Contraception Highlights December 2011

This month’s featured editorials The paradox of disability in abortion debates: bringing the pro-choice and disability rights communities together Sujatha Jesudason, Julia Epstein pages 541-543 There is an unfortunate paradox that arises when pro- and …

This month’s featured editorials

The paradox of disability in abortion debates: bringing the pro-choice and disability rights communities together
Sujatha Jesudason, Julia Epstein
pages 541-543
There is an unfortunate paradox that arises when pro- and anti-choice advocates talk about disabilities such as Down syndrome or spina bifida. The paradox works this way: On one hand, reproductive rights proponents can portray disability as a tragic state that justifies abortion—even for wanted pregnancies. At the same time, anti-choice advocates proclaim their value for all life, including individuals with and without disabilities. That paradox places disability rights advocates, generally a group that finds itself in the progressive political camp, on the same side as anti-choice advocates who are more usually associated with conservative political positions. read more >

Egon R. Diczfalusy, the discovery of the fetoplacental unit and much more
Giuseppe Benagiano, Mario Merialdi
pages 544-548
Fetal endocrinology is today recognized as a special branch of reproductive endocrinology, a subspecialty that has existed since the days when Egon Diczfalusy, some 50 years ago, started investigating the complex hormonal exchanges that take place between the maternal and fetal organism via the placenta. The father of this discipline turned 90 years a few months ago, and the occasion was celebrated by the Karolinska Institute in Stockholm with an ad hoc Symposium jointly sponsored with the Foundation dedicated to his name and that of his late wife Ann. Therefore, the time seems right to write about his life accomplishments and his legacy.

Controversies in Family Planning

Ophthalmic migraines and combined hormonal contraceptives
Misa Perron-Burdick, Courtney Schreiber, Pratima Gupta
pages 442-444
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Review Article

Ovulation inhibition doses of progestins: a systematic review of the available literature and of marketed preparations worldwide
Jan Endrikat, Christoph Gerlinger, Stephanie Richard, Peter Rosenbaum
pages 549-557
This review provides a comprehensive overview of all progestins ever tested for their ovulation inhibition potency and a summary of all preparations currently on the world market, including their regimens and their combinations with EE.
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Original research articles

Choice of birth control methods among European women and the role of partners and providers
Jokin de Irala, Alfonso Osorio, Silvia Carlos, Cristina Lopez-del Burgo
pages 558-564
Background: The choice of a birth control method is influenced by sociocultural and personal factors. We explored the perceived influences in women’s choice of a birth control method in five European countries (Germany, France, the UK, Romania and Sweden), where contraception is widely used.
Conclusions: Hormonal contraceptives and IUDs are commonly recommended by providers rather than requested by women. Partner preferences are taken into account when his cooperation in the use of the method is needed. As fertility care is a male and female issue, there is still more room for actively involving both women and men in their choice of a birth control method.
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Comparative pharmacokinetics and pharmacodynamics after subcutaneous and intramuscular administration of medroxyprogesterone acetate (25 mg) and estradiol cypionate (5 mg)
José Alfredo Sierra-Ramírez, Roger Lara-Ricalde, Miguel Lujan, Norma Velázquez-Ramírez
pages 565-570
Background: The efficacy of contraceptives is affected by its route and ease of administration. Herein, both pharmacokinetics and pharmacodynamics of the once-a-month combined injectable contraceptive medroxyprogesterone acetate (MPA) plus estradiol cypionate (E2-Cyp) were compared after intramuscular (IM) or subcutaneous (SC) injection in women of reproductive age.
Conclusion: The results presented herein demonstrate that the injection of 25 mg of MPA plus 5 mg of E2-Cyp has similar efficacy and safety with either the SC or IM route of administration. The SC option can be considered a viable self-administered contraceptive option that might increase women’s compliance to contraceptive use.
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Comparison of contraceptive method chosen by women with and without a recent history of induced abortion
Tessa Madden, Gina M. Secura, Jenifer E. Allsworth, Jeffrey F. Peipert
pages 571-577
Background: Women undergoing induced abortion may be more motivated to choose long-acting reversible contraception (LARC), including the intrauterine device (IUD) and implant, than women without a history of abortion. Our objective was to determine whether the contraceptive method chosen is influenced by a recent history of induced abortion and access to immediate postabortion contraception.
Conclusions: Women offered immediate postabortion contraception are more likely to choose the IUD and implant than women without a recent abortion history. Increasing access to immediate postabortion LARC is essential to preventing repeat unintended pregnancies.
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Contraceptive experiences among adolescents who experience unintended birth
Mandy S. Coles, Kevin K. Makino, Nancy L. Stanwood
pages 578-584
Background: Adolescents are at high risk of unintended pregnancy due to contraceptive nonuse and inconsistent use.
Conclusion: Access issues and misconceptions around contraceptive side effects and fertility place adolescents at higher risk for unintended pregnancy, especially among younger and Black teens. Ambivalence represents an additional area for intervention.
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Patients’ attitudes and experiences related to receiving contraception during abortion care
Megan L. Kavanaugh, Elizabeth E. Carlin, Rachel K. Jones
pages 585-593
Background: High risk for additional unintended pregnancies among abortion patients makes the abortion care setting an ideal one for facilitating access to contraception. This study documents attitudes of abortion patients about contraceptive services during their receipt of abortion services and identifies patient characteristics associated with desire for contraception and interest in using a long-acting reversible contraceptive method (LARC).
Conclusions: Many women are interested in learning about and obtaining contraceptive methods, including LARC, in the abortion care setting.
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A survey of provider experience with misoprostol to facilitate intrauterine device insertion in nulliparous women
Katherine Ward, Janet C. Jacobson, David K. Turok, Patricia A. Murphy
pages 594-599
Background: There is a significant need for research on treatments that provide pain relief during intrauterine device (IUD) insertion. Misoprostol is frequently used before IUD insertion but is not always necessary and its use may increase pain and side effects. This survey evaluated how providers who perform IUD insertion in nulliparous women report using misoprostol to facilitate the procedure.
Conclusion: Despite conflicting published data, nearly half of survey respondents use misoprostol before IUD insertion. Considerable variation in the timing of misoprostol use may explain differences in perception of its effectiveness. Evidence-based information about misoprostol for IUD insertion in nulliparous women, including pharmacokinetics, efficacy and optimal dosing, is needed.
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A randomized study of the effect of mifepristone alone or in conjunction with ethinyl estradiol on ovarian function in women using the etonogestrel-releasing subdermal implant, Implanon®
Edith Weisberg, Horatio B. Croxatto, John K. Findlay, Henry G. Burger
pages 600-608
Background: Mifepristone alone or in combination with ethinyl estradiol (EE) can effectively stop an episode of uterine bleeding in women using the etonogestrel-releasing contraceptive implant, Implanon® but could impair contraceptive efficacy.
Conclusions: Pregnancy is very unlikely to occur if mifepristone and EE are given during use of Implanon to stop an episode of bleeding.
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Mifepristone-induced abortion and vaginal bleeding in subsequent pregnancy
Hong Liang, Er-sheng Gao, Ai-min Chen, Lin Luo
pages 609-614
Background: The aim of this study is to explore the effect of first-trimester mifepristone-induced abortion on vaginal bleeding in subsequent pregnancy.
Conclusions: One previous mifepristone-induced abortion increased the risk of vaginal bleeding in early gestation period of subsequent pregnancy compared with no abortion, especially if abortion occurred before 7 weeks of gestation and was followed by a curettage or complications.
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Can nurses perform manual vacuum aspiration (MVA) as safely and effectively as physicians? Evidence from India
Shireen J. Jejeebhoy, Shveta Kalyanwala, A.J. Francis Zavier, Rajesh Kumar
pages 615-621
Background: Although legal, access to safe abortion remains limited in India. Given positive experiences of task-shifting from other developing countries, there is a need to explore the feasibility of expanding the manual vacuum aspiration (MVA) provider base to include nurses in India.
Conclusions: Findings of the study make a compelling case for amending existing laws to expand the MVA provider base in order to increase access to safe abortion in India.
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Menstrual bleeding: perspective of Brazilian women
María Y. Makuch, Maria José D. Osis, Carlos A. Petta, Karla Simonia de Pádua
pages 622-627
Background: Menstrual patterns, induced amenorrhea and the use of some contraceptive methods which induce non-bleeding are issues under debate among health professionals and women. The objective of the study was to describe perspectives and attitudes of Brazilian women regarding menstruation and its interference in daily activities.
Conclusions: A great proportion of the interviewed women disliked having menstruation even when they did not present menstrual-related problems. However, some women still preferred monthly menstruation because they felt healthy and it was a free pregnancy test.
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A prospective double-blinded, randomized, placebo-controlled trial on the use of letrozole pretreatment with misoprostol for second-trimester medical abortion
Vivian Chi Yan Lee, Oi Shan Tang, Ernest Hung Yu Ng, William Shu Biu Yeung
pages 628-633
Background: The aim of this randomized trial was to evaluate the abortion rate of combined regimen of letrozole and misoprostol in second-trimester abortion.
Conclusions: The use of letrozole pretreatment (7.5 mg daily for 3 days) with misoprostol in second-trimester abortion does not significantly improve the abortion rate of the misoprostol-only regimen.
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Oral contraceptive therapy modulates hemispheric asymmetry in spatial attention
Ettore Cicinelli, Marina De Tommaso, Antonio Cianci, Nicola Colacurci
pages 634-636
Background: Functional cerebral asymmetries (FCAs) are known to fluctuate across the menstrual cycle. The visual line-bisection task administered to normally cycling women showed different patterns of the interhemispheric interactions during menses and the midluteal cycle phase. However, the contribution of estrogens and progestins hormones to this phenomenon is still unclear.
Conclusions: The results of this study confirm a hormonal modulation on interhemispheric interaction and suggest that OCs may improve the interhemispheric interaction reducing FCAs compared with the low hormone level period. This opens new insights in OC prescription and choice of administration schedule in order to improve cognitive performances.
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Effect of copper intrauterine device on the cyclooxygenase and inducible nitric oxide synthase expression in the luteal phase endometrium
Ebru Coskun, Yigit Cakiroglu, Banu Kumbak Aygun, Bahar Muezzinoglu
pages 637-641
Background: To evaluate the effect of copper intrauterine device (IUD) on the expression of cyclooxygenase (COX) and inducible nitric oxide synthase (iNOS) in the luteal phase endometrium.
Conclusions: Although COX-2 expression increased 3 months after copper IUD insertion, iNOS expression of the luminal epithelium decreased. Local hypoxia caused by copper and vasoconstrictor prostanoids may play a role in IUD-related menstrual abnormalities.
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Serine protease inhibitor 4-(2-aminoethyl)benzenesulfonyl fluoride hydrochloride (AEBSF) inhibits the rat embryo implantation in vivo and interferes with cell adhesion in vitro
Ya-hong Jiang, Yan Shi, Ya-ping He, Jing Du
pages 642-648
Background: This study was conducted to observe the in vivo effect of 4-(2-aminoethyl)benzenesulfonyl fluoride hydrochloride (AEBSF) on embryo implantation in rats and its in vitro effect on cell adhesion.
Conclusions: 4-(2-Aminoethyl)benzenesulfonyl fluoride hydrochloride might be a potential leading compound for novel contraceptives, and its inhibitory effect on implantation might result from the interference in extracellular matrix remodeling process.
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Case Report

Etonorgestrel concentrations in morbidly obese women following Roux-en-Y gastric bypass surgery: three case reports
Cécile Ciangura, Nicola Corigliano, Arnaud Basdevant, Stéphane Mouly
pages 649-651
Background: Pregnancy should be avoided for 12 to 18 months after Roux-en-Y gastric bypass (RYGB) surgery. The etonorgestrel (ENG)-releasing implant (Implanon®) may represent a safe and effective contraceptive method in morbidly obese women who are candidates for bariatric surgery. In addition, the subcutaneous delivery of steroid is unaffected by malabsorptive surgery.
Conclusions: These unique data in morbidly obese women highlight the need for further pharmacokinetic studies of contraceptive agents in obese women during weight loss.
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Letters to the Editor

Recognizing existing framework for regulation of assisted reproductive technologies in the United States
Rogerio A. Lobo
pages 652
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Response by the leadership of the Society of Assisted Reproductive Technology (SART) to the article “Assisted Reproduction and Choices in the Biotech Age”
R. Stan Williams
pages 652-654
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Support for more research and evaluation of assisted reproductive technologies
Kirsten Moore
pages 654
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Response to letters regarding “Assisted Reproduction and Choice in the Biotech Age: Recommendations for a Way Forward”
Francine Coeytaux, Marcy Darnovsky, Susan Berke Fogel
pages 654-655
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Repeat use of emergency contraception in Kenya: letter to the editor
Elizabeth Raymond, Elizabeth Westley, James Trussell
pages 654-655
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Repeat use of emergency contraception in Kenya: response to a letter to the editor
Jill Keesbury, Gwendolyn Morgan
pages 656
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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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