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Factors associated with removal difficulties of etonogestrel-containing contraceptive implants (Nexplanon ®). Eur J Obstet Gynecol Reprod Biol 2018; 224:81-84. [PMID: 29554605 DOI: 10.1016/j.ejogrb.2018.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Nexplanon®'s new applicator system was designed to limit deep implant placements, known to lead to difficult removals. However, removal difficulties still exist and induce specific and potentially severe complications. Our objective was to identify risk factors associated with difficult removals. STUDY DESIGN A retrospective single-center study was performed from January 2015 to December 2016. Participants were divided into two groups depending on whether implant was removed during a standard ("standard removal" group) or difficult consultation ("difficult removal" group) after an initial failed removal attempt. RESULTS The difficult and standard removal groups comprised 63 and 660 women, respectively. In a univariate analysis, significant intergroup differences were found for weight gain (3.7 ± 7.3 kg in the difficult removal group vs. 1.3 ± 5.1 in the standard removal group), proportion of placements performed in private practice (66.7% vs. 19.8%, respectively), and duration of Nexplanon® placement (29.4 ± 11.3 months versus 26 ± 13.6, respectively). We also reported more frequent sub-brachial fascia placements when Nexplanon® was implanted by a private practitioner (7.5% cases versus 0.4% in hospital implantations, p < 0.001). In a stepwise binary logistic regression analysis, placement by a private practitioner, weight gain >1 kg since placement, and duration of implant placement >25 months were confirmed as independent risk factors for removal difficulties (respective risk ratios 7.63 [95% IC 4.35-13.33], 2.10 [1.18-3.70], and 1.91 [1.06-3.44], p < 0.05). CONCLUSIONS Awareness of these three simple parameters might help physicians to identify "at risk-patients", and suggest a specific consultation before risking a potentially hazardous removal (with its associated, specific morbidity). Our results also emphasize importance of training in implant insertion.
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Estrogenic and progestogenic effects of hormonal contraceptives in relation to sexual behavior: insights into extended sexuality. EVOL HUM BEHAV 2017. [DOI: 10.1016/j.evolhumbehav.2016.10.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Simon C, Agier MS, Béné J, Muller C, Vrignaud L, Marret H, Jonville-Bera AP. [Safety profile of etonogestrel contraceptive implant (Nexplanon ® and Implanon ®) reported in France]. ACTA ACUST UNITED AC 2016; 45:1074-1082. [PMID: 27125380 DOI: 10.1016/j.jgyn.2016.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the study was to assess the incidence of adverse effects (AE) reported with etonogestrel contraceptive implant in France (Implanon® and Nexplanon®). MATERIALS AND METHODS All cases of AE or unintended pregnancies reported to health authorities or to the firm were analyzed. RESULTS During 10 years, 5433 AE and 789 unintended pregnancies were reported. Only 388 (7 %) were serious. There were 1137 reports of difficulties to remove, failure to locate or migration, 430 of insertion difficulties and 203 of deformation or expulsion of the implant. Among other AE, the most common were 1694 gynecological AE, 524 skin reactions and 437 metabolic AE. Since the marketing of Nexplanon® which causes less deep insertions, the incidence of migrations, removal or insertion difficulties has decreased overall (0.92 vs. 1.31/1000 patients), particularly the incidence of removal difficulties, location failures or migrations (0.12 vs 1.01/1000). The infrequent but serious AE were infectious complications at the implant site and pregnancies. When the circumstances of the pregnancy were known, the contraceptive failure was due to the apparent inefficiency of the implant (n=224), to a technique failure (n=203) or to a drug-drug interaction (n=59). CONCLUSION This study confirms that AE of this implant are frequent but not serious, except for the pregnancies. The incidence of complications related to insertion decreased with Nexplanon®. Among other preventable AE, unintended pregnancies due to a drug-drug interaction would require to be better known by the practitioner.
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Affiliation(s)
- C Simon
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - M S Agier
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - J Béné
- Service de pharmacologie, centre régional de pharmacovigilance, CHRU de Lille, 59045 Lille, France
| | - C Muller
- Centre régional de pharmacovigilance, hôpital Civil, 67091 Strasbourg, France
| | - L Vrignaud
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - H Marret
- Service de gynécologie, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37032 Tours, France
| | - A P Jonville-Bera
- Service de pharmacologie, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'information sur le médicament, CHRU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
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Abstract
OBJECTIVE To examine the effect of hormonal contraception on sexual desire. MATERIALS AND METHODS We performed a cross-sectional analysis of 1,938 of the 9,256 participants enrolled in the Contraceptive CHOICE Project. This subset included participants enrolled between April and September 2011 who completed a baseline and 6-month telephone survey. Multivariable logistic regression was used to assess the association between contraceptive method and report of lacking interest in sex controlling for potential confounding variables. RESULTS More than 1 in 5 participants (23.9%) reported lacking interest in sex at 6 months after initiating a new contraceptive method. Of 262 copper intrauterine device (IUD) users (referent group), 18.3% reported lacking interest in sex. Our primary outcome was more prevalent in women who were young (younger than 18 years: adjusted odds ratio [OR] 2.04), black (adjusted OR 1.78), and married or living with a partner (adjusted OR 1.82). Compared with copper IUD users, participants using depot medroxyprogesterone (adjusted OR 2.61, 95% confidence interval [CI] 1.47-4.61), the vaginal ring (adjusted OR 2.53, 95% CI 1.37-4.69), and the implant (adjusted OR 1.60, 95% CI 1.03-2.49) more commonly reported lack of interest in sex. We found no association between use of the hormonal IUD, oral contraceptive pill, and patch and lack of interest in sex. CONCLUSION CHOICE participants using depot medroxyprogesterone acetate, the contraceptive ring, and implant were more likely to report a lack of interest in sex compared with copper IUD users. Future research should confirm these findings and their possible physiologic basis. Clinicians should be reassured that most women do not experience a reduced sex drive with the use of most contraceptive methods.
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Affiliation(s)
- Amanda Boozalis
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Boucoiran I, Trastour C, Faraj L, Delotte J, Bongain A. Grossesse sous Implanon® : une « enquête » à propos de trois cas. ACTA ACUST UNITED AC 2011; 39:e52-4. [DOI: 10.1016/j.gyobfe.2010.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 02/03/2010] [Indexed: 11/26/2022]
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Martin C, Tanguy M, Aspeele F, Fanello S. [Tolerance of the contraceptive implant by prescription context (postabortion or not): Prospective study on 127 consultants]. ACTA ACUST UNITED AC 2010; 39:632-6. [PMID: 20970261 DOI: 10.1016/j.jgyn.2010.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
AIM While contraceptive methods increased in number, the number of abortions has remained stable. The aim of this study was to estimate the satisfaction of women toward a contraceptive implant (Implanon(®)) available in France in order to clarify prescription. METHOD The survey concerned 127 women who visited Angers and Nantes family planning centres between January2009 and January2010 in two implant prescription contexts (postabortion or not). They agreed to answer a first questionnaire describing the reasons for their choice. A second questionnaire was sent six months after to assess its tolerance. RESULTS In our study, 82% of patients were using a contraceptive method prior to implant (68% in postabortion and 88% in the other group). The first reason for choosing the implant was the fear of forgetting - it was more important in the postabortion group (88% vs. 61%). The main side effects were amenorrhea (50%), weight gain (30%) and mood disorders (19%). More than one in two women (54%) was very satisfied by the implant. It should be noted that in one quarter of cases, women seek early withdrawal of the contraceptive implant (23% in postabortion and 21% in the other group), a rate that is 39% in patients under 25years and 47% in patients who reported a mood disorder. CONCLUSION There is a tendency to better tolerance of the implant out of a context of abortion. Furthermore, mood disorders appear to be poorly tolerated. These elements encourage greater caution in prescribing the contraceptive implant in postabortion, situation in which patients have already psychological disorders, and even more among younger patients.
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Affiliation(s)
- C Martin
- Centre d'orthogénie Flora-Tristan, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France
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Long-term contraceptives. Best Pract Res Clin Obstet Gynaecol 2010; 24:617-31. [DOI: 10.1016/j.bpobgyn.2010.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 04/15/2010] [Indexed: 02/06/2023]
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Duvan Cİ, Gözdemir E, Kaygusuz I, Kamalak Z, Turhan NÖ. Etonogestrel contraceptive implant (Implanon): analysis of patient compliance and adverse effects in the breastfeeding period. J Turk Ger Gynecol Assoc 2010; 11:141-4. [PMID: 24591920 DOI: 10.5152/jtgga.2010.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 08/05/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyse the compliance of patients and side effects of Implanon® during breast feeding. MATERIAL AND METHODS Prospective study of 61 postpartum women who chose Implanon® for long term contraception between April 2007 and December 2009. Compliance, side effects and removals were recorded. RESULTS Amenorrhoea, prolonged bleeding, frequent bleeding and infrequent bleeding were reported in 20 (32%), 13 (21%), 4 (6.5%) and 2 (3.2%) patients, respectively. Non-menstrual side effects experienced by participants included; weight gain reported by 10 patients (16%), anxiety by 6 (9.8%), breast tenderness by 4 (6.5%), headache by 4 (6.5%), pain at the insertion site by two (3.2%), hirstutism by two (3.2%), acne by 1 (1.6%), loss of libido by 1 (1.6%), weight gain and headache by two (3.2%), weight gain and anxiety by two (1.6%). The mean breastfeeding period was 16±7.4/months. During the follow up, Implanon® was removed from 24 patients (39%). CONCLUSION If patients are well informed about its expected side effects before placement, Implanon® is well tolerated and i an acceptable choice for women who have recently experienced labor and are looking for long term reversible contraception.
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Affiliation(s)
- Candan İltemir Duvan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Elif Gözdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Ikbal Kaygusuz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Zeynep Kamalak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
| | - Nilgün Öztürk Turhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fatih University, Ankara, Turkey
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Vicente L, Mendonça D, Dingle M, Duarte R, Manuel Boavida J. Etonogestrel implant in women with diabetes mellitus. EUR J CONTRACEP REPR 2009; 13:387-95. [DOI: 10.1080/13625180802382604] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wong RC, Bell RJ, Thunuguntla K, McNamee K, Vollenhoven B. Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users. Contraception 2009; 80:452-6. [PMID: 19835719 DOI: 10.1016/j.contraception.2009.03.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 03/30/2009] [Accepted: 03/31/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND The study was conducted to perform a direct comparison of the satisfaction of intrauterine device (IUD) users and Implanon users after 6 months. STUDY DESIGN Women were recruited to this study in the contraception clinics of Southern Health and Family Planning Victoria. Each woman completed a questionnaire at the time of starting her contraception with either an IUD or Implanon. Women were sent a follow-up questionnaire after 6 months to assess their satisfaction with their chosen method of contraception. RESULTS A total of 439 participants were recruited for this non randomized cohort study; 211 choosing an IUD and 228 choosing to use Implanon. The main reason patients in both groups chose their contraceptive method was recommendation by the doctor. Follow-up was achieved in over 84% in both groups. More than 50% of women in both groups reported at least one side effect. The most commonly reported side effect in both groups was abnormal bleeding and this was also the most common reason for having the contraceptive device removed. The IUD users reported a higher rate of satisfaction with their chosen method of contraception, although there was no difference between groups in the removal rate or whether the women would recommend the contraception to others. CONCLUSIONS IUD users reported a higher level of satisfaction than did Implanon users at 6 months. Side effects in women using IUDs and Implanon are common. The range of likely side effects should be included in counseling women about long-term reversible contraception.
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Affiliation(s)
- Renee C Wong
- Women's and Children's Program, Southern Health, Clayton, Victoria 3168, Australia.
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11
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Abstract
Women who cannot use hormonal contraception containing estrogen have a variety of progestin-only contraceptive methods from which to choose. Implanon is a new single-rod progestin-only contraceptive implant that is easily inserted and can remain in place for up to 3 years. It is highly effective with a rapid onset of action and an equally rapid return of fertility once removed. Counseling is important to help women decide if this method is appropriate for their needs.
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Affiliation(s)
- Mary A Fischer
- Graduate School of Nursing, University of Massachusetts, Worcester, MA 01655, USA.
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Vidin E, Garbin O, Rodriguez B, Favre R, Bettahar-Lebugle K. Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases. Contraception 2007; 76:35-9. [PMID: 17586134 DOI: 10.1016/j.contraception.2007.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 02/21/2007] [Accepted: 03/27/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We describe removal procedures for etonogestrel contraceptive implants in the operating theater. In addition, we discuss the management of removal of contraceptive implants that are difficult to palpate or are impalpable. DESIGN We conducted a retrospective single-center case series analysis of Implanon removals conducted at a university hospital between January 2002 and April 2005. MATERIALS AND METHODS We analyzed case notes for 28 patients who had their contraceptive implant removed in the operating theater. RESULTS Intermenstrual bleeding was the principal reason for removal (52.4%). Ten patients already had one attempted removal of their implant. Preoperative ultrasound localized the implant in all cases. Half of the removals were done under local anesthetic, with three cases progressing to general anesthesia (11%). Thirty percent of the implants had migrated from their initial implantation, 37% were in intramuscular tissue and 11% were in the humeral neurovascular sheath. The only postoperative complications were one small seroma and transient paresthesia in the territory of the ulnar nerve. The implant was not found in one case. CONCLUSIONS The removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound. Patients must be fully informed about the procedure, including its complications and the risk for failure.
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Affiliation(s)
- Eric Vidin
- Service de Gynécologie, SIHCUS-CMCO, 67300 Schiltigheim, France
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Sergent F. [Insertion problems, removal problems, and contraception failure with Implanon]. ACTA ACUST UNITED AC 2006; 34:368-70. [PMID: 16564733 DOI: 10.1016/j.gyobfe.2006.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jasaitis Y, Diguet A, Sergent F. [Is the etonogestrel contraceptive implant 100% sure? Concerning the article << Ectopic pregnancy with etonogestrel contraceptive implant (Implanon) >> by M. Mansour, C. Louis-Sylvestre and B.-J. Paniel (J Gynecol Obstet Biol Reprod n degree 6-2005)]. ACTA ACUST UNITED AC 2005; 34:819-20; author reply 820. [PMID: 16319776 DOI: 10.1016/s0368-2315(05)82961-8] [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]
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Bensouda-Grimaldi L, Jonville-Béra AP, Beau-Salinas F, Llabres S, Autret-Leca E. Implanon® : difficultés d'insertion et de retrait, échecs contraceptifs. ACTA ACUST UNITED AC 2005; 33:986-90. [PMID: 16321557 DOI: 10.1016/j.gyobfe.2005.10.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 10/11/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Analysis of the results of a national pharmacovigilance study on Implanon, a contraceptive implant containing 68 mg of etonogestrel. PATIENTS AND METHODS This survey concerns cases of pregnancies (contraception failures), of migrations and of insertion or removal problems with Implanon reported to French Regional Drug Pharmacovigilance Centres and to Organon SA between May 2001 and September 2002. RESULTS In France, 39 unintended pregnancies were reported over 17 months. The pregnancies were in 77% of cases (N = 30) due to an insertion technique error (implant not found when pregnancy has been diagnosed). For 3 patients (7,6%), pregnancy was due to a failure of etonogestrel contraceptive effect, explained twice by its association with an enzymatic inductor drug. For 4 patients (10%), pregnancy was due to an untimely insertion (insertion after day 5 of menstrual cycle or woman already pregnant). For two patients, no information was available. The incidence of reported pregnancies in France is estimated at 0.359 / 10(3) implants [0.246-0.482], in accordance with a typical Pearl Index of 0.06 [0.04-0.08]. Twenty-eight suspected migrations (N = 11), problems or failures in removal of the implant (N = 11) and insertion difficulties (N = 6) were notified, corresponding to an incidence of 0.257/10(3) implants [0.162-0.363]. DISCUSSION AND CONCLUSION Occurrence of pregnancy is possible with Implanon, due to errors in the insertion technique (device not really inserted) or to a non-respect of the SPC recommendations (drug-drug interaction or untimely insertion). Insertion problems can lead to localisation problems (implant not visible by X-ray) then needing further tests and even harmful practice (removal under general anaesthesia). That is why a real and strict training is highly recommended to physicians.
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Affiliation(s)
- L Bensouda-Grimaldi
- Service de pharmacologie, hôpital Bretonneau, université François-Rabelais, Centre régional de pharmacovigilance et d'information sur le médicament, Tours, France
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Abstract
Since the introduction of hormonal contraceptives in the 1960s, great advances have been achieved in contraception. Biological effects of sexual steroids as well as risks and benefits of oral contraception are better estimated. After the development of a new hormone-containing intra-uterine system, new hormone delivery systems offer women safe and effective contraceptive options. These new options that combine high efficacy and ease of use should allow better acceptance and compliance than daily pill ingestion and should then reduce the high rate of unintended pregnancies terminated by elective abortion. Transdermal contraceptive system and vaginal ring offer a promising innovative approach in pregnancy prevention. Subdermal implants give women the choice of a highly effective contraceptive system in spite of significant side effects. New hormonal delivery systems such as injectables are under development. Hysteroscopic tubal sterilization is now also available and is a very effective procedure. This wide variety of new contraceptive methods offers a marked improvement from previous medications for users by providing better efficacy and tolerability.
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Affiliation(s)
- O Graesslin
- Institut Mère-Enfant Alix-de-Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims Cedex.
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