Contraceptive Use and Controlled Fertility Health Issues for Women and Children (1989) / Chapter Skim
Currently Skimming:
Health Effects of Contraception
Health Effects of Contraception
Pages 48-95
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From page 48... ...
As these methods of contraception became more widely used, anecdotal reports of adverse health effects associated with their use began to appear. Since the late 1960s and early l970s, epidemiologic studies have more rigorously evaluated the health effects associated with the use of different contraceptive methods.
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From page 49... ...
The various contraceptive methods have health risks, but pregnancy itself has attendant risks of morbidity and mortality.
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From page 50... ...
However, user failure rates vary widely, a function of the degree of acceptability and compliance required for successful use of each method. ORAL CONTRACEPTIVES OCs, a highly effective method of birth control, are available in two types.
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From page 51... ...
Nulliparous 5 18 Parous >8 >28 Gp/spemucide 5 18 Periodic abstinence 20 Ovulation method 8 Symp~ermal 6 Calendar 10 Posto~rulation 2 Withdrawal 4 18 Female sterilization 0.2 0.4 Male sterilization 0.1 0.15 Among couples who use a method perfectly (both consistently and correctly) , an estimate of the percentage expected to c~cperience an accidents]
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From page 52... ...
The method failure rate for combination OCs is 0.1 percent per year and for progestin-only OCs is 0.5 percent per year (Table 2~. The user failure rate cannot be readily determined for the two types of OCs separately, but it is about 3 percent per year for any type of OC.
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From page 53... ...
Clearly, more information about the interrelationship between OC use, histologic types of BBD, and breast cancer is needed. Seven epidemiologic studies have found that current or recent OC use reduces the risk of pelvic inflammatory disease (PID)
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From page 54... ...
Decrease in risk appears to be confined to current OC users and is probably related to the suppression of ovulation that occurs during OC use. Evidence from a case-control study that used data collected from the Oxford Family Planning Association cohort study suggests that OC use protects a woman from developing uterine fibroids (Ross et al., 1986~.
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From page 55... ...
The increased risk of venous thromboembolism is an important source of illness attributable to OC use but is a very infrequent cause of mortality (Stadel, 1986~. In contrast to the low attributable risk of death from venous thromboembolism associated with OC use, the increased risk of MI and stroke observed in women currently using OCs has been demonstrated to be an important source of the mortality risk attributable to OCs (Stadel, 1986~.
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From page 56... ...
This risk has been observed to increase with increasing age and with increasing duration of OC use. Whether other risk factors for hypertension may be related to the increased risk attributable to OC use has not be established.
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From page 57... ...
For this reason as well as the fact that those tumors are quite rare, the public health impact of a true positive association would not be great for either type of malignancy. Conversely, the debate about whether OC use increases the risk of cervical and breast cancers remains heated; some studies have found no effect on cancer risk, while others have found disturbing increases in risk.
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From page 58... ...
To date, no definite causal relationship has been established between OC use and cervical cancer. Of 15 major epidemiologic studies, ~ have found no increased risk of cervical neoplasia and 7 have found significantly increased risks overall or increases among certain subgroups of users (Piper, 1985; Brinton et al.,
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From page 60... ...
Case and control women were from 20 to 54 years of age. Compared with women who had never used OCs, women who had used OCs had a relative risk of breast cancer of 1.0 (0.9-1.1~; even women who had used OCs for 15 or more years had no increased risk.
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From page 61... ...
Parous women who had used OCs for more than 6 years before their first term pregnancy, at 1~14 years after that pregnancy, were found to have a risk of breast cancer relative to nonusers of 1.1 (0.3-3.9~. Among nulliparous women with more than 6 years of OC use, the relative risk of breast cancer at 1~14 years after they last used OCs was 0.6 (0.1-3.7~.
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From page 62... ...
The IUD is a highly effective contraceptive, with method failure rates of about 1 percent per year for medicated IUD s and 2 percent per year for nonmedicated ones (Table 2~. Because of undetected IUD expulsion, the user failure rate for IUDs is estimated to be somewhat higher, about 6 percent per year.
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From page 63... ...
Most epidemiologic studies of the issue have found that IUD users have an increased risk of PID (Grimes, 1987~. This finding contrasts with all other modern methods of temporary contraception, which seem to protect a user from developing PID.
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From page 64... ...
One of the most important and serious sequellae of PID is tubal infertility. Results from a large cohort study of women with surgically confirmed PID have demonstrated that these women have an increased risk of subsequent tubal infertility Angstrom, 1987~.
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From page 65... ...
The estimated method failure rate for condom use (without spermicide3 is 2 percent per year, while the user failure rate is 12 percent (Table 2~. The effectiveness of condoms as both a contraceptive and a disease prophylactic depends on consistent and proper use.
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From page 66... ...
Among nulliparous women the failure rates for the contraceptive sponge are comparable to the failure rates for the diaphragm; the method failure rate is 5 percent per year and the user failure rate is 18 percent per year (Table 2~. However, among parous women the method failure rate is ~ percent and the user failure rate is 28 percent.
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From page 67... ...
Although the method failure rate is estimated to be about 3 percent per year, the user failure rate is much higher, about 18 percent per year (Table 2~. Clinicians should consider how motivated their patients are before advising diaphragm use (Sherris et al., 1984~.
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From page 68... ...
When used with spermicides, their effectiveness is comparable to that of diaphragms, with a method failure rate of about 5 percent per year and a user failure rate of 18 percent per year (Table 21. Cervical caps have not been widely used; hence, little published research is available.
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From page 69... ...
, the possibility of increased risk of cancer among DMPA users was one reason the FDA did not approve DMPA for contraceptive use in the United States (Sun, 1984~. In 1986 preliminary results were published from an ongoing case-control study conducted by WHO concerning the relationship between DMPA and breast cancer (WHO, 1986a)
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From page 70... ...
However, resumption of ovulation and fertility is delayed; ovulation can be inhibited for 4 to 9 months or more after the last injection (Pardthaisong et al., 1980; Affandi et al., 1987~. Although return to fertility is comparable to that seen with OC and IUD use, because of fears about permanent infertility, some family planning programs use injectables only among higherparity women (Liskin et al., 1987~.
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From page 71... ...
Further, several studies have demonstrated a negative association between the use of combination OCs and endometnal cancer, a protective effect thought to be caused by the progestin component. Preliminary results from a WHO case-control study found that DMPA users had a relative risk of 0.3 (0.04-2.4)
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From page 72... ...
However, no epidemiologic studies of cardiovascular complications among NORPLANT~ users have been completed. TUBAL STERILIZATION since the 1930s more than 95 million women worldwide have undergone tubal sterilization, making it the most widely used contraceptive method in the world (Liskin et al., 1985~.
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From page 73... ...
Alternative surgical approaches include the vaginal approach and the transcervical approach. Although the vaginal approach produces no visible scar, it is used less frequently because of the increased risk of pelvic infection (Ross et al., 1985~.
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From page 74... ...
Overall rates are estimated to be between 0.2 percent and 0.4 percent per year (Table 2~. No studies currently available permit rigorous comparison of failure rates by method of tubal occlusion, though one such study with the potential to do so is in progress in the United States.
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From page 75... ...
In that study major complication rates associated with minilaparotomy did not substantially vary between those minilaparotomy procedures performed postpartum, those performed in association with early pregnancy termination, or those performed as an interval procedure. By contrast, women undergoing interval laparoscopy had a complication rate of 1.2 percent, and women undergoing interval colpotomy (via a vaginal incision)
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From page 76... ...
One comparative study assessing complications among 1,112 women undergoing open laparoscopy and 288 women undergoing conventional laparoscopy failed to demonstrate a difference in complication rates (Bhiwandiwala et al., 1985~. However, to detect a difference between open and closed laparoscopy, an epidemiologic study would have to involve thousands of women to have sufficient study power to detect a difference.
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From page 77... ...
Three years after sterilization hospital referral or hospitalization for menstrual complaints was nearly equal for women undergoing sterilization and for the comparison Coup. After 6 years, sterilized women had a slight, but not statistically significant, increased risk for hospital referral or admission for menstrual complaints.
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From page 78... ...
These possibilities were assessed in the previously mentioned cohort study from the United Kingdom (Vessey et al., 1983~. After both 3 years and 6 years of follow-up, hospital referrals leading to hysterectomy were equally likely in women who had undergone tubal sterilization and in wives of men who had undergone vasectomy.
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From page 79... ...
(1986) compared the likelihood that women undergoing tubal sterilization will regret it relative to the likelihood that women whose husbands underwent vasectomy will have regrets.
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From page 80... ...
Outside the United States, particularly in developing countries, almost all vasectomies are performed using local anesthesia (Ross et al., 1985~. Vasectomy failure rates have ranged from 0 percent to 2.2 percent, with most studies reporting fewer than 1 percent (Liskin et al., 1983)
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From page 81... ...
Most Due vasectomy failures occur when fistulous tracks develop through a sperm granuloma, resulting in a spontaneous reanastomosis of the vas (Liskin et al., 1983~. The reanastomosis usually occurs within several months after vasectomy, although late reanastomosis up to 3 years after vasectomy has been documented, both after ligation and coagulation methods.
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From page 82... ...
As already noted, sperm granulomas can cause vasectomy failure if fistulous tracks develop through the granuloma. Ligation for vas occlusion is more likely to result in sperm granuloma formation than use of coagulation (Schmidt and Free, 1978~.
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From page 83... ...
Several epidemiologic studies have assessed the relationship between vasectomy and a variety of other diseases associated with alterations of the immune system. In a historical cohort study conducted in the United States, 10,590 vasectomized men from four cities were interviewed, along with a neighborhood control for each vasectomized man (Massey et al., 1984~.
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From page 84... ...
The possibility that vasectomized men may have an increased risk for genito-urinary disease warrants further evaluation, but available data are generally reassuring. Vasectomy Reversal Changes in life situation may lead men to regret their decision to undergo vasectomy.
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From page 85... ...
Fertility & Sterility 25:149-156. Anonymous 1986 Oral contraceptives and breast cancer.
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From page 86... ...
1987 The role of contraceptive use in cervical cancer: the Maryland cervical cancer casecontrol study. American Journal of Epidemiology 126:592 604.
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From page 87... ...
Schindler 1987 Use of oral contraceptives and risk of invasive cervical cancer in previously screened women. International Journal of Cancer 39:427~30.
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From page 88... ...
n.d. Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer.
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From page 89... ...
1988 Oral contraceptives and cervical cancer risk in Costa Rica: Detection bias or causal association? Journal of He American Medical Association 259:59 64.
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From page 90... ...
1983 Oral contraceptives and breast cancer. Lancet 2:1414-1415.
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From page 91... ...
1983 Breast cancer in young women and the use of oral contraceptives: possible modifying effects of formulation and age at use. Lancet 2:92~930.
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From page 92... ...
Mullay, et al. 1987 Consistency and plausibility in epidemiologic analyses: application to breast cancer in relation to use of oral contraceptives.
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From page 93... ...
1985 Oral contraceptives and breast cancer in young women. Lancet 2:97~973.
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From page 94... ...
B Petitti 1982 A rewew of problems of bias and confounding in epidemiologic studies of cervical neoplasia and oral contraceptives.
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From page 95... ...
"~~ EFFECTS OF C ~93 Wodd Hat Org~i~d~ 198~ ~~ed~=eslemne (SPA) and Manor: memorandum _ s WHO mung.
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