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Proust C, Trignol-Viguier N, Marret H. [Continuous/extended/flexible use of combined hormonal contraceptives: Prescribing habits of practitioners in Centre Val deLoire region]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:527-534. [PMID: 35227939 DOI: 10.1016/j.gofs.2022.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To date, oral contraceptives remain the most frequently prescribed contraceptive method. New combined oral contraceptive (COC) regimens (continued, extended or flexible) were developed to try and space out or avoid withdrawal bleedings in order to meet women's expectations and improve their quality of life. However, there is no recommendation published regarding the management of the prescription. The purpose of our study was to describe provider's prescription habits when it comes to new COC regimens. METHODS This is a descriptive observational study. A questionnaire was sent to gynecologists, general practitioners and midwives employed or in training in the Centre Valde Loire region. Prescription habits and knowledge about new oral contraceptive regimens were evaluated. RESULTS 83% of health professionals frequently prescribed new COC regimens. Most frequent indications were endometriosis, severe menstruation-associated symptoms, patient's desire for amenorrhea or patient's request. The extended regimen (hormone-free interval not every month) was the most frequently used. Provider's knowledge about indications and benefits of those new regimens were satisfactory. However, scientific societies guidelines were poorly acquired. CONCLUSIONS New COC regimens are frequently proposed by health care professionals with large variability in terms of prescription model. Along with reinforcement of COC prescription guidelines for healthcare professionals, further researches are needed to better understand differences in tolerability and acceptability in terms of quality of life of the several potential regimens.
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Affiliation(s)
- C Proust
- Pôle de gynécologie obstétrique, centre hospitalo-universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France.
| | - N Trignol-Viguier
- Pôle de gynécologie obstétrique, centre hospitalo-universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
| | - H Marret
- Pôle de gynécologie obstétrique, centre hospitalo-universitaire de Tours, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
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Sales Vieira C, Celis C, Galán G, Hernández L, Díaz I, López J. Drospirenone: a Latin American perspective for oestrogen-free oral contraception. EUR J CONTRACEP REPR 2020; 26:73-78. [PMID: 33155847 DOI: 10.1080/13625187.2020.1837364] [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: 10/23/2022]
Abstract
AIM Combined hormonal contraceptives, despite their high efficacy, are associated with an increased relative risk of cardiovascular events. The contraceptive mechanism of action of combined pills depends fundamentally on their progestin component. METHODS A narrative review was performed. RESULTS The drospirenone-only pill, including this synthetic progestogen with antimineralocorticoid and antiandrogenic activity, has high contraceptive efficacy that has been demonstrated with a 24-day schedule of 4-day administration of hormone-free pills. Due to its safety profile, the drospirenone-only pill is suitable even in high-risk populations, such as women with high blood pressure, thromboembolism, smoking or dyslipidemia. CONCLUSION Considering the increasing prevalence of these comorbidities in Latin America, the 4 mg drospirenone-only pill is suggested as one of the strategies of choice in the region for those women who choose oral contraceptives.
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Affiliation(s)
- Carolina Sales Vieira
- Department of Obstetrics and Gynecology of the Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Cuauhtémoc Celis
- The Mexican Federation of Obstetric and Gynecology Colleges, Mexico City, Mexico
| | - Guillermo Galán
- Centro de Capacitación e Investigaciones Clínicas, Santiago, Chile
| | | | - Ivonne Díaz
- Procreación Médicamente Asistida, Bogotá, Colombia
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MacGregor EA, Guillebaud J. The 7-day contraceptive hormone-free interval should be consigned to history. BMJ SEXUAL & REPRODUCTIVE HEALTH 2018; 44:bmjsrh-2017-200036. [PMID: 29945924 DOI: 10.1136/bmjsrh-2017-200036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
AIM This review summarises the available data on the disadvantages of the 7-day contraceptive-free interval (CFI) of combined oral contraceptives (COCs), in contrast to shorter CFIs or continuous use - including flexible regimens - and provides recommendations for practice. METHODS Relevant papers were identified by Medline and PubMed. The final reference list was generated on the basis of relevance to the review, with priority given to systematic reviews and randomised controlled trials. RESULTS There is considerable inter- and intra-individual variation in the absorption and metabolism of COCs. Even with perfect use, the loss of endocrine suppression during the standard 7-day CFI allows follicular development with the risk of escape ovulation in a vulnerable minority. This risk increases in typical users whenever the CFI is prolonged: late restarts are a common reason for pill omissions. Shortening or eliminating the CFI improves contraceptive efficacy using the lowest doses available, without evidence to date of compromised safety. CONCLUSIONS There is no scientific evidence to support a 7-day CFI and it should be replaced either by a continuous flexible regimen, or extended regimens with a shortened CFI, prescribed first-line. In women preferring a monthly 'bleed', a 4-day CFI similarly provides a greater safety margin when pills are omitted.
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Affiliation(s)
- E Anne MacGregor
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, Centre for Neuroscience & Trauma, London, UK
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Stawarz K, Rodríguez MD, Cox AL, Blandford A. Understanding the use of contextual cues: design implications for medication adherence technologies that support remembering. Digit Health 2016; 2:2055207616678707. [PMID: 29942574 PMCID: PMC6001179 DOI: 10.1177/2055207616678707] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Forgetfulness is one of the main reasons of unintentional medication non-adherence. Adherence technologies that help people remember to take their medications on time often do not take into account the context of people’s everyday lives. Existing evidence that highlights the effectiveness of remembering strategies that rely on contextual cues is largely based on research with older adults, and thus it is not clear whether it can be generalized to other populations or used to inform the design of wider adherence technologies that support medication self-management. Understanding how younger populations currently remember medications can inform the design of future adherence technologies that take advantage of existing contextual cues to support remembering. Methods We conducted three surveys with a total of over a thousand participants to investigate remembering strategies used by different populations: women who take oral contraception, parents and carers who give antibiotics to their children, and older adults who take medications for chronic conditions. Results Regardless of the population or the type of regimen, relying on contextual cues—routine events, locations, and meaningful objects—is a common and often effective strategy; combinations of two or more types of cues are more effective than relying on a single cue. Conclusions To effectively support remembering, adherence technologies should help users recognize contextual cues they already have at their disposal and reinforce relevant cues available in their environment. We show that, given the latest developments in technology, such support is already feasible.
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Affiliation(s)
| | - Marcela D Rodríguez
- Faculty of Engineering, Universidad Autónoma Baja California, Mexicali, Mexico
| | - Anna L Cox
- UCL Interaction Centre, University College London, UK
| | - Ann Blandford
- UCL Interaction Centre, University College London, UK
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5
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Rationale for eliminating the hormone-free interval in modern oral contraceptives. Int J Gynaecol Obstet 2016; 134:8-12. [DOI: 10.1016/j.ijgo.2015.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/23/2015] [Accepted: 03/07/2016] [Indexed: 11/21/2022]
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Duijkers IJM, Heger-Mahn D, Drouin D, Colli E, Skouby S. Maintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake. Contraception 2015; 93:303-309. [PMID: 26708301 DOI: 10.1016/j.contraception.2015.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/10/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Traditional progestogen-only pills (POPs) have stringent daily timing and missed pill rules that might affect contraceptive reliability. A new-generation oestrogen-free pill has been developed, containing 4-mg drospirenone with a unique regimen of 24 active treatment days followed by four placebo tablets. A previous study showed that this new drospirenone-only pill effectively inhibited ovulation. Clinical efficacy, however, can be affected by compliance, and delayed or forgotten pill intake often occurs in daily life. The aim of this study was to investigate if inhibition of ovulation was maintained after four scheduled 24-h delays in tablet intake. STUDY DESIGN One hundred thirty healthy women with proven ovulatory cycles were randomized, and 127 were treated with the drospirenone-only pill during two cycles. In treatment Group A (n=62), 24-h delays in tablet intake were scheduled on days 3, 6, 11 and 22 during Cycle 2 and, in treatment Group B (n=65) during Cycle 1, respectively. Ovulation was defined as disappearance or persistence of a large follicle and progesterone levels higher than 5 ng/mL for at least 5 consecutive days. RESULTS The overall ovulation rate was 0.8%; only one subject in Group A fulfilled the ovulation criteria in Cycle 2. Follicular diameters in the regular-intake and the delayed-intake cycles were similar. CONCLUSION Despite the 4-day hormone-free period and multiple intentional 24-h delays in tablet intake, ovulation inhibition was maintained. This property distinguishes this new-generation oestrogen-free pill from traditional POPs by allowing the same "safety window" or flexibility in intake as combined oral contraceptives without compromising contraceptive reliability. IMPLICATIONS Delayed or forgotten pill intake is very common. Ovulation inhibition by the new-generation oestrogen-free pill, containing 4-mg drospirenone for 24 days followed by a 4-day treatment-free period, was maintained despite four 24-h delays in tablet intake, so the impact of delayed intake on contraceptive reliability will be low.
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Affiliation(s)
| | | | | | | | - Sven Skouby
- Department of Gynaecology and Obstetrics, Faculty of Health and Medical Sciences, Herlev Hospital, Copenhagen University, Herlev, Denmark.
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Nappi RE, Kaunitz AM, Bitzer J. Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians. EUR J CONTRACEP REPR 2015; 21:106-15. [PMID: 26572318 PMCID: PMC4841029 DOI: 10.3109/13625187.2015.1107894] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives: The clinical utility of extended regimen combined oral contraceptives (COCs) is increasingly being recognised. Our objective was to understand the attitudes of women and clinicians about the use of these regimens. We present the rationale for extended regimen COCs from a historical perspective, and trace their evolution and growing popularity in light of their clinical benefits. We conclude by offering potential strategies for counselling women about extended regimen COC options. Methods: We conducted a MEDLINE search to identify and summarise studies of extended regimen COCs, focusing on attitudes of women and clinicians regarding efficacy, safety/tolerability and fewer scheduled bleeding episodes and other potential benefits. Results: The body of contemporary literature on extended regimen COCs suggests that their contraceptive efficacy is comparable to that of conventional 28-day (i.e., 21/7) regimens. For women seeking contraception that allows infrequent scheduled bleeding episodes, particularly those who suffer from hormone withdrawal symptoms and cyclical symptoms (e.g., headache, mood changes, dysmenorrhoea, heavy menstrual bleeding), extended regimen COCs are an effective and safe option. Although satisfaction with extended regimen COCs in clinical trials is high, misperceptions about continuous hormone use may still limit the widespread acceptance of this approach. Conclusions: Despite the widespread acceptance among clinicians of extended regimen COCs as an effective and safe contraceptive option, these regimens are underused, likely due to a lack of awareness about their availability and utility among women. Improved patient education and counselling regarding the safety and benefits of extended regimen COCs may help women make more informed contraceptive choices.
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Affiliation(s)
- Rossella E Nappi
- a Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Department of Obstetrics and Gynaecology , IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy
| | - Andrew M Kaunitz
- b Department of Obstetrics and Gynecology , University of Florida College of Medicine-Jacksonville , Jacksonville , FL , USA
| | - Johannes Bitzer
- c Department of Obstetrics and Gynaecology , Basel University Hospital , Basel , Switzerland
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Donadiki EM, Jimenez-Garcıa R, Velonakis EG, Hernandez-Barrera V, Sourtzi P, Lopez de Andres A, Jimenez-Trujillo I, Pino CG, Carrasco-Garrido P. Factors related to contraceptive methods among female higher education students in Greece. J Pediatr Adolesc Gynecol 2013; 26:334-9. [PMID: 24075084 DOI: 10.1016/j.jpag.2013.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE We aimed to determine the prevalence of contraceptive methods and identify factors associated with the use of contraception by Greek female higher education students. DESIGN Cross-sectional epidemiologic survey on the factors determining the use of contraception among higher educational students. SUBJECT 3,624 female students between 18 and 26 years of age. MAIN OUTCOME MEASURES We used primary individualized data drawn from a survey carried among female college students in Greece. The dependent dichotomous variables were the responses "YES" or "NO" to the question: "During the last 12 months, what contraceptive method have you generally used in your sexual intercourses?" The methods were male condoms, oral contraceptive use (OCs) and emergency contraception (EC). The independent variables which were analysed in this survey were socio-demographic characteristics, variables related to lifestyle and variables associated with sexual habits. RESULTS Condom was the most widely used (53.87%). The variables associated independently and significantly with a greater likelihood of the use of condoms were condom use at first sexual intercourse, occupational status and higher educational level of parents. As for OCs, those who had relationship, had more than 2 sexual lifetime partners and had ever visited gynecologist (OR 6.40; 95%CI 2.80-9.40) was more likely to use. For the use of EC, those who were older, had relationship, were smokers and had more than 2 sexual lifetime partners (OR 2.15; 95%CI 1.75-2.64), was more likely to use this method. CONCLUSIONS Condom is the most used contraceptive method among female higher educational students in Greece, followed by EC. The variable most strongly associated with use of the OCs was a gynecologist visit. The factors associated with use of EC were having more than 2 sexual partners, smoking, and having a stable sexual partner.
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Affiliation(s)
- Elisavet M Donadiki
- Department of Public Health, University of Athens, Faculty of Nursing, Athens, Greece
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9
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Evaluation of factors associated with noncompliance in users of combined hormonal contraceptive methods: a cross-sectional study: results from the MIA study. BMC WOMENS HEALTH 2013; 13:38. [PMID: 24138751 PMCID: PMC4015733 DOI: 10.1186/1472-6874-13-38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 10/09/2013] [Indexed: 11/10/2022]
Abstract
Background Understanding contraception from the perspective of the user may help to improve compliance. The aim of this project was to determine the factors that influence the noncompliance in young women that use combined hormonal contraceptives (pill, patch or vaginal ring). Methods A nationwide cross-sectional multicenter epidemiology study. Physicians [obstetricians/gynecologists]) recorded socio-demographic, clinical and current contraception data of 8,762 women. Women completed a self-administered questionnaire on compliance. After the assessment of self-administrated questionnaire, the physicians reported on their recommendations on the possibility of changing the contraceptive. Results Fifty-two percent of women were noncompliant, mainly because of simple forgetfulness (pill, 74.9%; patch, 47.8%; vaginal ring, 69.1%). The percentage of noncompliant women was lower in vaginal ring users (26.6%) than in patch users (42.4%) or pill users (65.1%) (p < 0.0001). The most common course of action after noncompliance was to take/use the contraceptive as soon as possible. In the multiple logistic regression analysis, the use of the pill increased the probability of noncompliance compared with the patch and the vaginal ring (odds ratio [IC95%]: 2.53 (2.13-3.02) and 4.17 (3.68-4.73, respectively), and using the patch compared with the vaginal ring (1.65 (1.36-1.99)). Others factors associated with noncompliance were: high treatment duration, low degree of information on the contraceptive method, understanding of instructions on the contraceptive method, indifference to becoming pregnant, lack of partner support, not participation in selecting the method, not having a routine for taking treatment and difficulties remembering use the contraceptive method. Switching contraceptive method was proposed by the physicians to 43.2% of women (51.8% of pill users, 58.2% of patch users and 19.4% of vaginal ring users). Conclusions More than 50% of combined hormonal contraceptive users did not comply with the treatment regimen. The percentage of noncompliant women was lower between vaginal ring users. Understanding user’s reasons for noncompliance by the clinician and encouraging a collaborative approach can go a long way to improving compliance.
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10
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Patient understanding of oral contraceptive pill instructions related to missed pills: a systematic review. Contraception 2013; 87:674-84. [DOI: 10.1016/j.contraception.2012.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/10/2012] [Accepted: 08/21/2012] [Indexed: 11/24/2022]
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Abstract
The first hormonal pill, called Enovid(®), was approved by the Federal Drug Administration (FDA) in May 1960. It contained mestranol and norethisterone. Over the years, oral contraceptives have evolved through gradual lowering of ethinyl estradiol (EE) content, introduction of 17β estradiol, and many different progestins. The standard regimen allows for 21 days of pill containing steroids and a pill-free interval of 7 days. Recently, continuous or extended regimens have been approved. In order to improve compliance, alternative routes of combined oral contraceptive (COC) administration have been developed such as vaginal or transdermal routes. In 2009, according to the United Nations, the mean global percentage using contraception in women who are married or in union was 62.7%. COC represented 8.8% of contraceptive prevalence, reaching 15.4% in more developed countries. More than 100 million women worldwide use COCs. However, each year, many unintended pregnancies occur, indicating that contraception still needs to be promoted.
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Affiliation(s)
- Sophie Christin-Maitre
- Department of Endocrinology, AP-HP, Hospital Saint-Antoine, University Pierre et Marie Curie, Paris VI, France.
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12
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Abstract
Taking into account the biological and psychosocial changes during the transition from childhood to adulthood adolescents would need a contraceptive method which ideally would be very effective, independent of compliance, without major health risks during use and no negative impact on the future health of the adolescent, protective against STI, favorable for bone development, with no or only few side effects and having some preventive and therapeutic potential with respect to frequent health problems of adolescent girls. Combined oral contraceptives (COC) used regularly and consistently have a more than 99% efficacy to prevent a pregnancy. COCs have a very low health risk (almost exclusively thromboembolic disease) which seems to differ marginally with respect to dosage and type of the components. Progestogen only oral contraceptives do not have any major negative health impact. The leading side effect is irregular bleeding which in COC users is mainly during the first 3 months and in progestogen only users during the period of use. Other side effects are reported but their frequency is similar to placebo. COC protect against endometrial and ovarian cancer and they may have beneficial effects on a variety of menstrual complaints and acne, which are frequent problems during adolescence. To be effective COCs have to be taken regularly which is frequently not the case. This diminishes considerably their effectiveness depending on the individual compliance. They do not protect against STI and may even have an inhibitory effect on the use of condoms. For most adolescents the risk benefit profile of oral contraceptives is favorable and makes this method valuable. At the same time the prescription of oral contraceptives for adolescents need to be individualized by taking into account the individual risk/benefit profile. Specialized counseling with a high degree of confidentiality adapted to the knowledge and needs of the individual adolescent is desirable.
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Affiliation(s)
- Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland.
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Crijns HJMJ, van Rein N, Gispen-de Wied CC, Straus SM, de Jong-van den Berg LTW. Prescriptive contraceptive use among isotretinoin users in the Netherlands in comparison with non-users: a drug utilisation study. Pharmacoepidemiol Drug Saf 2012; 21:1060-6. [PMID: 22228673 DOI: 10.1002/pds.3200] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 11/29/2011] [Accepted: 12/02/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the compliance with the isotretinoin Pregnancy Prevention Programme (PPP) by evaluating the use of prescribed contraceptives among isotretinoin users. The PPP contains a requirement for the use of contraceptive methods for women of childbearing potential. METHODS A drug utilisation study was performed using data from a drug prescription database (containing Dutch community pharmacy data) covering a population of 500 000 patients. Contraceptive use in female isotretinoin users and in a reference group of female non-isotretinoin users (aged 15-49 years) was compared using data from 1999 until 2006 in 2-year periods. Descriptive statistics were used. RESULTS Of the female isotretinoin users (n = 651), 52%-54% filled prescriptions on contraceptives in strict accordance to the PPP, used before, during, and after discontinuation of isotretinoin, compared with 39%-46% in the reference group. A more liberal approach of a minimum of one prescription for a contraceptive method showed 61%-64% use of contraceptives among isotretinoin users. Similar patterns were seen when data were broken down in age groups. Furthermore, a higher proportion of female patients using isotretinoin prescribed by general practitioners used prescribed contraceptives compared with those receiving isotretinoin by specialists. CONCLUSION Compliance with the contraceptive use according to a PPP for a teratogenic drug such as isotretinoin is 52%-64%, which is lower than anticipated. Reasons for the low compliance will need to be clarified before further measures can be taken.
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Affiliation(s)
- Hubertina J M J Crijns
- University of Groningen, Department of Pharmacoepidemiology & Pharmacoeconomics, Groningen, the Netherlands.
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Sköld A, Larsson M. Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2011; 3:43-7. [PMID: 22325801 DOI: 10.1016/j.srhc.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/20/2011] [Accepted: 11/25/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice. STUDY DESIGN The design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%. RESULTS The women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women's fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential. CONCLUSIONS 46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.
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Affiliation(s)
- Annelie Sköld
- Department of Women's and Children's Health, Uppsala University, Sweden.
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15
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Jamin C, André G, Audebert A, Christin-Maître S, Elia D, Harvey T, Letombe B, Lopes P, Moreau C, Nisand I, Pélissier C. Oublis de la contraception hormonale : réflexions sur leur prise en charge en pratique quotidienne. ACTA ACUST UNITED AC 2011; 39:644-55. [DOI: 10.1016/j.gyobfe.2011.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 07/31/2011] [Indexed: 10/16/2022]
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Carrasco‐Garrido P, Hernández Barrera V, Martin‐Lopez R, López de Andrés A, Esteban Hernandez J, Jiménez‐García R. Increased Use of Oral Contraceptives in Spain: Related Factors and Time Trend, 2003–2006. J Sex Med 2011; 8:383-90. [DOI: 10.1111/j.1743-6109.2010.02070.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Grodnitskaya EE, Grigoryan OR, Klinyshkova EV, Andreeva EN, Melnichenko GA, Dedov II. Effect on carbohydrate metabolism and analysis of acceptability (menstrual cycle control) of extended regimens of the vaginally inserted hormone-releasing system 'NuvaRing' as compared with the standard 21/7 regime in reproductive-age women with type 1 diabetes mellitus. Gynecol Endocrinol 2010; 26:663-8. [PMID: 20334583 DOI: 10.3109/09513591003686296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To evaluate the effect of the vaginally inserted hormone-releasing system 'NuvaRing' on carbohydrate metabolism and acceptability (menstrual cycle control) of extended regimens of using as compared with the standard regimen (21/7) in women with type 1 diabetes mellitus (DM) in reproductive period during 24 months. METHODS The open randomised study included a total of 109 women with type 1 DM, using 'NuvaRing' in different regimens (21/7, 42/7, 84/7 and 357/7). Average daily insulin requirements, the levels of glycosylated haemoglobin were determined at baseline, after 6, 12, 18 and 24 months of contraception. The control group was composed of 22 age-matched women with type 1 DM using no methods of contraception. RESULTS Using the contraceptive system 'NuvaRing' in type 1 DM women in the reproductive period has proved to exert no clinically significant effect on carbohydrate metabolism in prolonged regimens, as well as in standard regimen. The overall number of bleeding days and spotting days was comparable in different groups. Longer regimens with fewer breaks were associated with fewer days of bleeding but a larger number of spotting days as compared with the shorter regimens, with a tendency towards a gradual decrease in spotting days during a year. CONCLUSION The releasing system 'NuvaRing' proved to be a reliable and safe means of contraception for late reproductive age women with type 1 DM.
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Affiliation(s)
- Elena E Grodnitskaya
- Centre of Family Planning and Reproduction of the Moscow Public Health Department, Moscow, Russia.
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Cropsey KL, Matthews C, Campbel S, Ivey S, Adawadkar S. Long-Term, Reversible Contraception Use Among High-Risk Women Treated in a University-Based Gynecology Clinic: Comparison Between IUD and Depo-Provera. J Womens Health (Larchmt) 2010; 19:349-53. [DOI: 10.1089/jwh.2009.1518] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen L. Cropsey
- University of Alabama at Birmingham, Department of Psychiatry, Birmingham, Alabama
| | - Catherine Matthews
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Samuel Campbel
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Sara Ivey
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
| | - Swati Adawadkar
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, Virginia
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Lech MM, Ostrowska L. Oral contraceptives use and weight gain in women with a Central European life-style. EUR J CONTRACEP REPR 2009; 10:59-65. [PMID: 16036300 DOI: 10.1080/13625180500039084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of the study was to check and present data on the relation between combined oral contraceptives (COC) use and body weight in young women living in Poland. METHODS Observational study on the group of young women on COC and the control group of young women who never used COC. Candidates for study (145 women) and control (218 women) groups were recruited in selected gynecological clinics in Poland during the period of 1-31 January 2002 (with the use of randomization). RESULTS Both groups (study and control) were almost identical in age, anthropometric characteristics, number of pregnancies and deliveries. On the basis of this investigation it was found that there was no relation between use of COC and weight gain. Observed (in both groups) weight gain in young women was most probably related rather to time-passing (patients were getting older). The higher risk for overweight and obesity was found in the group of young women who had already had problems with overweight in their childhood. and in the group of women with high weight gain during the first pregnancy. CONCLUSION COC use is not associated with weight gain in young women with a Central European life-style.
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Affiliation(s)
- M M Lech
- Fertility and Sterility Research Center, Warsaw, Poland
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Dowse MSL, Gunby A, Moncad R, Fife C, Smerdon G, Bryson P. The combined oral contraceptive pill and the assumed 28-day cycle. J OBSTET GYNAECOL 2009; 27:481-4. [PMID: 17701795 DOI: 10.1080/01443610701405671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Some studies involving women taking the combined oral contraceptive pill (COCP) have on occasion assumed the COCP group to have a rigid 28-day pharmaceutically driven cycle. Anecdotal evidence suggests otherwise, with many women adjusting their COCP usage to alter the time between break-through bleeds for sporting and social reasons. A prospective field study involving 533 scuba diving females allowed all menstrual cycle lengths (COCP and non-COCP) to be observed for up to three consecutive years (St Leger Dowse et al. 2006). A total of 29% of women were COCP users who reported 3,241 cycles. Of these cycles, only 42% had a rigid 28-day cycle, with the remainder varying in length from 21 to 60 days. When performing studies involving the menstrual cycle, it should not be assumed that COCP users have a rigid confirmed 28-day cycle and careful consideration should be given to data collection and analysis. The effects of differing data interpretations are shown.
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Hayter M. The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory study. J Clin Nurs 2009; 18:2656-67. [PMID: 19220606 DOI: 10.1111/j.1365-2702.2008.02651.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education. BACKGROUND Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one-to-one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations. DESIGN A qualitative study using a grounded theory approach was used. RESULTS Three linked 'core categories' emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: 'reproductive education'. This core category is closely linked to 'surveillance' where women are taught to monitor their reproductive health and to 'contraceptive regimen' where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of 'contraceptive education'. CONCLUSIONS Nursing practice in this important area of women's health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one-to-one consultations with women - providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection. RELEVANCE TO CLINICAL PRACTICE Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side-effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.
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Affiliation(s)
- Mark Hayter
- Centre for Health and Social Care Education and Service Development, School of Nursing and Midwifery, University of Sheffield, Northern General Hospital, Sheffield, UK.
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22
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Lete I, Doval JL, Pérez-Campos E, Lertxundi R, Correa M, de la Viuda E, Gómez MÁ, González JV, Martínez MT, Mendoza N, Robledo J. Self-described impact of noncompliance among users of a combined hormonal contraceptive method. Contraception 2008; 77:276-82. [DOI: 10.1016/j.contraception.2007.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 11/05/2007] [Accepted: 11/26/2007] [Indexed: 10/22/2022]
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Barreiros FA, Guazzelli CAF, de Araújo FF, Barbosa R. Bleeding patterns of women using extended regimens of the contraceptive vaginal ring. Contraception 2007; 75:204-8. [PMID: 17303490 DOI: 10.1016/j.contraception.2006.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 10/22/2006] [Accepted: 10/31/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION This prospective observational study evaluated the bleeding patterns of women using a vaginal ring releasing 120 microg of etonogestrel and 15 microg of ethinyl estradiol daily, over a continuous period of 84 days followed by 7 ring-free days. METHODS The study enrolled 75 volunteers aged 18 to 37 years. Sixty-two (82.8%) recorded their menstrual cycles during 1 year. RESULTS At the end of the study, 85.5% had adequate menstrual patterns (two to four bleeding episodes, none lasting 10 days or more, with a range of bleeding-free intervals not exceeding 17 days), 9.7% had infrequent bleeding, 1.6% reported prolonged bleeding episodes, 1.6% had frequent bleeding and 1.6% had irregular bleeding. CONCLUSION Only 5 of the initial 75 patients discontinued the method due to bleeding. Among these 75 women, dissatisfaction with bleeding patterns was not a frequent reason given for discontinuation of the contraceptive vaginal ring.
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Affiliation(s)
- Fernando Augusto Barreiros
- Family Planning Clinic, Department of Obstetrics and Gynecology of São Paulo Federal University (UNIFESP), CEP 09090-050 São Paulo, Brazil
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Affiliation(s)
- Pam Campbell
- Staffordshire University and Family Planning Nurse, Stokeon-Trent PCT
| | - Sally Pickard
- Family Planning and Reproductive Health, Stoke-on-Trent PCT
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25
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Clark LR, Barnes-Harper KT, Ginsburg KR, Holmes WC, Schwarz DF. Menstrual irregularity from hormonal contraception: a cause of reproductive health concerns in minority adolescent young women. Contraception 2006; 74:214-9. [PMID: 16904414 DOI: 10.1016/j.contraception.2006.03.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 02/08/2006] [Accepted: 03/17/2006] [Indexed: 10/24/2022]
Abstract
CONTEXT Adolescents are frequent users of hormonal contraception (HC), yet their adherence to these methods is often poor. Concerns about side effects, especially those affecting the menstrual system, are often given as reasons for contraceptive nonadherence or discontinuation. We sought to identify teens' concerns and misperceptions about the menstrual-related side effects of HC. METHODS Open focus groups were conducted with both sexually active and virgin adolescent women aged 12-18 years who were recruited from the Philadelphia area. The adolescents did not have to be contraceptive users in order to participate. The question put to each group was, "What are the things you have heard about the birth control pill, Depo-Provera and Norplant?" Groups were audio-recorded, transcribed and analyzed using qualitative software. RESULTS We conducted 13 female-only groups. Participants raised frequent concerns about menstrual-related side effects, believing that these side effects were evidence of possible negative effects of HC on their reproductive health. Four themes related to hormonal contraceptive-induced menstrual irregularity emerged from the groups. Theme 1: Menstruation is natural and should not be altered in any way. Theme 2: The menstrual period is necessary for cleansing of the body. Theme 3: "Spotting," intermenstrual bleeding and amenorrhea cause doubts about the method's effectiveness and worries about pregnancy. Theme 4: All menstrual irregularity, from intermenstrual bleeding to amenorrhea, causes worry about the effects on fertility and on physical health. CONCLUSIONS Teens have concerns about the menstrual irregularity caused by HC. Providers understand that these side effects are minor and of little medical consequence. Yet, adolescent patients may be ascribing great significance to these effects and may be declining these methods because of fear and misperceptions.
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Affiliation(s)
- Liana R Clark
- Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Nappi RE, Liekens G, Brandenburg U. Attitudes, perceptions and knowledge about the vagina: the International Vagina Dialogue Survey. Contraception 2006; 73:493-500. [PMID: 16627033 DOI: 10.1016/j.contraception.2005.12.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 12/05/2005] [Accepted: 12/15/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND The International Vagina Dialogue Survey examined women's attitudes, perceptions and knowledge regarding the vagina. METHODS In total, 9441 women (18-44 years) from 13 countries underwent online interviews during April/May 2004. RESULTS The majority of the women thought that vaginal health did not receive the attention it deserves (66%) and that society has too many misconceptions about the vagina (65%); indeed, 78% agreed that society's taboos surrounding the vagina contribute to women's ignorance. Only 39% of the women had ever read an informative article on the vagina, although 83% would like to read such an article. Although 79% of the women relied on advice from healthcare professionals (HCPs) when choosing a contraceptive, <50% were comfortable talking to HCPs about vagina-related issues. CONCLUSIONS A more open and informative approach is needed with regard to the subject of the vagina in order to empower and educate women about their bodies and in matters such as choice of contraception.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy.
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Aubény E. [A prospective study of the provision of emergency contraception in family planning and education centers in Val-de-Marne, France. Gynecol Obstet Fertil 2005;33:403-408]. ACTA ACUST UNITED AC 2006; 34:175-7. [PMID: 16495111 DOI: 10.1016/j.gyobfe.2006.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Weisberg E, Brache V, Alvarez F, Massai R, Mishell DR, Apter D, Gale J, Sivin I, Tsong YY, Fraser IS. Clinical performance and menstrual bleeding patterns with three dosage combinations of a Nestorone progestogen/ethinyl estradiol contraceptive vaginal ring used on a bleeding-signaled regimen. Contraception 2005; 72:46-52. [PMID: 15964292 DOI: 10.1016/j.contraception.2004.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2004] [Revised: 12/10/2004] [Accepted: 12/15/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined the clinical performance of contraceptive vaginal rings (rings) delivering Nestorone (NES) progestin and ethinyl estradiol (EE). Ring removal times were signaled by menstrual events. Bleeding patterns, adverse events, patterns of use and continuation rates were the principal parameters evaluated. METHODS In a two-stage 6-month trial, subjects were randomized to use rings releasing 50 microg/day of NES and either 10 (50/10) or 20 (50/20) microg/day of EE. Subjects were to keep rings continuously in situ until menstrual bleeding or prolonged spotting-signaled removal. Reinsertion was to occur 96 h later. After the randomized stage, an open-label 6-month trial of rings releasing 150 microg/day of NES and 15 microg/day of EE (150/15) began with the same menstrually signaled regimen. RESULTS Two-hundred forty-six subjects participated in the trial. Six-month pregnancy rates ranged by ring dose from 1.3 to 3.9 per 100. For each ring dose combination, 6-month continuation rates were above 80 per 100. Bleeding and spotting (B+S) days in women with the 50 microg/day NES rings were similar in number to those experienced by cycling women not using contraception. Nevertheless, in the initial 90 days, fewer B+S days were reported by subjects with the 50/20 ring than by subjects with the 50/10 ring (p < .05). Throughout the trial, subjects using the 150/15 ring reported significantly fewer B+S episodes than did subjects with either 50 microg/day NES ring. CONCLUSION Combined contraceptive rings used with a bleeding-signaled regimen led to few terminations attributed to bleeding problems and to acceptable continuation rates. The 150/15 ring appeared to induce fewer bleeding problems than did the lower-dose NES combination rings, but no important difference in 6-month continuation rates among the three doses was noted.
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Affiliation(s)
- Edith Weisberg
- Sydney Center for Reproductive Health Research, Research Division of FPA Health, NSW 2131, Australia
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Omar H, Kives S, Allen L. Extended use of the oral contraceptive pill--is it an acceptable option for the adolescent? J Pediatr Adolesc Gynecol 2005; 18:285-8. [PMID: 16171734 DOI: 10.1016/j.jpag.2005.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hatim Omar
- Kentucky Clinic, University of Kentucky, Lexington, USA
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Penney G, Brechin S, Allerton L. FFPRHC Guidance (July 2005): The use of contraception outside the terms of the product licence. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2005; 31:225-41; quiz 242. [PMID: 16105289 DOI: 10.1783/1471189054483780] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This Guidance provides information for clinicians and women considering the use of contraception outside the terms of the product licence. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: CEU, Clinical Effectiveness Unit; COC, combined oral contraception/contraceptive; DMPA, depot medroxyprogesterone acetate; ENG, etonogestrel; IUD, copper-bearing intrauterine contraceptive device; LNG-IUS, levonorgestrel-releasing intrauterine system; NET-EN, norethisterone enantate; PGD, Patient Group Direction; PIL, Patient Information Leaflet; POC, progestogen-only contraception/contraceptive; POEC, progestogen-only emergency contraception; POP, progestogen-only pill; RCT, randomised controlled trial; SPC, Summary of Product Characteristics; UPSI, unprotected sexual intercourse; WHO, World Health Organization; WHOMEC, WHO Medical Eligibility Criteria for Contraceptive Use; WHOSPR, WHO Selected Practice Recommendations for Contraceptive Use.
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Aubeny E, Buhler M, Colau JC, Vicaut E, Zadikian M, Childs M. The Coraliance study: non-compliant behavior. Results after a 6-month follow-up of patients on oral contraceptives. EUR J CONTRACEP REPR 2005; 9:267-77. [PMID: 15799184 DOI: 10.1080/13625180400017776] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This follow-up study was planned to establish the frequency with which women miss their contraceptive pill, and to observe their behavior when they forget it. In those women who changed from a continuous cycle to an interrupted type of cycle, or vice versa, the study also aimed to evaluate the impact of this change on the pattern of omission of pills. METHODS The longitudinal, prospective cohort study included healthy women of child-bearing age for whom a change of pill was being prescribed by their gynecologist. Data were recorded during the 6 months preceding inclusion in the study, and for the 6 months of follow-up; the women were asked to complete a diary in which they recorded the number and exact times of pill omission, and their behavior at each omission. RESULTS A total of 617 gynecologists included 3316 women into the study; of these, a group of 2418 (73%) revisited the same gynecologist at follow-up. The groups who either visited the same or a different gynecologist were similar with respect to age, oral contraception type, omission type and frequency. A large non-compliance rate and women's difficulties in maintaining safe contraception after missing a pill were observed in the group with follow-up. Women were never risk-free when they missed a pill; they turned to numerous sources for discordant or conflicting information; 15% of 'not-forgetting' women at the pre-inclusion cycle recorded at least one omission at the last cycle of the 6-month follow-up period. Omission fluctuations during the observational period make it difficult to designate 'forgetful' or 'non-forgetful' classes of women. Administration of the pill in a continuous cycle, and probably 'study' and 'auto-questionnaire' effects, contributed to an improvement in compliance. In the group taking the continuous cycle pill, the omission number slightly decreased, particularly on the first day and week of the cycle, irrespective of the initial cycle type. CONCLUSIONS The importance of the phenomenon of non-compliance rate is confirmed as well as women's difficulties in knowing how to maintain contraceptive safety. The continuous cycle regimen is likely to improve women's compliance during the critical period of the cycle.
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Faculty Statement from the CEU on a New Publication: WHO Selected Practice Recommendations for Contraceptive Use Update Missed pills: new recommendations. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2005; 31:153-5. [PMID: 15921560 DOI: 10.1783/1471189053629572] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The World Health Organisation Selected Practice Recommendations for Contraceptive Use (WHOSPR) was first published in 2002 and provides evidence-based recommendations on how to use contraception effectively. The WHOSPR was adapted for UK use by the Faculty of Family Planning and Reproductive Heath Care (FFPRHC). The UK version is available on the FFPRHC website (www.ffprhc.org). Extensive field experience with the first edition of the WHOSPR highlighted to the WHO the need for revised recommendations for missed combined oral contraceptive pills (COCs). The WHOSPR was updated in 2004 and revised guidance on missed pills published. This guidance is now available on the WHO website (www.who.int/reproductive-health). The FFPRHC endorses the new recommendations from WHO on missed COCs for the following reasons: There is new evidence on which to base guidance. The WHOSPR follow a published and rigorous process for assessing the available evidence. The recommendations were developed by an international expert panel, with UK representation. Field experience shows a need for simple, harmonised guidance. This Statement summarises the revised WHOSPR evidence-based 'missed pill rules' in formats which we hope clinicians will find useful. We recognise that different individuals favour different styles for the presentation of information. Thus, both tabular and flow chart styles of summary are provided; these convey the same information but in different ways. The FFPRHC considers that the following statements may also serve as useful aides memoir for the 'missed pill rules': Whenever a woman realises that she has missed pills, the essential advice is 'just keep going'. She should take a pill as soon as possible and then resume her usual pill-taking schedule. Also, if the missed pills are in week three, she should omit the pill-free interval. Also, a back-up method (usually condoms) or abstinence should be used for 7 days if the following numbers of pills are missed: 'Two for twenty' (ie if two or more 20 microgram ethinylestradiol pills are missed). 'Three for thirty' (ie if three or more 30-35 microgram ethinylestradiol pills are missed). The fpa (Family Planning Association) has produced a revised COC user information sheet to reflect these changes; available from April 2005.
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Lech MM. Contraception in Europe: accessibility and availability. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2004; 30:151-4. [PMID: 15222917 DOI: 10.1783/1471189041261690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Medard M Lech
- School of Public Health, National Center of Postgraduate Education, Warsaw, Poland.
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New Product Review (September 2003) Norelgestromin/ethinyl oestradiol transdermal contraceptive system (Evra®). JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2004; 30:43-5. [PMID: 15006313 DOI: 10.1783/147118904322701974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This new transdermal contraceptive system (contraceptive patch), Evra (Janssen-Cilag), received a UK product licence in 2003. In clinical trials: Consistent doses of norelgestromin and ethinyl oestradiol are released into the systemic circulation daily. Pharmacokinetic data suggest that levels are sufficient to inhibit ovulation for at least 7 days. The overall Pearl index for the contraceptive patch (1.24; 95% CI 0.19-2.33) was similar to that of a triphasic combined oral contraceptive (COC) pill (2.18; 95% CI 0.57-3.8). Self-reported "perfect" compliance was significantly better with the contraceptive patch (88.2%) than with a combined contraceptive pill (77.7%). Patch detachment, requiring replacement with a new patch, with normal daily activity is uncommon (4.6%). Breakthrough bleeding and spotting were significantly more common with the contraceptive patch than with combined oral contraception in the first two cycles but differences were not significant by cycle three. In general, reported side effects were not significantly different with contraceptive patch or combined pill use. However, breast tenderness in the first two treatment cycles was more common with patch use. Symptoms were mild to moderate in 85% of women and were rarely treatment limiting. Currently, there are limited data regarding risk of venous thromboembolism, and cervical or breast cancer with the contraceptive patch. No clinically significant alterations in metabolic or haemostatic parameters were identified with contraceptive patch use. A month's supply of the contraceptive patch costs 7.74 UK pounds. Combined oral contraception prices range from approximately 0.80 to 5.00 UK pounds and hormone replacement therapy patches range from 10.00 to 13.00 UK pounds. The contraceptive patch offers additional choice for women who wish to use a combined hormonal method of contraception.
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MESH Headings
- Administration, Cutaneous
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/therapeutic use
- Device Approval
- Drug Combinations
- Estrogens/administration & dosage
- Estrogens/adverse effects
- Estrogens/therapeutic use
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Ethinyl Estradiol/therapeutic use
- Ethisterone/analogs & derivatives
- Female
- Humans
- Norgestrel/analogs & derivatives
- Oximes
- United Kingdom
- Women's Health
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FFPRHC Guidance (October 2003): First Prescription of Combined Oral Contraception. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2003; 29:209-22. [PMID: 14662054 DOI: 10.1783/147118903101198114] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Guidance provides information for clinicians on the steps to be taken before providing a woman with her first prescription for combined oral contraception. It updates and replaces previous Faculty Guidance. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance, and evidence tables summarising the research basis of the recommendations, are available on the Faculty website (www.ffprhc.org.uk). Abbreviations used include: blood pressure (BP), body mass (BMI), bone mineral density (BMD), breakthrough bleeding (BTB), British National Formulary (BNF), combined oral contraception (COC), Committee on Safety of Medicines (CSM), confidence interval (CI), deep vein thrombosis (DVT), emergency contraception (EC), ethinyl oestradiol (EE), Faculty Aid to Continuing Professional Development Topics (FACT), Family Planning Association (fpa), follicule-stimulating homone (FSH), general practitioner (GP), intermenstrual bleeding (IMB), luteinising hormone (LT), microgram, myocardial infarction (MI), odds ratio (OR), oral contraception (OC), pulmonary embolism (PE), relative risk (RR), Scottish Intercollegiate Guideline Network (SIGN), sexually transmitted infection (STI), Summary of Product Characteristics (SPCs), venous thomboembolism (VTE), World Health Organization (WHO), WHO Medical Eligibility Criteria (WHOMEC), WHO Selected Practice Recommendations (WHOSPR).
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