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  • Title: [Alternation, or the best approach to contraception].
    Author: Cazenave JC, Courbil LJ, Poupee JC, Schmidlin B, Anglade JP.
    Journal: Med Armees; 1982 Nov; ():849-58. PubMed ID: 12311921.
    Abstract:
    This article outlines the indications and contraindications of different contraceptive methods based on knowledge of the female reproductive cycle and variations by age and reproductive history. Methods should be chosen after clinical examination and interview to determine the wishes of the couple. The female reproductive cycle is reviewed through definitions and discussion of the endometrium, the ovaries and their endocrine and exocrine functions, the pituitary, and the hypothalamus, with indications where appropriate of their role in the action of specific contraceptive methods. Variations in the cycle at puberty, from adolescence to 35 years, at premenopause, postpartum and postabortion, and as a result of pathological conditions are described. The general characteristics, use instructions, effectiveness, and advantages and disadvantages of different contraceptive methods are then described, including the physiological methods (rhythm, temperature, and Billings); mechanical barriers and cervical chemical methods (condoms, diaphragms, spermicidal tablets); monophasic, sequential, and diphasic pills and progestin only pills; morning after pill; trimonthly injections of progesterone, and IUDs. Indications and contraindications for different age groups are outlined. IUDs are contraindicated for adolescents, low dose pills may be used at least 2 years after puberty if cycles are regular, and local spermicides may be the best choice for those with sporadic sexual activity. In general all methods may be utilized by women under 35 but different pill formulations are appropriate for different conditions and IUDs should be avoided in cases of local infection or retroverted uterus. For women over 35 sequential progestins are recommended to compensate for luteal insufficiency. Discontinuous progestins are recommended for premenopausal women because they simultaneously treat luteal insufficiency, mastopathies, and endometrial hypertrophies. For postpartum use minidose combined pills, injections of Depo-Provera, or local spermicides are recommended. A table of indications for various methods is included.
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