This month’s featured editorial

Birth Control Hormones In Water: Separating Myth From Fact
Kirsten Moore, Kimberly Inez McGuire, Rivka Gordon, Tracey J. Woodruff
pages 115-118
The past several years have seen a steady drumbeat of news reports, blog posts, and scientific studies which have raised concerns about the presence of estrogenic compounds (natural estrogens and synthetic chemicals that mimic natural estrogen) in waterways and drinking water, and potential harm to human health or aquatic life.Frequently, one particular synthetic estrogen has been singled out for purportedly detrimental effects on the environment: ethynyl-estradiol, or EE2, a synthetic estrogen used in birth control pills, patches, rings, and injectables. Journalists from along the political spectrum and anti-contraception advocates alike have seized on the idea of the-Pill-as-environmental-pollutant, and it has been difficult to separate environmental health concern from sensational coverage or politically motivated rhetoric. read more >

Commentary

Controversies in family planning: timing of ovulation after abortion and the conundrum of postabortion intrauterine device insertion
Amy Stoddard, David L. Eisenberg
pages 119-121
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Original research articles

Long-term assessment of forearm bone mineral density in postmenopausal former users of depot medroxyprogesterone acetate
Alexandre S. Viola, Sara Castro, Nadia M. Marchi, M. Valeria Bahamondes
pages 122-127
Background: There are many controversies on the association between depot medroxyprogesterone acetate (DMPA) and bone mineral density (BMD). This study reevaluated BMD in postmenopausal women who had used DMPA as a contraceptive until they reached menopause and compared them with non-users. BMD had previously been measured in these women either at 1 year or 2–3 years after menopause and was reassessed in these women 2 years later. Therefore, comparisons were made between the first and third years and between the second to third and fourth to fifth years after menopause.
Conclusions: No statistically significant differences were found in forearm BMD measurements between postmenopausal women who had been long-term users of DMPA and those who had been long-term users of an IUD until menopause. Evaluation of BMD after the menopause showed slightly higher values in former DMPA users compared with non-users.
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Menstrual problems and contraception in women of reproductive age receiving oral anticoagulation
Farah Yasmine Huq, Katerina Tvarkova, Aliaa Arafa, Rezan A. Kadir
pages 128-132
Background: Oral anticoagulation is associated with increased bleeding complications. The aim of this study was to assess the changes in menstrual loss and pattern in women taking anticoagulant treatment.
Conclusion: Women of reproductive age experience heavy and prolonged menstrual bleeding whilst on OA therapy. Women of reproductive age on OA therapy should be monitored for menstrual disorders to ensure that prompt and appropriate treatment is instituted. Advice about appropriate contraception should also be part of the medical care provided for these women. Barrier contraception, sterilization and progestin-only contraception are all suitable methods of contraception in this patient group.
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Effect of extended-cycle regimen with an oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest on bleeding patterns, safety, acceptance and contraceptive efficacy
Inka Wiegratz, Skadi Stahlberg, Torsten Manthey, Nicole Sänger
pages 133-143
Background: The present study compared the efficacy and safety of a combined oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest (EE/DNG) in conventional and extended-cycle regimen over 1 year of treatment.
Conclusions: Extended-cycle use of EE/DNG was effective and mostly well tolerated, appearing to be a favorable option for women who need or wish to omit the pill-free interval.
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TwoDay Method: a quick-start approach
Victoria Jennings, Irit Sinai, Luisa Sacieta, Rebecka Lundgren
pages 144-149
Background: Requiring that women wait until the onset of menses to initiate a family planning method is a medical barrier that can result in unintended pregnancies. In the efficacy study of the TwoDay Method, a new fertility awareness-based method of family planning, women were taught the method in the first seven days of their cycles. This study tested a quick-start approach (providing the method at any time in the cycle) to TwoDay Method delivery.
Conclusion: There is no need to limit delivery of the TwoDay Method to the first seven days of the menstrual cycle.
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Postpartum contraceptive preferences of HIV-infected women in the era of highly active antiretroviral therapy (HAART) and scheduled cesarean deliveries
Methodius G. Tuuli, Thinh H. Duong, Nicole P. Yost, Jane Ellis
pages 150-154
Background: We sought to determine if postpartum tubal ligation among HIV-infected women changed with the introduction of highly active antiretroviral therapy (HAART) and scheduled cesarean delivery.
Conclusions: HIV-infected women on HAART are overall more likely to have PPTL, but cesarean delivery appears to be the facilitator of this choice.
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Extended regimens of the combined contraceptive vaginal ring containing etonogestrel and ethinyl estradiol: effects on lipid metabolism
Fernando Augusto Barreiros, Cristina Aparecida Falbo Guazzelli, Ricardo Barbosa, Maria Regina Torloni
pages 155-159
Background: Oral contraceptives used for extended periods of time have been studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate modifications in the lipid profile of women using the vaginal ring continuously over a 1-year period.
Conclusion: The combined contraceptive vaginal ring used on an extended regimen causes changes in the lipid profile metabolism of users. Despite the vaginal route of administration, the steroids released by the ring caused significant changes in lipids and lipoproteins, which were typical of those seen with ethinyl estradiol given either orally or parenterally.
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Effect of a combination oral contraceptive (desogestrel+ethinyl estradiol) on the expression of low-density lipoprotein receptor and its transcription factor (SREBP2) in placental trophoblast cells
Albina Arjuman, Hemlata Pandey, Nimai Chand Chandra
pages 160-168
Background: This in vitro study deals with the effect of a combination oral contraceptive steroid — desogestrel and ethinyl estradiol — on the expression of low-density lipoprotein receptor (LDLR) and its transcription factor (SREBP2) in assessing the functional effectiveness of the LDLR.
Conclusions: The stimulatory effect of a combination contraceptive steroid on LDLR expression is an associated phenomenon of the contraceptive-mediated stimulation of SREBP2 expression.
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Mifepristone (RU 486) induces vasodilation and inhibits platelet aggregation: nongenomic and genomic action to cause hemorrhage
Mercedes Perusquía, Julia Espinoza, Aurora de la Peña
pages 169-177
Background: The regimen mifepristone/misoprostol is an established and highly effective method for early termination of pregnancy. However, its side effects such as a significantly long bleeding time and hemorrhage have been scantly studied.
Conclusions: These effects seem to be responsible for increased and prolonged hemorrhage. Since mifepristone-prevented platelet aggregation was observed in the anucleate platelets, and mifepristone-induced vasorelaxation remained unaffected in de-endothelized tissues, by inhibitors of transcription and translation and a nitric oxide (NO) synthase inhibitor, a nongenomic endothelium- and NO-independent mechanism was revealed. Additionally, the results indicated a blockade of voltage- and receptor-operated calcium channels. The antiglucocorticoid genomic action of mifepristone, by inducing an excess of NO, may also contribute to exacerbated hemorrhage.
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Has mifepristone medical abortion expanded abortion access in New Mexico? A survey of OB-GYN and Family Medicine physicians
Eve Espey, Larry Leeman, Tony Ogburn, Betty Skipper
pages 178-183
Background: The FDA approval of mifepristone in 2000 broadened the available options for abortion. The aim of this study was to evaluate whether physicians in New Mexico have integrated the use of mifepristone into their practice.
Conclusions: The number of physicians offering any abortion or medical abortion in New Mexico has not changed since the FDA approval of mifepristone. Residency training programs in FM and in Ob-gyn should include training in medical abortion.
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Quantitative perceptual differences among over-the-counter vaginal products using a standardized methodology: implications for microbicide development
Ellen D. Mahan, Kathleen M. Morrow, John E. Hayes
pages 184-193
Background: Increasing prevalence of HIV infection among women worldwide has motivated the development of female-initiated prevention methods, including gel-based microbicides. User acceptability is vital for microbicide success; however, varying cultural vaginal practices indicate multiple formulations must be developed to appeal to different populations. Perceptual attributes of microbicides have been identified as primary drivers of acceptability; however, previous studies do not allow for direct comparison of these qualities between multiple formulations.
Conclusions: Descriptive analysis, a quantitative approach that is based on consensus lexicon usage among participants, successfully quantified perceptual differences among vaginal products. Since perceptual attributes of products can be directly compared quantitatively, this study represents a novel approach that could be used to inform rational design of microbicides.
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Falling through the cracks: contraceptive needs of female sex workers in Cambodia and Laos
Guy Morineau, Graham Neilsen, Sopheab Heng, Chansy Phimpachan
pages 194-198
Background: Condom is the only method promoted for dual protection among female sex workers (FSWs) in most Asian countries, which may be insufficient to prevent pregnancies given FSWs' high frequency of sexual intercourse.
Conclusion: FSWs experience higher frequency of abortion than women from the general population. FSWs' reportedly high rate of condom use is insufficient to prevent pregnancies.
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Nomegestrol acetate: steroid receptor transactivation profile in Chinese hamster ovary cells and ovulation inhibition in rat and monkey
Harry A. van Diepen, Tsang W. Lam, Cor W. Kuil
pages 199-204
Background: Activity of nomegestrol acetate (NOMAC), levonorgestrel (LNG), drospirenone (DRSP), dienogest (DNG) and progesterone on human steroid receptor transactivation was investigated. Ovulation inhibition by NOMAC, LNG and progesterone was tested.
Conclusion: Nomegestrol acetate is a selective progestogen and a potent inhibitor of ovulation in the rat and monkey.
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Letters to the Editor

Copper IUD and emergency contraception
Kazým Emre Karaþahin, Ugur Keskin
pages 205
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The Copper IUD and emergency contraception
David K. Turok
pages 205-206
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Correspondence
Kelly Cleland, Elizabeth Raymond, James Trussell, Linan Cheng
pages 206-207
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Response to the letter to the editor by Cleland et al.
Zoltan Kozinszky, Marit Lieng
pages 207
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