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ESTRADIOL VALERATE CONTRACEPTIVE PILL ON BONE TURNOVER IN YOUNG FERTILE WOMEN
S580
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
M146 THE ENTRANCE IN THE CONTRACEPTION AND ITS IMPLICATIONS ON THE WOMEN’S CONTRACEPTIVE ITINERARY IN MALI A. Coulibaly1 . 1 Sant´e publique, Facult´e de M´edecine du Mali, Bamako, Mali Objectives: This study was led to help to understand better the initiation of the women in the contraceptive practice and the existing links between the entrance in the contraception and the contraceptive itinerary which ensues from it. Materials: The collection of the social actor’s discourses was in the center of this research. The interview guides, the research book and the logbook were used for the data collection. All the discourses were entirely registered with cassette recorder and then transcribed. Methods: It is about an anthropological study using widely the qualitative approach. The main used skills were the semi-directive interviews and the life stories. The researches were led in Bamako, the capital city of Mali during 3 months (December, 2009 and February, 2010). In all 40 women from 15 to 30 year old, from different social origins and school levels, were questioned. The data were analyzed through the method of content analysis. Results: At the conclusion of this study, we made following reports: – For a majority of women and independently of the marital status and of the school level, the entrance to the contraception start several months or years after the entrance in the sexuality. For the single women, this means the risks of unwanted pregnancies. – The entrance in the contraception for many women happens after an ’incident’ (pregnancies, abortions, etc.). – There is a correlation between the school level of the user and the place of purchase of the contraceptive products: the most educated women tend to buy in pharmacies while the least educated buy at the clandestine pharmaceutical product sellers. – The women initiated after getting information with the non professionals have more ’unstable’ contraceptive trajectories. – Contrary to what we could think, the initiatory age depends less on the school level than the individual lived experiences of the users. Conclusions: The entrance in the contraception is less the result of the influence of the “sanitary messages” than a consequence of the individual lived experiences of the social actors. The way the users enter into the contraception has an incidence on the continuation of their contraceptive trajectories: where to buy contraceptive products, organization of contraceptive itinerary, etc. M147 EFFECTIVENESS OF BEHAVIOR CHANGE INTERVENTION FOR INCREASING IUD ACCEPTANCE V. Lara1 . 1 Social Marketing Department, Population Services International/Nepal, Lalitpur, Bagmati, Nepal Objectives: To demonstrate effectiveness of PSI/Nepal’s targeted behavior change intervention on increasing IUD acceptance and service provision. Materials: Population Services International/Nepal has been implementing Women’s Health Project to support the Government of Nepal’s efforts to reduce maternal mortality and to increase the modern contraceptive prevalence rate. One of the major objectives under this program is to increase positive perception towards IUD leading to increase in use. PSI/Nepal identified two strategic priorities: (i) identify primary target audience (ii) increase demand generation to expand total market for IUD. Methods: A qualitative research on contraceptive use was conducted to better understand the target audience and the context in which behavior change takes place. Shanti was developed as a client archetype based on this study. As a frequent switcher, Shanti is searching for a contraceptive method she is satisfied with and is right for her body. Shanti’s main barriers to IUD use
are access, affordability and knowledge about the product. Shanti reported that her health provider rarely recommends IUD to her, another reason she has never seriously considered the method. Behavioral change interventions was developed based on the study findings and launched as a part of the demand generation activity targeted towards clients and IUD providers. Targeted mass-media interventions and inter-personal communication at household and community level were used to improve client’s perceptions and demand for IUDs. PSI/Nepal’s network of private providers offering IUD services was expanded from 19 to 46 districts and motivated these providers to increase their productivity and to maintain highquality standards. Results: Before the intervention, a total of 3664 women received IUD services and post intervention, 124,991 women in 2010 and 453,436 in 2011 were contacted at the household level through IPC activities. Out of these, 14,130 were referred for IUD services and 6,427 women received IUD services 2010. In 2011, 46,903 women were referred and 18,590 received IUD services. At the national level, IUD new acceptors increased from 16995 in 2008/09 to 31858 in 2009/10. Conclusions: this intervention highlights successful collaboration of research and program in development of evidence-based, strategic and cost-effective behavior change and program interventions focused on promoting IUD use among target group. M148 EFFECTS OF A COMBINED DIENOGEST/ESTRADIOL VALERATE CONTRACEPTIVE PILL ON BONE TURNOVER IN YOUNG FERTILE WOMEN R. Santoro1 , A. Fabozzi1 , V. Gargano1 , C. Di Carlo1 , G.A. Tommaselli1 , C. Nappi1 . 1 Department of Obstetrics and Gynecology, University of Naples “Federico II”, Naples, Italy Objectives: Hormonal contraceptives administration in young fertile women may expose users to modifications of bone metabolism. These may prevent the bone peak mass to be reached or induce an early bone loss, with an increased risk of osteoporosis. Several studies evaluated the effects of hormonal contraception on bone, but limited data on the influence of a combined dienogest (DNG)/estradiol valerate (E2V) contraceptive pill on bone metabolism are available. Aim of this prospective study was to evaluate the effects of a combined DNG/E2V contraceptive pill on bone turnover. Materials: We enrolled 20 healthy, young (age <35 years), fertile women requiring contraception, from the “General Gynecology Clinic” of our Department. All patients took a four-phasic dose regimen pill (the first two tablets contain 3 mg E2V; the next five tablets include 2 mg E2V + 2 mg DNG, followed by 17 tablets with 2 mg E2V + 3 mg DNG; followed by two tablets with 1 mg E2V only, and finally two placebo tablets). Methods: Serum osteocalcin (BGP), urinary pyridinoline (PYD) and deoxypyridinoline (D-PYD) were measured in all subjects at beginning of the study and after 3 and 6 months. Data have been evaluated with Student’s t-test for paired samples. Results: At 3 and 6 months, urinary levels of BGP, PYD and D-PYD were significantly reduced in comparison with values at baseline (p < 0.05). Conclusions: The present study suggests that the combined DNG/E2V contraceptive pill could exert a positive effect on bone turnover in young post-adolescent women.
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
M146 THE ENTRANCE IN THE CONTRACEPTION AND ITS IMPLICATIONS ON THE WOMEN’S CONTRACEPTIVE ITINERARY IN MALI A. Coulibaly1 . 1 Sant´e publique, Facult´e de M´edecine du Mali, Bamako, Mali Objectives: This study was led to help to understand better the initiation of the women in the contraceptive practice and the existing links between the entrance in the contraception and the contraceptive itinerary which ensues from it. Materials: The collection of the social actor’s discourses was in the center of this research. The interview guides, the research book and the logbook were used for the data collection. All the discourses were entirely registered with cassette recorder and then transcribed. Methods: It is about an anthropological study using widely the qualitative approach. The main used skills were the semi-directive interviews and the life stories. The researches were led in Bamako, the capital city of Mali during 3 months (December, 2009 and February, 2010). In all 40 women from 15 to 30 year old, from different social origins and school levels, were questioned. The data were analyzed through the method of content analysis. Results: At the conclusion of this study, we made following reports: – For a majority of women and independently of the marital status and of the school level, the entrance to the contraception start several months or years after the entrance in the sexuality. For the single women, this means the risks of unwanted pregnancies. – The entrance in the contraception for many women happens after an ’incident’ (pregnancies, abortions, etc.). – There is a correlation between the school level of the user and the place of purchase of the contraceptive products: the most educated women tend to buy in pharmacies while the least educated buy at the clandestine pharmaceutical product sellers. – The women initiated after getting information with the non professionals have more ’unstable’ contraceptive trajectories. – Contrary to what we could think, the initiatory age depends less on the school level than the individual lived experiences of the users. Conclusions: The entrance in the contraception is less the result of the influence of the “sanitary messages” than a consequence of the individual lived experiences of the social actors. The way the users enter into the contraception has an incidence on the continuation of their contraceptive trajectories: where to buy contraceptive products, organization of contraceptive itinerary, etc. M147 EFFECTIVENESS OF BEHAVIOR CHANGE INTERVENTION FOR INCREASING IUD ACCEPTANCE V. Lara1 . 1 Social Marketing Department, Population Services International/Nepal, Lalitpur, Bagmati, Nepal Objectives: To demonstrate effectiveness of PSI/Nepal’s targeted behavior change intervention on increasing IUD acceptance and service provision. Materials: Population Services International/Nepal has been implementing Women’s Health Project to support the Government of Nepal’s efforts to reduce maternal mortality and to increase the modern contraceptive prevalence rate. One of the major objectives under this program is to increase positive perception towards IUD leading to increase in use. PSI/Nepal identified two strategic priorities: (i) identify primary target audience (ii) increase demand generation to expand total market for IUD. Methods: A qualitative research on contraceptive use was conducted to better understand the target audience and the context in which behavior change takes place. Shanti was developed as a client archetype based on this study. As a frequent switcher, Shanti is searching for a contraceptive method she is satisfied with and is right for her body. Shanti’s main barriers to IUD use
are access, affordability and knowledge about the product. Shanti reported that her health provider rarely recommends IUD to her, another reason she has never seriously considered the method. Behavioral change interventions was developed based on the study findings and launched as a part of the demand generation activity targeted towards clients and IUD providers. Targeted mass-media interventions and inter-personal communication at household and community level were used to improve client’s perceptions and demand for IUDs. PSI/Nepal’s network of private providers offering IUD services was expanded from 19 to 46 districts and motivated these providers to increase their productivity and to maintain highquality standards. Results: Before the intervention, a total of 3664 women received IUD services and post intervention, 124,991 women in 2010 and 453,436 in 2011 were contacted at the household level through IPC activities. Out of these, 14,130 were referred for IUD services and 6,427 women received IUD services 2010. In 2011, 46,903 women were referred and 18,590 received IUD services. At the national level, IUD new acceptors increased from 16995 in 2008/09 to 31858 in 2009/10. Conclusions: this intervention highlights successful collaboration of research and program in development of evidence-based, strategic and cost-effective behavior change and program interventions focused on promoting IUD use among target group. M148 EFFECTS OF A COMBINED DIENOGEST/ESTRADIOL VALERATE CONTRACEPTIVE PILL ON BONE TURNOVER IN YOUNG FERTILE WOMEN R. Santoro1 , A. Fabozzi1 , V. Gargano1 , C. Di Carlo1 , G.A. Tommaselli1 , C. Nappi1 . 1 Department of Obstetrics and Gynecology, University of Naples “Federico II”, Naples, Italy Objectives: Hormonal contraceptives administration in young fertile women may expose users to modifications of bone metabolism. These may prevent the bone peak mass to be reached or induce an early bone loss, with an increased risk of osteoporosis. Several studies evaluated the effects of hormonal contraception on bone, but limited data on the influence of a combined dienogest (DNG)/estradiol valerate (E2V) contraceptive pill on bone metabolism are available. Aim of this prospective study was to evaluate the effects of a combined DNG/E2V contraceptive pill on bone turnover. Materials: We enrolled 20 healthy, young (age <35 years), fertile women requiring contraception, from the “General Gynecology Clinic” of our Department. All patients took a four-phasic dose regimen pill (the first two tablets contain 3 mg E2V; the next five tablets include 2 mg E2V + 2 mg DNG, followed by 17 tablets with 2 mg E2V + 3 mg DNG; followed by two tablets with 1 mg E2V only, and finally two placebo tablets). Methods: Serum osteocalcin (BGP), urinary pyridinoline (PYD) and deoxypyridinoline (D-PYD) were measured in all subjects at beginning of the study and after 3 and 6 months. Data have been evaluated with Student’s t-test for paired samples. Results: At 3 and 6 months, urinary levels of BGP, PYD and D-PYD were significantly reduced in comparison with values at baseline (p < 0.05). Conclusions: The present study suggests that the combined DNG/E2V contraceptive pill could exert a positive effect on bone turnover in young post-adolescent women.