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Han R, Zhang F, Jiang X, Wang C, Yang X. Effects of management of heavy menstrual bleeding of patients undergoing haploidentical hematopoietic stem cell transplantation. Int J Gynaecol Obstet 2024. [PMID: 39264070 DOI: 10.1002/ijgo.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/07/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE To investigate the benefits of menstrual management in women undergoing hematopoietic stem cell transplantation (HSCT), in whom heavy menstrual bleeding (HMB) can be an underestimated bleeding complication. METHODS This was a retrospective cohort study. Patients who had undergone HSCT in the Gynecological Endocrinology Clinic of Peking University People's Hospital were included over 10 years. The data of hematology and menstruation for all participants were collected. The management methods of the intervention group include gonadotropin-releasing hormone agonists (GnRHa), combined oral contraceptives (COC), or low-dose mifepristone. Patients who did not receive management were included in the control group. RESULTS There were 112 patients included in the intervention group and 218 patients included in the control group. In all, 90.0%(297/330) of patients presented with HMB before HSCT. In the control group, 83.5%(182/218) of patients experienced menstruation in the laminar air-flow room (LAFR), whereas only 22.3%(25/112) did in the intervention group. After leaving the LAFR, the incidence of recurrent uterine bleeding was significantly reduced in the intervention group (17.9%(20/112/) versus 50.9%(111/218), p < 0.001). Patients who did not undergo menstrual management had a higher risk of bleeding than those who did (odds ratio 18.12, p < 0.001). CONCLUSION Menstrual management significantly reduces the incidence of HMB in HSCT patients and acts as a protective factor to prevent menstrual bleeding in the LAFR.
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Affiliation(s)
- Ruxue Han
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
| | - Feifeng Zhang
- Medical College of Yichun University, Yichun, Jiangxi, China
| | - Xiaolin Jiang
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
| | - Chaohua Wang
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
| | - Xin Yang
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, China
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Creinin MD, Cagnacci A, Spaczyński RZ, Stute P, Chabbert-Buffet N, Korver T, Simoncini T. Experts' view on the role of oestrogens in combined oral contraceptives: emphasis on oestetrol (E4). Front Glob Womens Health 2024; 5:1395863. [PMID: 38655395 PMCID: PMC11035732 DOI: 10.3389/fgwh.2024.1395863] [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: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The evolution of contraception has been crucial for public health and reproductive well-being. Over the past 60 years, combined oral contraceptives (COCs) have remained an important part of the contraceptive landscape worldwide; continued development has worked toward maintaining efficacy and improving safety. Methods Seven global experts convened to discuss the clinical relevance of the oestrogen in COCs, focusing on the impact of the new oestrogen, oestetrol (E4). Participants then commented through an online forum on the summary content and other participants' feedback. We prepared this report to describe the experts' views, their follow-up from the open forum and the evidence supporting their views. Results Ethinylestradiol (EE) and oestradiol (E2) affect receptors similarly whereas E4 has differential effects, especially in the liver and breast. Adequate oestrogen doses in COCs ensure regular bleeding and user acceptability. EE and E4 have longer half-lives than E2; accordingly, COCs with EE and E4 offer more predictable bleeding than those with E2. Oestrogen type and progestin influence VTE risk; E2 poses a lower risk than EE; although promising, E4/DRSP VTE risk is lacking population-based data. COCs alleviate menstrual symptoms, impact mental health, cognition, libido, skin, and bone health. Conclusion Oestrogens play an important role in the contraceptive efficacy, bleeding patterns, and overall tolerability/safety of COCs. Recent studies exploring E4 combined with DRSP show promising results compared to traditional formulations, but more definitive conclusions await further research.
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Affiliation(s)
- M. D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, United States
| | - A. Cagnacci
- Academic Unit of Obstetrics and Gynecology, DINOGMI, IRCCS-Azienda Ospedaliera Universitaria San Martino di Genova, Genova, Italy
| | - R. Z. Spaczyński
- Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - P. Stute
- Department of Obstetrics and Gynecology, Bern University Hospital, Bern, Switzerland
| | - N. Chabbert-Buffet
- Gynécologie—Obstétrique et Médecine de la Reproduction—Maternité, Hospital Tenon, Paris, France
| | - T. Korver
- Reprovision Clinical Consultancy, Oss, Netherlands
| | - T. Simoncini
- Division of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Nielson MG, Beltz AM. Oral contraceptive use is not related to gender self-concept. Psychoneuroendocrinology 2021; 129:105271. [PMID: 34030085 PMCID: PMC8265989 DOI: 10.1016/j.psyneuen.2021.105271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
Oral contraceptive (OC) use is a valuable and underutilized natural experiment for examining exogenous hormone effects on aspects of cognition and behavior, especially aspects that show sex or gender differences. OC use, however, is not randomly assigned; women who use OCs may systematically differ from non-users for gender-linked reasons that potentially confound investigations of the pharmacokinetic effects of OCs. Thus, the primary aim of this study was to investigate whether OC users and non-users differ in gender self-concepts, as sociocultural factors might influence who uses OCs and why. A secondary aim was to examine whether OC users of different pill formulations differ in gender self-concept. Multivariate analyses of covariance (controlling for age) on a large sample of 395 young adult women revealed no significant differences between OC users (n = 247) and non-users (n = 148) in four aspects of gender self-concept (expressivity, instrumentality, femininity, and masculinity), with univariate effect sizes averaging d = 0.07. Moreover, inferences about group differences did not change when considering sociocultural factors (i.e., reason for OC use) or pharmacokinetic properties of the pills (i.e., androgenicity). Thus, findings indicate that differences in gender self-concept do not underlie OC use and non-use, and that the androgenicity of different OC formulations does not impact gender self-concept. Taken together, findings also highlight the specificity of exogenous ovarian hormone influences, as there are documented effects on cognition but not on personal characteristics, such as gender self-concept.
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Hedayati M, Rajabi S, Nikzamir A. Papillary Thyroid Cancer-Promoting Activities of Combined Oral Contraceptive Components. Galen Med J 2020; 9:e1648. [PMID: 34466561 PMCID: PMC8343887 DOI: 10.31661/gmj.v9i0.1648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/17/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Thyroid cancer is more common in women at reproductive age, suggesting the relationship between its high-incidence and therapeutic use of hormonal medications, such as oral contraceptives (OCPs). The aim of this study was to identify the effect of low-dose combined OCP (LD-COC) on proliferation, apoptosis, and migration of human papillary thyroid cancer (PTC) BCPAP cell line. Materials and Methods:
BCPAP cells were cultured and treated with the combination of 90nM levonorgestrel (LNG) and 20nM ethinylestradiol (EE) for 48 hours. Afterward, using 3-(4, 5-dimethylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide (MTT) assay, the proliferation of the cells was measured. Apoptosis was determined by using a Caspase-3 ELISA kit. Migratory properties of combined LNG and EE were studied through wound scratch assay. The expression levels of pro-apoptotic factor BAX, anti-apoptotic factor Bcl2, and proliferation marker Ki67 were analyzed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and western blotting.
Results:
Upon treatment with the combination of LNG and EE, proliferation and migration of BCPAP cells were significantly enhanced. However, LNG and EE remarkably inhibited apoptosis of these cells. Furthermore, treating PTC cells with combined LNG and EE caused a marked increase in the expression of Bcl2 and Ki67 and a considerable decrease in BAX levels (P˂0.05).
Conclusion: Our data linked the use of COCs and the progression and aggressiveness of PTC, suggesting the role of these hormonal compounds as promoting factors for PTC tumors. Despite these observations, further investigations will be required to fully establish the pathogenic impact of these medications on PTC.
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Affiliation(s)
- Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadegh Rajabi
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdolrahim Nikzamir
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to: Abdolrahim Nikzamir, Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, No 28, Kodakyar St, Velenjak, Tehran, Iran Telephone Number: 0711-2349332 Email Address:
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Bitzer J, Marin V, Lira J. Contraceptive counselling and care: a personalized interactive approach. EUR J CONTRACEP REPR 2018; 22:418-423. [DOI: 10.1080/13625187.2017.1414793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Johannes Bitzer
- Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland
| | | | - Josefina Lira
- Department of Adolescent Gynecology, Instituto Nacional de Perinatologia, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Albuquerque APDS, Pitangui ACR, Rodrigues PMG, Araújo RCD. Prevalence of rapid repeat pregnancy and associated factors in adolescents in Caruaru, Pernambuco. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-93042017000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to determine the prevalence and factors associated with the rapid repeat pregnancy (RRP) in pregnant adolescents. Methods: a cross-sectional study was carried out with pregnant adolescents assisted at the Family Health Strategies in Caruaru-PE from March to August 2013. A questionnaire with sociodemographic, economic, schooling, gynecological, obstetric and contraceptive characteristics was used. The data were analyzed in the Statistical Package for Social Sciences (SPSS), version 20. Binary logistic regression models were used. Results: among the 204 pregnant adolescents interviewed, the data of 26.5% (n = 54) multiparous were analyzed. The occurrence of RRP was 42.6% (n = 23) [95% CI 29.23-56.79]. The variables associated with RRP were non-use of contraceptive methods [OR 7.40 (CI95% 1.56-3.49)] and no previous pregnancy planning [OR 0.19 (95% CI 0.05-0.78)]. Conclusions: the percentage of RRP in adolescents was high. The non-use of contracep-tive methods increased the chances of RRP, while the no previous pregnancy planning decreased the chances of adolescents getting pregnant again without previous program-ming.
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Bitzer J, Abalos V, Apter D, Martin R, Black A. Targeting factors for change: contraceptive counselling and care of female adolescents. EUR J CONTRACEP REPR 2016; 21:417-430. [PMID: 27701924 DOI: 10.1080/13625187.2016.1237629] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sexual and reproductive health care should empower and enable all individuals to have a sex life that is as safe and pleasurable as possible. Achievement of this goal for adolescents is often impeded by regional and sociocultural barriers. OBJECTIVES To review global barriers to provision of effective counselling and care of adolescents seeking advice on contraception and sexual and reproductive health and identify elements of best practice that can be adapted to meet their needs at regional level. METHODS Experts with clinical experience and a scholarly background in the provision of contraceptive services to adolescents participated in a stepwise process of literature review and discussion according to the agreed objectives. RESULTS The Global CARE (Contraception: Access, Resources, Education) group identified barriers to the access, availability and acceptance of contraception by adolescents, not only at the political and sociocultural level but also within health care practice. The group collected and summarized successful local strategies and tools suitable for adaptation in other regions. Elements of best practice for providing contraception regardless of setting or regional constraints, including required skills, knowledge, and attitudes, were also proposed. CONCLUSION Sharing of evidence-based best practice in delivering contraceptive services, improvements in health care provider education, and sharing of experience between countries will hopefully help to overcome the barriers to appropriate and effective counselling and care of adolescents.
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Affiliation(s)
- Johannes Bitzer
- a Department of Obstetrics and Gynecology , University Hospital , Basel , Switzerland
| | | | - Dan Apter
- c Sexual Health Clinic , Väestöliitto (Family Federation of Finland) , Helsinki , Finland
| | - Ricardo Martin
- d Department of OB-GYN , Hospital Universitario Fundación Santa Fe de Bogota , Bogotá , Colombia
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Trends in the use of oral contraceptives among adolescents and young women in Spain. Reprod Health 2016; 13:122. [PMID: 27664123 PMCID: PMC5035482 DOI: 10.1186/s12978-016-0239-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background We aimed to determine the prevalence of consumption of oral contraceptives (OCs) among adolescents and young women living in Spain and to identify the factors associated with this consumption. Methods We performed a cross-sectional study on the consumption of OCs by women aged 15–30 years residing in Spain. We used secondary individualized data from the 2006 (n = 2513) and 2012 (n = 1530) Spanish National Health Surveys. The dependent variable was the use of OCs in the previous 2 weeks. Independent variables included sociodemographic characteristics, comorbidity, lifestyle, and healthcare resource utilization. The prevalence of OC consumption was analysed by investigating the changes observed between 2006 and 2012. We used multivariate logistic regression to identify the independent factors associated with OC use in each year. Results In 2006, 14.42 % of women reported using OCs; this percentage dropped to 10.21 % in 2012 (p < 0.05). Multivariate analysis revealed an association between OC use and visits to the gynaecologist (AOR, 5.60 [95 % CI, 2.93–10.73] in 2006; and AOR, 3.55 [95 % CI, 1.30–9.73] in 2012), Pap smear tests (AOR, 1.8 [95 % CI, 1.23–2.87] in 2006; and AOR, 2.42 [95 % CI, 1.30–4.51] in 2012), and smoking in 2006 (AOR, 1.42 [95 % CI, 1.04–1.93]). Conclusions There was a significant decrease in OC use from 2006 to 2012 among adolescents and young women living in Spain. In the present study, consumers of OCs were women who visited a gynaecologist more often and complied more with preventive measures such as Pap smear testing. Also, women who reported having used OCs were more likely to smoke than the rest of the study population, although the smoking habit is a risk factor for thrombotic events in women who take OCs.
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Endometrial Cancer: Using Evidence to Impact Practice and Policy. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vilallonga R, Himpens J, van de Vrande S. Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years). Obes Facts 2016; 9:91-100. [PMID: 27035348 PMCID: PMC5644862 DOI: 10.1159/000442758] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/24/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few data are available about obesity surgery in adolescent patients. OBJECTIVE To assess long-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients <18 years. SETTING University Hospital, Europe. METHODS A retrospective study of prospectively collected data of patients <18 years (childhood group; ChG) (n = 28) treated by LRYGB of which 19 were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). This group of patients was matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period. The extensive survey included a telephonic questionnaire. RESULTS 19 (12 females) of the 28 patients (67.9%) were available for follow-up. Preoperatively, 3 had type 2 diabetes mellitus (T2DM), 1 arterial hypertension, 5 dyslipidemia and 1 sleep apnea. In the ChG, average BMI after 7 years dropped from 38.9 kg/m2 preoperatively to 27.5 kg/m2. In the AdG, average BMI decreased from 39.4 to 27.1 kg/m2 in the same time period (nonsignificant between groups). One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions). All patients resolved their initial comorbidities. Two of 12 female patients in the ChG became pregnant 6 and 8 years after surgery, respectively, despite seemingly adequate oral contraception. Compliance with postoperative guidelines was good in 16/19 patients in ChG and in 14/18 patients in the AdG. Overall degree of satisfaction was high: 8.2/10 (SD 1.2, range 6-10) in the ChG and 8.9/10 (SD 1.7, range 5-10) in the AdG. CONCLUSION LRYGB seems to be safe, provide good weight loss, and cure comorbidities in an adolescent population. Satisfaction degree is high. Inadvertent pregnancy despite conventional contraception is a possible issue.
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Affiliation(s)
- Ramon Vilallonga
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde, Belgium
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Lawton B, Makowharemahihi C, Cram F, Robson B, Ngata T. Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers. J Prim Health Care 2016; 8:52-9. [DOI: 10.1071/hc15021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Timely and equitable access to contraception enables teenage mothers to make informed choices about their sexual and reproductive health. This study aimed to identify barriers and facilitators to contraception for Māori teenagers who become mothers.
METHODS
‘E Hine’ is a longitudinal qualitative Kaupapa Māori (by Māori for Māori) study involving Māori women (aged 14–19 years), following them through pregnancy (n = 44) and the birth of their babies until their babies’ first birthdays (n = 41). This analysis focusses on contraception access pre-and post-pregnancy.
FINDINGS
Pre-pregnancy most participants accessed contraception or advice. Contraception use was compromised by a lack of information, negative side effects, and limited follow up. All reported their subsequent pregnancies as unplanned. Participants gave considerable thought to post-pregnancy contraception. Despite this many experienced clinical and service delays, financial barriers, and negative contraceptive side effects. There was little focus on contraception initiation and a lack of integrated care between midwives and other primary care services, leaving many participants without timely effective contraception. The system worked well when there was a contraception plan that included navigation, free access, and provision of contraception.
CONCLUSION
The majority of participants actively sought contraception pre- and post-conception. Despite a publicly funded system, a lack of health sector integration resulted in multiple missed opportunities to meet the needs of these teenagers for effective contraception. Health service funding formulas should define the goal as initiation of contraception rather than advice and provide funding to improve timely access to long acting reversible contraception.
KEYWORDS
Indigenous teenage pregnancy; contraception; barriers to contraception; Māori mothers
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Transition von der Kindheit in das Erwachsenenalter bei chronischen Krankheiten. MED GENET-BERLIN 2015. [DOI: 10.1007/s11825-015-0066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Dank des medizinischen Fortschritts erleben zunehmend mehr Kinder mit chronischen Erkrankungen das Erwachsenenalter. Patienten mit angeborenen Stoffwechselkrankheiten stellen nur eine, jedoch in ihrer Größe und Problematik besondere Gruppe heranwachsender Patienten dar. Allerdings fehlen vielfach begleitende Strukturen im Gesundheitssystem, um eine erfolgreiche Transition zu ermöglichen. Dies kann zu erheblicher Beeinträchtigung der Gesundheit der Betroffenen führen. Der Artikel beschreibt den Transitionsprozess des gesunden Adoleszenten zum jungen Erwachsenen sowie die Schwierigkeiten dieses Prozesses für chronisch kranke junge Menschen mit erhöhtem Bedarf an Gesundheitsbetreuung, die zusätzlich den Übergang aus der pädiatrischen Medizin in die Erwachsenenmedizin zu bewältigen haben.
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Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review. J Womens Health (Larchmt) 2015. [PMID: 25825986 PMCID: PMC4441000 DOI: 10.1080/13625187.2017.1414793 10.1089/jwh.2015.5191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.
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