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Hillert J, Bove R, Haddad LB, Hellwig K, Houtchens M, Magyari M, Merki-Feld GS, Montgomery S, Nappi RE, Stenager E, Thompson H, Tulek Z, Verdun Di Cantogno E, Simoni M. Expert opinion on the use of contraception in people with multiple sclerosis. Mult Scler 2024:13524585241228103. [PMID: 38456514 DOI: 10.1177/13524585241228103] [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: 03/09/2024]
Abstract
BACKGROUND Current guidance on the selection of appropriate contraception for people with multiple sclerosis (PwMS) is lacking. OBJECTIVE To address this gap, an expert-led consensus program developed recommendations to support clinicians in discussing family planning and contraception with women and men with multiple sclerosis (MS). METHODS A multidisciplinary steering committee (SC) of 13 international clinical experts led the program, supported by an extended faculty of 32 experts representing 18 countries. A modified Delphi methodology was used for decision-making and consensus-building. The SC drafted 15 clinical questions focused on patient-centered care, selection of contraception, and timing of stopping/starting contraception and disease-modifying therapies (DMTs). Statements addressing each question were drafted based on evaluation of published evidence and the experts' clinical experience. Consensus was reached if ⩾75% of respondents agreed (scoring 7-9 on a 9-point scale) with each recommendation. RESULTS Consensus was reached on 24 of 25 proposed recommendations, including how and when to discuss contraception, types and safety of contraceptives, and how to evaluate the most appropriate contraceptive options for specific patient groups, including those with significant disability or being treated with DMTs. CONCLUSION These expert recommendations provide the first practical, relevant, and comprehensive guidance for clinicians on the selection of contraception in PwMS.
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Affiliation(s)
- Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum GmbH, Nordrhein-Westfalen, Bochum, Germany
| | - Maria Houtchens
- Brigham and Women's Hospital, Boston, MA, USA/ Harvard Medical School, Boston, MA, USA
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, University Hospital Boston, MA, USA/ Rigshospitalet, Copenhagen, Denmark
| | - Gabriele S Merki-Feld
- Clinic of Reproductive Endocrinology, University Hospital Zürich, Zürich, Switzerland
| | - Scott Montgomery
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center of Reproductive Medicine, IRCCS San Matteo Foundation, Pavia, Italy
| | - Egon Stenager
- Department of Regional Research, University of Southern Denmark, Odense, Denmark
- MS-Clinic of Southern Jutland (Aabenraa, Esbjerg, Kolding), Sønderborg, Denmark
| | - Heidi Thompson
- Southern Health & Social Care Trust, Portadown, Northern Ireland
| | - Zeliha Tulek
- Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, University Hospital and Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Benazzouz I, Bouhnik C, Chapron A, Esvan M, Lavoué V, Brun T. Effects of virtual reality on pain during intrauterine device insertions: A randomized controlled trial. J Gynecol Obstet Hum Reprod 2024; 53:102706. [PMID: 38013014 DOI: 10.1016/j.jogoh.2023.102706] [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: 06/22/2023] [Accepted: 11/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The trial aimed to compare the pain perceived by women during intrauterine device (IUD) insertion, with or without virtual reality (VR) therapy. Furthermore, anxiety during the insertions, pain after the insertions, and satisfaction with the insertions were compared. METHODS The trial was designed as a prospective, bi-centric, randomized, open-label interventional trial. All adult women that chose an IUD during a contraceptive consultation, and who provided informed consent were eligible. Women under legal guardianship, not affiliated to a national social security system, and with pre-existing dizziness, severe facial wounds, or epilepsy were not eligible. Eligible women were randomly allocated either standard care without VR therapy (Control group) or with VR therapy (Experimental group). Pain, anxiety, and satisfaction were measured using a 10-cm numerical scale. RESULTS Between September 2020 and April 2022, 100 women were randomized: 50 to each group. The mean pain scores during IUD insertion were 5.4 cm in the Control group versus 5.1 cm in the Experimental group (p = 0.54). Mean anxiety during insertion were 4.8 cm in the Control group versus 4.2 cm in the Experimental group (p = 0.13). While mean pain perceived after insertions were 2.4 cm in the Control Group and 2.4 cm in the Experimental group (p = 0.98). Mean satisfaction with the insertions was 9.6 cm in both groups (p = 0.87). Anxiety before IUD insertion, as well as anticipated pain, were significantly correlated with pain perceived during insertions. CONCLUSIONS VR therapy performed during the procedure did not alleviate perceived pain in women undergoing IUD insertions.
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Affiliation(s)
- Inès Benazzouz
- University of Rennes, CHU Rennes, Department of General Practice, 2 Av. du Professeur Léon Bernard, F-35000 Rennes, France.
| | - Céline Bouhnik
- University of Rennes, CHU Rennes, Department of General Practice, 2 Av. du Professeur Léon Bernard, F-35000 Rennes, France
| | - Anthony Chapron
- University of Rennes, CHU Rennes, Department of General Practice, 2 Av. du Professeur Léon Bernard, F-35000 Rennes, France; INSERM, CIC-1414, Primary Care Research Team, F-35000 Rennes, France
| | - Maxime Esvan
- INSERM, CIC-1414, Primary Care Research Team, F-35000 Rennes, France
| | - Vincent Lavoué
- University of Rennes, Service de Gynécologie, CHU Rennes, Inserm, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, F-35000, Rennes, France
| | - Tiffany Brun
- CHU de Rennes, Département de Gynécologie Obstétrique et Reproduction Humaine, F-35033, Rennes, France
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Anderson PO. Emergency Contraception While Breastfeeding. Breastfeed Med 2022; 17:635-637. [PMID: 35947854 DOI: 10.1089/bfm.2022.0160] [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: 11/12/2022]
Affiliation(s)
- Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
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