioli/75 mcg gestodeni – 4, 30 mcg ethinylestradioli/2 mg dienogesti – 9, 30 mcg ethinylestradioli/3 mg drospirenoni – 8, 35 mcg ethinylestradioli ∋∋/2 mg cyproteroni acetatis – 4. The supervision of all women included general physical and gynecological examination, monitoring of prolactin, potassium, sodium, calcium, magnium, chlorine, iron, copper, zinc levels in blood serum before and after 1,3,6 and 12's months of combined oral contraceptives using.
Results among the 46 women the significant increase of prolactin level was observed only in 17% by 12 month of contraceptive using, compared with baseline values (group 1), in others women with functional hyperprolactinaemia the significant changes in prolactin levels were not determined (group 2). Both groups were almost identical in age, anthropometric characteristics, and types of using contraceptives, but the frequency of menorrhagia was higher in women of group 1. We did not detected any significant changes of potassium, sodium, calcium, magnium, chlorine, copper and zinc levels by 1,3,6 and 12 months of combined oral contraceptives using, in comparison with baseline, in both groups. The significant increasing of iron levesl (from 17.3±1.12 mM/l to 29.7±1.65 mM/l) was observed only in women in the 1st group. The great majority of women using combined oral contraceptives had no serious side effects.
Conclusion The use of combined oral contraceptives had not caused any negative effects on the electrolytes and microelements levels in blood serum of examined women with functional hyperprolactinaemia.
P147
The experience of microdose combined oral contraceptives (COC) administration in primary dysmenorrhea
Vera Prilepskaya
Resaerch Centre for Obstetrics, Gyneacology and Perinatology, Moscow, Russian Federation
It is known, that the application of combined oral contraceptives (COC) promotes reduction of monthly bleeding duration and disappearance or improving of painful sensations in women with dysmenorrhea.
Objectives To study therapeutic effect of microdose combined oral contraceptive ‘Lindynette’ in women with primary dysmenorrhea.
Material and methods 30 women aged 16–39 (average 24.6±1.8) years with dysmenorrhea were enrolled in study. The duration of dysmenorrhea history varied from 6 month to 12 (average 4.4±2.5) years. The organic genesis of dysmenorrhea was excluded in all enrolled women by detailed examination. The basic examination included: the analysis of case history and clinical data, gynecological examination, ultrasound of genital and abdominal organs, the experts etc. All patients required a reliable method of contraception and had no contra-indications for hormonal contraception methods. All patients were offered independently to estimate their painful sensations during periods in 3-point score, where 0 points meant the absence of pain, and 3 points were the maximum of pain expression. In our opinion the application of similar system for the estimation of painful sensations allows to establish dysmenorrhea severity depending on an individual pain threshold.
Results In 4 (13.3%) women who have 2.5–3 points of painful sensations, the dysmenorrhea was assessed as severe. In 17 (56.6%) patients middle severity of painful sensations – from 2 up to 2.5 points was estimated, in 9 (30.1%) women – 1–2 points corresponded to light degree of severity. All patients were administered microdose monophasic combined oral contraceptive with 20 μg of ethinyl estradiol and 75 μg of gestoden (Lindynette 20, Gedeon Richter). The supervision for the patients was carried out with 1–3 month interval during 6 months. Contraceptive efficiency of the pills was 100%. No cases of pregnancy were registered during the period of supervision. Individual tolerance of preparation was determined by analysis of the incidence and character of unfavorable reactions and complications. The unfavorable reactions as breakthrough bleeding and spotting were marked in 3 (10%) patients, nausea in 1 (3.3%) and breast swelling in 1 (3.3%) woman for the first 2 months of administration of Lindynette 20. All unfavorable reactions were transient and required no withdrawal of treatment. The positive therapeutic effect was marked after 3 months of Lindynette 20 administration. It was demonstrated in significant reduction of painful sensations during monthly bleeding in 17 (56.7%) patients. In 3 months no one patient met criteria of severe dysmenorrhea. By the end of 6th month of Lindynette 20 application monthly bleedings were painless in 28 (93.3%) patients. Light dysmenorrhea persisted in 2 (6.7%) patients.
Conclusions According to our point of view, Lindynette 20 should be administered not only to women requiring a reliable contraceptive method, but also for the treatment of primary dysmenorrhea.
P148
Efficacy and acceptability of the hormonal contraceptive with antimineralcorticoid and antiandrogenic action
V. Prilepskaya, S. Rogovskaya, E. Mejevitinova, and L. Bostanjyan
Research Centre for Obstetrics, Gynaecology and Perinatology, Moscow, Russian Federation
COC Yarina (Yasmin) containing 0.03mg ethinylestradiol and 3 mg drospirenone is a new step in hormonal contraception. Drospirenone is a derivative substance and analogue of 17-α-spironolactone. Yarina antagonize to the water retention and increase acceptability of the hormonal contraception due to unique antimineralcorticoid and antiandrogenic action.
Objectives To study Yarina effects on skin and to evaluate side effects.
Method 38 women (age from 18 to 39) without contraindications to hormonal contraception were recruited. 19 patients used Yarina (group I), and 19 patients used Microginon (group II). Clinical (therapeutic) trial and PAP-test were made in both groups. The observation period was 6 months. The participants were asked to keep a menstrual diary.
Results 9 patients in group I, and 11 in group II had acne and seborrhea after initial examination. Mean body weight 63±1.4 kg (group I), and 61±2.1 kg (group II). 16% women in group I and 15% in group II noted contraction of menstruation. In both groups there was no intermenstrual bleeding. After 6 months: mean body weight - 59±2.1 kg (group I), and 62±2.2 kg (group II) (p < 0.05). Eight patients from group I and 2 patients from group II noted significant decrease of acne and seborrhea.
Conclusion Combined oral contraceptive with antimineralcorticoid and antiandrogenic action is effective, especially in women with hormonogenic water retention, acne and seborrhea.
P149
Experience of transdermal releasing system use
V. Prilepskaya, N. Nazarova, V. Yaglov, and A. Kuzemin
Scientific Centre for Obstetrics, Gynecology and Perinatology, Moscow, Russian Federation
Introduction New current tendencies of hormonal contraception include development of alternative methods – hormonal releasing systems. Their advantages include parenteral delivery, longtime and steady hormones release with a biological gradient, unnecessary daily medication. EVRA is the first, safe, effective and easy-to-use birth control plastic patch for women which adheres to the skin.
Objective The purpose of the study was to estimate the efficiency and acceptability of the EVRA Patch in reproductive age women for contraception.
Methods 20 women of reproductive age (18–40 years) used the contraceptive patch were observed for 6 months. A patch was placed on the skin of the buttocks, stomach, upper outer arm, or upper torso - once a week for three out of four weeks, no patch was used in the fourth week. The EVRA Patch releases synthetic estrogen and progestin to protect against pregnancy. The system represents a plastic patch containing 600 meg ethinylestradiol and 6 mg norelgestromin. It is as effective as the pill. Clinical examinations of weight gain, hemostasis, blood lipids, colposcopy, cytologic research and ultrasonic pelvic research were estimated.
Results Contraceptive efficiency of the Evra application was 100%. There were some side effects in 8 patients: mastodynia 2, headache 2, spotting within the first month of application 1, allergic reactions 2, gain-weight (+3 kg) within the first month of application 1. None of the patients had an increase of a blood pressure.
Conclusions Contraceptive hormonal releasing-system EVRA is a highly effective method of contraception in women of reproductive age. The side effects were observed in a low percent and had transitory character without any treatment necessary. That is a highly acceptable method of contraception.
P150
Preventive directivity prospects of modern contraceptive agents
A. T. Raisova, A. H. Rachimzhanova, T. S. Basibekova, G. Z. Kalibekova, L. B. Karamoldayeva, and N. P. Dolinskaya
Kazakh Medical University, Almaty, Kazakhstan
Fertility control and female reproductive health protection by prevention of undesirable pregnancy are serious problems of medical and social significance. Today the preference is given to combined oral contraceptives (COC) owing to high efficacy, acceptability, rapidity of fertility recovery after drug withdrawal and administration comfort and simplicity. Usage of modern contraceptives in therapeutic regimen for the purpose of pathological state correction validated by high prevalence of endocrinopathy and metabolic disorders among childbearing age women. Both therapeutic and side effects of COC depend to a large extend on progestagen constituent characteristics.
Purpose To estimate effectiveness, tolerance, and supplementary therapeutic effects of COC Yarina (by Bayer Schering Pharma, Germany) with a glance to pharmacology properties of the progestagen component.
Material and methods: 30 women, age 31 to 37 years (average 34.2 ± 1.3 years), receiving Yarina in standard regimen were examined with allowance to arterial pressure dynamic (AD), body weight (b.w.), diuresis, character of menstrual period (m.p.), US of mammary glands (before, during usage and 6 month after COC withdrawal).
Results From 30 examined women neurocirculatory dystonia identified in 4 (13.3%) cases, overweight in 12 (40%) cases (in average 28.75 ± 1.23 kg/m2), and mastodynia in every second woman. 26 (86.7%) women had BP in normal range: systolic pressure (SP) 118.2 ± 6.5 mm Hg, diastolic (DP) 73.0 ± 5.6 mm Hg. Under neurocirculatory dystonia Average SP was 145.8 ± 4.5 mm Hg, DP 92.6 ± 1.8 mm Hg. During Yarina usage all women noted good tolerance and period control with menstrual-like bleeding during COC interruption. At the end of the 3rd cycle of Yarina taking 25 (83.3%) women demonstrated tendency to b.w. decreasing by 1975.0 ± 27.0 g. in average. Examination after 6 month COC withdrawal detected b.w. increasing in only 2 (6,7%) women by 300 ± 80.0 g. from reference value. Body Weight decreasing cased by increasing of diuresis and decreasing of appetite. First cycle of Yarina taking demonstrate increasing of diuresis by 250–500 ml (on average1 300.5 ± 30.0 ml) and sponginess and hydropic syndrome disappearance in II phase of period. The therapeutic effect was achieved due to antimineralocorticoid effect of drospirenone which blocks binding of endogenous aldosterone with mineralocorticoid receptors and assists diuresis increasing without electrolyte balance changing. Another factor contributing to the effect achieving is Drospirenone/Ethinyl Estradiol combination. This mechanism interrupts retention of liquid in extra-cellular spaces; prevents increasing of plasma circulation volume, body weight, blood pressure and mastodynia development. Women who had invariably normal parameters BP was stable while taking Yarina, women with neurocirculatory dystonia average BP reliably (p < 0.05) decreased: SP from 145.8 ± 4.5 to 132.0 ± 2.4 mm Hg., DP from 92.6 ± 1.8 to 85.0 ± 1.2 mm Hg. The anti-androgen effect of Yarina was registered in all women and declared itself in skin condition improving, decreasing skin fattiness and acne, hair fattiness disappearing.
Conclusion Usage of COC Yarina prove not only high contraceptive effect, but also metabolic protective effect – decreasing and stabilizing of blood pressure and body weight; increasing of diuresis; correction of mastodynia and hyperandrogenia. The mentioned above allows to recommend COC Yarina in broad gynecological practice and especially in metabolic disorders risk-group patients. Absence of side effects and presence of supplementary treatment effect conditioned by individual COC adjustment subjected to progestagen component features.
P151
Multicentre prospective observational study of the compliance of three combined hormonal contraceptive methods: Study approach and methodology
I. Lete on behalf of the Contraceptive Experts Circle
Hospital Santiago Apóstol, Vitoria, Spain
Introduction The effectiveness of a combined hormonal contraceptive method depends, among other factors, of its correct and continued use. The WHO has assigned for each one of the three combined hormonal methods available: pill, patch and ring, a same effectiveness Index of Pearl and a same continuity rate.
Objective To evaluate compliance, continuity rate and reasons of drop out of three combined hormonal methods: pill, transdermal patch and vaginal ring in a sample of women followed during 12 cycles.
Methodology Multicentre prospective observational study carried out under routine conditions of clinical practice that it tries to recruit 5,000 user new women of combined hormonal contraception. The duration of the study will be 12 months. A total of 100 physicians of public and private health centres will participate into the study. The study duration, recruitment and data collection will be of 15 months (the limit date for the recruitment of patients is 31 December 2007). The study has been approved by the CEIC of the Independent Community of the Basque Country.
Topic 9: Intrauterine Contraception
P152
The Spanish Consensus Conference on clinical management of intrauterine contraception
F. Martínez San andrés, E. López Arregui, R. Lertxundi Barañano, M. A. Gómez Martínez, J. V. González Navarro, and E. Yáñez González
Spanish Society of Contraception, Madrid, Spain
Introduction Controversies were observed on IUD practice and low use rate in Spain of this highly effective and safe contraceptive method. Existing evidence justified to hold a Consensus Conference to draw recommendations for clinical use based upon critical analysis of evidence.
Method A systematic review of 974 references up to July 2001 by an expert group; public discussion by expert panel; the jury issued a consensus statement upon: (1) Contraceptive efficacy of IUDs; (2) Contraindications of IUDs; (3) IUD user management prior, during and after IUD insertion (level of evidence according to Grimes, 2000, in brackets).
Results The final consensus statement included among others:
(1) Contraceptive efficacy of today's IUDs. There is no conclusive evidence on contraceptive mechanism. IUD acts mainly by a foreign-body reaction, toxicity to gametes, thus preventing fertilization. Copper bearing-IUDs present a dose related efficacy. LNG-IUDs produce deciduous reaction and atrophy in the endometrium. Main contraceptive mechanism is pre-conceptional, not abortifacient (I). High loaded Copper-IUDs (>300 mm2) present high contraceptive efficacy with annual failure rate ≤1%. Low loaded copper-IUD use is not justified. LNG-IUD contraceptive efficacy is similar to Copper-IUDs (>300 mm2) (I). Contraceptive efficacy of Copper-IUDs can be affected by: age >40 (do not need to remove IUD until menopause) (II-2); health provider skill; expulsion rate and type of IUD; Similar efficacy among nulliparous and parous women (II-3).
(2) Contra-indications related to parity: the following are not contraindications: nulliparity IUD use per se does not impair future fertility (II-2); Prior ectopic pregnancy; immediate post-partum; after 4 weeks post-partum; after spontaneous or induced abortion of first or second trimester (II-1); Prior Pelvic Inflammatory Disease (PID) in the absence of pathogens in the genital tract (II-1). Wilson's disease, coagulation disorders, anaemia … for LNG IUD. The following are contraindications: current puerperal sepsis; septic abortion; current PID; current Sexual Transmitted Disease (STD). Known or suspected pregnancy, wearing another IUD, uterine bleeding of unknown origin, greatly distorted cervical or uterine cavity, congenital or acquired, acute genital infection active, genital neoplasia (excluding breast cancer), post-partum or post-abortion endometritis.
(3) IUD user management:
Prior to IUD insertion Appropriate counselling, complete anamnesis, STI assessment, usual gynaecological exam, advisable written consent form, other exams if required.
During insertion At any time in the menstrual cycle, if it is reasonably certain the woman is not pregnant; beneficial effect of NSAIDs, Misoprostol®, topical anaesthesia (II-3), careful no-touch technique, prophylactic antibiotics are not recommended for routine IUD insertion.
Follow-up A control visit after 1–2 months is recommended; no advantages of routine ultrasound exam versus clinical assessment; important to offer the possibility of contact if symptoms are present (pelvic infection, pain, persisting menstrual abnormalities, missed period or non-palpable threads).
Troubleshooting Pregnancy: according to site of implantation, discuss women intention; if ectopic, IUD removal unnecessary; low placed IUD: as long it is intrauterine, it is not necessary to remove.
P153
Levonorgestrel-releasing intrauterine system in the treatment of menorrhagia
S. Goncalves, S. Saleiro, C. Frutuoso, and C. F. Oliveira
Hospitais da Universidade de Coimbra, Coimbra, Portugal
Introduction Menorrhagia is a frequent motive for consultation. Medical therapy is often ineffective and surgical intervention is required. In addition to contraceptive efficacy, the levonorgestrel-releasing intra-uterine system (LNG-IUS) also shows benefits in controlling abnormal menstrual patterns, expanding medical treatment options for menorrhagia.
Objective To assess LNG-IUS efficacy in the treatment of menorrhagia.
Material and methods This is a retrospective study of 157 patients treated with LNG-IUS for menorrhagia control as the primary indication, between January 2001 and December 2006, at the Department of Maternal Medicine, Genetics and Human Reproduction.
Results Of the 157 patients, the ultrasound study showed that 55 (35%) had adenomyosis and 15 (9.5%) myomas. The age of patients varied between 27 and 53 years (mean age 41.3 years): 97% were multiparous and 25% nuliparous. At the 1-year assessment, 53 (33.8%) women were amenorrheic, 95 (60.5%) had menstruation with normal duration (between 2 and 7 days) and only 9 (5.7%) maintained menstruation with an average duration of 11 days. Twenty patients (12.7%) underwent hysterectomy and the histological study showed myomas in 8 (40%), adenomyosis in 6 (30%) and adenomyosis and myomas in 6 (30%). The device was removed in 10 women (6.4%), 6 for persistence of menorrhagia, 2 for menopause, 1 who wished to get pregnant and 1 for pelvic pain. The device was expelled spontaneously in 3 patients and 4 patients developed ovarian cysts but none needed surgical intervention.
Conclusion In line with previously published studies, the authors conclude that LNG-IUS is an effective method for the therapy of menorrhagia, and thus an important alternative to hysterectomy.
P154
Pelvic actinomycosis associated with intrauterine contraceptive device – a case report
C. Iavazzo1, N. Salakos2, K. Bakalianou2, G. Vorgias1, T. Akrivos1, and C. Papadias2
1Gynecology Unit – METAXA Memorial Cancer Hospital, Piraeus, Greece, and 22nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
Purpose The aim of our paper is to present a case of actinomycosis mimicking adnexal tumor in a 51-year-old woman with a long-term intrauterine device use. The etiology, clinical presentation associated with Actinomycosis and treatment of the disease are also discussed after a review of the literature.
Case A 51-year-old woman, para 2, gravida 2 with diabetes mellitus type 2 presented to our clinic with lower abdominal pain, menorrhagia the last three months and constipation. The transvaginal ultrasound revealed six uterine fibroids with uterine dimension 17.4 cm. The right ovary was normal but the left one revealed a cystic lesion with solid particles (diameter 6 cm). The Douglas space was free of peritoneal fluid. The CA125 reached 93 U/ml. It should be mentioned that the woman had used an intrauterine copper device for contraception for over 5 years which she took away three months before her symptoms. She underwent an explorative laparotomy due to the ovarian mass and an abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Postoperatively she received cephalosporine plus metronidazole for five days. The histological biopsy revealed uterine fibroids and the presence of an abscess with Actinomyces hyphae in the left ovary. Six months later her follow-up showed no recurrence.
Conclusion Pelvic actinomycosis could mimic pelvic malignancy and is strongly associated with the long-term use of intra-uterine contraceptive devices. Surgical removal of infected mass and antibiotic therapy is the proposed treatment.
P155
Persistence of petrified IUD in urinary bladder during 5 years – case report
S. Milosevic, A. Kapamadzija, and J. Vukelic
Clinic of Obstetrics and Gynecology, Clinical Center Vojvodina, Novi Sad, Serbia
Aim A case report of incorrect insertion of IUD in urinary bladder instead of uterus is presented.
Case report Patient S.D, 33 years old, 1 vaginal delivery, 4 abortions, had been admitted to our department with complaints – dysuria and chronic pelvic pain which lasted since insertion of IUD five years ago, but got worsened in the past few weeks. On admittance to the hospital blood analyses were in order, but urinalyses showed a lot of bacteria, leucocytes and erythrocytes, urinoculture was negative. A lot of different bacteria were found in vaginal smear. Ultrasound showed the echo of IUD at the level of uterus, but it was not placed in the uterine cavity. Cystoscopy showed calculus in the bladder, dimensions 5 ×3 cm, no signs of IUD. On the CT scan the old perforation of urinary bladder was described without signs of IUD. X ray showed IUD on the level of uterovesical fold. Hysteroscopy was performed and IUD was not seen in the uterus. Since on diagnostic laparoscopy IUD was not found in the abdomen, laparotomy was performed and the hidden perforation of urinary bladder was found on its upper wall, which was covered with omentum partially protruding in the bladder. Incision on the bladder wall was made and petrified formation was found, pear-like shaped, dimensions 5 × 3 cm. Patho-histological finding confirmed clinical finding of petrified IUD. Sutures were made on the bladder and the recovery of the patient went well.
Conclusion Perforation of uterus during insertion of IUD is a rare complication. Health of a patient could be seriously endangered if this is not recognized on time. Regular gynaecological controls after insertion of IUD are of essential significance in order to prevent complications which could become serious problems for patients life quality and health.
P156
Tubo-ovarian abscess as a complication of intrauterine contraception
M. Berisavac, R. Argirovic, V. Milenkovic, R. Sparic, and N. Markovic
Institute for Gynecology and Obstetrics Clinical Center of Serbia, Belgrade, Serbia
Objective Intrauterine contraceptive devices represent a significant risk factor for occurrence of pelvic inflammatory disease, especially with younger women with a great number of sexual partners. Additional risk factors are the type of the device, the period of usage, age, marital status, parity and health awareness. Pelvic inflammatory disease can lead to the formation of tubo-ovarian abscess, which, in some cases, is necessary to be treated surgically.
Design and methods The retrospective study encompasses all the patients with intrauterine contraceptive devices who were hospitalized during the year 2006 due to pelvic inflammatory disease.
Results During the test period there were 16 patients all treated parenteraly with two to three antibiotics (cephalosporins, aminoglycosides, metronidazole and hynolons). All the patients in the tested group were pluripara with 3 to 7 abortions, which was the determining factor for the choice of intrauterine device as a contraceptive method. The tubo-ovarian abscess occurred in 10 cases, which all underwent surgery. Intra-operatively taken microbiology samples were sterile in 8 cases.In two cases Escherichia coli and Streptococcus were isolated. Two patients had T shaped intrauterine devices and the others had Margulis like non-medicated devices. The patients in this group were 36 to 47 years of age (average 40). The average usage of contraception was 11.1 years (from 4 to 21). In six cases the peIvic inflammatory disease was treated conservatively. The average age in this group was 41.6 years (from 31 to 52). The average usage of this type of contraception was 9.8 years (from 3 to 20). The increased risk for the occurrence of pelvic inflammatory disease of nulliparous intrauterine contraceptive device users younger than 25 with a great number of sexual partners has not been found in the tested group.
Conclusion The prevention of tubo-ovarian abscess with the intrauterine contraception users implies detection of infection prior to insertion of the device as well as regular check-ups after that. Every spotted infection should be treated prior to application of intrauterine device. In case of infection after the application, the adequate antibiotic therapy has a great importance in prevention of complication occurrence, which explains the sterile bacteriological result in 8 cases in the examined group. The average period of intrauterine device usage in this study does not imply the increased risk of complication occurrence in the first months of the usage, which is explained by the sample size.
P157
Missing IUD – recovery of an unusual coil
M. Manoharan, L. Campbell, and K. Erskine
Homerton University Hospital NHS Foundation Trust, London, UK
It is very unusual for a stainless steel IUD to have been used in the western world. We report one such case of retrieval of fragments of a possible stainless steel IUD in a post menopausal woman.
A 59-year-old Afro-Caribbean woman presented for removal of a coil inserted 20 years previously. She was a Para 10 with all normal vaginal deliveries. She had attained menopause four years ago and was not on HRT. She gave no history of postmenopausal bleeding or discharge. An ultrasound scan showed a bright linear echo suggestive of an IUD noted at the fundus of the uterus. On examination, coil threads were not visible and attempts made to remove the coil under cervical block failed. She had a hysteroscopy where no definite coil was seen but 2 metallic foreign bodies were removed from the fundus which on analysis showed it to be made of stainless steel.
Intrauterine contraceptive device is the world's most widely used method of reversible birth control. But its history has been chequered. Grafenberg, designated the father of IUD, in 1929 devised the first IUD by wrapping silk worm gut with ‘German Silver’. He called it the ‘Grafenberg Ring’ but the demise of the Ring followed shortly due to reports of pelvic infections and high failure rates. A modification of the Grafenberg ring, made of coiled stainless steel, called the ‘Shanghai ring’ was developed in the 1970's in China and was one of the most widely used intrauterine contraceptive devices. It has since been banned due to high failure rates of up to 10% per year. It measures an inch in diameter and is springy and flexible. It does not have a thread attached to it and is removed with a special hook.The foreign body removed from our patient was probably a stainless steel IUD inserted 20 years ago.
Long term use of IUDs may be associated with problems like vaginal bleeding and difficulties in removal. Following long term insertions, concretions, corrosions, fragmentation and thinning of the device can occur. Entrapment and embedding, secondary to shrinkage of the endometrial cavity and atrophy of endometrium can also occur. Ultrasonography has been recommended to establish the location of lost IUD's within the uterus. Most ‘apparently lost’ IUDs can be both located and safely removed using hysteroscopic aid.
Our case report demonstrates that not only can patients with retained IUD's present in a number of ways but also that retrieval of lost IUD can prove difficult. As clinicians we must acknowledge that family planning practices have changed over time and differ between different cultures and countries.
P158
Intravesical migration of a Copper T intrauterine device with calculus formation in a postmenopausal woman: A case report
R. S. Karadeniz, M. Metin Altay, Y. Bayoglu Tekin, M. Dadali, and A. Haberal
Ministry of Health, Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
We report a postmenopausal case with intravesical migration of the intrauterine device (IUD) with secondary calculus formation. Two years after menopause, she applied to our department with complaint of abnormal vaginal bleeding. By transvaginal ultrasonographic examination we detected an IUD in the bladder. The patient had a history of an IUD insertion 25 years ago. After 5 years the IUD removed then she had given birth her last child. One year after birth, at about 18 years ago, another IUD had been inserted to the uterus. It was learned that she had difficulty of voiding and burning sensation, and urgency for the last two years. Intravesical migration is a rare complication and it is usually symptomatic, causing pelvic pain and irritative voiding symptoms. Usually the patients diagnosed during their fertile ages. Our case was the latest removed device in the literature since it was diagnosed and removed after 18 years.
P159
Levonorgestrel-releasing intrauterine system for treatment of endometrial hyperplasia: long-term follow-up
O. Shawki, M. Aboulghar, and W. Sherbini
Cairo University, Cairo, Egypt
Objectives Levonorgestrel (LNG), intrauterine delivery system has a prominent and profound effect on the histopathology of endometrium. The aim of the study was to use a LNG intrauterine system to treat non-atypical and atypical endometrial hyperplasia in women and to evaluate the long-term cure rate.
Methods Each of the 12 women in the study, of whom five were diagnosed with atypical hyperplasia, received a LNG-IUS, releasing 20 microg LNG/day. The study is a non-comparative study with long-term follow-up (range 12–36 months).
Intervention Ultrasound, endometrial biopsy and hysteroscopy for follow up.
Results All women developed a non pathological proliferative pattern of endometrium, except one asymptomatic woman with atypical hyperplasia who still had persistent bleeding and proved to be adenomatous hyperplasia at 16 monthes follow-up.
Conclusion Continuous intrauterine delivery of LNG appears to be a promising alternative to hysterectomy for the treatment of endometrial hyperplasia and could enhance the success rate when compared with other routes of progestagen administration as well as intrauterine progesterone delivery.
P160
Contraception and treatment of idiopathic menorrhagia with a frameless intrauterine levonorgestrel-releasing system
D. Wildemeersch1, A. Andrade2, and D. Janssens3
1Contrel Research, Ghent, Belgium, 2Centro de Biologia da Reprodução, Universidade Federal Juiz de Fora, Brazil, and 3Gynecologische Dienst, Turnhout, Belgium
Objective To review the clinical results of the frameless FibroPlant® levonorgestrel-releasing intrauterine system (LNG-IUS) for contraception.
Study design An open, prospective non-comparative contraceptive study, using FibroPlant® releasing 20 μg of LNG/d for contraception.
Results Three-hundred and fifteen insertions were performed, approximately 85% in parous women with mean age of 35.6 (range 15–51). Women with uterine pathology (e.g., fibroids, menorrhagia, polyps) were included in the study. Twenty-six insertions were performed after D&C for diagnostic reasons. This interim analysis calculated the cumulative gross discontinuation life table rates. The total observation period was 13,105 women-months with follow-up up to 5 years in a substantial number of women, the large majority of them received a replacement LNG-IUS after that period. Only one pregnancy occurred after unnoticed expulsion. The LNG-IUS was well-retained: only 6 expulsions occurred (rate 2.2 at 5 years). The cumulative total use-related discontinuation rate was 20.2 at 5 year, the majority for bleeding and pain complaints.
Conclusion This study suggests that the 20 μg/d releasing FibroPlant® LNG-IUS is a highly effective and well tolerated contraceptive. The LNG-IUS is effective in reducing menstrual blood loss in normally menstruating women as well as in women with idiopathic menorrhagia. The authors agree with the recommendations by the UK National Institute for Clinical Effectiveness (NICE) and the new Finnish guidelines for menorrhagia that the LNG-IUS should be positioned as first-line treatment prior to endometrial ablation or hysterectomy.
P161
Levonorgestrel-releasing intrauterine system in the treatment of adenomyosis
S. Saleiro, S. Goncalves, T. Rebelo, and C. Freire de Oliveira
University Hospital of Coimbra, Coimbra, Portugal
Introduction Adenomyosis is associated with menorrhagia and pelvic pain. The most effective treatment is hysterectomy, since medical treatment and endometrial ressection and ablation are associated with high failure rates. Although sucess rates of the levonorgestrel-releasing intrauterine system (LNG-IUS) to treat menorrhagia are lower than those achieved with histerectomy, LNG-IUS has the advantage of causing much less morbidity and patient disconfort. The LNG-IUD has been shown to reduce menstrual blood loss by 74% amd 97% at 3 and 12 months in women with menorrhagia with minimal systemic side effects.
Objectives To evaluate the clinical effects of LNG-IUS on adenomyosis.
Material and methods A retrospective study was performed on 68 patients with adenomyosis treated with LNG-IUS, between January 2001 and December 2006.
Results Average age at the time of insertion was 42.9 years (range 30–51). Ninety seven percent of the patients were multipara and 3% were nulipara. The LNG-IUS was inserted on 14 patients (21%) with adenomyosis and on 54 patients (79%) with adenomyosis and menorrhagia. Of the 68 women, 74% reported amenorrhea or oligomenorrhea, 22% had a moderate and regular flow and just 4% had no significant reduction on menstrual flow. Only 3% of the women maintained dysmenorrhea but with releaf of the symptoms and 97% showed no dysmenorrhea. After 1 year follow-up, 48 patients have done transvaginal sonography and in 78% there were no signs of adenomyosis and in 21% of the patients the signs of adenomyosis were still present. There were no cases of pregnancy or ectopic pregnancy after the insertion of LNG-IUS. Fourteen patients were submitted to hysterectomy and hystological evaluation showed adenomyosis in 5 patients (36%), adenomyosis and myomas in 5 (36%) and only myomas in 4 (28%). The average time LNG-IUS inserted was 34.1 months (range 3–60). Only 6 patients experienced side effects that required removal of the device. Pelvic pain (1 patient), weight gain (1), menometrorrhagia (4) were the most frequent adverse reactions. The device was expelled spontaneously in 2 patients and 5 patients developed ovarian cysts but none needed surgical intervention.
Conclusions The LNG-IUS is safe and effective in controlling bleeding and pain in patients with adenomyosis and is a good alternative to surgical treatment. LNG-IUS also provides effective contraception and has low rates of adverse reactions.
P162
Cu-IUCD and accidental pregnancy. Twenty years experience
T. Theodoridis, A. Zavlanos, D. Vavilis, I. Stergioudas, K. Papavasiliou, and T. Karagiannis
11st Department of Obstetrics & Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece, and 2Family Planning Clinic, Thessaloniki, Greece
Objective The estimation of the failure of IUCD regarding accidental pregnancy rate.
Material and methods During the period 1986–2006, 8785 Cu-IUCD were fitted in 6752 women (mean age 33.68±6.72 range 17–51 years). The types of IUCD were Multiload MLCu-250 = 2920, MLCu-375 = 1132, Nova-T = 670, Graviguard = 545, Anti-Con = 715, Omega = 2800 and Cu-sort = 3. The insertion of IUCD was performed at the end of menstruation by the same team of Gynaecologists. A follow-up appointment performed after one month and then every year. At the same time oral instructions were given to the women for self-examination after every menstruation.
Results During this period of 20 years, 6752 users completed 242,525 months of use. Hundred and five accidental pregnancies occurred (Pearl Index = 0.519). Fifty three per cent of accidental pregnancies occurred during the first year of use. In all cases termination of pregnancy was done.
Conclusion Cu-IUCD provides high contraceptive protection and the accidental pregnancy rate is very low. IUCD insertion at the end of menstruation, self-examination and regularly checks by physicians contribute to low IUCD failure rate.
P163
Screening and antibiotics before IUD insertion reduced PID
K. Stefanidis, P. Drakakis, V. Anastasiadou, D. Loutradis, and A. Antsaklis
Family Planing Unit.Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, Athens, Greece
Background It is believed that much of the small increased risk for developing pelvic inflammatory disease (PID) associated with the use of an intrauterine device (IUD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion.
Objective The aim of this study was to evaluate the effectiveness of (a) Identifying women with cervical infections and treat before IUD insertion, and (b) 200 mg of doxycycline (versus placebo) given orally at the time of IUD insertion in reducing the incidence of PID during the five years of IUD use.
Methods 600 women in Alexandra Hospital, Athens, Greece were evaluating the effectiveness of identification and treatment of cervical infection before IUD insertion and also the effectiveness of 200 mg of doxycycline given orally at the time of IUD insertion.
Results The incidence of PID was zero in five years follow up.
Conclusion Aseptic conditions during IUD insertion, follow-up visits with short intervals to monitor health, and treatment of opportunistic infections may have reduced the potential of PID within this population.
P164
Intrauterine system: Contraception and what else?
A. Rita Pinto, A. Lebre, S. Fraga, M. Brandão, O. Rodrigues, and R. Magarinho
Maternidade de Júlio Dinis, Porto, Portugal
Objective The intrauterine system (IUS)- Mirena® is a small T-shaped plastic device that slowly releases the hormone levonorgestrel (20 μg daily). It is effective for five years and can be used as a contraceptive as well as a therapeutic method. The aim of this study was to review indications and short term consequences of IUS introduction between 2005 and 2007.
Design and methods Retrospective study of the 212 IUS introduced between 1 January 2005 and 31 December 2007. The variables considered were women age, parity, former contraceptive method, past medical history, indications of use and immediate and short term complications (until 3 months after the introduction).
Results Mean age was 42.5 years. Out of the 212 IUS introduced, 45.3% (n = 96) of women were in perimenopause. Main indications for its use were menorraghias (60.8%, n = 129) and other irregular menstrual patterns (14.2%, n = 30). The incidence of women that combined contraceptive with therapeutic method was high (80.2%, n = 170), the remaining women used it only as a contraceptive method (9.4%, n = 20) or therapeutic (10.4%, n = 22). Women morbidity was low and is still being reviewed, as the last IUS were introduced past December.
Conclusions The IUS proved to be a highly effective contraceptive method, safe, well tolerated and with minimal side effects. Its non-contraceptive benefits, namely its action on the menstrual pattern was of major relevance, since it was effective in the treatment of menstrual irregularities and associated symptoms. Its short term consequences are still being reviewed.
P165
Contraception with Levonorgestrel intrauterine system (Mirena®) versus metal alloy-containing intrauterine devices
O. Hoxhaj, D. Bajraktari, M. Alushani, and F. Kopani
OG University Hospital ‘Queen Geraldine’, Tirana, Albania
Objective The aim of this study was to compare the effectiveness and the benefits of the contraception with Levonorgestrel Intrauterine System versus Metal Alloy-containing IUD.
Methods Randomized controlled study conducted between January 2004 and September 2007, enrolling 409 women using Metal Alloy-containig IUD and 313 women using Levonorgestrel IU System.
Results During use both systems provide excellent contraception, both of them have very low pregnancy rates, less then 0.2 per 100 women-years and protect against ectopic pregnancy.
The risk for PID in the women using both systems was the same as in general population.
There were no increased risk for infertility and women using both systems gave birth after IUD removal. Women using Metal Alloy-containing IUD report an increased menstrual bleeding and spotting whereas the other system by releasing levonorgestrel reduced menstrual bleeding and cramping. In several cases the Mirena® has been used to treat heavy menstrual bleeding.
Conclusion The Levonorgestrel IU System not only provides an effective contraception but also offers a painless, efficient treatment for heavy menstrual bleeding.
P166
Mirena® – our experience
M. Tîrnovanu and C. Trifan
University of Medicine and Farmacy -Gr.T. Popa-, Iasi, Romania
Objective To establish clinical uses for Mirena® in our clinic.
Materials and methods We had between January 2005–December 2007 33 women with option for Mirena®, with age 30 to 47 years. After age of 35 years we always made for uterine bleeding endometrial biopsy.
Results There were 5 groups of patients with different indications: only 3 for contraception – age 30–40 years, 9 with heavy or prolonged menstrual period (idiopathic menorrhagia) without response at hormonal treatment – age 36–43 years, 4 with endometrial hyperplasia – age 39–46 years, 14 with fibroids and bleeding – age 32–45 years and 3 with fibroids which want to avoid major surgery – age 39–47 years. Mirena® achieves a significant reduction in menstrual blood in 3 months of treatment. For patients with endometrial hyperplasia Mirena® controlling the monthly development of the womb lining, making it thinner, so in 6 months the endometrium becomes normal. For patients with fibroids in 1 year dimensions decreases very much.
Conclusions In our study Mirena® was used special for excessive uterine bleeding and the purpose of contraception is the second. We think that fibroids may be an indication for Mirena® at patients those doesn't choose surgical option.
P167
Rationale for the development of an improved LNG-IUS with long duration of action
D. Wildemeersch
Contrel Research, Ghent, Belgium
Objective To review the insertion-related aspects, contraceptive performance, effect on menstrual blood loss and duration of action of the new T-shaped Femilis® levonorgestrel-releasing intrauterine system (LNG-IUS).
Study design An open, prospective non-comparative contraceptive study, using Femilis® releasing 20 μg of LNG/d for contraception and treatment of idiopathic menorrhagia in parous and nulliparous women.
Results The rationale for the development of the Femilis® LNG-IUS will be discussed as well as the results of an ongoing clinical study. The previous report reviewed the results in two- hundred and thirty-five insertions performed in women seeking contraception, 143 (60.8%) parous and 92 (39.2%) nulliparous women. An update will be given during the current ESC congress.
Conclusion The Femilis ®LNG-IUS is an effective contraceptive, is easily inserted and has a significant impact on menstrual blood loss. The simple and safe insertion procedure could be an advantage for use by non-specialist providers such as nurses, midwives, general practitioners, and for those not inserting intrauterine devices regularly.
P168
Non-contraceptive advantages of IUS-LNG – case reports
J. Jenícek and T. Fait
1Lekarsky dum Praha 7, a.s., Climacteric Medicine Center, Prague, Czech Republic, and 2Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and General Faculty Hospital, Prague 2, Prague, Czech Republic
Introduction Application of intrauterine system with levonorgestrel (Mirena®) is advantageous contribution to individualization of hormonal replacement therapy (HRT). Mirena® together with systemic estrogen therapy protect sufficiently from endometrial proliferation, without general negative side effects of progestins. In period of pre-menopause and peri-menopause Mirena® provides reliable contraceptive effect and helps to reduce possible difficulties associated with menstrual cycle irregularities.
Case number 1 Mrs. E.B. born in 1956 with negative medical history including gynecological history, only after 2 spontaneous labors. Mirena® inserted in 2004, no menstrual bleeding afterwards. My first control in January 2007 – patient stated approximately 3 months of climacteric symptoms. Mammography performed – negative, gynecological exam – negative, vaginal ultrasonography (US): IUD well located, no cysts on ovaries, endometrial thickness 2.7 mm, FSH 38 IU/l, Kupperman index 22. Another visit in February 2007 – Oestrogel started (1x doser). In control in April 2007 patient subjectively satisfied, climacteric symptoms retreated, Kupperman index 9, no bleeding, vaginal US: endometrial thickness 3.4 mm, continued with same dose of Oestrogel.
Case number 2 Mrs. J.K. born in 1960, with negative medical history including gynecological history, just intolerance of progestin therapy. 3 years of heavy menstrual bleeding for 7 days. In April 2007 she had a hysteroscopy and subsequently thermo-ablation of endometrium with recurrence of the same intensity and length of menstrual bleeding after 2 cycles. US showed endometrial thickness 13mm one day before menstruation. In August 2007 IUS-LNG applied, 1st cycle: 3 days of spotting, 5 days of weaker menstrual bleeding. 2nd cycle: 2 days of spotting and 3 days of weak menstrual bleeding. 3rd cycle: 2 days of spotting and 4 days of weak menstrual bleeding, menses always painless.
Conclusion Usage of IUS-LNG (Mirena®) in further indications may bring higher benefit to patients and increase their quality of life. Its application as a part of hormonal treatment has already become usual; its usage for improvement of menstrual cycle disorders is perspective, cheap and minimally burdening for the patient.
P169
Is there any risk for infection in patients with IUD?
M. Bogavac, G. Relic, and A. Mitreski
1Clinical Centre Vojvodina, Department of Obstetrics and Gynaecology, Novi Sad, Novi Sad, Serbia, 2Medical faculty, Priština Health Center Kosovska Mitrovica, Kosovska Mitrovica, Serbia, and 3Private Unit of Obstetrics and Gynaecology ‘Minerva’, Novi Sad, Serbia
Introduction Urogenital infections with Chlamydia trachomatis belong to the most prevelent sexual transmitted diseases worldwide. The risk factors for the development of inflammatory pelvic diseases include the use of IUDs.The IUD is a major precipitant for pelvic inflammatory disease, initiated by Chlamydia trachomatis. Out of hypothetic risk factors the low socioeconomic status, history of sexual contacts with multiple partners and use of intrauterine devices (IUD), were significantly associated with CT infections.
Aim To investigate the incidence of chlamydial infections in IUD users.
Study design The chosen sample underwent testing by a direct immunoflorescence method of determining the Chlamydia trachomatis antigens in endocervical smear.
Results Three years investigation comprised a sample of 16.792 women's, including 893 IUD users. Most of the patients with positive chlamydial infection were at the age of 21–30. The Chlamydia trachomatis infection was recorded in all age groups. These infections were significantly more frequent in IUD users 233 of 893 (26.04%).
Conclusion It can be concluded that this method of examination of the cervical smear should be introduced as a routine in gynaecological examination of the IUD users. For successful diagnostics of infectionwith Chlamydia trachomatis, it is necessary to apply a direct method of determining the cause of infection from the cervical smear and the indirect method of determining the specific antibodies in the serum. The testing of chlamydia trachomatis should be recommended as a routine method before the IUD insertion.
P170
Pregnancy and complete abortion following switching from Combined Oral Contraception to Levonorgestrel Intrauterine Contraception
O. Ohizua
Walsall Hospitals NHS Trust/Walsall Primary Care Trust, Walsall, West Midlands, UK
Case report This is a case report about a 40-year-old female who had an undiagnosed pregnancy while ‘correctly and consistently’ using Combined Oral Contraceptive Pills (Microgynon-30 Levonorgestrel 150 mcg/Ethinyl Estradiol 30 mcg), then switched her contraceptive method to the Mirena®/Levonorgestrel Intra-uterine system(IUS). Thirteen days after having the Mirena® IUS fitted, she had heavy vaginal bleeding and abdominal pains. She passed some tissue vaginally and the histology of which showed ‘chorionic villi’-evidence of an ongoing intrauterine pregnancy present at the fitting of the Mirena® IUS. A pelvic ultrasound scan confirmed a complete Abortion.
Discussion The Wold Health Organization Selected Practice Recommendations1 for timing the insertion of intrauterine devices states that intrauterine devices can be fitted any time in the menstrual cycle, provided pregnancy can be reasonably excluded. It also lists certain criteria2 that must be present for this to be valid.
The potential risks of an undiagnosed pregnancy being present when switching from combined oral contraception to a Mirena® IUS is discussed. There is a need to include this in the counselling process as well as advising patients to use extra precautions, abstinence or reliable contraception if the intrauterine system is fitted outside the recommended day 0–7 of the menstrual cycle and if unprotected sexual intercourse is to occur within 7 days of fitting intrauterine contraception.
The possibility of an abortion or pregnancy-related complication in patients presenting with unusually heavy vaginal bleeding and abdominal pain after fitting intrauterine systems must also be considered in the differential diagnoses.
P171
The levonorgestrel-excreting releasing-system ‘Mirena®’ as a method of contraceptive choice of the women with menstrual disorders
M. Khamoshina and T. Novikova
1Vladivostok State Medical University, Vladivostok, Russian Federation, and 2Primorsky Region Diagnostic Center, Vladivostok, Russian Federation
Objective The study of the medical advantages and acceptabilities of the levonorgestrel-excreting rilizing-system ‘Mirena®’ in the group of the women with menstrual disorders.
Design and methods For the studies 78 women aged from 23 to 50 years and users of ‘Mirena®’ from 3 to 62 months were questioned. The study was conducted in 2002–2007. For statistical data processing the Statistica (StatSoft Inc., USA) was used. Verification of the qualitative signs change was performed by univariate analysis of variance, the difference between compared values – by differential test for proportion and average. The difference declared significant as p < 0.01. Results: The analysis has shown that the secondary dysmenorrhea (49.1%) and intense and frequent menstruations with irregular cycle (28.3%) were dominated in the structure of the menstrual disorders. These diseases were revealled in 74.3% and 42.9% of observations accordingly. The choice of 74.4% of women in favour of ‘Mirena®’ was conditioned by potential medical possibilities of the releasing-system. On the background of ‘Mirena®’ using the reduction of length (from 5.53 ± 0.15 to 2.26 ± 0.23 days, p < 0.01) and painfulness of menstruation (p < 0.01), menstrual hemorrhage (p < 0.01), and average length reduction of the menstrual cycle (from 28.6 ± 0.19 to 22.5 ± 1.87 days, p < 0.01) were noted. Before introduction of ‘Mirena®’ 44.9% of women had estimated menstruations as ‘intense’, 51.3% as ‘moderate’, 3.8% as ‘scanty’, 35.9% as ‘always painful’, 44.8% as ‘sometimes painful’. During the use of the releasing-system 5.2% of users have noted ‘moderate’ menstruations (p < 0.01), 59.1% of users ‘scanty’ (p < 0.01), 1.3% ‘sometimes painful’ (p < 0.01). 29.5% of respondents had no clinical menstruations. All users were satisfied with contraceptive effect, 91.0% ‘medical’ one. 91% women are going to continue to use the system.
Conclusions ‘Mirena®’ is the best choice for women with menstrual disorders, who want to use a safe, reliable and comfortable method.
P172
A case report of a woman with double IUDs
I. Gönenç, E. Zeynep Tuzcular Vural, Ö. Güldem Öncü, N. Aka, and G. Köse
Haydarpasa Numune Training and Research Hospital, Family Planning Unit, Istanbul, Turkey
Objective The widespread use of intrauterine devices (IUDs) has presented a variety of side effects and complications. Delayed complications are menometrorrhagia, often accompanied by dysmenorrhoea, lost IUD, total or partial expulsion, ectopic pregnancy and pelvic infections (PID). The undetected expulsion is common leading to unwanted pregnancies. We find it very important to stress the management of patients with pregnancies after IUD insertions and to make sure if the IUD remained within the uterine cavity even after pregnancy termination or delivery as it usually takes little effort to diagnose their presence.
Case presentation A 30-year-old woman, gravida 2, para 2, abortion 0, presented to the family planning unit in Haydarpaşa Numune Training and Research Hospital with a plain urinary system radiogram showing two T-shaped IUDs within the pelvic region. The patient's medical history revealed that a copper-T IUD had been inserted in 1998, and that she had a normal vaginal delivery in 2005 when she was informed by her physician that she probably dropped her IUD and conceived afterwards. It was assumed that the IUD had fallen out and another copper-T IUD was inserted six weeks after her delivery. Due to her urinary tract symptoms a plain radiogram of the urinary system was planned by the urology clinic and referred to our family planning unit after the presentation of the double IUDs. The strings of one of the IUDs were observed on the speculum evaluation of the cervix. The cervix appeared hyperemic and a mild yellowish leucorrhea was observed. Physical examination was otherwise unremarkable. A transvaginal ultrasound scanning was also performed to identify if both of the devices were within the uterine cavity. The first IUD which was presented from the cervix was simply pulled out by the strings with a Kelly forceps. The second one was explored and pulled out by using a Novak endometrial curette. She was prescribed with doxycyclin 100 mg BID for 7 days along with condoms and called back for a check visit afterwards in order to discuss her future contraceptive choice.
Conclusion We wanted to stress the necessity and the value of using plain abdominal x-rays which are very economical and easily accessed all over the country, rather than our inner voices in the detection of IUDs whenever their expulsions are suspicious.
Topic 10: Long-lasting Contraceptive Methods
P173
Profile of levonorgestrel-releasing intrauterine system and copper intrauterine device users in Europe
S. Haimovich
Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Spain
Objectives To assess the user profile of women who have chosen the levonorgestrel-releasing intrauterine system (LNG-IUS) or the copper intrauterine device (Cu-IUD) as their contraceptive method in Europe.
Methods A random sample of women aged 15–49 years in 14 European countries (Spain, Italy, UK, France, Germany, Sweden, Denmark, Norway, Czech Republic, Austria, Estonia, Latvia, Lithuania, and the Russian Federation) underwent web-based or computer-aided face-to-face interviews during June 2006. Data from a subgroup of women using the LNG-IUS or the Cu-IUD were further analyzed and are presented here.
Results A total of 11,490 women participated in the full study. Of these, 404 were LNG-IUS users and 548 were Cu-IUDs users, together representing over 70% of all long-acting reversible contraceptive method-users in the full study. The majority of LNG-IUS and Cu-IUD users were over the age of 30 years, representing over 90% of women in both groups. The estimated mean age (data collected by age group) of the current users was 39.1 years in the LNG-IUS group and 39.2 years in the Cu-IUD group. A high percentage of LNG-IUS and Cu-IUD users were married/co-habiting (76% and 69% respectively) and had 2 or more children (68% and 56% respectively). The main drivers for choosing the LNG-IUS or the Cu-IUD use were convenience and recommendation by the physician. The vast majority of LNG-IUS (94%) and Cu-IUD (89%) users were satisfied with their method of choice and only 6% and 13%, respectively, were thinking of switching methods in the next 12 months. Interestingly, the Cu-IUD users experienced symptoms or physical conditions that appeared or worsened during the week of their menstruation twice as often as those using the LNG-IUS (55% vs. 28%, respectively).
Conclusions The LNG-IUS and the Cu-IUD are popular methods of contraception in Europe, particularly in older married/co-habiting women who already have children. Overall, the vast majority of users are satisfied with their contraceptive method choice.
P174
Developing a training programme for primary health care professionals for long acting reversible contraceptives (LARC)
G. Holland, A. Ni Riain, and N. Kenny
ICGP, Dublin, Ireland
Objective To design and pilot an independent, externally accredited training programme for primary health care professionals for long acting reversible contraceptives (LARC).
Design and methods The Irish College of General Practitioners is the recognized training body for general practice in Ireland. One of the responsibilities of its Women's Health Programme is to provide educational courses in women's health. No independent training is currently available for general practitioners and practice nurses in Ireland. We are in the process of designing and piloting a course on LARCs which combines theoretical and practical components. his programme is informed by review of international literature and existing educational experience within the College.
Results Development of the programme is ongoing. An educational committee was formed; educational outcomes and curriculum are being agreed (March–May 2008). Assessment standards and ongoing competence requirements are being developed (March–May 2008). Tutors will be recruited and trained (June–Sept 2008). We are preparing for both internal and external accreditation of the programme. The first intake of trainees is planned for October 2008.
Conclusions We expect that presentation of this work in progress at the conference will outline the difficulties in designing and delivering a procedures-based course in the community setting and the strategies we have developed to address them. In addition we hope that input from conference delegates will inform the evolution of the process.
P175
Menstrual bleeding profile with levonorgestrel releasing intrauterine system (LNG IUS) in late reproductive age
T. Salmi
Department of Obstetrics and Gynaecology University Central Hospital of Turku, Turku, Finland
Objective To assess the menstrual bleeding profile during late fertile years in women using levonorgestrel releasing intrauterine system (20 μg LNG/24 h).
Design and methods Open, non-comparative study in 11 sites in 4 European countries (Belgium, Finland, The Netherlands and UK). Subjects aged 46–51 years, with regular menstrual cycle and with no climacteric symptoms before insertion of the IUS were eligible. Patients were enrolled between June 2000 and June 2003 for a period of use of maximum 4 years. Menstrual bleeding was evaluated by using menstrual bleeding diaries (90-day reference periods).
Results Totally 396 subjects with mean (SD) age of 47.8 (1.42) years and mean (SD) BMI of 25.45 (4.09) (kg/m2) started the treatment. At baseline, mean (SD) length of menstrual cycles was 27.6 days (2.24) ranging from 21 to 35 days. Treatment was completed by 336 subjects while 60 subjects (15.2%) discontinued the study prematurely. The first IUS insertion was successful for 379 subjects (95.7%). Of the 15 subjects who had a second insertion attempt, second insertion was successful in 11 cases. IUS insertion was rated ‘easy’ for 84.3% of the subjects by the investigators, dilatation was used for 30.8%, Para cervical block was used for 12.6%, and other medication was given to 14.3% of the subjects. Subjects evaluation of the pain during the insertion was none by 26.5%, mild by 43.3%, moderate by 24.2% and severe by 5.8% of the subjects. No pregnancies occurred during treatment. Totally 5 (4 partial and 1 total) expulsions of the IUS were reported in 4 subjects and 1 case of migration of the IUS (in the uterine muscle) occurred immediately after insertion.
The median (Q1; Q3) for bleeding only days at reference period (RP) 1 was 19.0 days (9.0; 32.0), but after the first year of LNG IUS use, the median (Q1; Q3) was 1.0 (0.0; 8.0) bleeding only days at RP 5, and 0.0 (0.0; 1.0) for the remaining RPs until end of period of use of 4 years (RP 16). The spotting only days were more common than the bleeding only days. The median (Q1; Q3) number of spotting only days decreased sharply from 26.0 (17.0; 36.0) days at the RP 1 to 12.0 (6.0; 20.0) at RP 3. Thereafter, the number of spotting only days decreased steadily from the median of 10.0 spotting only days (4.0; 16.0) in RP 4 to the median of 0.0 spotting only days (0.0; 7.0) in the RP 16.
Conclusions Continuation rate was high as only 15% discontinued the study prematurely. After the 1st year use of LNG IUS, number of menstrual bleeding days decreased near to zero, while spotting was more common and continued to decrease more steadily after a sharp decrease during the 1st year.
P176
Nurse training in intrauterine device/systems insertions and removals
A. Eady and M. Gormley
Margaret Pyke Centre, London, UK
Objectives There is a recognized need to broaden the provision and availability of contraceptive services that are both efficient and cost effective. Our aim is to show that nurses can have a role in providing long-acting contraceptives after suitable instruction.
Methods After receiving appropriate training by medical colleagues to fit and remove IUD/IUS, we subsequently developed a nurse-led clinic, which we have run largely independently. As colleagues became interested in this initiative, we decided to introduce a training course for nurses which has involved the input from both doctors and nurse specialists.
Results The first course was held in London in 2004. Since then the courses have taken place biannually in London, and annually in other centres in the UK. Of the 260 nurses enrolled in these courses, more than 160 have been accredited by the Royal College of Nursing. These nurses were also required to complete a standard period of practical training under the supervision of a doctor with a recognized teaching qualification. A number of nurses are now able successfully to run their own nurse-led clinics.
Conclusions With appropriate training, nurses can have a major role in providing long-acting contraception including IUD/IUS. This has immediate benefits in cost effectiveness and in reducing the burden placed on medical staff within contraception clinics. It also impacts on nurses’ career development and job satisfaction.
P177
Profile of long-acting reversible contraceptive methods users in Europe
S. Haimovich
Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Spain
Objectives To assess past contraceptive usage, awareness of and satisfaction with their chosen method, and sexual and reproductive behaviour of women using long-acting reversible contraceptives (LARC) in Europe.
Methods A random sample of women aged 15–49 years in 14 European countries (Spain, Italy, UK, France, Germany, Sweden, Denmark, Norway, Czech Republic, Austria, Estonia, Latvia, Lithuania, and the Russian Federation) underwent web-based or computer-aided face-to-face interviews during June 2006. Here we present data from a subgroup of women using LARC methods.
Results At total of 11,490 women participated in the full study. Of these, 1,188 women were LARC (hormonal implant, injection, levonorgestrel-releasing intrauterine system (LNG-IUS), copper intrauterine device (Cu-IUD)) users. Over 50% of LARC users were over the age of 30 years. Furthermore, more than 50% of LARC users found their convenience an extremely important factor when selecting it as a contraceptive method. The profile of LARC users is presented in the table.
Conclusions LARCs are popular methods of contraception, particularly among European women aged over 30 years. The majority of LARC users were satisfied with their chosen method; in particular LNG-IUS users were most satisfied among other LARC method users. Overall, the majority of users found the convenience of LARCs their most appealing feature.
Table. Profile of LARC users
Topic 11: Male Contraception
P178
Contraceptive effect of Centella asiaticain male mice
M. Mat Noor, N. Zainal Abidin, M. Aina Manan, and D. Siri EE
Universiti Kebangsaan Malaysia, Selangor, Malaysia
Contraceptive plants that were introduced by folk in traditional remedies are investigated worldwide. The objective of this research was to study the contraceptive effects of Centella asiatica aqueous extract in mice at four different doses; 25 mg/kg, 50 mg/kg, 100 mg/kg and 300 mg/kg body weight respectively. Control group was treated with distilled water. All treatments were by force-feeding, daily for 45 days. Marked decreases in sperm count and motility were found in sperm collected from cauda epididymis of treated mice. The treatment however did not affect sperm viability and morphology. Histological analysis revealed signs of inhibition of testicular cells development at doses of 100 mg/kg and 300 mg/kg, as the lumen of seminiferous tubules were full with spermatocytes and spermatids. The present results show that the plant has antispermatogenic effect in mice. It is therefore, suggested that the aqueous extracts of Centella asiatica possess antifertility activity in male reproductive system.
P179
Soldiers approve of family planning methods but they don't use them
S. Mucuk1, H. Zincir1, T. Ozkan1, M. Baser1, and S. Topuz2
1University of Erciyes Atatürk School of Health, Kayseri, Turkey, and 2University of Baskent, Faculty of Health Sciences, Ankara, Turkey
Aim The aim of this study was to determine soldiers' opinion and attitudes about family planning.
Methods This study includes privates discharged from the Zincidere 1st Commando Brigade, Kayseri, Türkiye in January, 2005. The study was composed of volunteers (n = 495) who were present at their Brigade at the time of the research. Data were collected with a questionnaire.
Results The average age of the soldiers was 21.9 ± 0.9 and 87.1% of them was single and 50.7% had primary school education. As the education level increased (high school and ↑) so did condom use (100%) and so did the approval of family planning (p < 0.05). It was found out that those who lived in city-centers (34.3%) and those married (55.6%) used any of the family planning methods (p < 0.05). The condom use was mostly preferred by the single individuals (97.3%) (p < 0.05). Seventy two percent of the married stated that they decided the family planning methods with the spouses (p < 0.05). It was learnt that those living in city centers (93.2%), those with a high income level (88.4%), the single privates (88.0%) think that both spouses (wife and husband) should take the responsibility to prevent pregnancy (p < 0.05).
Conclusions The results of this study show that although approval of family planning methods is relatively good, they are not widely used.
P180
No-scalpel vasectomy an outpatient simple and safe procedure
M. Gomes Vilela, R. Stryjer, Z. Mamman, J. Gilberto de Castro e Silva, and J. Lúcio dos Santos Júnior
Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Minas Gerais, Brazil
Objective Vasectomy is a safe, simple and efficient method of permanent masculine contraception, and, when compared to tubal ligation, is proven to be safer, more efficient and less expensive.
In recent years, 30% of all vasectomies in the United States were performed without scalpel; this surgical intervention is called no-scalpel vasectomy (NSV). NSV was performed by gyneco-obstetricians and other specialists in many countries and due to its relative simple performance it encouraged family physicians and general practitioners to prefer this procedure over invasive procedures. Because of its simplicity, it could be performed as an out-patient procedure The aim of this study was to evaluate NSV as a permanent contraceptive method as an out-patient procedure.
Design and methods A retrospective study was performed in order to evaluate NSV as a permanent contraceptive method in a family planning service as an out-patient procedure, performed by gynecolo-obstetricians and general practitioners. The medical records of all patients (213 patients) who underwent no NSV during the 2001–2004 were retrieved from the patient archives Family Planning Service of the Municipal Hospital of Ituiutaba, Minas Gerais, of the Department of Gynecology and Obstetrics of the Federal University of Minas Gerais. The charts were carefully reviewed for demographic data and patient medical history, intervention results and post-operative complications.
Results According to charts registration a total of 213 patients, aged 25–55 (mean age 33.4 ± SD = 5.96), were submitted to surgery over a period of four years, between 2001–2004. Of the 213 patients who underwent NSV, 209 did not present any postoperative complications and azoospermia was confirmed 90 days after surgery. Two patients presented transitory epididymitis, 10 days after surgical procedure, and were given anti inflammatory and antibiotic medication. One case of a small hematoma was resolved spontaneously after 7 days and one case of spontaneous recanalization was reoperated after confirmation of the presence of moving spermatozoids in the sperm count. In these four cases, azoospermia was confirmed after 90 days. Out of the 213 patients who underwent NSV, four patients presented post operative complications (1.88%); there was one case of spontaneous reanastomosis, who was referred to surgical correction; two subjects developed epididymitis and were treated with antibiotics; and there was one case of small post-op hematoma that had a spontaneous resolution.
Conclusion Our conclusion is that NSV is a rapid simple and safe surgical procedure with very low incidence of failure and complications, which can be performed by a gynecologist or a general practitioner in an out-patient clinic. In NVS there is a greater acceptability by the patients, due to less discomfort, absence of incision and skin sutures.
P181
Male condom use errors according to the report of female partner in Turkey
B. Akin1, E. Ege1, S. Benli1, and H. Erdem2
1University of Selcuk, School of Health, Nursing Department, Konya, Turkey, and 2Ministry of Health, Primary Health Care Centre, Number 15, Konya, Turkey
Objective The condom is widely used contraceptive method and also important for prevention of Sexually Transmitted Infections (STI). But its effectiveness depends on its correct and continued use. The aim of the study is to examine male condom use errors according to the evaluation of female partner.
Design and method This is a descriptive study. The study group consisted of 160 married women aged between 15 and 49 years who applied the family planning unite in a primary health care centre for taking male condom free of charge. The reason to chose women for taking information about male condom use errors that women come to centre for taking condom instead of their partners, so the women are counselled for correct condom use in Turkey. A questionnaire was used to collect data with face-to-face interview. Percentage distribution and logistic regression were used for statistical analyses.
Results Mean of condom use is 46.7±54.2 Month. Of the participants 124 (77.5%) reported one ore more errors related condom use. Of the 160 participants, 34.4% ‘starting intercourse without a condom and then stopping to put one on’, 22.5% ‘don't leave space at the tip’ and 52.5% ‘don't control for breakage after sex’ reported as errors related condom use. Of women 55.6%, of their partner only 18.1% have received instruction on correct condom use. Of women 39.4% has knowledge about emergency contraception (EG). Logistic regression revealed that not receiving instruction of men about correct condom use is a risk factor for ‘condom use error’ (OR:2.96, CI:1.112–7.593).
Conclusion Condom use errors were common and associated with not receiving instruction of men. Increasing the focus on counselling the men besides women may be an important public health strategy.
Topic 12: Miscellaneous
P182
Comparison of the effectiveness of Bromocriptine and Ciclodinon (Agnus Castus ‘Bionorica AG’, Germany). Therapy for the treatment of mild hyperprolactinemia
M. Korinteli, E. Datunashvili, H. Giorgadze, K. Bochorishvili, and E. Nikolaishvili
Resident, Tbilisi, Georgia
Objective To assess the clinical activity of Ciclodinon (Agnus Castus, ‘Bionorica AG’, Germany) for the treatment of mild hyperprolactinemia and to compare it with the efficacy of bromocriptine therapy.
Materials and methods 84 women with the age range of 20–40 years were enrolled in the study. Neoplasm's, pregnancy and purulent-hemorrhagic discharges from the breast were excluded in all cases. The patients were divided into 2 groups. In the first group (n = 42) Bromocriptine (2.5 mg 2 times a day), and in the second group (n = 42) Ciclodinon (Agnus Castus, ‘Bionorica AG’, Germany) (40 mg once a day) was administered. The duration of therapy was 3 months. The prolactin level was measured on the 5–7th day of menses before and after the therapy.
Results Level of prolactin before the therapy was 26.6±4.7 ng/ml (N – 1.2-19.5 ng/ml) in the both groups. After the treatment the prolactin level was rechecked and we received the following data: group I – 15.1±1.3 ng/ml and in group II – 16.2±1.4 ng/ml. During the treatment no adverse effects were noted in group II, while in group I nausea, vomiting and dizziness were observed in 12.5% of patients.
Conclusions Marked clinical effectiveness after the administration of the Ciclodinon (Agnus Castus, ‘Bionorica AG’, Germany) was observed, which does not differ from that of Bromocriptine and we recommend Ciclodinon (Agnus Castus,‘Bionorica AG’, Germany) as a priority means for the treatment of mild hyperprolactinemia.
P183
Contraception and reproductive issues after kidney transplantation
A. Rodrigues, A. Custódio, R. Lagarto, C. Frutuoso, and C. Oliveira
Coimbra University Hospital, Coimbra, Portugal
Background Women with end-stage kidney disease suffer from amenorrhea and anovulatory cycles. Kidney transplantation usually restores fertility, so those women who do not desire pregnancy, should be protected by an effective method of contraception.
Objective Our purpose was to describe contraceptive practices and desire of future pregnancy among female kidney transplant recipients.
Material and methods This study included 74 premenopausal women, who were submitted to a kidney transplantation and are being cared for at our institution. Data were obtained by analysis of clinical files and complemented by a telephone interview, regarding contraceptive and reproductive choices.
Results Subjects had a median age of 38.0 years. They had been transplanted for a mean of 7.1 years and the most common indications for transplant were type 1 diabetes mellitus (18.9%) and hypertension (17.6%). Fifty-four percent were nulliparous and 32% reported a desire to become pregnant in the future. Sterility was seen in 6.8%. Eight women had a successful pregnancy after transplant, none related to failure of the contraceptive method, and spontaneous abortion occurred in 2. Approximately 7% were abstinent. Of the 69 women who had an active sexual life, 12% were not using any form of contraception, 32% were using condoms, 13% coitus interruptus and 23% hormonal methods (16% oral pills and 7% levonorgestrel IUDs). Twenty percent chose tubal ligation for contraception. No side effects or cases of deterioration of kidney function related with the contraceptive method were reported.
Conclusions In our group of female kidney transplant recipients, we found a substantial fraction of women wanting to have children in the future; the majority preferred reversible methods of contraception. Thus, physicians must take into account that those women may benefit from counselling about reversible methods of contraception.
P184
Explorative evaluation of the impact of premenstrual disorder on daily functioning and quality of life
C. Damonte Khoury1, L. A. J. Heinemann2, A. Filonenko3, and P. M. Shaughn O'Brien4
1Gynaecology Department, Miguel Hernandez University, Campus de San Juan de Alicante, Alicante, Spain, 2ZEG Berlin, Center for Epidemiology & Health Research, Berlin, Germany, 3Bayer Schering Pharma AG, Berlin, Germany, and 4Obstetrics & Gynaecology, Keele University Medical School, Keele, UK
Objective Many women of childbearing age experience a variety of symptoms related to the menstrual cycle. These may be limited to mild discomfort or extend to premenstrual syndrome (PMS) or, depending on the degree of emotional and somatic impairment, to the most severe premenstrual dysphoric disorder (PMDD). This explorative study was designed to assess the impact of severe premenstrual disorder (PMD), i.e., PMDD and or moderate/severe PMS, on daily life functioning and quality of life (QoL) from a patient perspective.
Methods A population-based sample of women of reproductive age from four countries (Austria, Germany, Spain and Brazil) was invited to participate in a 2-month web-based survey concerning symptoms related to premenstrual problems. Recruited women completed the Premenstrual Symptoms Screening Tool (PSST) questionnaire at the onset of the study and at other selected time points, and prospectively completed Daily Record of Severity of Problems (DRSP) diaries over 2 months. Based on DRSP and PSST data, a computer based algorithm was developed to diagnose and allocate women into PMDD, severe PMS, mild PMS and no symptoms groups. Generic QoL was measured using SF 12 questionnaire.
Results A total of 4264 women from the four countries completed the initial screening. Of these, 822 women were eligible for the analysis: 293 in Austria; 271 in Germany; 126 in Spain and 132 in Brazil. For all countries, high impairment of daily activities was more common in women with moderate/severe PMS/PMDD compared with women with mild PMS/no symptoms. Moreover, a trend towards lower QoL, as observed by physical health and mental health scores, was seen in women with severe PMD.
Conclusions This study provides patient-reported evidence on clinical PMDD and PMS symptoms, daily functioning and QoL within an international setting. Taking into account the geographic heterogeneity, results of the study suggest that moderate/severe PMS/PMDD are associated with reduced QoL and impaired daily functioning.
P185
Methodology for the development of a new tool to assess Health-Related Quality of Life (HRQoL) in fertile women users of contraceptive methods
E. Perez Campos
Hospital de Requena, Valencia, Spain
Objectives In the last few years, the use of contraceptive methods has changed fertile women's life, both in an emotional level and in their Health-Related Quality of Life (HRQoL). There are no specific questionnaires for these type of population, and for this reason we are going to elaborate this questionnaire through a standardized methodology.
Methods With the objective that the questionnaire captures all the relevant aspects, a literature review and a meeting with 8 contraception experts was carried out. To assess the impact in HRQoL that symptoms related to the menstrual cycle and the use of contraceptive methods have in these population, a semi-structured interview to 24 women users of contraceptive methods will be carried out. From these interviews a group of items were identified. Each item will be later scored by the contraception group of experts, according to clarity, frequency and importance in order to do a qualitative reduction of the items. The final items will be edited in a questionnaire format and administered to a sample of 200 fertile women users of contraceptive methods. A factorial analysis and a Rasch analysis will be performed to obtain the final pilot questionnaire before initiating the validation study.
Results After the literature review and the meeting with the 8 contraceptive experts, a total of 40 expressions related with menstrual cycle discomforts (15 expressions), sexual dysfunctions (5 expressions), state of mind alterations (7 expressions), dermatological alterations (2 expressions), eating habits and sleep alterations (3 expressions), related with health perception (4 expressions) and related with the use of the method (4 expressions) were identified.
Conclusion This new questionnaire will allow, once the elaboration phase is completed and the psychometric properties (validity, feasibility and responsiveness to change) are assessed in the validation phase, to get better knowledge on fertile women users of contraceptive methods HRQoL both in usual clinical practice and clinical studies.
P186
Contraception and family planning to help prevent a global climate change holocaust
R. Grossman
Fort Lewis College, Durango, Colorado, USA
We are all aware of the threat of global climate change. We know that we are close to the tipping point, beyond which the planet cannot recover. The possible consequences of climate change include widespread extinction of species, desertification and death of hundreds of millions of people by starvation. Responsible people and governments have started to make changes in their lifestyles and policies that may help prevent too large a catastrophe.
The Ecological Footprint concept is able to measure human use of the planet's resources. The EC can also compare our consumption of resources with what is available. The outcome of this comparison is not good. Since about 1985 we humans have been using more resources than are available. In 2003 we used about 25% more resources than are available. It would take one and a quarter planets to support the human population sustainably. We have overdrawn on our ecological credit card! This overshoot helps to explain such tragedies as global climate change, fisheries depletion and environmental deterioration.
When we consider the benefits of modern contraception and family planning, we tend to think of benefits to individuals. These are very important, of course. I am the proud father of two sons and the proud grandfather of two granddaughters. This family size would be unlikely without modern family planning. For society there is an even more important benefit of contraception and family planning.
Our ability to limit our fertility significantly started in the second half of the 20th century. In the past half century the global Total Fertility Rate has dropped from about 6 to 2.7. In part this has been due to legalization of abortion in many countries. But the major part has been due to the development and dissemination of modern, effective, reliable and safe family planning methods.
Although we are thinking about ways to limit greenhouse gas emissions, the easiest method is already at hand. Making modern contraception available to the 200 million couples worldwide who desire to limit their family size is the least expensive and most humane way to prevent the global climate change holocaust.
P187
Is pregnancy ambivalence associated with perinatal behaviors?
W. Hellerstedt
University of Minnesota, Minneapolis, MN, USA
Objective In the US, it is estimated that 52% of all unintended pregnancies (about half of all livebirths) are associated with lack of contraceptive use, with the remaining associated with contraceptive failure. Negative feelings about pregnancy are associated with poor perinatal behaviors and outcomes, but not consistently. It is possible that the retrospective attempts to understand feelings may be improved by concurrently examining pregnancy avoidance behaviors (e.g., contraceptive use). The purpose of this study whether a series of questions about pregnancy feelings and avoidance behaviors could be combined to create a more useful measure of perinatal behaviors.
Design and methods The study involved 1,538 women from the 2002 National Survey of Family Growth, the largest reproductive health cross-sectional surveillance study in the US. The women were older than 17 years and had a singleton livebirth in the past 5 years. Women responded to questions about how they felt about their last pregnancy (satisfaction with pregnancy timing/intention, pregnancy happiness, pregnancy wantedness) and whether attempts were made to avoid the pregnancy. These variables were combined to identify three groups: women with negative feelings who tried to avoid pregnancy, women with ambivalent feelings who may not have tried to avoid pregnancy, and women with positive feelings who did not attempt to avoid pregnancy. In multivariable logistic regression analyses, the perinatal behaviors (early prenatal care, breastfeeding, prenatal smoking) of the ambivalent and negative women were compared to those of the positive women.
Results Forty-six percent reported ambivalent feelings, 36% were positive on all measures, and 18% were consistently negative. Compared with women with positive feelings, those who were negative about pregnancy were more likely to have initiated prenatal care after 8 weeks (odds ratio = 1.7; 95% confidence interval = 1.1, 3.0) and to have smoked during pregnancy (odds ratio = 3.2; 95% confidence interval = 1.6, 6.5). There were no differences between ambivalent and positive women.
Conclusions While retrospective recall of pregnancy feeling should be interpreted cautiously, these analyses do not support that pregnancy ambivalence is associated with select perinatal behaviors. The data suggest that women with negative pregnancy feelings who tried to avoid pregnancy may be at risk for pregnancy risk behaviors and that a series of questions – rather than a single question – may better identify the highest risk women.
P188
Childhood acute leukaemia and breast-feeding
S. Nikpour, S. Rahimayan, S. Shokrabi, and H. Haghani
Nursing & Midwifery, Iran University of Medical Sciences (IUMS), Rashid Yasami St.Valiasr ave, Tehran, Islamic Republic of Iran
Introduction The role of breast-feeding in protecting against childhood acute leukaemia is uncertain. In this study, we tested the hypothesis that breast-feeding decreases the risk of childhood acute leukaemia.
Methods We investigated this issue in a case control study comprising 300 patients, aged 2±14 years, with acute leukaemia, as well as 300 controls matched for sex, age at diagnosis. Information regarding breast-feeding was obtained through telephone interviews with mothers.
Results The median duration of breast-feeding among patients was significantly shorter than among controls, 3.5 ± 1.24 and 19.97 ± 7.52 months, respectively (p < 0.0001). Breast-feeding of 0 ± 6 months' duration, when compared with feeding of longer than 6 months, was associated with increased odds ratios (OR) for ALL (OR = 2.47, 95% confidence interval (CI) 1.17 ± 5.25. In the patient group, there were a significantly higher number of children and people per family, and patients were of a higher birth order than controls. In multivariate analysis, breast-feeding duration continues to be an independent predictor of acute leukaemia (p = 0.015).
Conclusion If confirmed in additional epidemiological studies, our findings suggest that future epidemiological immune- modulating effects of breastfeeding on leukemogenesis in children. And experimental efforts should be directed at investigating the anti-infective and/or immune-stimulatory or immune- modulating effects of breastfeeding on leukemogenesis in children.
P189
Attitudes and the quality of contraceptive decision-making
C. Picavet, L. van der Leest, and C. Wijsen
Rutgers Nisso Groep, Utrecht, Netherlands
Background Contraceptive attitudes are mostly conceptualized along a single dimension: positive or negative attitudes toward contraception in general. Positive attitudes are found to be related to the use of reliable contraceptives. However, since there are many options available for women who wish to prevent pregnancy, each with its own advantages and disadvantages, such a conceptualization of attitudes seems limited. Furthermore, it would be interesting to know whether attitudes account for differences in outcomes of contraceptive method use.
Method A convenience sample of 1265 women has been surveyed via the internet about contraceptive method choice. Particularly, women who use an alternative for oral contraceptive pills and condoms were asked to participate. Attitudes were assessed through 23 items about how important different aspects were in the decision which method to use. Quality of the decision was operationalized as: satisfaction with the current method, little difficulty in using the method correctly, and no concern about being pregnant while using the method.
Results Factor analysis yields a six-factor model of contraceptive attitudes. The factors are interpreted as attitudes toward: ease of use, menstrual control, sexual consequences, sharing responsibility, health concerns and impact on daily life. These attitudes are found to be related to current contraceptive method. The quality of the decision differs for different methods. For about three quarters of pill users, condom users and users of coitus interruptus the quality of the decision is less than optimal. On the other extreme, that is true for only one quarter of the women whose partner had had a vasectomy. Only attitudes toward menstrual control and ease of use are related to the quality of the decision, when all respondents are taken into account.
Conclusion Differences in attitudes toward contraception are related to different contraceptive method choices. Contraceptive method choice is also related to quality of the contraceptive decision. However, the relationship between attitudes and quality of the decision is limited.
P190
Opinions of women receiving pap smear screening about educational material used under the cervical cancer prevention programme in Chaiyapoom and Suphanburi Provinces in Thailand
S. Jivasak-Apimas, A. Otani, C. Leelapatanadit, T. Srichompoo, S. Leksungnern, C. Lamaigess, V. Soraj, and G. Chiravacharadej
Sisiraj Reproductive Health Research and Training Center, Department of Obstetrics and Gynaecology, Siriraj Hospital, Bangkok Noi, Bangkok 10700, Thailand
Educational programmes directed to certain population could work well in improving the number of registration of women in utilizing the health services1, especially those who received training about the subject2. Even though some educational campaigns do not really affect behaviour of the recipients, its impact on their attitudes to the subject matter is obviously reported3.
Educational materials such as VDO, poster, pamphlet, flipchart, little booklet and radio spot, were developed for use under the programme on cervical cancer prevention among women in Chaiyapoom and Suphanburi provinces since December 2001. During June–December 2006 the questionnaire was sent to each eligible women. 1300 (86.7%) questionnaires were sent back and 1291 questionnaire were completed for the analysis at Siriraj Reproductive Heath Research Center, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University.
Over 80% of the women were over 35 years of age. Most women were in low socio-economic status, with a monthly income of less than 5000 Baht (US$ 152). The educational materials that most women were in high favour of was pamphlet, 87.4%, poster ranked the second, 82.6% and VDO the third, 74.4%. Health station workers or doctors were the most important source of information. Only a little bit over half of women said that time allowed for viewing each educational material was enough. However, over three-quarters of women said that the educational materials were readable and understandable. Many women were in high favour of some educational materials such as pamphlet, poster and the VDO being used in the programme.
P191
Sexuality, gynaecological diseases and contraception
D. Baumane-Auza and M. Orleana
Diplomatic service medical centre, Riga, Latvia
About 10–16% women, when visiting a gynaecologist for a medical check-up, say that they cannot get a sufficient sexual excitement, and 38% women are worried about their sexual behaviour. 70% women have mentioned their relationship with a partner as being satisfactory.
On average 47% women are dissatisfied with their sexual partnership, despite the type of contraception. The women in Latvia most commonly use such contraceptive methods as: condoms, coitus iterruptus, calendar method, hormonal contraception. In more than 10% cases the contraception is not being used at all.
A great role in developing of sexuality is played by sex hormones, especially testosteron, estradiol and progesteron. Several preconditions are of importance to achieve a balanced hormonal effectivity in a woman's organism: psychological, organic, endocrinological, etc. The most common troublesome factors in sexuality are psychological and not the organic ones. The organic factors are most prevalent in connection with gynaecological diseases (uterine and vaginal inflammations, STD, menstrual cycle disorders, uterine and ovarian benign formations), when the use of hormonal contraception is for a short while contraindicated.
Conclusions
Each patient is offered an individual therapy and a contraception method for increasing one's sexual wishes, despite the sexual orientation.
Controlling etiological factors and short-term interruption of hormonal contraception.
Patient's wishes have to be taken into account, as well as the degree of comfort in choosing a therapy, which has to be correct.
In a patient's therapy it is important to have a cooperation of a gynaecologist, sexologist or psychotherapist.
P192
Contraceptive failure in the Netherlands
C. Wijsen and L. van Lee
Rutgers Nisso Group, Utrecht, Netherlands
Introduction Although The Netherlands are well-known for their good sexual education, high rates of contraception use and low abortion rates, still a considerable number of Dutch women do get pregnant unintentionally. It is easily assumed that when a woman is using contraceptives, she is protected against pregnancies. But from recent studies signs emerge that many women have difficulties using their method of contraception effectively. Reasons of this failure can be either attributed to the method itself (method flaw) or by inaccurate use (users' flaw). Apparently, a choice for ‘the pill’ or condom doesn't guarantee perfect use and prevention of pregnancies. Based on different datasources an estimation will be made of how many women are dealing with contraception failure. Furthermore we will use demographic characteristics to describe women with higher risks of contraception failure.
Data sources Two data sources will be used. Data from the National Abortion Registration 2006 will yield, besides reasons for contraception failure, detailed demographic characteristics of 85% of all women who terminated a pregnancy. Data from the Dutch Monitor on sexual health 2006 will yield self-reports on contraception failure of a representative sample of Dutch women aged 19-49.
Results It appears that about one in five women have trouble to use their contraception flawlessly for a period of 6 months. From the women who had had an abortion, the majority used contraception. Although many women admit to have made mistakes using their contraception, 30% of pill users and half of the condom users attribute the failure to the method. This is much more than is expected based on Trussels' reliability index. Whether a women's age or ethnic background have an effect on her risk for contraception failure will be investigated.
Conclusion Contraception failure occurs more frequently than often thought. Many women find it difficult to use contraception effectively in all circumstances. We argue to reconsider current contraception decision making. Adequate information and education on contraception is obvious. It should be followed by a decision in which all relevant personal circumstances are considered. Furthermore, commitment to adhere to contraception is important and needs ongoing attention.
P193
Assessment of the impact of severe premenstrual disorders on work absenteeism and productivity
C. Damonte Khoury1, L. A. J. Heinemann2, A. Filonenko3, and P. M. Shaughn O'Brien4
1Gynaecology Department, Miguel Hernandez University, Campus de San Juan de Alicante, Alicante, Spain, 2ZEG Berlin, Center for Epidemiology & Health Research, Berlin, Germany, 3Bayer Schering Pharma AG, Berlin, Germany, and 4Obstetrics and Gynaecology, Keele University Medical School, Keele, UK
Objective To estimate the impact of severe premenstrual disorder (PMD), i.e., moderate/severe premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD), on work absenteeism and productivity from a patient perspective.
Methods A population-based sample of women aged 15–45 years from Austria, Germany, Spain and Brazil were invited to participate in a 2-month web-based survey concerning symptoms related to premenstrual problems. The recruited women completed the Premenstrual Symptoms Screening Tool (PSST) questionnaire at the onset of the study and at other selected time points, and prospectively completed Daily Record of Severity of Problems (DRSP) diaries over 2 months. Both direct resource use and out-of-pocket costs and indirect costs of work absenteeism and productivity impairment were collected using a modified version of the Work Productivity and Activity Impairment (WPAI) questionnaire.
Results Overall, moderate/severe PMS/PMDD was associated with a higher rate of absenteeism (more than 8 hours or 1 working day in the last menstrual cycle) and decreased occupational productivity compared with mild PMS/no symptoms.
Conclusions Severe PMD has a negative impact on various aspects of working life. There is sufficient evidence to suggest that severe PMD is associated with work absenteeism and impairment in work productivity.
P194
Do patient personality characteristics influence the selection of contraceptives?
J. Hanacek and P. Krepelka
ÜMD, Prague, Czech Republic
Aim The evaluation of the knowledge of contraceptive method use in women before pregnancy and during the period of 6 months after birth and the possible connection with the personality characteristics of the patients. An analysis of the changes in the attitudes to contraception use after birth was undertaken.
Design and method A standardized questionnaire filled in by a group of women who gave birth at the Institute for the Care of the Mother and Child in Prague in the period from 15 November 2006 to 15.11.2007: the respondents filled in the questionnaire within the first 5 days after birth and subsequently 6 months after birth. A multiple logistic regression analysis for the designation of the influence of age, achieved education and personal characteristics on knowledge and practise concerning the use of contraceptive methods and any changes to them after the women have given birth.
Results The questionnaire was completed by 2540 women, 82.5% of the respondents were in the 26–35 age group, 61.3% were first parity, 32.3% second parity and 5.4% were tertiary parity. 48.8% of women perceived themselves to be active women who like to do sport, travel, have a social life and dedicate themselves to their careers (Group A). 40% of women evaluated themselves as women who enjoy some peace and quiet, like to read, watch television and attend to the needs of their families (Group B), 11.2% saw themselves as a kind of intermediary group. Only Groups A and B were further evaluated due to their similar numbers and to the fact that they involved two differing poles. The women from Group A were most frequently in the age group of 31 and above and this mainly involved women with a tertiary education and students. The women in Group A most frequently used OC and patch contraception as opposed to the women from Group B who preferred IUD, medicated IUD, the rhythm method or did not use any contraceptive method. The women from Group A had a greater knowledge of OC during breastfeeding than the women in Group B, who more frequently chose a condom or IUD and evaluated their knowledge of contraception as not overly good. In both groups, the main source of contraception information was their gynaecologist with the figure at 80%. A further source of information for the women from Group A was the internet and the experiences of female colleagues from work, whereas in Group B the women received their further information from television and the fliers in doctors' waiting rooms.
Conclusion The selection of the type of contraception depends on many variables such as age, education, social environment, personal and received experience and also the personal characteristics of the women. The role of the gynaecologist in the dissemination of the information regarding contraceptive methods is the most important. Knowledge of the types of women could assist us when choosing suitable contraception and thus lead to better patient compliance.
P195
Prevalence of postpartum depression and related risk factors in Haydarpaşa Numune Training and Research Hospital, Turkey
Tijen I. Eren, E. Zeynep Tuzcular Vural, I. Gönenç, G. Köse, and N. Aka
Haydarpasa Numune Training and Research Hospital, Obstetrics and Gynecology Clinic, Istanbul, Turkey
Objective Postpartum Depression (PPD) is a pathologic condition that affects both the mother and the child and, therefore, requires immediate attention. The objective of this study was to detect the prevalence of PPD and evaluate related risk factors using the Edinburgh Postpartum Depression Scale on women during their first month postpartum.
Design and methods Pregnant women who applied to Obstetrics and Gynecology Clinic of Haydarpasa Numune Training and Research Hospital between January–March of 2007 were evaluated. A total of 103 women who fulfilled the inclusion criteria were included in the study. Results were analyzed using the SPSS for Windows 10.0 programme.
Results The prevalence of PPD was found to be 17.5%. Low educational level was found related to PPD (p < 0.05). Suffering from a chronic disease, past experience of depression and smoking were identified as risk factors for PPD (p = 0.052, 0.004, 0.033 respectively). Parity and feeding fully or partially with formula were also found to be highly related to PPD (p = 0.01 and 0.032). Caesarean section, low economical income and domestic violence were not related to PPD.
Conclusions The studies concerning PPD are inadequate in Turkey. Multi-centered studies including large numbers of pregnant women would reveal risk factors specific to Turkish culture more definitely. Health workers should be more sensitive about and respond in time to PPD which otherwise may put both the mother and the child at risk.
P196
The use of a contraceptive hormonal method (levonorgestrel intrauterine system) as an alternative to hysterectomy for the treatment of idiopathic uterine bleeding
A. Zapico
Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain
Objective To confirm that the use of levonorgestrel intrauterine system [LNG-IUS] reduces the incidence of hysterectomy in idiopathic uterine bleeding. Study design: A prospective, observational study. Women diagnosed with idiopathic uterine haemorrhage and programmed for hysterectomy were selected and treated with LNG-IUS. Evolution of bleeding (assessed as days of bleeding, duration of the menstrual cycle, number of hygiene measures and patient's perception of bleeding), patient's quality of life (SF-36 questionnaire), tolerability and degree of satisfaction with treatment were studied throughout one year of follow-up. At the end of this period, the percentage of cancellation of programmed hysterectomies was calculated.
Results 82 women were enrolled, with a mean age of 44.34 (±4.94). A progressive reduction of bleeding was observed with significant differences between baseline and final visit for days of bleeding (8.9 vs. 5.00), duration of menstrual cycle (26.85 days vs. 52.60 days), number of hygiene measures (29.34 vs. 8.11) and percentage of patients declaring their bleeding to be ‘intense/very intense’ (98% vs. 6%). Significant improvement of well-being was achieved for most of the assessed quality of life items. Patient's satisfaction with treatment was scored as ‘very good/good’ by 92% of patients at the end of the study. 78% of hysterectomies were cancelled. No significant differences between visits were detected in terms of incidence of side effects during follow-up.
Conclusions The LNG-IUS meets the efficacy and tolerability criteria for being considered as a first-line treatment option for women with dysfunctional uterine bleeding. Its use may contribute to decrease the large number of hysterectomies indicated for this disorder in Spain.
P197
Use of contraception among Libyan women at Misurata Teaching Hospital
B. Elmadani, F. Elrishi, and A. Shahut
Misurata teaching hospital, Misurata, Libyan Arab Jamahiriya, Libya
Objective In Libya, grandmultiparity is still a common phenomenon and the use of modern contraceptive methods remains limited. The use of contraceptives have an impact on better spacing between children, better child care, improvement of children's health and preservation of the mother's health. This study aimed to investigate the use of contraception among women residing in Misurata, Libya.
Design and methods A detailed questionnaire was prepared, and a total of 460 married women aging 18–44 years old were interviewed. The population investigated consisted of women attending the combined obstetric and gynaecology out-patients clinic of the hospital.
Results Contraceptives prevalence in the sample was 47.8%, of which 45.5% of them were grandmultiparous having 5 living children or more and their age was ranged between 21 and 44 years and. The use of contraceptions increased linearly with age from a user rate of 27.6% among women 20–24 years old to 78% among women 40–44 years of age. 61% of the contraceptive users were used effective contraceptives including oral or injectable and IUD. 98% of the users planned for spacing between the pregnancies including 7.3% had big families and socioeconomic problems. IUDs were a popular choice among investigated women representing 13%; and its use tended to increase with age (5.6% for 24–29 year olds to 34.1% for 35–39 year olds). Calendar method and combined oral contraceptive pills accounted for 10.9% and 9.1% of them respectively. Current use of family planning methods was low with 1.7% using withdrawal, 2.6% using progestin-only oral contraceptive pills, 3% using condoms and 3.5% using injectable contraceptives. Also 3% had lactational amenorrhea. 20% of the hormonal contraceptive users change to another contraception method due to side effects, difficulty of use and safety concerns. The least common method was female sterilization representing 0.9% of the studied sample.
Conclusion Our patients using traditional methods of contraception. IUD is the most popular method of contraception among them that dose not require daily adherence. The fact that only 24.7% of the women were in one of the two categories; IUD or OC reveals poor awareness and knowledge of modern contraception is in our locality indicating implementation of educational programme about family planning methods.
P198
Investigation of relation between attitudes towards current menstruation with attitudes towards menarche of Turkish women: Study in two centers
N. Erbil, N. Felek, and E. Karakasli
Department of Nursing, School of Health, Ordu University, Ordu, Turkey
Objective To investigate the relation between attitudes towards current menstruation and attitudes towards menarche of Turkish women in Ordu province, in the East Blacksee Region, in North and in Aydin province in the Aegean Region, in West, in Turkey and to compare taken results from two countries.
Design and methods The research planned as descriptive and analytic type. Totally, 400 women examinated menarche (203 women from Ordu, 197 women from Aydin) who accepted to take part in were included in the study. This research was made between 15 February 2007–25 May 2007. The research data were collected via a questionnaire. The analysis of the data was made by using frequency, percentage, arithmetic mean, standard deviation and Chi-square tests in SPSS 11,5 statistic program.
Results When the feelings about menarche of the women were evaluated; it was determined that 46.8% of them feel fear, 23.8% of them feel shame, 17.8% of them feel happy, 7.0% of them feel ambivalent feels. It was found that 40.8% of the women have pain in menarche, 75.4% of them feel positive feelings about menarche, 83.2% of them have information about menstruation prior to menarche and 63.2% of them get information from their mothers. It was found that 61.1% of the women think that they were enough information, 5.2% of them were regularly menstrual periods, 73,3% of them were “normal” menstrual bleeding. It was found that 69.8% of them have ‘nervousness’, 50.8% of them have ‘breast tenderness’, 49.5% of them have ‘abdominal bloating’ during premenstrual period. 31.0% of the women had painful menstruation. 90.8% of the women's current menstrual attitude were ‘positive’.
Chi-square analysis results showed that there was a statistically significant correlation between living countries of the women with education level (p = 0.000), family type (p = 0.020), menarche age (p = 0.000), memory of menarche day (p = 0.000), feelings about menarche (p = 0.000), informed person before menarche (p = 0.000), taken enough information about menstruation prior to menarche (p = 0.000), regularly menstrual period (p = 0.000). A statistically significant difference wasn't found between living difference countries with women's current menstrual attitudes (p = 0.071). In addition there was a statistically significant correlation between women's attitudes towards current menstruation with family type (p = 0.014), feelings at menarche (p = 0.000), menarche perception (p = 0.027) and current painful menstruation (p = 0.039). Also, a significant relation was determined between current painful menstruation and feelings about first menstruation (p = 0.003).
Conclusions Consequently, it was determined that women's current menstrual attitudes weren't affected by difference countries living, in east or in west of women. Women's current menstrual attitudes were affected by their family type, feelings at menarche, menarche perception and current painful menstruation. Results suggest that early menstrual experiences may be related to menstrual experiences later in life. This research invites further investigation connecting menstruation.
Topic 13: Natural Methods
P199
Teaching natural family planning to university students: A 3 year experience
C. Lopez-delBurgo, A. Ruiz-Zambrana, C. Laparte, G. Lopez-Garcia, and J. deIrala
University of Navarra, Pamplona, Spain
Introduction A recent prospective study shows that the Symptothermal method (STM) is a highly effective natural family planning (NFP) method1. But, there is a lack of ‘academic level’ of NFP outreach and a lack of knowledge in health professionals as well. It is difficult for couples to use NFP if their doctors/providers have low knowledge on NFP or do not support their choice. NFP teaching was introduced at our university to improve this situation.
Objective to explore university students' opinion about NFP teaching.
Methods An optional subject about Human Reproduction (50 teaching hours) was introduced in degrees of Medicine, Pharmacy and Biology Sciences at our university. The subject includes classes about sexuality, affectivity, human reproduction, infertility, assisted reproductive technologies, sexually transmitted infections, contraception, abortion and 15 hours about NFP (Symptothermal and Billings methods, efficacy, advantages and disadvantages, new researches, naprotechnology). Students learn how to interpret symptothermal charts and they have to interpret one in the final exam. They also reply to an anonymous evaluation and write personal comments about the course. We present results from the last three years (2004–2007).
Results A total of 448 students have taken the course in the last 3 years. Sixty percent were women. Regarding NFP contents, a minority (<10%) referred that they disagree with the content of the classes. Approximately 95% of students referred either that classes have helped them to positively reconsider their opinion on NFP (45%) or that classes have helped them to strengthen their previous positive attitudes towards NFP (50%). During 2006–2007 course, 65% of the students stated that they admire more how their bodies work after studying NFP. At the poster, exam results of students interpreting a symptothermal chart as well as examples of individual comments on the course will be presented.
Conclusion There is great interest from students to learn about fertility and NFP. Teaching NFP is possible and acceptable in universities. It can be integrated in specific subjects such as human reproduction, courses on sexuality and love, gynecology or any research area in the health sciences. University settings are useful to increase awareness about NFP and its acceptance by health professionals and providers as well as by the public in general. This can be achieved by increasing the scientific knowledge about reproduction and NFP in universities.
P200
Fertility-awareness among women attending a specialist fertility service for infertility
K. Hampton
Monash University, Victoria, Australia
There has been a steady increase over the years in the number of children born from assisted reproductive technologies (ART) in Australia and around the world. Research ties a number of health problems to mothers and their babies conceived from ART making a natural conception preferable when possible.
In this poster, I will present the findings of a survey of fertility-awareness among infertile women attending a specialist fertility service for infertility.
The aim of the study was to find out if infertile women had maximized their chances of getting pregnant naturally through fertility-awareness and fertility-focused intercourse before they attend a specialist fertility service for infertility.
The study is scheduled for completion in February 2008. So far data confirms the clinical observation that fertility-awareness among infertile women is poor. If the hypothesis is proved that fertility-awareness among infertile couples is poor then this also has implications for women and contraception.
The objectives of the study were to:
Raise awareness among women and their primary health care providers of the nature and extent of fertility-awareness among women trying to get pregnant.
Raise awareness of the importance of fertility-awareness education in preconception care to help women maximize their chances of getting pregnant and reduce their risk for infertility.
Develop a fertility-awareness assessment tool for use in a range of clinical and education settings.
P201
Evaluation of affects on woman health, affected factors and prevalence of the vaginal douching among Turkish married women
N. Erbil, A. Alisarli, K. Özdemir, H. Ç. Terzi, and Y. Kus
Department of Nursing, School of Health, Ordu University, Ordu, Turkey
Objectives To determine affected factors and prevalence of vaginal douche practices among Turkish married women and also, to investigate affects on the woman health of vaginal douche practices.
Design and methods The study designed as cross-sectionally and descriptive type. This study was conducted 1 February–18 May 2007 in Maternity-Gynecology and Children's Hospital, in Ordu province, in Turkey. The material of our study consisted of 427 women. The data were collected with questionnarie (36 questions). The analysis of the data was made with frequency, percentage, arithmetic mean, standart deviation, chi-square test and Pearson correlation analysis test.
Results It was found that women participating in the research were the age of 32.66±8.86 (min 17, max 61). 37.7% of women had primary school education, 71.0% of them were hausewives, 36.2% of their husband graduated from high school, 75.2% of them had nuclear family, 58.1% of them lived in the city center, 53.6% of them had at the level middle income. In the past the most used contraceptive methods by women were withdrawal (43.1%), condom (21.5%), oral contraceptive (20.1%), IUD (13.1%) and vaginal douche (6.8%). The currently used contraceptive methods among participants were withdrawal (28.1%), condom (15.5%), IUD (15.0%), female sterilization (9.4%), oral contraceptive (8.7%) and vaginal douche (5.6%). 66.3% of the women had vaginal discharge. It was found that 38.6% of women (165 women) made vaginal douche. It was determined that vaginal douche was made for cleaning (27.4%), for contraception (11.0%), for cleaning menstrual bleeding (6.3%), for for decrease of vaginal odor and discharge (2.3%) and for religious reasons (1.9%) by women. 13.9% of women said that vaginal douching will be made detrimental affects on health. 57.4% of the women didn't know affects on health of vaginal douching. This habit learnt family elders. It was determined that 84.6% of women used ‘water’ and 14.7% of them used ‘soapy water’ in vaginal douching. The vaginal douching practice time mean was 5.06±4.18 minutes. Chi-square analysis results showed that there was a statistically significant correlation between whether vaginal douche was made and job (p = 0.002), husband's education level (p = 0.010), husband's job (p = 0.002), family type (p = 0.022), living place (p = 0.044), information about affects on health of vaginal douching (p = 0.000). In addition there was a statistically significant correlation between whether made vaginal douche and have vaginal discharge of women (p = 0.024), vaginal douching in their pregnancies (p = 0.000). If women were used to making vaginal douche, women were carrying on vaginal douching in their pregnancies too.
Conclusions This study provides information about women's vaginal douching practices and affected factors. The results may inform health care practitioners’ efforts and for future advanced research.
P202
Symptothermal method and fulfilled desire for children
K. Sipr and H. Siprova
1Palacky University Faculty of Medicine, Olomouc, Czech Republic, and 2University Hospital Pekarska, Brno, Czech Republic
Family planning has been predominantly understood as contraception in the recent time. Nevertheless, the original sense of the family planning also as a means to achieve pregnancy and child spacing seems to be stressed. In some special cases, the symptothermal method of ‘natural’ family planning can help to achieve pregnancy also in cases where an in-vitro fertilization attempt failed. A case report of two such cases is presented in the paper. Both women underwent ovarian stimulations and in-vitro fertilizations in different infertility clinics independently. Attempts for implantation were unsuccessful. Both women came in contact with NFP trainers and were taught in the use of the symptothermal method (German modification of authors Prof. Freundl and Dr. Raith). Women knew nothing about basal body temperature and or about cervical mucus changes until that time. The Czech book Natural and Reliable Family Planning was the source of their comprehensive information. They followed up the instructions and conceived after 3 month and 5 months respectively. The birth of children had a unique impact on the matrimonial relations. Notable achievements of modern technology do not decrease the importance of traditional and well-tested practices such as monitoring of the basal body temperature and of the quality of the cervical mucus. Simple and safe methods ought to be preferred in the family planning, too.
Topic 14: Oncology
P203
Contraception after breast cancer
H. Lopes, A. Rodrigues, A. Custódio, R. Santos, M. Dias, and C. F. de Oliveira
Gynaecology Department – Coimbra University Hospital, Coimbra, Portugal
Background Breast cancer is one of the most common neoplasms in reproductive age women. According to the advances both in diagnosis and treatment, the number of survivors is increasing. Although many patients undergo a sudden ovarian failure after treatment, some remain fertile. Considering fertile breast cancer patients, a contraceptive measure proposes a new challenge.
Objective The purpose of this study was to analyse the contraceptive methods after treatment among women diagnosed for early-stage breast cancer at reproductive age and disease free.
Material and methods Analysis of clinical data and contraceptive options from women diagnosed under age of 40, with non-invasive or invasive clinical stage I,II and IIIA breast cancer, remaining with ovarian function after treatment and disease free at evaluation.
Results Of 76 available disease free women we excluded 22: medical treatment-induced amenorrhea (n = 14) and surgical castration (n = 8). Remaining 54 women (mean age at diagnosis 36 ± 3.7 years old) still having regular cycles after treatment, were included in our study group. Ninety one percent had an invasive cancer diagnosis and 69% were positive estrogen receptor. Eleven were nulliparous at diagnosis and 19 were taking in consideration a future pregnancy. Before breast cancer diagnosis oral hormonal contraceptive was used in 74.1% of the cases. After treatment 11.1% were sexual abstinent. Among 48 patients with active sexual life, 43.8% chose surgical irreversible methods (tubal ligation in 19 women and vasectomy in 2 of their sexual partners). Nine (18.6%) couples were using barrier methods. Copper IUD was an option for 15 (31.3%) women and 3 (6.3%) reported no using of contraception due to previous history of infertility. The contraceptive option changed in 81% after breast cancer diagnosis. All women on hormonal contraceptive switch to a different method.
Conclusions Diagnosis of breast cancer changes contraceptive options among affected women, especially concerning patients previously on hormonal contraception. In our study, the majority of breast cancer patients chose an irreversible contraception method.
P204
Ovarian conservation at the time of hysterectomy: What is the risk of developing ovarian pathology?
S. Lemos, F. Ramos, I. Ferreira, and S. Esperança
Hospital Infante D. Pedro, Aveiro, Portugal
Objective Prophylactic oophorectomy during hysterectomy for benign disorders remains a controversial issue among gynaecological surgeons. This simple procedure is the best available tool to reduce the risk of ovarian cancer, as well as to prevent the need of further surgery for benign ovarian pathologies. However, it also has disadvantages, which are related to the premature menopause it leads to. The main objective of this study is to evaluate the reoperation rate for adnexal pathology after preservation of ovaries at the time of hysterectomy for benign disease.
Design and methods Retrospective study of clinical records from 54 premenopausal patients, who underwent total abdominal hysterectomy with or without unilateral oophorectomy, for benign gynaecological disorders, during the year of 2001.
Results Mean age of patients at time of surgery was 40 years (range 31–46). Most common indication for hysterectomy was uterine leiomyomas (66%), followed by dysfunctional bleeding in 14% of patients. Both ovaries were preserved in 78% of patients, while 22% were submitted to a unilateral salpingo-oophorectomy. Postoperative complications included 2 cases of vaginal cuff haematoma/abscess. Mean follow-up was 9.4 months (range 0–62). Four patients presented later with urinary incontinence and 2 with dyspareunia. In 3 patients an adnexal disorder was diagnosed by ultrasonography and a salpingo-oophorectomy was surgically performed, which corresponds to a reoperation rate of 5.5%. Histopathological study revealed the presence of periovarian adhesions in 2 cases and a benign serous cyst in the other patient.
Discussion The reoperation rate found in this study is according to the literature, with no case of ovarian cancer diagnosed. The decision to perform a prophylactic oophorectomy should consider not only the patient's age but also the individual risk of ovarian cancer, as well as the possibility to perform hormone replacement therapy. Therefore, knowledge about the risk of ovarian cancer and benign disorders in the conserved ovaries, and the risk of osteoporosis and cardiovascular disease in case of premature menopause, should guide the counselling process.
Topic 15: Service Delivery and Quality of Care
P205
Service mapping: Collaboration not competition
O. Graham, C. Waudby, and K. Guthrie
Sexual and Reproductive Health Partnership, Hull, UK
Objectives This is a city with significant social and therefore health challenges. The Local Authority is the 9th most deprived in the country (out of 354 local authority districts).1/3 of families live in ‘income deprived’ households. The Strategic Health Authority is rated ‘red’ for Pelvic Inflammatory Disease, Ectopic Pregnancy and Infertility. The teenage conception rates are twice the national average, the 9th highest incidence in the country; 2/3 continue with pregnancy and there is a 20% repeat conception rate. However, nationally, there is lack of investment in contraceptive services with the assumption GPs are the providers of basic and intermediate contraceptive care.
The objectives of the mapping exercise was to identify who actually was providing what sexual health service where, to identify the gaps, ask the community what they wanted and work with Commissioners to develop a robust, comprehensive Network of care.
Design and methods City-wide Sexual and Reproductive Health provision was mapped by looking at various data sources; community clinic timetables, Emergency Contraception provision, under 25 chlamydia screening programme data, school nurse sessions and provision, analysis of GP prescribing data for contraception, facilities and data on outreach services including voluntary sector. An analysis of unmet need and patient public feedback was undertaken.
Results Key findings include: geographical gaps in service provision, a desire by for integrated services (contraception and genitourinary medicine) by local communities, a lower than national average GP provision in contraceptive care, low GP participation in the national chalmydia screening programme, variable geographical provision of long acting reversible contraceptives and successful service provision by the voluntary sector and pharmacies.
Conclusions The mapping exercise showed a significant level of provision targeting young people and that compared to the national data, a lower participation in contraceptive care by General Practitioners. Recommendations were made to increase service access and capacity across the healthcare family by utilizing guidelines and pathways for a Network approach and looking at alternative models for provision of care.
P206
Asian women's use of contraception, sexual and reproductive health services
S. Moses and E. Oloto
University Hospitals of Leicester NHS Trust, Leicester, UK
Background It has been shown that Asian women in the United Kingdom have specific contraceptive and sexual health needs. Contraceptive usage has been reported as lower in Asian women with preference for non hormonal contraceptive methods. Cultural, religious and educational influences can affect women's use of a service. The aim of this study was to assess why Asian women were attending our specialist Contraception and Sexual Health service and compare their usage and requirements with non Asian users.
Method An anonymous questionnaire was offered to all service users in November 2007. 1062 questionnaires were completed which included information such as age, ethnicity, reasons and preferences for using the service. Data was analysed separately for Asian and non Asian women. Chi squared test was used for differences between proportions.
Results One hundred and fifty five Asian women completed questionnaires. There was no difference in mean age between groups. Asian women were significantly (p < 0.0001) less likely to be using the service for contraception and more likely to be using the service for another reason compared to non Asian women. There was no difference in usage of long acting reversible contraceptive methods with exception to the progestogen only injection which was used less often by Asian women (p < 0.02). Pills and condoms were used less frequently by Asian women (p < 0.01). Asian women were more likely to attend the service for pregnancy testing, smear tests and referral for unplanned pregnancy than non Asian women. Confidentiality and not wanting to see their GP were significantly (p < 0.01) more likely to be reasons for using our service compared to reasons given by non Asian women.
Conclusion The National Strategy for Sexual Health and HIV in the UK emphasizes the need for targeted services for ethnic minorities. Asian women use our service for a variety of their sexual health needs including contraception. Our service is used in preference to general practice by some Asian women which may reflect ease of access and increased confidentiality that a dedicated Contraception and Sexual Health service offers. Further education and promotion of all contraceptive methods in Asian women may be necessary to dispel any concerns and fears regarding certain methods.
P207
Review of changes introduced to improve access in a community-based, nurse-led, young persons GUM service
B. A. Beeching1 and K. E. Jones2
1Merseyside Brook Centre, Liverpool, UK, and 2Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, UK
Introduction The Merseyside Brook Centre has provided a community-based genitourinary medicine (GUM) service since 2004, offering 2 sessions a week with appointments booked in advance. After the Department of Health recommended more rapid access to GUM services in order to prevent the spread of STIs and to reduce diagnosis to treatment intervals, an open access system was introduced in January 2007, together with separate care pathways for symptomatic and asymptomatic clients.
Objectives To examine the impact of these changes on the numbers attending, the popularity of morning and afternoon sessions, and the range of presenting diagnoses, and to highlight problems and identify appropriate solutions.
Design and methods Retrospective, analytical, descriptive study comparing client access data for 6 months prior to the changes and 6 months post change.
Results 7.9% (40/505) of clients failed to attend booked appointments in the first half of 2006. In the first half of 2007, there was a 30% increase in overall attendances from 465 to 601. There was no change in the female to male ratio of 2:1 or in the proportion of symptomatic clients (45.8% and 42.3% respectively). The afternoon session remained the most popular, resulting in overcrowding and early closure of access to 14/26 clinics compared to 2/26 morning clinics (p < 0.01). Excluded clients were diverted to other local services. There was no change in the proportion of clients presenting with the most common STIs. An extra healthcare assistant was employed to help with the increased workload.
Conclusions Open access clinics allow greater numbers of people to be seen by the GUM service, but variation in demand provides challenges for planning clinic access. Adequate provision is needed to accommodate clients who attend early to beat the queues, and alternative clinics are needed for those who are turned away.
P208
Thinking ‘out of the box’: bringing specialist contraception & sexual health services into the village surgery. A report from the UK
S. Reuter
Chesterfield Contraception & Sexual Health Service, Chesterfield, UK
Background The UK has a high rate of unplanned pregnancy and is struggling to reduce rates of sexually transmitted infections (STIs). For most women in rural areas the only access to contraception & sexual health (C&SH) services is through their general practitioner (GP) as specialist services may only be available in towns and cities. GPs and practice nurses have many demands on their time and may find themselves hard pushed to widen their scope of practice particularly where long-acting methods of contraception such as intrauterine devices and implants are concerned. Providing good C&SH services is also time consuming and may be difficult to achieve in a ten-minute appointment.
The project A specialist doctor in contraception and sexual health was employed by a GP to provide two sessions per week for a GP surgery with branches in two small villages with high deprivation and high rates of unplanned pregnancy.
Outcomes Local women welcomed the opportunity to see a female doctor for their contraception & sexual health issues. For the first time implant contraception was available to the practice population. While this method was initially slow to be adopted, the number of fittings in the second year more than doubled and is still increasing. Similarly, the use of intrauterine methods increased four-fold in the second compared to the first year. This trend is continuing. STI discussion and testing where indicated was included in most consultations. One of the GPs successfully undertook diploma training in C&SH through this project; the practice nurse increased her skills; liaison with the school nurses, community midwives and health visitors improved choices and access for their clients; protocols and patient group directions were validated in line with national standards; all practice staff had the opportunity to attend updates in C&SH; women had speedy access to generalist services and secondary care referral when co-existing medical problems complicated their contraceptive care; the specialist increased her knowledge concerning general practice issues.
Conclusion Bringing specialist services into the village surgery has increased choice and created demand for long-acting contraceptive methods. A learning environment was created for medical staff as well as for the women accessing the service. It is postulated that similar projects may be effective in other rural areas.
P209
Who searches for youth friendly services? And why did they come?
M. Teixeira1, M. Fernandes1, H. Bachu1, A. P. Teixeira2, J. Santos1, D. Leite1, T. Oliveira1, and P. Sarmento1
1Maternidade Júlio Dinis, Porto, Portugal, and 2Mathematic Department-Trás-Os-Montes E Alto Douro University, Vila Real, Portugal
Objective Youth friendly services are recommended by World Health Organization since 1994, as a way to address adolescent reproductive and sexual health needs, safeguarding their privacy and confidentiality. In our hospital this service has been available since March 1994 and is called Youth Space. The aim of this study was to evaluate who search this service and why.
Design and methods A self-applied questionnaire was proposed to all 1480 Youth Space attendants between 11 June 2007 and 14 December 2007. 1085 (73.3%) questionnaires were returned. Were analysed demographic factors, reason for searching Youth Space and satisfaction about the service.
Results Mean age of attendants was 20.4 (±2.8) years and nearly everyone were female (97.2%). Most were students (70.6%), the majority university students (56.4%). More than two thirds (77.4%) were catholic and lived with their mother and/or father and brothers (61.5%). Only 26.2% and 6.8% reported smoking and drug use respectively. Slightly more than half referred alcohol consumption (59%) and going out at night (67.4%) less than 4 times per month. 79.2% had already had sexual intercourse, and only 11.2% reported using no contraceptive method in last intercourse.
These youth came mostly for contraception (45.5%) and gynaecological exam/cervical smear (25.9%), affirming that this service responded to their needs (68.2%). 83.8% heard about Youth Space by friends and/or family and more than half were regular attendants (54.1% used the service more than once every year). 65% felt comfortable asking questions at Youth Space. Being “free of charge” was the reason more frequent (69.4%) for searching the service, followed by “appointment in the same day” (52.7%) and “confidentiality” (40.8%).
Conclusions Having youth friendly services adapted to this special population requirements is in fact a need and is useful, not only to offer them basic health services, but also to educate them in healthy/protective sexual and reproductive lifestyles.
Funded by Grant 137/2007 from Ministry of Health Commission on the Promotion of Health Care Research.
P210
Ethical problems and methodological implementation of a contraception algorithm for mentally ill hospitalized patients
M. Nour Ciuhodaru, F. Pricop, and E. Danciu
UMF gr.t.popa, Iassy, Iassy, Romania
Objectives In order to protect the quality of life and to fight against discrimination in case of mentally ill hospitalized patients we developed a structured contraception algorithm based on serious research and taking into account the legal demands and the morality of this matter.
Design and methods A group of 726 female patients hospitalized during 2002–2007 in Socola Psychiatry Hospital Iassy, Romania, have been monitored and conciliated using studies concerning ethical problems and legal matters. A contraception method has been chosen after long and detailed analysing of the matter, in the context of a specific mental disease, a specific type of psychiatric medication and with the agreement of the subjects involved.
Results Out of 726 mentally ill female patients only 536 felt the need to strongly ask about contraception; 65% were schizophrenic, 23% psychotic, 11% retarded and 11% suffering from other diseases. After counselling, the methods they chose were: schizophrenics – 70% COC, 23% progesterone implants, 3% IUD, 4% condoms; psychotics – 62% implants, 20% IUD, 2% condoms, 16% refused contraception; mentally retarded – 59% IUD, 23% implants, 7% sterilisation, 11% refused contraception.
Conclusions Considering there is no legal record until now regarding contraception for mentally ill patients and underlining the ethical problems and taking into account the interaction effects of psychiatric medication and the agreement of the partners involved we had to gradually evaluate risks versus benefits in all the specific cases. Due to MTS risks, birth problems and legal implications, our algorithm is a proposition made in order to offer as many rights as possible for mentally ill hospitalised female patients after adequate counselling and adaptation of each contraceptive method to each psychiatric disease, without affecting specific treatment and recovery.
P211
Contraceptive method use of married women living in the different districts of Ankara, Turkey
O. Orsal1, S. S. Ozalp2, and O. Orsal3
1Eskisehir Osmangazi University Eskisehir Higher School of Health, Eskisehir, Turkey, 2Eskisehir Osmangazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Eskisehir, Turkey, and 3Eskisehir Osmangazi University Youth Friendly Center, Eskisehir, Turkey
Objective The purpose of this study was to determine contraceptive method use of women living in the different districts of Ankara namely Sincan, Golbasi, Etimesgut, Mamak, Yenimahalle, Cankaya and Kecioren, Turkey for the future planning of contraceptive services according to unmet need.
Design and methods This descriptive-correlation survey was conducted from selected households in the district of Ankara in Turkey. From every household, 15–49-year-old women were selected using two phases stratified cluster systematic random sampling method. Among 385 households chosen 360 (98.9%) women were interviewed.
Results In Ankara IUD (27.2%) and coitus interruptus (25.0%) were the most common methods used. Age (p = 0.007), level of education (p = 0.000), occupation (p = 0.021), number of living children (p = 0.005) and desired number of children (p = 0.011) were statistically different for the women living in the different districts of Ankara. In Sincan, 47.2% of women were not using any contraceptive method. Traditional methods were used mostly in Golbasi (22.2%). Most common modern method used in the different districts were, IUD (26.5%) in Mamak, Condom (20.0%) in Etimesgut, combined oral contraceptives (11.1%) in Golbasi, and tubal ligation (6.1%) in Yenimahalle. In Cankaya district women were using seven different modern contraceptive methods, while in Golbasi women were using only one modern contraceptive method. Type of contraceptive method use were statistically different among the districts (p = 0.004). Kecioren was the district with the highest percent of women with four or more living children.
Conclusion Even in the same city, percent and type of contraceptive method use was different among the districts. For planning contraceptive services it is very important to known the unmet need at the district level.
P212
Marital violence: Is it a factor affecting reproductive health status of women?
A. Akyuz1, G. Sahiner1, and B. Bakir2
1Gulhane Military Medical Academy School of Nursing, Ankara, Turkey, and 2Gulhane Military Medical Academy School of Medicine, Ankara, Turkey
In 2002, the World Health Organization (WHO) reported that domestic violence against women was the most common form of violence. Violence exposure has negative effects on all aspects of well being and a healthy life, and leads to problems that increase mortality and morbidity. The aim of this study is to determine the effects of violence on reproductive health of women, and utilization of reproductive health services. The study population consisted of 250 married women aged 15 to 49. The women were randomly selected from a university hospital's obstetrics and gynecology clinic, and from a training hospital dedicated to obstetrics and gynecology practice in Ankara, Turkey.
The ‘Data Collection Form’ and the ‘Scale of Domestic Violence Against Women’ were used to evaluate status of domestic violence and to determine the descriptive characteristics, reproductive health status, and the degree of benefit form reproductive health services for women.
Results of the study revealed that women, who have lower education levels and who experience their first marriage and first sexual intercourse at younger age, are exposed to violence more commonly. Additionally, women experiencing violence have higher gravida and para numbers. Unplanned pregnancies and induced abortions are also more common among women experiencing violence. These women usually do not undergo an appropriate prenatal care and they do not deliver their babies under supervision of a healthcare professional in a medical center. The contraception method among these women is usually a traditional and an ineffective one. Finally, these women usually cannot have access to appropriate gynecologic examination and follow-ups. As a result, these women define their sexual life as ‘unhappy’ and have negative feelings against their husbands, such as hate and fear.
Domestic violence against women has unfavorable effects on reproductive health and utilization of reproductive health services.
P213
Evaluation sexual and reproductive health problems of university students attending the Youth Friendly Center and the importance of counselling
O. Orsal1,2, S. S. Ozalp1, and A. Yildirim1
1Eskisehir Osmangazi University Youth Friendly Center, Eskisehir, Turkey, and 2Eskisehir Osmangazi University Eskisehir Higher School of Health, Eskisehir, Turkey
Aim This study was carried out to be able to recognize the health problems of the university students early, to determine the high risk cases with respect to certain health problems and to plan preventive health measures accordingly.
Material and methods Study population consisted of 1020 students who attended the Youth Friendly Center of Eskisehir Osmangazi University (ESOGU-YFC) between 1 April 2003–15 November 2007. The study was conducted using cross sectional and case management techniques together. Statistical analysis of the results was done using proportional analysis and Chi square test.
Results Reasons for attending the ESOGU-YFC were counselling only (66.6%) and counselling plus other complaints (33.4%). The subjects of counselling were sexual and reproductive health problems (97.8%), problems of adolescence (42.6%) and contraception (25.3%). Each student was given printed documents on the subject. The subjects of the other group (counselling+other complaints) were, gynecological (56.1%) and psychological (24.9%) problems among female students and urogenital complaints (11.4%) and suspicion for HIV/AIDS (76%) among male students. First among the diagnoses made and services given among female students were treatment for vaginitis (34.6%) and menstrual disturbances and dysmenorrhoea (20.5%). The need for emergency contraception was 17.3%. The most frequent lab tests applied were the pregnancy tests (14.4%) and the Rapid Pre-Test for HIV/AIDS (4.7%). Satisfaction from the providers' services was 99.1% from nurses, 98.7% from the physician and 95.6% from the psychologist. The behaviors of students who share a home with other friends, such as alcohol consumption (42.6%), cigarette smoking (45.3%) and asking for counselling + health service (39.6%) were found higher than those student dormitories or living with their families (p = 0.000 and = 0.001).
Conclusion The need for youth centers and their youth friendly approach for success is of great importance in the early recognition of health problems of students and the provision of services accordingly.
P214
Women's opinions and perceptions toward birth methods after birth
A. Karakus and N. H. Sahin
Istanbul University, Istanbul, Turkey
The rate of Cesarean section is showing an increase worldwide. The recommended Cesarean section rate from the World Health Organization (WHO) is 15%. The Cesarean section rate in Turkey as well as in developed countries is over the target set by WHO.
Objective This study was planned for the purpose of determining the opinions and attitudes about method of childbirth in women who had cesarean section and normal spontaneous vaginal birth in Istanbul.
Design and methods The women who had childbirth in Vehbi Koc Foundation American Hospital during six month constitute the population of this study (N = 766). The research sample included 600 of these women who agreed to participate in the study. Data were collected using ‘Opinions & Perceptions about Methods of Birth’ question form which contained 16 statements about birth on a two point scale (1-Agree 2- Disagree) and ‘Sociodemographic and Obstetric Characteristics’ question form that contained a total of 27 questions including the women's characteristics. These forms were administered through interviews with the women on their third postpartum day, in the women's room, after providing a comfortable setting, and took 8–10 minutes. The findings obtained in the research were statistically analyzed using SPSS (Statistical Package for Social Sciences) for Windows 11.5 program. The results were evaluated at a 95% confidence interval and at a p < 0.05 level for significance.
Results In this study which examined the opinions of 600 women about their method of childbirth at a private hospital in Istanbul, the majority of those who had Cesarean section thought that normal spontaneous vaginal birth was an old method. More than half thought that every woman had the potential to deliver normally and although they believed that if there was no indication for Cesarean section they should have normal spontaneous vaginal birth, they thought Cesarean section was safer and easier and that normal spontaneous vaginal birth was more painful, and the Cesarean section decision should not be left only to the physician.
Conclusions Increasing the availability of birth preparation programs will provide for low anxiety level birth without unnecessary medical intervention and with positive experiences that will decrease the Cesarean section rate.
P215
Age and contraception use in Lithuanian women
V. Vanagiene1, B. Zilaitiene2, and R. Zalinkevicius2
1Kaunas Medical University Hospital Department of Obstetrics and Gynecology, Kaunas, Lithuania, and 2Institute of Endocrinology Kaunas University of Medicine, Kaunas, Lithuania
Aim To evaluate age influence on contraception choice and attitude to different contraceptive methods in a group of Lithuanian women.
Methods A total of 314 15–44-year-old (mean±SD 26.52±6.78) women coming for gynecologist's consultation due to contraception in Kaunas city outpatient departments were asked to fill in a semi-structured questionnaire, consisting of 9 parts, total 150 questions. Analyzing study results we divided all women into 3 age groups – less than 20 year old (25 cases. 7.96%), 20–35 year old (237 cases, 75.48%) and older than 35 year (52 cases, 16.56%). Differences between proportions were evaluated using Chi-square test.
Results A significantly higher percentage of young women and older women consider their knowledge about contraception insufficient (p < 0.05). In the group of 20–35-year-old women the same percentage considered their knowledge sufficient and insufficient (41.35% and 58.65%, p > 0.05). The women's answers revealed that a rather low percentage of them use the most effective modern contraceptive methods. Only 14.33% of women used contraceptive pills and there was no difference between age groups. 8.6% of responders used intrauterine devices and usage significantly increases with age (0.00%, 8.47% and 13.46%, p < 0.05%). No responders using implants, injectable contraceptives, and sterilization were identified. The most popular method is condom – 41.08% of responders use it. Condom use significantly declines with age (28.85% in older than 35 year women vs. 52.00% and 42.80% in the other two groups, p<0.05). Older women significantly more frequently use coitus interruptus as contraceptive method if compare with two first groups (26.92% vs 16.00% and 18.64%, p < 0.05). Answers to the question about the negative attitude to some contraceptive methods corresponded to the contraceptive methods used. 228 women answered to this question and the highest percentage of women would avoid sterilization (76 cases, 33.33%), intrauterine devices (50 cases, 21.92%) and pills (28 cases, 12.28%). Despite of low percentage of women using modern effective contraception, majority of responders (64%) independently of their age indicated effectiveness of contraceptive method as the most important factor influencing their choice.
Conclusion The most effective modern contraception use is still insufficient among Lithuanian women, especially in women older than 35 years.
P216
Reproduction health status of women who had more than three childbirths
C. Yilmaz1, A. Akyuz1, and B. Babkir2
1Gulhane Military Medical Academy School of Nursing, Ankara, Turkey, and 2Gulhane Military Medical Academy School of Medicine, Ankara, Turkey
Objective The aim of this descriptive study was to determine the reproductive health status of women who were in their reproductive age and delivered 4 or more births.
Design and methods The study population was selected among women who applied to both Gulhane Military Medical Academy Hospital and Etlik Maternity Hospital. The inclusion criteria were as follows; at the ages 15 to 49, giving 4 or more births, being pregnant for their fourth child and at their 20th or more weeks. The questionnaire developed by researchers based on relevant literature and specialist's views was filled by a researcher one by one by using face to face method.
Results Study participants had a mean age of 35.4 ± 5.7. Of them, 73.1% were primary school graduates, 88.9% were housewives and 51.8% had 220 to 230 Euro monthly incomes. The first marriage mean age of the women was 18.1 ± 2.5. They had an average pregnancy number of 4.90 ± 1.3, an average unintended pregnancy number of 1.9 ± 1.6, and the mean live child's number of 3.6 ± 1.1. The proportion of the women who taken antenatal care from a physician at their last pregnancy was 84.3%. Similarly, 83.3% of them were delivered by a physician for their last pregnancy. The proportion of women having at least one abortion was 14.1%. While Coitus interrupts was the most common method at a rate of 50% among unintended pregnancies, 38.2% of women used no other method by trusting the preventive effect of breast feeding. On the other hand, 65.9% of unintended pregnancies resulted as births.
Conclusions The women had an unmet need of contraception, and this was significantly influenced with early marriages, low educational and economical levels.
P217
Birth of the placenta skills of midwives
E. Albayrak, Z. Korkmaz, and M. Baser
University of Erciyes, Atatürk School of Health, Kayseri, Turkey
Objective This study was performed to evaluate the birth of the placenta skills of the midwives working in Kayseri Maternity Hospital.
Material and methods The study was conducted between November 2006 and May 2007 with all of the midwives (n = 20) working in the delivery room, of Kayseri Maternity Hospital. Within the study, the births of the placenta skills of the midwives were observed during all day. Four hundred and fifty nine women who didn't have a risky pregnancy, whose gestation age was higher than 36 weeks and who had a fetus alive were recruited for observation. Data were collected by a questionnaire and observation method. Observations were carried out according to ‘Guidelines for Birth of the Placenta Skills’. Chi-square tests were performed for data assessment.
Results It was determined that 64.9% of the midwives waited for the placenta to separate for 5–30 minutes and 56.4% of whole births placenta were removed manually. It was determined that midwives were not controlled sudden gush of blood (p = 0.001), not observing the cord descends further from the vagina (p = 0.003), not controlled the uterus has a spheric shape (p < 0.001), not controlled separating membranes (p = 0.007), and were withdraw of the umbilical cord before the placenta separated (p < 0.001), so manual removal for retention placenta was used. In the present study, it was found that midwives who had graduated from health high school did not wait enough time for the placenta separation compared with the midwives who had graduated from university (p = 0.002). In addition, midwives who had graduated from health high school and had been working for 15 years and longer were removing manually more frequently than others (p < 0.001).
Conclusion Midwives were not controlled evidence of placental separation, not waiting enough time for the placenta separation and using manual removal very often.
P218
Quality of life assesment and correlation factors in pregnant women in the Health medical centers of Kashan university of Medical science in 2006
F. Abbaszadeh, A. Bagheri, M. Kafae, and N. Sarafraz
Kashan university, Kashan, Islamic Republic of Iran
Introduction Pregnancy is associated with not only intense physical change but often a great deal of emotional upheaval.The ability to perform usual roles is affected, and even in uneventful pregnancies, many womenhave subtle changes that may detract from their quality of life.
The aim of this Cross sectional study was to assesment quality of life in pregnant women and correlation factors.
Materials and methods This is a cross sectional study on 600 pregnant women receiving prenatal care in the Health medical centers of Kashan University of Medical Science. They completed Short Form 36 Health Survey (SF-36) to assess the quality of life. The results were analyzed statistically by the t- test, χ2, OR and CI in SPSS.
Results Results of the SF-36 showed means quality of life in pregnant women was 61.18±13.21 (27.96–92.62) (mean scores transformed 0 to 100, where a higher score represents better health).
Quality of life was correlated with age (p = 0.002), gestational age (p = 0.017), gravid (p = 0.000), para (p = 0.000), status of house (p = 0.000), income (p = 0.000), husband support (p = 0.017) and satisfaction of living (p = 0.011).
Conclusion It is very important to identify correlation factors with quality of life in pregnant woman to help them to promote of quality of life.
Topic 16: Sex Education
P219
The predictors of sexual confidence
M. Fontes1 and P. Roach2
1Johns Hopkins University, Baltimore, MD, USA, and 2Durex Network, Cambridge, UK
Objectives In the literature, sexual confidence is represented by a combination of individuals' sexual feelings and behaviours, such as sexual fulfillment with partners and understanding of the implications of not taking proper precautions against unwanted pregnancy and STIs during coitus. However, there is little evidence of the predictors that lead individuals to become more confident about their sexuality. Thus, the main objective of this study is to test various hypotheses on what factors influence most individuals' sexual confidence.
Methods Findings from this study are based on responses to the 2007 Durex Sexual Wellbeing Global Survey carried out in July and August 2006 in 26 countries across all regions of the world. The sampling for each country was based on a margin of error of 3% (N = 1,000). A sexual confidence scale, ranging from 0 to 240 points, was generated by combining results from seven-point Linker agreement sub-scales on being confident to know: (a) how to protect from STIs; (b) how to avoid pregnancy; (c) how to have a fulfilling sex life; and (d) where to find guidance on sex. An adjusted linear regression model was used to check for levels of association between this scale and 8 independent variables.
Results A Cronbach's alpha test indicated that the sexual confidence scale reliability coefficient reached 0.85. Gender and area of residency are not associated to the sexual confidence scale (p-value>0.05). Age is a major predictor. As an individual turns 1 year older, he or she becomes more confident about his or her sexuality, reaching a plateau at the age of 40. Higher income and education are also associated to greater sexual confidence. Formal sexual education before the age of 17 and loosing virginity before the age of 18 increase the levels of sexual confidence. Finally, even though the most frequently cited source of sexual education is friends/peers (50%) by all respondents, this source had no impact in higher levels of sexual confidence. By contrast, parents/guardians (22%) and health clinic doctors (14%) are respectively the 8th and 11th most cited source; however, these two sources are by far the ones most strongly associated to higher levels of sexual confidence.
Conclusions Three main conclusions were reached: (a) The 4 composites used for generating the overall confidence scale are highly inter-correlated and, when combined, the final scale represents a reliable measure of individual's sexual confidence; (b) formal sexual education, especially before 17, is a key predictor of future sexual confidence; and (c) high exposure to specific sources of sexual education (e.g., friends) does not lead to higher levels of sexual confidence.
P220
Oral sex and feminism: Implications for sex education
B. L. Murray, G. C. Hess, and J. J. Green
University of Alberta, Edmonton, Alberta, Canada
In recent years awareness and talk about oral sex has increased dramatically, particularly in the popular media. News stories and exploratory studies have brought attention to the issue of oral sex among adolescents, suggesting that fellatio is becoming an increasingly common and casual practice among young females, especially among young teens. This apparent trend raises concerns related to the health and sexual wellbeing of adolescents and warrants further investigation into the prevalence and correlates of oral sex behaviour. The trend in oral sex appears to be toward fellatio with little reciprocity, which could reflect female subservience and rejection of feminist values. However, some recent research findings suggest that women view fellatio as empowering rather than submissive, in that it allows them to take initiative and control in sexual interactions. The relationship between the practice of oral sex and belief in feminist principles is unclear among today's young women.
In the current study the authors had two objectives: to gather descriptive data about the oral sex behaviours and attitudes of young women, and to investigate the relationship between oral sex and feminism. Females between the ages of 18 and 25 years (N = 300) were recruited from both university and employment settings. Information about participants' experiences, emotions, and attitudes with regards to oral sex was collected using a sexual behaviour questionnaire. The construct of feminism was measured using the Liberal Feminist Attitude and Ideology Scale (LFAIS), which is a reliable and well-validated instrument designed to assess one's level of identification with feminist values. The data was collected in autumn 2007. The authors hope that the findings, which will be presented at the ESC conference, will contribute to current understanding of women's sexuality, and provide guidance in designing sex education programming that is relevant for females today.
P221
Age at first sex: When does it really happen?
M. Fontes1 and P. Roach2
1Johns Hopkins University, Baltimore, MD, USA, and 2Durex Network, London, UK
Objective The main objective of this study is to promote a less distorted model for assessing age at first sex, especially in less developed countries. This could potentially lead to empowerment of sexual education policies in various countries. Based on an extensive review of the literature, evidence suggests that calculations for age at first sex have been under-estimated by neglecting proportion of virgins and censoring.
Methods This analysis is based on responses from 26 countries to the 2006 Durex Sexual Wellbeing Global Survey (DSWGS). The survey was conducted electronically from a sampling of country specific panels of respondents over a 7-week period 11 August to 27 September 2006 (minimum n = 1,000, margin of error of approximately 3% based on a 95% CI). Median and mean survival time was calculated as the area under the Kaplan-Meier survival function and timetables. A Cox regression-based test was used for checking on the equality of survival curves for gender, income, age, education, and area type.
Results Traditional statistical models, such as arithmetic mean and median for sexually active individuals, under-estimate age at first sex by at least twelve months. By allowing censoring and including virgins, the median age at first sex using data from all countries changes from 19.1 (based on arithmetic mean) to 20.2 years. Even more significant differences were found in less developed countries. Also, based on the equality checks for various population profiles, differences for age at first sex were found for area of residency, income, and education. Rural residents, individuals with an income below-average for their respective countries and low education are significantly more likely to experience earlier first sexual intercourse.
Conclusions Results from this study show that using survival curves for estimating age at first sex improves validity of results by including virgins and censoring. The main policy implications for these results are: (a) improvement of assessment mechanisms of when children and adolescents are in fact losing their virginity; and (b) determination of when children and adolescents should be exposed to formal sexual education in schools, communities and families based on advanced statistical models for identification of age at first sex, especially in less developed countries.
P222
Sexual confidence in nine Western European Countries
M. Fontes1 and P. Roach2
1Johns Hopkins, Baltimore, MD, USA, and 2Durex Network, Cambridge, UK
Objectives In the literature, sexual confidence is represented by a combination of individuals' sexual feelings and behaviors, such as sexual fulfillment with partners and understanding of the implications of not taking proper precautions against unwanted pregnancy and STIs during coitus. The objective of this study is to present a sexual confidence scale and to check for statistical differences among nine Western European countries.
Methods Findings from this study are based on responses to the 2007 Durex Sexual Wellbeing Global Survey which was carried out in July and August 2006 in 9 Western European countries. The sampling for each country was based on a maximum margin of error of 3% (n = 1,000) for a 95% confidence interval. A sexual confidence scale, ranging from zero to 240 points, was generated by combining results from seven-point Linker agreement sub-scales on being confident to know: (a) how to protect from STIs/HIV/AIDS; (b) how to avoid pregnancy; (c) how to have a happy and fulfilling sex life; and (d) where to go to for help/advice/guidance on sex. Unpaired t-tests of statistical significant differences were performed among all 9 countries after a conversion of the zero-240 point scale to a zero-100% scale.
Results A Cronbach's alpha test indicated that the sexual confidence scale reliability coefficient reached 0.85. The countries in Europe that reached the highest levels of sexual confidence were Spain, Switzerland, and Austria at approximately 80%. On the other hand, Greece (68%), Italy (71%), and France (73%) reached a statistically significant lower level of sexual confidence. For each specific composite of the overall scale, similar trends were found for all nine countries in the case of confidence on how to avoid pregnancy, to have a fulfilling sex life, and where to go for guidance on sex. In the case on how to prevent from STIs/HIV/AIDS, France reached a higher level of confidence at about 80%.
Conclusions Out of the nine countries participating in this study, three sub-groups of countries were identified: (a) higher sexual confidence countries (Spain, Switzerland, and Austria); (b) average sexual confidence countries (the Netherlands, UK, and Germany; and (c) lower sexual confidence countries (France, Italy, and Greece).
P223
Knowledge, attitudes and perceptions on reproductive health in youth requesting termination of pregnancy proves need of sexuality education
P. S. Steyn1 and A. Britz2
1Reproductive Health Unit, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Stellenbosch University, Tygerberg, South Africa, and 2Adolescent project group, Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg, South Africa
Introduction Youth (15–24 years) constitute approximately 1.7 billion of the world's population and 86% are living in developing countries. They have traditionally been neglected as a target group for health interventions, including reproductive health, because they were seen as a relatively healthy age group. Failure of reproductive heath knowledge and services may result in an unintended pregnancy.
Objectives The study was designed to examine the knowledge, attitudes and perspectives of reproductive health issues of youth requesting termination of pregnancy.
Methods Anonymous structured in-depth interviews on 20 clients requesting a termination of pregnancy (TOP) were conducted by a social scientist at the TOP clinic at Tygerberg Hospital. The qualitative interview schedule was designed to complement the survey component of this study. This kind of research aims to find the insider perspective on social action.
Results Most respondents knew that contraception prevented pregnancy, but there were some responses that would not be elicited by a survey. Respondents motivated their choice of most effective contraception in several ways and prefer condoms mostly. Ninety-five percent of the respondents felt that there are sufficient places to get contraceptives from. Sixty-percent of the interviewees reported that they learn about contraceptives at school but agreed that the information taught in school is not sufficient and that the teacher did not have the skills to teach a subject such as life orientation. Information on the leaflet that comes with contraception is perceived as sufficient, helpful, enough but boring. Awareness rising and education are important methods that should be use to increase the use of contraception, using trainers who communicate well with youth.
Conclusion Improvement in sexual and reproductive health requires greater focus on young people. School and community based interventions supported by explicit government policies are imperative. Qualitative data complement quantitative surveys to improve reproductive health messages and programmes.
P225
Sexual transmitted diseases – Survey of university students
R. Martins, R. Fernandes, M. Durao, and T. Bombas
Coimbra's University Health Care Center, Coimbra, Portugal
Introduction This study examines the effects of sexual partnership patterns and protective practices on the risk of contracting sexually transmitted diseases (STDs), including Human immunodeficiency virus (HIV) in Coimbra's University population.
Materials and methods This study analyzed the frequency and type of questions about sex and sexuality that were anonymously submitted to college graduates enrolled in health consults at Coimbra's University. 200 queries were submitted from an original pool of 220 possible subjects.
Results The mean age was 21.8 years in the population of this study. Almost 85% had active sexual activities. 95.5% recognized HIV as a STD, and about 85% recognized syphilis as a STD. Only 60%, 55% and 47.5% recognized Hepatitis B, Human Papilloma and Hepatitis C virus, as potentially STDs. As many as, 67% had used barriers methods like condoms to prevent STDs, and only 40% had never been screened for HIV. In this population, only 43% were familiarized with the existence of an HPV vaccine.
Discussion The authors concluded that the anonymous-submission technique was an effective means of enhancing the learning process and meeting student needs in sexuality education. We observed that creating a climate in which sexual issues can be discussed openly is an important step for the improvement of sexual health for young people. This will inevitably improve knowledge and understanding of contraceptives and STDs and may lead to a safer sexual life among this group of young people.
P226
Attitudes towards contraception in Czech and Romanian women
J. Justinova1, D. Cibula1, V. Unzeitig2, and P. Weiss1
11st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic, and 2Faculty of Medicine, Masaryk University, Brno, Czech Republic
Objectives One of the objectives of the comparative international study was to identify the sources of information about contraception and to describe attitudes towards contraception in Czech and Romanian women.
Design and methods Large samples of women 15–50 years old were interviewed in 2007 – 1,011 women in the Czech Republic, 1,001 in Romania. The samples were representative according to age, education and place of residence.
Results Czech women use hormonal contraception more often than Romanian women (currently 40% and 16% respectively). Czech women know more about the potential negative side-effects. In addition they are more likely to believe that the use of hormonal contraception causes some negative side-effects. 77% of Czech women agree with the use of hormonal contraception and could imagine to use it (if they are not users already). But only 54% of Romanian women support this opinion. Romanian women are more likely to disagree with the use of hormonal contraception in general. In Czech women hormonal contraception (40%) and in Romanian women condoms (27%) are the most used method of contraception. Czech and Romanian women also differ in the reasons why they choose their type of contraception. In general, the main factors in the decision in Romania are safety and simplicity (27% and 5% respectively). In the Czech Republic the main factors are reliability, contentment and convenience and doctors’ advice (16%, 10% and 8% respectively). Women who live in rural areas are more willing to use natural methods of contraception like infertile days or withdrawal. On the contrary, women who live in urban areas are more willing to use hormonal contraception. In both countries doctors are considered as the most reliable, relevant and sufficient source of information about contraception (70% in Czech republic and 64% in Romania).
Conclusions The findings of the study have displayed some interesting differences between Czech and Romanian women populations in attitudes towards contraception. There is a significant difference in using hormonal contraception and in preferable types of contraception in general. Also the attitudes towards safety and side-effects of contraception defer. Positively, it was confirmed that doctors are considered a most reliable, relevant and sufficient source of information in this field.
P227
Greek Family Planning Association: “Youth – Friendly” health services
N. Salakos, K. Bakalianou, Christos Iavazzo, G. Paltoglou, P. Christopoulos, E. Deligeoroglou, and K. Papadias
Division of Family Planning, 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
Aim Young people in Greece often feel uncomfortable at traditional family planning or reproductive health clinics. This fact in combination with an increased awareness of the special needs and rights of youth in the area of sexual and reproductive health led to our division to use a new model in order to provide ‘youth-friendly’ services based on evidence documenting what young people want.
Methods and results The services that the Family Planning Association provides are the following:
Programmes in the Greek islands involving the distribution of informative booklets. The phrase that characterizes the programmes is the ‘Youth to youth’.
Speeches in high schools (age group 15–18 years) on subjects of sexual and reproductive health (over 50 schools visited each year in all Greece involving over 2000 students).
Organization of the annual educational meeting on the field in which over 300 health professionals are participating.
Speeches are provided in cities of urban Greece with the title: ‘The sexual health and contraception’ (over 10 speeches annually).
Free informative booklets are offered to young people in world days such as the Day of AIDS in collaboration with the Youth Team of the Greek Family Planning Association.
Hot telephone line in which answers in questions of public are provided regarding sexual and reproductive health.
P228
Safe sexual practices in a population of Portuguese medical students – results of a survey
M. Durão, R. Martins, R. Veríssimo, T. Sousa Fernandes, and T. Bombas
Medical Services of Coimbra's University, Coimbra, Portugal
Introduction Unawareness is cited as a major factor in the practice of unsafe sexual conducts concerning transmission of diseases and unwanted pregnancies. We aimed to characterize the sexual practices of a population of young adults with medical formation.
Materials and methods An anonymous written enquiry regarding the respondent's sexual practices was distributed among the 5th and 6th year medical students at Coimbra's University.
Results Nearly 50% of those inquired refused to answer the questionnaire, mostly because they felt it was intrusive - of the 300 enquiries delivered, 152 were returned and statistically analysed. Of the respondents, 94% (82 females, 61 males) were sexually active. Their median age was 22.9 years (SD1.43). Median age of initiation of an active sexual life was 18.1 years (females – 18.6 years; males – 17.5 years). As to the first sexual intercourse, 7.7% admitted having used no contraception; 64.3% had used a barrier method. A percentage of 57.3 admitted having had at least one totally unprotected sexual intercourse (65.6% for males). Regarding current condom use, 38.5% always utilised it, 37.7% almost always, 13.9% seldomly, and 9% never - most frequent reasons for lack of constant use were utilization of other birth control methods and having a stable monogamous relationship. In the study population 53.8% had submitted to a blood screen for sexually transmitted diseases – STDs (44.6% of male and 59.8% of female students); their last screen had occurred at a median of 15 and 12 months ago, respectively. Emergency oral contraception had been used by 32.1% of the students (50.8% of the males, 18.2% of the females). Only one voluntary interruption of pregnancy was described, along with one STD. All of the female students were informed regarding the human papilloma virus vaccine; 34.1% had been or were planning to be immunized.
Comments An alarmingly high percentage of those asked admitted to having had at least one totally unprotected sexual intercourse, higher still for male students. Condoms seem to be used primarily as a contraceptive method, for a high percentage of those inquired justify their lack of condom use on the utilization of other birth control methods. Nearly half of all the students had never been screened for STDs. As to emergency oral contraception, more than 50% of the male students had utilized it. From these results, it seems necessary to reassess the knowledge of our medical students regarding a safe sexual life.
P229
Knowledge and attitude of male and female students, before and after studying family planning course at Karaj Azad University
M. Parsinia, P. Ashkvari, and G. Babaee
Islamic Azad University-Karaj Branch, Karaj/Tehran, Islamic Republic of Iran
Introduction Family planning is in fact the most effective program to control population crises all over the world. Undoubtedly every form of planning in this aspect requires contribution of the people in the same country, if they are educated enough in Family planning.
Objective The purpose of the present study was to evaluate knowledge and attitude of girls and boys students. in karaj Azad university before as well as after they pass family planning course.
Materials and methods The study was carried out during 2006 to 2007 in 200 students, 100 girls and 100 boys randomly by giving questions to all selected students on the bases of students responses data were collected and statistically analyzed.
Results The results of the study proved significant differences regarding students attitude befor and after their participation in family planning course (p < 0.05) our results showed no significant diflerences in different ages, occupations and their marital status (p > 0.05). It was also found no significant differences among girls and boys students in this aspect (p > 0.05). There was no significant differences for the lectures being different as well as different colleges.
Conclusion This investigation proved that family planning course has very positive effect on the students attitude, therefore we suggest to start teaching this important subject earlier in secondary school.
P230
Improvement of Red Cross Medical College and Riga Stradins University students' education in the field of sexual health
M. Pukite1, D. Balodis2, and D. Lutinska2
1Red Cross Medical College, Riga, Latvia, and 2Riga Stradins University, Riga, Latvia
The issues on the public and patients' education are getting more and more topical now. The contemporary society is open to receive the information offered to us by the world. This function is mainly provided by mass media, teachers and peers. We acquire our knowledge, practical skills in the teaching institutions. At present the attention is paid to very acute issues when discussing the problems of sexual health. When acquiring a study subject, a student will be able to explain the unclear questions. The topicality of this problem has influenced the field of the research.
Aim To study the level of knowledge of RCMC and RSU students in the field of sexual health.
Objectives
To study the scientific literature.
To learn about the knowledge students have acquired when undertaking studies at RCMC and RSU.
To assess the real education level during the study process.
To work out an assessment criteria model for perfecting students' education experience.
To test the productivity of the model in practice by defining its advantages.
Course Professional observations were followed by clarification of students' opinions by means of the questionnaire and then analysis of the survey data. A questionnaire was devised considering the following criteria:
Baseline knowledge.
Analysis of study subject contents.
Conformity of study subject material.
Study intensity.
Application of the acquired knowledge into practice.
Conclusions
Students consider the level of basic knowledge to be insufficient in order to start acquiring the offered study subjects on sexual health independently.
Contents of the study subject, for acquiring the knowledge, is sufficient for the needs of students' knowledge.
Study intensity is satisfactory, however, majority of students avoid doing individual work in their free-of-class time.
Students will be able to apply the acquired knowledge only partially.
Teachers should promote students' wish to learn the study subjects with interest.
P231
Knowledge about and use of contraception in female students of chosen Universities of Gdansk, Poland
A. Abacjew-Chmylko1, L. Chmylko2, H. Olszewska1, and J. Olszewski3
1Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Poland, Gdansk, Poland, 2F. Ceynowa Hospital, Wejherowo, Poland, and 3Department of Nursing, Medical University of Gdansk, Poland, Gdansk, Poland
Objective Nowadays the access to different sources of knowledge about contraception is easy and unrestricted, however, the information about it can be widened and verified most efficiently during medical studies. The aim of the study was to compare rules and ways of using contraception by female students of chosen Universities of Gdansk in Poland.
Design and methods The research was conducted by the use of an anonymous questionnaire among 280 female students of the Medical University (MedU), 244 female students of the Academy of Physical Education and Sport (SportU) and 143 female students of the Technical University (TechU). The received data was statistically analysed.
Results The main source of knowledge about contraception for MedU students was medical literature, whereas for non-medical universities were physician and magazines. In the opinion of all female students the most effective methods of contraception were oral contraceptives (92.1%), intrauterine devices (68.2%) and condoms (60.2%). Despite that, MedU students most frequently used condoms (43.7%), whereas SportU and TechU students used oral contraceptives (44.4% and 41.4% respectively). Simultaneously, SportU students presented the poorest knowledge about the mechanism of oral contraceptives. The mean age of sexual initiation was 18 years (±1.5) for SportU, 19 years (±1.78) for TechU and 20 years (±2.05) for MedU. The rate of women that began sexual activity was the highest in TechU (78.7%) and the lowest in MedU (66.1%). The most popular form of contraception during the first intercourse was condom (mean 67.8%), however, SportU students used interrupted intercourse statistically more often at that time (12.2%) than TechU (8.1%) and MedU (4.9%) students. The greatest number of sexual partners had students from SportU, followed by MedU and TechU. Unprotected intercourses were most common in SportU and MedU students (37.3% and 34.5% respectively). Emergency contraception was used in a similar percentage in all groups (15.1%), however, MedU students were more aware of its contraceptive effect (of this group still 71% considered it as an early abortive).
Conclusions A majority of students from all three universities presented correct knowledge about methods of contraception. Despite better theoretical background, MedU students did not use more effective methods. SportU students gave less correct answers concerning the rules of contraception, but this did not influence their choices for less effective methods.
P232
Does the knowledge obtained during medical university education in Poland determine the use of contraception?
A. Abacjew-Chmylko1, L. Chmylko2, H. Olszewska1, and J. Olszewski3
1Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Poland, Gdansk, Poland, 2F. Ceynowa Hospital, Wejherowo, Poland, and 3Department of Nursing, Medical University of Gdansk, Poland, Gdansk, Poland
Objective The knowledge about contraception gained by students during their education on the medical university should be widening and have its influence on practical usage.The aim of this research was to verify if the education obtained by female students during studies on the Medical University of Gdansk determined the pattern and type of chosen methods of contraception.
Design and methods The study was conducted by the use of an anonymous questionnaire and included 367 female students of Faculty of Medicine aged between 20 and 28. Among them three age groups were formed: I: 20–21 years old, II: 22–23 years old, III: 24–28 years old. The selected groups were statistically compared with chi-square and t-Student tests.
Results The results revealed a gradual increase of women that began sexual activity from 42.9% in group I to 80.7% in group III. The age of initiation was the highest in the oldest group (20.6 years ±2.16) and in the other two groups was comparable (mean 18.8 years ±1.59). In all groups the most popular method used during the first intercourse was condom - 81% used it in group I, while only 59.6% in group III. In these groups an unprotected first intercourse declared 1.6% and 13.8% respectively. Currently, the most popular contraception in the oldest groups (II and III) was still condom, followed by oral contraception (OC) and natural methods, whereas in group I the most frequent became oral contraceptives, followed by condom and natural methods. Such conversion in position of OC did not reflect the increasing knowledge about the drug action in the older students (about the mechanism and about the recovery of fertility after discontinuing its administration). Statistically, there was no difference in their sexual activity. The older students more frequently declared not using any contraception (53.3%). Emergency contraception was used most rarely in group I (4.1%), while group II and III used it in a comparable rate of a mean 15.1%. For most women this medication was an early abortive, however, the older the respondents were the more often was it treated as a contraceptive (from 21.1% to 34.3%). The possibility of having an abortion due to unintended pregnancy was considered most often among students in the middle of their studies (16.5%).
Conclusions Despite the fact that the older students had larger theoretical knowledge about contraception, they used less effective methods in comparison to the younger students.
P233
Sexual behaviour of adolescent students: Results from a local survey
M. Moreira, A. Sofia Custodio, T. Bombas, and T. Sousa Fernandes
Medical Services of Coimbra‘s University, Coimbra, Portugal
Objectives To assess knowledge and attitudes about contraception and sexually transmitted diseases (STDs) among adolescent students in an urban population of Coimbra, a Portuguese city.
Design and methods An anonymous questionnaire was conducted among 200 secondary school students in Coimbra, Portugal. Specific questions on contraceptive methods and STDs were asked. One hundred and sixty two students completed the questionnaire.
Results Average age was 15,9 years (range 15 to 17). Most were female. Questioned about ‘What contraceptive methods they know’, everyone knew condoms and oral contraceptives but only a minority was aware of other methods. Most students were aware of HIV/AIDS, viral hepatitis and gonorrhoea but only 18.5% (30) students know that HPV infection is transmitted sexually. Questioned about ‘Who will they ask to clarify doubts about sexual health’ they answered: 59.3% friends, 54.3% health-professionals, 47.5% parents and internet, 28.4% school-people and media. About the risk of pregnancy, only 66.7% knew that it is higher 10–14 days after the start of menstruation and 14.8% weren't aware of any relationship. All students answered that condoms protect from STDs, but some answered also: vaginal ring, 18.5%; intrauterine-device, 6.2%; oral contraceptives and coitus interruptus, 3.7%. Thirty-seven percent of all students admitted to have had sex, with the majority starting at 14–15 years, most having only one sexual partner; 96.7% used condom during sexual intercourse and 47.6% of the girls used also oral contraceptive. Comparing the fear of pregnancy or STDs, males are more aware of these risks (88.8% on males versus 80.9% on females about pregnancy and 77.7% on males versus 71.4% on females about STDs).
Conclusions Most students were sufficiently clarified about contraception and STDs. However, some places like school, home, internet and health care centres can play an important role in protecting and promoting the sexual health of their adolescents. A higher number are using condoms, however that number should be ideally 100%. These adolescents aren't sufficiently aware of the risks of unintended pregnancy or of STDs they may be exposed to.
Topic 17: Sexual Dysfunctions
P234
Treating vulval vestibulitis in a community setting
S. Marshall, J. Deighton, and D. Mansour
Graingerville Family Planning Clinic, Newcastle-upon-Tyne, UK
Objective A significant number of women present with superficial dyspareunia to healthcare professionals (HCPs) and, in general, management is sub-optimal. An audit was undertaken to investigate treatment of such women who were diagnosed as suffering from vulval vestibulitis.
Design and methods A retrospective case note review was undertaken of women attending an office gynaecology clinic. Detailed demographic information relating to these women suffering from vulval vestibulitis was recorded and their therapeutic outcomes documented.
Results The results of this audit will be presented. A case series of 30 women diagnosed with vulval vestibulitis has been identified and their personal characteristics and management will be described.
Discussion and conclusion Vulval vestibulitis is a relatively common condition which is under diagnosed. Reasons for this include lack of awareness amongst HCPs, its diffuse aetiology and poorly researched therapeutic options. From this audit we recommend that the first line treatment option should be local application of a topical, potent steroid for 8 weeks whilst abstaining from sexual intercourse. Over 60% of women reported a subjective significant improvement of symptoms with these measures.
P235
Impact of oral contraceptives on female sexuality. A review of literature
Z. Kaplan-Labat and J. Bitzer
Universitätsspital Basel, Basel, Switzerland, Switzerland
Introduction There is clinical experience and observational studies that oral contraceptives may have a negative input on female sexuality.
Methods Review of literature concerning studies about the impact of oral contraceptives on desire, arousal, orgasm and sexual pain disorder. (Search words: Contraception, Sexual dysfunction, HSDD, Arousal disorder, Orgasmic disorder, Pain; Published in English.)
Results 10 studies; 3 randomized controlled and 7 observational prospective studies showed decreased sexual desire among OC-users while 3 observational studies described an increase in sexual desire. The reduction observed ranged from 0.3% up to 50% of OC-users. There was no clear relationship between SHBG levels and sexual desire. Psychosocial factors neither were in most studies not controlled for nor were the physician-patient interaction taken into account. 3 observational and 1 experimental studies indicated an increased incidence of introital pain. 1 experimental survey reported less pain and positive impact on sexuality among OC-users.
Conclusions Results are inconclusive and controversial due to large variability of research methodology and large number of interviewing psychosocial variables which in most studies was not controlled for. Evaluating sexual experiences and discussing a possible impact of contraceptive methods on the users' sexuality should be an important part of contraceptive counseling.
P236
Advantageous and disadvantageous effects of oral contraception on female sexuality
Z. Pastor1, L. Horcicka1, and R. Chmel2
1GONA, Private Sexological Center, Prague, Czech Republic, and 2Department of Obstetrics and Gynecology, Charles University Prague, 2nd Medical Faculty, Teaching Hospital Motol, Prague, Czech Republic
Objectives The aim of this work is to evaluate the relation between use of oral contraceptives (OC) and female sexuality. We commented on hormone effect on sexual behaviour, on mental state and on a risk of sexually transmitted diseases.
Design and methods We evaluated advantageous and disadvantageous effects of OC on female sexuality on the basis of the results of the scientific articles in the impact literature.
Results Impact of OC on sex hormone-binding globulin (SHBG) and androgen levels in women exists but its clinical meaning is not too clear and has not significant effect on sexual behaviour. Pill users reported sexual intercourse earlier, were less likely to be virgins, more likely to have a sex partner, reported more frequent intercourse than sexually active non-users. Pill users reported a higher frequency of sexual thoughts and fantasies, and a higher level of sexual interest than active non-users. Sexual arousal and orgasm did not change while using OC. Most of the verified studies found that a majority of women did not report any change in their libido while using OC. We rarely see the cases of women who have higher or lower sexual desire caused by the use of OC. The issue whether a use of OC is affecting a mental state of a female is still controversial. Clinical significance of these findings is being discussed. Some patients reported changes in their mood, initiative and basic needs including appetite, sleep, a need for warmth, sexual behaviour and changes in emotional pattern like depression, psychiatric symptoms etc. A statistically significant correlation between impairment of sexual function and incidence of other undesirable side effects was noted. Any future research must focus on exploring the individual differences and OC - related risk factors for negative mood change. HPV infection is the most frequent sexually transmitted disease. HPV infection is manifested by the development of precancerous cervical lesions and condylomas. Epidemiological data about HPV lead to conclusions that the use of OC is not independent risk factor of cervical cancer.
Conclusions Effect of OC on female sexuality is a complex of interaction of somatical, mental, social and spiritual aspects. We don't have any definite conclusions yet and there is a high demand for future prospective research on this subject.
P237
Frequency of sexual dysfunction and related factors in women referred to health centres
E. Hajikazemi, M. Hossaini, and F. Hossaini
Iran University of Medical sciences(IUMS), Tehran, Islamic Republic of Iran
Background Safe sexual function is based on family health but despite the importance of this issue, many studies show problems which impose suffering on self, family and society.
Objective To determine of the frequency of sexual dysfunction and related factors in women referred to health centres.
Design This was a cross- sectional study, in which questionnaires FSFI were used for data gathering.
Sample Enrolment of 899 women in this study was performed by Multi stages sampling method.
Results regarding findings 45.2% of the samples group had sexual dysfunction. Frequency of this dysfunction for sexual desire, excitement, lubrication, orgasm, dyspareunia were respectively 39.6%, 35.5%, 39.8%, 42.7% and 47.3%. We also, found that the dysfunction were mostly related to the age gap with husband (p = 0.021), permanent fatigue (p = 0.000), disagreement of the time of having sex (p = 0.000) and the age menarche (p = 0.000).
Conclusion Considering the results, finding intervention for prevents the factors that interfere a healthy and happy sexual life is of great importance. Healthy and happy families are the consequences of a good intervention in this issue. Safe sexual function in families is very important, because couples physical psychosocial healthy are related to sexual function.
Topic 18: Sexually Transmitted Infections
P238
Use of contraceptive methods by HIV-positive women
A. Rodrigues, H. Lopes, R. Lagarto, C. Frutuoso, and C. Oliveira
Coimbra University Hospital, Coimbra, Portugal
Background HIV-positive women need an appropriate sexual education and access to contraception, to avoid the transmission of the disease to their partners and to decrease the risk for other sexually transmitted infections as well as unintended pregnancies.
Objective The purpose of this study was to assess contraceptive use among women with the human immunodeficiency virus (HIV) and investigate if their contraceptive practices were influenced by the HIV-serologic status of the sexual partner.
Material and methods We analysed clinical data and contraceptive choices of 78 HIV-infected women at reproductive age receiving care at our department.
Results Assessed women had a medium age of 36.7 years (range 20–50) and had been diagnosed with HIV for a mean of 7.5 years. Six percent were abstinent, while 94% reported an active sex life. Of those who were sexually active, 2 women had two or more sexual partners and 71 had currently one sexual partner, who was also HIV-seropositive in 41 cases. Four desired future childbearing. Seven percent of the sexually active women were using no contraception, 15% had been sterilized and 78% were using reversible methods (32% barrier methods, 15% oral hormonal contraception, 7% implants, 1% natural methods and 23% dual use of condoms and hormonal methods). Considering only the monogamous women and their partner's serostatus, contraceptive use was reported by 90% of those with an HIV-seropositive partner and by 97% of those with an HIV-seronegative partner (p = n.s.). Condom use was higher in HIV-serodiscordant couples (86.7% vs. 41.5%; p < 0.001), while the use of hormonal contraception was higher in HIV-seroconcordant couples (58.5% vs. 26.7%; p = 0.007).
Conclusions Most contraceptive methods are safe and should be available to HIV-positive women. In our study the majority of women was using contraception; condom use was the preferred method. Our results also suggest that contraceptive choices may be influenced by the HIV-serologic status of the partner.
P239
High school students' knowledge of Human Papilloma Virus (HPV)
T. Tydén, A. Höglund, and A.-K. Hannerfors
Uppsala University, Uppsala, Sweden
Objectives As there are new vaccines against Human Papilloma Virus (HPV) the aim of this study was to investigate knowledge of and attitudes to sexually transmitted diseases (STI) with focus on HPV among 16 year old high school students.
Method The study was designed to collect information from first year high school students. In the spring of 2007 a classroom questionnaire was answered by 466 students at six high schools representing app. 10% of first year high school students in a medium sized town, Sweden.
Results Nine out of ten students (88%) were aware of HIV and 86% of Chlamydia. Seventy percent of the students thought that Chlamydia was the most common STI in Sweden and 58% knew that Chlamydia can generate infertility and can be cured with antibiotics. Only 5% had ever heard about HPV. Eight students (2%) knew that HPV can lead to cervical cancer and 6 students answered that HPV can lead to Condylomata.
Half of the students had had sexual intercourse, more girls 57% (n = 142) than boys 45% (n = 94), p = 0.01. Six out of ten used condom at the first intercourse. The estimated risk of contracting an STI when having sex with new partner was considered low by both sexes (on a visual analogue scale (VAS) from 0 mm=entirely unlikely to 100 mm=highly likely). Girls estimated the risk to be higher than did boys (34 mm vs. 27 mm, p = 0.02). One question concerned potential arguments for vaccination against STIs. They thought that ‘protection against an incurable disease’, 43%, would highly motivate them to get vaccinated, 19% stated ‘avoiding the risk of becoming infertile’, and 13% stated ‘protection against cancer’ would encourage them. Girls rated it more likely than boys that adolescents would not use condom if they were vaccinated, 55 mm vs. 50 mm (p = 0.03).
Conclusion Even though HPV is a prevalent STI with a potential to cause cervical cancer, the awareness and knowledge is much lower than for HIV/AIDS. The study shows that high school students need more information about HPV and its consequences.
P240
Prevalence of infections caused by bacterial species, Chlamydia trachomatis and Candida albicans in patients treated with in vitro fertilization technique
R. Streda
CAR SANUS, Pardubice, Czech Republic
Objective The objective of this study was to evaluate prevalence of infections caused by Gardnerela vaginalis, other bacterial species, Chlamydia trachomatis and Candida albicans in patients treated with in vitro fertilization technique.
Methods This was a prospective study. We performed vaginal samples and samples from cervix (detection of Chlamydia trachomatis antigen by ELISA) at 207 asymptomatic women from 1.4.2005 to 31.1.2007 treated with in vitro fertilization technique.
Results We detected the infection caused by Gardnerela vaginalis in 24 cases, other bacterial species infection in 50 cases, Chlamydia trachomatis infection in 17 cases, Candida albicans infection in 12 cases. Total number of all infections was 98 cases from all examined women.
We proved prevalence of infections caused by Gardnerela vaginalis 12% (24 cases from 207), prevalence of other bacterial species 24% (50 cases from 207), prevalence of Chlamydia trachomatis 8% (17 cases from 207), prevalence of Candida albicans 6% (12 cases from 207). Total prevalence of all infections was 47% (98 cases from 207 examined women). After treatment based on laboratory findings, we performed in-vitro fertilization treatment of infertility.
Conclusions The risk of abnormal vaginal flora is high for women treated with in vitro fertilization technique. Vaginal and cervical samples are advantageous tests in assisted reproductive techniques.
P241
HIV and STD prevention in young Polish women in the context of their knowledge and sexual behaviour
H. Olszewska1, J. Olszewski2, A. Abacjew-Chmylko1, and L. Chmylko3
1Department of Gynecology and Gynecological Oncology, Medical University of Gdansk, Gdansk, Poland, 2Department of Nursing, Medical University of Gdansk, Gdansk, Poland, and 3F. Ceynowa Hospital, Wejherowo, Poland
Objective Safe sexual practice is particularly most significant for young women beginning their adult life. The aim of the research was to asses whether young women at risk for sexually transmitted infections (STD) including HIV infections were characterized by more safe sexual behaviour.
Design and methods The research was conducted by the use of an anonymous questionnaire among 1067 young women from the urban region of Gdansk, Poland. It included 309 high school and 758 university female students aged between 18 and 29. The data was statistically analysed with chi-square test.
Results Of 1067 young women investigated 89.5% treated the condom as the most effective method of HIV prevention during the sexual intercourse. Few respondents treated other contraceptive methods also as good prevention: diaphragm (13.8%), intrauterine device (3.5%), interrupted intercourse (2.5%). Of the respondents examined 65.8% were sexually active (47.1% adolescents and 74.1% young adults). During the first intercourse the most frequently used method of contraception was the condom (67.0%), followed by oral contraceptives (22.2%). Currently only 41.5% used the condom, whereas the usage of oral contraceptives increased to 40.9%. Among sexually active women 61.9% declared having one sexual partner, 28.5% declared having 2 or 3 partners, whereas 9.6% had at least 4 partners. The use of condoms was similar in the groups with 1 partner (40.8%) and 2-3 partners (39.0%), however, it was more frequent in the group with at least 4 partners (53.0%). Moreover, the largest number of unprotected sexual intercourses had respondents with 4 or more partners (57.6%) compared to those with 1 partner (29.5%). Simultaneously, the more sexual partners the young women had, the more aware were they of an increased risk of HIV infection (a high risk was considered by 4.2% with 1 partner and 37.8% with 4 or more partners). Young women who used condoms estimated their risk for HIV infection similarly to those respondents who used other methods. Moreover, their knowledge about the STD prevention did not differ.
Conclusions A large majority of young women had medical knowledge about the methods of preventing HIV and STD infections during a sexual intercourse. Nevertheless, only every second student used condoms currently. The women at increased risk used the condom more frequently and were more aware of a possibility of infection, however, more often had they an unprotected intercourse.
P242
HPV infection and abnormal pap smears: an epidemiologic and correlative study in a multicultural society
C. Abboud1, J. Abboud1, G. Aftimos2, W. Karam2, C. Khater1, and E. Attieh1
1Hotel-Dieu de France, Beirut, Lebanon, and 2Institut National de Pathologie, Hazmieh, Lebanon
Objective This is the first study in the Middle East describing the prevalence and distribution of the different abnormalities on pap smears, their correlation with the types of HPV infection and their evolution and modification in time.
Design and methods It was retrospective study, undertaken in a multicultural country with heterogeneous habits and sexual behaviors. We reviewed and gathered the results of pap smears and HPV DNA detection and typing by PCR, tested between 1 January 2005 and 31 December 2006, at one of the country's most renowned pathology institutions in Lebanon, regrouping samples from more than 20 hospitals and 110 gynecologists. We calculated the prevalence then established the correlations between the different abnormalities on the pap smears and of the different types of HPV infection. We also followed-up these infections: clearance, persistence or upgrading of the lesions.
Results 48670 pap smears were examined over the period of 2 years. We collected the data for a sample of 1434 patients, meaning 2.9% of the population, regrouping the abnormal pap smears, and HPV DNA testing by PCR. The mean age of this sample was 37.5 years old (SD 8.6). 50% of the sample benefited of an HPV DNA testing, which was positive in 43%, with a low risk HPV in 64% of the positive HPV DNA. The distribution of the different categories of abnormal pap smears shows an ASCUS, LSIL, HSIL and other in 79%, 13%, 2% and 6%. 54% of the positive HPV DNA were detected in patients younger than 30 years old, whereas this number declines after the age of 30 years old to 38% (p = 0.001). For the patients in whom we studied both the pap smear and the HPV DNA status, 18% of the normal pap smears were positive for HPV DNA and 45% of the abnormal pap smears were positive for HPV DNA (p < 0.001). This result can be explained by the high percentage of the ASCUS, which are HPV DNA positive in 59%. Within 3–6 months of the abnormal pap smears and/or positive HPV DNA, 58% had a disappearance of the lesions and/or a clearance of the virus. 77% of the ASCUS persisted at 3–6 months and 86% at 9–12months, with an upgrade to a LSIL in 14% and 7% at 3–6 months and 9–12 months respectively. As for the LSIL, 50% and 20% persisted at 3–6 months and 9–12 months respectively. There was no upgrading of the lesions. We have no follow-up for the HSIL and CIS, most of them being operated.
Conclusion The population studied presents a lower prevalence of abnormal pap smears than the world population, with a very high percentage of ASCUS and LSIL and a very low percentage of HSIL, which correlates with a majority of low risk HPV infection (64%) and the absence of an up-grading of the lesions. These infections are persistent and upkeep the detected lesions. However, a normal pap smear doesn't rule out an HPV infection as 18% of the normal pap smears are HPV DNA positive.
Topic 19: Sterilization
P243
Effect of metformin on in vitro maturation of rat oocyte following induced polycystic ovary syndrome
S. Fakhroddin Mesbah-A, M. Moslem, Z. Vojdanh, and H. Mirkhani
1Anatomical sciences Department, Medical School, Shiraz, Fars, Iran, Islamic Republic of, and 2Pharmacology Department, Shiraz, Fars, Islamic Republic of Iran
Objectives Approximately 80% of cases of anovulatory infertility appear after polycystic ovary syndrome (PCOS). Having high quality oocytes during in vitro fertilization (IVF) is one of the main factors of a successful IVF operation. In order to investigate whether metformin increases the oocyte nuclear maturation and cumulus cells expansion, oocyte were supplemented with metformin in culture media following induced PCOS in animal model.
Design and methods PCOS was experimentally induced by a single IM injection of estradiol valerate (0.4 ml/kg) in 15 Sprague dawely rats. Control group (15 rats) were given IM injection of olive oil (0.4 ml/kg). Twelve weeks after injection all animals were sacrificed, control rats were sacrificed in proestrous. Ovaries were removed and oocytes captured by dissection method. Cumulus oocyte complexes (COCs) were incubated with or without metformin in HamsF-10 culture media during 12, 24, 36 and 48 hours. Oocyte nuclear maturation was evaluated following aceto-orcein (%1) staining, as well as cumulus cells expansion was assisted by light microscopy.
Results A majority of the oocytes (65.55%) which treated with metformin underwent germinal vesicle break down (GVBD), MI, AT and MII and also 83.33% of COCs were showed cumulus cells expansion (expansion 53.03% and semi-expansion 30.3%). Less germinal vesicle (GV) nuclei were seen than those without metformin. Degenerated oocytes were increased in PCOS-induced rats.
Conclusions Metformin improves the cumulus cells expansion and nuclear maturation of immature oocyte recovered from the PCOS animals model, thereby, increasing fertilization outcomes. Further studies are needed to investigate the effects of metformin on ultrastructure organelles of oocyte that involved in nuclear maturation.
P244
VEGF and inos expression in rat ovaries and uterine tubes after tubal ligation: A controlled immunohistochemical study
S. Kilic, N. Tasdemir, B. Yuksel, N. Lortlar, G. Budak, and S. Batioglu
1Dr.Zekai Tahir Burak Women Health and Resarch hospital, Ankara, Turkey, and 2University of Gazi Medical School, Histology and Embryology Department, Ankara, Turkey
Objective The aim of this study is to evaluate effects of tubal ligation on ovarian and tubal tissues, through immunohistochemical evaluation of expression of VEGF (vascular endothelial growth factor) and iNOS (inductible nitric oxide synthase), mediators related with hypoxia, on a rat model.
Design 14 Sprague–Dawley female rats were divided into two groups. Tubal ligation with Pomeroy Technique was administered to group 1 (n = 7), others were chosen for the control group (n = 7). Salpingo-oophorectomy was applied to all rats postoperative second cycle. VEGF and iNOS expressions in ovarian and uterin tubal tissues were evaluated via immunohistochemical method. Hscores were recorded for statistical analysis.
Results When the ovarian tissues of two groups were compared; mean VEGF immune-reactivities of granulosa and theca cells of group 1 were more intense (p = 0.002, p = 0.001). But there was no difference between VEGF immune-reactivities of ovarian medullas and germinal epithelium of two groups (p = 0.259, p = 0.209). Similarly iNOS immune reactivities of ovarian granulosa cells and germinal epithelium did not differ between two groups (p = 0.073; p = 0.805). When tubal tissues were examined, epithelial cytoplasmic VEGF and iNOS immune-reactivities of group 1 were significantly more intense (p = 0.001; p = 0.017), but they had similar VEGF immune-reactivities in tubal lamina propria (p = 0.209).
Conclusion Tubal ligation with Pomeroy Technique may lead to supraphysiological hypoxia and increased VEGF and iNOS expression in ovarian and tubal tissues.
P245
The menstrual pattern after tubal sterilization
G. Aydin1, E. Ozyurek1, I. Koc1, Y. Uncu2, and G. Uncu1
1Uludag University Faculty of Medicine Department of Obstetrics and Gynecology, Bursa, Turkey, and 2Uludag University Faculty of Medicine Department of Family Medicine, Bursa, Turkey
Aim In this study our purpose was to detect the effect of tubal sterilization on menstrual parameters and if any effect is determined, to define the time span of the defined effects. In our study, some additional complaints such as mastalgia, urological, cardiovascular and psychiatric problems have been analysed as well.
Method Between 1996 and 2003, 301 patients were applied tubal sterilization in our clinic and 97 of them volunteered for a telephone-questionnaire. The patients were asked questions about menstrual parameters regarding the five years’ period before and after the operation, considering each year separately. Statistical analysis was done in such a way that the pre-operative data of the patients represents the control group while the post-operative data of the patients stands for the study group.
Symptoms Any kind of menstrual pattern change was detected on 7.6% of the patients. No statistically significant difference for intermittent bleeding-spotting, dyspareunia and chronic pelvic pain was determined. While the clotted-fragmented bleeding (as Turkish women describe) bleeding incidence was 31.9% (31/97) during the preoperative period, in the second year the highest incidence was determined as 20.6% (20/97), (p < 0.05). Dysmenorrhoea was observed on 38.1% of the patients in the preoperative period. During the following two years after the operation, no obvious difference was detected, while in the third, fourth and fifth years the percentages were 21.6, 16.4, 13.4, respectively (p < 0.05). Premestrual syndrome incidence was reported as 45.3% before the operation and in the fourth and fifth post-operative years it was 30.9% and 24.7%, respectively (p < 0.05). After the operation a marked decrease of the frequency of coitus was observed. Depression was reported by 42.3% patients and mastalgia was found at 28.9% patients.
Conclusion In our study, clotted-fragmented bleeding and dysmenorrhoea appeared to be the most affected parameter. It was also detected that the longer the post-operative period, decreased frequency of these symptoms were observed. Premenstrual syndrome incidence decreased after the third year. Other parameters and menstrual pattern did not seem to have been affected by tubal sterilization action significantly. On the contrary of the literature and our expectations, a marked decrease of the frequency of coitus in the post-operative period was detected and further evaluation of additional factors of this decrease may be needed.
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