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Lindh I, Milsom I. The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study. Hum Reprod 2013; 28:1953-60. [DOI: 10.1093/humrep/det101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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52
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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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53
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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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54
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Continuation of copper-containing intrauterine devices at 6 months. Contraception 2012; 87:101-6. [PMID: 23083530 DOI: 10.1016/j.contraception.2012.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intrauterine devices (IUDs) are highly effective at preventing pregnancy and cost-effective. Suboptimal continuation of IUDs places women at risk of unintended pregnancy. Little is known about prevalence or predictors of discontinuation of IUDs within the first 6 months. STUDY DESIGN A retrospective cohort analysis was conducted among 306 family planning patients who had a CuT380A IUD inserted from November 2008-August 2011. Rates of continuation among 283 users were calculated using survival analyses, and predictors of removal within 6 months of insertion were assessed using logistic regression. RESULTS Among 306 IUD insertions, 13 (4.2%) full or partial expulsions occurred within the first 6 months: 9 (10.7%) among nulliparous and 4 (2.0%) among parous women (chi-square, p<.001). In the first 6 months, four (1.3%) pregnancies occurred among women without prior removal or expulsion of the device (unadjusted Pearl Index: 2.61 per 100 woman-years at 6 months), all among parous women. Of 283 women in continuation analyses, 26% were under 20 years old and 29% nulliparous. Most (84%) received health education specific to IUDs before insertion. Overall, 11% had their IUD removed within 6 months of insertion. In an adjusted logistic regression model, women who did not receive health education were significantly more likely (Adjusted Odds Ratio=3.37, 95% confidence interval: 1.35-8.39) to have a removal within 6 months, but no significant association was found for age, race/ethnicity or parity. CONCLUSION Early discontinuation of IUDs was prevalent but lower among women who received method-specific health education.
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Abstract
Emergency contraception (EC) is any method used after sexual intercourse to prevent pregnancy. This article provides an overview of the history of EC methods and describes the current availability of oral and intrauterine EC. Oral forms include the Yuzpe regimen (combining ethinyl estradiol and levonorgestrel), levonorgestrel-only pills, and ulipristal acetate, which is a new emergency contraceptive drug recently approved by the US Food and Drug Administration. The copper T-380A intrauterine device can also be used for EC. Information about dosing, timing, access, and other considerations in the provision of EC is covered. Clinicians should be aware of all available options in order to counsel women in need of EC appropriately.
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56
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Management of missing strings in users of intrauterine contraceptives. Contraception 2012; 86:354-8. [DOI: 10.1016/j.contraception.2012.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 11/22/2022]
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57
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Wiebe ER, Trouton KJ. Does using tampons or menstrual cups increase early IUD expulsion rates? Contraception 2012; 86:119-21. [DOI: 10.1016/j.contraception.2011.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 11/16/2022]
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58
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Bahamondes L, Bahamondes MV. Assessment of the use of two new low-dose levonorgestrel-releasing intrauterine systems as contraceptives. WOMENS HEALTH 2012; 8:235-8. [PMID: 22554171 DOI: 10.2217/whe.12.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, Phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil. Steril. 97(3), 616-622.e3 (2012). A randomized, open-label, Phase II study was conducted in 37 centers in five European countries to assess the optimal dose for a new contraceptive levonorgestrel intrauterine system (LNG-IUS). Overall, 742 parous or nulliparous women aged 21-40 years were allocated to receive a LNG-IUS that initially releases 12 µg/day (LNG-IUS(12)) or 16 µg/day (LNG-IUS(16)) in vitro or the currently available device that releases 20 µg/day (LNG-IUS(20)). The two new devices are shorter than the current one. Pearl Indices of 0.17, 0.82 and 0.00 for the LNG-IUS(12), LNG-IUS(16) and LNG-IUS(20), respectively, reflect the contraceptive efficacy of these devices. The mean number of bleeding and spotting days decreased in all three groups; however, this decrease was more significant in LNG-IUS(20) users. Placement of the new shorter devices was considered simple by providers, while patients reported significantly less pain with the two new devices compared with the current one. This study provided further insight into the development of two new LNG-IUS devices as contraceptives, with the additional possibility of using them to treat heavy menstrual bleeding or as endometrial protection during estrogen therapy.
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Affiliation(s)
- Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics & Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, 13084-971 Campinas, SP, Brazil.
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59
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Health Care Provider Attitudes and Practices Related to Intrauterine Devices for Nulliparous Women. Obstet Gynecol 2012; 119:762-71. [DOI: 10.1097/aog.0b013e31824aca39] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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60
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Sivin I, Batár I. State-of-the-art of non-hormonal methods of contraception: III. Intrauterine devices. EUR J CONTRACEP REPR 2012; 15:96-112. [PMID: 20230337 DOI: 10.3109/13625180903519885] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Since the 1959 revival of the IUD, non-hormonal devices have become the most widely used of all reversible contraceptives. Pregnancy rates of copper-releasing IUDs in current use range from approximately 0.5 to 1.5 per hundred continuing users in the first year, with somewhat lower annual pregnancy rates thereafter. Evidence-based research has been systematically conducted and translated into guidelines for eligibility criteria and problem management. Recent device research, beyond the T, Multiload and frameless devices has centred on improved designs such as U ,Y and Slimline shapes, or enhanced copper release, the latter through electrochemical effects or nanotechnology applications. Other IUD research foci concern devices that decrease bleeding and pain by releasing non-steroidal anti-inflammatory drugs. Yet other research lines indicate noncontraceptive benefits of copper intrauterine devices in protecting against endometrial cancer, and favourable risk-benefit analyses of IUD use by women at risk of or post HIV infection. IUD mechanisms of action and the relation of IUDs to pelvic infection and ectopic pregnancy are briefly reviewed. For our literature search we used Medline, Popline and Cochrane Library data bases, Google search, our personal files, and the references contained in articles in our files.
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61
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Zhang W, Xia X, Qi C, Xie C, Cai S. A porous Cu/LDPE composite for copper-containing intrauterine contraceptive devices. Acta Biomater 2012; 8:897-903. [PMID: 21982847 DOI: 10.1016/j.actbio.2011.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 08/07/2011] [Accepted: 09/20/2011] [Indexed: 01/15/2023]
Abstract
To improve the rates of both cupric ion release and the utilization of copper in non-porous copper/low-density polyethylene (Cu/LDPE) composite, a porous Cu/LDPE composite is proposed and developed in the present work. Here 2,5-di-tert-butylhydroquinone was chosen as the porogen, ethyl acetate was chosen as the solvent for extraction, and the porous Cu/LDPE composite was obtained by using injection molding and the particulate leaching method. After any residual ethyl acetate remaining inside the porous Cu/LDPE composite had been removed by vacuum drying, the composite was characterized by X-ray diffraction, scanning electron microscopy, Fourier transform infrared spectroscopy, gas chromatography-mass spectrometry and absorption measurement. For comparison, a non-porous Cu/LDPE composite was also characterized in the same way. The results show that the porous structure was successfully introduced into the polymeric base of the non-porous Cu/LDPE composite, and the porous Cu/LDPE composite is a simple hybrid of copper particles and porous LDPE. The results also show that the introduction of a porous structure can improve the cupric ion release rate of the non-porous Cu/LDPE composite with a certain content of copper particles, indicating that the utilization rate of copper can be improved either the introduction of a porous structure, and that the porous Cu/LDPE composite is another promising material for copper-containing intrauterine devices.
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Affiliation(s)
- Weiwei Zhang
- State Key Laboratory of Material Processing and Die & Mould Technology, Department of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, People's Republic of China
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Laurence V, Rousset-Jablonski C. Contraception and Cancer Treatment in Young Persons. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:41-60. [DOI: 10.1007/978-94-007-2492-1_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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63
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Krishnan S, Grimes DA, Lopez LM, Tang JH. Intrauterine devices for contraception in nulliparous women. Hippokratia 2011. [DOI: 10.1002/14651858.cd009254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sheila Krishnan
- Northwestern University, Feinberg School of Medicine; Department of Obstetrics and Gynecology; 680 North Lake Shore Drive Suite 1015 Chicago Illinois USA IL 60611
| | - David A Grimes
- FHI; Clinical Sciences; PO Box 13950 Research Triangle Park North Carolina USA NC 27709
| | - Laureen M Lopez
- FHI; Clinical Sciences; PO Box 13950 Research Triangle Park North Carolina USA NC 27709
| | - Jennifer H. Tang
- University of North Carolina; Department of Obstetrics and Gynecology; Chapel Hill North Carolina USA
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Abstract
Family planning is one of the principle tools of human development. Ensuring that all babies are wanted and planned reduces health care and social costs. Human numbers will increase to 11 billion by the end of this century, and human activities are the leading cause of environmental change that threaten our health and happiness. Therefore, the provision of highly effective contraceptive methods represents an important priority of primary medical care. Since women and men with complicated medical problems remain interested in sex, medical and surgical specialists need to understand how contraception and pregnancy will interact with the underlying condition. This paper discusses the interaction between population growth and the environment, and reviews modern methods of contraception.
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Affiliation(s)
- Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA.
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65
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Nelson AL. Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2011. [DOI: 10.4137/cmwh.s5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.
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Affiliation(s)
- Anita L. Nelson
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
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66
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Cadilla A, Qureshi N, Johnson DC. Pediatric antiretroviral therapy. Expert Rev Anti Infect Ther 2011; 8:1381-402. [PMID: 21133664 DOI: 10.1586/eri.10.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The rate of perinatal HIV transmission has decreased significantly in developed countries. However, worldwide, it remains the main source of HIV infection within the pediatric population. Recent advances as a result of findings from clinical trials, viral resistance testing and the advent of new drugs have increased the options for initial treatment regimens. This article provides an overview of antiretroviral therapy in treatment-naive children, including recent pediatric data and updated guidelines from the NIH. It also provides information on new drugs approved for the pediatric age group, dosage information, drug resistance testing and monitoring suggestions for children and adolescents receiving antiretroviral therapy. Special issues pertaining to adherence, disclosure and contraception are also highlighted.
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Affiliation(s)
- Adriana Cadilla
- University of Chicago, Pritzker School of Medicine, 5841 S. Maryland Avenue, MC6082, Chicago, IL 60637, USA
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67
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Length of the endometrial cavity and intrauterine contraceptive device expulsion. Int J Gynaecol Obstet 2011; 113:50-3. [DOI: 10.1016/j.ijgo.2010.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/22/2010] [Accepted: 12/14/2010] [Indexed: 11/21/2022]
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68
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Blumenthal P, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update 2010; 17:121-37. [DOI: 10.1093/humupd/dmq026] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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69
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Hofmeyr GJ, Singata M, Lawrie TA. Copper containing intra-uterine devices versus depot progestogens for contraception. Cochrane Database Syst Rev 2010; 2010:CD007043. [PMID: 20556773 PMCID: PMC8981912 DOI: 10.1002/14651858.cd007043.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Highly effective contraception is essential to reduce unintended pregnancies and the effect these have on individuals, society and public health resources. Intrauterine devices (IUDs) and depot progestogens are two commonly used long-acting, reversible contraceptive methods with different risk and benefit profiles. OBJECTIVES To compare the contraceptive and non-contraceptive benefits and risks of using the copper-containing IUD versus depot progestogens for contraception. SEARCH STRATEGY In June 2009 we searched the Cochrane Pregnancy and Childbirth Group Trials Register, the Cochrane Central Register of Controlled Trials, Pubmed, Popline, Clinical Trials.gov, the Current Controlled Trials metaRegister, EMBASE and LILACS, and contacted study authors. SELECTION CRITERIA Randomized trials comparing women using copper-containing IUDs with women using depot progestogens. DATA COLLECTION AND ANALYSIS We assessed eligibility and trial quality, extracted and double-entered data. MAIN RESULTS Two studies were included in the review. In the one study in HIV infected women, the IUD was compared with depot progestogen or the oral contraceptive, according to the women's choice. As the majority of women chose depot progestogen, we have included this study in the review, within a mixed hormonal contraception sub-group.Overall, the copper IUD was more effective than depot progestogens/hormonal contraception at preventing pregnancy (risk ratio (RR) 0.45; 95% confidence interval (CI) 0.24 to 0.84). HIV disease progression was reduced in the IUD group (RR 0.58; 95% CI 0.39 to 0.87). There was no significant difference in pelvic inflammatory disease rates between the two groups. Discontinuation of the allocated method was less frequent with the IUD in one study, and less frequent with hormonal contraception in the other study (in which women were allowed to switch between various hormonal methods). AUTHORS' CONCLUSIONS In the populations studied, the IUD was more effective than hormonal contraception with respect to pregnancy prevention. High quality research is urgently needed to compare the effects, if any, of these two commonly used contraception methods on HIV acquisition/seroconversion and HIV/AIDS disease progression.
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Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - Mandisa Singata
- University of the Witwatersrand/University of Fort Hare/East London Hospital complexEffective Care Research UnitEast LondonSouth Africa
| | - Theresa A Lawrie
- Royal United HospitalThe Cochrane Gynaecological Cancer Review GroupWolfson CentreBathUKBA13NG
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70
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Use of the Mirena™ LNG-IUS and Paragard™ CuT380A intrauterine devices in nulliparous women. Contraception 2010; 81:367-71. [DOI: 10.1016/j.contraception.2010.01.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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71
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Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand. Contraception 2010; 82:260-5. [PMID: 20705155 DOI: 10.1016/j.contraception.2010.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 02/25/2010] [Accepted: 03/02/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many misconceptions still prevail about the appropriateness of use of the intrauterine device (IUD), particularly for younger women. This study examines the factors associated with post abortion IUD use as compared to the combined oral contraceptive pill (COC). It then examines the effect of type of post abortion contraception with the likelihood of seeking subsequent abortions. STUDY DESIGN This prospective cohort study followed, for a period of 3 years, 1422 women who had a first trimester surgical abortion between November 2004 and January 2005 in Auckland's public abortion clinic. RESULTS Compared to women who left the clinic with COC, those leaving with an IUD (OR 0.3) at baseline were less likely to return for a subsequent abortion. Among women who had not had a previous termination, younger women were less likely than older women to have had an IUD inserted post abortion. With every additional live birth, women were three times as likely to have left the abortion clinic with an IUD. Among women who had had a previous termination, age was no longer significantly associated with post abortion IUD insertion. However, parity was still significantly associated, as was having a negative sexually transmitted infection test. CONCLUSIONS Young and nulliparous women are less likely to use an IUD as a method of contraception following an abortion. However, those women who have an IUD inserted following an abortion are much less likely to return for a subsequent abortion. IUDs are a safe and effective method of contraception that are currently still underused among the younger population.
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72
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Wiebe ER, Trouton KJ, Dicus J. Motivation and Experience of Nulliparous Women Using Intrauterine Contraceptive Devices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:335-338. [DOI: 10.1016/s1701-2163(16)34477-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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73
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The effect of patient gynecologic history on clinician contraceptive counseling. Contraception 2010; 82:281-5. [PMID: 20705158 DOI: 10.1016/j.contraception.2010.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Contraceptive providers have an important influence on women's selection of contraception. Previous studies suggest that clinicians inappropriately limit use of intrauterine contraception (IUC). This study investigated the influence of patients' gynecologic histories on recommendations for IUC and other methods of contraception. STUDY DESIGN Videos of standardized patients varying by history of pelvic inflammatory disease (PID) and parity were shown to clinicians at meetings of national medical societies. Participants indicated their contraceptive recommendations for the patient and whether they would have concerns were the patient to use IUC. RESULTS Five hundred twenty-four providers viewed one video of a standardized patient and completed the survey. Gynecologic history was significantly associated with recommendations for the contraceptive ring, contraceptive patch, and copper IUC. Many clinicians indicated that they had concerns about the use of IUC with respect to risks such as PID, infertility and ectopic pregnancy. Concerns about infertility and pain with use of IUC were related to gynecologic history. CONCLUSIONS Patient gynecologic characteristics affect recommendations for some reversible contraceptive methods. Clinicians continue to have concerns about IUC use despite evidence supporting its safety.
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74
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Canteiro R, Bahamondes MV, dos Santos Fernandes A, Espejo-Arce X, Marchi NM, Bahamondes L. Length of the endometrial cavity as measured by uterine sounding and ultrasonography in women of different parities. Contraception 2010; 81:515-9. [PMID: 20472119 DOI: 10.1016/j.contraception.2010.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 01/05/2010] [Accepted: 01/08/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND In view of current controversies regarding the need for new, shorter intrauterine devices (IUDs) that would reduce expulsion rates in nulligravida, endometrial cavity length was measured in women of different parities using uterine sounding and ultrasonography. STUDY DESIGN A cross-sectional descriptive study was performed including 570 women of 17-52 years of age, 260 of whom were nulligravida and 310 parous. RESULTS The difference in mean length between measurements taken by uterine sounding and ultrasonography was 0.28 cm. Mean endometrial cavity length was 3.84+/-0.03 cm (mean+/-S.E.M.) in nulligravida and 4.25+/-0.03 cm in parous women according to uterine sounding (p<.001) and 3.70+/-0.03 cm and 3.84+/-0.03 cm, respectively, according to ultrasonography (p=.006). CONCLUSIONS By either technique, mean length of the endometrial cavity was >3.6 cm, the length of the most common IUDs, the TCu380A and the levonorgestrel-releasing intrauterine system. Therefore, the issue appears controversial for developing new, shorter IUDs, since current models fit most women, including nulligravida, albeit one third of the women of our sample showed endometrial length shorter than 3.2 cm.
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Affiliation(s)
- Renata Canteiro
- Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences and National Institute of Hormones and Women's Health, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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75
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Allen RH, Goldberg AB, Grimes DA. Expanding access to intrauterine contraception. Am J Obstet Gynecol 2009; 201:456.e1-5. [PMID: 19527902 DOI: 10.1016/j.ajog.2009.04.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 03/05/2009] [Accepted: 04/16/2009] [Indexed: 11/30/2022]
Abstract
The intrauterine device is a safe, highly effective, long-lasting, yet reversible method of contraception. Expanding access to intrauterine contraception is an important measure to reduce the rate of unintended pregnancy in the United States. Clinicians should consider intrauterine contraception in appropriate candidates, including women who are nulliparous, adolescent, immediately postpartum or postabortal, and desiring emergency contraception, and as an alternative to permanent sterilization. Barriers to intrauterine contraception such as requiring cervical cancer screening before insertion, routine testing for gonorrhea and chlamydial infection in low-risk women, or scheduling insertion only during menses are unnecessary.
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Affiliation(s)
- Rebecca H Allen
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, RI, USA
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76
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Moss E, Reynolds T, Kundu A. Emergency contraception: Patterns of use in community sexual health clinics. J OBSTET GYNAECOL 2009; 29:337-9. [DOI: 10.1080/01443610902862712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brockmeyer A, Kishen M, Webb A. Experience of IUD/IUS insertions and clinical performance in nulliparous women–a pilot study. EUR J CONTRACEP REPR 2009; 13:248-54. [DOI: 10.1080/02699200802253706] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paterson H, Ashton J, Harrison-Woolrych M. A nationwide cohort study of the use of the levonorgestrel intrauterine device in New Zealand adolescents. Contraception 2009; 79:433-8. [DOI: 10.1016/j.contraception.2008.12.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 11/30/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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PATERSON H, MILLER D, DEVENISH C. A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents. Aust N Z J Obstet Gynaecol 2009; 49:220-5. [DOI: 10.1111/j.1479-828x.2009.00973.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Whitaker AK, Johnson LM, Harwood B, Chiappetta L, Creinin MD, Gold MA. Adolescent and young adult women's knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78:211-7. [PMID: 18692611 DOI: 10.1016/j.contraception.2008.04.119] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 04/24/2008] [Accepted: 04/28/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to assess adolescent (aged 14-18 years) and young adult (aged 19-24 years) women's knowledge of and attitudes toward intrauterine devices (IUDs) before and after a brief educational intervention. STUDY DESIGN We administered a 43-item survey to 144 women aged 14-24 years, with half in each age category. The survey assessed knowledge of and attitudes toward IUDs, and incorporated a 3-min educational intervention about IUDs. Predictors for knowledge of and attitudes toward the IUD were examined using logistic regression. RESULTS Forty percent of participants had heard of the IUD. Having ever heard of the IUD was associated with age >18 years [adjusted odds ratio (OR)=5.7; 95% confidence interval (95% CI)=2.1-15.7], a higher level of maternal education (adjusted OR=4.5; 95% CI=1.5-13.3) and a history of voluntary sexual intercourse (adjusted OR=4.9; 95% CI=1.0-23.5). Of those who had heard of the IUD previously, 37.5% reported a positive attitude toward the IUD before the intervention. After the educational intervention, 53.5% of all participants reported a positive attitude toward the IUD, with both adolescent and young adult women having similarly positive attitudes (51.4% vs. 55.6%, p=.62). This positive attitude was associated only with a history of voluntary sexual intercourse (adjusted OR=5.2; 95% CI=1.3-21.1). The characteristics of the IUD that the participants strongly liked and disliked were rated similarly by the two age groups. However, more adolescent women considered the privacy of the IUD and the ability to use the copper IUD for 10 years as positive characteristics. CONCLUSION Most young women were unaware of IUDs but were likely to think positively about IUDs after being educated about them. Demographic and reproductive health history did not predict attitude; thus, all young women should be offered education about IUDs.
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Affiliation(s)
- Amy K Whitaker
- Department of Obstetrics and Gynecology, University of Chicago Hospitals, Chicago, IL 60637, USA
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