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Bryson AE, Milliren CE, Borzutzky C, Golub SA, Pitts SAB, DiVasta AD. Adolescent and young adult long-acting reversible contraception post-insertion visit attendance before and after COVID-19. Int J Adolesc Med Health 2024; 36:55-60. [PMID: 37982676 DOI: 10.1515/ijamh-2023-0134] [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: 08/24/2023] [Accepted: 11/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Widespread use of telemedicine for contraceptive care, including long-acting reversible contraception (LARC), was adopted in the United States in response to the COVID-19 pandemic. Given the rapid implementation of these services, little is known about the use of telemedicine for adolescent and young adult (AYA) contraceptive care. This study examined the routine use of telemedicine for LARC post-insertion care by comparing visit attendance between AYAs receiving LARC before and after the COVID-19 pandemic onset. METHODS This analysis included LARC insertions 3/1/19-11/30/19 (pre-pandemic onset cohort) and 4/1/20-12/31/20 (post-pandemic onset cohort) from three Adolescent Medicine subspecialty clinics in the United States. De-identified data were collected via review of the electronic health record. Descriptive statistics, χ2 tests, and t-tests described and compared groups. Adjusted logistic regression models examined factors associated with attending a post-insertion visit and attending this visit via telemedicine. RESULTS This analysis included 525 LARC insertions (279 pre- and 246 post-pandemic onset). The proportion of AYAs attending a post-insertion visit increased after the COVID-19 pandemic onset (pre 30 % vs. post 46 %; p≤0.001). Adjusted models revealed that the post-pandemic onset cohort was nearly twice as likely to attend a post-insertion visit as the pre-pandemic onset cohort (OR=1.90; 95 % CI=1.68-2.15). Of those attending this visit in the post-pandemic onset cohort (n=112), 42 % utilized telemedicine. CONCLUSIONS AYAs were more likely to attend post-insertion visits after the COVID-19 pandemic onset than before. Telemedicine may have influenced this change in visit attendance.
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Affiliation(s)
- Amanda E Bryson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sarah A Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah A B Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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2
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de Oliveira ECF, Rocha ALL. Five-year Contraceptive Use of 52-mg Levonorgestrel Releasing Intrauterine System in Young Women, Menstrual Patterns, and New Contraceptive Choice. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e654-e660. [PMID: 38029767 PMCID: PMC10686754 DOI: 10.1055/s-0043-1776032] [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: 04/08/2023] [Accepted: 07/24/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To evaluate the continuation rates of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) during the first 5 years of use, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year, in adolescents and young women. METHODS The present study was a 5-year prospective cohort conducted in a Family Planning Service of a tertiary hospital in Brazil. We selected 100 healthy women between 15 and 24 years old who used 52-mg LNG-IUS for contraception. The clinical follow-up of these women took place from June 2017 to December 2022. The study evaluated the continuation rates of the method, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year. Continuous data were reported as mean ± standard deviation (SD) and range (minimum-maximum). Categorical variables were described as percentages. RESULTS The continuation rates of LNG-IUS were 89.1% (82/92), 82.9% (72/87), 75.3% (64/85), 70.5% (60/85), and 64.2% (54/84) in the 1st, 2nd, 3rd, 4th, and 5th years of use, respectively. The main reason for discontinuation was acne (11/30). Amenorrhea rates were 50, 54.1, 39, 35.7, and 51.8% at 12, 24, 36, 48, and 60 months, respectively. All patients who completed the study and needed contraception after the 5th year opted for long-acting contraceptive methods (LARC). CONCLUSION The LNG-IUS showed high continuation rates in adolescents and young women in the first 5 years of use. Most patients who completed the study chose a LARC method after the 5th year.
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Affiliation(s)
| | - Ana Luiza Lunardi Rocha
- Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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3
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Lencha B, Daba SG, Ahmed JA, Washo A, Beressa G, Yalew A, Ganfure G. Determinants of implanon discontinuation among women who ever used implanon in Shashemene district, west Arsi zone, Southern Ethiopia: unmatched case control study. Contracept Reprod Med 2023; 8:46. [PMID: 37789494 PMCID: PMC10548583 DOI: 10.1186/s40834-023-00248-6] [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: 02/16/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Despite tremendous work has been done on demand creation, capacity building and ensuring the logistics of Implanon; its discontinuation rate remained high in Ethiopia; the prevalence is reported to be 31% in Shashemene District. However, the factors contributing to the high prevalence of early Implanon discontinuation were not well understood in our study setting. OBJECTIVE This study aimed to identify the determinants of implanon discontinuation among women who had ever used Implanon in Shashemene District, Southern Ethiopia. METHODS A community-based unmatched case-control study was conducted among randomly selected 264 women (88 cases and 176 controls) in Shashemene District, Southern Ethiopia, from April 12 to May 18, 2021. A systematic random sampling technique was used to select the respondents. Cases were women who discontinued Implanon before 3 years and controls were those who used implanon for 3 full years. A pre-tested, interviewer-administered structured questionnaire was used to collect data. Bivariable and multivariable binary logistic regression analyses were performed to identify determinants of Implanon discontinuation. An odds ratio (OR) with a 95% confidence interval (CI) was used to estimate the strength of the association, and significance was declared at a P value of less than 0.05. RESULT The mean age of the respondents was 28.23 (± 5.46) years: 27.27 (± 5.38) years for cases and 28.70 (± 5.5) years for controls. Women with no formal education [AOR = 3.09, 95% CI: (1.20, 8.00)], fewer than four children [AOR = 2.47, 95% CI: (1.20, 5.08)], no history of abortion [AOR = 2.84, 95% CI: (1.25, 6.46)], being new acceptors [AOR = 2.14, 95% CI: (1.02, 4. 49)], being counseled for less than fifteen minutes [AOR = 2.47, 95% CI: (1.29, 4.70)], not discussing it with a partner [AOR = 2.88, 95% CI: (1.42, 5.84)] and experiencing side effects [AOR = 0.35, 95% CI: (0.17, 0.71)] were significantly associated with discontinuation of implanon. CONCLUSION Women with no formal education, having less than four children, history of abortion, new acceptors, duration of counseling, discussion with partner, and side effects were determinants of Implanon discontinuation among women. There is a need to ensure adequate pre-implantation counseling and appropriate management of side effects. Furthermore, interventions should target new acceptors and those without formal education.
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Affiliation(s)
- Bikila Lencha
- Department of Public Health, Madda Walabu University, Shashemene, Oromia, Ethiopia.
| | | | | | - Asefa Washo
- Paradise Valley College, Shashemene, Oromia, Ethiopia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University, Bale Goba, Oromia, Ethiopia
| | - Aster Yalew
- Department of Nursing, Madda Walabu University, Shashemene, Oromia, Ethiopia
| | - Gemechu Ganfure
- Department of pediatrics, Ambo University, Ambo, Oromia, Ethiopia
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4
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Poehling C, Downey MM, Gwan AP, Cannady S, Ismail O. How Can We Address What We Do Not Measure? A Systematic Scoping Review of the Measurement and Operationalization of Social Determinants of Health Research on Long-Acting Reversible Contraceptive among Adolescents in the US. ADOLESCENTS (BASEL, SWITZERLAND) 2023; 3:240-258. [PMID: 38912095 PMCID: PMC11192542 DOI: 10.3390/adolescents3020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Teen pregnancy is often considered an adverse health outcome that accentuates gender inequities, diminishes opportunities, and jeopardizes the safety of adolescent and young adult birthing people. Long-Acting Reversible Contraceptives (LARC) have been hailed as a panacea for teen pregnancy. However, adolescents and emerging adults intersect with multiple assaults on their health and well-being due to gender inequity and racism. To establish equitable care, it is imperative to discern all barriers that influence their reproductive autonomy. This study evaluates the measurement, operationalization, and quality of research conducted on adolescents and emerging adults that analyzed the use of LARC within the social determinant of health framework (SDOH) in the US. SDOH were assessed using the Dahlgren and Whitehead model, and reports were analyzed using a modified version of the Joanna Briggs Institute (JBI) Critical Appraisal tools. Nineteen articles were included in this study. Researchers found the insufficient measurement of race, ethnicity, sexuality, and gender among studies on LARC and SDOH in adolescents and emerging adults. Future studies must measure a full range of identities in data collection to generate knowledge on the impact of SDOH and LARC use among diverse populations.
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Affiliation(s)
- Catherine Poehling
- School of Social Work, University of Southern Mississippi, Hattiesburg, MS 39401, USA
| | | | - Anwei Polly Gwan
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Olivia Ismail
- School of Social Work, University of Southern Mississippi, Hattiesburg, MS 39401, USA
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5
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Milliren CE, DiVasta AD, Edwards AJ, Maslyanskaya S, Borzutzky C, Pitts S. Contraceptive Implant-Associated Bleeding in Adolescent/Young Adult Clinical Practice: Associated Factors, Management, and Rates of Discontinuation. J Adolesc Health 2023; 72:583-590. [PMID: 36599757 DOI: 10.1016/j.jadohealth.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/31/2022] [Accepted: 11/02/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To identify factors associated with bothersome implant-associated uterine bleeding, and to evaluate the impact of bleeding management on implant discontinuation. METHODS We analyzed a quality improvement database of implant insertions (n = 825) at three adolescent/young adult programs and described individuals with and without reported bothersome bleeding. We utilized logistic regression to assess for factors associated with bleeding. RESULTS Implant recipient mean age was 18.9 ± 2.6 years, and 27% reported having subsequent bothersome uterine bleeding. Recipients had increased odds of reporting such bleeding if they had previously irregular menses (odds ratio [OR] = 1.36; 95% confidence interval [CI]: 1.11-1.68 irregular and infrequent, OR = 1.41; 95% CI: 1.07-1.86 irregular and frequent) or sought the implant for menstrual management purposes exclusively (OR = 1.67; 95% CI 1.42-1.96) or in combination with contraceptive need (OR 1.65; 95%: CI 1.57-1.72). Prior use of the progestin injection or implant was associated with lower odds of subsequent bleeding report (OR = 0.63; 95% CI: 0.54-0.73; OR = 0.54; 95% CI: 0.39-0.75, respectively). Medication management of bleeding was associated with the likelihood of implant discontinuation at 1 year compared to those with untreated bleeding (hazard ratio 1.98 times, 95% CI: 1.39-2.81). The implant was continued for 3 years in over 50% of recipients with ever-managed bothersome bleeding. DISCUSSION Individuals with historically irregular menses and those seeking the implant for menstrual management more often reported bothersome bleeding. Treating such bleeding with medication was associated with higher 1-year discontinuation rates, although many continued implant use for 3 years. Such findings may influence implant preinsertion counseling and/or postinsertion bleeding management.
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Affiliation(s)
- Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Alexandra J Edwards
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
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6
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Scott N, Silver EJ, Dodson NA, Coupey SM. Does Obesity Influence Body Mass Index Changes in Nulliparous Adolescent Users of Long-Acting Reversible Contraceptives? J Pediatr Adolesc Gynecol 2021; 34:815-820. [PMID: 34389461 DOI: 10.1016/j.jpag.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), specifically, the etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD), and copper IUD (Cu-IUD), by initial BMI category from the time of LARC insertion to within 6-18 months after insertion. DESIGN This was a single-center retrospective cohort study. SETTING AND PARTICIPANTS We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. MAIN OUTCOME MEASURE BMI change from LARC insertion to first BMI documented after 6-18 months RESULTS: Mean age was 17.2 ± 0.2 years; 59% of the cohort was Hispanic and 29% Black. Mean BMI was 26.4 ± 7.1 kg/m2. Of the total cohort of adolescents, 51% were underweight/normal, 24% overweight, and 25% obese. Mean time to first BMI documented after LARC insertion was 10.1 ± 3.2 months. Mean BMI change for the total cohort was +0.73 ± 1.8 kg/m2, indicating weight gain. Mean BMI change for the ENG-implant + LNG-IUD users (n = 127) was larger than for Cu-IUD users (n = 69) (+0.92 ± 1.9 kg/m2 vs +0.37 ± 1.6 kg/m2, respectively, P < .05). Two-way analysis of variance showed that both initial BMI category (P = .001) and type of LARC (P = .011) had an independent significant main effect on BMI change. A significant interaction effect (P = .017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC, either ENG-implant or LNG-IUD, as compared to a Cu-IUD (P < .05). CONCLUSION Adolescents using progestin-releasing LARCs had a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs was primarily contributed by obese users.
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Affiliation(s)
- Nadia Scott
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Ellen J Silver
- Division of Academic General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Nancy A Dodson
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Susan M Coupey
- Division of Adolescent Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.
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7
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Lee Y, Li W, Tang J, Schwendeman SP, Prausnitz MR. Immediate detachment of microneedles by interfacial fracture for sustained delivery of a contraceptive hormone in the skin. J Control Release 2021; 337:676-685. [PMID: 34375689 DOI: 10.1016/j.jconrel.2021.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 12/27/2022]
Abstract
Despite their high efficacy and safety, long-acting contraceptive methods are underutilized among women in some settings because they usually require injection or implantation by healthcare personnel. Here, we report a self-administrable microneedle (MN) patch for the rapid administration of a sustained-release contraceptive hormone delivery system into the skin that increases the simplicity and reliability of the MN delivery. We developed an immediate microneedle detachment system using a porous patch backing that has sufficient strength during MN insertion into skin under compression, but enables immediate detachment (< 1 s) of the MNs due to fracture at the MN - backing interface upon patch removal under tension from the skin surface. After patch application, the removed patch produced no biohazardous sharps waste, and was designed to achieve long-acting contraception by formulating poly(lactic-co-glycolic acid) MNs to slowly release the contraceptive hormone levonorgestrel for up to 1 month. Our combined strategy using immediate MN detachment in the skin and sustained drug delivery from the MNs could facilitate greater access to long-acting contraception by providing a simple and convenient option for self-administered, long-acting contraception.
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Affiliation(s)
- Yunki Lee
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Wei Li
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; School of Pharmaceutical Sciences, Wuhan University, Wuhan, Hubei 430071, China
| | - Jie Tang
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Steven P Schwendeman
- Department of Pharmaceutical Sciences and the Biointerfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mark R Prausnitz
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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8
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Farah D, Andrade TRDM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Pooled incidence of continuation and pregnancy rates of four contraceptive methods in young women: a meta-analysis. EUR J CONTRACEP REPR 2021; 27:127-135. [PMID: 34431421 DOI: 10.1080/13625187.2021.1964467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.
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Affiliation(s)
- Daniela Farah
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Manoel João Batista Castello Girão
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Department of Gynaecology, Health Technologies Assessment Centre, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, Sao Paulo, Brazil
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9
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Attendance of an Initial Follow-up Visit after Long-Acting Reversible Contraception Insertion and Method Continuation Among Adolescents and Young Adults: A Retrospective Study. J Pediatr Adolesc Gynecol 2021; 34:525-529. [PMID: 33486086 DOI: 10.1016/j.jpag.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/16/2020] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs). DESIGN Retrospective chart review including patients receiving LARC (etonogestrel 68 mg implant, levonorgestrel 52 mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1, 2017. SETTING An urban adolescent center providing primary care and reproductive health services. PARTICIPANTS A total of 331 patients 13-28 years of age. INTERVENTIONS Attendance of a follow-up visit 4-8 weeks after LARC insertion. MAIN OUTCOME MEASURES Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used. RESULTS Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR] = 2.10, 95% confidence interval [CI] 1.33-3.32). At 500 days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR = 1.07, 95% CI 0.67-1.71). CONCLUSION Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.
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10
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Farah D, Andrade TRM, Di Bella ZIKDJ, Girão MJBC, Fonseca MCM. Current evidence of contraceptive uptake, pregnancy and continuation rates in young women: a systematic review and Meta-analysis. EUR J CONTRACEP REPR 2021; 25:492-501. [PMID: 33140990 DOI: 10.1080/13625187.2020.1833187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER CRD42017055452.
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Affiliation(s)
- Daniela Farah
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Teresa Raquel Moraes Andrade
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Manoel João Batista Castello Girão
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Cunio Machado Fonseca
- Health Technologies Assessment Centre, Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Gynaecology, Universidade Federal de São Paulo, São Paulo, Brazil
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11
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Jaisamrarn U, Santipap M, Santibenchakul S. Discontinuation rates of different contraceptive methods in Thai women up to 1-year after method initiation. Sci Rep 2021; 11:10819. [PMID: 34031521 PMCID: PMC8144200 DOI: 10.1038/s41598-021-90373-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the discontinuation rate and the reason for discontinuation of common contraceptives used by reproductive-aged Thai women. We recruited 1880 women aged 18-45 years from the Family Planning Clinic of the Chulalongkorn Hospital in Bangkok. The participants were followed at three, six and twelve months. A Cox proportional hazards model was used to determine personal risks of discontinuing contraceptives. The incidence rate for discontinuation of combined oral contraceptive pills (COCs), depot medroxyprogesterone acetate (DMPA), copper intrauterine device (IUD), and contraceptive implant(s) were 21.3, 9.2, 4.4, and 2.3/100 person-years, respectively. Most of the women who discontinued (185/222) discontinued contraceptives due to side effects. Compared to contraceptive implant users, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of discontinuing COCs, DMPA, and the copper IUD were 9.6 (4.3-21.8), 4.2 (1.8-10.0), and 2.2 (0.8-5.9), respectively. Lower income, higher parity, history of miscarriage, and history of abortion were independent predictors of contraceptive discontinuation in a multivariable model.
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Affiliation(s)
- Unnop Jaisamrarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand
| | - Monchai Santipap
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand. .,Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, 1873 Rama IV Rd, Pathum Wan, Pathum Wan District, Bangkok, 10330, Thailand.
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Abstract
PURPOSE OF REVIEW Long-acting reversible contraception (LARC) is increasingly used by adolescents and young adults (AYAs). Subsequent to LARC insertion, AYAs are presenting to their primary care providers with LARC concerns. This article seeks to equip primary care clinicians with the tools necessary to assess and manage common LARC-associated side effects. RECENT FINDINGS Side effects are common with progestin-only LARC, and can precipitate early discontinuation of an otherwise effective, low-maintenance form of contraception. Abnormal uterine bleeding, pelvic pain, acne, and weight change are often cited as progestin-only LARC side effects, yet the causes are poorly understood despite extensive research. While most side effects improve with time, therapeutic interventions are available for patients with undesirable side effects that prefer medical management. Research emphasizes the importance of proper patient counseling and clinical follow-up. SUMMARY Counseling remains essential in the management of LARC-associated side effects. However, options are available to temporarily mitigate such side effects and increase LARC satisfaction. While these therapeutic options are prescribed based on expert opinion, such regimens remain inadequately studied in AYA populations.
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Hillard PJA. Pediatric and Adolescent Gynecology-A Global Perspective. J Pediatr Adolesc Gynecol 2020; 33:1-2. [PMID: 31959319 DOI: 10.1016/j.jpag.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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