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Grange R, Magand N, Grand N, Leroy S, Corsini T, Azarnoush K, Grange S. Endovascular retrieval of a migrated contraceptive implant into the pulmonary artery : case report and review of literature. CVIR Endovasc 2024; 7:35. [PMID: 38581571 PMCID: PMC10998818 DOI: 10.1186/s42155-024-00450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The migration of contraceptive devices into pulmonary arteries is extremely rare, reported to be 1 in 100,000. CASE PRESENTATION A 19-year-old female presented no sensation of a contraceptive implant in her arm which had been placed one year prior. A CT scan confirmed that the implant had migrated into the left lower segmentary pulmonary artery. After a multidisciplinary meeting, an endovascular approach was attempted. Following right femoral venous access, a 8F NeuronMax® introducer was placed into the left pulmonary artery under fluoroscopic guidance. The contraceptive device was removed using a 25-mm loop snare, with a proximal capture technique. The patient was discharged the following day, with no reported complications. CONCLUSION In cases of contraceptive device migration, the first medical decision involves deciding between removal or 'watching and waiting'. Previous reports describe two removal options: endovascular or surgical approaches. Fourteen reports have been published, with high technical success and low rates of complications. The loop snare technique is described as the optimal technique for an endovascular approach. Due to their invasive nature, surgical approaches should be reserved for cases of endovascular removal failure, after evaluating risks and benefits.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Nicolas Magand
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Nathalie Grand
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Stéphanie Leroy
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Thomas Corsini
- Department of Gynecology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Kasra Azarnoush
- Department of Cardiac Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Mihretie GS, Abebe SM, Abebaw Y, Gedefa L, Gure T, Alemayehu BA, Amenu D, Tadesse D, Fanta GA, Abubeker FA, Yemane A, G/Michael AD, Teklu AM, Damtew MH, Girma B. Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia. BMJ Open 2022; 12:e059372. [PMID: 35918115 PMCID: PMC9351308 DOI: 10.1136/bmjopen-2021-059372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users. DESIGN A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women. SETTING The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study. PARTICIPANTS The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period. INTERVENTIONS A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation. RESULT From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation. CONCLUSION The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
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Affiliation(s)
- Getasew Sisay Mihretie
- Department of Obstetrics and Gynecology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- University of Gondar, Gondar, Ethiopia
- University of Gondar, Gondar, Ethiopia
- Human Nutrition, Institute of Public Halth, Gondar, Ethiopia
| | - Yeshiwas Abebaw
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- Obstetrics and Gynecology, School of Medicine, Gondar, Ethiopia
| | - Leta Gedefa
- Haramaya University, Dire Dawa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Haromaya, Ethiopia
| | - Tadesse Gure
- Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, Harar, Ethiopia
- Obstetrics and Gynaecology, Haramaya University College of Health and Medical Sciences, Haramaya, Oromia, Ethiopia
| | - Birtukan Asmare Alemayehu
- Department of Obstetrics and Gynecology, Menelik II Referral Hospital, Ethiopia, Addis Ababa, Ethiopia
| | | | - Daniel Tadesse
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research and project unit, Addis Ababa, Ethiopia
| | - Girma Abraham Fanta
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Addis Ababa, Ethiopia
| | - Ferid Abbas Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Medical College, Addis Ababa, Ethiopia
| | - Awol Yemane
- Mekelle University, Mekelle, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Mekella, Ethiopia
| | - Amanuel Desta G/Michael
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
- College of Health Science, Mekelle, Ethiopia
| | - Alula M Teklu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research, MERQ PLC LLC, Baltimore, Maryland, USA
- Research Unit, Addis Ababa, Ethiopia
| | - Mengistu Hailemariam Damtew
- University of Michigan Center for International Reproductive Health Training Ethiopia, Addis Ababa, Oromia, Ethiopia
- CIRHT, Addis Ababa, Ethiopia
| | - Bisrat Girma
- Jimma University, Jimma, Ethiopia
- College of health and Medical Sciences, Jimma, Ethiopia
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Friedman JC, Buyers E, Laurin J, Hampanda K, Alaniz VI. Tamoxifen for the Treatment of Etonogestrel Implant-Associated Bleeding in an Adolescent Gynecology Practice. J Pediatr Adolesc Gynecol 2022; 35:341-345. [PMID: 34780932 DOI: 10.1016/j.jpag.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe clinical outcomes in a cohort of adolescent female patients using tamoxifen for the treatment of bothersome etonogestrel (ENG) implant-associated bleeding. DESIGN Retrospective chart review SETTING: A tertiary children's hospital PARTICIPANTS: Adolescent female patients ages 12-21 seen between August 2016 and August 2019 with an ENG implant in place who received a tamoxifen prescription for the indication of implant-associated bleeding. INTERVENTIONS None MAIN OUTCOME MEASURES: Main outcome measures were implant continuation rates, average time to implant discontinuation after tamoxifen prescription, reasons for implant removal, number of doses and timing of tamoxifen use, bleeding patterns, and adverse effects. RESULTS A total of 67 patients met the inclusion criteria. The mean age of patients was 16.7 years old. Of the patients with available follow-up data, 49 out of 60 (81.7%) were still using the implant at 12 months, 29 out of 53 (54.7%) at 24 months, and 9 out of 40 (22.5%) at 36 months. The average time from tamoxifen prescription to implant removal was 12.1 months. Bothersome bleeding was the primary reason for ENG implant discontinuation (68.6%). No side effects from tamoxifen use were reported. CONCLUSION Tamoxifen was well-tolerated among this cohort of patients and can be considered a treatment option to manage bothersome implant bleeding in adolescents.
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Affiliation(s)
- Julie C Friedman
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado.
| | - Eliza Buyers
- Children's Hospital of Colorado Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Jaime Laurin
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Karen Hampanda
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado
| | - Veronica I Alaniz
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado; Children's Hospital of Colorado Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
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Scott N, Silver EJ, Dodson NA, Coupey SM. Does Obesity Influence Body Mass Index Changes in Nulliparous Adolescent Users of Long-Acting Reversible Contraceptives? J Pediatr Adolesc Gynecol 2021; 34:815-820. [PMID: 34389461 DOI: 10.1016/j.jpag.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), specifically, the etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD), and copper IUD (Cu-IUD), by initial BMI category from the time of LARC insertion to within 6-18 months after insertion. DESIGN This was a single-center retrospective cohort study. SETTING AND PARTICIPANTS We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. MAIN OUTCOME MEASURE BMI change from LARC insertion to first BMI documented after 6-18 months RESULTS: Mean age was 17.2 ± 0.2 years; 59% of the cohort was Hispanic and 29% Black. Mean BMI was 26.4 ± 7.1 kg/m2. Of the total cohort of adolescents, 51% were underweight/normal, 24% overweight, and 25% obese. Mean time to first BMI documented after LARC insertion was 10.1 ± 3.2 months. Mean BMI change for the total cohort was +0.73 ± 1.8 kg/m2, indicating weight gain. Mean BMI change for the ENG-implant + LNG-IUD users (n = 127) was larger than for Cu-IUD users (n = 69) (+0.92 ± 1.9 kg/m2 vs +0.37 ± 1.6 kg/m2, respectively, P < .05). Two-way analysis of variance showed that both initial BMI category (P = .001) and type of LARC (P = .011) had an independent significant main effect on BMI change. A significant interaction effect (P = .017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC, either ENG-implant or LNG-IUD, as compared to a Cu-IUD (P < .05). CONCLUSION Adolescents using progestin-releasing LARCs had a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs was primarily contributed by obese users.
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Affiliation(s)
- Nadia Scott
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Ellen J Silver
- Division of Academic General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Nancy A Dodson
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Susan M Coupey
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.
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Are Births More Likely to be Intended Following Use of Long-Acting Reversible Contraceptives? An Analysis of U.S. Births in 2003–2015. POPULATION RESEARCH AND POLICY REVIEW 2021. [DOI: 10.1007/s11113-021-09680-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Farah D, Andrade TRDM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis. EUR J CONTRACEP REPR 2021; 27:127-135. [PMID: 34431421 DOI: 10.1080/13625187.2021.1964467] [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: 10/20/2022]
Abstract
BACKGROUND Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.
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Affiliation(s)
- Daniela Farah
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Manoel João Batista Castello Girão
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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8
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Farah D, Andrade TRM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis. EUR J CONTRACEP REPR 2021; 25:492-501. [PMID: 33140990 DOI: 10.1080/13625187.2020.1833187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER CRD42017055452.
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Affiliation(s)
- Daniela Farah
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa Raquel Moraes Andrade
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Manoel João Batista Castello Girão
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
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Rocca ML, Palumbo AR, Visconti F, Di Carlo C. Safety and Benefits of Contraceptives Implants: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:548. [PMID: 34201123 PMCID: PMC8229462 DOI: 10.3390/ph14060548] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.
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Affiliation(s)
- Morena Luigia Rocca
- Operative Unit of Obstetric and Gynaecology, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Anna Rita Palumbo
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
| | - Federica Visconti
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
| | - Costantino Di Carlo
- Department of Obstetrics and Gynaecology, “Magna Graecia” University, 88100 Catanzaro, Italy; (A.R.P.); (F.V.); (C.D.C.)
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Runyan A, Welch RA, Kramer KJ, Cortez S, Roberts LJ, Asamoah C, Ottum S, Sanders J, Shafi A, Recanati MA. Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic. J Clin Med 2021; 10:jcm10091918. [PMID: 33925203 PMCID: PMC8125758 DOI: 10.3390/jcm10091918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States.
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Affiliation(s)
- Aliye Runyan
- Department of Obstetrics and Gynecology, Westchester Medical Center, Valhalla, NY 10595, USA;
| | - Robert A. Welch
- Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, MI 48503, USA;
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Catholic Medical Centers, New York, NY 10011, USA;
| | - Sarah Cortez
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - LeAnne J. Roberts
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Clementina Asamoah
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA; (S.C.); (L.J.R.); (C.A.)
| | - Sarah Ottum
- Department of Surgery, Wayne State University, Detroit, MI 48202, USA;
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA;
| | - Adib Shafi
- Department of Computer Science, Wayne State University, Detroit, MI 48202, USA;
| | - Maurice-Andre Recanati
- NIH-Women’s Reproductive Health Research (WRHR) Scholar, Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48202, USA
- Correspondence:
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Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health 2021; 18:4. [PMID: 33407632 PMCID: PMC7788930 DOI: 10.1186/s12978-020-01054-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/06/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Unintended pregnancies (UIP) have a significant impact on health of women and the health budget of countries. Contraception is an effective way to prevent UIPs. The study objective was to collate evidence on clinical effectiveness of etonogestrel subdermal implant (ESI), continuation rate and side effect profile among eligible women of reproductive age group, as compared to levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (Cu-IUD) and depot medroxy progesterone acetate injections; other types of contraceptive implants were excluded as comparators. METHODS The protocol of the systematic review was registered in Prospero (registration number: CRD42018116580). MEDLINE via PubMed, Cochrane library and web of science were the electronic databases searched. A search strategy was formulated and studies from 1998 to 2019 were included. Clinical trial registries and grey literature search was done. Critical assessment of included studies was done using appropriate tools. A qualitative synthesis of included studies was done and a meta-analysis was conducted in RevMan software for continuation rates of ESI as compared to other long acting reversible contraceptives (LARC) e.g. LNG IUS and Cu-IUD. RESULTS The search yielded 23,545 studies. After excluding 467 duplicates, 23,078 titles were screened and 51 studies were included for the review. Eight of the 15 studies reporting clinical effectiveness reported 100% effectiveness and overall pearl index ranged from 0 to 1.4. One-year continuation rates ranged from 57-97%; 44-95% at the end of second year and 25-78% by 3 years of use. Abnormal menstruation was the most commonly reported side effect. There was no significant difference in bone mineral density at 1 year follow-up. The meta-analyses showed that odds ratio (OR) of 1-year continuation rate was 1.55 (1.36, 1.76) for LNG-IUS vs. ESI and 1.34 (1.13, 1.58) for copper-IUD vs. ESI; showing that continuation rates at the end of one-year were higher in LNG-IUS and copper-IUD as compared to ESI. CONCLUSION ESI is clinically effective and safe contraceptive method to use, yet 1-year continuation rates are lower as compared to LNG-IUS and copper-IUD, mostly attributed to the disturbances in the menstruation.
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Affiliation(s)
- Kusum V Moray
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Himanshu Chaurasia
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Oshima Sachin
- Health Technology Assessment Secretariat, Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Beena Joshi
- Regional Resource Hub for Health Technology Assessment, Indian Council of Medical Research, National Institute for Research in Reproductive Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
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Hendrick CE, Cone JN, Cirullo J, Maslowsky J. Determinants of Long-acting Reversible Contraception (LARC) Initial and Continued Use among Adolescents in the United States. ADOLESCENT RESEARCH REVIEW 2020; 5:243-279. [PMID: 34056060 PMCID: PMC8159026 DOI: 10.1007/s40894-019-00126-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/03/2019] [Indexed: 05/28/2023]
Abstract
Long-acting reversible contraception (LARC) has gained attention as a promising strategy for preventing unintended adolescent pregnancies in the United States. However, LARC use among adolescents at risk for pregnancy remains low compared to women in their 20s. The purpose of the current study was to synthesize the empirical literature published between 2010 and 2018 identifying the facilitators of and barriers to adolescents' (< age 20) LARC use in the United States. Thirty quantitative and qualitative studies were included in the current systematic review. The facilitators of and barriers to adolescent LARC use fell within five themes: LARC method characteristics, individual characteristics, social networks, healthcare systems, and historical time and geographical region. Barriers to adolescent LARC use largely echoed those identified in previous research noting the barriers to LARC use among young adult women (e.g., provider concerns with placing IUDs for nulliparous women, common adverse side effects associated with some LARC methods). However, qualitative studies identified adolescents' mothers as central figures in helping adolescents successfully obtain the LARC methods they desired. Conversely, adolescents' partners seemed to only play a minor role in adolescents' contraceptive decisions. Findings within the reviewed studies also suggested some subpopulations of adolescents may be experiencing pressure to initiate LARC use or have less ability to have their LARC device removed if they wish to discontinue use. Adolescent health practitioners and clinicians should consider the unique social-environmental influences of adolescents' contraceptive access and behaviors to best meet adolescents' contraceptive needs and desires.
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Affiliation(s)
- C. Emily Hendrick
- Health Disparities Research Scholars Program, Department of Obstetrics & Gynecology—Division of Reproductive & Population Health, School of Medicine and Public Health, University of Wisconsin-Madison, 667 WARF, 610 Walnut Street, Madison, WI 53726
| | - Joshua N. Cone
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
| | - Jessica Cirullo
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
| | - Julie Maslowsky
- Health Behavior & Health Education Program, Department of Kinesiology & Health Education, The University of Texas at Austin, 2109 San Jacinto Blvd., D3700, Austin, TX 78712-1415
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Abstract
Long-acting reversible contraceptives are the most effective methods to prevent pregnancy and also offer noncontraceptive benefits such as reducing menstrual blood flow and dysmenorrhea. The safety and efficacy of long-acting reversible contraception are well established for adolescents, but the rate of use remains low for this population. The pediatrician can play a key role in increasing access to long-acting reversible contraception for adolescents by providing accurate patient-centered contraception counseling and by understanding and addressing the barriers to use.
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Affiliation(s)
- Seema Menon
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Murphy J, McKenna M, Abdelazim S, Battiwalla M, Stratton P. A Practical Guide to Gynecologic and Reproductive Health in Women Undergoing Hematopoietic Stem Cell Transplant. Biol Blood Marrow Transplant 2019; 25:e331-e343. [PMID: 31394266 DOI: 10.1016/j.bbmt.2019.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
Abstract
Optimum care of female transplant recipients requires gynecologic care at several stages through the allogeneic hematopoietic stem cell transplantation (HCT) process. Sex-based considerations in women post-HCT span gynecologic sequelae of transplant along with assessment and maintenance of optimal sexual and gynecologic health. Pre-HCT, managing menstruation and abnormal uterine or genital bleeding, considering fertility preservation, and assessing for sexually transmitted infections, including human papillomavirus (HPV)-related disease and cervical cancer, enhance women's health. While inpatient during transplant when women are thrombocytopenic, menstrual bleeding requires suppression. Whenever graft-versus-host disease (GVHD) is assessed, screening for genital GVHD merits consideration. After the first 100 days, periodic assessments include obtaining a menstrual history, assessing ovarian function, and reviewing current hormonal use and contraindications to hormonal methods. Regular assessment for primary ovarian insufficiency, dyspareunia, and intimacy guides provision of contraception and hormone replacement options. As part of ongoing screening for genital GVHD and HPV-related disease, including sexually transmitted infections, periodic pelvic examinations are performed. Once successful long-term survival is achieved, planning for fertility may be considered. This article offers a comprehensive approach to these aspects of gynecologic care of patients throughout the trajectory of HCT and beyond into survivorship. We review the effects of HCT treatment on sexual health, ovarian function, and resulting menstrual changes and fertility challenges. Identification, treatment, and prevention of subsequent malignancies, including breast cancer, are discussed, with a focus on regular assessment of genital HPV disease and GVHD in long-term follow-up.
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Affiliation(s)
- Jeanne Murphy
- George Washington University School of Nursing, Washington, District of Columbia.
| | - Mary McKenna
- Loyola University Medical Center, Maywood, Illinois; NIH Clinical Center, Bethesda, Maryland
| | - Suzanne Abdelazim
- NIH Clinical Center, Bethesda, Maryland; Riverside Regional Medical Center, Newport News, Virginia
| | | | - Pamela Stratton
- Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Roberts TA, Smalley JM, Weir LF, Adelman WP. Contraceptive use and childbirth rates by service branch during the first 24 months on active duty in the United States military from 2013 to 2018: a retrospective cohort analysis. Contraception 2019; 100:147-151. [DOI: 10.1016/j.contraception.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022]
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Agostini A, Godard C, Laurendeau C, Benmahmoud Zoubir A, Lafuma A, Lévy-Bachelot L, Gourmelen J, Linet T. Two year continuation rates of contraceptive methods in France: a cohort study from the French national health insurance database. EUR J CONTRACEP REPR 2018; 23:421-426. [DOI: 10.1080/13625187.2018.1535653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A. Agostini
- Gynecology-Obstetric Department, La Conception Hospital, Marseille, France
| | | | | | | | | | | | - J. Gourmelen
- Epidemiological Cohorts in population Unit, UMS 011, INSERM-UVSQ, Villejuif, France
| | - T. Linet
- Gynecology-Obstetric Department, Hospital Loire Vendée Ocean, Challans, France
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Jacobson J, Nasso J, Glantz JC. Use of an Evidence-Based Guideline for Management of Side Effects from Long-Acting Reversible Contraceptives: A Quality Improvement Report. J Midwifery Womens Health 2018; 64:225-229. [PMID: 30444322 DOI: 10.1111/jmwh.12925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Many health care providers believe that women who initiate long-acting reversible contraceptives (LARC) discontinue the method because of side effects too soon for the method to be economical. The purpose of this quality improvement project was to implement and evaluate an evidence-based telephone triage nursing guideline for management of side effects of LARC with an ultimate goal of reducing the number of early discontinuations. PROCESS A telephone triage guideline was adapted from the Contraceptive Choice Project's Clinician Call Back System, supplemented with evidence-based resources, and approved by clinicians at 2 community women's health and midwifery offices. Baseline retrospective data were collected on all women over the age of 18 who had LARC inserted at the 2 sites in the year prior to guideline implementation and in the 3 months after implementation. Rates of LARC removal at or before 3 months postinsertion, before and after guideline implementation, were evaluated. OUTCOMES Approximately 1 in 5 women called for help managing LARC side effects. Of the callers, 3 of 32 (9.4%) women receiving standard care discontinued their LARC prior to 3 months, whereas 0 of 24 women who were triaged using the guideline discontinued their LARC prior to 3 months (P = .12). Cramping, bleeding, and malposition or expulsion were the most common concerns and reasons for discontinuation. DISCUSSION Fewer women than anticipated called to report side effects, and even fewer chose to discontinue their LARC early. There were fewer discontinuations with guideline use, but this was not a statistically significant difference. Most women did not discontinue their LARC early for any reason, including side effects.
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Sonalkar S, Hunter T, Gurney EP, McAllister A, Schreiber C. A Decision Analysis Model of 1-Year Effectiveness of Intended Postplacental Compared With Intended Delayed Postpartum Intrauterine Device Insertion. Obstet Gynecol 2018; 132:1211-1221. [PMID: 30303909 PMCID: PMC6328318 DOI: 10.1097/aog.0000000000002926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare, using decision analysis methodology, the 1-year probability of pregnancy after intended postplacental intrauterine device (IUD) insertion with intended delayed insertion at an outpatient postpartum visit (delayed postpartum placement). METHODS We developed an evidence-based decision model with the primary outcome of 1-year probability of pregnancy. We compared 1-year probability of pregnancy after intended postplacental or intended delayed postpartum IUD placement. We obtained estimates from the literature for the proportions of the following: mode of delivery, successful IUD placement, IUD type, postpartum visit attendance, IUD expulsion, IUD discontinuation, and contraceptive use, choice, and efficacy after IUD discontinuation. We performed sensitivity analyses and a Monte Carlo simulation to account for variations in proportion estimates. RESULTS One-year probabilities of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a postplacental IUD after vaginal birth and 1,250,000 women intending to receive a postplacental IUD after cesarean birth were 17.3% and 11.2%, respectively; the 1-year probability of pregnancy among a theoretical cohort of 2,500,000 women intending to receive a delayed postpartum IUD was 24.6%. For delayed postpartum IUD placement to have effectiveness equal to postplacental placement, 91.4% of women delivering vaginally and 99.7% of women delivering by cesarean would need to attend postpartum care. Once placed, the effectiveness of postplacental IUDs was lower than that of delayed postpartum IUDs: 1-year probabilities of pregnancy after IUD placement at a vaginal birth, cesarean birth, and an outpatient postpartum visit were 15.4%, 6.6%, and 3.9%, respectively. CONCLUSION After accounting for factors that affect successful IUD placement and retention, this decision model indicates that intended postplacental IUD insertion results in a lower 1-year probability of pregnancy as compared with intended delayed postpartum IUD insertion.
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Affiliation(s)
- Sarita Sonalkar
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
| | | | | | - Arden McAllister
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
| | - Courtney Schreiber
- University of Pennsylvania Perelman School of Medicine, Department of Obstetrics and Gynecology
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Okugawa K, Sonoda K, Ohgami T, Yasunaga M, Kaneki E, Yahata H, Kato K. Pelvic abscess: A late complication of abdominal trachelectomy for cervical cancer. J Obstet Gynaecol Res 2018; 45:412-416. [PMID: 30251418 DOI: 10.1111/jog.13814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/20/2018] [Indexed: 11/26/2022]
Abstract
AIM Only a few reports of pelvic abscess as a late complication of trachelectomy have been published to date. To evaluate the cases of pelvic abscess as a late complication of abdominal trachelectomy for cervical cancer. METHODS In June 2005, we began a clinical trial of abdominal trachelectomy at our institution. Written informed consent was obtained from all patients. We retrospectively reviewed the medical records of patients who underwent trachelectomy and extracted the data of patients who experienced pelvic abscess as a late complication. RESULTS From June 2005 to September 2017, we performed 181 trachelectomies at our institution. In total, 15 pelvic abscesses occurred in 12 of these patients more than 1 month after trachelectomy. The median postoperative period before the onset of pelvic abscess was 51 months (range, 1-104 months). Among the 15 cases, abscess formed in the uterine adnexa in 12, in a pelvic lymphocyst in two, and in the uterus in one. Abscess drainage was performed in six cases. Three patients underwent laparotomy with salpingo-oophorectomy. CONCLUSION It is possible that not only surgical removal of the uterine cervix but also the use of nonabsorbable suture in cervical cerclage and placement of an intrauterine device triggered post-trachelectomy infection. Pelvic abscess can occur as a late complication of abdominal trachelectomy.
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Affiliation(s)
- Kaoru Okugawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenzo Sonoda
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuhiro Ohgami
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Yasunaga
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eisuke Kaneki
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Romano MJ, Toye P, Patchen L. Continuation of long-acting reversible contraceptives among Medicaid patients. Contraception 2018; 98:S0010-7824(18)30148-3. [PMID: 29702080 DOI: 10.1016/j.contraception.2018.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our objective was to compare continuation and complication rates of subdermal etonogestrel implants and intrauterine devices (IUDs) using Medicaid insurance claims. STUDY DESIGN We performed a retrospective cohort study using insurance claims data for 15- to 44-year-old subjects receiving implants or IUDs from 2012 to 2015 in a Medicaid managed care organization in Washington, DC, and Maryland. We performed a planned Kaplan-Meier survival analysis for long-acting reversible contraceptive (LARC) continuation, defined as the absence of a claim for LARC removal, during periods of continuous insurance plan enrollment. RESULTS Three thousand one hundred three subjects received 1335 implants and 1970 IUDs, with implants more common than IUDs among subjects 15-19 years old (rate ratio=2.42), and implants less common than IUDs for subjects 20-44 years old (rate ratio=0.54). Implants had higher continuation rates at 1 year than IUDs (81.0% vs. 76.7%, p=.01). The difference was larger among subjects 25 to 44 years old (84.1% vs. 79.3%, p=.03) compared with subjects 15 to 19 years old (89.5% vs. 86.8%, p=.09) and subjects 20 to 24 years old (75.7% vs. 73.2%, p=.44). Claims for potential complications were similarly uncommon for both implants and IUDs (8.09% vs. 6.95%, p=.65), as were claims for pregnancies prior to LARC removal (0.82% vs. 0.86%, p=.86). CONCLUSION Among a sample of 15- to 44-year-old Medicaid recipients, both implants and IUDs had high continuation rates and low complication rates; however, implants were slightly more likely than IUDs to remain in use 1 year after insertion. IMPLICATIONS Among 15- to 44-year-old Medicaid recipients, both etonogestrel implants and IUDs have high continuation rates and low complication rates at 1-year postinsertion; however, implants are slightly more likely than IUDs to remain in use at 1 year.
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Affiliation(s)
- Max J Romano
- MedStar Franklin Square Medical Center Department of Family Medicine, 9101 Franklin Square Dr. Baltimore, MD 21237; Johns Hopkins Bloomberg School of Public Health General Preventive Medicine Residency, 615 N. Wolfe St. Room WB602, Baltimore, MD 21205-1996.
| | - Patryce Toye
- MedStar Family Choice, 5233 King Ave, Ste. 400, Rosedale, MD 21237
| | - Loral Patchen
- MedStar Health Research Institute, 110 Irving St. NW Suite EB-7113, Washington, DC 20010; MedStar Washington Hospital Center, 110 Irving St. NW Suite EB-7113, Washington, DC 20010
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Law A, Liao L, Lin J, Yaldo A, Lynen R. Twelve-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg and subdermal etonogestrel implant in women aged 18-44: A retrospective claims database analysis. Contraception 2018; 98:S0010-7824(18)30142-2. [PMID: 29684326 DOI: 10.1016/j.contraception.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 03/27/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the 12-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg (LNG-IUS 13.5) and subdermal etonogestrel (ENG) implant in the US. STUDY DESIGN We identified women aged 18-44 who had an insertion of LNG-IUS 13.5 or ENG implant from the MarketScan Commercial claims database (7/1/2013-9/30/2014). Women were required to have 12 months of continuous insurance coverage prior to the insertion (baseline) and at least 12-months after (follow-up). Discontinuation was defined as presence of an insurance claim for pregnancy-related services, hysterectomy, female sterilization, a claim for another contraceptive method, or removal of the index contraceptive without re-insertion within 30 days. Using Cox regression we examined the potential impact of ENG implant vs. LNG-IUS 13.5 on the likelihood for discontinuation after controlling for patient characteristics. RESULTS A total of 3680 (mean age: 25.4 years) LNG-IUS 13.5 and 23,770 (mean age: 24.6 years) ENG implant users met the selection criteria. Prior to insertion, 56.6% of LNG-IUS 13.5 and 42.1% of ENG implant users had used contraceptives, with oral contraceptives being most common (LNG-IUS 13.5: 42.1%; ENG implant: 28.5%). Among users of LNG-IUS 13.5 and ENG implant, rates of discontinuation were similar during the 12-month follow-up (LNG-IUS 13.5: 24.9%; ENG implant: 24.0%). Regression results showed that women using LNG-IUS 13.5 vs. ENG implant had similar likelihood for discontinuation (hazard ratio: 0.97, 95% confidence interval: 0.90-1.05, p=.41). CONCLUSION In the real-world US setting, women aged 18-44 using LNG-IUS 13.5 and ENG implant have similar discontinuation rates after 12 months. IMPLICATIONS In the United States, women aged 18-44 using levonorgestrel intrauterine system (13.5 mg) and subdermal etonogestrel implant have similar discontinuation rates after 12 months.
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Affiliation(s)
- Amy Law
- Bayer HealthCare, Whippany, NJ.
| | | | - Jay Lin
- Novosys Health, Green Brook, NJ
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Sabbioni L, Petraglia F, Luisi S. Non-contraceptive benefits of intrauterine levonorgestrel administration: why not? Gynecol Endocrinol 2017; 33:822-829. [PMID: 28586290 DOI: 10.1080/09513590.2017.1334198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Levonorgestrel intrauterine systems (LNG-IUS) represent a modern therapy for an array of preexisting gynecological conditions, though they were first marketed in Finland in 1990. However, there are countries in which their use is extremely limited by social and cultural factors. This manuscript describes the possible reasons for this misuse, taking in consideration the clinical noncontraceptive benefits of intrauterine levonorgestrel in routinary practice. Medical diseases in which LNG-IUS represent a treatment include abnormal uterine bleeding, iron-deficiency anemia, endometrial hyperplasia, uterine fibroids, adenomyosis, endometriosis, and coagulopathies. The advantage of reducing the need for more radical treatments such as surgery or hysterectomy is well demonstrated, with remarkable benefits for patients. However, in many countries, surgery is still used as a first-line treatment and there is a need to define who could benefit from a less invasive option. It seems clear that such a reduced use of LNG-IUS depends on factors that imply both patients and practitioners, and that the role of counseling is becoming a key component in the decision-making process to reach the ultimate goal of compliance.
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Affiliation(s)
- Lorenzo Sabbioni
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Felice Petraglia
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Stefano Luisi
- a Obstetrics and Gynecology, Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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Howard DL, Ford A, Ceballos S, Volker KW. Temporal Trends in the Uptake and Continuation of the Etonogestrel Implant in a Large Private Practice Setting. J Womens Health (Larchmt) 2017; 27:191-195. [PMID: 28976797 DOI: 10.1089/jwh.2017.6468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess temporal trends in the uptake and continuation of the etonogestrel subdermal implant in a large private practice setting. METHODS This was a retrospective cohort study based on billing records from a large multispecialty private practice in Las Vegas, Nevada. We looked at women of all ages seeking long-acting reversible contraception (LARC) between January 1, 2013, and December 31, 2016. The main outcome measure was uptake of the etonogestrel subdermal implant, expressed as a fraction of all insertions of LARC across four calendar years (2013-2016). The Kaplan-Meier method was used to estimate 12-month continuation stratified by year of insertion. RESULTS There were 3477 total LARC insertions across the 4-year study period. In unadjusted analyses, the uptake of the etonogestrel implant increased from 3.0% of LARC insertions in 2013 to 9% in 2016 among women aged 30 years and older. For women younger than 30 years, the uptake of the implant stayed stable from 2013 to 2015 (22.8%, 21.7%, and 22.4%, respectively), but increased to 30.9% in 2016. We modeled the uptake of the implant as a function of year of insertion adjusted for age (continuous) and insurance status (private vs. Medicaid), and we stratified the models by age (younger than 30 years, 30 years, and older than 30 years). The positive association between year of insertion and uptake of the implant was significantly stronger for women aged 30 years and older, compared to women younger than 30 years. There was a progressive decrease in the 12-month continuation of implant from 2013 (95.7%) to 2015 (57.7%). CONCLUSIONS In this large private practice setting, among women aged 30 years and older, we observed a threefold increase in the uptake of the subdermal implant from 2013 to 2016. We also observed a significant decrease in the 12-month continuation of the implant over time. Further studies of implant uptake and continuation in the private practice setting are needed.
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Affiliation(s)
- David L Howard
- 1 Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center , Las Vegas, Nevada
| | - Avery Ford
- 2 Department of Molecular, Cellular and Developmental Biology, University of Colorado , Boulder, Colorado
| | - Sonia Ceballos
- 1 Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center , Las Vegas, Nevada
| | - K Warren Volker
- 1 Las Vegas Minimally Invasive Surgery and Women's Pelvic Health Center , Las Vegas, Nevada
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25
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Brunson MR, Klein DA, Olsen CH, Weir LF, Roberts TA. Postpartum contraception: initiation and effectiveness in a large universal healthcare system. Am J Obstet Gynecol 2017; 217:55.e1-55.e9. [PMID: 28257962 DOI: 10.1016/j.ajog.2017.02.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 02/07/2017] [Accepted: 02/21/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeat pregnancies after a short interpregnancy interval are common and are associated with negative maternal and infant health outcomes. Few studies have examined the relative effectiveness of postpartum contraceptive choices. OBJECTIVE We aimed to determine the initiation trends and relative effectiveness of postpartum contraceptive methods, with typical use, on prevention of short delivery intervals (≤27 months) among women with access to universal healthcare, including coverage that entails no co-payments and allows unlimited contraceptive method switching. STUDY DESIGN This retrospective cohort study included women who were enrolled in the United States military healthcare system who were admitted for childbirth between October 2010 and March 2015, with ≥6 months postpartum enrollment. With the use of insurance records, we determined the most effective contraceptive method initiated during the first 6 months after delivery, even if subsequently discontinued. Rates of interdelivery intervals of ≤27 months, as proxies for interpregnancy intervals ≤18 months, were determined with the use of the Kaplan-Meier estimator. Women who were disenrolled, who reached 27 months after delivery without another delivery, or who reached the end of the study period were censored. The influence of sociodemographic variables and contraceptive choices on time to subsequent delivery was evaluated by Cox regression analysis, which accounted for a possible correlation among multiple deliveries by an individual woman. RESULTS During the study timeframe, 373,840 women experienced a total of 450,875 postpartum intervals. Women averaged 27 (standard deviation, 5.3) years of age at the time of delivery; 33.9% of them were <25 years old; 15.5% of them were active duty service members, and 31.6% of them had insurance sponsors of junior enlisted rank (which suggests lower income). Postpartum contraceptive methods that were initiated included self or partner sterilization (7%), intrauterine device (13.5%), etonogestrel implant (3.4%), depot medroxyprogesterone acetate (2.5%), and pill, patch, or ring (36.8%). Furthermore, 36.7% of them did not initiate a prescription method. Etonogestrel implant initiation increased from 1.7% of postpartum women in the first year of our study to 5.3% in the final year. The estimated short interdelivery interval rate was 17.4%, but rates varied with contraceptive method: 1% with sterilization, 6% with long-acting reversible contraception, 12% with depot medroxyprogesterone, 21% with pill, patch, or ring, and 23% with no prescription method. In a multivariable analysis, the adjusted hazard of a short interdelivery interval was highest among women who were younger, on active duty, or with officer insurance sponsors. Compared with nonuse of any prescription contraceptive, the use of an intrauterine device reduced the hazard of a subsequent delivery (adjusted hazard ratio, 0.19; 95% confidence interval, 0.18-0.20), as did etonogestrel implant (adjusted hazard ratio, 0.21; 95% confidence interval, 0.19-0.23); the pill, patch, or ring had less effect (adjusted hazard ratio, 0.80; 95% confidence interval, 0.78-0.81). CONCLUSION Postpartum initiation of long-acting reversible contraception is highly effective at the prevention of short interdelivery intervals, whereas pill, patch, or ring methods are associated with rates of short interdelivery intervals similar to users of no prescription contraception. This study supports long-acting reversible contraception as first-line recommendations for postpartum women who wish to retain fertility but avoid early repeat pregnancy.
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Affiliation(s)
- Michael R Brunson
- Department of Pediatrics, San Antonio Military Medical Center, Fort Sam Houston, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - David A Klein
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cara H Olsen
- Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Larissa F Weir
- Obstetrics and Gynecology, San Antonio Military Medical Center, Fort Sam Houston, TX; Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Timothy A Roberts
- Department of Pediatrics, San Antonio Military Medical Center, Fort Sam Houston, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Abstract
A 17-year-old high school student who has never been pregnant presents for advice regarding contraception. She has an unremarkable medical history and is planning to become sexually active with her boyfriend in the near future. Her primary concern is an unintended pregnancy, and she inquires about methods of contraception that are highly effective. How would you counsel her about options for contraception?
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Affiliation(s)
- Kathryn M Curtis
- From the Centers for Disease Control and Prevention, Atlanta (K.M.C.); and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (J.F.P.)
| | - Jeffrey F Peipert
- From the Centers for Disease Control and Prevention, Atlanta (K.M.C.); and the Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis (J.F.P.)
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Sznajder KK, Tomaszewski KS, Burke AE, Trent M. Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic. J Pediatr Adolesc Gynecol 2017; 30:53-57. [PMID: 27423766 PMCID: PMC5203808 DOI: 10.1016/j.jpag.2016.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To estimate long-acting reversible contraception (LARC) discontinuation rates. Secondary aims were to determine risk factors for discontinuation, describe reasons for discontinuation, evaluate complications related to placement, and estimate pregnancy rates after discontinuation. DESIGN We conducted a retrospective cohort study of LARC method use through review of electronic medical record data. SETTING Our program is housed in an academic primary care pediatric and adolescent clinic in Baltimore, Maryland. PARTICIPANTS One hundred sixty women ages 12-24 years who received an intrauterine device or subdermal implant through our program between December 10, 2012 and December 10, 2015. INTERVENTIONS None. MAIN OUTCOME MEASURES Complications from LARC insertion, device discontinuation, reason(s) for discontinuation, pregnancies resulting from device failure, and occurrence of pregnancy within 1 year of discontinuation. RESULTS Thirty-five women discontinued their LARC method. The 6-month discontinuation rate was 11.3% and the 12-month rate was 21.9%. Discontinuation was associated with history of sexually transmitted infection (adjusted hazard ratio, 3.21; 95% confidence interval, 1.49-6.90). The most common reason for discontinuation was bleeding for the implant and expulsion for the intrauterine device. CONCLUSION Our results support the safety and low discontinuation rates of LARC provision to adolescents and young adult women in a primary care setting. Discontinuation rates and reasons are consistent with those described in other studies.
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Affiliation(s)
- Katharine K Sznajder
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Kathy S Tomaszewski
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne E Burke
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Trent
- Section on Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family, and Reproductive Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29:659-667. [PMID: 27386754 DOI: 10.1016/j.jpag.2016.06.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Adolescents are at high risk for unintended pregnancies. Although intrauterine devices (IUDs), long-acting reversible contraceptives (LARCs), are known to be highly effective in preventing pregnancy, little is known about IUD adherence in adolescents. In this systematic review (SR) we examined IUD continuation rates compared with other forms of contraception in young women aged 25 years and younger. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A systematic search of Ovid Medline, Cochrane Library, and Embase was conducted for the years 1946-2015. Included studies examined IUD use in women 25 years of age and younger, compared IUD use with another form of contraception, and measured continuation rates at 12 months. The quality of each study was appraised using the Downs and Black criteria, and 12-month continuation rates among studies were pooled and analyzed according to contraceptive type. RESULTS Of 3597 articles retrieved, 9 studies met criteria for SR. Synthesized across studies, 12-month continuation was significantly higher for IUD users (86.5%, 12,761/14,747) compared with oral contraceptives (39.6%, 1931/4873), Depo-Provera (Pfizer Inc, New York, NY) hormonal injection (39.8%, 510/1282), vaginal ring (48.9%, 196/401), and transdermal patch (39.8%, 37/93; all P values < .001). There was no statistically significant difference in 12-month continuation between the IUD and another LARC method, the subdermal etonogestrel implant (85.3%, 4671/5474). CONCLUSION Findings of this SR suggest that continuation rates for IUDs are generally higher compared with other contraceptive methods for women aged 25 years and younger. In a population with high rates of unintended pregnancies, generally low adherence, and imperfect use with other non-LARCs, IUD use should be encouraged.
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Affiliation(s)
- K M Usinger
- Columbia University School of Nursing, New York, New York
| | - S B Gola
- Columbia University School of Nursing, New York, New York
| | - M Weis
- Columbia University School of Nursing, New York, New York
| | - A Smaldone
- Columbia University School of Nursing, New York, New York.
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Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception 2016; 95:17-39. [PMID: 27771475 DOI: 10.1016/j.contraception.2016.10.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective was to determine the association between use of intrauterine devices (IUDs) by young women and risk of adverse outcomes. METHODS We searched Pubmed, CINAHL, Embase, Popline and the Cochrane Library for articles from inception of database through December 2015. For outcomes specific to IUD use (IUD expulsion and perforation), we examined effect measures for IUD users generally aged 25 years or younger compared with older IUD users. For outcomes of pregnancy, infection, pelvic inflammatory disease (PID), and heavy bleeding or anemia, we examined young IUD users compared with young users of other contraceptive methods or no method. RESULTS We identified 3169 articles of which 16 articles from 14 studies met our inclusion criteria. Six studies (Level II-2, good to poor) reported increased risk of expulsion among younger age groups compared with older age groups using copper-bearing (Cu-) IUDs. Two studies (Level II-2, fair) examined risks of expulsion among younger compared with older women using levonorgestrel-releasing (LNG-) IUDs; one reported no difference in expulsion, while the other reported increased odds for younger women. Four studies (Level II-2, good to poor) examined risk of expulsion among Cu- and LNG-IUD users combined and reported no significant differences between younger and older women. For perforation, four studies (Level II-2, fair to poor) found very low perforation rates (range, 0%-0.1%), with no significant differences between younger and older women. Pregnancies were generally rare among young IUD users in nine studies (Level I to II-2, fair to poor), and no differences were reported for young IUD users compared with young combined oral contraceptive (COC) or etonogestrel (ENG) implant users. PID was rare among young IUD users; one study reported no cases among COC or IUD users, and one reported no difference in PID among LNG-IUD users compared with ENG implant users from nationwide insurance claims data (Level I to II-2, fair). One study reported decreased odds of bleeding with LNG-IUD compared with COC use among young women, while one study of young women reported decreased odds of removal for bleeding with LNG-IUD compared with ENG implant (Level I to II-2, fair). CONCLUSION Overall evidence suggests that the risk of adverse outcomes related to pregnancy, perforation, infection, heavy bleeding or removals for bleeding among young IUD users is low and may not be clinically meaningful. However, the risk of expulsion, especially for Cu-IUDs, is higher for younger women compared with older women. If IUD expulsion occurs, a young woman is exposed to an increased risk of unintended pregnancy if replacement contraception is not initiated. IUDs are safe for young women and provide highly effective reversible contraception.
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Affiliation(s)
- Tara C Jatlaoui
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Halley E M Riley
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
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Chiles DP, Roberts TA, Klein DA. Initiation and continuation of long-acting reversible contraception in the United States military healthcare system. Am J Obstet Gynecol 2016; 215:328.e1-9. [PMID: 27005514 DOI: 10.1016/j.ajog.2016.03.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Long-acting reversible contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, long-acting reversible contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase long-acting reversible contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. OBJECTIVE We aimed to determine long-acting reversible contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. STUDY DESIGN This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. RESULTS During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their method at 36 months; however, 45.8% continued until 33 months (ie, 3 months before the currently recommended expiration date). Compared with intrauterine contraceptive users, implant users were more likely to discontinue their method during the 36 months after insertion (hazard ratio, 1.59; 95% confidence interval, 1.56-1.62; P < .001). Adolescents aged 14-19 years were the least likely age group to discontinue the implant before 36 months; women aged 35-40 years were the least likely to discontinue an intrauterine contraceptive before 60 months. In multivariable analysis that controlled for demographic factors and contraceptive type, early contraceptive method discontinuation was most likely among women aged 20-24 years, implant users, and women with method initiation in military clinics. CONCLUSION In the US military healthcare system, TRICARE Prime, the initiation of long-acting reversible contraception is low but increasing, and continuation rates are high. This evidence supports long-acting reversible contraception as first-line recommendations for women of all ages who seek contraception.
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Affiliation(s)
- Daniel P Chiles
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Timothy A Roberts
- Department of Pediatrics, San Antonio Military Medical Center, San Antonio, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - David A Klein
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
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Twelve-month discontinuation of etonogestrel implant in an outpatient pediatric setting. Contraception 2016; 94:81-6. [PMID: 26948183 DOI: 10.1016/j.contraception.2016.02.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/24/2016] [Accepted: 02/28/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The etonogestrel (ENG) contraceptive implant is the most effective reversible contraceptive method. Uptake remains limited in adolescents, a population at high risk for unintended pregnancy. The objectives of this study were to determine the 12-month discontinuation rate of the ENG implant among adolescents in an outpatient setting and to characterize risk factors for discontinuation. STUDY DESIGN A retrospective chart review identified adolescent females aged 12 to 22years who received the ENG implant in one pediatric institution between January 1, 2011, and April 15, 2014. Patients were categorized into ENG discontinuers (removed prior to 12months) and ENG continuers (continued for ≥12months). Associations between demographic, clinical and postplacement characteristics with ENG discontinuation category were assessed with t tests, χ(2)/Fisher's Exact Tests and backwards stepwise logistic regression. RESULTS Of the 750 patients who had an ENG implant inserted, 77 (10.3%) had the device removed prior to 12months of use. The mean length of implant use for those who discontinued was 7.5months. Problematic bleeding was the most commonly cited reason for discontinuation. Older age at time of insertion, history of pregnancy and ≥1 medical visit for implant concerns (not including removal) were independently predictive (p<.01) of method discontinuation. CONCLUSION The vast majority of adolescents continued the ENG implant at 12months, making it an excellent contraceptive choice for adolescents within the outpatient pediatric setting. Greater efforts should be made to increase its use by pediatric providers. IMPLICATIONS The ENG implant is an excellent contraceptive option for adolescents in the outpatient pediatric setting.
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Gallo MF, Legardy-Williams J, Hylton-Kong T, Rattray C, Kourtis AP, Jamieson DJ, Steiner MJ. Association of Progestin Contraceptive Implant and Weight Gain. Obstet Gynecol 2016; 127:573-576. [PMID: 26855107 PMCID: PMC11264238 DOI: 10.1097/aog.0000000000001289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate initiation of a two-rod, 150-mg levonorgestrel contraceptive implant on women's perceived and observed body weight. METHODS We conducted a secondary analysis of data from an open, randomized controlled trial of adult, nonpregnant, human immunodeficiency virus-negative women attending a public clinic in Kingston, Jamaica, who were assigned to initiate implant use either immediately or after a 3-month delay. The primary objective of the parent study was to assess the effect of initiation of the implant on the frequency of condom use. We compared study arms during follow-up using one-sided χ tests for differences in perceived weight gain and loss, one-sided Wilcoxon-Mann-Whitney tests for median gain in measured weight, and logistic regression with generalized estimating equations for risk of gaining greater than 2 kg. RESULTS From 2012 to 2014, women were assigned to the implant (n=208) or delay arm (n=206). At 3 months, more women in the implant arm (15.3%) reported perceived weight gain than in the control arm (4.3%) (P=.01). Despite differences in perception, the implant and control arms did not differ significantly in median weight gain at 1-month (0.0 kg and 0.0 kg, respectively; P=.44) and 3-month visits (0.5 kg and 0.0 kg, respectively; P=.27). Study arms did not differ in risk of gaining greater than 2 kg (odds ratio 0.9, 95% confidence interval 0.6-1.3). CONCLUSION We found no evidence of weight gain from short-term implant use. Through the power of the nocebo effect, the practice of counseling women to expect possible weight gain from initiating implant use could lead them to perceive weight gain even in its absence and contribute to the early discontinuation of this highly effective contraceptive method.
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Affiliation(s)
- Maria F Gallo
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio; the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; the Comprehensive Health Centre/Epidemiology Research and Training Unit and the University Hospital of the West Indies, the Ministry of Health, Kingston, Jamaica; and the Contraceptive Technology Innovation Division, FHI 360, Durham, North Carolina
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Chaudhry F. Nexplanon® removals in a community sexual and reproductive health service. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2016; 42:160-1. [PMID: 26747656 DOI: 10.1136/jfprhc-2015-101182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Farah Chaudhry
- Clinical Lead, Contraception and Sexual Health Kirklees, Princess Royal Hospital, Huddersfield, UK;
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Carlson C, Plonczynski DJ, Yao P. The Impact of Personal Characteristics on Contraceptive Choices and Use Over 5 years. SAGE Open Nurs 2016. [DOI: 10.1177/2377960816680824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Worldwide, there is an unintended pregnancy rate of 40%. That rate is higher in some areas, such as in the United States—where it is nearly 50%. These pregnancies have potentially negative outcomes for the mother and child that include health, economic, social, and psychological aspects. Long-acting reversible contraceptives (LARCs) are highly reliable methods for family planning. Identifying personal characteristics associated with choosing LARCs will better address the unintended pregnancy rates. The purpose of this research project was to evaluate characteristics of adolescents and women at high risk for unintended pregnancies by (a) describing the use of a LARC and selected personal characteristics for the years 2009 and 2014 and (b) exploring relationships among LARC choice and selected personal characteristics of clients seeking family planning services. A retrospective chart review was conducted on 268 randomly selected records, half of which were each from the years 2009 and 2014. One Midwestern U.S. family planning clinic was the site of the research. The characteristics used in the chart reviews were derived from the literature and Healthy People 2020 goals. Key differences between the years 2009 and 2014 included a significant increase in the number of LARCs prescribed to high-risk women. There was a significant relationship between the choice of a LARC and having used one in the past. Personal characteristics influencing LARC birth control choice included White, Hispanic females, those with a history of a teen pregnancy, those who experienced any previous pregnancy or live birth, and those below the poverty level. The findings indicate the importance of educating clients on LARC options. To foster initial use of a LARC, an application, based on the findings of this study, has been developed that provides individualized choices and education on contraceptive methods including LARCs.
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Affiliation(s)
- Cathy Carlson
- School of Nursing and Health Studies, Northern Illinois University, DeKalb, USA
| | | | - Ping Yao
- School of Nursing and Health Studies, Northern Illinois University, DeKalb, USA
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