This month’s featured editorial

Strategies To Expand Contraception Coverage: Another Tool In The Box
Emily M. Godfrey
pages 339-341
Despite the extensive body of evidence about the health benefits and cost-savings of contraception coverage, women's health care advocates are bracing themselves for the possibility that contraceptive care will lose the political debate as a no cost-sharing preventive service under the Affordable Care Act (ACA). As a second alternative to no cost-sharing, the Health Resources and Services Administration (HRSA) may determine that contraceptive care under the ACA is an essential women's health preventive service that all health plans must cover, but with cost-sharing. Should HRSA decide to exclude comprehensive contraceptive coverage as an essential women's health preventive service altogether, strategists would likely attempt to (a) convince more states to classify contraceptive services as essential benefits that all health plans must cover (with cost-sharing) or (b) convince more employers to include contraceptive services as covered benefits in the health plans that they sponsor or participate in (with cost-sharing). read more >

Review Article

Current issues and available options in combined hormonal contraception
Johannes Bitzer, James A. Simon
pages 342-356
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Original research articles

The association between oral contraceptive use, bone mineral density and fractures in women aged 50–80 years
Shuying Wei, Alison Venn, Changhai Ding, Stella Foley
pages 357-362
Background: The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial.
Conclusions: Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance.
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Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel
Anna Glasier, Sharon T. Cameron, Diana Blithe, Bruno Scherrer
pages 363-367
Background: Emergency contraception (EC) does not always work. Clinicians should be aware of potential risk factors for EC failure.
Conclusion: Women who have intercourse around ovulation should ideally be offered a copper intrauterine device. Women with body mass index >25 kg/m2 should be offered an intrauterine device or UPA. All women should be advised to start effective contraception immediately after EC.
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Ongoing contraception after use of emergency contraception from a specialist contraceptive service
Sharon T. Cameron, Anna Glasier, Anne Johnstone, Leanne Rae
pages 368-371
Background: A consultation for emergency contraception (EC) gives way to an opportunity to provide women with an ongoing effective method of contraception.
Conclusions: Research is required to develop strategies to improve the uptake of effective contraception after EC.
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Opportunities missed: improving the rate of contraceptive counseling or provision when prescribing reproductive-aged women potentially teratogenic medications in a family medicine resident clinic
Melissa D. Fritsche, Adrienne Z. Ables, Heather Bendyk
pages 372-376
Background: Studies show poor documentation of contraceptive counseling when prescribing women teratogenic medications, suggesting a missed opportunity for contraceptive education.
Conclusion: This study is the first to document contraceptive counseling rates when providing teratogenic medications in a training setting. It illustrates a need for increased attentiveness in primary care training practices to the risks of teratogenic medications and the need for comprehensive contraceptive counseling. Simple interventions may improve this rate and decrease missed opportunities.
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Postpartum insertion of levonorgestrel–intrauterine system at three time periods: a prospective randomized pilot study
Joshua D. Dahlke, Eric R. Terpstra, Abigail M. Ramseyer, Jeanne M. Busch
pages 244-248
Background: The study was conducted to determine the feasibility of levonorgestrel–intrauterine system (LNG-IUS) insertion at three different times postpartum.
Conclusions: Insertion of LNG-IUS ≤48 h postpartum is feasible in our institution and may be associated with similar utilization at 6 months, increased expulsion rates and decreased pain at insertion when compared to placement after 6 weeks.
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The effectiveness of contraceptive counseling for women in the postabortion period: an intervention study
Ana Laura Carneiro Gomes Ferreira, Ariani Impieri Souza, Rafaela Evangelista Pessoa, Cynthia Braga
pages 377-383
Background: Brazilian women who have undergone abortion use contraceptive methods; however, their use of contraceptive methods is inconsistent and/or inappropriate.
Conclusion: The strategy on individualized contraceptive counseling increased the acceptance and the use of contraceptive methods and increased the adequate use of the methods.
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Extended-use oral contraceptives and medically induced amenorrhea: attitudes, knowledge and prescribing habits of physicians
Carrie E. Frederick, Alison Edelman, Nichole E. Carlson, Kenneth D. Rosenberg
pages 252-258
Background: The study was conducted to determine whether geographic location, primary specialty, attitudes and knowledge influence the prescribing habits of physicians regarding extended-use oral contraceptives (OC) and medically induced amenorrhea.
Conclusions: Physicians' attitudes regarding medically induced amenorrhea influence the use of extended-cycle OC more than any other characteristic.
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The efficacy and safety of an oral contraceptive containing chlormadinone acetate: results of a pooled analysis of noninterventional trials in adult and adolescent women
Georg A.K. Schramm, Guido Schrah
pages 390-401
Background: The study was conducted to assess the contraceptive efficacy, cycle events, dysmenorrhea symptoms and skin complaints of a combined oral contraceptive containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol (CMA/EE) (Belara^®, Grünenthal GmbH, Aachen, Germany) in adolescent and adult women using a conventional- or extended-cycle regimen.
Conclusions: Chlormadinone acetate/ethinylestradiol is effective and well tolerated in adolescent and adult women.
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Use of the levonorgestrel-releasing intrauterine system, quality of life and sexuality. Experience in an Italian family planning center
Carlo Bastianelli, Manuela Farris, Giuseppe Benagiano
pages 402-408
Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) was first marketed in 1990 in Finland. Since then, it has been approved in approximately 120 countries throughout the world, with almost 50 million women-years of cumulative experience to date. Its high contraceptive effectiveness and favorable bleeding profile, leading to significant reduction of menstrual bleeding both in women with idiopathic menorrhagia and in those with normal menstrual bleedings, have been the key to the success of the system. At the same time, women need to be provided adequate preinsertion counseling about changes in menstrual bleeding to be expected. In the Italian context, it is important to highlight during counseling that amenorrhea is not harmful but can lead to health benefits such as an increase in iron blood stores and blood hemoglobin concentration.
Conclusions: Although in Italy intrauterine contraception is poorly accepted, once started on LNG-IUS, women found that the device represents a safe and effective contraceptive modality, with valuable noncontraceptive benefits, especially in the presence of heavy or prolonged bleeding.
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Metabolic effects of contraceptive implants in adolescents
Cristina A.F. Guazzelli, Flaviano Teixeira de Queiroz, Marcia Barbieri, Fernando A. Barreiros
pages 409-412
Background: The study population comprised 47 postpartum adolescents (mean 17.2 years old) managed at the Family Planning Sector of São Paulo Federal University. Participants received an implant containing etonogestrel (68 mg) within 6 months of delivery (on average 102 days after giving birth) and were followed for 1 year. Blood was collected at baseline and 12 months later to assess total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), hemogram, urea, creatinine, sodium, potassium, fasting glucose, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and bilirubin.
Conclusions: Our results indicate that an etonogestrel implant used by adolescents for 1 year is associated with changes in the lipid profile and hepatic function without adverse clinical effects.
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Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population
David Hubacher, Alice Olawo, Carolyne Manduku, James Kiarie
pages 413-417
Background: Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.
Conclusion: The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.
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Assessment of the activity of an oral contraceptive on the levels of oxidative stress and changes in oxidative stress after co-treatment with two different types of physiological modulators with antioxidant action
Annarosa Finco, Gianni Belcaro, Maria Rosaria Cesarone
pages 418-422
Background: The aims of this research were to document the nature of oxidative stress (OS) while taking an estrogen/progestagen-combined oral contraceptive (OC) and to evaluate the action of two different products composed of a combination of antioxidant, vitamins and natural products in physiological quantity and classified as antioxidant/food supplement. For this reason, the two products are classified as physiological modulators (PM), able to restore the balance between antioxidants and reactive oxygen species in the organism.
Conclusion: We conclude that to control the OS generated by OC, specific types of physiological modulators are needed
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Differential regulation of endogenous pro-inflammatory cytokine genes by medroxyprogesterone acetate and norethisterone acetate in cell lines of the female genital tract
Donita Africander, Renate Louw, Nicolette Verhoog, Dewald Noeth
pages 423-435
Background: Medroxyprogesterone acetate (MPA) and norethisterone (NET) and its derivatives are widely used in female reproductive therapy, but little is known about their mechanisms of action via steroid receptors in the female genital tract. MPA used as a contraceptive has been implicated in effects on local immune function. However, the relative effects of progesterone (Prog), MPA and norethisterone acetate (NET-A) on cytokine gene expression in the female genital tract are unknown.
Conclusion: Collectively, these data demonstrate that cell lines from different anatomical sites of the female genital tract respond differently to Prog and the synthetic progestins, most likely due to differential actions via different steroid receptors. The results highlight the importance of choice of progestins for immune function in the cervicovaginal environment. They further suggest that choice of progestins in endocrine therapy may have implications for women's risk of susceptibility to infections due to differential actions on genes involved in inflammation and immune function.
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