One-year assessment of women receiving sub-dermal contraceptive implant at Siriraj Family Planning Clinic.

BACKGROUND: The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method. MATERIAL AND METHOD: This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed. RESULTS: Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use. CONCLUSION: Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.

Preliminary report on characteristics of women participating in the meeting of the Oral Contraceptive Pill Members Club at Siriraj Hospital.

BACKGROUND: Oral Contraceptive (OC) services are not frequented a lot in Siriraj Hospital. Therefore, the OC services initiated the Siriraj OC Members Club to increase the number of OC users, develop a 'one-stop-service' clinic and a 'help line' to assist women cope with the side effects during OC use, and provide proper information. MATERIAL AND METHOD: Hospital personnel who worked at Sirriaj Hospital were informed about the program of the Siriraj OC Members Club by posters, leaflets, hospital website, and word of mouth. Those who registered as members participated in the half-day meeting of the program. Questionnaire assessment was distributed to all members who attended the meeting. RESULTS: The average age ofparticipants was 31.4 years. The lowest education level was secondary school and the highest was doctorate. Most married members have used at least one kind of contraceptive method OC's and condoms were the most common contraceptive method used in the past. Their source for obtaining OC was drug stores. In general, most women had had irritability and depression. Almost all women expected to have more information about advantages and disadvantages of OC use to cope with fear and side effects of OC use. CONCLUSION: Women who attended the meeting still need accurate and full information about the OC's. This program proposed to provide them with up-to-date and correct information about the OC. Furthermore, the one-stop-service will save their time and the help-line will assist them to cope with the side effects of OC use.

The comparative study of different contraceptive methods between copper T 380A and norplant 6, Siriraj experience.

Objective: To evaluate and study the demographic and clinical profile among the users of these 2 different contraceptive methods, to assess the continuation rates of these 2 methods as well as the frequency of Pap smear screening plus the resultsof Pap smears in each contraceptive method. Methods: This was a case note-based study in which the data were transferred to a standardized pre-tested proforma. Results: During 1 January - 31 December 2001 There were 162 Copper T 380 A users and 307 Norplant 6 users. The age group of IUD users were found higher than Norplant-6 users with a statistical difference. The continuation rates after 5 years were 39.5% for copper T 380 A and 11.4% for Norplant users. The frequency of Pap smear screening as well as the follow up rate was found much higher in copper T 380 A. The results of Pap smear of these two groups using long-acting contraception were statistically different : IUD users had a higher infection rate but Norplant users had higher abnormal cells. After treatment all users return to normal Pap smear. Conclusion: This contraceptive study was conducted in 2001. The continuation rate for copper T 380 A was significantly higher than Norplant 6 and encouraged the participants to have Pap smear screening as well as keeping the appointment for follow up. The report of Pap smear screening was found abnormally higher in the Norplant users. Actinomyces infection was commonly found with copper T 380 A.

Prevalence of bacterial vaginosis in Thai women attending the family planning clinic, Siriraj Hospital.

OBJECTIVES: To investigate the prevalence of bacterial vaginosis (BV) among Thai women attending a family planning clinic and to evaluate the association of BV with potential risk factors. MATERIAL AND METHOD: A cross sectional prevalence study was conducted among 800 women attending the family planning clinic, Siriraj Hospital, between August and December 2003. BV was diagnosed according to Amsel's criteria. Prevalence and risk factor models were compiled and statistically analyzed RESULTS: Among the low risk population acquiring sexually transmitted diseases, the prevalence of BV was 14.6% (117 of 800). Asymptomatic disease was recognized in up to 47.9% (56 of 117). BV was significantly more prevalent among those who used douching inside the vagina [OR = 3.98 (1.85-8.33), p < 0.01] and high a prevalence among IUD users [OR = 1.84 (1.22-2.79), p < 0.01]. Although not statistically significant, BV tended to be more prevalent among women with a lower age at first intercourse, higher numbers of lifetime partners, higher frequency of sexual intercourse and current smokers. CONCLUSION: BV is a relatively high prevalent condition. The two potential risk factors, douching inside the vagina and IUD use, can be demonstrated, adding to be more concerned about the inappropriate practice of douching and more consideration in IUD users. The other potential risk factors, the impact to adverse reproductive outcomes and the prevention of BV need further studies, particularly in various Thai populations.

Birth control in married women : Study in postpartum women at Siriraj Hospital.

The study interviewed 494 postpartum women at Siriraj Hospital. Of These 44.9 percent were women with first para and 55.1 percent were those with at least one child. Among women with first para, 37.4 percent were 19 years old or less, which is not an appropriate age for having children. Among the group on non-contraceptive use, 45.3 percent were adolescents who were 19 years old or less. 40.9 percent of the women with first para and 52.4 percent of the women in the other group who stopped using contraception gave the reason that they wanted to have a child. In addition, 14.2 percent of the women with first para and 9.2 percent of women with at lest one child stated that they stopped using the contraceptive method was 19.7 percent among women with first para and 20.1 percent among women with at least one child. Therefore, counseling before and after the method use is essential for client to select the appropriate method and to prolong the use of the method.

Sexual risk of adolescent in school.

There were 2,098 school boys and girls who answered questionnaires aged 11-20 years, 9.1% had had sexual intercourse and 0.3% had become pregnant. About 5.3% of girls and 7.2% of boys were homosexual. There were 37.8% of this group had seen pornographic pictures at their friends' house, 42.7% went to discotheques and 4.9% had experience of drug abuse. Most of them knew of at least one contraceptive method as a result of their teachers' education and the condom was the most popular one. When asked if they had any sexual health problems who would they consult, most of them consulted their parents and friends. Comparing the group that had had sexual intercourse with the group that had not, the sexual intercourse group had had more experience of pornographic pictures; had attended discotheques and used drugs which was statistical significant (p < 0.05). This result shows that the risks for having sexual intercourse in this group were viewing pornographic pictures, attending discotheques and drug abuse. Sexual intercourse started in the 12-year old group. Increasing age lead to increased discotheque attendance, drug abuse, use of pornographic pictures and increased sexual intercourse. We conclude that sex education should be started at 12 years. Parents and teachers should be both consultant and educator for sexual health and sex education. Well educated boys and girls will be good counselors or consultants for their friends. Drug abuse, pornographic pictures and discotheques were the risk factors for premarital sexual intercourse.