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Contraception Journal
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Contraception Editorial July 2012

This month’s featured editorial

Race, Reproductive Politics and Reproductive Health Care in the Contemporary United States
Carole Joffe, Willie J. Parker
pages 1-3
To paraphrase Leo Tolstoy, who famously wrote that all unhappy families are unhappy in their own way, we can say that all nations confront the thorny issue of demographics, but each in its own, typically controversial, way. Various European countries, for example, have anxieties about a “demographic winter,” which is a below replacement birth rate of the native population, which has led to corresponding fears about rising birth rates among Muslim immigrants. read more >

Original research articles

Fifty years on “the pill”: a qualitative analysis of nondaily contraceptive options
Beth Sundstrom
pages  4-11
Background: Despite widespread use of “the pill,” half of all pregnancies in the United States remain unplanned. Although nondaily contraceptive options offer a safe, effective alternative to oral contraception, these methods are not widely used.
Conclusions: These findings offer practical suggestions to health communication campaign planners and health care providers to increase uptake of nondaily contraceptive options to improve method satisfaction and reduce unplanned pregnancies among young women.
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A Bridge for postpartum women to Standard Days Method® Developing the Bridge
Irit Sinai, Jeannette Cachan
pages 12-15
Background: A new fertility-awareness-based Bridge was developed for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article describes the development of the Bridge and theoretical efficacy.
Conclusions: The Bridge can potentially be effective for postpartum women until they are eligible to use the Standard Days Method. Results from an efficacy study of the Bridge are described in a companion article.
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A Bridge for postpartum women to Standard Days Method® II. Efficacy study
Irit Sinai, Jeannette Cachan
pages 16-21
Background: In a companion article, we described the development of a new fertility-awareness-based Bridge for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article presents the results of an efficacy trial to test the Bridge.
Conclusions: The Bridge can offer significant protection from pregnancy for postpartum women who prefer using a fertility-awareness-based approach to avoiding pregnancy but are not yet eligible to use the Standard Days Method. Counseling should emphasize the importance of following the Bridge guidelines for it to be effective.
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Unscheduled bleeding with continuous oral contraceptive pills: a comparison of progestin dose
Bliss Kaneshiro, Alison Edelman, Nichole E. Carlson, Mark Nichols, Jeffrey Jensen
pages 22-27 
Background: Although the use of continuous oral contraceptive pills (OCPs) eliminates scheduled uterine bleeding, unscheduled bleeding is common. The objective of this study was to determine whether progestin dose influences bleeding with use of continuous OCPs.
Conclusion: Our results do not support the use of one LNG dose over another to decrease the amount of unscheduled bleeding women experience when initiating a continuous OCP.
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Suppression of ovarian activity with a low-dose 21/7-day regimen oral contraceptive containing ethinylestradiol 20 mcg/drospirenone 3 mg in Japanese and Caucasian women 
Yuzuru Anzai, Doris Heger-Mahn, Ilka Schellschmidt, Joachim Marr
pages 28-34
Background: Two studies assessed the effect of a low-estrogen-dose 21/7-day oral contraceptive containing ethinylestradiol and drospirenone (EE 20 mcg/drsp 3 mg) on ovarian activity in Japanese and Caucasian women.
Conclusions: EE 20 mcg/drsp 3 mg in a 21/7-day regimen provides comparable ovarian suppression in Japanese and Caucasian women, with normal ovarian function resuming shortly after treatment end in both populations.
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A combined oral contraceptive containing drospirenone changes neither endothelial function nor hemodynamic parameters in healthy young women: a prospective clinical trial 
Cassiana R.G. Giribela, Nilson R. Melo, Rita C.G. Silva, Valeria M. Hong, Grazia M. Guerra, Edmund C. Baracat, Fernanda M. Consolim-Colombo
pages 35-41
Background: Combined oral contraceptives (COCs) may lead to a rise in cardiovascular disease risk, possibly associated with changes in blood pressure and endothelial function.
Conclusion: These data suggest COC with 20 mcg EE and 3 mg DRSP does not alter arterial endothelial function or hemodynamic parameters in healthy young women.
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Lack of insurance and parity influence choice between long-acting reversible contraception and sterilization in women postpregnancy 
Maureen K. Baldwin, Maria I. Rodriguez, Alison B. Edelman
pages 42-47
Background: Disparities in postpregnancy contraception utilization exist, with low-income women disproportionately undergoing sterilization. We assessed the impact of increased intrauterine device (IUD) availability on rates of female sterilization.
Conclusions: Women choosing sterilization are more likely to have public insurance than women choosing IUD and may represent a continued trend toward nonreversible contraception among women of lower socioeconomic status despite available long-acting reversible methods.
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Primary care physicians' perceptions of rates of unintended pregnancy 
Sara M. Parisi, Shannon Zikovich, Cynthia H. Chuang, Mindy Sobota, Melissa Nothnagle, Eleanor Bimla Schwarz 
pages 48-54  
Background: Primary care physicians (PCPs) treat many women of reproductive age who need contraceptive and preconception counseling.
Conclusions: Many PCPs have inaccurate perceptions of rates of unintended pregnancy, both with and without use of contraception, which may influence the frequency and the content of the contraceptive counseling they provide.
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Prostate-specific antigen as a biomarker of condom failure: comparison of three laboratory assays and self-reported condom use problems in a randomized trial of female condom performance
Terri Walsh, Lee Warner, Maurizio Macaluso, Ron Frezieres, Margaret Snead, Brian Wraxall
pages 55-61
Background: Prostate-specific antigen (PSA), a biomarker for semen exposure, may provide a more objective measure of condom failure than subject self-reports. Methods for measuring PSA vary and their comparability with respect to assessing condom performance has not been adequately evaluated. This study compared results from three different PSA assays of vaginal samples collected by subjects in a randomized clinical trial which compared the performance of female condoms.
Conclusions: In combination with user self-report of condom failure, PSA testing provides a reliable, objective marker of condom functionality. Studies based on PSA testing may improve on conventional contraceptive clinical trials by offering a more direct assessment of a condom product's ability to prevent semen exposure.
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Effect of vitamin E and C supplements on lipid peroxidation and GSH-dependent antioxidant enzyme status in the blood of women consuming oral contraceptives
Fatemeh Zal, Zohreh Mostafavi-Pour, Fatemeh Amini, Afrooz Heidari
pages 62-66
Background: Oral contraceptives (OCs) may affect oxidative stress status. We aimed to assess whether supplementation with vitamins E and C reduced this OC effect.
Conclusions: These data suggest that low-dose OCs, by enhancing the stress oxidative and lipid peroxidation, may represent a potential cardiovascular risk factor, and the use of vitamins E and C may be beneficial in ameliorating this side effect of OCs.
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Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation
Sharon T. Cameron, Anna Glasier, Helen Dewart, Anne Johnstone, Audrey Burnside
pages 67-73
Introduction: Telephone follow-up with a self-performed low-sensitivity urine pregnancy (LSUP) test was introduced at the Royal Infirmary of Edinburgh, Scotland, as an alternative to routine ultrasonography for confirming successful abortion at 2 weeks following early medical abortion (<9 weeks' gestation). Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result subsequently attended the clinic for a confirmatory ultrasound.
Conclusions: A telephone follow-up and an LSUP test at 2 weeks are effective for detecting ongoing pregnancy, have good follow-up rates and are popular choices for women.
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Clinical diagnosis of completeness of medical abortion by nurses: a reliability study in Mozambique
Hailemichael Gebreselassie, Momade Ustá, Kathryn L. Andersen, Ellen M.H. Mitchell
pages 74-78
Background: The provision of medical abortion continues to rely on routine use of ultrasound to confirm expulsion of pregnancy. However, the absence of ultrasound in most of the health facilities in developing countries and the additional training required to enable providers to use ultrasound is often prohibitive. The purpose of this study was to compare clinical history and physical examination with ultrasound in confirming completion of abortion.
Conclusions: Clinical history and physical examination alone, without the use of ultrasonography, are effective for the determination of successful pregnancy expulsion. However, greater emphasis is required on the clinical identification of ongoing pregnancy during any training of providers.
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A double-blind, randomized controlled trial of the use of a 50:50 mixture of nitrous oxide/oxygen in legal abortions
Aubert Agostini, Julia Maruani, Pascale Roblin, Jocelyne Champion,Ludovic Cravello, Marc Gamerre
pages 79-83
Background: The study was conducted to evaluate the effectiveness of oxygen/nitrous oxide (O2/N2O) in elective abortions by vacuum aspiration with paracervical block and intravenous paracetamol.
Conclusions: O2/N2O did not reduce intraoperative or postoperative pain in elective abortions by vacuum aspiration with paracervical analgesia and intravenous paracetamol, and its adverse effect rate was substantial.
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How women anticipate coping after an abortion
Diana Greene Foster, Heather Gould, Katrina Kimport
pages 84-90
Background: Prostate-specific antigen (PSA), a biomarker for semen exposure, may provide a more objective measure of condom failure than subject self-reports. Methods for measuring PSA vary and their comparability with respect to assessing condom performance has not been adequately evaluated. This study compared results from three different PSA assays of vaginal samples collected by subjects in a randomized clinical trial which compared the performance of female condoms.
Conclusions: In combination with user self-report of condom failure, PSA testing provides a reliable, objective marker of condom functionality. Studies based on PSA testing may improve on conventional contraceptive clinical trials by offering a more direct assessment of a condom product's ability to prevent semen exposure.
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