[Teenagers and interruption of pregnancy (author's transl)]. / L'adolescente et l'interruption de grossesse.

PIP: Abortion, especially repeat abortion, may involve complications in young childless women which threaten the success of their future pregnancies. Adolescents should be made aware of the possible risks of pregnancy interruption and the use of contraception should be promoted among them. Adolescent sexual activity, requests for abortion, and term pregnancies have been increasing in almost all industrialized countries. In 1976, 20% of 16-year olds, 30% of 17-year olds, and 45-60% of 18-year olds in the canton of Vaud were reported to be sexually active. The proportion of adolescent deliveries declined from 4.5% in 1970 to 2.1% in 1978, while the number of abortions in those aged 20 or under remained stable or declined slightly over the same time. It appears that the program of sex education carried out in the schools by a multidisciplinary team and the easy access to family planning have combined to limit the incidence of abortion among teenagers. The situation can be further improved: only about 50% of sexually active adolescents use effective contraception at 1st intercourse, and doctors and teachers could make greater efforts to identify those at high risk. Late complications of abortion that can effect future childbearing include sterility due to pelvic inflammation and infection, incomplete cervix, and premature delivery. Physicians should be aware of the conscious and unconscious phychic factors which impede contraceptive use among adolescents, especially the unstable and immature. It is sometimes necessary to insert an IUD in adolescents unable to accept the discipline of other methods, despite the elevated risks of pelvic infection in young nulliparas and those with numerous partners, in order to avoid abortions or undesired births.^ieng

[Secondary effects and complications of new intra-uterine devices (author's transl)]. / Effets secondaires et complications des nouveaux appareils intra-utérins.

PIP: New IUDs, especially copper devices, have reduced the incidence of pregnancy, expulsion, pain, and bleeding complications, but the risks of ectopic pregnancy and of infection and subsequent sterility have not entirely disappeared. New solutions to the problems of hemorrhage and expulsion include Progestaserts which release a daily dose of progesterone into the uterine cavity, longer-lasting copper devices, devices which release levonorgestrel or antifibrinolytic substances, and devices especially designed for postpartum or postabortal insertion. Some studies have indicated that insertion during the menstrual cycle has little influence on the incidence of side effects. Pregnancy rates with different IUDs vary between .5 and 2.8%, and 30 to 50% of pregnancies with an IUD in place terminate in 1st trimester spontaneous abortions. Removal during pregnancy reduces the risk of abortion by half and reduces the risk of premature labor. IUDs in pregnant women should be removed whenever possible to reduce the risk of septic abortion, and the pregnancy should thereafter be regarded as high risk. Ectopic pregnancy is 10 times more likely in IUD users than for non-IUD users. Risk of expulsion, widely reported as 2 to 15% after 1 year, diminishes after age 30 and increases with parity. Excessive bleeding causes removal of IUDs in 13% of cases; none of the proposed remedies for excessive bleeding and pain have been truly satisfactory. The rate of perforation is generally estimated at 1.2/1000 insertions and is related to the skill of the inserter. IUD wearers have 4 times more risk of pelvic inflammatory disease and childless users have 7 times greater risk than nonusers. A careful gynecological examination with bacteriological study should be performed before each insertion and high risk patients including young nulliparas and women with numerous sexual partners should be carefully watched. To avoid complications, the devices should be carefully inserted and all contraindications should be observed.^ieng

[Psychological and sexological aspects of contraception in adolescence (author's transl)]. / Aspects psychologiques et sexologiques de la contraception chez l'adolescente

PIP: Contraception in adolescence presents some particular psychological and sexual aspects. From the experience of 2 family planning centers in Lausanne, Switzerland, it is concluded that most of the patients attending the centers began their sexual life at the age of 16-17; most of them used contraceptive methods that were very unreliable, in spite of a sex education program that is well organized in the canton of Vaud; 88% of them had already had sexual relations before attending the center s; the number of adolescents visiting the centers is increasing each year. There is, however, still resistance to contraception, for conscious or unconscious motives. The most frequent causes of resistance are analyzed and generally attributed to immaturity. Physicians should be aware of the psychological conditions of each case and provide the appropriate advice and assistance.^ieng

[Development and limits of contraception]. / Evolution et limites de la contraception

PIP: Although family planning is generally regarded as the best method to limit abortions, the decline in the number of abortions and interruptions of pregnancy following the opening of family planning centers in Switzerland has been less spectacular than had been predicted. Several factors account for the relative ineffectiveness of family planning: some women abandon contraceptive methods for illogical reasons, especially after a traumatic event in their lives; sex education is still often insufficient; ignorance causes excessive fear of possible or imagined effects of contraceptives; part of the population is simply apathetic and irresponsible; finally, the availability of abortion may be a factor, although it is the worst method of birth control. Physicians also should be better informed on available methods, and should help couples in selecting the method that they prefer, provided that there are no medical contraindications, because there is no ideal method and the one spontaneously chosen is likely to be followed more carefully and therefore to be the most effective. Methods are available that are both effective and safe. While new revolutionary methods are being studied, they are still in the experimental stage.^ieng

[20 questions aporopos of trimestrial injection of depot contraceptives]. / Vingt questions à propos de l'injection trimestrielle de contraceptif - retard

PIP: The treatment studied is the injection of 150 mg of medroxyprogesterone acetate (MPA) every 3 months, effective for a minimum of 13 and a maximum of 41 weeks. It is regarded as a safe, effective, and practical contraceptive method, without permanent effects and with limited side effects, but its use remains limited to certain categories of women because of some side effects and contraindications. The absence of estrogen tends to reduce contraindications. The most important side effect consists of irregular hemorrhages and spotting during the first 9-12 months, followed by amenorrhea, which is reversible. The ovarian function is generally reestablished within 6-12 months following the last injection, and fertility is also reestablished. Studies showing a higher incidence of cancer of the uterus among women using MPA, which prompted the Food and Drug Administration to rstrict its use, are refuted by the author.^ieng

[Critical study of new contraceptive methods]. / Etude critique de nouvelles méthodes contraceptives.

PIP: The application of several new or experimental contraceptives is summarized: graduated sequential pills, continuous pills, progestagen or combined pills, once monthly pills, continuous progestagen minipills, injectables, alkaloids, antiestrogens, postcoital estrogens, antizygotics, and an antiluteotropic. Graduated sequentials, which have 3 increasing estrogen dose levels, are appropriate for young nulliparas. Continuous pills could be prescribed to women incapable of taking conventional combined pills. The once monthly pills, formulated of long-acting quinestrol 2 mg and quingestanol 5 mg have the same side effects as conventional pills but about a 2% failure rate. Minipills are effective, cheap, and produce few side effects except irregular bleeding. Injectables similarly are very effective but produce irregular and sometimes prolonged (6-20) days) bleeding between "intervals" of a few to 60 days. Ovulation is sometimes not reestablished after stopping. Thus, injections are more suitable for dull or negligent women who want no more children. The alkaloids ergoco rnine, vinblastine, and colcemide are only experimental drugs for contraception because they appear to be toxic or teratogenic. Antiestrogens, such as dimethylstilbestrol, MER 25, clomiphene and U 11,000 have antiimplantation potency in rabbits, but their mechanism is unknown. Postcoital estrogens, e.g., 2.5 mg ethinyl estradiol for 4-6 days are effective although they produce estrogenic side effects. 3 nonsteroidal antizygotics, ORF 3858, Fenestrel, and U 10,293 are being investigated. F 6066 and F 6103 are antiluteotropics without evident teratological effect; F 6066 has been used in clinical trials in Sweden.^ieng