[Additional non-contraceptive effects of contraception: CNGOF Contraception Guidelines]. / Bénéfices non contraceptifs des contraceptions. RPC Contraception CNGOF.

Hormonal and intrauterine contraceptive methods provide women with highly efficient protection against undesired pregnancy. Additional non-contraceptive effects are now well documented. Combined hormonal contraceptives use, either through the oral transdermal and vaginal route, allow a reduction in menorrhagia, dysmenorrhea, functional ovarian cysts, benign breast and uterine disease, endometriosis-related pain and recurrence. A reduction in ovarian cancer risks, including in women with BRCA syndrome, endometrial and colon cancer is documented. This effect is prolonged for years after contraception discontinuation. Non-contraceptive benefits of progestin-only contraceptives are less documented. Use of the levonorgestrel IUD is associated with a reduction in menorrhagia, dysmenorrhea including in case of endometriosis. Copper IUD use is associated with a decrease in cervix and endometrial cancer risk.

Cervical squamous intraepithelial lesions in HIV-infected women: prevalence, incidence and regression. European Study Group on Natural History of HIV Infection in Women.

OBJECTIVES: To assess the impact of HIV-related immunodeficiency and antiretroviral treatment on the occurrence and evolution of abnormal Papanicolaou tests. STUDY DESIGN: Cohort of 485 HIV-infected women with a known date of infection, enrolled during May 1993-April 1998 in 23 centres (gynaecology, infectious disease or STD clinics, or drug treatment centres) in 12 European countries; in 21 centres, follow-up was performed every 6 months (median follow-up: 2 years). METHODS: Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. The prevalence of squamous intraepithelial lesions (SIL), the incidence of SIL and regression from low-grade SIL were studied according to CD4 count after controlling for HPV detection results. RESULTS: Compared with women with CD4 cell counts > 500 x 10(6)/l, women with CD4 cell counts < 200 x 10(6)/l had a twofold increase in both prevalence and incidence of SIL and in non-regression from untreated low-grade SIL; in addition, these women had a lower response rate to treatment of high-grade cervical intraepithelial neoplasia. The increase in SIL incidence associated with a low CD4 cell count was significant in women not receiving antiretroviral treatment (relative risk, CD4 cell count 200-499 x 10(6)/l, 1.9; CD4 cell count < 200 x 10(6)/l, 2.9; CD4 cell count > 500 x 10(6)/l, reference), whereas it was less marked and not statistically significant in treated women. CONCLUSIONS: Severe HIV-related immunodeficiency strongly increases the risk of occurrence of SIL; antiretroviral treatment may reduce this risk, probably by restoring or at least preserving immune function.

[Human immunodeficiency virus infection in pregnancy. General aspects]. / Infection par le virus de l'immunodéficience humaine chez la femme enceinte. Aspects généraux.

Seroprevalence of HIV infection in pregnancy is on the increase worldwide. Approximately 10 million infants will have been infected by the year 2000 and the majority of these children will have acquired infection by vertical transmission of HIV from infected mothers. Recent reports suggested that pregnancy does not accelerate the course of HIV infection. Prospective studies from industrialized countries where most women have asymptomatic HIV infection, have not shown an association with increased risk of adverse pregnancy outcome. Estimates of the rate of vertical transmission range from 15% to 40%.

[Transmission of human immunodeficiency virus to the fetus during pregnancy]. / Transmission du virus de l'immunodéficience humaine à l'enfant pendant la grossesse.

Estimates of the rate of human immunodeficiency virus vertical transmission range from 15% to 40%, and the rate is lower in European and American studies than in African studies. There appears to be a relationship between maternal factors, mode of delivery and mother-to-child transmission. The risk factors or markers associated with increased vertical transmission are analyzed in this review. The use of zidovudine, administered to HIV-infected women during pregnancy and labour, and to the offspring for 6 weeks reduce the mother-to-infant transmission rate from 25% to 8%. Other strategies to alter transmission of HIV, including the use of combinaison of anti-retroviral drugs, immunoprophylaxis against HIV or obstetric interventions needs to be evaluated.

[The adolescent and contraception: psychological factors]. / L'adolescente et la contraception: aspects psychologiques

PIP: Psychological aspects of contraception in adolescence tend to be of interest primarily because of the belief that better understanding of psychological resistence to contraception would lead to more effective use and a lower rate of pregnancy. The failure of adolescents to use contraception appears to be due in part to irresponsibility but in part also to a variety of other factors. There is no ideal contraceptive for adolescents. The pill has potentially serious side effects whose significance may be exaggerated by adolescents, and the price of the contraceptive sponge may be prohibitive. Contraceptives themselves are perceived by adolescents as belonging more to parents, physicians, or the media than to themselves. Low-dose pills considered appropriate for adolescents are often abandoned because of their annoying minor side effects. Most adolescents do not seek contraception in an independent way, but out of fear that they are already pregnant or, if they have been sexually active for some time without using contraception, out of fear of infertility. Use of contraception may also be initiated by the partner, or the mother wishing to protect her daughter against pregnancy or to regularize the menstrual cycle. Contraceptive use by adolescents is complex because it signifies delaying rather than spacing or terminating pregnancy. The long duration of use that may be required until the time is right for pregnancy and the need to foresee future consequences are difficult given the cognitive level of adolescents. There are also difficult problems of access, prescription, and follow-up. Prescription of contraceptives for an adolescent is likely to invoke ambivalent feelings. Follow-up should be scheduled at fairly short intervals because of the fragility of motivation for contraceptive use at this age. The constraints of contraceptive use are not adapted to the sporadic and unplanned nature of much adolescent sexual activity. Society has an image of the adolescent as preoccupied with sexuality, but in fact adolescents are seeking to know and understand the new realities of their identity in a process in which the sexual quest plays only a secondary part. In order to improve the contraceptive performance of adolescents, a 3rd party other than a parent is needed to interact in a complementary way with the adolescent and to allow the adolescent to be heard. The objective of the interaction should not be to avoid abortion but to work to replace the rigid complementary interaction of adolescents with parents and other authority figures with a symmetrical model of communication open to the search for identity.^ieng

[Cervical screening and surveillance of the cervix uteri before the age of 20]. / Dépistage cervical et surveillance du col avant vingt ans.

The authors record a sample of 2,234 adolescents who were aged 20 years or less and who had systematic cervical screening. This was carried out in a Social Service gynaecological department and the reason for it was mainly to research in the epidemiology. The authors have analysed the results of 870 cervical smears and 62 colposcopies. They found that in this young population there were 11% dysplastic smears; 59% viral type smears (condylomata or herpes); 11% mild or moderate dysplasias and 16% flat condylomata that were proven histologically. The authors review the recent literature and their results and the risk factors for cancer of the cervix in adolescents and demonstrate the value of early screening of this population.

[Synechia and elective abortion]. / Synechie et I.V.G.

PIP: 2267 records of vacuum aspiration abortions performed at 7-17 weeks gestation were examined in search of a predictor for risk of synechia. 13 possible risk factors were identified and given possible weights of 1-5. A score of over 20 would be regarded as an indicator for hysteroscopy, which was carried out at the beginning of the 1st cycle after the 1st postabortal menstruation. Hysteroscopy was done on an ambulatory basis under local anesthesia with xylocaine. Hysteroscopy was indicated in 274 cases, or 12.1% of the total. The population at risk was found to comprise disproportionately women of parities higher than 3, with histories of abortion, undergoing abortions for pregnancies of over 10 weeks, in procedures lasting longer than 20 minutes. 206 of the 274 did not undergo hysteroscopy because of gynecological, psychological, or general contraindications, or failure of the patient to appear for follow-up. 73 hysteroscopies were carried out, 68 only because of a score over 20 and 5 on clinical grounds. Synechia was diagnosed in 30 cases, in 5 of which the condition was suspected. There were 12 failures in the 73 hysteroscopies, due to operator inexperience, pain, fibrous retraction of the cervix, or problems with the apparatus. Of the 73 hysteroscopies attempted, 12 faled, 31 were completely normal, 12 showed retention, of which 3 were associated with synechias, and 18 showed synechias. Cases of retention were treated with reaspiration and synechias by removal under hysteroscopy. If the predictive power of the test can be improved, it will allow diagosis and early treatment of postabortal synechias.^ieng