This month’s featured editorial
Keeping evidence-based recommendations up to date: the World Health Organization's global guidance for family planning
Kathryn M. Curtis, Herbert B. Peterson, Catherine d'Arcangues
pages 323-324
Since the mid 1990s, the World Health Organization's (WHO) Department of Reproductive Health and Research, in collaboration with international partners, has been creating and updating global guidance for family planning, based on the best scientific evidence. In April 2008, WHO held its most recent expert meeting to update this guidance and create the fourth edition of the Medical Eligibility Criteria for Contraceptive Use and the third edition of the Selected Practice Recommendations for Contraceptive Use. The Medical Eligibility Criteria for Contraceptive Use gives recommendations regarding whether women with specific characteristics and medical conditions can use various methods of contraception. The Selected Practice Recommendations for Contraceptive Use addresses 33 contraceptive management issues, including contraceptive method initiation and continuation, management of side effects, and screening tests needed prior to contraceptive initiation. WHO has also created two companion documents that incorporate all of the guidance of the Medical Eligibility Criteria for Contraceptive Use and the Selected Practice Recommendations for Contraceptive Use into tools for family planning providers. The first is the Decision Making Tool for Family Planning Clients and Providers, which is a flip chart used to facilitate provider–client interaction in choosing a method of contraception. The second is Family Planning: A Global Handbook for Providers, created in collaboration with major family planning organizations around the world. These WHO Four Cornerstones for Evidence-based Guidance for Family Planning have had an impact on family planning practice globally. For example, the third edition of the Medical Eligibility Criteria for Contraceptive Use has been incorporated into guidelines in over 50 countries and is available in 13 languages.
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This month’s commentary
WHO provider brief on hormonal contraception and liver disease
Nathalie Kapp
pages 325-326
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Review articles
Intrauterine device insertion during the postpartum period: a systematic review
Nathalie Kapp, Kathryn M. Curtis
pages 327-336
Background: Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications.
Conclusion: Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications.
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Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review
Kelly R. Culwell, Kathryn M. Curtis
pages 337-345
Background: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use.
Conclusion: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management.
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Progestogen-only contraceptive use in obese women
Kathryn M. Curtis, Anita Ravi, Mary Lyn Gaffield
pages 346-354
Background: The objective of this systematic review is to determine whether obese women who use progestogen-only contraceptives are more likely to experience weight gain or serious adverse events as compared to nonobese users.
Conclusions: Adolescent DMPA users who are obese may gain more weight than normal weight users. This observation was not seen in adult DMPA users or adolescent Norplant users.
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Use of combined oral contraceptives post abortion
Mary E. Gaffield, Nathalie Kapp, Anita Ravi
pages 355-362
Background: Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method.
Conclusions: Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy.
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Combined oral contraceptive and intrauterine device use among women with gestational trophoblastic disease
Mary E. Gaffield, Nathalie Kapp, Kathryn M. Curtis
pages 363-371
Background: Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy.
Conclusions: Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method.
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Oral contraceptives and family history of breast cancer
Mary E. Gaffield, Kelly R. Culwell, Anita Ravi
pages 372-380
Background: Questions remain regarding whether oral contraceptive (OC) use among women with a family history of breast cancer increases disease risk.
Conclusions: Current evidence shows that women with a family history of breast cancer do not increase their disease risk by using OCs.
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The effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver: a systematic review
Nathalie Kapp, Ian B. Tilley, Kathryn M. Curtis
pages 381-386
Background: This report evaluates the effects of hormonal contraceptive use among women with viral hepatitis or cirrhosis of the liver.
Conclusion: Data from one study suggest that COCs do not affect the course of acute hepatitis. Limited data from studies on chronic hepatitis or its sequelae suggest that COC use does not affect the rate of progression or severity of cirrhotic fibrosis, the risk of hepatocellular carcinoma in women with chronic hepatitis, or the risk of liver dysfunction in hepatitis B virus carriers.
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Hormonal contraceptive use among women with liver tumors: a systematic review
Nathalie Kapp, Kathryn M. Curtis
pages 387-390
Background: The review was conducted to evaluate from the literature the safety of hormonal methods of contraception in women with liver tumors, specifically in benign and malignant disease.
Conclusions: The studies identified examined oral contraceptive use among women with FNH. We did not identify any studies of hormonal contraceptive use among women with hepatocellular adenoma or with malignant liver tumors. Limited, poor-quality evidence suggests that for women with FNH, use of low-dose COCs or POCs does not appear to influence either liver lesion resolution or progression.
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When can a woman have repeat progestogen-only injectables–depot medroxyprogesterone acetate or norethisterone enantate?
Melissa E. Paulen, Kathryn M. Curtis
pages 391-408
Background: Currently, there is a generally accepted 2-week grace period for women returning early/late for reinjection of either depot medroxyprogesterone acetate (DMPA) or norethisterone enantate (NET-EN). This systematic review evaluates the evidence regarding return to fertility and ovulation after injection of a progestogen-only contraceptive.
Conclusion: Studies evaluating time to pregnancy after last injection of DMPA or NET-EN reported extremely low pregnancy rates during the 2-week interval following the reinjection date; extremely low pregnancy rates for DMPA were also reported for 4 weeks following the reinjection date. Studies of return to ovulation after last injection of DMPA generally found that the earliest ovulation did not occur until several months after the last injection while studies of NET-EN reported ovulations around (or even before) the time for reinjection.
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