Contraception Highlights September 2010

This month’s featured editorial

Happy anniversary mifepristone: a decade of promise and challenges
Beth Jordan, Wayne C. Shields
pages 219-220
September 29, 2010, marks the 10th anniversary of Food and Drug Administration's approval of Mifeprex (mifepristone) in the United States. That moment 10 years ago brought women the promise of increased access to early, safe, noninvasive abortion and the potential mainstreaming of abortion services into the larger scope of routine comprehensive women's health care. The arduous 12-year path to approval required an intensive level of collaboration among key professional, advocacy and research organizations, working closely to navigate abortion-related politics and meet the natural challenges of introducing a new medical option to women and their health care providers. read more

Original Research Articles

Factors affecting mortality in a large cohort study with special reference to oral contraceptive use
Martin Vessey, David Yeates, Susan Flynn
pages 221-229
Background: This analysis updates mortality in the Oxford-Family Planning Association (Oxford-FPA) contraceptive study, with emphasis on oral contraceptive (OC) use.
Conclusions: Long-term follow-up strongly suggests that OC use slightly reduces all cause mortality.
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Contraceptive sterilization use among married men in the United States: results from the male sample of the National Survey of Family Growth
John E. Anderson, Lee Warner, Denise J. Jamieson, Dmitry M. Kissin, Ajay K. Nangia, Maurizio Macaluso
pages 230-235
Background: Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women.
Conclusion: One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.
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Sex education and contraceptive use at coital debut in the United States: results from Cycle 6 of the National Survey of Family Growth
Michelle M. Isley, Alison Edelman, Bliss Kaneshiro, Dawn Peters, Mark D. Nichols, Jeffrey T. Jensen
pages 236-242
Background: The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents.
Conclusions: Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.
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Clinician satisfaction and insertion characteristics of a new applicator to insert radiopaque Implanon: an open-label, noncontrolled, multicenter trial
Diana Mansour, Ellen Mommers, Helena Teede, Bjarne Sollie-Eriksen, Oliver Graesslin, Hans-Joachim Ahrendt, Kristina Gemzell-Danielsson
pages 243-249
Background: The etonogestrel (ENG) implant Implanon® is a progestin-only contraceptive that provides effective contraception for up to 3 years. A new radiopaque ENG implant has been developed to extend the diagnostic modalities of Implanon and a next-generation applicator (NGA) was designed to facilitate correct subdermal insertion of Implanon.
Conclusions: The NGA was well accepted by investigators with or without prior experience with Implanon. The results stressed the importance of correctly following implant insertion instructions.
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Vaginal estrogen supplementation during Depo-Provera initiation: a randomized controlled trial
Angela Dempsey, Claudia Roca, Carolyn Westhoff
pages 250-255
Background: Irregular bleeding is often cited as the reason for discontinuation of depot-medroxyprogesterone acetate (DMPA) after the first injection. Estrogen supplementation during DMPA initiation may decrease bleeding and improve continuation.
Conclusions: Vaginal estrogen supplementation during DMPA initiation is acceptable to women and may decrease total bleeding.
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Etonogestrel implant in postpartum adolescents: bleeding pattern, efficacy and discontinuation rate
Cristina Ap. F. Guazzelli, Flaviano Teixeira de Queiroz, Marcia Barbieri, Maria Regina Torloni, Fabio Fernando de Araujo
pages 256-259
Background: The increasing rate of teenage pregnancies is a challenge to health professionals. New contraceptive methods have been developed to try to improve adherence in this group of patients. The study was conducted to evaluate the bleeding pattern, efficacy and discontinuation rate of etonogestrel implant (68 mg) inserted in postpartum adolescents.
Conclusion: These findings suggest that the etonogestrel implant is a safe and effective contraceptive method that is well accepted by adolescents after a pregnancy.
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Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand
Helen Roberts, Martha Silva, Sylvia Xu
pages 260-265
Background: Many misconceptions still prevail about the appropriateness of use of the intrauterine device (IUD), particularly for younger women. This study examines the factors associated with post abortion IUD use as compared to the combined oral contraceptive pill (COC). It then examines the effect of type of post abortion contraception with the likelihood of seeking subsequent abortions.
Conclusions: Young and nulliparous women are less likely to use an IUD as a method of contraception following an abortion. However, those women who have an IUD inserted following an abortion are much less likely to return for a subsequent abortion. IUDs are a safe and effective method of contraception that are currently still underused among the younger population.
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Comparison of two dose regimens of misoprostol for second-trimester pregnancy termination
Joseph Franciscus Gertrudis Maria Brouns, Madelon van Wely, Mattheus Petrus Maria Burger, Willem Jacobus van Wijngaarden
pages 266-275
Objective: The study was conducted to compare the efficacy of two different dose regimens of misoprostol administered vaginally in combination with mifepristone for second trimester termination of viable and non-viable pregnancies.
Conclusions: Both regimens used in this trial proved to be equally effective for termination of both viable and non-viable pregnancies during the second trimester. The time between the first administration of misoprostol and delivery of the fetus was significantly longer in the 200-mcg group than in the 400-mcg group. This outcome may be used as the rationale for choosing a 400 mcg misoprostol regimen for termination of pregnancy during the second trimester.
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Effect of oral contraceptives on markers of hyperandrogenism and SHBG in women with polycystic ovary syndrome
Vincenzo De Leo, Alessandra Di Sabatino, Maria C. Musacchio, Giuseppe Morgante, Valeria Scolaro, Antonio Cianci, Felice Petraglia
pages 276-280
Background: This randomized study's aim was to compare the effect of four oral contraceptives (OCs) containing 30 mcg of ethinylestradiol (EE) and different progestogens [drospirenone, (DRSP), chlormadinone acetate (CMA), desogestrel (DSG), gestodene (GSD)] on biochemical and hormonal parameters of hyperandrogenism and sex hormone-binding globulin (SHBG) in women with polycystic ovary syndrome (PCOS).
Conclusions: Clinical studies need to be performed to determine effects of these OCs upon clinical signs of hyperandrogenism.
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The effect of patient gynecologic history on clinician contraceptive counseling
Christine Dehlendorf, Rachel Ruskin, Philip Darney, Eric Vittinghoff, Kevin Grumbach, Jody Steinauer
pages 281-285
Background: Contraceptive providers have an important influence on women's selection of contraception. Previous studies suggest that clinicians inappropriately limit use of intrauterine contraception (IUC). This study investigated the influence of patients' gynecologic histories on recommendations for IUC and other methods of contraception.
Conclusions: Patient gynecologic characteristics affect recommendations for some reversible contraceptive methods. Clinicians continue to have concerns about IUC use despite evidence supporting its safety.
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Vaginal swab specimen processing methods influence performance of rapid semen detection tests: a cautionary tale
Marcia M. Hobbs, Markus J. Steiner, Kimberly D. Rich, Maria F. Gallo, Lee Warner, Maurizio Macaluso
pages 291-295
Background: Detection of semen biomarkers in vaginal fluid can be used to assess women's recent exposure to semen. Quantitative tests for detection of prostate-specific antigen (PSA) perform well, but are expensive and require specialized equipment. We assessed two rapid immunochromatographic strip tests for identification of semen in vaginal swabs.
Conclusion: Investigators are urged to optimize vaginal swab specimen preparation methods for performance of RSID or other tests to detect semen components other than PSA. Previously described methods for PSA testing are not uniformly applicable to other tests.
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Reduced community access to a key contraceptive: public health consequence from false suspicion of HIV-contaminated injectables
David W. Jenkins, Robert Krysiak, Connie Sexton
pages 296-300
Background: This study was conducted to investigate a report of positive test results with DMPA on an HIV rapid test. Suspecting HIV contamination, the Zambian Ministry of Health initiated a product withdrawal pending full evaluation.
Conclusions: The DMPA sample was negative for HIV and human IgG. Formulation components may have led to the interpretation of false-positive results, reinforcing the need to validate the sample type used in any test. DMPA use was reinstated in Zambia, minimizing the public health impact that resulted from the initial rapid test results.
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Levonorgestrel inhibits proliferation and induces apoptosis in uterine leiomyoma cells
Qing Xu, Lili Qiu, Liqun Zhu, Li Luo, Changfen Xu
pages 301-308
Background: The levonorgestrel intrauterine system (LNG-IUS) is a widely recognized intrauterine anti-fertility system, which can alleviate symptoms of uterine leiomyoma. This study aims to evaluate leimyoma cell growth inhibition induced by high concentrations of LNG.
Conclusions: This study demonstrated that LNG may suppress the proliferation and induce apoptosis of the uterine leiomyoma cells.
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