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Barton BE, Erickson JA, Allred SI, Jeffries JM, Stephens KK, Hunter MI, Woodall KA, Winuthayanon W. Reversible female contraceptives: historical, current, and future perspectives†. Biol Reprod 2024; 110:14-32. [PMID: 37941453 PMCID: PMC10790348 DOI: 10.1093/biolre/ioad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.
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Affiliation(s)
- Brooke E Barton
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffery A Erickson
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Stephanie I Allred
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jenna M Jeffries
- College of Art & Science, Washington State University, Pullman, WA, USA
| | - Kalli K Stephens
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
- Translational Bioscience Program, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Mark I Hunter
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Kirby A Woodall
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Wipawee Winuthayanon
- OB/GYN & Women’s Health, School of Medicine, University of Missouri, Columbia, MO, USA
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2
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Yland JJ, Wesselink AK, Hernandez-Diaz S, Huybrechts K, Hatch EE, Wang TR, Savitz D, Kuohung W, Rothman KJ, Wise LA. Preconception contraceptive use and miscarriage: prospective cohort study. BMJ MEDICINE 2023; 2:e000569. [PMID: 37705685 PMCID: PMC10496668 DOI: 10.1136/bmjmed-2023-000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 09/15/2023]
Abstract
Objectives To evaluate the association between preconception contraceptive use and miscarriage. Design Prospective cohort study. Setting Residents of the United States of America or Canada, recruited from 2013 until the end of 2022. Participants 13 460 female identified participants aged 21-45 years who were planning a pregnancy were included, of whom 8899 conceived. Participants reported data for contraceptive history, early pregnancy, miscarriage, and potential confounders during preconception and pregnancy. Main outcome measure Miscarriage, defined as pregnancy loss before 20 weeks of gestation. Results Preconception use of combined and progestin-only oral contraceptives, hormonal intrauterine devices, copper intrauterine devices, rings, implants, or natural methods was not associated with miscarriage compared with use of barrier methods. Participants who most recently used patch (incidence rate ratios 1.34 (95% confidence interval 0.81 to 2.21)) or injectable contraceptives (1.44 (0.99 to 2.12)) had higher rates of miscarriage compared with recent users of barrier methods, although results were imprecise due to the small numbers of participants who used patch and injectable contraceptives. Conclusions Use of most contraceptives before conception was not appreciably associated with miscarriage rate. Individuals who used patch and injectable contraceptives had higher rates of miscarriage relative to users of barrier methods, although these results were imprecise and residual confounding was possible.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology and CAUSALab, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Krista Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - David Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Wendy Kuohung
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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3
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Jindal AB, Bhide AR, Salave S, Rana D, Benival D. Long-acting Parenteral Drug Delivery Systems for the Treatment of Chronic Diseases. Adv Drug Deliv Rev 2023; 198:114862. [PMID: 37160247 DOI: 10.1016/j.addr.2023.114862] [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: 12/30/2022] [Revised: 03/12/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
The management of chronic conditions often requires patients to take daily medication for an extended duration. However, the need for daily dosing can lead to nonadherence to the therapy, which can result in the recurrence of the disease. Long-acting parenteral drug delivery systems have the potential to improve the treatment of chronic conditions. These systems use various technologies, such as oil-based injectables, PLGA-based microspheres, and in situ forming gel-based depots, to deliver different types of drugs. The use of long-acting parenteral formulations for the treatment of chronic infections such as HIV/AIDS and tuberculosis is a recent development in the field. Researchers are also exploring the use of long-acting parenteral formulations for the treatment of malaria, with the aim of reducing dosing frequency and improving adherence to treatment. This review discusses various aspects of long-acting formulation development, including the impact of the physicochemical properties of the drug, the type of long-acting formulation, and the route of administration. The clinical significance of long-acting formulations and recent advances in the field, such as long-acting nanoformulations and long-acting products currently in clinical trials, have also been highlighted.
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Affiliation(s)
- Anil B Jindal
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Jhunjhunu, Rajasthan - 333031, India.
| | - Atharva R Bhide
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, Jhunjhunu, Rajasthan - 333031, India
| | - Sagar Salave
- National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A) An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Opp. Airforce Station, Palaj, Gandhinagar - 382355, Gujarat, India
| | - Dhwani Rana
- National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A) An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Opp. Airforce Station, Palaj, Gandhinagar - 382355, Gujarat, India
| | - Derajram Benival
- National Institute of Pharmaceutical Education and Research - Ahmedabad (NIPER-A) An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Opp. Airforce Station, Palaj, Gandhinagar - 382355, Gujarat, India
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4
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Akintomide H, James A, Moffat M, Barnes P, Rankin J. Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type. BMJ Open 2022; 12:e060606. [PMID: 36192095 PMCID: PMC9535170 DOI: 10.1136/bmjopen-2021-060606] [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: 11/24/2022] Open
Abstract
OBJECTIVES No copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A systematic review to determine which IUDs have higher continuation rates in young nulliparous women was undertaken. DESIGN Systematic review and meta-analyses of available evidence based on IUD type. DATA SOURCES AMED, BNI, CINAHL, DARE, EMBASE, EMCARE, HMIC, MEDLINE, PsycINFO, PubMed, TRIP, and the Cochrane Library electronic databases were searched from inception to 11 May 2022; as well as the Bandolier, Medicines and Healthcare products Regulatory Agency, Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, Department of Health, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines, WHO and Google Scholar websites. ELIGIBILITY CRITERIA All studies on IUDs currently available in the UK or comparable (same design and size) to those available in the UK, involving nulliparous women of any age including those aged under 30. DATA EXTRACTION AND SYNTHESIS Independently extracted data were assessed as low risk of bias using the Mixed Methods Appraisal Tool. Random effects meta-analyses of proportions were performed where data, including subgroups, were amenable to quantitative synthesis. Heterogeneity was reported using tau2 and I2 statistics, and sensitivity analyses were also performed. RESULTS Nineteen studies involving 13 045 nulliparous women were included but the heterogeneity of participant ages, parity and IUD types made quantitative synthesis of outcome data in totality inappropriate. The highest continuation rate obtained was 91.02% (95% CI 88.01% to 93.64%) for the smaller TCu 380A at 12 months post insertion. CONCLUSIONS Evidence for IUD use in young nulliparous women based on IUD type remains limited. Smaller sized IUD types appear better suited to this group of IUD users, however, more research is needed. PROSPERO REGISTRATION NUMBER CRD42019120969.
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Affiliation(s)
- Hannat Akintomide
- Sexual Health Services, New Croft Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alison James
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Pam Barnes
- Sexual Health Services, New Croft Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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D'Souza A, Marshall LR, Yoon J, Kulesha A, Edirisinghe DIU, Chandrasekaran S, Rathee P, Prabhakar R, Makhlynets OV. Peptide hydrogel with self-healing and redox-responsive properties. NANO CONVERGENCE 2022; 9:18. [PMID: 35478076 PMCID: PMC9046503 DOI: 10.1186/s40580-022-00309-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/06/2022] [Indexed: 06/12/2023]
Abstract
We have rationally designed a peptide that assembles into a redox-responsive, antimicrobial metallohydrogel. The resulting self-healing material can be rapidly reduced by ascorbate under physiological conditions and demonstrates a remarkable 160-fold change in hydrogel stiffness upon reduction. We provide a computational model of the hydrogel, explaining why position of nitrogen in non-natural amino acid pyridyl-alanine results in drastically different gelation properties of peptides with metal ions. Given its antimicrobial and rheological properties, the newly designed hydrogel can be used for removable wound dressing application, addressing a major unmet need in clinical care.
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Affiliation(s)
- Areetha D'Souza
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA
| | - Liam R Marshall
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA
| | - Jennifer Yoon
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA
| | - Alona Kulesha
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA
| | - Dona I U Edirisinghe
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA
| | - Siddarth Chandrasekaran
- National Biomedical Center for Advanced ESR Technology, Department of Chemistry and Chemical Biology, Cornell University, Ithaca, NY, 14583, USA
| | - Parth Rathee
- Department of Chemistry, University of Miami, Coral Gables, FL, 33146, USA
| | - Rajeev Prabhakar
- Department of Chemistry, University of Miami, Coral Gables, FL, 33146, USA
| | - Olga V Makhlynets
- Department of Chemistry, Syracuse University, 111 College Place, Syracuse, NY, 13244, USA.
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6
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Bao G, Wang K, Yang L, He J, He B, Xu X, Zheng Y. Feasibility evaluation of a Zn-Cu alloy for intrauterine devices: In vitro and in vivo studies. Acta Biomater 2022; 142:374-387. [PMID: 35108602 DOI: 10.1016/j.actbio.2022.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
The comprehensively adopted copper-containing intrauterine devices (Cu-IUDs) present typical adverse effects such as bleeding and pain at the initial stage of post-implantation. The replacement of Cu material is demanded. Zinc and its alloys, the emerging biodegradable materials, exhibited contraceptive effects since 1969. In this work, we evaluated the feasibility of bulk Zn alloys as IUD active material. Using pure Cu and pure Zn as control groups, we investigated the contraceptive performance of Zn-0.5Cu and Zn-1Cu alloys via in vitro and in vivo tests. The results showed that the main corrosion product of Zn-Cu alloys is ZnO from both in vitro and in vivo studies. CaZn2(PO4)2·2H2O is formed atop after long-term immersion in simulated uterine fluid, whereas CaCO3 is generally formed atop after implantation in the rat uterine environment. The cytocompatibility of the Zn-1Cu alloy was significantly higher than that of the pure Zn and pure Cu to the human endometrial epithelial cell lines. Furthermore, the in vivo results showed that the Zn-1Cu alloy presented much improved histocompatibility, least damage and the fastest recovery on endometrium structure in comparison to pure Zn, Zn-0.5Cu and pure Cu. The systematic and comparing studies suggest that Zn-1Cu alloy can be considered as a possible candidate for IUD with great biochemical and biocompatible properties as well as high contraceptive effectiveness. STATEMENT OF SIGNIFICANCE: The existing adverse effects with the intrinsic properties of copper materials for copper-containing intrauterine devices (Cu-IUD) are of concerns in their employment. Such as burst release of cupric ions (Cu2+) at the initial stage of the Cu-IUD. Zinc and its alloys which have been emerging as a potential biodegradable material exhibited contraceptive effects since 1969. In this study, Zn-1Cu alloys displayed significantly improved biocompatibility with human uterus cells and a decreased inflammatory response within the uterus. Therefore, high antifertility efficacy of the Zn-1Cu alloy was well maintained, while the adverse effects are significantly eased, suggesting that the Zn-1Cu alloy is promising for IUD.
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Affiliation(s)
- Guo Bao
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing 100081, China
| | - Kun Wang
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing 100081, China; Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Lijun Yang
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing 100081, China; Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Jialing He
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing 100081, China
| | - Bin He
- Department of Reproduction and Physiology, National Research Institute for Family Planning, Beijing 100081, China.
| | - Xiaoxue Xu
- School of Mathematical and Physical Sciences, Faculty of Science, University of Technology Sydney, NSW 2007, Australia.
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, No.5 Yi-He-Yuan Road, Hai-Dian District, Beijing 100871, China; International Research Organization for Advanced Science and Technology, Kumamoto University, 2-39-1 Kurokami, Chuo-Ku, Kumamoto 860-8555, Japan.
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7
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Tanko RF, Bunjun R, Dabee S, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Harryparsad R, Happel AU, Gamieldien H, Qumbelo Y, Sinkala M, Scoville CW, Heller K, Baeten JM, Bosinger SE, Burgener A, Heffron R, Jaspan HB, Passmore JAS. The Effect Of Contraception On Genital Cytokines In Women Randomized To Copper Intrauterine Device, Intramuscular Depot Medroxyprogesterone Acetate Or Levonorgestrel Implant. J Infect Dis 2022; 226:907-919. [PMID: 35263421 PMCID: PMC9470113 DOI: 10.1093/infdis/jiac084] [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: 10/07/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ECHO Trial randomized women to intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG-implant), or copper intrauterine device (Cu-IUD). In a sub-study of the ECHO Trial, we tested the hypothesis that contraceptives influence genital inflammation by comparing cervicovaginal cytokine changes following contraception initiation. In addition, we compared cytokine profiles in women who acquired HIV (cases) versus those remaining HIV-negative (controls). METHODS Women (n=251) from South Africa and Kenya were included. Twenty-seven cervicovaginal cytokines were measured by Luminex at baseline, 1- and 6-month post-contraceptive initiation. In addition, cytokines were measured pre-seroconversion in HIV cases (n=25) and controls (n=100). RESULTS At 6-months post-contraceptive initiation, women using Cu-IUD had increased concentrations of 25/27 cytokines compared to their respective baseline concentrations. In contrast, women initiating DMPA-IM and LNG-implant did not experience changes in cervicovaginal cytokines. Pre-seroconversion concentrations of IL-1β, IL-6, and TNF-α, previously associated with HIV risk, correlated with increased HIV risk in a logistic regression analysis, although not significantly after correcting for multiple comparisons. Adjusting for contraceptive arm did not alter these results. CONCLUSION Although Cu-IUD use broadly increased cervicovaginal cytokine concentrations at 6-months post-insertion, these inflammatory changes were found not to be a significant driver of HIV risk.
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Affiliation(s)
- Ramla F Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Rushil Harryparsad
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Yamkela Qumbelo
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Musalula Sinkala
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Jared M Baeten
- University of Washington, Seattle, USA.,Gilead Sciences, Foster City, USA
| | - Steven E Bosinger
- Emory University, Atlanta, USA.,Yerkes National Primate Research Center, Atlanta, USA
| | - Adam Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Ohio, USA.,Department of Obstetrics & Gynecology and Medical Microbiology, University of Manitoba, Canada.,Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Heather B Jaspan
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,Seattle Children's Research Institute, Seattle, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,NRF-DST CAPRISA Centre of Excellence in HIV Prevention, Durban, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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8
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Wang K, Bao G, Fan Q, Zhu L, Yang L, Liu T, Zhang Z, Li G, Chen X, Xu X, Xu X, He B, Zheng Y. Feasibility evaluation of a Cu-38 Zn alloy for intrauterine devices: In vitro and in vivo studies. Acta Biomater 2022; 138:561-575. [PMID: 34774783 DOI: 10.1016/j.actbio.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/01/2022]
Abstract
The existing adverse effects of copper in copper-containing intrauterine devices (Cu-IUDs) have raised concerns regarding their use. These adverse effects include burst release of cupric ions (Cu2+) at the initial stage and an increasingly rough surface of the Cu-IUDs. In this study, we investigated the use of two copper alloys, Cu-38 Zn and H62 as the new upgrading or alternative material for IUDs. Their corrosive properties were studied in simulated uterine fluid (SUF) by using electrochemical methods, with pure Cu as a control. We studied the in vitro long-term corrosion behaviors in SUF, cytotoxicity to uterine cells (human endometrial epithelial cells and human endometrial stromal cells), in vivo biocompatibility and contraceptive efficacy of pure Cu, H62, and Cu-38 Zn. In the first month, the burst release rate of Cu2+ in the Cu-38 Zn group was significantly lower than those in the pure Cu and H62 groups. The in vitro cytocompatibility Cu-38 Zn was better than that of pure Cu and H62. Moreover, Cu-38 Zn showed improved tissue biocompatibility in vivo experiments. Therefore, the contraceptive efficacy of the Cu-38 Zn is still maintained as high as the pure Cu while the adverse effects are significantly eased, suggesting that Cu-38 Zn can be a suitable potential candidate material for IUDs. STATEMENT OF SIGNIFICANCE: The existing adverse effects associated with the intrinsic properties of copper materials for copper-containing intrauterine devices (Cu-IUD) are of concern in their employment. Such as, burst release of cupric ions (Cu2+) at the initial stage and an increasingly rough surface of the Cu-IUD. In this work, Cu alloyed with a high amount of bioactive Zn was used for a Cu-IUD. The Cu-38 Zn alloy exhibited reduced burst release of Cu2+ within the first month compared with the pure Cu and H62. Furthermore, the Cu-38 Zn alloy displayed significantly improved biocompatibility and a much smoother surface. Therefore, high antifertility efficacy of the Cu-38 Zn alloy was well maintained, while the adverse effects are significantly eased, suggesting that the Cu-38 Zn alloy is promising for a Cu-IUD.
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9
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Abraham J, Dowling K, Florentine S. Can Copper Products and Surfaces Reduce the Spread of Infectious Microorganisms and Hospital-Acquired Infections? MATERIALS (BASEL, SWITZERLAND) 2021; 14:3444. [PMID: 34206230 PMCID: PMC8269470 DOI: 10.3390/ma14133444] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 01/04/2023]
Abstract
Pathogen transfer and infection in the built environment are globally significant events, leading to the spread of disease and an increase in subsequent morbidity and mortality rates. There are numerous strategies followed in healthcare facilities to minimize pathogen transfer, but complete infection control has not, as yet, been achieved. However, based on traditional use in many cultures, the introduction of copper products and surfaces to significantly and positively retard pathogen transmission invites further investigation. For example, many microbes are rendered unviable upon contact exposure to copper or copper alloys, either immediately or within a short time. In addition, many disease-causing bacteria such as E. coli O157:H7, hospital superbugs, and several viruses (including SARS-CoV-2) are also susceptible to exposure to copper surfaces. It is thus suggested that replacing common touch surfaces in healthcare facilities, food industries, and public places (including public transport) with copper or alloys of copper may substantially contribute to limiting transmission. Subsequent hospital admissions and mortality rates will consequently be lowered, with a concomitant saving of lives and considerable levels of resources. This consideration is very significant in times of the COVID-19 pandemic and the upcoming epidemics, as it is becoming clear that all forms of possible infection control measures should be practiced in order to protect community well-being and promote healthy outcomes.
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Affiliation(s)
- Joji Abraham
- School of Engineering, Information Technology and Physical Sciences, Mt Helen Campus, Ballarat, VIC 3353, Australia;
| | - Kim Dowling
- School of Engineering, Information Technology and Physical Sciences, Mt Helen Campus, Ballarat, VIC 3353, Australia;
- Department of Geology, University of Johannesburg, Johannesburg 2006, South Africa
| | - Singarayer Florentine
- Future Regions Research Centre, School of Science, Psychology and Sport, Federation University Australia, Mt Helen Campus, Ballarat, VIC 3353, Australia;
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10
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Ahmed MS, Yunus FM. Factors associated with knowledge and use of the emergency contraceptive pill among ever-married women of reproductive age in Bangladesh: findings from a nationwide cross-sectional survey. EUR J CONTRACEP REPR 2020; 26:195-201. [PMID: 33251881 DOI: 10.1080/13625187.2020.1850675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aimed to assess the prevalence and factors associated with knowledge and use of the emergency contraceptive pill (ECP) among ever-married women in Bangladesh. METHODS The study was based on a secondary dataset of the 2014 Bangladesh Demographic and Health Survey. Complete (weighted) data of 17,592 women aged 15-49 years were analysed. RESULTS The prevalence of having knowledge and use of the ECP among ever-married women in Bangladesh was 13.6% and 1.8%, respectively. Administrative region and type of residence (urban or rural), household wealth index, educational level (of both the woman and her spouse), spouse's occupation, number of living children, weight, current use of contraception and a history of pregnancy termination were positively associated with knowledge and use of the ECP. CONCLUSION A large proportion of Bangladeshi women of reproductive age had a lack of knowledge and use of the ECP. Nationwide reproductive health education programmes may improve the situation.
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Affiliation(s)
- Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Bangladesh
| | - Fakir Md Yunus
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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11
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Ti AJ, Roe AH, Whitehouse KC, Smith RA, Gaffield ME, Curtis KM. Effectiveness and safety of extending intrauterine device duration: a systematic review. Am J Obstet Gynecol 2020; 223:24-35.e3. [PMID: 31954154 DOI: 10.1016/j.ajog.2020.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/05/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To systematically review the literature to determine if extended use of intrauterine devices, including the copper or levonorgestrel intrauterine device, beyond approved durations is effective and safe for preventing pregnancy. STUDY DESIGN We searched PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus from inception through June 2019. We considered primary studies of women using the T380A copper or currently available levonorgestrel intrauterine devices past their approved duration (extended use). The primary outcome was pregnancy. Safety outcomes included adverse events and side effects that led to discontinuation. We abstracted study data into evidence tables and assessed study quality as related to the risk of bias, precision, and external validity. For each intrauterine device type, we calculated a pooled pregnancy rate during the first 2 years of extended use using the Poisson inverse variance method. RESULTS Of 4068 studies identified by our search, 4 good-to-poor-quality studies of the 52 mg levonorgestrel intrauterine device (approved for 5 years), with a total of 2098 women starting extended use, and 2 good-to-fair-quality studies of the T380A copper intrauterine device (approved for 10 years), with 245 women starting extended use, met inclusion criteria. For the levonorgestrel intrauterine device, the pooled pregnancy rate was 0.02 per 100 person-years (95% confidence interval, 0.00-0.45) in year 6, 0.03 per 100 person-years (95% confidence interval, 0.00-0.71) in year 7, and 0.02 per 100 person-years (95% confidence interval, 0.00-0.29) in years 6 and 7 combined. During this same time, annual rates of adverse events or discontinuation owing to side effects ranged from 0 to 3.7 per 100 participants. For the copper intrauterine device, the pooled pregnancy rate for years 11 and 12 was 0.0 per 100 person-years (95% confidence interval, 0.0-0.8), and annual rates of adverse events and discontinuation owing to side effects during extended use ranged from 0 to 4.6 per 100 participants. CONCLUSION The available evidence suggests that rates of pregnancy, adverse events, and discontinuation owing to side effects during the first 2 years of extended use of the 52 mg levonorgestrel intrauterine device and the T380A copper intrauterine device are low and comparable to rates during approved duration of use. Data were limited in quantity and quality, and may not be generalizable to all intrauterine device users.
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Hammoud R, Saleh S, Halawani D, Mezher H, Abou El Naga A, Azakir B. Knowledge and attitudes of Lebanese women of childbearing age towards emergency contraception. EUR J CONTRACEP REPR 2019; 25:28-32. [PMID: 31809200 DOI: 10.1080/13625187.2019.1695118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objectives: Unwanted pregnancy is sometimes associated with unsafe abortion, which may lead to maternal death. Pregnancy after unprotected sexual intercourse can be avoided by using emergency contraception (EC). Our study aimed to assess the knowledge and attitudes of reproductive-aged Lebanese women towards EC use.Methods: A descriptive cross-sectional study was conducted by interviewing randomly selected women aged between 15 and 49 years from the five major Lebanese governates. A pre-tested, pre-structured questionnaire was applied composed of three parts: (1) personal information, (2) knowledge about EC methods and (3) attitude towards EC.Results: We found that 78% of participants had never heard of EC. Among those who had heard of EC, only 29.3% had good knowledge about it. Knowledge about EC was not, however, associated with participants' sociodemographic characteristics (i.e., age, marital status, educational level and background, occupation and occupational field and area of residence). There was a positive attitude towards EC among 57.3% of participants. Attitudes were statistically associated with level of education, area of residence and whether the respondent had ever heard of EC.Conclusion: Most Lebanese women of childbearing age lack knowledge about EC. There is a need to raise public awareness of EC.
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Affiliation(s)
- Rima Hammoud
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Sirine Saleh
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Doha Halawani
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | - Hayat Mezher
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Bilal Azakir
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
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Akintomide H, Barnes P, Brima N, Mansour D. Higher discontinuation rate with a standard-sized compared to a small-sized 'gold standard' copper intrauterine device: a case-control review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2018-200296. [PMID: 31484662 DOI: 10.1136/bmjsrh-2018-200296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/12/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND T-shaped intrauterine devices (IUDs) with a copper surface area of 380 mm2 and copper bands on the transverse arms are the most effective types of copper-containing IUDs. A small-sized 'gold standard' IUD is available but there has been little research to compare the effects of this small-sized IUD to its standard-sized counterpart. AIM To determine discontinuation rates and reasons for discontinuation at 1 year of the small-sized Mini TT380 Slimline IUD compared with the standard-sized TT380 Slimline. METHODS The clinical records of women fitted with Mini TT380 Slimline ('mini') IUDs were compared with those of women fitted with standard-sized TT380 Slimline ('standard') IUDs over a 3-year period (2013-2016). RESULTS Clinical records were available for 67 women fitted with a mini IUD (mean age 23 years, 64% nulliparous) and 63 women fitted with a standard IUD (mean age 25 years, 39% nulliparous). At 1 year, twice as many standard IUD users (32%, n=20) had discontinued their IUD use compared with mini IUD users (15%, n=10). Complaints of pain and bleeding were more than double (70%, n=14) in those women who discontinued standard IUD use compared with those who discontinued using the mini IUD (30%, n=3). These differences were statistically significant and were unrelated to parity. CONCLUSIONS More women using a standard-sized 'gold standard' IUD rather than its smaller counterpart complained of pain and bleeding, leading to higher discontinuation at 1 year. More research on the association between size and discontinuation of these IUDs is needed.
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Affiliation(s)
- Hannat Akintomide
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Pam Barnes
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nataliya Brima
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Diana Mansour
- Sexual Health Services, New Croft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Kaitz M, Mankuta D, Mankuta L. Long-acting reversible contraception: A route to reproductive justice or injustice. Infant Ment Health J 2019; 40:673-689. [PMID: 31329311 PMCID: PMC6972575 DOI: 10.1002/imhj.21801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article presents information on unintended pregnancies and the ongoing efforts of policy makers to promote long-acting reversible contraception (LARC) to reduce the numbers of such pregnancies. Also discussed is the tension between the encouragement of LARC to promote the public's interests in achieving that goal versus the need to assure that all women can decide about their bodies and reproductive needs. Our discussion includes information, primarily from the United States, on (a) risks associated with unintended pregnancies, (b) LARC devices approved in the United States (copper intrauterine devices (IUDs), hormone IUDs, and implants), (c) public and social benefits of increasing the use of LARC, (d) disadvantages and barriers to using LARC, (e) dangers of promoting LARC in unjust ways, and (f) the meaning of reproductive justice and its connection to social justice. By sharing the information with the audience of this journal, we hope that it will be integrated into clinical work and research on mental health and development. We also hope that experts in those fields will become discussants in the conversation regarding women's reproductive health and social justice that is taking place in the United States and elsewhere.
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Affiliation(s)
- Marsha Kaitz
- Department of PsychologyHebrew UniversityJerusalemIsrael
| | - David Mankuta
- Department of Obstetrics and GynecologyHadassah Hebrew University HospitalJerusalemIsrael
| | - Lihi Mankuta
- Department of MedicineFaculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
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Black A, Guilbert E. Consensus canadien sur la contraception (partie 3 de 4): chapitre 7 - Contraception intra-utérine. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S1-S23. [DOI: 10.1016/j.jogc.2019.02.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vidal F, Paret L, Linet T, Tanguy le Gac Y, Guerby P. [Intrauterine contraception: CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:806-822. [PMID: 30429071 DOI: 10.1016/j.gofs.2018.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide national clinical guidelines focusing on intrauterine contraception. METHODS A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well. RESULTS Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B). CONCLUSION Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
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Affiliation(s)
- F Vidal
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France.
| | - L Paret
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier Loire-Vendée-Océan, 85300 Challans, France
| | - Y Tanguy le Gac
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - P Guerby
- Pôle Femme Mère Couple, hôpital Paule-de-Viguier, CHU Purpan, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; Université Toulouse III, 118, route de Narbonne, 31062 Toulouse, France
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Gurney EP, Sonalkar S, McAllister A, Sammel MD, Schreiber CA. Six-month expulsion of postplacental copper intrauterine devices placed after vaginal delivery. Am J Obstet Gynecol 2018; 219:183.e1-183.e9. [PMID: 29870737 DOI: 10.1016/j.ajog.2018.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immediate placement of an intrauterine device after vaginal delivery is safe and convenient, but longitudinal data describing clinical outcomes have been limited. OBJECTIVE We sought to determine the proportion of TCu380A (copper) intrauterine devices expelled, partially expelled, malpositioned, and retained, as well as contraceptive use by 6 months postpartum, and determine risk factors for expulsion and partial expulsion. STUDY DESIGN In this prospective, observational study, women who received a postplacental TCu380A intrauterine device at vaginal delivery were enrolled postpartum. Participants returned for clinical follow-up at 6 weeks, and for a research visit with a pelvic exam and ultrasound at 6 months. We recorded intrauterine device outcomes and 6-month contraceptive use. Partial expulsion was defined as an intrauterine device protruding from the external cervical os, or a transvaginal ultrasound showing the distal end of the intrauterine device below the internal os of the cervix. Multinomial logistic regression models identified risk factors associated with expulsion and partial expulsion by 6 months. The area under the receiver operating characteristics curve was used to assess the ability of a string check to predict the correct placement of a postplacental intrauterine device. The primary outcome was the proportion of intrauterine devices expelled at 6 months. RESULTS We enrolled 200 women. Of 162 participants with follow-up data at 6 months, 13 (8.0%; 95% confidence interval, 4.7-13.4%) experienced complete expulsion and 26 (16.0%; 95% confidence interval, 11.1-22.6%) partial expulsion. Of 25 malpositioned intrauterine devices (15.4%; 95% confidence interval, 10.2-21.9%), 14 were not at the fundus (8.6%; 95% confidence interval, 5.2-14.1%) and 11 were rotated within the uterus (6.8%; 95% confidence interval, 3.8-11.9%). Multinomial logistic regression modeling indicated that higher parity (odds ratio, 2.05; 95% confidence interval, 1.21-3.50; P = .008) was associated with expulsion. Provider specialty (obstetrics vs family medicine; odds ratio, 5.31; 95% confidence interval, 1.20-23.59; P = .03) and gestational weight gain (normal vs excess; odds ratio, 9.12; 95% confidence interval, 1.90-43.82; P = .004) were associated with partial expulsion. Long-acting reversible contraceptive method use at 6 months was 80.9% (95% confidence interval, 74.0-86.6%). At 6 weeks postpartum, 35 of 149 (23.5%; 95% confidence interval, 16.9-31.1%) participants had no intrauterine device strings visible. Sensitivity of a string check to detect an incorrectly positioned intrauterine device was 36.2%, and specificity of the string check to predict a correctly positioned intrauterine device was 84.5%. This corresponds to an area under the receiver operating characteristics curve of 0.5. CONCLUSION This prospective assessment of postplacental TCu380A intrauterine device placement, with ultrasound to confirm device position, finds a complete intrauterine device expulsion proportion of 8.0% at 6 months. The association of increasing parity with expulsion is consistent with prior research. The clinical significance of covariates associated with partial expulsion (provider specialty and gestational weight gain) is unclear. Due to the observational study design, any associations cannot imply causality. The proportion of partially expelled and malpositioned intrauterine devices was high, and the area under the receiver operating characteristics curve of 0.5 indicates that a string check is a poor test for assessing device position. Women considering a postplacental intrauterine device should be counseled about the risk of position abnormalities, as well as the possibility of nonvisible strings, which may complicate clinical follow-up. The clinical significance of intrauterine device position abnormalities is unknown; future research should evaluate the influence of malposition and partial expulsion on contraceptive effectiveness and side effects.
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Dual-responsive lidocaine in situ gel reduces pain of intrauterine device insertion. Int J Pharm 2018; 538:279-286. [PMID: 29360560 DOI: 10.1016/j.ijpharm.2018.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/12/2018] [Accepted: 01/18/2018] [Indexed: 11/18/2022]
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Relationship between copper IUD complications and ultrasonographic findings. Arch Gynecol Obstet 2018; 297:989-996. [DOI: 10.1007/s00404-018-4711-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Zhao X, Liu Q, Sun H, Hu Y, Wang Z. Chronic Systemic Toxicity Study of Copper Intrauterine Devices in Female Wistar Rats. Med Sci Monit 2017; 23:3961-3970. [PMID: 28813370 PMCID: PMC5569927 DOI: 10.12659/msm.902137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to evaluate the chronic systemic and local toxicity of a copper intrauterine device in a rat model. Material/Methods Cu-IUD fragments were inserted into the uterine horns of female Wistar rats for 26 weeks (equivalent 15.42–17.33 years in humans). We tested copper at 20, 40, and 60 times the clinical dosages to study copper toxicity under severe conditions. Classic chronic systemic toxicity evaluations, including body weight, hematology, organ coefficient, and tissue reactions, were performed. Results The body weight of the rats increased during the 26 weeks, which showed that the Cu-IUD implant had no effect on animal growth. Histological examinations and organ coefficients of the uterus and other major organs indicated no obvious systemic or local impairment. Blood tests confirmed that the hepatic and renal functions remained normal. Conclusions These results obtained at different dosages and long-term implantation provide solid data confirming the safety of long-term use of Cu-IUDs. However, the elevated leucocyte levels found in this study warrant further investigation.
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Affiliation(s)
- Xia Zhao
- Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Qian Liu
- Jiangsu Province Institute for Medical Equipment Testing, Nanjing, Jiangsu, China (mainland)
| | - Haixiang Sun
- Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Yali Hu
- Center for Reproductive Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China (mainland)
| | - Zhaoxu Wang
- Testing Department of Biomaterials, Chinese National Institutes for Food and Drug Control, Beijing, China (mainland)
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Lohr PA, Lyus R, Prager S. Use of intrauterine devices in nulliparous women. Contraception 2017; 95:529-537. [DOI: 10.1016/j.contraception.2016.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 02/07/2023]
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Reeves MF, Katz BH, Canela JM, Hathaway MJ, Tal MG. A randomized comparison of a novel nitinol-frame low-dose-copper intrauterine contraceptive and a copper T380S intrauterine contraceptive. Contraception 2017; 95:544-548. [PMID: 28495299 DOI: 10.1016/j.contraception.2017.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to compare VeraCept (VC175), a novel nitinol intrauterine contraceptive (IUC) with 175 square-mm of copper surface area, to a copper T380S IUC. STUDY DESIGN We enrolled parous women into a randomized subject-blinded comparison of VC175 and a copper T380S in a 2:1 fashion at a single clinic. The primary outcomes were total adverse events and continuation at 12 months. We also examined pain on insertion, ease of placement, expulsion, tolerability and pregnancy. Subjective ratings were on a 5-point Likert scale (0, no pain to 5, worst pain). We followed subjects through 24-month follow-up. RESULTS We enrolled 300 women with 199 randomized to VC175 and 101 to the T380S. Insertion was successful in 198 subjects for VC175 and 100 for the T380S. Mean age was 25 years (range 18, 41), and median parity was 2 (range 1, 8), with 39% having only had Cesarean deliveries. No subjects developed clinical infection or reported serious adverse events. In the VC175 and T380S groups, mean pain at insertion was 1.4 and 2.4, respectively (p<.01). At the 12-month primary endpoint for VC175 and T380S, respectively, continuation was 84% and 68% (p<.002) with expulsions in 5.0% and 12.0% (p<.05) and removal for pain/bleeding in 3.5% and 17.0% (p<.01). At the 24-month visit for VC175 and T380S, respectively, continuation was 77% and 62% (p<.02 by log-rank). One ectopic pregnancy was identified at the 12-month follow-up in a VC175 user. No other pregnancies were diagnosed. With 297.3 and 132.4 woman-years, pregnancy rates were 0.3 and 0.0 per 100 woman-years for VC175 and T380S, respectively. CONCLUSIONS VC175 resulted in less pain at insertion, fewer expulsions and higher total continuation than the T380S, with similar contraceptive efficacy. IMPLICATIONS VC175 is a promising new intrauterine copper contraceptive on a nitinol frame that warrants further clinical trials.
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Affiliation(s)
- Matthew F Reeves
- Johns Hopkins School of Public Health, Baltimore, MD, USA; Stanford University School of Medicine, Stanford, CA, USA.
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El Ayadi AM, Rocca CH, Kohn JE, Velazquez D, Blum M, Newmann SJ, Harper CC. The impact of an IUD and implant intervention on dual method use among young women: Results from a cluster randomized trial. Prev Med 2017; 94:1-6. [PMID: 27773708 PMCID: PMC6373723 DOI: 10.1016/j.ypmed.2016.10.015] [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: 04/27/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
Abstract
Long-acting reversible contraceptives (LARCs) are highly effective at preventing pregnancy but do not protect against sexually transmitted infection (STI). Recent efforts to improve access to intrauterine devices (IUDs) and implants have raised concerns about STI prevention and reduced condom use, particularly among teenagers and young women. We evaluated whether a provider-targeted intervention to increase LARC access negatively impacted dual method use and STI incidence among an at-risk patient population. We conducted a cluster randomized trial in 40 reproductive health centers across the United States from May 2011 to May 2013. After training providers at 20 intervention sites, we recruited 1500 sexually-active women aged 18-25years who did not desire pregnancy and followed them for one year. We assessed intervention effects on dual method use, condom use and STI incidence, modeling dual method use with generalized estimating equations and STI incidence with Cox proportional hazard regression models, accounting for clustering. We found no differences between intervention and control groups in dual method use (14.3% vs. 14.4%, aOR 1.03, 95% CI 0.74-1.44) or condom use (30% vs. 31%, aOR 1.03, 95% CI 0.79-1.35) at last sex at one year. STI incidence was 16.5 per 100 person-years and did not differ between intervention and control groups (aHR 1.20, 95% CI 0.88-1.64). A provider training intervention to increase LARC access neither compromised condom use nor increased STI incidence among young women. Dual method use was very low overall, highlighting the need to bolster STI prevention efforts among adolescents and young women.
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Affiliation(s)
- Alison M El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States.
| | - Corinne H Rocca
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Julia E Kohn
- Planned Parenthood Federation of America, United States
| | | | - Maya Blum
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Sara J Newmann
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
| | - Cynthia C Harper
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, United States
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Rowe P, Farley T, Peregoudov A, Piaggio G, Boccard S, Landoulsi S, Meirik O. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. Contraception 2016; 93:498-506. [PMID: 26916172 PMCID: PMC5357727 DOI: 10.1016/j.contraception.2016.02.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare rates of unintended pregnancy, method continuation and reasons for removal among women using the 52-mg levonorgestrel (daily release 20 microg) intrauterine device (LNG-IUD) or the copper T 380 A IUD (TCu380A). STUDY DESIGN This was an open-label 7-year randomized controlled trial in 20 centres, 11 of which in China. Data on 1884 women with interval insertion of the LNG-IUD and 1871 of the TCu380A were analysed using life tables with 30-day intervals and Cox proportional hazards models. RESULTS The cumulative 7-year pregnancy rate of the LNG-IUD was 0.5 (standard error 0.2) per 100, significantly lower than 2.5 (0.4) per 100 of the TCu380A, cumulative method discontinuation rates at 7 years were 70.6 (1.2) and 40.8 (1.3) per 100, respectively. Dominant reasons for discontinuing the LNG-IUD were amenorrhea (26.1 [1.3] per 100) and reduced bleeding (12.5 [1.1] per 100), particularly in Chinese women and, for the TCu380A, increased bleeding (9.9 [0.9] per 100), especially among non-Chinese women. Removal rates for pain were similar for the two intrauterine devices (IUDs). Cumulative rates of removal for symptoms compatible with hormonal side effects were 5.7 (0.7) and 0.4 (0.2) per 100 for the LNG-IUD and TCu380A, respectively, and cumulative losses to follow-up at 7 years were 26.0 (1.4) and 36.9 (1.3) per 100, respectively. CONCLUSION The LNG-IUD and the TCu380A have very high contraceptive efficacy, with the LNG-IUD significantly higher than the TCu380A. Overall rates of IUD removals were higher among LNG-IUD users than TCu380A users. Removals for amenorrhea appeared culturally associated. IMPLICATIONS The 52-mg LNG-IUD and the TCu380A have very high contraceptive efficacy through 7 years. As an IUD, the unique side effects of the LNG-IUD are reduced bleeding, amenorrhea and symptoms compatible with hormonal contraceptives.
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Affiliation(s)
- Patrick Rowe
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Tim Farley
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Alexandre Peregoudov
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Gilda Piaggio
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Simone Boccard
- UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Sihem Landoulsi
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olav Meirik
- Instituto Chileno de Medicina Reproductiva (ICMER), Santiago, Chile.
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman W, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM, Mansouri S. Canadian Contraception Consensus (Part 3 of 4): Chapter 7--Intrauterine Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:182-222. [PMID: 27032746 DOI: 10.1016/j.jogc.2015.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. OUTCOMES Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the relative cost and availability of cited contraceptive methods in Canada. EVIDENCE Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis in incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). CHAPTER 7: INTRAUTERINE CONTRACEPTION: SUMMARY STATEMENTS 1. Intrauterine contraceptives are as effective as permanent contraception methods. (II-2) 2. The use of levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg by patients taking tamoxifen is not associated with recurrence of breast cancer. (I) 3. Intrauterine contraceptives have a number of noncontraceptive benefits. The levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg significantly decreases menstrual blood loss (I) and dysmenorrhea. (II-2) Both the copper intrauterine device and the LNG-IUS significantly decrease the risk of endometrial cancer. (II-2) 4. The risk of uterine perforation decreases with inserter experience but is higher in postpartum and breastfeeding women. (II-2) 5. The risk of pelvic inflammatory disease (PID) is increased slightly in the first month after intrauterine contraceptive (IUC) insertion, but the absolute risk is low. Exposure to sexually transmitted infections and not the IUC itself is responsible for PID occurring after the first month of use. (II-2) 6. Nulliparity is not associated with an increased risk of intrauterine contraceptive expulsion. (II-2) 7. Ectopic pregnancy with an intrauterine contraceptive (IUC) is rare, but when a pregnancy occurs with an IUC in situ, it is an ectopic pregnancy in 15% to 50% of the cases. (II-2) 8. In women who conceive with an intrauterine contraceptive (IUC) in place, early IUC removal improves outcomes but does not entirely eliminate risks. (II-2) 9. Intrauterine contraceptives do not increase the risk of infertility. (II-2) 10. Immediate insertion of an intrauterine contraceptive (10 minutes postplacental to 48 hours) postpartum or post-Caesarean section is associated with a higher continuation rate compared with insertion at 6 weeks postpartum. (I) 11. Immediate insertion of an intrauterine contraceptive (IUC; 10 minutes postplacental to 48 hours) postpartum or post-Caesarean section is associated with a higher risk of expulsion. (I) The benefit of inserting an IUC immediately postpartum or post-Caesarean section outweighs the disadvantages of increased risk of perforation and expulsion. (II-C) 12. Insertion of an intrauterine contraceptive in breastfeeding women is associated with a higher risk of uterine perforation in the first postpartum year. (II-2) 13. Immediate insertion of an intrauterine contraceptive (IUC) post-abortion significantly reduces the risk of repeat abortion (II-2) and increases IUC continuation rates at 6 months. (I) 14. Antibiotic prophylaxis for intrauterine contraceptive insertion does not significantly reduce postinsertion pelvic infection. (I) RECOMMENDATIONS: 1. Health care professionals should be careful not to restrict access to intrauterine contraceptives (IUC) owing to theoretical or unproven risks. (III-A) Health care professionals should offer IUCs as a first-line method of contraception to both nulliparous and multiparous women. (II-2A) 2. In women seeking intrauterine contraception (IUC) and presenting with heavy menstrual bleeding and/or dysmenorrhea, health care professionals should consider the use of the levonorgestrel intrauterine system 52 mg over other IUCs. (I-A) 3. Patients with breast cancer taking tamoxifen may consider a levonorgestrel-releasing intrauterine system 52 mg after consultation with their oncologist. (I-A) 4. Women requesting a levonorgestrel-releasing intrauterine system or a copper-intrauterine device should be counseled regarding changes in bleeding patterns, sexually transmitted infection risk, and duration of use. (III-A) 5. A health care professional should be reasonably certain that the woman is not pregnant prior to inserting an intrauterine contraceptive at any time during the menstrual cycle. (III-A) 6. Health care providers should consider inserting an intrauterine contraceptive immediately after an induced abortion rather than waiting for an interval insertion. (I-B) 7. In women who conceive with an intrauterine contraceptive (IUC) in place, the diagnosis of ectopic pregnancy should be excluded as arly as possible. (II-2A) Once an ectopic pregnancy has been excluded, the IUC should be removed without an invasive procedure. The IUC may be removed at the time of a surgical termination. (II-2B) 8. In the case of pelvic inflammatory disease, it is not necessary to remove the intrauterine contraceptive unless there is no clinical improvement after 48 to 72 hours of appropriate antibiotic treatment. (II-2B) 9. Routine antibiotic prophylaxis for intrauterine contraceptive (IUC) insertion is not indicated. (I-B) Health care providers should perform sexually transmitted infection (STI) testing in women at high risk of STI at the time of IUC insertion. If the test is positive for chlamydia and/or gonorrhea, the woman should be appropriately treated postinsertion and the IUC can remain in situ. (II-2B) 10. Unscheduled bleeding in intrauterine contraception users, when persistent or associated with pelvic pain, should be investigated to rule out infection, pregnancy, gynecological pathology, expulsion or malposition. (III-A)
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Jagroep SR, Pichardo MS, Arribas L, Heredia G, Coccio E, Palermo TM. A retrospective evaluation of the intrauterine device in a patient population in Buenos Aires, Argentina. THE JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2015; 42:88-92. [PMID: 26420847 DOI: 10.1136/jfprhc-2014-101153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 09/03/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The intrauterine device (IUD) is a long-acting reversible contraceptive method that is safe for a wide range of women, including adolescents and nulliparous women. Globally, it is often underutilised due to misperceptions among patients. Examination of characteristics associated with IUD discontinuation including adverse effects and IUD expulsion can inform provider practices to improve contraception success and patient satisfaction with this method. We studied IUD performance at a public family planning clinic in Buenos Aires, Argentina, serving a predominantly immigrant, low-income population. METHODS We conducted a retrospective evaluation of 1047 IUD insertions between 2002 and 2007 with 5 years of follow-up data. We performed bivariate and survival analysis to examine characteristics associated with IUD discontinuation: adverse outcomes including pain, bleeding, and IUD expulsion, and time to removal. FINDINGS Of 1047 patients, only 188 (18%) had their IUD removed within 5 years. The main causes of IUD discontinuation were involuntary (38%) reasons such as an IUD expulsion and personal choice (34%) such as desiring pregnancy. CONCLUSIONS Findings suggest overall good long-term performance with IUD insertion, with minimal complaints or adverse outcomes. These findings may help to support providers serving similar populations in promoting this method.
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Affiliation(s)
- Sherani R Jagroep
- Education, Research and Training Associate, Physicians for Reproductive Health (work was conducted while at Stony Brook University), New York, NY 10018, USA
| | - Margaret S Pichardo
- Howard University College of Medicine, MS1 (work was conducted while at Stony Brook University), Washington DC, 20001
| | - Lia Arribas
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Graciela Heredia
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Elina Coccio
- Obstetrician Gynecologist, Department of Gynecology, Hospital Bernardino Rivadavia, Buenos Aires Ministry of Health, Buenos Aires, Argentina
| | - Tia M Palermo
- Assistant Professor, Program in Public Health, Department of Preventative Medicine, Stony Brook University (State University of New York), Health Sciences Center 3-021, Stony Brook, NY 11790, USA
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Bahamondes L, Brache V, Meirik O, Ali M, Habib N, Landoulsi S. A 3-year multicentre randomized controlled trial of etonogestrel- and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. Hum Reprod 2015; 30:2527-38. [DOI: 10.1093/humrep/dev221] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/14/2015] [Indexed: 11/13/2022] Open
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Borkow G. Using Copper to Improve the Well-Being of the Skin. ACTA ACUST UNITED AC 2015; 8:89-102. [PMID: 26361585 PMCID: PMC4556990 DOI: 10.2174/2212796809666150227223857] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
Copper has two key properties that are being exploited in consumer and medical
device products in the last decade. On the one hand, copper has potent biocidal properties.
On the other hand, copper is involved in numerous physiological and metabolic processes
critical for the appropriate functioning of almost all tissues in the human body. In the skin,
copper is involved in the synthesis and stabilization of extracellular matrix skin proteins and
angiogenesis. This manuscript reviews clinical studies that show that the use of textile consumer
and medical device products, embedded with microscopic copper oxide particles, improve
the well-being of the skin. These include studies showing a) cure of athlete’s foot infections
and improvement in skin elasticity, especially important for individuals suffering from diabetes; b)
reduction of facial fine line and wrinkles; and c) enhancement of wound healing; by copper oxide embedded
socks, pillowcases and wound dressings, respectively. The manuscript also reviews and discusses the mechanisms
by which the presence of copper in these products improves skin well-being.
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Shahnazi M, Sarrafi S, Asgari Jafarabadi M, Azari S, Esmaili F. Comparing Hemorrhages and Dysmenorrhea with Copper T380A and Multiload 375 Intrauterine Devices: A Randomized Clinical Trial. J Caring Sci 2014; 3:193-204. [PMID: 25276763 DOI: 10.5681/jcs.2014.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/17/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION One of the most common complications of IUD users is bleeding and dysmenorrhea. These complications vary in the different types of IUDs. The aim of this study was to compare the bleeding and dysmenorrhea in ML CU 375 IUD and Copper T 380A IUD. METHODS This randomized double-blind controlled clinical trial was performed on 48 women in a health care centres from January to October 2012, in Tabriz, Iran. Participants allocated into two equal groups of receiving IUD ML CU 375 or receiving IUD Copper T 380A in randomized blocking method. Data were collected by demographic questionnaire and Higham chart and Visual Analog Scale 1 month before IUD insertion and 4 months after IUD insertion. Analysis of covariance, ANOVA with repeated measures, Friedman, Ordinal regression and SPSS Ver. 13 were used to analysis the data. RESULTS The results showed that the mean score of bleeding in the first four months after IUD insertion in IUD ML CU 375 users was significantly lower than IUD Copper T 380A group. In the third and fourth months in both groups showed severity of dysmenorrhea in group IUD ML CU 375 was lower than IUD Copper T 380A. The results showed that the duration of dysmenorrhea in the first four months after IUD insertion in IUD ML CU 375 group was significantly lower than IUD Copper T 380A group. CONCLUSION Counseling and educating women by family planning service providers about both Copper T 380A and ML CU 375 IUDs before taking IUD is recommended.
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Affiliation(s)
- Mahnaz Shahnazi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayyeh Sarrafi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asgari Jafarabadi
- Department of Statistic and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Azari
- Department of Midwifery, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Fariba Esmaili
- Information Technology, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Extended use of the intrauterine device: a literature review and recommendations for clinical practice. Contraception 2014; 89:495-503. [DOI: 10.1016/j.contraception.2014.02.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/15/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022]
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Lazary A, Weinberg I, Vatine JJ, Jefidoff A, Bardenstein R, Borkow G, Ohana N. Reduction of healthcare-associated infections in a long-term care brain injury ward by replacing regular linens with biocidal copper oxide impregnated linens. Int J Infect Dis 2014; 24:23-9. [PMID: 24614137 DOI: 10.1016/j.ijid.2014.01.022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Contaminated textiles in hospitals contribute to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. Copper oxide impregnated linens have wide-spectrum antimicrobial, antifungal, and antiviral properties. Our aim was to determine if replacing non-biocidal linens with biocidal copper oxide impregnated linens would reduce the rates of healthcare-associated infections (HAI) in a long-term care ward. METHODS We compared the rates of HAI in two analogous patient cohorts in a head injury care ward over two 6-month parallel periods before (period A) and after (period B) replacing all the regular non-biocidal linens and personnel uniforms with copper oxide impregnated biocidal products. RESULTS During period B, in comparison to period A, there was a 24% reduction in the HAI per 1000 hospitalization-days (p<0.05), a 47% reduction in the number of fever days (>38.5°C) per 1000 hospitalization-days (p<0.01), and a 32.8% reduction in total number of days of antibiotic administration per 1000 hospitalization-days (p<0.0001). Accordingly there was saving of approximately 27% in costs of antibiotics, HAI-related treatments, X-rays, disposables, labor, and laundry, expenses during period B. CONCLUSIONS The use of biocidal copper oxide impregnated textiles in a long-term care ward may significantly reduce HAI, fever, antibiotic consumption, and related treatment costs.
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Affiliation(s)
- A Lazary
- Brain Injury Division, Reuth Medical Center, 2 Ha'Hayil blvd, Tel Aviv 61092, Israel.
| | - I Weinberg
- Brain Injury Division, Reuth Medical Center, 2 Ha'Hayil blvd, Tel Aviv 61092, Israel
| | - J-J Vatine
- Outpatient and Research Division, Reuth Medical Center, Tel Aviv, Israel; Department of Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Jefidoff
- Brain Injury Division, Reuth Medical Center, 2 Ha'Hayil blvd, Tel Aviv 61092, Israel
| | - R Bardenstein
- Microbiology Laboratory, Kaplan Medical Center, Rehovot, Israel
| | - G Borkow
- Cupron Scientific, Herzliya, Israel
| | - N Ohana
- Brain Injury Division, Reuth Medical Center, 2 Ha'Hayil blvd, Tel Aviv 61092, Israel
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Benagiano G, Gabelnick H, Farris M. Contraceptive devices: intravaginal and intrauterine delivery systems. Expert Rev Med Devices 2014; 5:639-54. [DOI: 10.1586/17434440.5.5.639] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Xu XX, Ding MH, Zhang JX, Zheng W, Li L, Zheng YF. A novel copper/polydimethiylsiloxane nanocomposite for copper-containing intrauterine contraceptive devices. J Biomed Mater Res B Appl Biomater 2013; 101:1428-36. [DOI: 10.1002/jbm.b.32962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- X. X. Xu
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
| | - M. H. Ding
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
| | - J. X. Zhang
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
| | - W. Zheng
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
| | - L. Li
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
| | - Y. F. Zheng
- Center for Biomedical Materials and Engineering, Harbin Engineering University; Harbin 150001 China
- Department of Materials Science and Engineering; College of Engineering, Peking University; Beijing 100871 China
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Berger-Kulemann V, Einspieler H, Hachemian N, Prayer D, Trattnig S, Weber M, Ba-Ssalamah A. Magnetic field interactions of copper-containing intrauterine devices in 3.0-Tesla magnetic resonance imaging: in vivo study. Korean J Radiol 2013; 14:416-22. [PMID: 23690707 PMCID: PMC3655294 DOI: 10.3348/kjr.2013.14.3.416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 02/18/2013] [Indexed: 11/15/2022] Open
Abstract
Objective An ex vivo study found a copper-containing intrauterine device (IUD) to be safe for women undergoing an MRI examination at a 3.0-T field. No significant artifacts caused by the metallic implant were detected. However, there are still no in vivo data about these concerns. The aim of this study was to evaluate 3.0-T magnetic field interactions of copper-containing IUDs in vivo. Materials and Methods Magnetic field interactions and potential adverse events were evaluated in 33 women using a questionnaire-based telephone survey. Two experienced radiologists performed artifact evaluation on MR images of the pelvis. Results Eighteen patients were eligible for the survey. One patient reported a dislocation of the IUD after the MR examination. All other patients had no signs of field interactions. No IUD-related artifacts were found. Conclusion MRI at 3.0-T is possible for women with copper-containing IUDs. However, consulting a gynecologist to check the correct position of the IUD and exclude complications after an MR examination is highly recommended. High-quality clinical imaging of the female pelvis can be performed without a loss in image quality.
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Russo JA, Miller E, Gold MA. Myths and misconceptions about long-acting reversible contraception (LARC). J Adolesc Health 2013; 52:S14-21. [PMID: 23535052 DOI: 10.1016/j.jadohealth.2013.02.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 02/03/2013] [Accepted: 02/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To discuss common myths and misconceptions about long-acting reversible contraception (LARC) among patients and health care providers. METHODS We address some of these common myths in an effort to provide clinicians with accurate information to discuss options with patients, parents, and referring providers. The list of myths was created through an informal survey of an online listserv of 200 family planning experts and from the experiences of the authors. RESULTS When presented with information about LARC, adolescents are more likely to request LARC and are satisfied with LARC. Clinicians have an important role in counseling about and providing LARC to their adolescent patients as well as supporting them in managing associated side effects. CONCLUSIONS This review article can be used as a resource for contraceptive counseling visits and for the continuing education of health professionals providing adolescent reproductive health care.
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Affiliation(s)
- Jennefer A Russo
- Planned Parenthood of Orange and San Bernardino Counties, Orange, California 92866, USA.
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Koyama A, Hagopian L, Linden J. Emerging options for emergency contraception. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2013; 7:23-35. [PMID: 24453516 PMCID: PMC3888080 DOI: 10.4137/cmrh.s8145] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Emergency post-coital contraception (EC) is an effective method of preventing pregnancy when used appropriately. EC has been available since the 1970s, and its availability and use have become widespread. Options for EC are broad and include the copper intrauterine device (IUD) and emergency contraceptive pills such as levonorgestrel, ulipristal acetate, combined oral contraceptive pills (Yuzpe method), and less commonly, mifepristone. Some options are available over-the-counter, while others require provider prescription or placement. There are no absolute contraindications to the use of emergency contraceptive pills, with the exception of ulipristal acetate and mifepristone. This article reviews the mechanisms of action, efficacy, safety, side effects, clinical considerations, and patient preferences with respect to EC usage. The decision of which regimen to use is influenced by local availability, cost, and patient preference.
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Affiliation(s)
- Atsuko Koyama
- Department of Pediatric Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura Hagopian
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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McNicholas CP, Madden T, Zhao Q, Secura G, Allsworth JE, Peipert JF. Cervical lidocaine for IUD insertional pain: a randomized controlled trial. Am J Obstet Gynecol 2012; 207:384.e1-6. [PMID: 23107081 DOI: 10.1016/j.ajog.2012.09.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/16/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.
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Affiliation(s)
- Colleen P McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
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Continuation of copper-containing intrauterine devices at 6 months. Contraception 2012; 87:101-6. [PMID: 23083530 DOI: 10.1016/j.contraception.2012.09.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intrauterine devices (IUDs) are highly effective at preventing pregnancy and cost-effective. Suboptimal continuation of IUDs places women at risk of unintended pregnancy. Little is known about prevalence or predictors of discontinuation of IUDs within the first 6 months. STUDY DESIGN A retrospective cohort analysis was conducted among 306 family planning patients who had a CuT380A IUD inserted from November 2008-August 2011. Rates of continuation among 283 users were calculated using survival analyses, and predictors of removal within 6 months of insertion were assessed using logistic regression. RESULTS Among 306 IUD insertions, 13 (4.2%) full or partial expulsions occurred within the first 6 months: 9 (10.7%) among nulliparous and 4 (2.0%) among parous women (chi-square, p<.001). In the first 6 months, four (1.3%) pregnancies occurred among women without prior removal or expulsion of the device (unadjusted Pearl Index: 2.61 per 100 woman-years at 6 months), all among parous women. Of 283 women in continuation analyses, 26% were under 20 years old and 29% nulliparous. Most (84%) received health education specific to IUDs before insertion. Overall, 11% had their IUD removed within 6 months of insertion. In an adjusted logistic regression model, women who did not receive health education were significantly more likely (Adjusted Odds Ratio=3.37, 95% confidence interval: 1.35-8.39) to have a removal within 6 months, but no significant association was found for age, race/ethnicity or parity. CONCLUSION Early discontinuation of IUDs was prevalent but lower among women who received method-specific health education.
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Norman WV, Chiles JL, Turner CA, Brant R, Aslan A, Kaczorowski J. Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial. Trials 2012; 13:147. [PMID: 22920273 PMCID: PMC3495410 DOI: 10.1186/1745-6215-13-147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion. METHODS/DESIGN Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes. DISCUSSION The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01174225.
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Affiliation(s)
- Wendy V Norman
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Jessica L Chiles
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Caroline A Turner
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Rollin Brant
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, V6H 3V4, Canada
| | - Andra Aslan
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Janusz Kaczorowski
- Contraception Access Research Team, Women’s Health Research Institute, Vancouver, British Columbia, V6H 1G3, Canada
- Département de médecine familiale et médecine d’urgence, L’Université de Montréal, Montréal, Quebec, Canada
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McNicholas C, Hotchkiss T, Madden T, Zhao Q, Allsworth J, Peipert JF. Immediate postabortion intrauterine device insertion: continuation and satisfaction. Womens Health Issues 2012; 22:e365-9. [PMID: 22749197 PMCID: PMC3608473 DOI: 10.1016/j.whi.2012.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/28/2012] [Accepted: 04/30/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The provision of intrauterine devices (IUDs) immediately postabortion has the potential to decrease unintended pregnancy in the United States. Studies have demonstrated safety and efficacy; however, there are limited data about continuation, satisfaction, and bleeding patterns among women receiving immediate postabortion IUDs. STUDY DESIGN We performed a retrospective cohort study of women undergoing immediate postabortion IUD insertion. Demographics and clinical data were collected from intake forms and procedure notes. We attempted to contact women by telephone to administer a short questionnaire to assess continuation, satisfaction, and bleeding patterns. RESULTS We were able to contact 77 of 225 (34%). Women lost to follow-up were more likely to have higher parity or a pregnancy of greater gestational age at the time of abortion compared with women who were successfully contacted. Continuation and satisfaction rates were high (80.5% and 80.6%, respectively). Reported bleeding patterns with IUD use were similar to previously reported patterns. CONCLUSION Follow-up of women undergoing immediate postabortion IUD insertion is challenging. However, we found that women choosing immediate postabortion IUD had high rates of continuation and satisfaction.
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Affiliation(s)
- Colleen McNicholas
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
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Awareness and interest in intrauterine contraceptive device use among HIV-positive women in Cape Town, South Africa. Infect Dis Obstet Gynecol 2012; 2012:956145. [PMID: 22778537 PMCID: PMC3388580 DOI: 10.1155/2012/956145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/14/2012] [Indexed: 11/18/2022] Open
Abstract
Objective. To assess awareness of and interest in intrauterine contraceptive device (IUCD) use among HIV-positive women in Cape Town, South Africa. Design. Cross-sectional survey. Methods. HIV-positive women aged 18 through 45 years presenting for care at a primary health care clinic in Cape Town, South Africa participated in this study. Consented participants completed a staff-administered questionnaire in a private setting. Descriptive statistics were generated. Comparisons between demographic and reproductive health-related variables and IUCD awareness and interest were performed with multiple logistic regression. Analyses for IUCD interest excluded women with prior surgical sterilization. Results. Of 277 HIV-positive women, 37% were aware of the IUCD; awareness was independently associated with greater age (adjusted odds ratio (AOR) = 1.15, 95%; confidence interval (CI): 1.10–1.20) and not switching contraceptive methods in the last year (AOR = 2.45, 95% CI: 1.03–5.83). Following an IUCD information session, 86% of women (n = 206/240) were interested in IUCD use. IUCD interest was inversely associated with age (AOR = 0.91, 95% CI: 0.86–0.97) and marginally positively associated with current menstrual bleeding pattern complaints (AOR = 2.14, 95% CI: 0.98–4.68). Conclusions. Despite low levels of method awareness, HIV-positive women in this setting are frequently interested in IUCD use, indicating need for programming to expand method access.
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Loeber O. A cheer for the diaphragm. EUR J CONTRACEP REPR 2012; 17:89-92. [PMID: 22292510 DOI: 10.3109/13625187.2011.636461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Effective inhibition of the early copper ion burst release with ultra-fine grained copper and single crystal copper for intrauterine device application. Acta Biomater 2012; 8:886-96. [PMID: 22040688 DOI: 10.1016/j.actbio.2011.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/08/2011] [Accepted: 10/13/2011] [Indexed: 11/24/2022]
Abstract
To solve the main problems of existing coarse grained copper (CG Cu) intrauterine devices (IUD)-namely burst release and a low transfer efficiency of the cupric ions during usage-ultra-fine grained copper (UFG Cu) and single crystal copper (SC Cu) have been investigated as potential substitutes. Their corrosion properties with CG Cu as a control have been studied in simulated uterine fluid (SUF) under different conditions using electrochemical measurement methods. Long-term immersion of UFG Cu, SC Cu and CG Cu samples in SUF at 37 °C have been studied for 300 days. A lower copper ion burst release and a higher efficiency release of cupric ions were observed for UFG Cu and SC Cu compared with CG Cu in the first month of immersion and 2 months later. The respective corrosion mechanisms for UFG Cu, SC Cu and CG Cu in SUF are proposed. In vitro biocompatibility tests show a better cellular response to UFG Cu and SC Cu than CG Cu. In terms of instantaneous corrosion behavior, long-term corrosion performance and in vitro biocompatibility, the three pure copper materials follow the order: UFG Cu>SC Cu>CG Cu, which indicates that UFG Cu could be the most suitable candidate material for intrauterine devices.
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Alvarez F, Schilardi PL, de Mele MFL. Reduction of the “burst release” of copper ions from copper-based intrauterine devices by organic inhibitors. Contraception 2012; 85:91-8. [DOI: 10.1016/j.contraception.2011.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 05/16/2011] [Accepted: 05/19/2011] [Indexed: 12/01/2022]
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Nelson AL. Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2011. [DOI: 10.4137/cmwh.s5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.
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Affiliation(s)
- Anita L. Nelson
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA, USA
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Length of the endometrial cavity and intrauterine contraceptive device expulsion. Int J Gynaecol Obstet 2011; 113:50-3. [DOI: 10.1016/j.ijgo.2010.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/22/2010] [Accepted: 12/14/2010] [Indexed: 11/21/2022]
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Dispositifs intra-utérins. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health 2010; 2:211-20. [PMID: 21072313 PMCID: PMC2971735 DOI: 10.2147/ijwh.s6914] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Indexed: 11/23/2022] Open
Abstract
The intrauterine device (IUD), primarily in the form of the copper IUD, is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. With a remarkably low failure rate of less than 1 per 100 women in the first year of use, the Copper T-380A is in the top tier of contraceptives in terms of efficacy. Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion. Overall, the number of adverse events is low, making the Copper T-380A a very safe contraceptive method. The most common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. However, cumulative discontinuation rates of Copper T-380A are lower than that have been reported for other methods, indicating that the Copper T-380A is highly acceptable to women. After 5 years, approximately 50% of all women, who have a Copper T-380A inserted, will continue to use this highly effective contraceptive method.
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Affiliation(s)
- Bliss Kaneshiro
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Tod Aeby
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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Use of the Mirena™ LNG-IUS and Paragard™ CuT380A intrauterine devices in nulliparous women. Contraception 2010; 81:367-71. [DOI: 10.1016/j.contraception.2010.01.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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