| 1. |
- Bengtsdotter, H., et al.
(författare)
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Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use
- 2018
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Ingår i: European Journal of Contraception and Reproductive Health Care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 23:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders. Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle. Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2). Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.
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| 2. |
- Bramsved, Rebecka, 1982, et al.
(författare)
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Birth Weight, Childhood and Young Adult Overweight, and the Risk of Coronary Heart Disease in Men.
- 2024
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Ingår i: Arteriosclerosis, thrombosis, and vascular biology. - 1524-4636. ; 44:1, s. 314-321
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Tidskriftsartikel (refereegranskat)abstract
- Low birth weight is a known risk factor for adult coronary heart disease (CHD), but the additional effect of weight development during childhood and early adult life has not been studied.We included 35659 men born 1945 to 1961 from the population-based BMI Epidemiology Study Gothenburg, with data available on birthweight, BMI in childhood (8 years), and BMI in young adulthood (20 years). Information on CHD diagnoses was retrieved from national registers. We used Cox proportional hazards regression to estimate hazard ratios and 95% CIs for the risk of early and late CHD (before and after 58.4 years of age, respectively).During follow-up, a total of 3380 cases of CHD (fatal and nonfatal) were registered. Birth weight was inversely associated with the risk of both early (hazard ratio, 0.88 per SD increase [95% CI, 0.84-0.92]) and late (hazard ratio, 0.94 per SD increase [95% CI, 0.90-0.98]) CHD, independently of BMI at 8 years and BMI change during puberty. In a model including birth weight (below or above the median) together with overweight at 8 and 20 years, only birth weight and young adult overweight, but not overweight in childhood, were significantly associated with the risk of CHD. A birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (hazard ratio, 2.29 [95% CI, 1.86-2.81]), compared with the reference (birth weight above the median and normal weight at 20 years of age). This excess risk was even more pronounced for a birthweight below 2.5 kg.We demonstrate that low birth weight and young adult overweight are important developmental markers of risk for adult CHD. These findings motivate a life course perspective for prevention and risk assessment of adult CHD.
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| 3. |
- Bramsved, Rebecka, 1982, et al.
(författare)
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Impact of BMI and smoking in adolescence and at the start of pregnancy on birth weight
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBirth weight is an indicator of intra-uterine conditions but also a determinant for future health. The importance of preconception health for a healthy birth weight has been emphasized, but evidence is lacking on how modifiable factors in adolescence, such as body mass index (BMI) and smoking, affect future pregnancy outcome. We evaluated associations between BMI and smoking in adolescence and at the start of pregnancy and birth weight of the first-born child.MethodsThis longitudinal study included 1256 mothers, born 1962-1992, and their first-born children, born between 1982-2016. Self-reported questionnaire information on weight, height and smoking at age 19 was cross-linked with national register data obtained at the start of pregnancy and with the birth weights of the children. Univariable and multivariable linear regressions were performed to determine the impact of maternal factors at 19 years of age and at the start of the pregnancy respectively, and the importance of BMI status at these points of time for the birth weight of the first child.ResultsBMI and smoking at the start of the pregnancy displayed strong associations with birth weight in a multivariable analysis, BMI with a positive association of 14.9 g per BMI unit (95% CI 6.0; 23.8 p = 0.001) and smoking with a negative association of 180.5 g (95% CI -275.7; -85.4) p = 0.0002). Smoking and BMI at 19 years of age did not show this association. Maternal birth weight showed significant associations in models at both time-points. Becoming overweight between age 19 and the start of the pregnancy was associated with a significantly higher birth weight (144.6 (95% CI 70.7;218.5) p = 0.0002) compared to mothers with normal weight at both time points.ConclusionsOur findings indicate that the time period between adolescence and first pregnancy could be a window of opportunity for targeted health promotion to prevent intergenerational transmission of obesity.
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| 4. |
- Fernström, Ingela, et al.
(författare)
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Bildpedagogiska processer på distans under pandemin : Dilemman och utvecklingspotential
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med rapporten är att beskriva hur undervisning och examination i ämnet bildpedagogik påverkats av att genomföras helt på distans under pandemiåren 2020–2021. Rapporten bygger på semistrukturerade intervjuer med samtliga lärare som undervisade i bildpedagogik vid Högskolan i Gävle under pandemiåren. Intervjuerna fokuserade på undervisning, examination och framåtblick. I en tematisk innehållsanalys togs teman fram under dessa rubriker. Resultatet visar att all undervisning och examination i bildpedagogik inte går att genomföra digitalt på distans med bibehållen kvalité. Delar av den digitala undervisningen som generellt fungerar väl är föreläsningar och individuell handledning. I bildpedagogisk undervisning länkas teori och praktik samman. Under pandemin har det praktiska arbetet påverkats negativt och därmed har också kopplingen till teoretiska perspektiv försvagats. Den digitala undervisningen under pandemin har inneburit merarbete för lärare i ämnet då nya eller omformulerade uppgifter och examinationer har behövt tas fram.
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| 5. |
- Hognert, Helena, 1973, et al.
(författare)
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Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries
- 2018
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- RESULTS: Both annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15-19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18-19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden. CONCLUSIONS: Birth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers. OBJECTIVES: Compare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between countries. DESIGN: Ecological study using national registry data concerning births and abortions among all women aged 15-19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008-2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008-2015 were obtained from national databases in Denmark, Norway and Sweden. SETTING: Denmark, Finland, Iceland, Norway and Sweden. PARTICIPANTS: Women 15-19 years old in all Nordic countries (749 709) and 13-19 years old in Denmark, Norway and Sweden (815 044). © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 6. |
- Hognert, Helena, 1973, et al.
(författare)
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High birth rates despite easy access to contraception and abortion : a cross-sectional study.
- 2017
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 96:12, s. 1414-1422
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to describe and compare contraceptive use, fertility, birth and abortion rates in the Nordic countries.National data on births, abortions, fertility rate (1975-2013), redeemed prescriptions of hormonal contraceptives and sales figures of copper intrauterine devices (2008-2013) among women 15-49 years of age in the Nordic countries were collected and analysed.Use of hormonal contraceptives and copper intrauterine devices varied between 31-44%. The highest use was in Denmark (39-44%) and Sweden (40-42%). Combined hormonal contraception followed by the levonorgestrel-releasing intrauterine system were the most common methods. During 1975-2013 abortion rates decreased in Denmark (27-15/1000 women aged 15-44) and Finland (20-10), remained stable in Norway (≈16) and Sweden (≈20) and increased in Iceland (6 -15). Birth rates remained stable around 60/1000 women aged 15-44 in all countries except for Iceland where the birth rate decreased from 95-65. Abortion rates were highest in the age group 20-24 years. In the same age group Sweden had a lower contraceptive use (51%) compared to Denmark (59%) and Norway (56%) and a higher abortion rate 33/1000 compared to Denmark (25/1000) and Norway (27/1000).In contrast to the declining average fertility and birth rates in Europe, rates in the Nordic countries remain high and stable despite high contraceptive use and liberal access to abortion on womens' request. This article is protected by copyright. All rights reserved.
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| 7. |
- Hognert, Helena, 1973, et al.
(författare)
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Immediate versus delayed insertion of an etonogestrel releasing implant at medical abortion-a randomized controlled equivalence trial
- 2016
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 31:11, s. 2484-2490
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Tidskriftsartikel (refereegranskat)abstract
- Does a progestin releasing subdermal contraceptive implant affect the efficacy of medical abortion if inserted at the same visit as the progesterone receptor modulator, mifepristone, at medical abortion? A etonogestrel releasing subdermal implant inserted on the day of mifepristone did not impair the efficacy of the medical abortion compared with routine insertion at 2-4 weeks after the abortion. The etonogestrel releasing subdermal implant is one of the most effective long acting reversible contraceptive methods. The effect of timing of placement on the efficacy of mifepristone and impact on prevention of subsequent unintended pregnancy is not known. This multicentre, randomized controlled, equivalence trial with recruitment between 13 October 2013 and 17 October 2015 included a total of 551 women with pregnancies below 64 days gestation opting for the etonogestrel releasing subdermal implant as postabortion contraception. Women were randomized to either insertion at 1 hour after mifepristone intake (immediate) or at follow-up 2-4 weeks later (delayed insertion). An equivalence design was used due to advantages for women such as fewer visits to the clinic with immediate insertion. The primary outcome was the percentage of women with complete abortion not requiring surgical intervention within 1 month. Secondary outcomes included insertion rates, pregnancy and repeat abortion rates during 6 months follow-up. Analysis was per protocol and by intention to treat. Women aged 18 years and older who had requested medical termination of a pregnancy up to 63 days of gestation and opted for an etonogestrel releasing contraceptive implant were recruited in outpatient family planning clinics in six hospitals in Sweden and Scotland. Efficacy of medical abortion was 259/275 (94.2%) in the immediate insertion group and 239/249 (96%) in the routine insertion group with a risk difference of 1.8% (95% CI -0.4 to 4.1%), which was within the +/- 5% margin of equivalence. The insertion rate was 275/277 (98.9%) in the immediate group compared to 187/261 (71.6%) women in the routine group (P < 0.001). At 6 months of follow-up significantly fewer women in the immediate group had become pregnant again (2/277, 0.8%) compared to the routine group (10/261, 3.8%) P = 0.018. For the main outcome loss to follow-up data was minimized through access to patient records. Efforts were made to reduce loss to follow-up also for secondary outcomes. The results of the sensitivity analysis did not differ from the intention to treat or per protocol analysis. Guidelines on postabortion contraception should be amended to include insertion of the etonogestrel releasing implant at the time of mifepristone intake for medical abortion up to and including a gestation of 63 days. This study was funded by the Swedish Research Council (2012-2844), Stockholm City County and Karolinska Institutet (ALF). The contraceptive implants were provided by Merck and supplied by MSD Sweden. HKK and KGD have received honorariums for giving lectures for MSD/Merck and have participated in the national (HKK and KGD) and international (KGD) medical advisory boards for MSD/Merck. The other authors have nothing to declare.
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| 8. |
- Lindh, Ingela, 1954, et al.
(författare)
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A longitudinal study of contraception and pregnancies in the same women followed for a quarter of a century.
- 2010
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 25:6, s. 1415-22
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a need to improve our understanding of contraceptive use over the long term. The aims of this study were to describe contraceptive use and pregnancies in the same women followed prospectively from 19 to 44 years of age. METHODS: In 1981, a postal questionnaire about contraception, pregnancies and reproductive health was sent to a random sample (n = 656) of 19-year-old women resident in Gothenburg, Sweden. The responders were contacted again every fifth year. RESULTS: At 19 years of age, 74% of the women had already used contraception and this increased to 98% at 44 years. Combined oral contraception was the commonest method currently used up to 29 years of age (48/51/22% at 19/24/29 years of age, respectively) and thereafter an intrauterine device (IUD: 34/39/38% at 34/39/44 years of age, respectively). Condom use alone during the 25-year study period was: 14/12/24/21/21/15% and non-use of contraception was: 35/24/26/20/21/26%. The mean number of pregnancies/children increased from 0.2/0.1 at 19 years of age to 3.1/2.1 at 44 years. Women who had been pregnant and women who had not been pregnant
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| 9. |
- Lindh, Ingela, 1954, et al.
(författare)
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Contraceptive use and pregnancy outcome in three generations of Swedish female teenagers from the same urban population
- 2009
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Ingår i: Contraception. - : Elsevier BV. - 0010-7824. ; 80:2, s. 163-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The primary objective of the study was to describe contraceptive use, reasons for discontinuation of contraception and pregnancy outcome in three generations of female teenagers over a period of 20 years. The secondary objective was to describe the relationship between contraception, smoking, body mass index (BMI) and socioeconomic status (SES). STUDY DESIGN: A cross-sectional comparison of 19-year-old women born in 1962, 1972 and 1982 and living in the city of Gothenburg, Sweden, in 1981, 1991 and 2001 was conducted. Contraceptive use, pregnancy outcome, smoking and weight/height were assessed by a postal questionnaire. RESULTS: Current contraceptive use was unchanged between the 62 (60%) and 72 cohorts (62%) but had increased (p<.01) in the 82 cohort (78%); there was no difference in contraceptive use between SES groups at any time. Condom use alone increased over time (p<.01), and the use of oral contraception and a condom together had increased in the 72 and 82 cohorts compared to the 62 cohort (p<.01). Reasons given for using and discontinuing oral contraceptives in three generations of teenagers were studied over 20 years. In addition to contraception, oral contraception was used to reduce dysmenorrhea and heavy bleeding. Discontinuation due to bleeding disturbances decreased (p<.01) over time, whereas discontinuation due to mental side effects increased (p<.01). The percentage of women who had been pregnant at < or =19 years of age in the 82 cohort (7%) was lower (p<.01) than in the 1962 (11%) and 1972 (13%) cohorts. However, there was a successive increase (p<.001) in the percentage of women who had been pregnant more than once at < or =19 years of age (1962/1972/1982: pregnant more than once, 8%/21%/31%). Smoking decreased over time (p<.01) and was no longer related to SES in the 82 cohort. BMI increased (p<.01) over time. There was no difference in BMI between SES groups in the 62 and 72 cohorts but was higher in the low-SES group in the 82 cohort compared to the middle (p<.01) and high (p<.05) SES groups. CONCLUSIONS: Contraceptive use was higher in the 82 cohort where there was a corresponding reduction in the percentage of women who had been pregnant at < or =19 years of age compared with the 62 and 72 cohorts. Discontinuation of oral contraception due to mental side effects increased over time. The prevalence of smoking decreased and BMI increased, and there were changes in smoking prevalence and BMI in the different SES groups over time.
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| 10. |
- Lindh, Ingela, 1954, et al.
(författare)
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Contraceptive use in the Nordic countries.
- 2017
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 96:1, s. 19-28
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to compare contraceptive use in the Nordic countries and to assess compliance with recommendations from the European Medicines Agency regarding the use of combined oral contraception containing low-dose estrogen and levonorgestrel, norethisterone or norgestimate.Data on hormonal contraceptive prescriptions and sales figures for copper intrauterine devices were obtained from national databases and manufacturers in Denmark, Finland, Iceland, Norway and Sweden in 2010-2013.Contraceptive use was highest in Denmark (42%) and Sweden (41%), followed by Finland (40%). Combined oral contraception was the most used method in all countries, with the highest use in Denmark (26%). The second most used method was the levonorgestrel-releasing intrauterine system, with the highest use in Finland (15%) and ≈10% in the other countries. Copper intrauterine devices (7%) and the progestin-only pill (7%) were most often used in Sweden. Combined oral contraception use decreased with increasing age and levonorgestrel-releasing intrauterine system and progestin-only pills use increased. The use of long-acting reversible methods of contraception (=levonorgestrel-releasing intrauterine system, copper intrauterine devices, and implants) increased with time and was highest in Sweden (20%) and Finland (18%). The highest use of European Medicines Agency recommended combined oral contraception was in Denmark, increasing from 13 to 50% between 2010 and 2013. In Finland, recommended combined oral contraception remained below 1%.Contraceptive use was highest in Denmark and Sweden, levonorgestrel-releasing intrauterine system use was highest in Finland and all long-acting methods were most common in Sweden. The use of combined oral contraception recommended by the European Medicines Agency was highest in Denmark.
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| 11. |
- Lindh, Ingela, 1954
(författare)
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Factors influencing women´s choice of contraception
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Factors influencing women’s choice of contraception Ingela Lindh, Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg Sweden Aims: To describe contraceptive use and to identify factors influencing women’s use of contraception in order to improve future contraceptive compliance. Methods: Contraceptive use, reproductive health, weight/height and smoking were assessed by postal questionnaires distributed to random samples of 19-year old women resident in Gothenburg, Sweden, born in 1962, 1972 and 1982. Longitudinal and cross-sectional comparisons were performed between the cohorts from 1981 to 2006. Results: Combined oral contraceptives (COCs) were the commonest method used < 29 years of age while intrauterine methods were more common later in life. Condom use increased successively over time. Current contraceptive use in 19-year old women from the 82-cohort was higher (78%) and the number of women ≤19 yr who had been pregnant was lower whereas repeated abortions were higher compared to the 62- and 72-cohorts. Common reasons for cessation with COC´s were mental side effects and weight increase. Smoking decreased over time and BMI increased over time and was higher in low socio-economic status areas in the 82-cohort. At 44 years of age there was a difference in contraceptive use and pregnancies between women who had been pregnant ≤ 19 years of age compared to those who had not been pregnant as teenagers. The only predictor found for weight increase was age resulting in a gain of 0.45 kg/year. COC use was not a predictor of weight increase (0.072 kg/year). Smokers decreased their weight by 1.64 kg per 15 years. Women from the 82-cohort reported a greater severity of dysmenorrhea. The efficacy of COCs to relieve dysmenorrhea was evaluated using a verbal multidimensional scoring (VMS) system and a visual analogue scale (VAS). COC use and increasing age independently of each other reduced dysmenorrhea. Conclusion: Choice of contraception was strongly related to age and parity. COC use did not influence long-term weight increase. COC use and increasing age, independent of each other reduced dysmenorrhea severity. The prevalence of smoking decreased over time while body mass index (BMI) increased, in particular in lower socioeconomic status areas.
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| 12. |
- Lindh, Ingela, 1954, et al.
(författare)
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New types of diaphragms and cervical caps versus older types of diaphragms and different gels for contraception: A systematic review
- 2021
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Ingår i: BMJ Sexual and Reproductive Health. - : BMJ. - 2515-1991 .- 2515-2009. ; 47:3
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Forskningsöversikt (refereegranskat)abstract
- © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. Introduction: Our primary objective was to evaluate whether new types of single-size diaphragms or cervical caps differ in prevention of pregnancy compared with older types of diaphragms, and whether different types of gels differ in their ability to prevent pregnancy. A secondary aim was to evaluate method discontinuation and complications. Methods: A comprehensive search was conducted in PubMed, Embase and the Cochrane Library. The certainty of evidence was assessed according to the GRADE system. Results: Four randomised controlled studies were included in the assessment. When comparing the new and old types of female barrier contraceptives the 6-month pregnancy rate varied between 11%-15% and 8%-12%, respectively. More women reported inability to insert or remove the FemCap device (1.1%) compared with the Ortho All-Flex diaphragm (0%) (p<0.0306). Urinary tract infections were lower when using the single-size Caya, a difference of -6.4% (95% CI -8.9 to -4.09) compared with the Ortho All-Flex diaphragm. The 6-month pregnancy rate for acid-buffering gel and spermicidal nonoxynol-9 gel varied between 10% and 12%. The discontinuation rate was lower in women who used acid-buffering gel compared with nonoxynol-9 gel (risk ratio (RR) 0.77, 95% CI 0.68 to 0.97). Conclusions: Pregnancy rates were generally high in women using female barrier contraceptives. There was no difference in the efficacy for pregnancy prevention between the new types of diaphragms and cervical caps and the older diaphragms. The new types of diaphragms and cervical caps resulted in fewer urinary tract infections. Acid-buffering gels did not differ from spermicidal nonoxynol-9 gels regarding pregnancies but seemed to be better tolerated.
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| 13. |
- Lindh, Ingela, 1954, et al.
(författare)
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Reproductive changes among women in their 40s: A cross-sectional study
- 2022
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 101:42, s. 248-255
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim was to describe and compare changes in the reproductive pattern of women in their 40s observed over a decade in Scandinavia. Material and Methods: Cross-sectional study using the total population of women aged 40-49 years between 2008-2018 in Denmark, Norway and Sweden (on average n = 1.5 million). Aggregated data concerning birth and induced abortion rate were collected and analyzed from national health registers. National data on redeemed prescriptions of hormonal contraceptives in the three countries were collected from prescription registers. Births after spontaneous and assisted conceptions were identified by using cross-linked data on deliveries from the Medical Birth Registers and National Registers of Assisted Reproduction in the three countries. Results: Use of hormonal contraception increased among women aged 40-44 years in Denmark from 24% to 31%, in Sweden from 27% to 30%, and in Norway from 22% to 24%. The levonorgestrel-releasing intrauterine device was the most frequently used method in all countries. Birth rates among women 40-44 years increased continuously from 9.5 to 12/1000 women in Denmark and from 11.7 to 14.3/1000 in Sweden, but remained stable in Norway at similar to 11/1000 women. There was a doubling of assisted conceptions in Denmark from 0.71 to 1.71/1000 women, Sweden from 0.43 to 0.81/1000 and Norway from 0.25 to 0.53/1000 women 40-49 years of age. Sweden had the highest induced abortion rate (7.7 to 8.1/1000 women) in women aged 40-49 years during the study period. Conclusions: From 2008 to 2018, birth rates continuously increased among women aged 40-49 years in Denmark and Sweden and births resulting from assisted reproductive technology doubled in all three countries.
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| 14. |
- Lindh, Ingela, 1954, et al.
(författare)
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The changing pattern of contraceptive use and pregnancies in four generations of young women
- 2016
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 95:11, s. 1264-1272
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to describe contraceptive use and pregnancies and their relationship to socio-economic status (SES) in four generations of young Swedish women. Material and methodsQuestionnaires regarding contraceptive use and pregnancies were sent to random samples of 19-year-old women in 1981, 1991, 2001 and 2011 (n=4732). ResultsCurrent contraceptive use was higher in 2001 (78%) (p<0.01) and 2011 (69%) (p<0.05) compared with 1981 (60%) and 1991 (62%). Combined hormonal contraception (CHC) was the most common form of contraception throughout (p<0.0001). The use of long-acting reversible contraception (LARC=implants, intrauterine contraception) and progestogen-only pills increased over time (p<0.01). Mental side effects as a reason for CHC cessation increased over time and was the most common reason for cessation of CHC in 2011 (p<0.001). Contraceptive use was lower in women from low SES areas (p<0.05) in 2011. The percentage of young women who had been pregnant at 19years of age was lower (p<0.05) in the assessment from 2001 (7%) than in that in 1991 (13%) and 2011 (12%). The proportion of teenage mothers decreased from 4.4% (1981) to 1.6% (2011) (p<0.01). More women had been pregnant at 19years of age in low SES areas than in middle and high SES areas (p<0.05). ConclusionsThe lowest pregnancy rate was in the cohort with the highest contraceptive use. Term pregnancies declined over time. A greater number of pregnancies in low SES areas and a change towards lower contraceptive use in low SES areas was recorded in 2011.
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| 15. |
- Lindh, Ingela, 1954, et al.
(författare)
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The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study.
- 2012
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 27:3, s. 676-682
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDCombined oral contraceptives (COCs) are widely advocated as treatment for primary dysmenorrhoea, but their efficacy has been questioned in a Cochrane review. The aim of this study was to evaluate COCs and the influence of age on the severity of dysmenorrhoea.METHODSPostal questionnaires regarding weight/height, contraception, pregnancy history and other reproductive health factors were sent to random samples of 19-year-old women born in 1962 (n = 656), 1972 (n = 780) and 1982 (n = 666) resident in the city of Gothenburg in 1981, 1991 and 2001. The responders were assessed again 5 years later at the age of 24 years. Current severity of dysmenorrhoea was measured on each occasion by a verbal multidimensional scoring system (VMS) and by a visual analogue scale (VAS).RESULTSThe severity of dysmenorrhoea was lower (P< 0.0001) in COC users compared with non-users. In a longitudinal analysis of the severity of dysmenorrhoea, COC use and increasing age, independently of each other, were associated with the severity of dysmenorrhoea (COC use, VMS score: a reduction of 0.3 units/VAS: a reduction of 9 mm, both P< 0.0001; increasing age, VMS score: a reduction of 0.1 units per 5 years, P< 0.0001/VAS: a reduction of 5 mm per 5 years, P< 0.0001). Childbirth also reduced the severity of dysmenorrhoea (VAS, P< 0.01 with a reduction of 7 mm). Women from the 82-cohort reported a greater severity of dysmenorrhoea compared with the 62 and 72 cohorts at both 19 and 24 years of age.CONCLUSIONSIn this longitudinal case-control study, COC use and increasing age, independent of each other, reduced the severity of dysmenorrhoea. COC use reduced the severity of dysmenorrhoea more than increasing age and childbirth. There was a trend over time regarding the severity of dysmenorrhoea where women from the 82-cohort reported a greater severity of dysmenorrhoea compared with the 62 and 72 cohorts.
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| 16. |
- Lindh, Ingela, 1954, et al.
(författare)
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The long-term influence of combined oral contraceptives on body weight.
- 2011
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 26:7, s. 1917-24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND There is a need to increase our knowledge regarding the influence of combined oral contraceptive (COC) use on individual weight change in the long term. The first aim of this study was to assess the long-term influence of COC's on body weight, and the second aim was to describe body weight increase during the fertile period. METHODS Postal questionnaires regarding weight/height, contraception, reproductive health, smoking and exercise were sent to random samples of 19-year-old women born in 1962 (n= 656) and 1972 (n = 780) resident in the city of Gothenburg, Sweden in 1981 and 1991. The responders were followed longitudinally, and the same women were contacted again every fifth year from 1986-2006 and from 1996-2006, respectively. RESULTS There was no significant difference in weight increase in the women grouped according to use or non-use of COC or duration of COC use. The two cohorts of women were grouped together in a longitudinal analysis and the following factors age, COC use, children, smoking and exercise were included in the model. The only predictor for weight increase was age (P < 0.001), resulting in a gain of 0.45 kg/year. There was no correlation between weight change and COC use or duration of COC use, number of children or exercise. Smokers decreased (P < 0.001) their weight by 1.64 kg per 15 years. Between 19 and 44 years of age, the 62-cohort had successively increased (P < 0.0001) their body weight/BMI by 10.6 kg/3.7. Women from the 72-cohort had a higher (P < 0.05) weight/BMI compared with women of the same age from the 62-cohort. CONCLUSIONS COC use was not found to be a predictor for weight increase in the long term. Body weight/BMI increased by 10.6 kg/3.7 between 19 and 44 years of age in a random sample of Swedish women born in 1962. Women from the 72-cohort had a greater body weight/BMI compared with the 62-cohort.
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| 17. |
- Lundin, Cecilia, et al.
(författare)
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Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial
- 2017
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Ingår i: Psychoneuroendocrinology. - : Elsevier BV. - 0306-4530 .- 1873-3360. ; 76, s. 135-143
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ever since the introduction of combined oral contraception (COC), one of the major reasons for discontinuing the pill use has been mood-related side effects. Moreover, women who discontinue the pill turn to less effective methods whereby the probability of an unintended conception increases. Approximately 4-10% of COC users complain of depressed mood, irritability or increased anxiety, but drug-related causality has been difficult to prove. Given the lack of randomized controlled trials in this area, we aimed to prospectively estimate the severity of adverse mood in COC users that would be as representative of general users as possible. Methods: This investigator-initiated, multi-center, randomized, double-blinded, placebo-controlled study included 202 healthy women. Women were randomized to a COC (1.5 mg estradiol and 2.5 mg nomegestrolacetate) or placebo for three treatment cycles. Main outcome measure was the Daily Record of Severity of Problems (DRSP), which was filled out daily during one baseline cycle and the final treatment cycle. Results: Results from 84 women in the COC group and 94 women in the placebo group were analysed. COC use was associated with small, but statistically significant, increases in mean anxiety (0.22; 95% CI: 0.07-0.37, p = 0.003), irritability (0.23; 95% CI: 0.07-0.38, p = 0.012), and mood swings scores (0.15; 95% CI: 0.00-0.31, p = 0.047) during the intermenstrual phase, but a significant premenstrual improvement in depression (-0.33; 95% CI: -0.62 to -0.05, p = 0.049). Secondary analyses showed that women with previous adverse hormonal contraceptive experience reported significantly greater mood worsening in the intermenstrual phase in comparison with healthy women, p <0.05. The proportion of women who reported a clinically relevant mood deterioration did not differ between those allocated to COC (24.1%) or placebo (17.0%), p = 0.262. Conclusion: COC use is associated with small but statistically significant mood side effects in the inter menstrual phase. These findings are driven by a subgroup of women who clearly suffer from COC-related side effects. However, positive mood effects are noted in the premenstrual phase and the proportion of women with clinically relevant mood worsening did not differ between treatment groups. (C) 2016 Elsevier Ltd. All rights reserved.
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| 18. |
- Lundin, Cecilia, et al.
(författare)
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Sexual function and combined oral contraceptives : a randomised, placebo-controlled trial
- 2018
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Ingår i: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 7:11, s. 1208-1216
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The effect of combined oral contraceptives (COCs) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an oestradiol-containing COC influences sexual function.Design: Investigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomised to a combined oral contraceptive (1.5 mg oestradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles.Methods: Sexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points.Results: Compared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: -2.0; interquartile range (IQR): -5.0 to 0.5 vs placebo: -1.0; IQR: -3.0 to 2.0, P=0.019), which remained following adjustment for change in self-rated depressive symptoms (B= -0.80 +/- 0.30, Wald =7.08, P=0.008). However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs placebo 16 (17.8%), P=0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments.Conclusions: This study suggests that use of oestradiol-based COCs is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.
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| 19. |
- Lundin, C., et al.
(författare)
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Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial
- 2018
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Ingår i: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 7:11, s. 1208-1216
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The effect of combined oral contraceptives (COCs) on female sexuality has long been a matter of discussion, but placebo-controlled studies are lacking. Thus, the aim of the present study was to investigate if an oestradiol-containing COC influences sexual function. Design: Investigator-initiated, randomised, double-blinded, placebo-controlled clinical trial where 202 healthy women were randomised to a combined oral contraceptive (1.5 mg oestradiol and 2.5 mg nomegestrol acetate) or placebo for three treatment cycles. Methods: Sexual function at baseline and during the last week of the final treatment cycle was evaluated by the McCoy Female Sexuality Questionnaire. Serum and hair testosterone levels were assessed at the same time points. Results: Compared to placebo, COC use was associated with a small decrease in sexual interest (COC median change score: -2.0; interquartile range (IQR): -5.0 to 0.5 vs placebo: -1.0; IQR: -3.0 to 2.0, P=0.019), which remained following adjustment for change in self-rated depressive symptoms (B= -0.80 +/- 0.30, Wald =7.08, P=0.008). However, the proportion of women who reported a clinically relevant deterioration in sexual interest did not differ between COC or placebo users (COC 18 (22.2%) vs placebo 16 (17.8%), P=0.47). Change in other measured aspects of sexual function as well as total score of sexual function did not differ between the two treatments. Conclusions: This study suggests that use of oestradiol-based COCs is associated with reduced sexual interest. However, the changes are minute, and probably not of clinical relevance.
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| 20. |
- Milsom, Ian, 1950, et al.
(författare)
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Effects on cycle control and bodyweight of the combined contraceptive ring, NuvaRing, versus an oral contraceptive containing 30 microg ethinyl estradiol and 3 mg drospirenone
- 2006
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Ingår i: Hum Reprod. ; 21:9, s. 2304-11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of this study was to compare cycle control, cycle-related characteristics and bodyweight effects of NuvaRing with those of a combined oral contraceptive (COC) containing 30 microg of ethinyl estradiol and 3 mg of drospirenone. METHODS: A randomized, multicentre, open-label trial in which 983 women were treated (intent-to-treat population) with NuvaRing or the COC for 13 cycles. RESULTS: Breakthrough bleeding or spotting during cycles 2-13 was in general less frequent with NuvaRing than that with the COC (4.7-10.4%) and showed a statistically significant odds ratio of 0.61 (95% confidence interval: 0.46, 0.80) with longitudinal analysis. Intended bleeding was significantly better for all cycles with NuvaRing (55.2-68.5%) than that with the COC (35.6-56.6%) (P < 0.01). Changes from baseline in mean bodyweight and body composition parameters were relatively small for both groups with no notable between-group differences. CONCLUSION: NuvaRing was associated with better cycle control than the COC, and there was no clinically relevant difference between the two groups in bodyweight.
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| 21. |
- Milsom, Ian, 1950, et al.
(författare)
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The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study.
- 2013
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 28:7, s. 1953-1960
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: Does intrauterine contraception influence the prevalence and severity of dysmenorrhea? SUMMARY ANSWER: In this longitudinal study, a copper intrauterine device (Cu-IUD) did not influence the severity of dysmenorrhea, whereas the levonorgestrel-releasing intrauterine system (LNG-IUS) reduced dysmenorrhea severity. WHAT IS KNOWN ALREADY: Dysmenorrhea is a common problem among young women. The LNG-IUS has been reported to be associated with less painful menstruation, although more long-term studies are necessary. In contrast Cu-IUDs have been reported to exacerbate dysmenorrhea. STUDY DESIGN, SIZE, DURATION: A longitudinal population study. The prevalence and severity of dysmenorrhea was compared in a longitudinal analysis of variance performed in the same women when using either intrauterine contraception (Cu-IUD or LNG-IUS) or combined oral contraceptives (COCs) with other methods of contraception or no contraception. PARTICIPANTS/MATERIALS, SETTING, METHODS: Random samples of 19-year-old women born in 1962 (n = 656), 1972 (n = 780) and 1982 (n = 666) assessed at 5-year intervals between 1981 and 2001. Current severity of dysmenorrhea was assessed on each occasion by a verbal multidimensional scoring system (VMS) and by a visual analog scale (VAS). MAIN RESULTS AND THE ROLE OF CHANCE: Dysmenorrhea severity was unchanged in the same woman when using a Cu-IUD compared with using other methods (= condom use, barrier methods, natural family planning, coitus interruptus and sterilization)/no method of contraception in the longitudinal analysis of factors influencing dysmenorrhea severity (VMS score: +0.05 units/VAS: -0.3 mm, both NS). LNG-IUS and COC use were associated with reduced dysmenorrhea severity compared with other methods/no method (LNG-IUS use, VMS score: -0.4 units/VAS: -13 mm, both P < 0.01; COC use, VMS score: -0.4 units/VAS: -11 mm, both P < 0.0001). Childbirth reduced dysmenorrhea (VMS score: -0.3 units, P < 0.05/VAS: -16 mm, P < 0.001). Dysmenorrhea severity decreased between the ages of 19 and 44 years. LIMITATIONS, REASONS FOR CAUTION: There was a decline in the response rate over time during the 20 years of this longitudinal study which may be due to the fact that the distribution of questionnaires has become much more common and people are becoming increasingly tired of answering questionnaires. No information about the diagnosis or treatment of endometriosis or adenomyosis, which are important confounding factors, were included in the questionnaire. In this study we specifically studied dysmenorrhea and have clearly separated this from the assessment of possible pain caused by intrauterine contraception experienced between periods. RCTs should be initiated to further investigate the influence of intrauterine contraception on dysmenorrhea and the risk of developing abdominal pain between periods. WIDER IMPLICATIONS OF THE FINDINGS: In this study Cu-IUD use did not influence the severity of dysmenorrhea and the LNG-IUS was shown to reduce the severity of dysmenorrhea. This is valuable information for prescribers and users when considering intrauterine contraception. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by grants from the Gothenburg Medical Society, Hjalmar Svenssons Fund and a National LUA/ALF (grant no. 11315). I.L. has received lecture fees from Organon/Schering-Plough/MSD and Bayer Pharma. I.M. has participated in International Advisory Boards sponsored by Organon/Schering-Plough/MSD and Schering/Bayer Pharma. I.M. has received lecture fees for presentations sponsored by Organon, Schering/Bayer and Pfizer.
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| 22. |
- Sandberg Kedfors, Kajsa, 1987, et al.
(författare)
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The value of an extended postnatal program for contraceptive use during the first year postpartum
- 2024
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Ingår i: Reprod Female ChildHealth. - 2768-7228 .- 2768-7228. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective:To investigate if earlier and repeated postpartum care visits (PPCVs) (3and 7 weeks) compared to a standard visit (7 weeks) would increase earlyinitiation of contraception and contraceptive use at 1‐year postpartum.Design:Comparative clinical trial.Setting:Six maternity clinics in Gothenburg, Sweden.Population:There were 447 women in the intervention group and 511 in thestandard group.Methods:Comparing standard postpartum care with an intervention model of care.Main Outcome Measures:Initiation of contraception and method used.Results:From January 2019 to June 2020, 1159, participants were enrolled.Analyses included 958 subjects where the intervention group had higher use ofcontraception (55.5%) compared to the standard group (48.5%), (95% confidenceinterval [CI]: 0.4–13.5),p= 0.037. Long‐acting reversible contraceptives werehigher among users in the intervention group (56.9%) compared to the standardgroup (48%), (95% CI:−0.3 to 18.0),p= 0.059. Condom use was higher in thestandard group (19%) compared to the intervention group (12.1%), (95% CI:0.1–13.6),p= 0.047. Contraceptive use 1‐year postpartum was higher in theintervention group (55.7%) compared to the standard group (47.2%), (95% CI:1.2–15.9),p= 0.023 and more pregnancies were reported in the standard group(7.8%) compared to the intervention group (4.1%), (95% CI: 0.5–7.0),p= 0.040.Conclusion:These results indicate the importance of earlier and additionalPPCVs to increase early start‐up of contraception and to obtain a higher frequencyof contraceptive use 1‐year postpartum to reduce pregnancies close to delivery.
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| 23. |
- Öhlén, Joakim, 1958, et al.
(författare)
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A Clinical Intervention Model for Communication and Information Focusing on Existential Uncertainty – A Participatory Action Research Project Informed by Qualitative Outcome Analysis
- 2011
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Ingår i: Supportive Care in Cancer. ; 19:Suppl 2
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Konferensbidrag (refereegranskat)abstract
- Objectives. The aim was to develop a team oriented intervention model for palliative cancer care focusing on communicating changes in goals of care. Methods. A participatory action research project was designed by means of qualitative outcome analysis. Initially, bimonthly focus groups with one palliative care team at an oncology outpatient unit were performed during one and a half year. Previous major results, from qualitative studies into patients’ knowledge seeking and experiences of communication and information in palliative cancer care, were used as facilitators for discussion and reflection on the team’s professional experiences. Collaboratively, the researchers and the team worked on developing an intervention model for communication and information. Group discussion data were analyzed concurrently. A preliminary clinical intervention model was developed and refined by means of focus groups with additional palliative care teams and patients respectively. Results. A model of communication and information in palliative cancer care aimed for clinical intervention will be presented, including main concepts, strategies and outcomes. The focus of the model is communication of changes in patients’ goals of care in relation to progress of disease as well as patients’ existential uncertainty (conceptualized as certainty–uncertainty). Conclusions. The model is found to have clinical fit, thanks of the collaborative development by clinicians and researchers. The next step is to further evaluate it clinically.
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