Given her circumstances and taking into account that she is exclusively breastfeeding, the best thing to do would be to prescribe only gestagens.

A 30-year-old woman requesting a contraceptive method. She has a history of an emergency cesarean section 7 months ago, giving birth to a 3,550 g baby girl. She is exclusively breastfeeding. Point out the correct statement:

Explain to her that, if she is amenorrheic, she does not require another contraceptive method since breastfeeding is sufficient as a contraceptive method.

He informed her that the levonogestrel IUD is contraindicated because she had a cesarean section less than a year ago.

He explains that she could use a gestagen-only hormonal method.

She is offered combined hormonal contraception.

Norplant contraceptive maker accused of profiteering on drug.

Family planning groups and a lawmaker accused a US drug company yesterday of profiteering on Norplant, the implantable, 5-year contraceptive.  The company said its $365 product is cheaper than birth-control pills.   But Rep. Ron Wyden said Norplant was developed with extensive government support and sells for $23 in some Third World countries.  He said its cost to Wyeth-Ayerst laboratories may be as little as $16.  About 875,000 US women have had 6 match-sized hormone-dispensing rubber capsules implanted in their upper arms since 1990.  Dr. Amy Pollack of the Association of Reproductive Health Professionals said 56% of the 6 million pregnancies in the US each year are unwanted. She said 1.7 million pregnancies occur among women using contraceptives. The failure rate is less than 4 per 10,000 with Norplant compared with 3 per 100 women on the pill, she said.  Dr. Marc W. Deitch, Wyeth's medical director, said the company made a risky decision to bring Norplant to market in collaboration with the nonprofit Population Council.  The implant costs women 20 cents a day over its 5-year life, said Dr. Deitch.  The $365 cost is significantly less than the $1481 they would pay over 5 years for birth-control pills, $762 for a diaphragm and $590 for shots of Depo Provera, he said.  Male condoms cost $312 and an IUD $176.  Family planning advocates challenged Dr. Deitch's math.  Judith DeSarno, president of the National Family Planning and Reproductive Health Association, said federally funded clinics pay only $60 for a 5-year supply of oral contraceptives.  Women also must pay doctor fees--usually from $150 to $200--for inserting Norplant and eventually removing it from their upper arms.

Gynecology_Novak

A patient who is mildly anemic will benefit from hormone therapy. If the patient is not bleeding at the time of evaluation and has no contraindications to the use of estrogen, a combination low-dose oral contraceptive can be prescribed for use in the manner in which it is used for contraception. If the patient is not sexually active, she should be reevaluated after three to six cycles to determine whether she desires to continue this regimen. Parents may sometimes object to the use of oral contraceptives if their daughter is not sexually active (or if they believe her not to be or even if they would like her not to be). These objections are frequently based on misconceptions about the potential risks of the pill and can be overcome by careful explanation of the pill’s role as medical therapy. Objections may be based on concerns that hormonal therapy for medical indications is likely to hasten the onset of coitarche or sexual debut, although no data support this fear. If the medication

Doctor Knows Best? Tubal Ligation in Young, Childless Women.

When a gynecologist asks a twenty-one-year-old patient about her use of contraception, he is surprised that she would like to have a tubal ligation. The patient says that she would "never want to bring a child into this screwed up world." She has discussed tubal ligation with her boyfriend of one year, and he has told her that he accepts her decision. She asks her doctor if she can schedule the procedure as soon as possible. Her gynecologist mentions that he is concerned that she is very young and may eventually change her mind about having children. She insists that she has thought about it carefully and is certain that she wants the procedure. Her doctor feels very uncomfortable about this request. He consults the hospital ethics committee. Should he do as the patient asks or suggest that she wait at least six months and reconsider?

[Summary of the practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners].

When choosing a method of contraception, a woman must consider the pros and cons of various methods together with her family physician. In this process, the doctor provides information on the advantages and disadvantages, while the woman decides. A sub-50 pill of the second-generation preparation is the oral contraceptive of choice. If the woman chooses a newly developed method of contraception, she must be carefully informed about the uncertainties with regard to reliability and safety. Oral contraceptives are absolutely contra-indicated in the following cases: a history of myocardial infarction, stroke (CVA), venous thromboembolism, a known coagulation-factor deficiency, breast or endometrial carcinoma or severe liver-function disorders. Non-hormonal methods of contraception are preferred in such a case. If there are two or more risk factors for cardiovascular disease, the doctor and the patient must consider the pros and cons of hormonal contraception. In this connection, stopping smoking is more effective than not using an oral contraceptive. A prescription for an oral contraceptive can be given without a physical examination, not even a measurement of the blood pressure; follow-up is only necessary in the case of side effects or questions. Progestagen-only contraceptives are absolutely contraindicated in the following cases: current venous thromboembolism, vaginal bleeding of unknown origin, progestagen-dependent tumours such as breast cancer, and severe liver function disorders.

Contraception in the adolescent patient.

Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). If the adolescent plans to be sexually active, however, she is encouraged to select some form of hormonal contraception, namely Norplant, Depo-Provera, or oral contraceptives, in conjunction with condoms. The authors have had little success recommending barrier methods alone. Condoms are used sporadically and the diaphragm is very awkward for adolescents who are still uncomfortable with their bodies and with touching themselves. Of the three hormonal methods, Depo-Provera seems to be well-accepted by our patients. It offers several advantages that we believe make it attractive. First, it does not require any forethought by the patient other than coming in for the injection every 3 months. There is an effective grace period, so the patient is afforded good contraception even if she is up to a month late for her injection. The frequent visits for injections actually can be looked upon as positive, frequent contacts with the patient and can provide opportunities for counseling. In addition, some patients become amenorrheic, which teens view as an advantage, increasing compliance. If it is not likely that a patient will be compliant with every-3-month injections, Norplant is recommended. Studies have shown good acceptance of Norplant by adolescents and that has been the experience of the authors. With appropriate counseling prior to insertion and a counseling session with patients who request removal, the number of actual Norplant removals has been limited. If Depo-Provera and Norplant are not acceptable to the patient, then oral contraceptives are recommended. Of the three methods, more opportunities for failure exist with oral contraceptives. Pills are missed for a variety of reasons, including going away for the weekend; not having a regular schedule, which can interrupt pill-taking; and even ambivalence about becoming pregnant. One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)

Married Love

Downton Abbey (Series 5, Episodes 2, 3, and 6): In Episode 2 of the fifth series, Lady Mary (Michelle Dockery) has a copy of the book, which she uses to ensure her week-long dalliance with Lord Gillingham (Tom Cullen) has no "unwanted epilogue". In Episode 3 she asks for her lady's maid Anna Bates (Joanne Froggatt) to hide the book and the contraceptive device (most likely a cervical cap, which she had had Anna purchase according to the book's recommendation) in her home to avoid it being discovered in the house. In Episode 6 Anna's husband, John Bates (Brendan Coyle), discovers the device in their home, and is hurt by the prospect that his wife is trying to prevent them having children, which had been a topic of the series between them, but he is unaware that the book and device were being used by Lady Mary and not his wife. Only after a while did he realize that the device was Mary's and not Anna's.

Postpartum contraception: the lactational amenorrhea method.

Breastfeeding still accounts for a significant proportion of all fertility reduction, the average birth interval being longer among populations that breastfeed. However, per se it is not reliable for individual fertility suppression. The lactational amenorrhea method (LAM) is a highly efficient tool for the individual woman to utilize physiology to space births. Suckling induces a reduction in gonadotropin releasing hormone, luteinizing hormone and follicle stimulating hormone release, resulting in amenorrhea, through an intracerebral opioid pathway: beta-endorphins inhibit gonadotropin releasing hormone and dopamine secretions, which, in turn stimulates prolactin secretion and milk production. Reduced suckling precipitates the return of ovulation. During lactation, menses before 6 months are mostly anovulatory, and fertility remains low. The lactational amenorrhea method is based on three simultaneous conditions: (1) the baby is under 6 months; (2) the mother is still amenorrheic; and (3) she practises exclusive or quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM extended to 9-12 months are ongoing. We use a standardized algorithm to present LAM. The lactational amenorrhea method is a way both to space births and to support breastfeeding, which should be replaced by a contraceptive method in due course. A 'Breastfeeding-LAM-Family Planning' team is very helpful in maternity wards for promoting modern breastfeeding, LAM, and contraception, and for alleviating barriers and misconceptions. The lactational amenorrhea method is at least 98% effective, comparing favorably with other contraceptive methods. Acceptability and continuity are not very well known; as with other 'natural' methods the figures are probably low in a general population but high for motivated couples. The lactational amenorrhea method avoids double protection, and thus saves resources, is especially (but not exclusively) suitable for couples interested in natural family planning and is accepted by religious authorities. The lactational amenorrhea method gives time to decide upon a long-term method of contraception. Unwanted pregnancies, although infrequent, conceived while using LAM result in very short, high-risk birth intervals. Introduction of LAM in family planning programs demands training, attention to be given to working mothers, positive attitudes of health personnel, close links between postpartum and family planning teams, situation analysis, budgets, evaluations, follow-up activities, modifications of record keeping systems and computing programs, and of national family planning guidelines. In conclusion, LAM is an efficient family planning method which should be promoted. The lactational amenorrhea method should always include the shift to another method when its criteria are no longer implemented.

[Women's opinion on hormone pills and the main sources of information].

The aim of this paper was to analyze and to evaluate women's opinion on hormone pills and the influence on hormone pill usage and reveal the main sources of information. Women who came for pregnancy termination (Group A) and women who came for consultation on further usage of contraception (Group K) have been interrogated. Interrogation according the special questionnaire has been performed at four consultation centers and three gynecologic clinics of Kaunas city. It was find out that due to the wrong information 25.1% of women in group A and 35% of women in group K thought that hormone pills cause irregular bleeding (p=0.01). Another myth - the possibility to become pregnant when taking pills - was indicated by 17% of women in group A and 32.4% of women in group K (p=0.01). Nine percent in group A and 12% in group K were confident that when taking hormone pills for some period of time one will not be able to become pregnant in the future. Seventy three percent of group A women and 80% of group K women indicated that the use of hormone pills increases the body weight (p=0.01). This research showed that the women that used hormone pills were properly informed about their treatment and side effects. Fifty four percent of group A women and 36% of group K women indicated that hormone pills were not suitable in case of several diseases (p=0.01). Eighty three percent of group A women and 71% of group K knew that hormone pills did not protect from cervical cancer (p=0.01). This information was mainly obtained from medical workers. The main reason why women of fertile age who took part in our research used little of hormone pills was false information received from insufficiently skilled persons and accordingly the negative opinion about hormone pills. Women's opinion on hormone pills is a very important factor for its usage. This opinion depends on sources of information, whether women received correct or false information on hormone pills. The most reliable source of information indicated by investigated women was medical personnel.

Helping patients handle accusations of infidelity.

You may have experience with women patients who assume their partners are being unfaithful if they try to use condoms because that behavior could indicate they are trying to prevent potential sexually transmitted diseases (STDs).  These same women may believe the same will be assumed of them if they begin to use the new female condom.  If women present the device to their partners in the context of a birth control product rather than a device to prevent STDs, men might be more willing to accept it, says sexuality expert Beverly Wipple, PhD, RN, an associate professor at Rutgers State University of New Jersey in Newark and the author of Safe Encounters:  How a Woman Can Say Yes to Pleasure and No to Unsafe Sex (Pocketbooks, 1990).  Wipple has been a leader in female sexuality research since 1979, having conducted the original research on the "G-spot" (Dell Publishers, 1983).  Wipple bases her hypothesis on a presentation about the male condom given at the 1992 annual meeting of the International Society for the Scientific Study of Sex, held in San Diego.  The presenter showed that if women were using the male condom as their only form of contraception, then the male was more likely to use it.  If the woman was taking oral contraceptives or using another form of contraception--and was only relying on the condom or STD protection--then the male was less likely to use the condom.   "I think the same thing might apply to the female condom," Wipple suggests.  "If she identifies that this is her method of birth control.  I think it is much more likely to be accepted than if she says she is using it to prevent the spread of diseases."  Wipple says practitioners should tell women to emphasize the birth control angle and downplay the STD angle.  "It may not be the only method they are using, but they don't have to tell him that." she says.  "This way, it is not putting an accusation [of infidelity] on him."  While she acknowledge and dislikes the lack of honesty inherent in this practice, she says the end justifies the means. "Although it is not addressing the issues that should be addressed, we have to recognize there are people in situations where it is just impossible for them to address the issues," Wipple explains.  She says this inability to communicate has led to the spread of STDs.

Jonathan Eig

Eig's first book was Luckiest Man: The Life and Death of Lou Gehrig (2005). Opening Day: The Story of Jackie Robinson's First Season was his second book. For his third book, Get Capone, Eig discovered thousands of pages of never-before-reported government documents on the government's case against Capone. The Birth of the Pill (2014), Eig's fourth book, told the story of the renegades who invented the first oral contraceptive.

Contraception in sea-going service personnel.

The right to make an informed choice about contraception should be afforded to every individual serving within the United Kingdom (UK) Armed Forces. This article looks at the responsibilities and approach that healthcare professionals should take within a Primary Care setting, summarises the common contraceptive options available, discusses the associated advantages and disadvantages of each technique, and considers operational factors in a military environment that combine to influence the final contraceptive choice an individual makes. Case Study. A 19-year old Able Rate joined the Royal Navy (RN) and at her joining medical it was noted that she had been on Microgynon™ combined oral contraceptive pill for approximately three years. During this time, her menstrual periods remained light; she never experienced adverse effects, demonstrated good compliance, and was happy to remain on this contraceptive regimen. Over the course of the next eighteen months, she was reviewed by a number of Medical Officers and Civilian Medical Practitioners on a quarterly basis, with Microgynon™ re-prescribed on each occasion. The appropriate Defence Medical Information Capability Programme (DMICP) template was used, with weight, smoking status, compliance and any issues or comments documented accordingly. In December 2010, a discussion regarding long-acting reversible contraception (LARC) was documented for the first time. The patient agreed to give LARC some thought and a review appointment was made for one month. She was subsequently started on the progestogen-only pill Cerazette™. It was noted by the consulting doctor that both the patient's mother and grandmother had a positive history of cerebrovascular events and the combined oral contraceptive pill was discontinued. Upon review at two months, the patient reported that she was content on Cerazette™ and wished to continue with this medication. She was amenorrhoeic, highly compliant, had given up smoking and her weight and blood pressure were stable. However, due to supply issues, it was explained that Cerazette™ was no longer a viable option for her. She had no plans to start a family, and was keen to investigate other contraceptive options. Furthermore, she expressed a particular desire to remain amenorrhoeic, as she was due to deploy overseas in the coming months, and not only wanted to avoid the inconvenience of having her period, but also felt it preferable not to have to take a daily pill when considering the constantly changing time zones. She subsequently had the etonogestrel-releasing subdermal implant Nexplanon™ fitted without complication. She has remained amenorrhoeic throughout and this form of long-acting reversible contraception has particularly suited her busy working role and active lifestyle.

Second-wave feminism

Some important events laid the groundwork for the second wave. French writer Simone de Beauvoir had in the 1940s examined the notion of women being perceived as "other" in the patriarchal society. She went on to conclude in her 1949 treatise The Second Sex that male-centered ideology was being accepted as a norm and enforced by the ongoing development of myths, and that the fact that women are capable of getting pregnant, lactating, and menstruating is in no way a valid cause or explanation to place them as the "second sex". This book was translated from French to English (with some of its text excised) and published in America in 1953. In 1960, the Food and Drug Administration approved the combined oral contraceptive pill, which was made available in 1961. This made it easier for women to have careers without having to leave due to unexpectedly becoming pregnant. It also meant young couples would not be routinely forced into unwanted marriages due to accidental pregnancies.

Ivermectin to prevent hospitalizations in patients with COVID-19 (IVERCOR-COVID19): a structured summary of a study protocol for a randomized controlled trial.

To assess the efficacy of ivermectin in addition to standard treatment compared to standard treatment alone in reducing hospitalizations in the COVID-19 patient population. IVERCOR-COVID19 will be a single-center, prospective, randomized, double-blind, parallel group (1:1 ratio), placebo-controlled study. Patients who meet the following criteria will be invited to participate: Inclusion criteria: (1) Over 18 years of age who reside in the province of Corrientes at the time of diagnosis. (2) Confirmed diagnosis of COVID-19 by polymerase chain reaction (PCR) test for detection of SARS-CoV2 in the last 48 h. (3) In the case of women of childbearing age, they must be using a contraceptive method of proven efficacy and safety (barrier, hormonal, or permanent contraceptives) for at least 3 months prior to inclusion in the present study and for the entire period of time for the duration of the study and until at least 30 days after the end of this study. A woman will be considered to have no reproductive capacity if she is postmenopausal (at least 2 years without her menstrual cycles) or if she has undergone surgical sterilization (at least 1 month before the time of inviting her to participate in this study). (4) Weight at the time of inclusion greater than 48 kg. (5) That they sign the informed consent for participation in the study. (1) pregnant or breastfeeding women; (2) known allergy to ivermectin or some of the components of ivermectin tablets or placebo; (3) current use of home oxygen; (4) require hospitalization due to COVID-19 at the time of diagnosis or history of hospitalization for COVID-19; (5) presence of mal-absorptive syndrome; (6) presence of any other concomitant acute infectious disease; (7) known history of severe liver disease, for example liver cirrhosis; (8) need or use of antiviral drugs at the time of admission for another viral pathology other than COVID-19; (9) need or use of hydroxychloroquine or chloroquine; (10) use of ivermectin up to 7 days prior to randomization; (11) patients on dialysis or who have required it in the last 2 months or who plan to do it in the next 2 months; and (12) current participation or in the last 30 days in a research study that has included the administration of a drug (Table 1). Table 1 Ivermectin/placebo dose according to patient weight Patient weight Ivermectin/placebo dose Total dose (mg) Equal to or greater than 48 kg and less than 80 kg 2 tablets of 6 mg each at the time of inclusion and 2 tablets 24 h after the first intake 24 Equal or greater than 80 kg and less than 110 kg 3 tablets of 6 mg each at the time of inclusion and 3 tablets 24 h after the first intake 36 Equal or greater than 110 kg 4 tablets of 6 mg each at the time of inclusion and 4 tablets 24 h after the first intake 48 The study will be carried out by the Ministry of Public Health of the Province of Corrientes (Argentina) in coordination with the Institute of Cardiology of Corrientes in the Province of Corrientes, Argentina. Intervention group: patients who are randomized to ivermectin will receive the dose according to their weight (patients up to 80 kg will receive 2 tablets of 6 mg ivermectin; patients with more than 80 kg and up to 110 kg will receive 3 tablets of 6 mg of ivermectin; patients weighing more than 110 kg will receive 4 tablets of 6 mg ivermectin) the day they enter the study and the same dose 24 h after the first dose. patients who are randomized to placebo will receive the dose according to their weight (patients up to 80 kg will receive 2 tablets of 6 mg placebo; patients with more than 80 kg and up to 110 kg will receive 3 tablets of 6 mg of placebo; patients weighing more than 110 kg will receive 4 tablets of 6 mg placebo) on the day they enter the study and the same dose 24 h after the first dose (Table 2). Table 2 Inclusion and exclusion criteria Inclusion criteria Exclusion criteria 1. Over 18 years of age who reside in the province of Corrientes at the time of diagnosis 1. Pregnant or breastfeeding women 2.Confirmed diagnosis of COVID-19 by polymerase chain reaction test for detection of SARS-CoV2 in the last 48 h 2. Known allergy to ivermectin or some of the components of ivermectin tablets or placebo 3. In case of being women of childbearing age, they must be using a contraceptive method of proven efficacy and safety (barrier, hormonal, or permanent contraceptives) for at least 3 months prior to inclusion in the present study, during the entire period of time for the duration of the study, and until at least 30 days after the end of this study. A woman will be considered to have no reproductive capacity if she is postmenopausal (at least 2 years without her menstrual cycles) or if she has undergone surgical sterilization (at least 1 month before the time of inviting her to participate in this study) 3. Current use of home oxygen 4. Weight at the time of inclusion equal to or greater than 48 kg 4. That require hospitalization due to COVID-19 at the time of diagnosis or history of hospitalization for COVID-19 5. That they sign the informed consent for participation in the study 5. Presence of mal-absorptive syndrome 6. Presence of any other concomitant acute infectious disease 7. Known history of severe liver disease, for example liver cirrhosis 8. Need or use of antiviral drugs at the time of admission for another viral pathology other than COVID-19 9. Need or use of hydroxychloroquine or chloroquine 10. Use of ivermectin up to 7 days prior to randomization 11. Patients on dialysis or who have required it in the last 2 months or who plan to do it in the next 2 months 12. Current participation or in the last 30 days in a research study that has included the administration of a drug MAIN OUTCOMES: Primary outcome will be the percentage of hospitalizations in patients with COVID-19 in the intervention and control groups. time to hospitalization in each of the arms of the study: number of days elapsed from the inclusion in the study until the hospitalization of the patient; percentage of use of invasive mechanical ventilation in each of the study arms: every patient who is connected to invasive mechanical ventilation after signing the informed consent and before the final study visit; time to invasive mechanical ventilation in each of the arms of the study: number of days elapsed from inclusion in the study to connection to invasive mechanical ventilation of the patient; percentage of patients requiring dialysis in each of the study arms: all patients who require renal replacement therapy of any kind, temporary or permanent, and which begins after signing the informed consent and before the final visit; mortality from all causes in each of the two trial groups: death of the patient, from any cause. Negative PCR swab at 3 ± 1 and 12 ± 2 days after entering the study. Ivermectin safety: it will be analyzed according to the incidence of adverse events that patients present in the intervention and control groups. The end of study (EOS) is recorded as the day the patient is discharged or death. Discharge will be granted according to the current recommendations of the Ministry of Public Health of the Province of Corrientes. A follow-up visit (EOF) will be made by phone 30 days after the EOS when vital status will be verified. Randomization will be done through a web system with randomly permuted blocks. Randomization will be carried out by one of the investigators who will not participate in the inclusion of patients or in the delivery of medication (Table 3). Table 3 EOS end of study, EOF end of follow-up Visit Basal and randomization, day 0 Day 3 ± 1 Day 12 ± 2 V#1 V#2 V#3 EOS EOF Informed consent X - - - - Inclusion/exclusion criteria X - - - - Demographic data and medical history X - - - - Concomitant medication X - - - - Vital signs* X X - - - Anthropometric data<sup^</sup X - - - - Basal laboratory X - - - - PCR swab - X X - - Assessment of adverse events - X X X - Final objective evaluation - X X X X Randomization X - - - - Adherence to treatment X X - - - *Includes heart rate, temperature, and oxygen saturation by a digital saturometer ^Includes weight and height BLINDING (MASKING): The participants, investigators, care providers, and outcome assessors will be blinded. We will include a total of 500 patients (250 patients in each group). This is version 1.0, 17 August 2020. The recruitment started on 19 August 2020, and we anticipate the trial will finish recruitment on 31 December 2020. ClinicalTrials.gov NCT04529525 . Registered on 26 August 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

July 1921

Professor Anne Louise McIlroy (Professor of Obstetrics and Gynaecology at the Royal Free Hospital for Women) delivered a paper at the Medico-Legal Society London, and described the contraceptives dispensed at Marie Stopes Mothers' Clinic as the "most harmful method of which I have experience". Dr Halliday Sutherland would quote her words in his 1922 book "Birth Control". When Stopes sued Sutherland for libel, McIlroy testified for the defence. Born: Ezzard Charles, U.S. boxer, World Heavyweight Champion 1951, in Lawrenceville, Georgia (died 1975)

Katharine Betts

as the oral contraceptive pill, IUDs, condoms and diaphragms. Most of these women said they either abandoned the Billings method or miscalculated because the method was either "too complicated," or there were "too many rules to follow" or there were "too many qualifications" to observe. Betts argues that while all methods of contraception require that individuals adhere to proper use, the Billings method was still less effective than other methods and she questioned the Government's continued support of this as a primary family planning strategy.

Probable drug interaction between warfarin and hormonal contraceptives.

To report a single patient case that presented with a probable drug interaction between warfarin and 3 methods of hormonal contraceptives, as assessed by the Horn Interaction Probability Scale. A 33-year-old female patient required long-term anticoagulation following an aortic valve replacement. While taking warfarin (38.5 mg weekly), she transitioned from a monophasic combined oral contraceptive (ethinyl estradiol plus norethindrone) to an implantable progestin-only contraceptive (etonogestrel) on the advice of her cardiologist. Nineteen days following etonogestrel implant insertion, her international normalized ratio (INR) decreased to 1.8 and required a 55.8% warfarin dose increase (resulting dose of 60 mg weekly). Within 10 months, the patient elected to have the implant removed due to vaginal bleeding. Nine days following removal of etonogestrel, she experienced a transient INR increase to 6.5. Her INR returned to within goal range after her warfarin dose was decreased to 55.5 mg weekly. After using barrier methods of contraception for 48 days, she initiated an oral progestin-only contraceptive (norethindrone). Further warfarin dose adjustments were made, resulting in a weekly warfarin dose of 53.5 mg. Thirty-nine days after initiation of oral norethindrone, she elected to discontinue use due to vaginal bleeding and no longer uses hormonal contraceptive methods. No further adjustments to her warfarin dose were warranted. The increased warfarin requirement observed in this patient may have been a result of multiple factors. Based on a literature review, we hypothesize that the predominant mechanism of interaction was ethinyl estradiol inhibition of CYP1A2 and 2C19. We recommend that further in vivo studies be completed to definitively identify the mechanism of the interaction. It is necessary to intensify warfarin monitoring upon initiation or alteration of hormonal contraceptives.

[Natural contraception--a real option?].

In the article, a method developed by John Billings is introduced, based on the presumption that a woman will learn to know her fertile days and the day of ovulation by observing the consistency of the cervical mucus. The method has many uses. The woman gets to know her body and its functions. The woman can avoid becoming pregnant without long periods of continence and she can get pregnant when she wants it herself. The method can also provide help in various problems of childlessness.

Comparison of birth control methods

The fertility awareness-based method is when a woman who has a predictable and consistent menstrual cycle tracks the days that she is fertile. The typical woman has approximately 9 fertile days a month and either avoids intercourse on those days or uses an alternative birth control method for that period of time. The failure rate is between 2-23%. Lactational Amenorrhea method is an option for women who have had a baby within the past 6 months and are breastfeeding . This method is only successful if it has been less than 6 months since the birth of the baby, they must be fully breastfeeding their baby, and not having any periods. The method is almost as effective as an oral contraceptive if the 3 conditions are strictly followed.

Nancy Miriam Hawley

In 1966, after the birth of Hawley's first son, she paid a visit to her OB/GYN for her six-week check up at the age of 23. During this check up, Hawley's doctor recommended she try a new pill on the market for birth control. When she asked what was in it, her doctor simply told her not to worry about it, and she refused to take the pill. At the time, most OB/GYNs were male, and most of the time husbands were told about their wives' conditions instead of the woman herself. In 2004, when reflecting on the 35th birthday of the first meeting, Hawley said, "We weren't encouraged to ask questions, but to depend on the so-called experts. Not having a say in our own health care frustrated and angered us. We didn't have the information we needed, so we decided to find it on our own." At a conference organized by the Women's, Gender, & Sexuality Studies Program at Boston University, Hawley claimed she had one burning question: "what's in this birth control pill?" It was a question her doctor

Delayed presentation of uterine and bowel perforation following insertion of an intrauterine device.

Insertion of intrauterine methods of contraception (IUC) carries an inherent but small risk of perforation of the uterus, usually quoted at 2 in 1000. If perforation occurs, it is usually discovered either when a patient presents with 'missing threads' or with an unplanned pregnancy. Rarely, if the IUC has perforated bowel, patients can present acutely unwell although this sometimes occurs years after insertion. Asymptomatic perforation of the bowel (with IUC insertion or otherwise) is not common. In January 2018, a 41-year-old woman attended our community sexual and reproductive health service requesting removal of her intrauterine system (IUS). The clinic nurse performed this and during the consultation the patient revealed that several days earlier she had passed a previous 'lost' intrauterine device (IUD) when she opened her bowels. She came to believe this was an IUD inserted in 2006 that had been 'lost' and resulted in a pregnancy with her third child. We counselled her about her options and she had the IUS removed as she was worried this could happen again and opted to use condoms. This case reports an unusual presentation of a delayed and importantly 'silent' perforation of the uterus and bowel on insertion of IUC. The case highlights the importance of cross-specialty communication when an IUD has perforated or expelled resulting in a continuing pregnancy, so that appropriate imaging can be arranged following delivery of the baby.

[First visit for contraception].

The first visit for contraception essentially aims at listening and providing information and counseling. The choice of the contraceptive methods takes into account the contra-indications of the method as well as the patient personnel history, the type of demand, the needs and the fears. For young women, the most preferred choice is the combined pills, very effective and with minima sides effects but other methods (IUD, barrier methods) should be kept in mind. Observance requires proper information and reassurance on side effects particularly on menstruation disorders (amenorrhea, spotting) to avoid drop out.

Awareness of and attitude toward hormonal emergency contraception among married women in Kuwait.

To describe the awareness of and attitudes toward hormonal emergency contraception among women in Kuwait. A cross-sectional survey was conducted among married women at obstetrics/gynecology outpatient clinics at the government Maternity Hospital in Kuwait. A pretested Arabic self-administered questionnaire was distributed to the women in March 2005. The questionnaire provided a short explanation as to what was meant by hormonal emergency contraception and then elicited whether the respondent was aware of it, what concerns she had, and whether she thought it should be made available in Kuwait. One hundred three questionnaires were completed. Respondents were mostly Kuwaiti (78%) and non-Bedouin (78%) with postsecondary school education (74%) and a mean (SD) age of 33.1 (7.8) years and a mean (SD) number of children of 2.8 (1.9) About half of the women were not currently using contraceptive methods; 40% of contraceptive users were taking oral contraceptive pills. Bedouin women were more likely than non-Bedouins to use breastfeeding as a contraceptive measure (p = 0.012). Ten women (9.7%, 95% CI 4.8-17.1) reported having heard of hormonal emergency contraception, mostly from informal sources, 1 had used it, and 7 knew of other women who had used it. Only 8 (7.8%) respondents were willing to use or inform a friend about hormonal emergency contraception, but 89.3% thought it should be available in the health system. Awareness of hormonal emergency contraception is low among women in Kuwait. Despite concerns and apparent negative attitudes, women believe it should be made available in the health system.

Charity Dingle

for a baby, she is still having contraceptive injections. Charity records Jimmy talking about this and her plan to set Charity up. Initially, she simply blackmails Jimmy but then plays the video at a party and Tom throws them out before begging her to give him another chance but she refuses, saying that she no longer loves him and leaves with Noah.

Breast-feeding alters LH secretion pattern.

The contraceptive effects of breast feeding are probably due to the marked changes which suckling causes in the pattern of luteinizing hormone (LH) secretion, studies conducted in Scotland have shown.  In mothers who fully breast feed their babies, these changes are sufficient to offer contraceptive protection of 98% for about 6 months postpartum. Breast feeding mothers should start to use another method of contraception 6 months after giving birth, or after they start supplementing breastfeeds with other food, or after the 1st menses, a plenary session on breast feeding, birth spacing, and child survival heard.  The researchers from Scotland also presented striking new evidence of the protective effect of breast feeding on the heaLth of newborn babies.  The studies were conducted in Edinburgh and Dundee over a period of more than 10 years and covered a range of different aspects of breast feeding and fertility.  Dr. Anna Glasier, who presented findings on the hormonal changes which occur in breast feeding women, showed that suckling postpones the return of ovarian activity after childbirth.  The results for 1 mother who bottle fed her baby showed that menstruation returned as early as 6 weeks postpartum, ovulation occurred at 10 weeks, and that by 14 weeks, a normal ovarian cycle had returned.  In a group of 27 breast feeding mothers, the onset of ovarian activity was found to coincide with the introduction of solid food and a decline in suckling activity.  In many cases, ovulation suppressed for several months after supplementation of breast feeding began and a normal ovarian cycle did not return until well after breast feeding had been stopped completely.  Dr. Glasier said all the women studied showed marked disturbances of the pulsatile pattern of LH secretion, which gradually returned to normal as suckling declined.  The disturbance is thought to be caused by the effect of suckling on the hypothalamic pulse generator, although the mechanism by which this occurs is not yet understood, she said.  The Scottish researchers believe that it is this disturbance which is responsible for the contraceptive effect of breast feeding.  Their findings appear to disprove the theory that ovarian suppression is due to the increased levels of prolactin which occur during breast feeding.  Dr. Glasier explained that the administration of exogenous GnRH restored normal LH secretion patterns and ovarian activity in women who were fully breast feeding their babies, despite the presence of elevated prolactin concentrations.   Her fellow-researcher Prof. Peter Howie presented the findings of a study of 750 Dundee mothers and their babies, aimed at examining the effects of breast feeding on the infants.  Because most previous studies have been criticized as methodologically flawed, the Dundee investigation was carefully designed to meet important methodological criteria.  Prof. Howie told the meeting that in the babies who were bottle fed or weaned before 13 weeks, gastrointestinal illness was 5-8 times more common than in babies who were breast fed for longer.  The rate of illness among the babies breast fed for less than 13 weeks the close to that in some developing countries.  The protective effect of breast feeding persisted beyond the period of breast feeding itself up to 1 year of life.  These data support the view that breast feeding of offers important health benefits to babies in all environments, she said.

Roe v. Wade

History of the case Sarah Weddington was persuaded to join Linda Coffee after listening to her give a speech about a new lawsuit she was going to file representing a woman and her husband. The suit would claim that the woman needed to be able to have abortions, because the woman had a neurochemical disorder and should not give birth or raise children, they didn't want to abstain from sex, and contraception might fail. But one lawsuit was not enough, since they wanted to go forum shopping to improve their chances of winning in court. They wanted to have another case so that they would end up with different judges due to the rotating system used for assigning cases to judges. Then, if either received a particular judge who they thought would be sympathetic, they would ask to combine the cases. Weddington later wrote that they "needed to find a pregnant Texas woman who wanted an abortion and would be willing to be a plaintiff."

Spontaneous Twin Pregnancy: A Challenging and Exceptional Scenario in a Patient on Maintenance Hemodialysis in Sub-Saharan Africa.

Chronic hemodialysis is associated with reduced fertility. Hence, pregnancy remains rare, challenging, and deleterious when unplanned, especially in low-resource countries. Contraception and births are very important in these settings. Though the main modes of contraception have been proposed in the chronic kidney disease (CKD) population, contraception still remains challenging in patients on maintenance hemodialysis. Most doctors, however, overlook contraception because of the low fertility, high rate of amenorrhea, and low libido. Furthermore, patients are less receptive to contraceptive counseling either because of a high desire to give birth or due to amenorrhea and low libido. Management of unplanned pregnancies is therefore very challenging and a multidisciplinary approach is the rule; however, it does not guarantee a good prognosis for both the mother and child. Very few cases of multiple pregnancies without induction of ovulation have been reported in patients with severe renal failure, especially those on maintenance dialysis. A 32-year-old multiparous woman with end-stage kidney failure (ESKF) and a residual diuresis of 700 mL per day who had been on inadequate maintenance hemodialysis for 36 months, presented with abdominal distension, which was confirmed on abdominal ultrasound to be a twin pregnancy at 22 weeks of gestation. Thereafter, we intensified hemodialysis (3 sessions/week), managed hypertension and anemia. The obstetrical course was uneventful until the 25th week of gestation when she developed grade 3 (WHO) hypertension and peripheral fluid overload. At the 29th week, she had a spontaneous vaginal preterm delivery of 2 babies weighing 1,350 g and 1,000 g, with an Apgar score of 8 and 7, respectively. Babies, however, died on day 1 and day 5 postpartum, respectively, from respiratory distress and early neonatal infection. The evolution of the mother was uneventful as she continued with her hemodialysis sessions. Twin pregnancies are a rare and very high-risk condition in end-stage renal disease and require multidisciplinary management.

The Legend of Good Women

There is also plenty of foreshadowing. The stories that are told later in the piece are foreshadowed by the nineteen women present in the prologue and the ballad they sing. The Problem with Two Prologues The story itself has two alternate prologues Chaucer authored for the story. The prevailing theory is that the contemporary criticism of the story following its release motivated Chaucer to sanitize or edit his prologue to be more fitting for the audience at hand. With Queen Anne in power, the topic of feminism was very much a hot button issue. Chaucer’s motivation for authoring the work in the first place is understood as a penance of his previous and unflattering depictions of women in his society. This factor could have had a strong influence on Chaucer to edit his original take.

Cystoscopic removal of a migrated intrauterine device to the bladder; a case report.

An intrauterine device (IUD) is a well-accepted means of reversible contraception. Migration of IUD to the bladder through partial or complete perforation has been rarely reported. This phenomenon could be strongly associated with history of prior cesarean sections (C-section) or early insertion of the device in the postpartum period. In this study, a case of copper IUD migration through cesarean scar defect is presented, in such a way that was successfully managed by cystoscopic removal. A 31-year-old female with a history of lower urinary symptoms referred to the clinic for her secondary infertility work-up. A copper IUD outside the uterus in the bladder was found using hysterosalpingraphy. A plain abdominal radiography also confirmed the presence of a T-shaped IUD in the pelvis. According to ultrasound, the copper IUD was partly in the bladder lumen and within the bladder wall. The patient had a history of an intrauterine device insertion eight years ago followingher second cesarean delivery. Three years later, her IUD was expelled, and another copper IUD was inserted. Thesecond copper IUD was alsoremoved while she decided to be pregnant. The patient finally underwent a hysteroscopic cystoscopy. The intrauterine device with its short arms embedded in the bladder wall was successfully extracted through the urethra. IUD insertion seems to be more challenging in women with prior uterine incisions and requires more attention. Cystoscopic removal should be considered as a safe and effective minimally invasive approach tomanage a migrated intrauterine device in the bladder.

[When there is no suitable contraceptive method].

Despite of the many possibilities there are some situations where no method of contraception seems to be suitable. The reasons for this may be medical and clear such as rise of blood pressure, which is an obstacle to using combination pills. Sometimes a question arises, whether the feelings are really caused by the contraceptive method, or does the woman possibly blame contraception for some other reason.

Medical contraindications and issues for consideration in the use of once-a-month injectable contraceptives.

A number of once-a-month injectable contraceptives have been studied over the last 30 years and at least three different formulations are currently in use worldwide. Each of these formulations contains an ester of the natural estrogen, estradiol, and a synthetic progestin. This is in contrast to the combined oral contraceptives which contain synthetic analogs of both estradiol and progesterone. This paper considers medical contraindications or precautions related to the use of once-a-month injectable formulations and suggests some considerations for their programmatic use, particularly in the developing world. Because once-a-month injectables contain both an estrogen and a progestin, the precautions related to their use are similar to those of combined oral contraceptives; however, since the estrogen component is a natural estrogen, administration is parenteral and the circulating levels reach peaks that are in the range of those of the normal preovulatory phase of the menstrual cycle, some of these precautions may be very conservative. Absolute contraindications to the use of monthly injectables are current or suspected pregnancy, and estrogen-responsive tumors of the breast or genital tract. Other factors have been termed precautions for use rather than absolute or relative contraindications. Primary precautions are conditions under which a woman should probably not use monthly injectables, but if she does, she should be monitored closely. These include current or individual history of cardiovascular disease, current liver disease or liver tumors, and over age 40 if a smoker. Secondary precautions to use are those which should be considered very carefully and balanced against the risks of not using the particular method. These include suspicion of breast or genital tract cancer until cancer is ruled out, unexplained abnormal vaginal bleeding, use of drugs which might affect metabolism and decrease effective levels of circulating steroids, breastfeeding, and having combinations of several risk factors for cardiovascular disease. These precautions are categorized as proposed, based on the fact that most women in the developing world face a risk from pregnancy that is probably far greater than the risks from any of the present formulations of steroidal contraceptives. A key consideration during programmatic use of monthly injectables is attention to compliance with follow-up schedules to minimize the risk of pregnancy. Because little information on monthly injectables is available that is directly related to these precautions, additional research studies will be required in order to reconsider whether some of the listed precautions are valid or others should be considered.

John 21

Conclusion (verses 24–25) The chapter (and the whole book) is closed by two verses referring to the author of the gospel in the third person ("We know that his testimony is true"). Verse 24 This is the disciple who is bearing witness about these things, and who has written these things, and we know that his testimony is true. Verse 25 And there are also many other things that Jesus did, which if they were written one by one, I suppose that even the world itself could not contain the books that would be written. Amen.''

Calendar-based contraceptive methods

Calendar-based methods use records of past menstrual cycles to predict the length of future cycles. However, the length of the pre-ovulatory phase can vary significantly, depending on the woman's typical cycle length, stress factors, medication, illness, menopause, breastfeeding, and whether she is just coming off hormonal contraception. If a woman with previously regular cycles has a delayed ovulation due to one of these factors, she will still be fertile when the method tells her she is in the post-ovulatory infertile phase. If she has an unusually early ovulation, calendar-based methods will indicate she is still in the pre-ovulatory infertile phase when she has actually become fertile. Finally, calendar-based methods assume that all bleeding is true menstruation. However, mid-cycle or anovulatory bleeding can be caused by a number of factors. Incorrectly identifying bleeding as menstruation will cause the method's calculations to be incorrect.