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Preumont V. Contraception and diabetes: Which modalities should we consider in 2021? ANNALES D'ENDOCRINOLOGIE 2022:S0003-4266(22)00025-7. [PMID: 35217021 DOI: 10.1016/j.ando.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Diabetes affects many women of reproductive age. Choice of contraceptive method is essential in order to combine efficacy and the patient's wishes, while taking into account the potential side effects. In this review, we will discuss the different methods available for women with diabetes, focusing the discussion on their metabolic and general effects. We will not discuss the side effects and contraindications common to all women, whether they have diabetes or not. The objective is to try to identify an algorithm to help in the decision to choose the most suitable contraceptive method for women with type 1 or type 2 diabetes.
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Affiliation(s)
- Vanessa Preumont
- Service d'Endocrinologie et Nutrition, Cliniques universitaires UCL Saint-Luc, Avenue Hippocrate, 10, 1200 Bruxelles, Belgium.
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Bléas C, Llouquet F, Neveu ME, Gaudu S, Fernandez H, Vigoureux S. Study on the use practices and knowledges of French practitioners about the use of intra-uterine devices in early post-partum contraception in France. J Gynecol Obstet Hum Reprod 2022; 51:102240. [PMID: 34610488 DOI: 10.1016/j.jogoh.2021.102240] [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: 06/04/2021] [Accepted: 09/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Intra-Uterine Device (IUD) insertion is possible in early postpartum. Although this contraception method is recognized and used in lots of country, it seems infrequent and poorly known in France. Our study aims to assess the barriers to the application of this method in France. METHODS A questionnaire was sent to obstetricians-gynaecologist professionals and midwives in France, through the affiliation to CNGOF (French National College of Obstetricians and Gynecologists) and to CNSF (French National College of Midwives). Questions were focused on the practices and knowledge about the insertion of IUD in early postpartum. RESULTS four hundred eight practitioners responded. Amongst them, 63% knew about the possibility to use IUDs after a vaginal delivery and 31% knew it could be inserted during cesarean section. Ten percent of them used this method. Most of these practitioners (80% of them) would like to discuss the insertion of an IUD in early postpartum with their patients and 71% would like to perform the insertion themselves after training. Besides, this study shows that contraception is rarely addressed by physicians during the follow-up of pregnancies. Less than 15% of respondents report discussing the topic systematically with the patient during the pregnancy follow during pregnancy follow. CONCLUSION insertion of IUDs in early postpartum is uncommon in France. The main limitation seems to be a lack of knowledge, but practitioners seem to be interested in this practice. Training courses could be created in order to rase up the adoption of this practice.
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Affiliation(s)
- C Bléas
- Faculty of medicine University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe, France.
| | - F Llouquet
- Faculty of medicine Université Paris-Descartes, 12 Rue de l'École de Médecine, 75006 Paris, France
| | - M-E Neveu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - S Gaudu
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France
| | - H Fernandez
- AP-HP, GHU-Sud, Hospital Bicêtre, Department of Gynecology and Obstetrics, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France. Service de gynécologie obstétrique, hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78, rue du Général-Leclerc, 94000 Le Kremlin-Bicêtre, France; CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France
| | - S Vigoureux
- CESP-INSERM, U1018, Soins Primaires, Paris-Sud University, Paris-Saclay University, UVSQ, INSERM, Villejuif Cedex, France; Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
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Ciangura C, Bachelot A. [Contraception in women with obesity]. Med Sci (Paris) 2021; 37:882-887. [PMID: 34647876 DOI: 10.1051/medsci/2021147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obese women are at high risk of unintended pregnancy. In addition, obesity is an important risk factor for venous thromboembolism events and arterial thrombosis. All of these data are to be considered in choosing a contraceptive method for obese women. The metabolic changes and the increased body mass of these women may be the cause of a reduction in the effectiveness of hormonal contraception. The progestin-only contraceptives (progestin only pills and etonogestrel subdermal implant) and the intra-uterine devices are the preferred contraceptive methods in women with obesity. The combined estrogen-progestin contraceptives may be proposed in young obese women without other cardiovascular risk factor. Obesity per se does not seem to increase the risk of failure of most contraceptive methods. Bariatric surgery is a complex situation. Contraception is needed for at least 12 months after surgery. Some bariatric surgery such as bypass can induce gastrointestinal malabsorption. In this situation, all oral contraceptives are not recommended because of a higher risk of failure.
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Affiliation(s)
- Cécile Ciangura
- Service de nutrition, ICAN (Institut de cardiométabolisme et nutrition), Hôpital Pitié Salpêtrière, Sorbonne Université, 47-83 boulevard de l'hôpital, 75013 Paris, France
| | - Anne Bachelot
- Endocrinologie et médecine de la reproduction, Centre de référence des maladies endocriniennes rares de la croissance et du développement, Centre de référence des pathologies gynécologiques rares, Hôpital universitaire Pitié Salpêtrière, 47-83 boulevard de l'hôpital, 75013 Paris, France
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Abstract
The request for a contraception in adolescent women makes it possible to address HPV vaccination and prevention of STIs and to search for abuse. Optimizing the use of contraception is the priority. Any contraceptive methods can be offered. Adhesion is improved by prior information and individualized counselling. Apart from the vascular risk associated with the combined hormonal contraception, hormonal contraception provides gynecologic benefits. The efficacy of long-acting methods is higher compared to short-acting methods but their tolerance is a sensitive matter. Emergency contraception can be prescribed in advance. There are measures to facilitate the delivery to minors.
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Affiliation(s)
- Lise Duranteau
- Unité de gynécologie adolescente et jeune adulte, AP-HP, université Paris Saclay (Bicêtre), Hôpital Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
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Wan L, Wang Y, Xiao C, Li X, Cao J, Wang S, Wei X, Liu X. Four cases of heterotopia of an intrauterine device embedded in the bladder muscular layer causing cystolithiasis: case report and review of the literature. J Int Med Res 2021; 49:300060520979444. [PMID: 33472467 PMCID: PMC7829606 DOI: 10.1177/0300060520979444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Family planning is a basic national policy in China. An intrauterine device (IUD)
is an important method of achieving family planning owing to its high safety,
low cost, and convenient use. The indwelling birth control ring has no obvious
adverse effects on the sexual life of women after the operation, and the process
is reversible. This ring can be removed for women who want to have children
again. There are approximately 100 million women with IUDs worldwide, with
approximately 80 million in China. This finding accounts for approximately 40%
of women of childbearing age in China. Although an IUD is safe, the invasive
operation inevitably leads to complications, such as pelvic infection, abnormal
menstruation, and damage to adjacent organs. Among them, ectopic bladder stone
formation is a rare complication, but several related cases have been reported.
We report four cases of heterotopia of an IUD and cystolithiasis, with diagnosis
based on the medical history, clinical manifestations, imaging, and cystoscopic
findings. The four patients with ectopic IUDs were treated with cystoscopy
combined with laparoscopy (or hysteroscopy). We describe the process of
diagnosis and treatment of our patients, and the related literature on an
ectopic IUD is reviewed.
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Affiliation(s)
- Li Wan
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Yong Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Chuan Xiao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xin Li
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Jingzhao Cao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Shubin Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xupan Wei
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xiangyu Liu
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
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Pérez-López FR, Pérez-Roncero GR, López-Baena MT, Santabárbara J, Chedraui P. Hormonal contraceptives and the risk of suicide: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 251:28-35. [PMID: 32470654 DOI: 10.1016/j.ejogrb.2020.04.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the effect of hormonal contraceptive use over the risk of suicide. METHOD Systematic review and meta-analysis of observational studies retrieved from five search engines until September 2019, comparing the use of any hormonal contraceptive versus non-hormonal contraceptive use or no use. Primary outcome was consumed suicide, and secondary outcomes were suicidal attempt and ideation. Random effects meta-analyses with the inverse variance method were used to evaluate the effects of exposure over outcomes. Effect was calculated as risk ratio (RR) with their corresponding 95% confidence interval (CI). Risk of bias was assessed with the Newcastle-Otawa Scale. RESULTS There were no randomized controlled trials concerning suicide and hormonal contraceptive use. Only three cohort studies (n = 184,721 women), that evaluated the primary outcome (consumed suicide), were included in the meta-analysis. Hormonal contraceptive use was associated to a higher risk of consumed suicide (RR = 1.36, 95% CI 1.06 to 1.75, P = 0.015, I2 = 0%). There were no secondary outcomes in at least two cohorts. CONCLUSION This meta-analysis found a positive association between hormonal contraceptive use and consumed suicides. Prior to their use, populations at suicidal risk should be properly evaluated.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza, Faculty of Medicine, Zaragoza, Spain; Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain.
| | | | | | - Javier Santabárbara
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain; Department of Preventive Medicine and Public Health University of Zaragoza, Faculty of Medicine, Zaragoza, Spain
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador; Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
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