Asunto(s)
Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Acetato de Ciproterona/efectos adversos , Progestinas/efectos adversos , Tromboembolia Venosa/inducido químicamente , Europa (Continente) , Femenino , Humanos , Medición de Riesgo , Salud de la MujerAsunto(s)
Anticonceptivos Orales Combinados/efectos adversos , Anticonceptivos Hormonales Orales/efectos adversos , Acetato de Ciproterona/efectos adversos , Progestinas/efectos adversos , Tromboembolia Venosa/inducido químicamente , Europa (Continente) , Femenino , Humanos , Medición de Riesgo , Salud de la MujerRESUMEN
OBJECTIVE: Systematic review of the literature on the effectiveness and safety of permanent female contraception. MATERIAL AND METHODS: A systematic Medline and Cochrane Library review of the literature on technique, effectiveness, safety and complications of female sterilisation. Keywords used for research were 'female sterilisation', 'tubal occlusion', 'history', 'counselling', 'hysteroscopy', 'laparoscopy', 'complications' and 'effectiveness'. RESULTS: Worldwide over 220 million couples have resorted to either male (nearly 43 million) or female sterilisation (180 million). In this review the different methods of female sterilisation are described and their advantages and disadvantages discussed. Tubal occlusion is carried out via (mini-) laparotomy, laparoscopy or hysteroscopy. The Ovabloc, Essure and Adiana permanent contraception systems make use of the latter route. CONCLUSIONS: Female sterilisation via the transcervical route is an outpatient or office procedure; it is performed under local anaesthesia or even without anaesthesia. Its complication rate is low. It should be preferred to the abdominal procedures provided the equipment and the experience required are available. Counselling should include information on vasectomy for the partner as well as on alternative long-acting reversible contraceptives. The ten-year cumulative pregnancy rate of sterilisation techniques ranges from 0.1 to 3.6 per 1000 procedures. The life-time risk of failure is around 1/200.
Asunto(s)
Esterilización Tubaria/métodos , Consejo , Femenino , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Reversión de la Esterilización , Esterilización Tubaria/historia , Esterilización Tubaria/legislación & jurisprudenciaRESUMEN
A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the 'no-scalpel technique'. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30-60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure.
Asunto(s)
Vasectomía/métodos , Contraindicaciones , Consejo , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Masculino , Vasectomía/historia , Vasectomía/estadística & datos numéricos , VasovasostomíaRESUMEN
OBJECTIVES: To investigate the effect of a single low dose of mifepristone on ovarian function, when administered in the preovulatory period. METHODS: Healthy women with regular menstrual cycles were studied during two consecutive menstrual cycles. Either mifepristone or placebo was given in a randomized double-blind order when the leading follicle reached a diameter between 15 and 17 mm. Daily ultrasound and serum hormone measurements were obtained until follicular collapse. Statistical analysis was performed using Wilcoxon signed-rank test. RESULTS: Eight women entered the study, although one woman had to be excluded afterwards from analysis because her LH surge had already appeared on the day of treatment. The LH surge was delayed from day 14 to 17 (P = 0.01). Mifepristone caused a 3-day delay in follicular collapse, occurring on day 16 in control cycles and on day 19 in mifepristone treatment cycles (P = 0.02). The median cycle length was 26 days in control cycles and 30 days in mifepristone treatment cycles (P = 0.03). Progesterone measurement 7 days after follicular collapse did not differ significantly between both cycles. CONCLUSIONS: A single 10-mg dose of mifepristone administered during the preovulatory phase of the cycle delays the LH surge and postpones ovulation.