Contraception Highlights December 2009

This month’s featured editorial Buyer beware Anita L. Nelson pages 495-496 As the safety and efficacy of IUDs are being appreciated by more clinicians and by more women, the demand for these devices has grown. …

This month’s featured editorial

Buyer beware
Anita L. Nelson
pages 495-496
As the safety and efficacy of IUDs are being appreciated by more clinicians and by more women, the demand for these devices has grown. Unfortunately, the prices of these devices have also increased over the last few years. The cost of the IUD, when amortized over the average time of utilization, is very low, but that does little to buffer women from the initial sticker shock. In times of economic hardship, effective contraception is especially important. Clearly, the women who have already invested in their devices are in a very enviable position. However, for today’s patient who needs effective contraception, the upfront cost of IUDs can be overwhelming. Even insured women may find insurance coverage for IUDs to be inadequate.

This month’s commentaries

Forgettable contraception
David A. Grimes
pages 497-499
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Evaluating research on abortion and mental health
Julia R. Steinberg, Nancy Felipe Russo
pages 500-503
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Original research articles

Continuous, daily levonorgestrel/ethinyl estradiol vs. 21-day, cyclic levonorgestrel/ethinyl estradiol: efficacy, safety and bleeding in a randomized, open-label trial
Alexander Teichmann, Dan Apter, Janusz Emerich, Klaus Greven, Dagmara Klasa-Mazurkiewicz, Giambi B. Melis, Marek Spaczynski, Gary S. Grubb, Ginger D. Constantine, Daniele Spielmann
pages 504-511
Background: This Phase 3, randomized, open-label, multicenter study conducted at 44 sites in Europe evaluated the safety and efficacy of a continuous, daily regimen of levonorgestrel (LNG) 90 mcg/ethinyl estradiol (EE) 20 mcg compared with a 21-day, cyclic LNG 100 mcg/EE 20 mcg regimen.
Conclusions: Continuous LNG 90 mcg/EE 20 mcg was shown to be a safe and effective OC in this direct comparison to a cyclic OC. Suppression of menses and the potential for no bleeding requiring sanitary protection may be provided by this continuous, low-dose OC.
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Effect of interpregnancy interval on adverse perinatal outcomes — a national study
Sorina Grisaru-Granovsky, Ethel-Sherry Gordon, Ziona Haklai, Arnon Samueloff, Michael M. Schimmel
pages 512-518
Background: The interpregnancy interval (IPI) has been reported to influence the outcome of pregnancy and birth. We performed a national study in Israel to determine the impact of IPI on multiple adverse perinatal outcomes.
Conclusion: Optimal IPI recommendation of >11 months is an accessible and low-cost means to improve multiple adverse perinatal outcomes.
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Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study
Milena Bastos Brito, Rui Alberto Ferriani, Silvana Maria Quintana, Marta Edna Holanda Diogenes Yazlle, Marcos Felipe Silva de Sá, Carolina Sales Vieira
pages 519-526
Background: The effects of etonogestrel (ETG)-releasing contraceptive implant during the immediate postpartum period on maternal safety are unknown.
Conclusion: The insertion of ETG-releasing contraceptive implant during the immediate postpartum period was not associated with deleterious maternal clinical effects or with significant maternal metabolic alterations or decreased infant weight gain.
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Continuation rates and reasons for removal among Implanon® users accessing two family planning clinics in Queensland, Australia
Caroline Harvey, Charrlotte Seib, Jayne Lucke
pages 527-532
Background: This study examined demographic profile, continuation rates and reasons for removal among Implanon® users accessing two family planning clinics in Queensland, Australia.
Conclusions: Implanon® continuation rates and reasons for removal differ between clinics in metropolitan and rural locations. A cooling-off period did not affect the likelihood of continuation with Implanon®. Preinsertion counselling should emphasize potential changes in bleeding patterns.
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Changing patterns of contraceptive use in Australian women
Jayne C. Lucke, Melanie Watson, Danielle Herbert
pages 533-539
Background: This longitudinal analysis examines how patterns of contraceptive use changed over 11 years among Australian women born between 1973 and 1978.
Conclusions: Women’s contraceptive use and the factors associated with contraceptive use change over time as women move into relationships, try to conceive, have babies and complete their families.
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The EVAPIL® scale, a new tool to assess tolerance of oral contraceptives
Olivier Graesslin, Philippe Barjot, Médéric Hoffet, Daniel Cohen, Philippe Vaillant, Pierre Clerson
pages 540-554
Background: The EVAPIL® scale is a self-questionnaire aimed to assess tolerability of oral contraceptives (OC).
Conclusion: The EVAPIL® scale demonstrated interesting psychometric properties to evaluate the tolerability of OCs in OC users. Further research is needed to address sensitivity to change and usefulness in new OC users.
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Use of injectable progestin contraception and risk of STI among South African women
Audrey Pettifor, Sinead Delany, Immo Kleinschmidt, William C. Miller, Julius Atashili, Helen Rees
pages 555-560
Objective: This study was conducted to determine the association between the use of injectable progestin contraception (IPC) and the risk of infection with Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), bacterial vaginosis (BV) and Trichomonas vaginalis (TV) among women in South Africa.
Conclusions: The use of DMPA among women in this study population was associated with an increased — but not statistically significant — risk of cervical infection with chlamydia and gonorrhea, and a decreased risk of TV and BV. Given the inconsistencies and limitations of the data describing an increased risk of CT and GC with IPC use, the potential risk of sexually transmitted infections (STIs) must be balanced against the risk of unintended pregnancy and its health consequences, especially in developing countries. Women opting to use IPC should be counseled to use condoms to protect against STIs and HIV.
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Contraception services for incarcerated women: a national survey of correctional health providers
Carolyn B. Sufrin, Mitchell D. Creinin, Judy C. Chang
pages 561-565
Background: Incarcerated women have had limited access to health care prior to their arrest. Although their incarceration presents an opportunity to provide them with health care, their reproductive health needs have been overlooked.
Conclusions: Contraception does not appear to be integrated into the routine delivery of clinical services to incarcerated women. Because the correctional health care system can provide important clinical and public health interventions to traditionally marginalized populations, services for incarcerated women should include access to contraception.
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Sociodemographic predictors of postvasectomy noncompliance
Yefim Sheynkin, Alek Mishail, Praneeth Vemulapalli, Jacqueline Lee, Hongshik Ahn, David Schulsinger
pages 566-568
Background: Postvasectomy semen analysis (PVSA) is critical to establish the success of the vasectomy but the rate of compliance with PVSA is notoriously low. We determined various sociodemographic predictors of high noncompliance rate.
Conclusion: Objective sociodemographic variables were associated with a higher risk of PVSA noncompliance. A more thorough approach to vasectomy counseling and timely reminder of upcoming PVSA in a preoperatively defined group of patients will help to improve compliance and prevent possible medical and legal repercussions.
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Reasons for ineffective pre-pregnancy contraception use in patients seeking abortion services
Juell B. Homco, Jeffrey F. Peipert, Gina M. Secura, Vanessa A. Lewis, Jenifer E. Allsworth
pages 569-574
Background: We sought to better understand reasons for not obtaining desired contraception among women presenting for a pregnancy termination.
Conclusions: Many reasons for not obtaining desired contraception exist and are associated with non-use of contraception. Removing these reasons may help reduce unintended pregnancies and rates of pregnancy termination.
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Women’s experience of viewing the products of conception after an abortion
Ellen R. Wiebe, Lisa C. Adams
pages 575-577
Background: The objectives of this study were to assess perceptions of women viewing the products of conception after abortion and to assess the feasibility of offering this choice.
Conclusions: It is feasible to offer women having abortions the choice to view the products of conception and for most, viewing does not make it emotionally harder for them.
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Impact of paracervical block on postabortion pain in patients undergoing abortion under general anesthesia
Gweneth B. Lazenby, Nicholas S. Fogelson, Tod Aeby
pages 578-582
Background: Paracervical block is used as a way to decrease postoperative pain in patients having abortions under general anesthesia. To date, no studies have evaluated the efficacy of this practice.
Conclusion: This study does not support the hypothesized benefit of local anesthesia prior to surgical abortion under general anesthesia to reduce postoperative pain.
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Clinical Guidelines

Contraceptive considerations in obese women: Release date 1 September 2009 SFP Guideline 20091
Susan Higginbotham
pages 583-590
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Letters to the Editor

Young women’s perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study
Sunny Onyeabor
page 591
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Young women’s perceptions of pregnancy risk and use of emergency contraception: findings from a qualitative study — authors’ reply
Lisa M. Williamson, Katie Buston, Helen Sweeting
pages 591-592
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Drug Integrity Associate Audrey Amos is a pharmacist with experience in health communication and has a passion for making health information accessible. She received her Doctor of Pharmacy degree from Butler University. As a Drug Integrity Associate, she audits drug content, addresses drug-related queries

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