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Contraception Journal
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Contraception Highlights March 2010

This month’s featured editorial

Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promise
Bethany Young Holt, Maggie Kilbourne-Brook, Alan Stone, Polly Harrison, Wayne C. Shields
pages 177-180
Over the past four decades, the world has made substantial gains in the effort to prevent unplanned pregnancies and reduce the risk of sexually transmitted infections (STIs), including HIV, and other reproductive tract infections (RTIs). Yet, STIs and RTIs still cause a heavy health burden, especially in developing countries, and there is an equally urgent unmet need for contraception.

To date, prevention strategies have focused largely on single indications, namely, the prevention of unplanned pregnancy, prevention of STIs or prevention of RTIs. This approach does not adequately recognize the intrinsic link between unplanned pregnancy and STIs: a woman at risk of an unplanned pregnancy is often simultaneously at risk for an STI, including HIV, or other RTI. Thus, there is a critical need for multipurpose prevention technologies that will allow people to avoid more than one adverse health outcome.
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Commentary

Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultation
John Stanback, Jeff Spieler, Iqbal Shah, William R Finger, The Expanding Access to Injectable Contraceptives Technical Consultation Participants (see Acknowledgments)
pages 181-184
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Review Articles

Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review
Hans-Peter Zahradnik, Aida Hanjalic-Beck, Klaus Groth
pages 185-196
Background: This article is a comprehensive overview of dysmenorrhea and a systematic review of the available literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives for the therapy and management of dysmenorrhea.
Conclusions: The findings of this review support the use of NSAIDs as a first-line therapy for pain relief from dysmenorrhea in women without wish for contraception. For women who wish contraception, combined oral contraceptives (COCs) are the preferential therapy for pain relief from dysmenorrhea as the additional noncontraceptive benefit of pain relief from dysmenorrhea is not linked to additional risks, eliminates the risks associated with taking NSAIDs and is a more suitable long-term option. Recommendations are made to strengthen the impact of future trials through improved methodology.
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Sino-implant (II) — a levonorgestrel-releasing two-rod implant: systematic review of the randomized controlled trials
Markus J. Steiner, Laureen M. Lopez, David A. Grimes, Linan Cheng, Jim Shelton, James Trussell, Timothy M.M. Farley, Laneta Dorflinger
pages 197-201
Background: Sino-implant (II) is a subdermal contraceptive implant manufactured in China. This two-rod levonorgestrel-releasing implant has the same amount of active ingredient (150 mg levonorgestrel) and mechanism of action as the widely available contraceptive implant Jadelle. We examined randomized controlled trials of Sino-implant (II) for effectiveness and side effects.
Conclusions: Sino-implant (II) is one of the most effective contraceptives available today. These available clinical data, combined with independent laboratory testing, and the knowledge that 7 million women have used this method since 1994, support the safety and effectiveness of Sino-implant (II). The lower cost of Sino-implant (II) compared with other subdermal implants could improve access to implants in resource-constrained settings.
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Original research articles

Epidemiological and clinical aspects of migraine in users of combined oral contraceptives
Rogério Bonassi Machado, Alice Pinheiro Pereira, Geórgia Perez Coelho, Larissa Neri, Larissa Martins, Daniele Luminoso
pages 202-208
Background: Migraine was assessed in users of combined oral contraceptives (COCs).
Conclusions: The prevalence of migraine in COC users appears similar to that found in the general population. Migraines, but not other types of headache, were significantly affected by COCs. The EE/DRS combination was associated with a greater likelihood of improvement in migraine compared with other types of COCs.
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Effects of the contraceptive patch and the vaginal ring on bone metabolism and bone mineral density: a prospective, controlled, randomized study
Mariangela Massaro, Costantino Di Carlo, Virginia Gargano, Carmen Formisano, Giuseppe Bifulco, Carmine Nappi
pages 209-214
Background: This study was conducted to compare the effects of the combined contraceptive vaginal ring releasing 15 mcg of ethinylestradiol (EE) and 120 mcg of etonorgestrel daily with the effects of the contraceptive patch, a transdermal system that delivers a daily dose of 20 mcg of EE and 150 mcg of norelgestromin on bone turnover and bone mineral density (BMD) in young fertile women.
Conclusion: Both contraceptive systems exert a similar positive influence on bone turnover in young postadolescent women.
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Bleeding patterns and menstrual-related symptoms with the continuous use of a contraceptive combination of ethinylestradiol and drospirenone: a randomized study
Rogério Bonassi Machado, Nilson Roberto de Melo, Hugo Maia
pages 215-222
Background: The objective of this study was to compare bleeding patterns of women using a contraceptive combination of 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) continuously or cyclically. Menstrual-related symptoms were also evaluated.
Conclusions: Continuous use was associated with amenorrhea and fewer menstrual-related symptoms compared to cyclic use.
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Extended regimens of the contraceptive vaginal ring: evaluation of clinical aspects
Fernando Augusto Barreiros, Cristina Aparecida Falbo Guazzelli, Ricardo Barbosa, Francisco de Assis, Fábio Fernando de Araújo
pages 223-225
Background: Oral contraceptives used for extended periods of time have been extensively 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 the clinical symptoms, body weight and blood pressure changes in women using the vaginal ring continuously over a 1-year period.
Conclusion: The vaginal ring used on an extended regimen is a well-tolerated contraceptive method and also offers noncontraceptive benefits.
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A randomized prospective trial comparing the levonorgestrel-releasing intrauterine system with thermal balloon ablation for the treatment of heavy menstrual bleeding
Sérgio S. de Souza, Aroldo F. Camargos, Carolina P. de Rezende, Francisco A.N. Pereira, Cícero A.A. Araújo, Agnaldo L. Silva Filho
pages 226-231
Background: Use of the levonorgestrel-releasing intrauterine system (LNG-IUS) was compared with thermal balloon ablation (TBA) for the treatment of heavy menstrual bleeding (HMB).
Conclusions: Both the LNG-IUS and TBA appear to be effective in controlling HMB; however, posttreatment uterine bleeding patterns are different.
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Results of a safety and feasibility study of the diaphragm used with ACIDFORM Gel or K-Y® Jelly
Claire E. von Mollendorf, Lut. Van Damme, Jocelyn A. Moyes, Vera Helen Rees, Marianne M. Callahan, Christine K. Mauck, Adrian J. Puren, Kathryn Tweedy, Doug Taylor
pages 232-239
Background: New strategies are needed for preventing HIV infection in women. One potential approach is female-initiated use of an effective topical microbicidal gel in combination with a cervical barrier such as the diaphragm.
Conclusion: There was a trend towards more safety events in the ACIDFORM plus diaphragm group, although no primary comparisons achieved statistical significance. Adding an effective microbicidal gel to a mechanical barrier may still prove to be an important and acceptable combination method to help prevent pregnancy and HIV/sexually transmitted infection transmission.
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A comparison of transabdominal and transvaginal ultrasonography for determination of gestational age and clinical outcomes in women undergoing early medical abortion
Patricia A. Lohr, Matthew F. Reeves, Mitchell D. Creinin
pages 240-244
Background: We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion.
Conclusions: Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists.
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Antimullerian hormone and obesity: insights in oral contraceptive users
Anne Z. Steiner, Frank Z. Stanczyk, Stan Patel, Alison Edelman
pages 245-248
Background: The study was conducted to examine the impact of oral contraceptives (OCs) on serum antimullerian hormone (AMH) levels by obesity status in reproductive-age women.
Conclusions: In reproductive-age women, serum AMH levels do not appear to fluctuate during OC use, but AMH levels are significantly lower in obese women. Lower levels do not appear to be due to differences in gonadotropin levels or ovarian activity.
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Perceived competence and contraceptive use during adolescence
Jennifer B. Hillman, Sonya Negriff, Lorah D. Dorn
pages 249-253
Background: Little is known about psychosocial correlates of different contraceptive methods in adolescence.
Conclusions: Type of contraceptive method was associated with parent and adolescent's perceived competence. For rule-breaking behavior, parental perception may be more relevant to contraceptive use.
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Perceptions of the safety of oral contraceptives among a predominantly Latina population in Texas
Daniel Grossman, Leticia Fernández, Kristine Hopkins, Jon Amastae, Joseph E. Potter
pages 254-260
Background: Fear of side effects and previous negative experiences are common reasons for contraceptive nonuse.
Conclusions: Women's perception of OC safety does not correlate well with medical eligibility for use. More education about the safety and health benefits of hormonal contraception is needed. OTC availability might contribute to more positive safety perceptions of OCs compared to a prescription environment.
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In vitro Actinomyces israelii biofilm development on IUD copper surfaces
Mónica Carrillo, Benjamín Valdez, Lidia Vargas, Lydia Alvarez, Miguel Schorr, Roumen Zlatev, Margarita Stoytcheva
pages 261-264
Background: Female pelvic actinomycosis may involve fallopian tubes, ovaries, uterus and bladder. This condition is often associated with the use of intrauterine contraceptive devices (IUDs), vaginal pessaries and/or tampons. The predominant causative agent of human actinomycosis is Actinomyces israelii, which has been found on copper IUDs retrieved from patients.
Conclusion: A. israelii was able to attach and grow in synthetic intrauterine media and to present on the copper surface is likely due to the production of biofilm.
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Letter to the Editor

Is there evidence for tripling the dose of 200 mg mifepristone for medical abortion?
Gilda Piaggio, Paul Van Look, Helena von Hertzen, Kristina Gemzell, Oskari Heikinheimo, Allan Templeton
page 265
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