Compliance with depot medroxyprogesterone acetate: a randomized, controlled trial of intensive reminders.

We enrolled women in a prospective, randomized study to determine whether an intensive reminder system would improve compliance in women receiving depot medroxyprogesterone injections. Women selecting this treatment were assigned to a group that received both mail and telephone reminders or to a second group that received only a scheduled appointment at the time of the previous injection. The rate of continuation and the rate of on-time injections did not differ between groups. Women who had prolonged bleeding were more likely to discontinue depot medroxyprogesterone injections.

PIP: Depot-medroxyprogesterone acetate (DMPA) injection is an effective contraceptive that must be given within 14 weeks after previous injection to facilitate effective contraceptive action. This study investigated the effect of an intensive reminder system on the compliance and continuation of DMPA treatment. About 250 women (mean age, 20.7 years) who were not currently on DMPA treatment were enrolled in the study conducted in Pennsylvania between October 1993 and November 1994. These women were given DMPA injections and two groups were formed--those who came back for another treatment and those who came back after a year for 4 additional injections. One group of women received both mail and telephone reminders for treatment compliance, while another group received only a scheduled appointment at the time of the previous injection. Results revealed that the rate of continuation and rate of on-time injections was almost similar between the two groups. Presence of side effects, such as bleeding, would likely cause the discontinuation of the treatment.

Oral contraception and the recognition of endometritis.

OBJECTIVE: Oral contraceptive use has been associated with a lower risk of symptomatic pelvic inflammatory disease but a higher risk of chlamydial cervicitis. To explain these seemingly contradictory findings, we asked whether oral contraceptive use was more common among women with unrecognized endometritis than among women with recognized endometritis. STUDY DESIGN: A multicenter case-control study was performed. Women without signs of pelvic inflammatory disease were ascertained through contact tracing of partners with sexually transmitted diseases or through presentation with cervicitis. Women with symptomatic pelvic inflammatory disease met a set of standard clinical criteria. We compared the 43 cases without signs of pelvic inflammatory disease but with endometritis ("unrecognized endometritis") with the 111 controls with recognized pelvic inflammatory disease and endometritis ("recognized endometritis"). RESULTS: Women with unrecognized endometritis were 4.3 times (95% confidence interval 1.6 to 11.7) more likely than women with recognized endometritis to use oral contraceptives. CONCLUSION: Future studies need to fully characterize the risks and benefits of oral contraceptives in relation to sexually transmitted diseases.

Compliance with breast self-examination instruction in healthy adolescents.

Compliance with breast self-examination was prospectively assessed in three groups of healthy outpatient adolescents 6 weeks, 3 months, and 6 months after instruction. Although 87%, 59%, and 71% of the three respective groups reported sporadic practice of breast self-examination, only 39%, 9%, and 18%, respectively, performed the procedure timed correctly with the menstrual cycle. Those adolescents tested at 6 weeks demonstrated a high degree of proficiency in replicating the procedure on a silicone model. There was no significant difference between demographic variables or personal health beliefs regarding breast cancer and breast self-examination compliance. Our findings suggest that adolescents can effectively perform breast self-examination, but their practice is erratic. Thus, we recommend that when instruction in breast self-examination is given, the examination schedule should be reinformed at a follow-up visit.