1
|
Curtis KM, Zapata LB, Pagano HP, Nguyen A, Reeves J, Whiteman MK. Removing Unnecessary Medical Barriers to Contraception: Celebrating a Decade of the U.S. Medical Eligibility Criteria for Contraceptive Use. J Womens Health (Larchmt) 2020; 30:293-300. [PMID: 33370207 DOI: 10.1089/jwh.2020.8910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2010, the Centers for Disease Control and Prevention (CDC) released the U.S. Medical Eligibility Criteria for Contraceptive Use, providing recommendations for health care providers on safe use of contraception for people with certain characteristics or medical conditions. Adapted from World Health Organization guidance, the goal of the recommendations is to remove unnecessary medical barriers to contraception. Over the past decade, CDC has updated recommendations based on new evidence, collaborated with national partners to disseminate and implement the guidelines, and conducted provider surveys to assess changes in attitudes and practices around contraception safety and provision. CDC remains committed to supporting evidence-based guidelines for safe use of contraception, as the basis for improving access to contraception and high-quality family planning services, reducing unintended pregnancy, and improving reproductive health in the United States.
Collapse
Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lauren B Zapata
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Pamela Pagano
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antoinette Nguyen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reeves
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maura K Whiteman
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Levi EE, Findley MK, Avila K, Bryant AG. Placement of Levonorgestrel Intrauterine Device at the Time of Cesarean Delivery and the Effect on Breastfeeding Duration. Breastfeed Med 2018; 13:674-679. [PMID: 30376369 PMCID: PMC6306674 DOI: 10.1089/bfm.2018.0060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Studies have shown that immediate postpartum initiation of long-acting reversible contraception (LARC) methods leads to increased utilization of LARC and prevention of unintended pregnancies. It is unclear if immediate postpartum levonorgestrel-releasing intrauterine device (LNG-IUD) insertion has an effect on breastfeeding success. Study Design: This study was a secondary analysis of a randomized trial that compared intrauterine device (IUD) use at 6 months postpartum among women who underwent intracesarean IUD placement with women who planned for interval IUD placement at 6 or more weeks postpartum. This parallel, 1:1, nonblinded randomized trial was conducted between March 2012 and June 2014 at the University of North Carolina Women's Hospital. We recruited pregnant women aged 18-45 years who were undergoing a cesarean delivery and desired an IUD for contraception postpartum. Results: We received breastfeeding information from 63 women who desired to use a LNG-IUD. A proportion analysis demonstrated that there was no difference in the proportion of women breastfeeding at any of the three time points, 6, 12, and 24 weeks, following placement. This remained true after adjusting for age, parity, and ethnicity. Conclusion: This study adds to the existing body of evidence that shows that most women are able to successfully breastfeed after immediate postpartum LNG-IUD placement. Women should be encouraged to breastfeed, and the desire to breastfeed should not preclude the initiation of a postplacental IUD. This study provides reassurance that immediate postpartum LNG-IUD placement does not adversely affect breastfeeding; however, more high-quality data are needed on the impact of hormonal IUDs on breastfeeding outcomes.
Collapse
Affiliation(s)
- Erika E. Levi
- Division of Family Planning, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Molly K. Findley
- Division of Family Planning, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Karina Avila
- Division of Family Planning, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Amy G. Bryant
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Averbach S, Silverberg MJ, Leyden W, Smith-McCune K, Raine-Bennett T, Sawaya GF. Recent intrauterine device use and the risk of precancerous cervical lesions and cervical cancer. Contraception 2018; 98:S0010-7824(18)30144-6. [PMID: 29673740 PMCID: PMC6192861 DOI: 10.1016/j.contraception.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Understanding the effect of contraceptives on the development of precancerous lesions of the cervix and cervical cancer may provide information that is valuable to women in contraceptive decision-making. The purpose of this study was to evaluate the association between recent intrauterine device (IUD) use (by type) and cervical intraepithelial neoplasia 2, 3, adenocarcinoma in situ or cancer (CIN2+ or CIN3+). STUDY DESIGN Case-control study of 17,559 women age 18-49 with incident CIN2+ cases and 5:1 age-matched, incidence-density selected controls (N=87,378) who were members of Kaiser Permanente Northern California Healthcare System from 1996 to 2014. Recent IUD use, within 18 months prior to index, was the exposure of interest. RESULTS We identified 1,657 IUD users among the cases and 7,925 IUD users among controls. After adjusting for sexually transmitted infection testing, smoking, HPV vaccination, hormonal contraceptive use, parity, race and number of outpatient healthcare system visits, IUD use was associated with an increased rate of CIN2+ [rate ratio (RR) 1.12, 95% confidence interval (1.05-1.18), p<0.001] but not CIN3+ [RR 1.02 (0.93-1.11), p=0.71]. Levonorgestrel-IUD use was associated with an increased rate of CIN2+ [RR 1.18 (1.08-1.30), p<0.001] but not CIN3+ [RR 1.05 (0.91-1.21), p=0.48]. Copper-IUD use was not associated with CIN2+ [RR 0.88 (0.75-1.04), p=0.13] or CIN3+ [RR 0.81 (0.64-1.02), p=0.07]. CONCLUSION Recent IUD use had variable weak associations with CIN2+ but was not associated with increased risk of CIN3+. IMPLICATIONS Recent levonorgestrel-IUD use may be associated with CIN2, a lesion with a high rate of regression, but not CIN3, which is considered a true pre-cancerous lesion. The observed association between levonorgestrel-IUDs and CIN2+ was modest but warrants further investigation. It may have clinical importance for contraceptive counseling if this finding is shown to be consistent across other studies and other populations.
Collapse
Affiliation(s)
- Sarah Averbach
- University of California, San Diego, Department of Obstetrics, Gynecology and Reproductive Sciences, San Diego, CA; University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA.
| | | | - Wendy Leyden
- Kaiser Permanente Northern California (KPNC), Division of Research, Oakland, CA
| | - Karen Smith-McCune
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA
| | - Tina Raine-Bennett
- Kaiser Permanente Northern California (KPNC), Division of Research, Oakland, CA
| | - George F Sawaya
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, San Francisco, CA
| |
Collapse
|
4
|
Horton LG, Folger SG, Berry-Bibee E, Jatlaoui TC, Tepper NK, Curtis KM. Research gaps from evidence-based contraception guidance: the US Medical Eligibility Criteria for Contraceptive Use, 2016, and the US Selected Practice Recommendations for Contraceptive Use, 2016. Contraception 2016; 94:582-589. [DOI: 10.1016/j.contraception.2016.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
|
5
|
Allen R, Cwiak C. January 2015 editorial. Contraception 2016; 93:1-2. [PMID: 26687738 DOI: 10.1016/j.contraception.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
6
|
Dragoman MV, Jatlaoui T, Nanda K, Curtis KM, Gaffield ME. Research gaps identified during the 2014 update of the WHO medical eligibility criteria for contraceptive use and selected practice recommendations for contraceptive use. Contraception 2015; 94:195-201. [PMID: 26723202 DOI: 10.1016/j.contraception.2015.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Monica V Dragoman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Tara Jatlaoui
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
7
|
Stuart GS, Lesko CR, Stuebe AM, Bryant AG, Levi EE, Danvers AI. A randomized trial of levonorgestrel intrauterine system insertion 6 to 48 h compared to 6 weeks after vaginal delivery; lessons learned. Contraception 2015; 91:284-8. [DOI: 10.1016/j.contraception.2014.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/16/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
|
8
|
Ng CHM, Fraser IS, Berbic M. Contraception for women with medical disorders. Best Pract Res Clin Obstet Gynaecol 2014; 28:917-30. [PMID: 25087667 DOI: 10.1016/j.bpobgyn.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 11/29/2022]
Abstract
Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article.
Collapse
Affiliation(s)
- Cecilia H M Ng
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| | - Ian S Fraser
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia.
| | - Marina Berbic
- Department of Reproductive Endocrinology and Infertility, Level 5, RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, 2050, NSW, Australia
| |
Collapse
|
9
|
Chih HJ, Lee AH, Colville L, Xu D, Binns CW. Condom and oral contraceptive use and risk of cervical intraepithelial neoplasia in Australian women. J Gynecol Oncol 2014; 25:183-7. [PMID: 25045430 PMCID: PMC4102736 DOI: 10.3802/jgo.2014.25.3.183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/19/2013] [Accepted: 08/27/2013] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the association between condom use and oral contraceptive consumption and the risk of cervical intraepithelial neoplasia (CIN). Methods A cross-sectional study was conducted in Perth clinics. A total of 348 women responded to the structured questionnaire. Information sought included demographic and lifestyle characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration of oral contraceptive usage. Crude and adjusted odds ratio (OR) and associated 95% confidence interval (CI) were calculated using unconditional logistic regression models and reported as estimates of the relative risk. Results The prevalence of CIN was found to be 15.8%. The duration of oral contraceptive consumption among women with abnormal Papanicolaou (Pap) smear result indicating CIN was significantly shorter than those without abnormal Pap smear result (mean±SD, 5.6±5.2 years vs. 8.2±7.6 years; p=0.002). Comparing to ≤3 years usage, prolonged consumption of oral contraceptive for ≥10 years reduced the risk of CIN (p=0.012). However, use of condom for contraception might not be associated with a reduced risk of CIN after accounting for the effects of confounding factors (adjusted OR, 0.52; 95% CI, 0.05 to 5.11; p=0.577). Conclusion Use of oral contraceptives, but not condoms, for contraception appeared to be inversely associated with CIN. Prolonged use of oral contraceptive demonstrated its benefits of reducing the risk of CIN.
Collapse
Affiliation(s)
- Hui Jun Chih
- School of Public Health, Curtin University, Perth, Australia
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
| | - Linda Colville
- School of Public Health, Curtin University, Perth, Australia
| | - Daniel Xu
- Department of Medical Education, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Colin W Binns
- School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|
10
|
Abstract
BACKGROUND Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. OBJECTIVE The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women. METHODS Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012-present) randomized controlled trials (RCTs) on hirsutism treatment. RESULTS Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation. LIMITATIONS In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. CONCLUSIONS Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.
Collapse
|
11
|
Effect of protease inhibitors on steady-state pharmacokinetics of oral norethindrone contraception in HIV-infected women. J Acquir Immune Defic Syndr 2014; 65:72-7. [PMID: 24025339 PMCID: PMC3946363 DOI: 10.1097/qai.0b013e3182a9b3f1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pharmacokinetic interactions exist between combined oral contraceptives and protease inhibitors (PI). However, such information is lacking for progestin-only oral contraception. We sought to define the steady-state pharmacokinetic interaction between norethindrone (NET) and PI in HIV-infected women. METHODS AND DESIGN We conducted an open-label, prospective, nonrandomized trial to characterize the steady-state pharmacokinetics of serum NET in HIV-infected women receiving PI compared with a control group of HIV-infected women receiving other noninteracting drugs. After 21 days of 0.35 mg of NET ingestion once daily, serial serum samples were obtained at 0, 1, 2, 3, 4, 6, 8, 12, 24, 48, and 72 hours. The area under the curve between 0 and 72 hours after ingestion was calculated by trapezoidal approximation. RESULTS Thirty-five women were enrolled, 2 withdrew. Sixteen women in the PI group and 17 controls completed the study. NET half-life and maximum concentration were not significantly different between the 2 groups. Minimum concentration of NET was significantly higher in the PI group (P = 0.01). The ratio of the geometric mean NET area under the curve in the PI group compared with controls was 1.5 (90% confidence interval: 1.21 to 1.86). NET serum concentrations were significantly higher in HIV-infected women taking a PI compared with controls (P = 0.004). CONCLUSIONS Coadministration of PI inhibits NET metabolism as shown by higher serum NET area under the curve levels, a surrogate marker for therapeutic contraceptive efficacy. This study supports the increased utilization of progestin-only pills in HIV-infected women receiving certain PI regimens.
Collapse
|
12
|
Brownell EA, Fernandez ID, Fisher SG, Howard CR, Ternullo SR, Lawrence RA, Duckett JW, Dozier AM. The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation. Contraception 2013; 87:836-43. [PMID: 23153897 PMCID: PMC4038903 DOI: 10.1016/j.contraception.2012.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/23/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
Collapse
Affiliation(s)
- Elizabeth A Brownell
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Brownell EA, Fernandez ID, Howard CR, Fisher SG, Ternullo SR, Buckley RJJ, Dozier AM. A systematic review of early postpartum medroxyprogesterone receipt and early breastfeeding cessation: evaluating the methodological rigor of the evidence. Breastfeed Med 2012; 7:10-8. [PMID: 22085201 PMCID: PMC3270056 DOI: 10.1089/bfm.2011.0105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Breastfeeding has numerous maternal and infant benefits. Progesterone contraception after birth is frequently recommended, but because a decrease in progesterone is required to initiate lactation, early postpartum progesterone contraception use could inhibit lactation. The purpose of this article is to critically evaluate the scientific basis for conflicting clinical recommendations related to postpartum medroxyprogesterone use among breastfeeding women. METHODS Relevant peer-reviewed literature was identified through a comprehensive search of PubMed through December 2010. The search was restricted to clinical trials, randomized clinical trials, or comparative studies written in English and conducted among humans. The studies included in this review addressed the effect of medroxyprogesterone administration at <6 weeks postpartum on breastfeeding exclusivity and/or duration and measured breastfeeding outcomes at ≥ 6 weeks postpartum. RESULTS Of the 20 articles identified, only three studies satisfied the inclusion criteria. However, all three studies were of low-quality methodological rigor, and none accounted for potential confounders. CONCLUSION Current evidence is methodologically weak and provides an inadequate basis for inference about a possible causal relationship between early postpartum medroxyprogesterone use and poor breastfeeding outcomes. However, given the presence of a strong biological model describing the potential deleterious effect of postpartum medroxyprogesterone use on lactation, further research that improves on current literature is warranted. Meanwhile, we recommend that potential breastfeeding risks associated with early (<6 weeks) postpartum medroxyprogesterone use be disclosed to allow for a fully informed consent and decision-making process.
Collapse
Affiliation(s)
- Elizabeth A Brownell
- Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642-0644, USA.
| | | | | | | | | | | | | |
Collapse
|
14
|
Jacobson JC, Aikins Murphy P. United States medical eligibility criteria for contraceptive use 2010: a review of changes. J Midwifery Womens Health 2011; 56:598-607. [PMID: 22060220 DOI: 10.1111/j.1542-2011.2011.00093.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC.
Collapse
Affiliation(s)
- Janet C Jacobson
- Universityof Utah, Department of Obstetrics and Gynecology, Salt Lake City, Utah, USA.
| | | |
Collapse
|
15
|
Curtis KM, Tepper NK, Marchbanks PA. Putting risk into perspective: the US medical eligibility criteria for contraceptive use. Rev Endocr Metab Disord 2011; 12:119-25. [PMID: 21541854 DOI: 10.1007/s11154-011-9177-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Unintended pregnancy remains a considerable problem in the United States, with health risks for both mother and infant. These risks may be increased among women with medical conditions, for whom pregnancy can lead to severe adverse outcomes. Highly effective and safe contraceptive methods are available to prevent unintended pregnancy. However, women with medical conditions and their providers also may be concerned about potential risks associated with contraceptive method use. Evidence-based guidance documents can be helpful tools for clinicians to efficiently use evidence and put risks into perspective. The US Medical Eligibility Criteria for Contraceptive Use, 2010, provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions and other characteristics. While some contraceptive methods pose risks for some women, these must be considered in context and weighed against such considerations as the absolute risk of adverse events and the risks associated with pregnancy. Most women, even women with medical conditions, can safely use highly effective methods of contraception and promoting their use will further efforts to reduce unintended pregnancy.
Collapse
Affiliation(s)
- Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | |
Collapse
|
16
|
Curtis KM, Tepper NK, Marchbanks PA. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. J Womens Health (Larchmt) 2011; 20:825-8. [DOI: 10.1089/jwh.2011.2851] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kathryn M. Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naomi K. Tepper
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Polly A. Marchbanks
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
17
|
Jackson E. Controversies in postpartum contraception: when is it safe to start oral contraceptives after childbirth? Thromb Res 2011; 127 Suppl 3:S35-9. [PMID: 21262436 DOI: 10.1016/s0049-3848(11)70010-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The timely initiation of contraception postpartum is an important consideration for breastfeeding and non-breastfeeding women; many women prefer oral contraceptive pills to other methods. In breastfeeding women, combined hormonal pills are not recommended prior to 6 weeks postpartum, due to effects on milk production. Although progestogen-only pills do not adversely affect milk, lack of data regarding possible effects on infants exposed to progestogens in breastmilk renders timing of initiation of this method controversial. In non-breastfeeding women, elevated risk of venous thromboembolism restricts use of combined hormonal pills prior to 21 days postpartum. From 21 to 42 days, use of combined hormonal pills should be assessed based on a woman's personal venous thromboembolism risk profile; after 42 days postpartum there is no restriction in the use of combined hormonal pills for otherwise healthy women. Non-breastfeeding women may safely use progestogen-only pills at any time during the postpartum.
Collapse
Affiliation(s)
- Emily Jackson
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| |
Collapse
|
18
|
|