News Highlights
Teens committed to not getting pregnant still having unprotected sex
There’s no way to discover the intimate details of someone’s life like reading their diary. That’s why researchers asked a group of adolescent women at increased risk for pregnancy and sexually transmitted infections (STIs),to log journal entries about their experiences with sexual intercourse and contraception. The teens were tracked and interviewed every three months about their intentions regarding pregnancy.
The majority of the teens (more than 92%) indicated that they did not wish to become pregnant, but more than half the episodes of intercourse (57%) were unprotected.
Women who were trying to avoid pregnancy used contraceptive methods half of the time. In comparison, women who were not trying to avoid pregnancy used contraception in 13% of sexual encounters.
This study confirms that women who do not wish to become pregnant are more likely to use some form of protection with intercourse, even though they still had unprotected intercourse almost half of the time. There is a discrepancy between intention and behavior which may be related to complex social, relational and emotional factors.
Bartz D et al. Pregnancy intentions and contraceptive behaviors among adolescent women: a coital event level analysis. Journal of Adolescent Health 2007;41:271-6.
Which birth control pill has the fewest side effects?
No combined oral contraceptive pill—the birth control pills made up of the hormones estrogen and progestin in varying doses—has a better side effect profile than any other, a study has found. One type of pill may affect different women in different ways. The good news is that even though one type of pill may not work for you, there are several options out there to try.
A French study examined the reported side effects of oral contraceptives in more than 2,800 women taking different types of pills. The symptoms often associated with oral contraceptives include weight gain, nausea, breast tenderness, swollen legs, fewer periods, breakthrough bleeding and heavy or painful periods. Researchers compared the frequency of these side effects to the dose of estrogen, and to the type and dose of progestin present in the pill. There was no relationship between any of these factors, aside from the association between the progestin only pill and more breakthrough bleeding and fewer periods.
Most the side effects that are a nuisance often disappear or decrease over time. You should try a pill for three to six months before giving up on it. It is also important to know that not all of the symptoms listed are caused by the pill just because they are reported by people on the pill. For instance, weight gain occurs similarly in women both on and off the pill.
Moreau C, et al. Oral Contraceptive Tolerance: Does the Type of Pill Matter? Obstet Gynecol 2007;109:1277-85.
Pregnant women have higher risk of blood clots than users of hormonal contraception
Women who take oral contraceptives (OC) have a much lower risk of blood clots than women who are pregnant.
In a study of over 600,000 pregnancies, blood clots occurred 10 times in every 10,000 pregnancies. Venous thromboembolic disease, which includes blood clots in the blood vessels of the legs and lungs, occurred 1 to 1.5 times for every 10,000 users per year of use of OCs. In women who are neither pregnant nor taking combined hormonal contraception the risk falls to about 0.5 cases per 10,000 women a year.
Among birth control users, the risk of getting a blood clot is highest during the first year of use. Other factors such as older age and cigarette smoking increase the risk for a blood clot. When considering the risks of taking any medication, it is important to compare them with the risks to those associated with the disease that you are treating or the condition you are preventing. Although there is a risk of blood clots associated with the pill, this risk is very low, and certainly a lot lower than the risk of a blood clot in pregnancy.
Jacobsen AF et al. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium—a register-based case-control study. Am J Obstet Gynecol 2007;197:x.ex-x.ex.
Black A et al. Canadian Contraception Consensus. J Obstet Gynaecol Can 2004;26(3):219-54.
Toronto Public Health clinics offer second chance to protect young women against cervical cancer
Grade 8 females who missed their first or second dose of the HPV vaccine can get vaccinated free of charge at one of several catch-up clinics being held throughout the city next week. Human Papillomavirus (HPV) is a common virus that can cause cancer of the cervix and genital warts.
“This vaccine is a form of cancer prevention for young women,” said Dr. Barbara Yaffe, Associate Medical Officer of Health, and Director of Communicable Disease Control for the City of Toronto. “Last year, there were 500 cases and 140 deaths from cervical cancer in Ontario. These clinics are giving girls another chance to prevent this serious illness.”
Three doses of the vaccine are required for protection. Grade 8 students who attend the clinics next week will still be able to get all three doses for free during this school year. Girls who do not get the vaccine at their school or a Toronto Public Health catch-up clinic may still be vaccinated by their physicians but must pay for the shots, which cost between $400 - $500 for all three doses.
Dr. Yaffe urged parents to talk with their daughters about the vaccine, and about other steps they should take to prevent cancer and sexually transmitted infections (STIs). The vaccine does not replace the need for regular Pap tests, which are recommended for girls once they become sexually active, nor does it protect against other STIs.
The clinics will be held from 4 p.m. to 8 p.m. as follows:
- Monday, January 28: Scarborough Civic Centre (Rotunda), 150 Borough Dr.
- Tuesday, January 29: North York Civic Centre (Members’ Lounge), 5100 Yonge St.
- Wednesday, January 30: Etobicoke Civic Centre (Meeting Rooms 1, 2, 3), 399 The West Mall
- Thursday, January 31: East York Civic Centre (Committee Room A), 850 Coxwell Ave
FOR HEALTH PROFESSIONALS
Using FSH levels to determine menopausal status in Depro Provera users
Depro Provera, also known as depot medroxyprogesterone acetate (DMPA), is a very reliable form of contraception used by many women. It causes periods to cease in 70% of users after one year and it also causes estrogen levels to remain low. Most women on DMPA do not have symptoms of low estrogen, but some users report hot flashes. Women need to know when they are menopausal so they know when they no longer need contraception.
Many physicians ask their patients to discontinue DMPA in order to assess menopausal status, thereby rendering the women unprotected against pregnancy if they do not choose alternate methods. This study assessed the usefulness of follicle-stimulating hormone (FSH) measurements done just prior to DMPA injections as a method of assessment regarding menopausal status. Typically, when the ovaries are no longer able to release an egg, the brain sends more messenger hormone (FSH) to try to get them to respond. Therefore in menopausal women circulating levels of FSH are high.
DMPA can suppress FSH levels even in women who are postmenopausal but usually not to the same level as the low FSH levels of women who are in reproductive age group. A single FSH measurement was unreliable as over 40% of women with a high FSH initially had a low FSH in subsequent measurements. The authors recommended that two consecutive high levels (≥ 35-40 mIU/mL) be required to confirm menopausal status as levels often fluctuate as they do in non-users of DMPA in the perimenopausal years. They also suggest only doing measurements in those women who are fifty or older as they are more likely to be postmenopausal. Discontinuation in women fifty-five or older without measuring FSH levels is another strategy since the chance of ovulation at this age is close to zero.
Juliato CT et al. Usefulness of FSH measurements for determining menopause in long-term users of depot medroxyprogesterone acetate over 40 years of age. Contraception 2007;76:282–286.
Sexualityandu presents: Sex Over 50
If you were sexually active in your younger years, you will probably continue to be sexually active as you grow older – though health situations may change the way that you express your sexuality. A lowered libido, decreased lubrication in women, and erectile dysfunction in men are all very common issues we face as we age, but that doesn’t have to stand in the way of a fun and active sex life!
That’s why we’ve put together a guide to maintaining a healthy sexuality as you age. Click here to read Sex Over 50.
Ask Sexualityandu
I was a day late in changing my second week patch. I've started bleeding, is that normal and why?
The estrogen present in the patch and the pill stabilize the lining of the uterus, which is shed during menstruation. When estrogen levels decline bleeding can occur. This can happen when the patch is removed late. The patch will still offer effective protection from pregnancy if you change it up to two days late—the so-called two days of forgiveness—but beyond this you should use a backup method for a week. There are no two days of forgiveness if the patch falls off or is removed.
I've been stacking birth control pills (taking them for three months in a row) for 6 months now. This month I've stopped and am trying to get my period at its regular time, only it hasn’t come yet. Its three days late so far, could this be because I've stopped stacking?
When “stacking” birth control pills, also known as semi-continuous use, a woman will usually still get her period in the week off the pill. It often takes a few days for a period to start after the last pill has been taken. A small percentage of women will also achieve amenorrhea, or no periods, as a result of thinning of the lining of the uterus such that there is no tissue to shed when the pill is stopped (thus no menstrual bleeding). It is good practice to get a pregnancy test the first time you miss your period when on hormonal contraception since accidental pregnancy can result if pills are missed.
How can I find a gynecologist in my area? None of my friends go to one and my family (and family doctor) lives far away.
You can access the web pages for the College of Physicians and Surgeons relevant to the province where you live. On that webpage you can access a doctor search for any specialty in any city. To see a specialist, you usually need to get a referral from your family physician. Ask your family doctor to refer you to a gynecologist in your area. You can give them a name that you found or they can find someone for you.
