Convenience Drives U.S. Women To Buy Over-The-Counter Contraception In Mexico

American women who live along the U.S.-Mexico border frequently buy over-the-counter oral contraceptives from Mexican pharmacies because they don’t need a prescription and can send a friend to pick up the pills, according to a study by researchers from two University of Texas campuses and Ibis Reproductive Health.

The research, conducted in the El Paso-Juarez area, suggests there is demand in the United States for over-the-counter birth control pills and that many U.S. women would buy such contraception without a doctor’s prescription if given the option.

“The fact that many women in El Paso make use of the cross-border option suggests a substantial latent demand for an over-the-counter option at pharmacies in the United States,” said lead author Joseph E. Potter, a professor in the Sociology Department and Population Research Center at The University of Texas at Austin.

“Since crossing the border can be time-consuming for many, a domestic over-the-counter option would provide even more convenience than the cross-border option that’s available in El Paso,” he said.

The study’s other authors are Kari White and Kristine Hopkins of The University of Texas at Austin, Jon Amastae of the University of Texas at El Paso, and Daniel Grossman of Ibis Reproductive Health, a non-profit research organization based in Cambridge, Mass., and Oakland, Calif.

Women are now required to get a prescription to obtain oral contraceptives in the U.S. But the high prevalence of unwanted pregnancy and mounting evidence about the safety of such pills have led some to call for an over-the-counter option.

Grossman, who also coordinates a group of researchers, clinicians and advocates exploring the feasibility of an over-the-counter option for pills in the U.S., said, “This study gives us a better idea of who might take advantage of the over-the-counter option if it were available in the U.S., and it suggests that it would appeal to a broad range of women.”

As part of the study, researchers interviewed more than 1,000 El Paso women, about half of whom obtained their birth control pills across the border at Mexican pharmacies and half of whom went to U.S. clinics to get their pills.

Older women and those who were born and educated in Mexico were more likely to buy their pills in Mexican pharmacies. Women who received public assistance from such federal programs as Women, Infant and Children were more likely to go to the U.S. clinics.

Among both groups, most of the women said they believed the facility where they obtained the pills was cheaper and more convenient than the options on the other side of the border.

About 90 percent of the women who obtained oral contraceptives on the U.S. side said they trusted their clinic to give them good information (versus 46 percent of Mexican pharmacy consumers) and that they liked the other health services provided there.

Conversely, about 90 percent of the women who bought pills from the Mexican pharmacies said they wanted to bypass a doctor’s prescription and be able to send family or friends to pick up the pills.

“Making oral contraceptives available over the counter in the U.S. would add another option for women who find the clinic inconvenient or inaccessible. Our research shows that some women highly value the services they receive at clinics, and it’s important that they continue to have access to those services even if the pill goes over the counter,” said Grossman.

The findings are published in the American Journal of Public Health. For more information, visit: www.utexas.edu.

Study: Birth Control Doubles Chance OF Stroke

A 30-year old woman began to experience the classic symptoms of a stroke. What triggered her stroke, at such a young age, may have been the birth control pills she was taking. Oral contraceptives nearly double the risk of stroke, according to a review article in MedLink Neurology by three Loyola University Health System neurologists.

Nearly 100 million women worldwide use birth control pills. Pills now in use contain much lower concentrations of estrogens than older preparations. The relationship between oral contraceptives and stroke has been studied and debated for decades, and studies have yielded conflicting results.

There are about 4.4 ischemic strokes for every 100,000 women of childbearing age. Birth control pills increase the risk 1.9 times, to 8.5 strokes per 100,000 women, according to a well-performed “meta-analysis” cited in the article. (A meta-analysis combines the results of multiple studies.) This is still a small risk; there’s one additional stroke for every 25,000 women who take birth control pills, according to the article.

But for women who take birth control pills and also smoke, have high blood pressure or have a history of migraine headaches, the stroke risk is significantly higher, researchers said.

“When prescribing oral contraceptives, doctors should balance the risks and benefits for each individual patient,” said senior author Dr. Jose Biller. “For a healthy young woman without any other stroke risk factors, the benefits of birth control pills probably outweigh the risks. But if a woman has other stroke risk factors, she should be discouraged from using oral contraceptives.”

The 30-year-old woman was one of two patients described in the article. She had suffered migraine headaches since she was 15 years old, which further increased her stroke risk. Doctors took her off birth control pills and gave her medication for her migraines.

Authors also described a 27-year-old woman who suffered severe right-sided headaches, nausea, vomiting and unsteadiness while on oral contraceptives. She stopped taking birth control pills and was treated with a blood thinner for six months. On a follow up visit, she was doing well except for occasional headaches.

“These observations obviously need to be considered in the proper context of a careful understanding of possible risks and benefits associated with the use of oral contraceptives, as well as those associated with other forms of contraception,” Biller said.

How oral contraceptives might cause strokes is not completely understood, the researchers noted.

But two possible mechanisms are the increased risks of blood clots and high blood pressure associated with oral contraceptives, authors wrote.

Biller is chairman of the Department of Neurology at Loyola University Chicago Stritch School of Medicine. His co-authors are Dr. Michael J. Schneck, a professor in the Departments of Neurology and Neurological Surgery and lead author Dr. Sarkis Morales-Vidal, a stroke fellow in the Department of Neurology.

For more information, visit: http://loyolamedicine.org/ or www.medlink.com.

Contraceptive Ring Enters Testing For HIV Prevention

The new device is a vaginal ring that releases multiple types of non-hormonal agents and microbicides, which would prevent conception as well as sexually transmitted HIV infection.

Worldwide, there are about 5 million new infections and 3 million deaths per year due to HIV/AIDS. If proven successful in future clinical trials, the new device could provide women with the stone to kill two birds – protecting themselves from unintended pregnancy and sexually transmitted infection (STI).

The ring may also someday represent a novel method to prevent STIs for those with aversion to currently available methods, with hormonally derived active agents, or with allergies to latex condoms, researchers said.

“This device is a new approach to birth control, because it avoids the long-term use of hormonal methods that have been associated with increased risk of certain cancers,” said Dr. Brij Saxena, lead author and the Harold and Percy Uris Professor of Reproductive Biology and professor of endocrinology in the Department of Obstetrics and Gynecology at Weill Cornell Medical College. “At the same time, this is the first device to simultaneously offer the possibility to prevent unintended pregnancy and HIV transmission.”

“No one has ever conquered a viral epidemic with treatment, so prevention is the most effective option. Ideally, an HIV vaccine is the most desirable method, but that is not foreseeable in the near future,” explained Dr. Jeffrey Laurence, co-author of the study and attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. “The next best thing would be something that would prevent infection and put the power in the susceptible female partner’s control. That’s the potential a device such as this can offer.”

The vaginally inserted ring is incorporated with multiple antiviral drugs that prevent HIV infection and are time-released over a period up to 28 days. The compounds tested were a newly developed anti-HIV agent, Boc-lysinated betulonic acid, TMC120 (dapivirine), PMPA, and 3′-azido-3′-deoxythymidine (AZT or zidovudine), which, when combined, were found to block infection in human cells exposed to the virus in a laboratory setting, researchers said.

“The combination of these antiviral drugs has proven to be potent agents that may block infection by the HIV virus,” said Saxena.

The ring is also incorporated with compounds that prevent conception by arresting sperm motility, raising vaginal mucous viscosity, and sustaining the acidity of the vagina in which sperm do not survive.
Traditionally, similar devices have used hormonal compounds that have been linked to increased risk of breast and cervical cancers, or spermicidal compounds that kill sperm, but may lead to irritation and inflammation. Past findings published in the journal Contraception found the device to be highly effective in animal models and in laboratory testing, said researchers.

“The compounds in the device are natural materials that are already approved by the U.S. Food and Drug Administration for use in humans,” explained Saxena.

The study was supported by grants by the National Institutes of Health, International Partnership for Microbicides and BioRing LLC, and published in the journal AIDS.

For more information, visit www.med.cornell.edu.

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Contraceptive Pill Influences Partner Choice, Study Found

The contraceptive pill may disrupt women’s natural ability to choose a partner genetically dissimilar to themselves, research at the University of Liverpool has found.

Disturbing a woman’s instinctive attraction to genetically different men could result in difficulties when trying to conceive, an increased risk of miscarriage and long intervals between pregnancies. Passing on a lack of diverse genes to a child could also weaken their immune system, said researchers.

Humans choose partners through their body odor and tend to be attracted to those with a dissimilar genetic make-up to themselves, maintaining genetic diversity. Genes in the Major Histocompatibility Complex (MHC), which helps build the proteins involved in the body’s immune response, also play a prominent role in odor through interaction with skin bacteria. In this way these genes also help determine which individuals find us attractive, said researchers.

The research team analyzed how the contraceptive pill affects odor preferences. One hundred women were asked to indicate their preferences on six male body odor samples, drawn from 97 volunteer samples, before and after initiating contraceptive pill use.

Craig Roberts, a Lecturer in Evolutionary Psychology who carried out the work in collaboration with the University of Newcastle, said “The results showed that the preferences of women who began using the contraceptive pill shifted towards men with genetically similar odors.

“Not only could MHC-similarity in couples lead to fertility problems but it could ultimately lead to the breakdown of relationships when women stop using the contraceptive pill, as odor perception plays a significant role in maintaining attraction to partners,” said Roberts.

The research has been published in the journal Proceedings of the Royal Society B: Biological Sciences. More information can be found by visiting, www.liv.ac.uk.