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Barton BE, Erickson JA, Allred SI, Jeffries JM, Stephens KK, Hunter MI, Woodall KA, Winuthayanon W. Reversible female contraceptives: historical, current, and future perspectives†. Biol Reprod 2024; 110:14-32. [PMID: 37941453 PMCID: PMC10790348 DOI: 10.1093/biolre/ioad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.
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Affiliation(s)
- Brooke E Barton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffery A Erickson
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Stephanie I Allred
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jenna M Jeffries
- College of Art & Science, Washington State University, Pullman, WA, USA
| | - Kalli K Stephens
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Mark I Hunter
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Kirby A Woodall
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Wipawee Winuthayanon
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
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Rudzinski P, Lopuszynska I, Pazik D, Adamowicz D, Jargielo A, Cieslik A, Kosieradzka K, Stanczyk J, Meliksetian A, Wosinska A. Emergency contraception - A review. Eur J Obstet Gynecol Reprod Biol 2023; 291:213-218. [PMID: 37922775 DOI: 10.1016/j.ejogrb.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/21/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Emergency contraception (EC), or postcoital contraception, is a therapy aimed at preventing unintended pregnancy after an act of unprotected or under-protected sexual intercourse. Options include both emergency contraceptive pills (most commonly containing levonorgestrel or ulipristal acetate) and insertion of an intrauterine device. The aim of this paper is to summarize current evidence surrounding the use of emergency contraceptives and to present an evidence-based approach to EC provision. Emergency contraception is a safe and effective option in preventing unwanted pregnancy, irrespective of age, weight, or breastfeeding status. Efforts should be made to increase their availability, as well as knowledge of these methods, both among patients and healthcare providers.
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Affiliation(s)
- Patryk Rudzinski
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland.
| | - Inga Lopuszynska
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
| | - Dorota Pazik
- Independent Public Clinical Hospital Named After Prof. W. Orłowski of the Centre for Postgraduate Medical Education, Warsaw, Poland
| | - Dominik Adamowicz
- University Clinical Centre of the Medical University of Warsaw, Warsaw, Poland
| | - Anna Jargielo
- Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | | | | | - Justyna Stanczyk
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Astrik Meliksetian
- The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
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Belachew TB, Negash WD, Belay DG, Aragaw FM, Asratie MH, Asmamaw DB. Emergency contraceptive knowledge and associated factors among abortion experienced reproductive age women in Ethiopia: a multilevel analysis using EDHS 2016 data. BMC Pregnancy Childbirth 2023; 23:775. [PMID: 37946102 PMCID: PMC10634145 DOI: 10.1186/s12884-023-06091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Emergency contraceptives (EC) are used to avoid unintended pregnancy, hence avoiding its incidence and its effects. In Ethiopia, emergency contraception is commonly accessible, especially in the big cities. However, there is virtually little understanding of or awareness of EC and Ethiopia has a high abortion rate. Therefore this study was aimed to assess the magnitude and associated factors for emergency contraceptive knowledge in Ethiopia. METHODS The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of emergency contraceptive knowledge. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. RESULTS Overall magnitude of emergency contraceptive knowledge was observed to be 17.19% (95% CI: 15.18, 19.40) with intra-class correlation (ICC) 57% and median odds ratio (MOR) 6.4 in the null model. Women's age 25-34 (AOR = 2.6; 95% CI: 1.2, 5.5), and 35-49 (AOR = 1.5; 95% CI: 1.06, 3.3), secondary and above educational level (AOR = 3.41; 95% CI: 2.19, 4.88), media exposure (AOR = 2.97; 95% CI: 1.56, 5.64), Being in metropolitan region (AOR = 2.68; 95% CI: 1.46, 4.74), and women being in urban area (AOR = 3.19; 95% CI: 1.20, 5.23) were associated with emergency contraceptive knowledge. CONCLUSION Emergency contraceptive knowledge in this study was low. Women age, educational level, media exposure, residency, and region were significantly associated with emergency contraceptive knowledge. Therefore, to enhance understanding and use of ECs in the current Ethiopian setting, it is imperative to ensure exposure to EC information, particularly in rural regions.
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Affiliation(s)
- Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women's and Family health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Durante JC, Sims J, Jarin J, Gold MA, Messiah SE, Francis JKR. Long-Acting Reversible Contraception for Adolescents: A Review of Practices to Support Better Communication, Counseling, and Adherence. Adolesc Health Med Ther 2023; 14:97-114. [PMID: 37181329 PMCID: PMC10167958 DOI: 10.2147/ahmt.s374268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Long-acting reversible contraception (LARC) methods, including levonorgestrel and copper intrauterine devices (IUDs) and the subdermal contraceptive implant, are the most effective reversible forms of contraception and thus are an important aspect of adolescent pregnancy prevention. While LARC efficacy, safety, and appropriateness are supported by major medical organizations and usage rates are increasing, overall LARC uptake among United States (US) adolescents remains lower than uptake of short-acting contraceptive methods. A better understanding of the barriers affecting adolescent LARC uptake and reasons for discontinuation could help facilitate effective communication. For example, learning how to improve adolescent-centered communication, shared decision-making, and motivational counseling strategies may be the first step to improving utilization rates. This narrative review includes three sections. First, this review will describe the history, mechanisms of action, and epidemiology of adolescent LARC use in the US and globally. Next, this review will describe key factors influencing adolescent LARC uptake, reasons for discontinuation, and multilevel barriers specific to adolescent LARC use. Finally, this review will characterize communication techniques and LARC counseling strategies for adolescents in the context of a reproductive justice approach set in the health belief model framework. The distinction between moving away from a presumptive counseling approach towards an adolescent-centered, shared decision-making approach to encourage parent-adolescent sexual health communication to lay the foundation of empowering adolescent reproductive autonomy should be the underpinning of all effective reproductive communication strategies.
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Affiliation(s)
- Julia C Durante
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jessica Sims
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
| | - Jason Jarin
- Children’s Health System of Texas, Dallas, TX, USA
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie A Gold
- Department of Pediatrics and Department of Population & Family Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric and Population Health, UTHealth School of Public Health, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health System of Texas, Dallas, TX, USA
- Peter O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ramanadhan S, Goldstuck N, Henderson JT, Che Y, Cleland K, Dodge LE, Edelman A. Progestin intrauterine devices versus copper intrauterine devices for emergency contraception. Cochrane Database Syst Rev 2023; 2:CD013744. [PMID: 36847591 PMCID: PMC9969955 DOI: 10.1002/14651858.cd013744.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND The copper intrauterine device (Cu-IUD) is a highly effective method of contraception that can also be used for emergency contraception (EC). It is the most effective form of EC, and is more effective than other existing oral regimens also used for EC. The Cu-IUD provides the unique benefit of providing ongoing contraception after it is inserted for EC; however, uptake of this intervention has been limited. Progestin IUDs are a popular method of long-acting, reversible contraception. If these devices were also found to be effective for EC, they would provide a critical additional option for women. These IUDs could not only provide EC and ongoing contraception, but additional non-contraceptive benefits, including a reduction in menstrual bleeding, cancer prevention, and pain management. OBJECTIVES To examine the safety and effectiveness of progestin-containing IUDs for emergency contraception, compared with copper-containing IUDs, or compared with dedicated oral hormonal methods. SEARCH METHODS We considered all randomized controlled trials and non-randomized studies of interventions that compared outcomes for individuals seeking a levonorgestrel IUD (LNG-IUD) for EC to a Cu-IUD or dedicated oral EC method. We considered full-text studies, conference abstracts, and unpublished data. We considered studies irrespective of their publication status and language of publication. SELECTION CRITERIA We included studies comparing progestin IUDs with copper-containing IUDs, or oral EC methods for emergency contraception. DATA COLLECTION AND ANALYSIS We systematically searched nine medical databases, two trials registries, and one gray literature site. We downloaded all titles and abstracts retrieved by electronic searching to a reference management database, and removed duplicates. Three review authors independently screened titles, abstracts, and full-text reports to determine studies eligible for inclusion. We followed standard Cochrane methodology to assess risk of bias, and analyze and interpret the data. We used GRADE methodology to assess the certainty of the evidence. MAIN RESULTS We included only one relevant study (711 women); a randomized, controlled, non-inferiority trial comparing LNG-IUDs to Cu-IUDs for EC, with a one-month follow-up. With one study, the evidence was very uncertain for the difference in pregnancy rates, failed insertion rates, expulsion rates, removal rates and the difference in the acceptability of the IUDs. There was also uncertain evidence suggesting the Cu-IUD may slightly increase rates of cramping and the LNG-IUD may slightly increase bleeding and spotting days. AUTHORS' CONCLUSIONS: This review is limited in its ability to provide definitive evidence regarding the LNG-IUD's equivalence, superiority, or inferiority to the Cu-IUD for EC. Only one study was identified in the review, which had possible risks of bias related to randomization and rare outcomes. Additional studies are needed to provide definitive evidence related to the effectiveness of the LNG-IUD for EC.
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Affiliation(s)
- Shaalini Ramanadhan
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa
| | - Jillian T Henderson
- Fertility Regulation Group, Oregon Health Sciences University, Portland, OR, USA
| | - Yan Che
- NHC Key Lab of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan University, Shanghai, China
| | - Kelly Cleland
- American Society for Emergency Contraception, Princeton, NJ, USA
| | - Laura E Dodge
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alison Edelman
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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Simmons RG, Baayd J, Elliott S, Cohen SR, Turok DK. Improving access to highly effective emergency contraception: an assessment of barriers and facilitators to integrating the levonorgestrel IUD as emergency contraception using two applications of the Consolidated Framework for Implementation Research. Implement Sci Commun 2022; 3:129. [PMID: 36494859 PMCID: PMC9737706 DOI: 10.1186/s43058-022-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emergency contraception prevents unwanted pregnancy after sexual intercourse. New evidence has demonstrated that the levonorgestrel 52 mg IUD is a highly effective method of emergency contraception. However, translating this research finding into clinical practice faces existing barriers to IUD access, including costs and provider training, novel barriers of providing IUDs for emergency contraception at unscheduled appointments. The purpose of this study was to identify barriers and facilitators to the utilization of the levonorgestrel IUD as emergency contraception from client, provider, and health systems perspectives. METHODS We conducted English and Spanish-speaking focus groups (n=5) of both contraceptive users (n=22) and providers (n=13) to examine how the levonorgestrel IUD as EC was perceived and understood by these populations and to determine barriers and facilitators of utilization. We used findings from our focus groups to design a high-fidelity in-situ simulation scenario around EC that we pilot tested with clinical teams in three settings (a county health department, a community clinic, and a midwifery clinic), to further explore structural and health systems barriers to care. Simulation scenarios examined health system barriers to the provision of the levonorgestrel IUD as EC. We coded both focus groups and in-clinic simulations using the modified Consolidated Framework for Implementation Research (CFIR). We then applied our findings to the CFIR-Expert Recommendations for Implementing Change (ERIC) Barrier Busting Tool and mapped results to implement recommendations provided by participants. RESULTS Ultimately, 9 constructs from the CFIR were consistently identified across focus groups and simulations. Main barriers included suboptimal knowledge and acceptability of the intervention itself, appropriately addressing knowledge and education needs among both providers and contraceptive clients, and adequately accounting for structural barriers inherent in the health system. The CFIR-ERIC Barrier Busting Tool identified eight strategies to improve levonorgestrel IUD as EC access: identifying implementation champions, conducting educational meetings, preparing educational toolkits, involving patients and their partners in implementation, conducting a local needs assessment, distributing educational materials, and obtaining patient feedback. CONCLUSIONS To sustainably incorporate the levonorgestrel IUD as EC into clinical practice, education, health systems strengthening, and policy changes will be necessary.
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Affiliation(s)
- Rebecca G. Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Jami Baayd
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Sarah Elliott
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - Susanna R. Cohen
- LIFT Simulation Design Lab, Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
| | - David K. Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132 USA
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Pagano HP, Zapata LB, Curtis KM, Whiteman MK. Changes in U.S. Healthcare Provider Practices Related to Emergency Contraception. Womens Health Issues 2021; 31:560-566. [PMID: 34511322 PMCID: PMC11079952 DOI: 10.1016/j.whi.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Emergency contraception (EC), including EC pills (ECPs) and the copper intrauterine device, can prevent pregnancy after sexual encounters in which contraception was not used or used incorrectly. The U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), initially released in 2013, provides evidence-based clinical recommendations on the provision of EC. The objective of this analysis was to assess the percentage of health care providers reporting frequent provision of select EC practices around the time of and after the release of the U.S. SPR. METHODS We conducted two cross-sectional mailed surveys using different nationwide samples of office-based physicians and public-sector providers in 2013 and 2014 (n = 2,060) and 2019 (n = 1,420). We compared the percentage of providers reporting frequent provision of select EC practices by time period, overall, and by provider type. RESULTS In 2019, few providers frequently provided an advance prescription for ECPs (16%), an advance supply of ECPs (7%), or the copper intrauterine device as EC (8%), although 41% frequently provided or prescribed regular contraception at the same time as providing ECPs. Providers in 2019 were more likely than providers in 2013 and 2014 to provide or prescribe contraception at the same time as providing ECPs (adjusted prevalence ratio, 1.26; 95% confidence interval, 1.001-1.59) and to provide a copper intrauterine device as EC (adjusted prevalence ratio, 3.87; 95% confidence interval 2.10-7.15); there were no other significant differences by time period. CONCLUSIONS Few providers report frequent implementation of recommended EC practices. Understanding the barriers faced by providers and clinics in implementing these practices may improve access to EC.
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Affiliation(s)
- H Pamela Pagano
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Lauren B Zapata
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathryn M Curtis
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maura K Whiteman
- Division of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Cheung TS, Goldstuck ND, Gebhardt GS. The intrauterine device versus oral hormonal methods as emergency contraceptives: A systematic review of recent comparative studies. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100615. [PMID: 33799166 DOI: 10.1016/j.srhc.2021.100615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
Oral emergency contraceptives do not appear to be as effective as the copper IUD as an emergency contraceptive. There is as yet no estimation of the relative efficacy rates rather than the failure rates. The references for this study were obtained by entering the terms "intrauterine device" "and "emergency contraception" in Medline, PubMed, Popline, Global Health and ClinicalTrials.gov. Chinese references were obtained from the Wanfang database. For the short term study articles with a defined population who were followed up after the index cycle were eligible. Women who were adequately followed for at least 6 months were included in the long term study. There were 13(of 228) studies which met our selection criteria and were conducted between August 2011 and January 2019. There were 960 insertions of four types of copper IUD with a failure rate of 0.104%. There were 22 failures out of 1453 oral emergency contraception users with a failure rate of 1.51%. The relative risk of failure for an intrauterine device versus an oral method was 0.1376(95% CI -0.03-0.58). The 6 month to 12 month pregnancy rate was 0-6% for IUDs and 2.7-12% for oral methods. The copper IUD appears to be more effective than oral methods as an emergency contraceptive. The 6 to 12 month pregnancy rates after using either method is 4-10%. Emergency contraception is not a solution to unintended pregnancy.
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Affiliation(s)
- Tik Shan Cheung
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa
| | - Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa.
| | - Gabriel S Gebhardt
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Francie van Zyl Dr, Tygerberg Hospital, Bellville, Cape Town 7505, South Africa
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The potential for intramuscular depot medroxyprogesterone acetate as a self-bridging emergency contraceptive. Contracept X 2020; 3:100050. [PMID: 33367229 PMCID: PMC7749364 DOI: 10.1016/j.conx.2020.100050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To examine the rate of ovulatory disruption when intramuscular depot medroxyprogesterone acetate (DMPA) is administered across graded stages of dominant follicle development. Study design We assigned enrolled participants to one of three preassigned dominant follicle size groups: 12-14 mm, 15–17 mm and ≥ 18 mm. We followed dominant follicles via serial transvaginal ultrasound (TVUS) until the follicles reached their assigned size, at which time we administered DMPA. For 5 consecutive days thereafter, we followed the follicles via TVUS to observe follicle rupture and obtained serum luteinizing hormone (LH), estradiol, and progesterone concentrations. In the following 2 weeks, we collected serum progesterone concentrations twice weekly to detect possible ovulatory delay or dysfunction. We also collected serum medroxyprogesterone acetate (MPA) concentrations at 1 and 24 h after DMPA administration to examine against ovulatory outcomes. Results Twenty-six of 29 enrolled women completed the study. DMPA suppressed ovulation in 17/26 (65%) and caused ovulatory dysfunction in 1/26 (4%) participants. Larger follicles were more likely to rupture despite DMPA (12–14 mm: 0/10 (0%); 15–17 mm: 3/10 (30%); ≥ 18 mm: 6/6 (100%); p < .01). Pre-DMPA LH concentrations ranged from 13.8 to 93.7 IU/L (mean 49.0 IU/L) in cases of follicle rupture. We observed no cases of follicle rupture when DMPA was administered through cycle day 12. All 24-h MPA concentrations exceeded those needed for ovulation suppression. Conclusion DMPA suppressed and additionally disrupted ovulation in 65% and 4% of observed cycles, respectively. DMPA may provide effective emergency contraception as well as ongoing contraception if administered prior to an expected ovulation and specifically before the LH surge. Implications DMPA may be an alternative form of emergency contraception that can also self-bridge to ongoing contraception. As ovulation was not observed among any follicles when DMPA was given through cycle day 12, women who initiate DMPA up through cycle day 12 may not require backup contraception.
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Cleland K, Che Y, Dodge LE, Edelman A, Goldstuck N, Ramanadhan S. Progestin-containing versus copper intrauterine devices for emergency contraception. Hippokratia 2020. [DOI: 10.1002/14651858.cd013744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kelly Cleland
- American Society for Emergency Contraception; Princeton USA
| | - Yan Che
- Centre for Clinical Research and Training; Fudan University; Shanghai China
| | | | - Alison Edelman
- Department of Obstetrics and Gynecology; Oregon Health and Science University; Portland Oregon USA
| | | | - Shaalini Ramanadhan
- Department of Obstetrics and Gynecology; Oregon Health and Science University; Portland Oregon USA
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Oral and IUD emergency contraception provision among a national sample of obstetrician-gynecologists. Contraception 2020; 102:406-408. [PMID: 32898546 DOI: 10.1016/j.contraception.2020.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess obstetrician-gynecologists' practices related to emergency contraception (EC). We performed a survey of ACOG Fellows and Junior Fellows between August 2016 and March 2017. RESULTS The final sample was 1280 respondents (52.2% response rate). The majority (84%) reported offering at least one form of EC, with 18% offering ulipristal acetate and 29% offering copper IUDs. Fifty-seven percent of those offering IUDs reported recommending them in the last 12 months. Few had placed IUDs for EC. Half of ob-gyns reported not recommending copper IUDs because patients rarely seek EC. CONCLUSION Many obstetrician-gynecologists are not offering the most effective forms of EC. IMPLICATIONS Both patients and clinicians need more outreach about the most effective methods of emergency contraception.
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Serpico JJ, Ricks JM, Smooth WG, Romanos C, Brook DL, Gallo MF. Access to single-visit IUD insertion at obstetrician-gynecology practices in Ohio: An audit study. Contraception 2020; 102:190-194. [DOI: 10.1016/j.contraception.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
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Borsella M, Foster AM. Exploring the Availability of Emergency Contraception in New Brunswick Pharmacies: A Mystery-Client Telephone Study. PHARMACY 2020; 8:pharmacy8020076. [PMID: 32365837 PMCID: PMC7356777 DOI: 10.3390/pharmacy8020076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/05/2020] [Accepted: 04/25/2020] [Indexed: 11/25/2022] Open
Abstract
Although levonorgestrel-only emergency contraceptive pills (LNg-ECPs) have been available over the counter in Canada for more than a decade, barriers to access persist. We aimed to obtain information about the availability and cost of LNg-ECPs in New Brunswick. Using a mystery-client study design, we called all 207 non-specialty pharmacies in the province posing as a 17-year-old woman seeking something to prevent pregnancy after sex. We evaluated the information provided for accuracy and quality. The overwhelming majority of pharmacies (n = 180, 87%) had at least one brand of LNg-ECPs in stock; the price averaged CAD28.69 (USD21.65). Although the majority of pharmacy representatives provided accurate information about LNg-ECPs, a small number made incorrect statements about the timeframe for use, side effects, and mechanism of action. In nine interactions (4%) pharmacy representatives incorrectly indicated that a male partner could not obtain LNg-ECPs; none indicated that parental involvement was required to procure LNg-ECPs. None of the pharmacy representatives referenced any other modality of emergency contraception, including ulipristal acetate. Our findings suggest that LNg-ECPs are widely available and that most pharmacy representatives are providing accurate medical and regulatory information. However, supporting the continuing education of pharmacists and pharmacy staff, particularly around alternative modalities of emergency contraception, appears warranted.
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Dorney E, Botfield JR, Robertson S, McGeechan K, Bateson D. Acceptability of the copper intrauterine device as a form of emergency contraception in New South Wales, Australia. EUR J CONTRACEP REPR 2020; 25:114-119. [PMID: 32072848 DOI: 10.1080/13625187.2020.1726888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The copper-intrauterine device (Cu-IUD) is the most effective emergency contraception (EC), and the only method providing ongoing contraception; however, it is underutilised in Australia.Methods: An online cross-sectional survey of clients and clinicians at a family planning service was undertaken. Clients aged 16-55 and identifying as female or transgender male were eligible. The survey explored previous experience with and knowledge of the Cu-IUD as EC among clients, current EC practices among clinicians, and barriers and enablers among clients and clinicians.Results: Of 470 clients, 64.5% had previously used EC. Only 12.7% knew the Cu-IUD was a form of EC and 2% had used it. When given information on effectiveness, side-effects and costs, 46.8% reported they would consider the Cu-IUD for EC. However, 40% viewed cost and possible side-effects as barriers. Of the 58 clinicians surveyed, 55% reported discussing Cu-IUD as EC with clients versus 94% discussing oral EC, with time pressures reported as the main barrier.Conclusion: Low awareness among clients, and limited discussion by clinicians, highlights a need for increased education and promotion strategies for the Cu-IUD as EC. With greater knowledge, demand for this option may increase. This will require processes to ensure timely access to insertions.
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Affiliation(s)
- E Dorney
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, Australia
| | - J R Botfield
- Research Centre, Family Planning NSW, Sydney, Australia
| | - S Robertson
- Research Centre, Family Planning NSW, Sydney, Australia
| | - K McGeechan
- Research Centre, Family Planning NSW, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - D Bateson
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, Australia.,Research Centre, Family Planning NSW, Sydney, Australia
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Hillard PJA. Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update. J Pediatr Adolesc Gynecol 2019; 32:S14-S22. [PMID: 30802602 DOI: 10.1016/j.jpag.2019.02.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.
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Affiliation(s)
- Paula J Adams Hillard
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
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Goldstuck ND, Cheung TS. The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update. Int J Womens Health 2019; 11:471-479. [PMID: 31686919 PMCID: PMC6709799 DOI: 10.2147/ijwh.s213815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background The copper intrauterine device (IUD) is a very effective form of emergency contraception. The failure rate is about 0.1%. IUDs are also very cost-effective when used as long acting-reversible contraception (LARC). The purpose of this review is to attempt to confirm these findings. Methods The references for this study were generated by entering the terms “intrauterine device” and “emergency contraception” in Medline, PubMed, Popline, Global Health and ClinicalTrials.gov. Chinese references were obtained from the Wanfang database. For the emergency contraception study, articles with a defined population who were followed up until outcome were eligible. Women who were adequately followed for at least 6 months were included in the long term arm of the study. Results There were 18 (of 228) studies which met our selection criteria and were conducted in five countries, between August 2011 and January 2018. There were 1720 insertions of seven types of copper IUD with a failure rate of 0.12%. The maximum time from intercourse to IUD insertion was 14 days. The discontinuation rate at 12 months was over 20% in the long term studies. Conclusion There are now a combined total of 8550 reported insertions from two reviews with 8 pregnancies and a failure rate of 0.093%. Copper IUDs remain an effective form of emergency contraception, for which they are under-promoted. The major limitation of the studies is the lack of data relating unprotected intercourse to the day of the cycle.
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Affiliation(s)
- Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town 7505, South Africa
| | - Tik Shan Cheung
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town 7505, South Africa
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Implementing best practices for the provision of long-acting reversible contraception: a survey of obstetrician-gynecologists. Contraception 2019; 100:123-127. [DOI: 10.1016/j.contraception.2019.03.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/18/2022]
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Onyewuchi UF, Tomaszewski K, Upadhya KK, Gupta PS, Whaley N, Burke AE, Trent ME. Improving LARC Access for Urban Adolescents and Young Adults in the Pediatric Primary Care Setting. Clin Pediatr (Phila) 2019; 58:24-33. [PMID: 30318927 PMCID: PMC6261697 DOI: 10.1177/0009922818805234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this quality improvement study was to assess the feasibility, acceptability, and impact of integrating long-acting reversible contraceptive (LARC) delivery services into an academic pediatric primary care practice. Adolescent medicine providers in Baltimore, Maryland, were trained in LARC placement with gynecology providers integrated to offer onsite LARC placement and procedural support. Referrals, appointments, and contraceptive method choice/receipt were tabulated. Of 212 individuals referred for LARC consultations, 104 attended appointments. LARC placement at the initial referral increased from year 1 (N = 1) to year 2 (N = 42; P < .01). Adolescent medicine providers placed more LARCs in year 2 (N = 34) than year 1 (N = 0; P < .01). Patients aged 18 to 24 years were less likely to have a LARC placed than those aged 13 to 17 years (unadjusted odds ratio = 0.47 [0.26-0.86]). In conclusion, provider training and service integration of LARC services within a pediatric practice is feasible, acceptable, and increases LARC access and placement.
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Affiliation(s)
| | | | | | - Priya S. Gupta
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | | | - Anne E. Burke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria E. Trent
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Haeger KO, Lamme J, Cleland K. State of emergency contraception in the U.S., 2018. Contracept Reprod Med 2018; 3:20. [PMID: 30202545 PMCID: PMC6123910 DOI: 10.1186/s40834-018-0067-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/20/2018] [Indexed: 12/30/2022] Open
Abstract
Emergency contraception is indicated in instances of unprotected sexual intercourse, including reproductive coercion, sexual assault, and contraceptive failure. It plays a role in averting unintended pregnancies due to inconsistent use or non-use of contraception. Options for emergency contraception vary by efficacy as well as accessibility within the U.S. This paper provides an overview of levonorgestrel (Plan B One-Step and generic counterparts), ulipristal acetate (sold as ella), and the copper intrauterine device (IUD, sold as ParaGard), including the mechanisms of action, administration, efficacy, drug interactions, safety, side effects, advantages, and drawbacks. It will also review current misconceptions about emergency contraception and access for subpopulations, including adolescents, immigrants, survivors of sexual assault, rural populations, and military/veteran women. This paper will address barriers such as gaps in knowledge, and financial, health systems, and practice barriers. Continuing areas of research, including the impact of body weight on the efficacy of emergency contraceptive pills and potential interactions between ulipristal acetate and ongoing hormonal contraceptives, are also addressed.
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Affiliation(s)
- Kristin O. Haeger
- Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Women’s Health Services, 810 Vermont Ave., NW, Washington, DC, 20420 USA
| | - Jacqueline Lamme
- Department of Obstetrics & Gynecology, U.S. Naval Hospital Okinawa, Okinawa, Japan
| | - Kelly Cleland
- Office of Population Research, Princeton University, 218 Wallace Hall, Princeton, NJ 08544 USA
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Chew KT, Salim N, Abu MA, Abdul Karim AK. Knowledge, attitudes and practice regarding copper intrauterine contraceptive devices among doctors in Malaysia. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:jfprhc-2017-101869. [PMID: 29972367 DOI: 10.1136/bmjsrh-2017-101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Intrauterine contraceptive devices (IUDs) are an important method to reduce unmet need for family planning and for prevention of unintended pregnancy. However, IUD use in Malaysia is still low. Doctors play a major role in influencing IUD uptake among women. This study was designed to evaluate doctors' knowledge, attitudes and perceptions towards IUDs and factors associated with their current practice. METHODS A questionnaire was mailed to public and private contraceptive providers who practise in Kuala Lumpur, Malaysia. RESULTS A total of 400 doctors were invited and 240 (60%) of them responded to the survey. Of the respondents, 161 (65.9%) were from the public or government sector and 89 (34.1%) were from the private sector. The knowledge score of doctors was classed as 'average', and correlated well with their previous training level, working position, number of patients seen in a week and number of contraceptive methods available in their facilities. The age, gender, working duration, availability of IUDs in the premises and number of IUD insertions in a month were not statistically associated with the providers' knowledge. The use of IUDs was low, especially among private doctors, and was significantly related to their knowledge of the method. Knowledge scores, perception and practice were significantly lower in the private sector.
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Affiliation(s)
- Kah Teik Chew
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norsaadah Salim
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Azrai Abu
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Abdul Kadir Abdul Karim
- Department of Obstetrics and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Goodman SR, El Ayadi AM, Rocca CH, Kohn JE, Benedict CE, Dieseldorff JR, Harper CC. The intrauterine device as emergency contraception: how much do young women know? Contraception 2018; 98:S0010-7824(18)30145-8. [PMID: 29679591 PMCID: PMC6546552 DOI: 10.1016/j.contraception.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Unprotected intercourse is common, especially among teens and young women. Access to intrauterine device (IUD) as emergency contraception (EC) can help interested patients more effectively prevent unintended pregnancy and can also offer ongoing contraception. This study evaluated young women's awareness of IUD as EC and interest in case of need. STUDY DESIGN We conducted a secondary analysis of data from young women aged 18-25 years, not desiring pregnancy within 12 months, and receiving contraceptive counseling within a cluster-randomized trial in 40 US Planned Parenthood health centers in 2011-2013 (n=1500). Heath centers were randomized to receive enhanced training on contraceptive counseling and IUD placement, or to provide standard care. The intervention did not focus specifically on IUD as EC. We assessed awareness of IUD as EC, desire to learn more about EC and most trusted source of information of EC among women in both intervention and control groups completing baseline and 3- or 6-month follow-up questionnaires (n=1138). RESULTS At follow-up, very few young women overall (7.5%) visiting health centers had heard of IUD as EC. However, if they needed EC, most (68%) reported that they would want to learn about IUDs in addition to EC pills, especially those who would be very unhappy to become pregnant (adjusted odds ratio [aOR], 1.3; 95% confidence interval, 1.0-1.6, p<.05). Most (91%) reported a doctor or nurse as their most trusted source of EC information, over Internet (6%) or friends (2%), highlighting providers' essential role. CONCLUSION Most young women at risk of unintended pregnancy are not aware of IUD as EC and look to their providers for trusted information. Contraceptive education should explicitly address IUD as EC. IMPLICATIONS Few young women know that the IUD can be used for EC or about its effectiveness. However, if they needed EC, most reported that they would want to learn about IUDs in addition to EC pills, especially those very unhappy to become pregnant. Contraceptive education should explicitly address IUD as EC.
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Affiliation(s)
- Suzan R Goodman
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA.
| | - Alison M El Ayadi
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
| | - Corinne H Rocca
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
| | - Julia E Kohn
- Planned Parenthood Federation of America, 123 William Street, New York, NY 10038, USA
| | - Courtney E Benedict
- Planned Parenthood Federation of America, 123 William Street, New York, NY 10038, USA
| | | | - Cynthia C Harper
- UCSF Bixby Center for Global Reproductive Health, 3333 California Street, UCSF Box 0744, San Francisco, CA 94143-0744, USA
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Wong K, Hum S, McCarthy L, Dunn S. Beyond Plan B: A Qualitative Study of Canadian Pharmacists' Emergency Contraception Counselling Practices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:1021-1027. [DOI: 10.1016/j.jogc.2017.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 12/30/2022]
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Edwards C, Panjwani D, Pendrith C, Ly A, Dunn S. Knowledge of and Interest in the Copper Intrauterine Device Among Women Seeking Emergency Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:41-47. [PMID: 28780215 DOI: 10.1016/j.jogc.2017.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Emergency contraception (EC) includes hormonal pills (levonorgestrel or ulipristal acetate) and the copper IUD (Cu-IUD). The Cu-IUD is more effective for EC than hormonal pills but remains underused, possibly because of lack of knowledge or interest. The objective of this study was to examine knowledge of and interest in the Cu-IUD for EC among Canadian women seeking EC. METHODS The study used a cross-sectional convenience survey of English-speaking women presenting for EC at two sexual health clinics in Toronto. The anonymous paper-based survey was completed in the waiting room. The main outcome measures were women's knowledge of and interest in the Cu-IUD for EC. Demographic and reproductive health data were also collected. RESULTS Between January and December 2013, 124 surveys were completed. Mean age of respondents was 26 years (SD ± 6.9). Most were single (85%), and over one half had completed postsecondary education. Overall, 77% had heard of the Cu-IUD, but only 21% were aware of its use for EC. Over 50% were aware that the Cu-IUD is hormone-free and may be used for long-term contraception. Women were less familiar with the window of administration of the Cu-IUD for EC (26%) and its efficacy (6%). In total, 23% (28 of 124) of women were interested in the Cu-IUD, including eight women scheduled to receive one that day. CONCLUSION Women presenting for EC were unaware of the Cu-IUD but were moderately interested in it once informed. Public education and routine counselling about the Cu-IUD at EC visits may increase the uptake of this method.
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Affiliation(s)
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON
| | - Ciara Pendrith
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, Toronto, ON
| | - Anna Ly
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - Sheila Dunn
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, ON; Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON.
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Lee JK, Schwarz EB. The safety of available and emerging options for emergency contraception. Expert Opin Drug Saf 2017; 16:1163-1171. [PMID: 28730840 DOI: 10.1080/14740338.2017.1354985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Emergency contraception (EC) is a way to significantly reduce the chance of becoming pregnant after an episode of unprotected intercourse. Considerable data support the safety of all available and emerging options for EC. Areas covered: This review presents a comprehensive summary of the literature regarding the safety of EC as well as directions for further study. PubMed was searched for all relevant studies published prior to June 2017. Expertopinion: All available methods of EC (i.e., ulipristal acetate pills, levonorgestrel pills, and the copper-IUD), carry only mild side effects and serious adverse events are essentially unknown. The copper IUD has the highest efficacy of EC methods. Given the excellent safety profiles of mifepristone and the levonorgestrel IUD, research is ongoing related to use of these products for EC.
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Affiliation(s)
- Jessica K Lee
- a Department of Obstetrics and Gynecology , Johns Hopkins University , Baltimore , MD , USA
| | - Eleanor Bimla Schwarz
- b Department of General Internal Medicine , UC Davis, Division of General Internal Medicine , Sacramento , CA , USA
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Schubert FD, Bishop ES, Gold M. Access to the copper IUD as post-coital contraception: results from a mystery caller study. Contraception 2016; 94:561-566. [PMID: 27374737 DOI: 10.1016/j.contraception.2016.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess access to the copper IUD as post-coital contraception (PCC) and identify barriers to obtaining this contraceptive method. STUDY DESIGN We used a "mystery caller" approach to survey primary care, family planning, and Ob/Gyn clinics in nine U.S. cities, identified via online search. A single researcher called 199 clinics, assuming the role of a patient seeking the copper IUD for PCC. Using a standard script, the researcher collected information regarding access to the copper IUD and respondent's knowledge of the copper IUD's indication for PCC. The primary outcome was availability of the copper IUD as PCC. Secondary outcomes included any provision of the copper IUD, awareness of the copper IUD's indication for use as PCC, and offering accurate information regarding the copper IUD as PCC. Fisher's exact test was used to compare outcomes by clinic type. RESULTS Two thirds (68%) of primary care clinics, 87% of family planning clinics, and all Ob/Gyn clinics offered the copper IUD (p<.001). Only 11% of primary care clinics, however, were aware of the copper IUD's use as PCC, as compared with 63% of family planning clinics and 24% of Ob/Gyn clinics (p<.001). Few primary care or Ob/Gyn clinics offered the copper IUD as PCC, while 49% of family planning clinics did so (p<.001). CONCLUSION Access to the copper IUD as PCC is limited and varies by clinic type. Knowledge gaps exist regarding the use of the copper IUD as PCC, as well as regarding the general medical guidelines for copper IUD placement. IMPLICATIONS A majority of primary care and Ob/Gyn clinics do not offer the copper IUD as PCC, and only about half of family planning clinics do so. Barriers included lack of knowledge, unavailability of device, unavailability of an appointment with a trained provider, and outdated IUD provision protocols.
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Affiliation(s)
- Finn D Schubert
- getLARC / Grants for Education and Training in LARC, Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY.
| | | | - Marji Gold
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
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EC4U: results from a pilot project integrating the copper IUC into emergency contraceptive care. Contraception 2016; 94:48-51. [DOI: 10.1016/j.contraception.2016.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/06/2016] [Accepted: 02/08/2016] [Indexed: 12/30/2022]
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Wright RL, Frost CJ, Turok DK. Experiences of Advanced Practitioners with Inserting the Copper Intrauterine Device as Emergency Contraception. Womens Health Issues 2016; 26:523-8. [PMID: 27264913 DOI: 10.1016/j.whi.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The copper intrauterine device (IUD) is the most effective method of emergency contraception (EC) available for use after unprotected intercourse. Family planning clinics, commonly staffed by advanced practice clinicians, fulfill a significant role in health care and contraceptive service delivery for women in the United States. There are limited data assessing the perspectives and experiences of these providers in using the copper IUD as EC in these settings. METHODS Semistructured individual interviews were conducted with 12 advanced practice clinicians with experience inserting the copper IUD. A phenomenological approach was used to frame the study and analysis. A modified version of the Van Kaam method of analysis was used to analyze the data from interview transcripts. RESULTS Participants reported feelings of responsibility to support long-acting and highly effective methods of contraception. Patients' abilities to provide an accurate history of the last instance of unprotected intercourse in relation to their menstrual cycles and fear of painful insertions influenced participants' willingness to offer the copper IUD. This included provider concerns about causing uterine perforation prompting discontinuation of IUD insertion attempts. The participants perceived patients as having little knowledge about the copper IUD in general and as not being committed to using the copper IUD long term. CONCLUSIONS Numerous factors influenced advanced practice clinicians' decisions to present the copper IUD as a method of EC. Promoting support and sharing practitioner experiences with inserting the copper IUD as EC may increase practitioner comfort with the copper IUD as EC.
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Affiliation(s)
- Rachel L Wright
- Department of Social Work, Appalachian State University, Boone, North Carolina.
| | - Caren J Frost
- College of Social Work, University of Utah, Salt Lake City, Utah
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
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Batur P, Kransdorf LN, Casey PM. Emergency Contraception. Mayo Clin Proc 2016; 91:802-7. [PMID: 27261868 DOI: 10.1016/j.mayocp.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/30/2022]
Abstract
Emergency contraception (EC) may help prevent pregnancy in various circumstances, such as contraceptive method failure, unprotected sexual intercourse, or sexual assault, yet it remains underused. There are 4 approved EC options in the United States. Although ulipristal acetate requires a provider's prescription, oral levonorgestrel (LNG) is available over the counter for women of all ages. The most effective method of EC is the copper intrauterine device, which can be left in place for up to 10 years for efficacious, cost-effective, hormone-free, and convenient long-term primary contraception. Ulipristal acetate tends to be more efficacious in pregnancy prevention than is LNG, especially when taken later than 72 hours postcoitus. The mechanism of action of oral EC is delay of ovulation, and current evidence reveals that it is ineffective postovulation. Women who weigh more than 75 kg or have a body mass index greater than 25 kg/m(2) may have a higher risk of unintended pregnancy when using oral LNG EC; therefore, ulipristal acetate or copper intrauterine devices are preferable in this setting. Providers are often unaware of the range of EC options or are unsure of how to counsel patients regarding the access and use of EC. This article critically reviews current EC literature, summarizes recommendations, and provides guidance for counseling women about EC. Useful tips for health care providers are provided, with a focus on special populations, including breast-feeding women and those transitioning to long-term contraception after EC use. When treating women of reproductive age, clinicians should be prepared to counsel them about EC options, provide EC appropriately, and, if needed, refer for EC in a timely manner.
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MESH Headings
- Administration, Oral
- Attitude of Health Personnel
- Body Mass Index
- Breast Feeding
- Contraception, Postcoital/adverse effects
- Contraception, Postcoital/economics
- Contraception, Postcoital/methods
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/economics
- Contraceptive Agents, Female/supply & distribution
- Contraceptives, Postcoital/administration & dosage
- Contraceptives, Postcoital/adverse effects
- Contraceptives, Postcoital/economics
- Contraceptives, Postcoital/supply & distribution
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Intrauterine Devices, Copper/adverse effects
- Intrauterine Devices, Copper/economics
- Intrauterine Devices, Copper/supply & distribution
- Levonorgestrel/administration & dosage
- Levonorgestrel/adverse effects
- Levonorgestrel/economics
- Levonorgestrel/supply & distribution
- Nonprescription Drugs/economics
- Nonprescription Drugs/standards
- Nonprescription Drugs/supply & distribution
- Norpregnadienes/administration & dosage
- Norpregnadienes/adverse effects
- Norpregnadienes/economics
- Norpregnadienes/supply & distribution
- Ovulation/drug effects
- Patient Education as Topic/methods
- Pregnancy
- Prescription Drugs/economics
- Prescription Drugs/standards
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Affiliation(s)
- Pelin Batur
- Department of Internal Medicine, Primary Care Women's Health, Cleveland Clinic, Cleveland, OH
| | - Lisa N Kransdorf
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Petra M Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
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30
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Turok DK, Sanders JN, Thompson IS, Royer PA, Eggebroten J, Gawron LM. Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study. Contraception 2016; 93:526-32. [PMID: 26944863 DOI: 10.1016/j.contraception.2016.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We assessed intrauterine device (IUD) preference among women presenting for emergency contraception (EC) and the probability of pregnancy among concurrent oral levonorgestrel (LNG) plus LNG 52 mg IUD EC users. METHODS We offered women presenting for EC at a single family planning clinic the CuT380A IUD (copper IUD) or oral LNG 1.5 mg plus the LNG 52 mg IUD. Two weeks after IUD insertion, participants reported the results of a self-administered home urine pregnancy test. The primary outcome, EC failure, was defined as pregnancies resulting from intercourse occurring within five days prior to IUD insertion. RESULTS One hundred eighty-eight women enrolled and provided information regarding their current menstrual cycle and recent unprotected intercourse. Sixty-seven (36%) chose the copper IUD and 121 (64%) chose oral LNG plus the LNG IUD. The probability of pregnancy two weeks after oral LNG plus LNG IUD EC use was 0.9% (95% CI 0.0-5.1%). The only positive pregnancy test after treatment occurred in a woman who received oral LNG plus the LNG IUD and who had reported multiple episodes of unprotected intercourse including an episode more than 5 days prior to treatment. CONCLUSIONS Study participants seeking EC who desired an IUD preferentially chose oral LNG 1.5 mg with the LNG 52 mg IUD over the copper IUD. Neither group had EC treatment failures. Including the option of oral LNG 1.5 mg with concomitant insertion of the LNG 52 mg IUD in EC counseling may increase the number of EC users who opt to initiate highly effective reversible contraception. IMPLICATIONS Consideration should be given to LNG IUD insertion with concomitant use of oral LNG 1.5 mg for EC. Use of this combination may increase the number of women initiating highly effective contraception at the time of their EC visit.
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Affiliation(s)
- David K Turok
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209.
| | - Jessica N Sanders
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Ivana S Thompson
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Pamela A Royer
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Jennifer Eggebroten
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
| | - Lori M Gawron
- University of Utah, Department of Obstetrics and Gynecology, 30 North 1900 East, Room 2B200, Salt Lake City, UT 84132-2209
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31
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32
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Batur P, Cleland K, McNamara M, Wu J, Pickle S. Emergency contraception: A multispecialty survey of clinician knowledge and practices. Contraception 2015; 93:145-52. [PMID: 26363429 DOI: 10.1016/j.contraception.2015.09.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. STUDY DESIGN A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. RESULTS The final sample included 1684 providers (response rate=51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide LNG EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide LNG, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods [UPA and copper intrauterine device (IUD)] were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. CONCLUSIONS Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. IMPLICATIONS In our sample of 1684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of EC (UPA and the copper IUD) are far lower than for LNG EC. Women should be offered the full range of EC methods.
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Affiliation(s)
- Pelin Batur
- Department of Internal Medicine and Primary Care Women's Health at the Cleveland Clinic, Cleveland, OH, USA.
| | - Kelly Cleland
- Office of Population Research at Princeton University, Princeton, NJ, USA
| | - Megan McNamara
- Department of Internal Medicine at the Louis Stokes Department of Veterans Affairs Medical Center Hospital of Case Western Reserve University, Cleveland, OH, USA
| | - Justine Wu
- Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sarah Pickle
- Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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33
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California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision. Obstet Gynecol 2015; 126:338-345. [DOI: 10.1097/aog.0000000000000969] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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34
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Testing for sexually transmitted infections at intrauterine device insertion: an evidence-based approach. Clin Obstet Gynecol 2015; 57:682-93. [PMID: 25222531 DOI: 10.1097/grf.0000000000000054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article reviews evidence to guide safe and cost-effective testing for asymptomatic Neisseria gonorrhea and Chlamydia trachomatis infection before inserting intrauterine devices (IUDs). All women should be screened with a history and pelvic examination before IUD insertion, but only high-risk women need a laboratory test; this includes women aged 25 years or younger with no test within the last year, and women with additional behavioral risk factors. If testing is indicated, it should be done on the same day as insertion not a separate visit. Women with positive test results should be treated as soon as results are available.
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35
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Thompson K, Belden P. Counseling for emergency contraception: time for a tiered approach. Contraception 2014; 90:559-61. [PMID: 25444255 DOI: 10.1016/j.contraception.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Kirsten Thompson
- Bixby Center for Global Reproductive Health, University of California, San Francisco, 3333 California Street, Suite 335, Box 0744, San Francisco, CA 94143.
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36
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Cleland K, Raymond EG, Westley E, Trussell J. Emergency contraception review: evidence-based recommendations for clinicians. Clin Obstet Gynecol 2014; 57:741-50. [PMID: 25254919 PMCID: PMC4216625 DOI: 10.1097/grf.0000000000000056] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several options for emergency contraception are available in the United States. This article describes each method, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, whereas ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex.
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Affiliation(s)
- Kelly Cleland
- Office of Population Research, Princeton University, Princeton, NJ
| | | | | | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ
- The Hull York Medical School, University of Hull, Hull England
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37
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Picavet C, van der Vlugt I, Wijsen C. Intention to use emergency contraceptive pills and the role of knowledge in a Dutch national sample. EUR J CONTRACEP REPR 2014; 19:250-8. [DOI: 10.3109/13625187.2014.910595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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Factors Influencing the Provision of Long-Acting Reversible Contraception in California. Obstet Gynecol 2014; 123:593-602. [DOI: 10.1097/aog.0000000000000137] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Luchowski AT, Anderson BL, Power ML, Raglan GB, Espey E, Schulkin J. Obstetrician-gynecologists and contraception: practice and opinions about the use of IUDs in nulliparous women, adolescents and other patient populations. Contraception 2014; 89:572-7. [PMID: 24679477 DOI: 10.1016/j.contraception.2014.02.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Use of intrauterine devices (IUDs) by US women is low despite their suitability for most women of reproductive age and in a variety of clinical contexts. This study examined obstetrician-gynecologists' practices and opinions about the use of IUDs in adolescents, nulliparous women and other patient groups, as well as for emergency contraception. DESIGN A survey questionnaire was sent to a computer-generated sample of 3000 fellows who were reflective of the American College of Obstetricians and Gynecologists (College) membership. RESULTS After exclusions from the 1552 returned surveys (51.7% response rate), 1150 eligible questionnaires were analyzed. Almost all obstetrician-gynecologists (95.8%) reported providing IUDs, but only 66.8% considered nulliparous women, and 43.0% considered adolescents appropriate candidates. Even among obstetrician-gynecologists who recalled reading a College publication about IUDs, only 78.0% and 45.0% considered nulliparous women and adolescents appropriate candidates, respectively. Few respondents (16.1%) had recommended the copper IUD as emergency contraception, and only 73.9% agreed that the copper IUD could be used as emergency contraception. A total of 67.3% of respondents agreed that an IUD can be inserted immediately after an abortion or miscarriage. Fewer (43.5%) agreed that an IUD can be inserted immediately postpartum, and very few provide these services (11.4% and 7.2%, respectively). Staying informed about practice recommendations for long-acting reversible contraception was associated with broader provision of IUDs. CONCLUSIONS Although most obstetrician-gynecologists offer IUDs, many exclude appropriate candidates for IUD use, both for emergency contraception and for long-term use, despite evidence-based recommendations. IMPLICATIONS This study shows that obstetrician-gynecologists still do not offer IUDs to appropriate candidates, such as nulliparous women and adolescents, and rarely provide the copper IUD as emergency contraception.
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Affiliation(s)
- Alicia T Luchowski
- Long-Acting Reversible Contraception Program, The American College of Obstetricians and Gynecologists, Washington, DC.
| | - Britta L Anderson
- Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024
| | - Michael L Power
- Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024
| | - Greta B Raglan
- Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024
| | - Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - Jay Schulkin
- Research Department, The American College of Obstetricians and Gynecologists, 409 12th St SW, Washington, DC 20024; Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, WA
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40
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Biggs MA, Arons A, Turner R, Brindis CD. Same-day LARC insertion attitudes and practices. Contraception 2013; 88:629-35. [DOI: 10.1016/j.contraception.2013.05.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/06/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
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41
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Dermish AI, Turok DK. The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception. Expert Rev Med Devices 2013; 10:477-88. [PMID: 23895075 DOI: 10.1586/17434440.2013.811865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.
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Affiliation(s)
- Amna I Dermish
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
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42
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Russo JA, Miller E, Gold MA. Myths and misconceptions about long-acting reversible contraception (LARC). J Adolesc Health 2013; 52:S14-21. [PMID: 23535052 DOI: 10.1016/j.jadohealth.2013.02.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 02/03/2013] [Accepted: 02/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To discuss common myths and misconceptions about long-acting reversible contraception (LARC) among patients and health care providers. METHODS We address some of these common myths in an effort to provide clinicians with accurate information to discuss options with patients, parents, and referring providers. The list of myths was created through an informal survey of an online listserv of 200 family planning experts and from the experiences of the authors. RESULTS When presented with information about LARC, adolescents are more likely to request LARC and are satisfied with LARC. Clinicians have an important role in counseling about and providing LARC to their adolescent patients as well as supporting them in managing associated side effects. CONCLUSIONS This review article can be used as a resource for contraceptive counseling visits and for the continuing education of health professionals providing adolescent reproductive health care.
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Affiliation(s)
- Jennefer A Russo
- Planned Parenthood of Orange and San Bernardino Counties, Orange, California 92866, USA.
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43
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Hillard PJA. What Is LARC? And why does it matter for adolescents and young adults? J Adolesc Health 2013; 52:S1-5. [PMID: 23535051 DOI: 10.1016/j.jadohealth.2013.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 02/01/2013] [Indexed: 01/13/2023]
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44
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Practical tips for intrauterine devices use in adolescents. J Adolesc Health 2013; 52:S40-6. [PMID: 23535056 DOI: 10.1016/j.jadohealth.2012.09.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 09/16/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022]
Abstract
The American Congress of Obstetricians and Gynecologists (ACOG) has endorsed intrauterine devices (IUDs) as first-line contraceptive choices for both nulliparous and parous adolescents. The committee opinion did address some of the practical elements of IUD use in adolescents, but because these practical concerns may be barriers to use for both teens and clinicians, this review is devoted to "practical tips," based on the available literature as well as the author's clinical experience. Counseling, informed consent, techniques of pain management, and preventive guidance about possible side effects are addressed in an effort to promote successful use of this long-acting reversible contraception (LARC) option.
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45
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Gemzell-Danielsson K, Berger C, P.G.L. L. Emergency contraception — mechanisms of action. Contraception 2013; 87:300-8. [DOI: 10.1016/j.contraception.2012.08.021] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 08/20/2012] [Indexed: 12/30/2022]
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46
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Koyama A, Hagopian L, Linden J. Emerging options for emergency contraception. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2013; 7:23-35. [PMID: 24453516 PMCID: PMC3888080 DOI: 10.4137/cmrh.s8145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.
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Affiliation(s)
- Atsuko Koyama
- Department of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura Hagopian
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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47
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Abstract
This review will focus on the available methods for emergency contraception (EC), efficacy, side effects and mechanisms of action. Copper intrauterine device (IUD) has been shown to be the most effective method for EC which can be continually used for regular contraception. However, this possibility is seldom used and may be little known. Among the hormonal EC methods 1.5 mg levonorgestrel is the most widely used EC pill while the more recently developed Ulipristal acetate (UPA) has been shown to be the most effective option. This is probably due to a more pronounced prevention of follicular rupture compared with other hormonal EC methods. Knowledge is needed to better advise lactating women and obese women on optimal EC method. Furthermore a possible interaction of UPA with regular hormonal contraception and possibilities for "bridging" from EC to regular contraception needs to be explored. To increase efficacy future studies should focus on EC methods that target the endometrium.
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Affiliation(s)
- P G L Lalitkumar
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/WHO-Collaborating Center, Karolinska University Hospital, Stockholm, Sweden
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48
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Lee JK, Parisi SM, Baldauf E, Rapkin RB, Updike GM, Schwarz EB. Asking for what she needs? Pregnancy testing or EC? Contraception 2012; 87:859-63. [PMID: 23218857 DOI: 10.1016/j.contraception.2012.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/18/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND When used within 5 days of unprotected sex, emergency contraception (EC) can reduce the risk of pregnancy. Our objective was to explore how often women seeking clinic-based pregnancy testing who do not desire pregnancy might benefit from EC and examine variables associated with patients asking for EC when use is indicated. STUDY DESIGN Women seeking pregnancy testing or EC from an inner-city Title-X-funded family planning clinic between January 2011 and June 2012 were invited to complete surveys. RESULTS Twenty-seven percent (n=79) of respondents were seeking EC, and 73% (n=215) were seeking pregnancy testing. Of those seeking pregnancy testing, 39% might have benefited from same-day use of EC pills. Women who had never used EC and who had more than one episode of unprotected sex within the past month were less likely to request EC when use was indicated, while single women were more likely to request EC. CONCLUSIONS Counseling regarding EC options is particularly important for women seeking same-day pregnancy testing who do not desire pregnancy.
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Affiliation(s)
- Jessica K Lee
- University of Pittsburgh, Magee Women's Hospital, Pittsburgh, PA 15213, USA.
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49
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Bergin A, Tristan S, Terplan M, Gilliam ML, Whitaker AK. A missed opportunity for care: two-visit IUD insertion protocols inhibit placement. Contraception 2012; 86:694-7. [DOI: 10.1016/j.contraception.2012.05.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
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50
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Bond S. INTRAUTERINE DEVICES PROVIDE SAFE AND EFFECTIVE CONTRACEPTION FOLLOWING UNPROTECTED INTERCOURSE AND BEYOND. J Midwifery Womens Health 2012; 57:524-5. [DOI: 10.1111/j.1542-2011.2012.00219_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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