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Torres E, Carter G, Gero A, Simmons RG, Sanders JN, Turok DK. Frequency of same-day contraceptive initiation, recent unprotected intercourse, and pregnancy risk: a prospective cohort study of multiple contraceptive methods. Am J Obstet Gynecol 2024; 230:661.e1-661.e7. [PMID: 38367756 DOI: 10.1016/j.ajog.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Same-day start removes barriers to contraceptive initiation and may reduce the risk of unintended pregnancy. It may be appropriate for all contraceptive methods, but we lack data comparing methods. OBJECTIVE This study aimed to assess the frequency of same-day start with 6 contraceptive methods among new contraceptive users and describe the efficacy of same-day start in terms of first-cycle pregnancy risk overall and by each method. STUDY DESIGN Using prospective data from the HER Salt Lake Contraceptive Initiative, we identified and assessed outcomes for participants initiating a new method of contraception beyond the first 7 days of their menstrual cycle (same-day start). Enrolled participants at 4 family planning clinics in Salt Lake County, Utah between September 2015 and March 2017 received their method of choice regardless of their cycle day or recent unprotected intercourse. All participants self-reported last menstrual period data and unprotected intercourse events in the previous 2 weeks. We excluded participants who received care immediately after or within 2 weeks of abortion care. Clinical electronic health records provided information on contraceptive method initiation and use of oral emergency contraception. Participants reported pregnancy outcomes in 1-, 3-, and 6-month follow-up surveys with clinic verification to identify any pregnancy resulting from same-day initiation. The primary outcomes report the frequency of same-day start use and first-cycle pregnancy risk among same-day start users of all contraceptive methods. The secondary outcomes include frequency of and pregnancy risk in the first cycle of use among same-day start contraception users by method. We also report the frequency of unprotected intercourse within 5 days and 6 to 14 days of contraception initiation, frequency of concomitant receipt of oral emergency contraception with initiation of ongoing contraception, and pregnancy risk with these exposures. We analyzed pregnancy risk for each contraceptive method initiated on the same day and assessed the simultaneous use of oral emergency contraception. RESULTS Of the 3568 individuals enrolled, we identified most as same-day start users (n=2575/3568; 72.2%), with 1 in 8 of those reporting unprotected intercourse in the previous 5 days (n=322/2575; 12.5%) and 1 in 10 reporting unprotected intercourse 6 to 14 days before contraceptive method initiation (n=254/2575; 9.9%). We identified 11 pregnancies among same-day start users (0.4%; 95% confidence interval, 0.2-0.7), as opposed to 1 (0.1%; 95% confidence interval, 0.002-0.6) among those who initiated contraception within 7 days from the last menstrual period. Users of oral hormonal contraception and vaginal hormonal methods reported the highest first-cycle pregnancy rates (1.0-1.2). Among same-day start users, 174 (6.8%) received oral emergency contraception at enrollment in conjunction with another method. Among the same-day start users who received emergency contraception at initiation, 4 (2.3%) pregnancies were reported. CONCLUSION Same-day start is common and associated with a low pregnancy risk. Using the "any method, any-time" approach better meets contraceptive clients' needs and maintains a low risk of pregnancy.
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Affiliation(s)
- Erica Torres
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT.
| | - Gentry Carter
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Alexandra Gero
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Rebecca G Simmons
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
| | - David K Turok
- Division of Family Planning, Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT
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Gawron LM, Sexsmith CD, Carter G, Kaiser JE, Pangasa M, Turok DK. Efficacy of oral levonorgestrel emergency contraception with same day etonogestrel contraceptive implant: A prospective observational study. Contraception 2024; 131:110344. [PMID: 38008305 PMCID: PMC10872399 DOI: 10.1016/j.contraception.2023.110344] [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: 10/12/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To determine a 1-month pregnancy rate point estimate and 95% confidence interval for guideline-supported, same-day initiation of an etonogestrel implant plus oral levonorgestrel emergency contraception. STUDY DESIGN In this single-arm, prospective observational study, all emergency contraception clients who presented to four Planned Parenthood Association of Utah clinics from February 2021 to March 2023 received information about oral levonorgestrel with same-day etonogestrel implant insertion. Participants were ≤35 years and reported unprotected intercourse within 5 days with negative pregnancy testing. The primary outcome measure was a 1-month home pregnancy test. We calculated the efficacy using a test of proportions with Yates continuity correction. RESULTS A total of 160 emergency contraception clients (7.6% of 2106 approached) enrolled and 153 had 1-month pregnancy outcomes. A positive pregnancy test occurred in 2 participants resulting in an overall pregnancy rate of 1.32% (95% confidence interval 0.23%-5.19%). Ultrasound gestational dating assigned conception of the first pregnancy to 8 days before enrollment. For the second pregnancy, ultrasound dating designated conception at 5 days prior to enrollment. Limiting the efficacy rate to the single pregnancy that occurred within 5 days of unprotected intercourse, we report a pregnancy rate of 0.66% (95% confidence interval 0.03%-4.19%). CONCLUSIONS In this observational study of emergency contraception clients selecting oral levonorgestrel with same-day etonogestrel implant, we identified a pregnancy rate within the established range of oral emergency contraception methods alone. IMPLICATIONS Clients presenting for emergency contraception may also desire ongoing highly-effective contraception, yet current clinical guidelines serve as a barrier to same-day method initiation for the etonogestrel implant and other hormonal methods. Improving access to contraceptive method initiation will reduce the ongoing risk of unwanted pregnancy for this population. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT04678817; registered 12/16/20.
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Affiliation(s)
- Lori M Gawron
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States.
| | - Corinne D Sexsmith
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Gentry Carter
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jennifer E Kaiser
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Misha Pangasa
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David K Turok
- ASCENT Center for Reproductive Health, Family Planning Division, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, United States
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Bruce KH, Merchant MA, Kaskowitz AP, Mickelsen RS, Lau JS. Adolescent Long-Acting Reversible Contraceptive Use, Same-Day Insertions, and Pregnancies Following a Quality Initiative. J Adolesc Health 2023; 73:946-952. [PMID: 37436353 DOI: 10.1016/j.jadohealth.2023.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To compare long-acting reversible contraceptive (LARC) use, pregnancy rate, and same-day LARC insertion among adolescents before and after a Kaiser Permanente Northern California quality initiative. METHODS A 2016 Kaiser Permanente Northern California initiative aimed to increase adolescent LARC access. Interventions included patient education resources, electronic protocols, and insertion training for pediatric, family medicine, and gynecology providers. This study examined a retrospective cohort of adolescents aged 15-18 years who used contraception before (2014-2015, n = 30,094) and after (2017-2018, n = 28,710) implementation. Contraceptive types included LARC (intrauterine device or implant), injectable, and contraceptive pill, patch, or ring. We reviewed a random sample of LARC users (n = 726) to identify same-day insertions. Multivariable analysis examined the effects of year of provision, age, race, ethnicity, LARC type, and counseling clinic. RESULTS Preintervention, 12.1% of adolescents used LARC, 13.6% used injectable, and 74.3% used pill, patch, or ring. Postintervention, the proportions were 23.0%, 11.6%, and 65.4%, respectively, with the odds of LARC provision of 2.57 (95% confidence interval (CI) 2.44-2.72). The pregnancy rate decreased from 2.2% to 1.4% (p < .0001). Higher rates of pregnancy were observed with injectable contraception and in Black and Hispanic adolescents. Same-day LARC insertion rate was 25.1% without significant variation post intervention (OR 1.44, 95% confidence interval 0.93-2.23). Contraceptive counseling in gynecology clinics increased the odds of same-day provision, while non-Hispanic Black race lowered odds. DISCUSSION A multifaceted quality intervention was associated with a 90% increase in LARC use and a 36% decrease in teenage pregnancy rate. Future directions may include promoting same-day insertions, targeting interventions in pediatric clinics, and focusing on racial equity.
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Affiliation(s)
- Kelly H Bruce
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Maqdooda A Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Alexa P Kaskowitz
- Division of Pediatric and Adolescent Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Riley S Mickelsen
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | - Josephine S Lau
- Division of Adolescent Medicine, Kaiser Permanente San Leandro Medical Center, San Leandro, California.
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Manhiça SI, Bahamondes L, Laporte M, Anjos F, Viscola M, Garcia E, Paiva LC. Single-visit long-acting reversible contraception provision and pregnancy rates within 3 months. Int J Gynaecol Obstet 2022; 161:1028-1032. [PMID: 36527255 DOI: 10.1002/ijgo.14630] [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: 09/17/2022] [Revised: 11/17/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the occurrence of pregnancy in a cohort of women who received a copper intrauterine device (IUD), hormonal IUDs or an etonogestrel (ENG) contraceptive implant at a single-visit practice. METHODS Prospective study conducted at the University of Campinas, Campinas, São Paulo, Brazil. We obtained data from four ongoing studies including both the date of the device placement, the first day of the last menstrual period, and the occurrence of pregnancy up to 3 months after device placement. RESULTS We included 2479 device placements (413 TCu380A IUDs, 1476 hormonal IUD and 590 ENG implants). Almost half of the device placements (1113/2479; 44.9%) were performed within the first 5 days of the menstrual cycle. We observed three pregnancies: one in an ENG implant user who received the implant within days 1-5 of the menstrual cycle; one in a woman who received a hormonal IUD during days 6-10 of the menstrual cycle; and one in a copper IUD user with placement during days 21-25 of menstrual cycle. CONCLUSIONS Single-visit long-acting reversible contraception placements are a good strategy with overall very low pregnancy rates. This strategy has a potential to reduce unintended pregnancies and to reduce costs and barriers to both women and the healthcare system.
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Affiliation(s)
- Suzana I Manhiça
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Montas Laporte
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Fabiana Anjos
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Marco Viscola
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Elaine Garcia
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
| | - Lucia C Paiva
- Department of Obstetrics and Gynecology, University of Campinas, São Paulo, Brazil
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Averbach S, Hofler L. Long-Acting Reversible Contraception With Contraceptive Implants and Intrauterine Devices. JAMA 2022; 327:2013-2014. [PMID: 35522320 DOI: 10.1001/jama.2022.5448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego
- Center on Gender Equity and Health, University of California, San Diego
| | - Lisa Hofler
- Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque
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Abstract
IMPORTANCE Many women spend a substantial proportion of their lives preventing or planning for pregnancy, and approximately 87% of US women use contraception during their lifetime. OBSERVATIONS Contraceptive effectiveness is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation. In the US, oral contraceptive pills are the most commonly used reversible method of contraception and comprise 21.9% of all contraception in current use. Pregnancy rates of women using oral contraceptives are 4% to 7% per year. Use of long-acting methods, such as intrauterine devices and subdermal implants, has increased substantially, from 6% of all contraceptive users in 2008 to 17.8% in 2016; these methods have failure rates of less than 1% per year. Estrogen-containing methods, such as combined oral contraceptive pills, increase the risk of venous thrombosis from 2 to 10 venous thrombotic events per 10 000 women-years to 7 to 10 venous thrombotic events per 10 000 women-years, whereas progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks. Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder. Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences. CONCLUSIONS AND RELEVANCE Oral contraceptive pills are the most commonly used reversible contraceptives, intrauterine devices and subdermal implants have the highest effectiveness, and progestin-only and nonhormonal methods have the lowest risks. Optimal contraceptive selection incorporates patient values and preferences.
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Affiliation(s)
- Stephanie Teal
- Department of OB/GYN, University Hospitals Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alison Edelman
- Department of OB/GYN, Oregon Health & Science University, Portland
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Green S, Sheeder J, Richards M. The Etonogestrel Implant in Adolescents: Factors Associated With Removal for Bothersome Bleeding in the First Year After Insertion. J Pediatr Adolesc Gynecol 2021; 34:825-831. [PMID: 34089858 DOI: 10.1016/j.jpag.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE Temporizing measures such as hormonal pills can temporarily improve the side effect of breakthrough bleeding in individuals using the etonogestrel implant. The aims of this study were to determine demographic factors that are associated with bothersome bleeding and to evaluate the impact of prescribing temporizing measures on implant continuation. DESIGN Retrospective chart review. SETTING The research was conducted in an adolescent medicine primary and specialty care clinic, an adolescent family planning clinic, and a clinic that cares for parenting adolescents. PARTICIPANTS A chart review was conducted on 1200 patients aged 12-24 years who received the implant in 2016. INTERVENTIONS AND MAIN OUTCOME MEASURES The primary outcome measure was removal of the implant within the first year of use. We followed each patient for 1 year to determine rates of removal, reasons for removal, and temporizing measures prescribed for bleeding. RESULTS Younger age and lower body mass index were associated with reporting bothersome vaginal bleeding. Patients who were nulliparous or had bothersome bleeding were more likely to have the implant removed in the first year. Patients who received a temporizing measure for bleeding were more likely to retain the implant for 1 year than were those who did not receive one (67.1% vs 40%, P < .001). CONCLUSIONS Some patients are more likely to report concerns with bleeding or to have the implant removed in the first year after insertion. Prescribing temporizing measures to control bothersome vaginal bleeding may decrease rates of removal in the first year.
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Affiliation(s)
- Sarah Green
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Molly Richards
- Department of Pediatrics, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado; University of Colorado School of Medicine, Aurora, Colorado
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Lew J, Sheeder J, Lazorwitz A. Etonogestrel contraceptive implant uptake and safety among solid organ transplant recipients. Contraception 2021; 104:556-560. [PMID: 34147509 PMCID: PMC8502202 DOI: 10.1016/j.contraception.2021.06.007] [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: 03/31/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the safety of etonogestrel contraceptive implant use among reproductive-age women who are solid organ transplant recipients. STUDY DESIGN We conducted a retrospective cohort study with matching of reproductive-age women (14-45 years) who were solid organ transplant recipients and received care at a tertiary medical center in Denver, Colorado between 2011 and 2019. We identified cases who used an etonogestrel contraceptive implant post-transplant and then matched controls (no hormonal contraceptive use) in a 1:1 ratio according to age, transplant type, and institution. We compared pregnancy patterns, post-transplant infections, immunosuppressant therapy adjustments, and graft complications between cases and controls. We also evaluated implant-related side effect profiles and continuation rates among cases only. RESULTS We identified 24 cases and 24 matched controls. When compared to age and transplant organ-matched controls, contraceptive implant users were not at increased risk for adverse transplant-related outcomes. Graft rejection was the most common transplant-related complication in both groups (n = 11, 45.8% cases; n = 10, 41.7% controls). Additionally, outcomes concerning pregnancies, infections and immunosuppressant therapy changes showed no statistically significant difference between either group. CONCLUSIONS This study provides the first data that the etonogestrel contraceptive implant is likely a safe contraceptive option for reproductive-age women who are solid organ transplant recipients. Given the solid organ transplant recommendations to avoid pregnancy during the first 1 to 2 years post-transplant, healthcare providers should continue to counsel solid organ transplant recipients at risk of pregnancy on the etonogestrel contraceptive implant as an effective and safe method of pregnancy prevention. IMPLICATIONS Reproductive age women who are solid organ transplant recipients face additional health risks with unintended pregnancies. The etonogestrel contraceptive implant remains a safe and effective method of contraception for this specific population, with no increase in graft-related complications among contraceptive implant users.
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Affiliation(s)
- Jessica Lew
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States
| | - Jeanelle Sheeder
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States
| | - Aaron Lazorwitz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, United States.
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Gawron LM, Gero A, Kushner KL, Turok DK, Sanders JN. Unprotected intercourse in the 2 weeks prior to quick-start initiation of an etonogestrel contraceptive implant with and without use of oral emergency contraception. Am J Obstet Gynecol 2020; 222:S891-S892. [PMID: 31809707 PMCID: PMC7219276 DOI: 10.1016/j.ajog.2019.11.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/07/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Lori M Gawron
- University of Utah, 30N 1900E, Room 2B-200, Salt Lake City, UT 84132.
| | - Alexandra Gero
- University of Utah, 30N 1900E, Room 2B-200, Salt Lake City, UT 84132
| | | | - David K Turok
- University of Utah, 30N 1900E, Room 2B-200, Salt Lake City, UT 84132
| | - Jessica N Sanders
- University of Utah, 30N 1900E, Room 2B-200, Salt Lake City, UT 84132
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Mohtashami Z, Esmaili Z, Vakilinezhad MA, Seyedjafari E, Akbari Javar H. Pharmaceutical implants: classification, limitations and therapeutic applications. Pharm Dev Technol 2019; 25:116-132. [DOI: 10.1080/10837450.2019.1682607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Zahra Mohtashami
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esmaili
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamid Akbari Javar
- Pharmaceutics Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Cohen R, Sheeder J, Teal SB. Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women. J Adolesc Health 2019; 65:295-302. [PMID: 31196778 DOI: 10.1016/j.jadohealth.2019.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the article was to describe adolescent and young women's rates of discontinuation of intrauterine devices (IUDs) and contraceptive implants, the extent to which discontinuation is predicted by baseline factors, reasons for discontinuation, and subsequent contraceptive initiation. METHODS We recruited English-speaking women, aged 13-24 years, from a family planning clinic serving clients <25 years old. Participants completed surveys before and after contraceptive initiation visits. We reviewed medical records and contacted participants who initiated use of an IUD or contraceptive implant and assessed contraceptive discontinuation before 30 months of use. We collected follow-up data on duration of use, reasons for discontinuation, and new method selected. We used multivariable regression models to ascertain factors associated with method discontinuation. RESULTS From 2011 to 2013, 775 young women completed surveys and initiated IUD or implant use. We determined 30-month discontinuation status of 633 women (81.7%). Among those with known outcome, fewer IUD than implant initiators had discontinued use (36.3% vs. 45.4%, p = .02). Mean duration of use was 733 days (95% confidence interval 702-763 days) for the IUD and 697 days (95% confidence interval 666-728 days) for the implant. Participants who stated at baseline that it was "very important" to avoid pregnancy were about half as likely to discontinue use. The most common reasons for discontinuation were pain (IUD) and bleeding (implant). Most participants initiated alternate contraception after discontinuing their original method. CONCLUSIONS Adolescents and young women who initiate an IUD or implant make decisions for discontinuation based on weighing high contraceptive effectiveness with other reproductive health values and preferences.
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Affiliation(s)
- Rebecca Cohen
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Section of Adolescent Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie B Teal
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Section of Adolescent Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Lazorwitz A, Coleman-Minahan K, Teal SB, Guiahi M. Ongoing Etonogestrel Contraceptive Implant Use Throughout Pregnancy. J Adolesc Health 2018; 63:363-364. [PMID: 30076014 DOI: 10.1016/j.jadohealth.2018.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/23/2018] [Accepted: 03/22/2018] [Indexed: 10/28/2022]
Abstract
Case reports of pregnancies with inadvertent etonogestrel contraceptive implant exposure in the first-trimester have not demonstrated teratogenic risks or adverse pregnancy outcomes. We report the clinical observations of a 15-year-old nulligravida who continued her etonogestrel contraceptive implant throughout pregnancy and delivery, without any adverse maternal or neonatal outcomes. The patient then continued her contraceptive implant as a reliable postpartum contraceptive method. Although her favorable outcomes are consistent with available pharmacologic literature, more data is needed regarding maintenance of a contraceptive implant during a desired pregnancy.
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Affiliation(s)
- Aaron Lazorwitz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, Colorado.
| | - Kate Coleman-Minahan
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado.
| | - Stephanie B Teal
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, Colorado.
| | - Maryam Guiahi
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, Colorado.
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Intrauterine Devices and Contraceptive Implants: Overview of Options and Updates on Method Use. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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