This month’s featured editorial
Putting the pill to work
Jessica Arons
pages 483-485
This year marked the 50th anniversary of the FDA approval of the birth control pill, and with that milestone came numerous stories about the sexual liberation of women. While the pill deserves much credit for revolutionizing our sexual culture, it merits even more for transforming our workforce.
Providers have long known the individual and public health benefits of family planning, but the medical community may not be fully aware of the economic stability contraception brings to their patients' lives and to society overall.
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Controversies in Family Planning
When uterine leiomyomas complicate uterine evacuation. . .
Ericka Gibson, Courtney A. Schreiber
pages 486-488
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Review Article
Metabolism and pharmacokinetics of contraceptive steroids in obese women: a review
Alison B. Edelman, Ganesh Cherala, Frank Z. Stanczyk
pages 314-323
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This Month's Commentary
If the condom doesn't fit, you must resize it
Michael Cecil, Anita L. Nelson, James Trussell, Robert Hatcher
pages 489-490
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Original research articles
Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability
Radha A. Lewis, DeShawn Taylor, Melissa F. Natavio, Alexander Melamed, Juan Felix, Daniel Mishell
pages 491-496
Background: In levonorgestrel intrauterine system (LNG-IUS) users, the prevention of sperm penetration through cervical mucus has not been demonstrated.
Conclusions: Mid-cycle cervical mucus of LNG-IUS users is poor quality and prevents endocervical sperm transport in vitro.
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Safety and bleeding profile of continuous levonorgestrel 90 mcg/ethinyl estradiol 20 mcg based on 2 years of clinical trial data in Canada
Robert L. Reid, Michel P. Fortier, Lynne Smith, Sebastian Mirkin, Gary S. Grubb, Ginger D. Constantine
pages 497-502
Background: The study was conducted to evaluate bleeding profile and safety of continuous oral contraceptive (OC) containing levonorgestrel (LNG) 90 mcg/ethinyl estradiol (EE) 20 mcg.
Conclusions: Continuous LNG 90 mcg/EE 20 mcg had a safety profile similar to low-dose cyclic OCs. Short-term safety profile remained excellent, with increasing rates of amenorrhea and decreasing incidence of unscheduled bleeding and/or spotting.
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Biopsychosocial variables associated with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate in adolescents: adolescents who lost 5% or more from baseline vs. those who lost less than 5%
Zeev Harel, Kevin Wolter, Melanie A. Gold, Barbara Cromer, Margaret Stager, Christine Cole Johnson, Robert Brown, Ann Bruner, Susan Coupey, Paige Hertweck, Henry Bone, Ronald Burkman, Anita Nelson, Sharon Marshall, Laura K. Bachrach
pages 503-512
Background: It is unclear why some adolescents experience substantial bone mineral density (BMD) loss, while others experience a minimal decrease during depot medroxyprogesterone acetate (DMPA) use. We examined biopsychosocial factors in adolescents who experienced ≥5% BMD loss from baseline compared with adolescents who experienced <5% BMD loss during DMPA use.
Conclusions: BMD loss of ≥5% was more common at the hip than at the lumbar spine among adolescents using DMPA. Decreased serum estradiol levels did not correlate with magnitude of BMD loss. Lower BMI and calcium intake and greater alcohol use were associated with greater BMD loss in adolescents using DMPA.
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Comparison of 400 mcg buccal and 400 mcg sublingual misoprostol after mifepristone medical abortion through 63 days' LMP: a randomized controlled trial
Sheila Raghavan, Rodica Comendant, Irena Digol, Sergiu Ungureanu, Iurie Dondiuc, Steliana Turcanu, Beverly Winikoff
pages 513-519
Background: Buccal misoprostol 800 mcg and sublingual misoprostol 400 mcg demonstrate high efficacy and few adverse effects when used with 200 mg mifepristone for medical abortion through 63 days since the last menstrual period (LMP). Little is known about a 400-mcg buccal dose. This study compares two in-the-mouth routes of misoprostol using the same dose.
Conclusions: Both 400 mcg buccal misoprostol and 400 mcg sublingual misoprostol after mifepristone appear to be good options for medical abortion through 63 days' LMP.
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A pilot study of the Copper T380A IUD and oral levonorgestrel for emergency contraception
David K. Turok, Shawn E. Gurtcheff, Erin Handley, Sara E. Simonsen, Christina Sok, Patricia Murphy
pages 520-525
Background: This study evaluates the willingness of women presenting for emergency contraception (EC) to enroll in a study offering the copper intrauterine device (IUD) or oral levonorgestrel (LNG) and follows up the two groups for 6 months after EC administration to compare use of an effective method of contraception.
Conclusion: Women presenting for EC were willing to enroll in a study offering the copper IUD or oral LNG.
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Hormonal evaluation and midcycle detection of intrauterine glycodelin in women treated with levonorgestrel as in emergency contraception
Marta Durand, Riitta Koistinen, Mayel Chirinos, José Luis Rodríguez, Elena Zambrano, Markku Seppälä, Fernando Larrea
pages 526-533
Background: The study was conducted to assess the effects of levonorgestrel (LNG) on hormonal behavior and on the secretory pattern of intrauterine glycodelin at the midcycle of ovulatory women.
Conclusions: LNG taken at the dose used in emergency contraception before the LH surge increased prematurely serum and intrauterine concentrations of glycodelin at the time of ovulation. Since there are well established glycodelin inhibitory effects upon fertilization, these results may represent an additional action of LNG in situations where the intervention did not interfere with ovulation.
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Cultural adaptation among Hispanic women as related to awareness and acquisition of emergency contraception
Kristy K. Ward, Angelica M. Roncancio, Abbey B. Berenson
pages 534-537
Background: The study was conducted to examine the relationship between cultural adaptation (acculturation), contraceptive use, personal history of induced abortion, and emergency contraceptive (EC) awareness and acquisition among a sample of young sexually active Hispanic women.
Conclusions: Educational programs should make an effort to include Hispanic women with lower acculturation levels as increasing their knowledge about EC use and its mechanism of action may greatly reduce the number of unplanned pregnancies in this population.
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Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study
Anna Glasier, Rachel Manners, Joanna C. Loudon, Aileen Muir
pages 538-542
Background: UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use.
Conclusions: The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying.
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Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic
Emily M. Godfrey, Santina G. Wheat, Rosalie Cyrier, William Wong, James Trussell, Eleanor Bimla Schwarz
pages 543-548
Objectives: To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC.
Conclusion: Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.
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Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents
Patricia A. Cavazos-Rehg, Melissa J. Krauss, Edward L. Spitznagel, Mario Schootman, Jeffrey F. Peipert, Linda B. Cottler, Laura Jean Bierut
pages 549-555
Objective: This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents.
Conclusion: Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age.
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Evaluation of the effect of a patient decision aid about vasectomy on the decision-making process: a randomized trial
Michel Labrecque, Cristina Paunescu, Ioana Plesu, Dawn Stacey, France Légaré
pages 556-562
Background: Between 7% and 10% of men who choose vasectomy as a contraceptive method regret their decision. This study evaluates the effect of a patient decision aid (PtDA) designed to help men decide whether or not to have a vasectomy.
Conclusion: In men considering vasectomy, both versions of the PtDAs improved the quality of decision-making process to a similar extent. Information alone may be sufficient to support good decision making in these patients.
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Expanded safety and acceptability of the candidate vaginal microbicide Carraguard® in South Africa
The Carraguard Phase II South Africa Study Team
pages 563-571
Background: Carraguard's safety and acceptability was assessed among women in Gugulethu and Ga-Rankuwa, South Africa.
Conclusions: Carraguard was not associated with more vaginal, cervical or external genital irritation than placebo, and it was acceptable when used approximately 3.5 times per week, including during sex.
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Inhibition of vascular endothelial growth factor during the postovulatory period prevents pregnancy in the marmoset
Hamish M. Fraser, Keith D. Morris, Stanley J. Wiegand, Helen Wilson
pages 572-578
Background: This study investigated the effects of inhibition of vascular endothelial growth factor (VEGF) during the first postpartum cycle in marmosets housed with a fertile male where a 90% fertility rate is normal.
Conclusion: These results show that stringent pharmacological inhibition of VEGF suppresses luteal progesterone and prevents the successful establishment of pregnancy.
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Letters to the Editor
Finding the right face for advanced provision of emergency contraception
Courtney A. Schreiber, Sarah Ratcliffe, Kurt T. Barnhart
page 579
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Facing the facts on advance provision of emergency contraception
Chelsea B. Polis, Elizabeth G. Raymond, James Trussell
pages 579-580
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Olivier Graesslin, Pierre Clerson
pages 580-581
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Capturing the sexual side effects of hormonal contraception
Ellen Wiebe
page 581
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Pharmacokinetics of a combined oral contraceptive in obese and three normal-weight women
Carolyn Westhoff, Malcolm Pike
pages 581-582
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BMI, pharmacokinetics, and OCP failure
Ganesh Cherala, Alison Edelman
page 582
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