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Baró-Mariné F, Pijuan-Domènech A, Goya MDM, Suárez-Edo E, Miranda-Barrio B, Dos-Subirà L, Pancorbo ML, Ferreira-Gonzalez I, Carreras-Moratonas E. Progestogen only contraception in women with congenital heart disease. J OBSTET GYNAECOL 2024; 44:2320296. [PMID: 38466189 DOI: 10.1080/01443615.2024.2320296] [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: 07/15/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND There is little information of progestogen-only contraceptives in patients with congenital heart disease (CHD) on the long-term. OBJECTIVE To evaluate the use of contraception in patients with CHD. We studied both short-acting reversible contraceptives (SARCs), oral progestin-only pills (POPs) and long-acting reversible contraceptives (LARCs): intrauterine devices (IUD-IPs) and subdermal implants both impregnated with progestogens (SI-IPs). STUDY DESIGN Retrospective study of all women attending the preconception clinic. Contraceptive methods were classified in three TIERs of effectiveness before and after consultation. ESC classification regarding pregnancy risk, WHOMEC classification for combined oral contraceptive safety was collected. RESULTS Six hundred and fifty-three patients. A significant proportion of them switched from TIER 3 to TIER 2 or 1 (p < .001) after consultation. One hundred and ninety-nine patients used POPs, 53 underwent IUD-IPs implantation and 36 SI-IPs, mean duration was 58 ± 8, 59 ± 8 and 53 ± 38 months, respectively. CONCLUSIONS Because of their safety and efficacy, IUD-IPs and SI-IPs should be considered as first-line contraception in patients with CHD.
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Affiliation(s)
- Francesc Baró-Mariné
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonia Pijuan-Domènech
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Del Mar Goya
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Elena Suárez-Edo
- Department of Anesthesiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Berta Miranda-Barrio
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Laura Dos-Subirà
- Integrated Hospital Vall d'Hebron-Hospital Sant Pau Adult Congenital Heart Disease Unit, University Hospital Vall d'Hebron, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Maria Luisa Pancorbo
- Department of Obstetrics and Gynaecology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
- Department of Cardiology, University Hospital Vall d'Hebron, CIBER-ESP, Barcelona, Spain
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Brandão JDP, Machado RB, Cardoso ACF. Knowledge, Use, and Perception of Brazilian Women about Contraceptive Methods: An Observational Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:460-472. [PMID: 39035133 PMCID: PMC11257120 DOI: 10.1089/whr.2023.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 07/23/2024]
Abstract
Background In Brazil, where approximately 48.7 million women are of reproductive age, understanding contraceptive practices is essential for addressing public health challenges. This study evaluated into the knowledge, usage, and perceptions of contraceptive methods among Brazilian women, highlighting the influence of socioeconomic and demographic factors on their choices. Methods We conducted a cross-sectional survey with a representative sample of 2000 Brazilian women aged 18-49 years. The questionnaire collected detailed information on their awareness, preferences, and utilization of various contraceptive methods, alongside demographic and socioeconomic data. Results Oral contraceptives, condoms, injectables, and intrauterine devices (IUDs) were the most recognized methods. Younger women demonstrated greater awareness of modern methods. Socioeconomic disparities were evident, with lower-income women displaying limited knowledge about condoms and IUDs but a higher usage for injectable contraceptives. Oral contraceptives were the most used method, with higher use in the South, and lower in the Central-West and Northeast regions. Satisfaction with current contraceptive methods was high (87.5%), closely associated with personal responsibility in method choice. Although the majority self-financed their contraceptives (63.1%), a significant portion of lower-income women (27.7%) relied on public health care. Physicians' recommendations predominantly influenced contraceptive choice (53.9%), with younger women also guided by other influences. Conclusions Persistent disparities in contraceptive awareness and access highlight the need for educational initiatives and policy interventions. Health care providers play a vital role in facilitating informed contraceptive choices, enhancing the chances of satisfaction with the method.
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Niemann J, Wicherski L, Glaum L, Schenk L, Stadler G, Richter M. YouTube and the implementation and discontinuation of the oral contraceptive pill: A mixed-method content analysis. PLoS One 2024; 19:e0302316. [PMID: 38787833 PMCID: PMC11125465 DOI: 10.1371/journal.pone.0302316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/01/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube. METHODS A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis. FINDINGS The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91). CONCLUSIONS The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform.
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Affiliation(s)
- Jana Niemann
- Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
| | - Lea Wicherski
- Osnabrück University, School of Human Sciences, Osnabrück, Lower Saxony, Germany
| | - Lisa Glaum
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
| | - Liane Schenk
- Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Getraud Stadler
- Institute for Gender Research in Medicine (GiM), Charité Universitätsmedizin Berlin, Berlin, Berlin, Germany
| | - Matthias Richter
- Medical Faculty, Institute of Medical Sociology, Institute of Medical Sociology (IMS), Martin Luther University Halle Wittenberg, Interdisciplinary Centre for Health Sciences, Halle (Saale), Saxony-Anhalt, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Bavaria, Germany
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4
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Luo X, Jia K, Xing J, Yi J. The utilization of nanotechnology in the female reproductive system and related disorders. Heliyon 2024; 10:e25477. [PMID: 38333849 PMCID: PMC10850912 DOI: 10.1016/j.heliyon.2024.e25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
The health of the reproductive system is intricately linked to female fertility and quality of life. There has been a growing prevalence of reproductive system disorders among women, particularly in younger age groups, resulting in significant adverse effects on their reproductive health. Consequently, there is an urgent need for effective treatment modalities. Nanotechnology, as an advanced discipline, provides innovative avenues for managing and treating diseases of the female reproductive system by enabling precise manipulation and regulation of biological molecules and cells. By utilizing nanodelivery systems, drugs can be administered with pinpoint accuracy, leading to reduced side effects and improved therapeutic efficacy. Moreover, nanomaterial imaging techniques enhance diagnostic precision and sensitivity, aiding in the assessment of disease severity and progression. Furthermore, the implementation of nanobiosensors facilitates early detection and prevention of ailments. This comprehensive review aims to summarize recent applications of nanotechnology in the treatment of female reproductive system diseases. The latest advancements in drug delivery, diagnosis, and treatment approaches will be discussed, with an emphasis on the potential of nanotechnology to improve treatment outcomes and overall quality of life.
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Affiliation(s)
- Xin Luo
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
- Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Keran Jia
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jinshan Xing
- Department of Neurosurgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jingyan Yi
- Department of Medical Cell Biology and Genetics, School of Basic Medical Sciences, Basic Medicine Research Innovation Center for Cardiometabolic Diseases, Ministry of Education, Southwest Medical University, Luzhou, 646000, Sichuan, China
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5
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Lőczi LL, Török M, Vezér M, Gerszi D, Gyarmathy VA, Ács N, Várbíró S, Keszthelyi M. Motivators for emergency contraception: Previous pregnancy and condom rupture. Heliyon 2024; 10:e23757. [PMID: 38192856 PMCID: PMC10772218 DOI: 10.1016/j.heliyon.2023.e23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
Objectives Little is known about the motivations to apply for emergency contraception (EC). Our first aim was to explore the motivating circumstances to use EC as fast as possible. Our second aim was to explore the contraceptive method of the population seeking EC. Study design This present retrospective observational study between July 2021 and September 2021 is embedded in the MEEC (Motivation and Epidemiology of Emergency Contraceptive Pill) based on the study cohort of a Hungarian data bank containing follow-up data of 455 women applied for EC telemedicine consultation. Variables assessed were: age, gynecological history (pregnancies, abortions, miscarriages), data of the intercourse (elapsed time, contraceptive method), and data of the menstrual cycle, and relationship status. Results Of all patients, 59.3 % reported condom rupture, 29.5 % no protection, and 11.2 % other. Patients using condom applied for EC significantly sooner than those using no protection and using other protective methods. A significantly shorter elapsed time was observed in patients with a history of a previous pregnancy. No significant relationship was seen between the way of protection, previous pregnancies, and surprisingly the time of ovulation despite the obvious intention of avoiding pregnancy. Conclusions This is the first study to examine the potential role of epidemiologic factors as motivators for EC on the basis of a large patient cohort. Our study demonstrates the significant role of condom rupture/use and the history of previous pregnancies to be the strongest motivators for EC.
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Affiliation(s)
- Lotti Lúcia Lőczi
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
| | - Marianna Török
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
- Workgroup for Science Management Doctoral School, Semmelweis University, Üllői út 22., 1085, Budapest, Hungary
| | - Márton Vezér
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
| | - Dóra Gerszi
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
| | - V. Anna Gyarmathy
- EpiConsult LLC, 8 The Green, STE A, Dover, DE, 19904, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
| | - Szabolcs Várbíró
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
- Workgroup for Science Management Doctoral School, Semmelweis University, Üllői út 22., 1085, Budapest, Hungary
| | - Márton Keszthelyi
- Department of Obstetrics and Gynecology, Semmelweis University, Üllői út 78/a, 1082, Budapest, Hungary
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Genazzani AR, Fidecicchi T, Arduini D, Giannini A, Simoncini T. Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice. Gynecol Endocrinol 2023; 39:2247093. [PMID: 37599373 DOI: 10.1080/09513590.2023.2247093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
The debate about contraception has become increasingly important as more and more people seek safe and effective contraception. More than 1 billion women of reproductive age worldwide need a method of family planning, and wellbeing, socio-economic status, culture, religion and more influence the reasons why a woman may ask for contraception. Different contraceptive methods exist, ranging from 'natural methods' (fertility awareness-based methods - FABMs) to barrier methods and hormonal contraceptives (HCs). Each method works on a different principle, with different effectiveness.FABMs and HCs are usually pitted against each other, although it's difficult to really compare them. FABMs are a valid alternative for women who cannot or do not want to use hormone therapy, although they may have a high failure rate if not used appropriately and require specific training. HCs are commonly used to address various clinical situations, although concerns about their possible side effects are still widespread. However, many data show that the appropriate use of HC has a low rate of adverse events, mainly related to personal predisposition.The aim of this review is to summarize the information on the efficacy and safety of FABMs and HCs to help clinicians and women choose the best contraceptive method for their needs.
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Affiliation(s)
- Andrea R Genazzani
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tiziana Fidecicchi
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Domenico Arduini
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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7
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Howard SA, Benhabbour SR. Non-Hormonal Contraception. J Clin Med 2023; 12:4791. [PMID: 37510905 PMCID: PMC10381146 DOI: 10.3390/jcm12144791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
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Affiliation(s)
- Sarah Anne Howard
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Soumya Rahima Benhabbour
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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8
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FSRH Guideline (March 2023) Intrauterine contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:1-142. [PMID: 37188461 DOI: 10.1136/bmjsrh-2023-iuc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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9
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Margaritis K, Margioula-Siarkou G, Margioula-Siarkou C, Petousis S, Galli-Tsinopoulou A. Contraceptive methods in adolescence: a narrative review of guidelines. EUR J CONTRACEP REPR 2023; 28:51-57. [PMID: 36637987 DOI: 10.1080/13625187.2022.2162336] [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: 01/14/2023]
Abstract
PURPOSE Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. Education and counselling are deemed crucial and this review aims at comparing published contraceptive guidelines, thus resolving any surrounding misconceptions. MATERIALS AND METHODS Recently published contraception guidelines regarding adolescent pregnancy were retrieved. In particular, guidelines and recommendations from ACOG, RCOG, SOCG, AAP, CPS, NICE, CDC, and WHO were compared and reviewed based on each guideline's method of reporting. RESULTS Three categories of contraceptive methods are available for adolescents and recommendations on their initiation should be made based on their efficacy, according to all guidelines. Therefore, long acting reversible contraceptives (LARCs) should be highly recommended as the most effective method (typical use failure rate: 0.05%), followed by short-acting hormonal contraceptives (typical use failure rate: 3-9%). The third contraceptive option includes contraceptives used in the moment of intercourse and displays the lowest effectiveness (typical use failure rate: 12-25%), mostly due to its dependence on personal consistency, however offers protection against STI transmission. CONCLUSION Adolescents should be encouraged to initiate contraception, with LARCs being the primary choice followed by short-acting hormonal contraception. However, regardless of the chosen effective contraceptive method, the use of condom is necessary for STI prevention.
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Affiliation(s)
- Kosmas Margaritis
- 2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - Georgia Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
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Fajloun Z, Abi Khattar Z, Kovacic H, Legros C, Sabatier JM. Anti-COVID-19 Vaccination, COVID-19, and Female Contraception: The Exacerbated Risks (Thromboembolism) of the Estrogen-progestin Pill. Infect Disord Drug Targets 2023; 23:e240223214000. [PMID: 36823996 DOI: 10.2174/1871526523666230224094439] [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: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Ziad Fajloun
- Department of Biology, Faculty of Sciences 3, Lebanese University, Campus Michel Slayman Ras Maska, Tripoli 1352, Lebanon
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, Tripoli 1300, Lebanon
| | - Ziad Abi Khattar
- Laboratory of Georesources, Geosciences and Environment (L2GE), Microbiology/Tox-Ecotoxicology Team, Faculty of Sciences 2, Lebanese University, Campus Fanar, Jdeidet El-Matn, Beirut, P.O. Box 90656, Lebanon
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Byblos Campus, Byblos, P.O. Box 36, Lebanon
| | - Hervé Kovacic
- The Institute of Neurophysiopathology, Aix-Marseille University, CNRS, INP, Marseille 13385, France
| | - Christian Legros
- University of Angers, INSERM, CNRS, MITOVASC, Team 2 CarMe, SFR ICAT, Angers 49000, France
| | - Jean-Marc Sabatier
- The Institute of Neurophysiopathology, Aix-Marseille University, CNRS, INP, Marseille 13385, France
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Schimpf U, Caldas-Silveira E, Katchan L, Vigier-Carriere C, Lantier I, Nachmann G, Gidlöf S, Jonasson AF, Björndahl L, Trombotto S, Druart X, Crouzier T. Topical reinforcement of the cervical mucus barrier to sperm. Sci Transl Med 2022; 14:eabm2417. [PMID: 36449601 DOI: 10.1126/scitranslmed.abm2417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Close to half of the world's pregnancies are still unplanned, reflecting a clear unmet need in contraception. Ideally, a contraceptive would provide the high efficacy of hormonal treatments, without systemic side effects. Here, we studied topical reinforcement of the cervical mucus by chitosan mucoadhesive polymers as a form of female contraceptive. Chitosans larger than 7 kDa effectively cross-linked human ovulatory cervical mucus to prevent sperm penetration in vitro. We then demonstrated in vivo using the ewe as a model that vaginal gels containing chitosan could stop ram sperm at the entrance of the cervical canal and prevent them from reaching the uterus, whereas the same gels without chitosan did not substantially limit sperm migration. Chitosan did not affect sperm motility in vitro or in vivo, suggesting reinforcement of the mucus physical barrier as the primary mechanism of action. The chitosan formulations did not damage or irritate the ewe vaginal epithelium, in contrast to nonoxynol-9 spermicide. The demonstration that cervical mucus can be reinforced topically to create an effective barrier to sperm may therefore form the technological basis for muco-cervical barrier contraceptives with the potential to become an alternative to hormonal contraceptives.
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Affiliation(s)
- Ulrike Schimpf
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden.,Department of Material and Environmental Chemistry (MMK), Stockholm University, 106 91 Stockholm, Sweden
| | - Erika Caldas-Silveira
- PIXANIM, Physiologie de la Reproduction et des Comportements, UMR INRAE, CNRS, Université de Tours, IFCE, 37380 Nouzilly, France
| | - Ljudmila Katchan
- Cirqle Biomedical Contraception ApS, Ole Maaløes Vej 3, 2200 Copenhagen, Denmark
| | | | - Isabelle Lantier
- French National Institute for Agriculture, Food, and Environment (INRAE), UMR ISP, Université de Tours, 37380 Nouzilly, France
| | - Gilai Nachmann
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden
| | - Sebastian Gidlöf
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, Sweden
| | - Aino Fianu Jonasson
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 141 86 Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, Sweden
| | - Lars Björndahl
- ANOVA-Andrology, Sexual Medicine, Transmedicine, Karolinska University Hospital and Karolinska Institutet, Norra Stationsgatan 69, 113 64 Stockholm, Sweden
| | - Stéphane Trombotto
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, IMP, UMR 5223, F-69622 Villeurbanne, France
| | - Xavier Druart
- PIXANIM, Physiologie de la Reproduction et des Comportements, UMR INRAE, CNRS, Université de Tours, IFCE, 37380 Nouzilly, France
| | - Thomas Crouzier
- Division of Glycoscience, Department of Chemistry, School of Engineering Science in Chemistry, Biotechnology and Health (CBH), AlbaNova University Center, KTH Royal Institute of Technology, 106 91 Stockholm, Sweden.,Cirqle Biomedical Contraception ApS, Ole Maaløes Vej 3, 2200 Copenhagen, Denmark.,AIMES-Center for the Advancement of Integrated Medical and Engineering Sciences, Karolinska Institutet and KTH Royal Institute of Technology, 171 77 Stockholm, Sweden.,Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
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12
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Ko PJ, Milad MA, Radulovic LL, Gibson D. Pharmacokinetics of Levonorgestrel in Rat and Minipig and Pharmacokinetics of Etonogestrel in Rat Following Various Administration Routes. Xenobiotica 2022; 52:575-582. [PMID: 35975955 DOI: 10.1080/00498254.2022.2079023] [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: 10/15/2022]
Abstract
1. The objective of these studies was to determine the pharmacokinetics of levonorgestrel and etonogestrel in Sprague-Dawley rat or Göttingen minipig following various administration routes.2. Four sequential crossover studies were conducted: Study 1 administered levonorgestrel 30 µg intravenously and intradermally in four minipigs; Study 2 administered levonorgestrel 30 µg intravenously in 12 rats; Study 3 administered levonorgestrel 60 µg intravenously and subcutaneously in 12 rats; and Study 4 administered etonogestrel 30 µg intravenously in 12 rats. Samples were quantified using liquid chromatography-tandem mass spectrometry and pharmacokinetic parameters were estimated via noncompartmental analysis.3. Cmax and AUCinf for etonogestrel and levonorgestrel were similar following 30 µg intravenous bolus in rat, suggesting comparable pharmacokinetics. Levonorgestrel exposure was dose-proportional in rats, based on two-fold higher AUCinf following levonorgestrel 60 versus 30 µg. Bioavailability of intradermal and subcutaneous levonorgestrel was 97.7% (Study 1) and 90.3% (Study 3), respectively. The minipig levonorgestrel clearance was 21.5 L/hr, which was about 10-fold higher than both the rat levonorgestrel (range: 0.985 to 1.45 L/hr) and etonogestrel clearance (range: 0.803 to 0.968 L/hr).4. These studies contribute to the gap in knowledge of nonclinical levonorgestrel and etonogestrel pharmacokinetics, which is necessary for ongoing development of long-acting reversible contraceptives.
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Affiliation(s)
- Paul J Ko
- Milad Pharmaceutical Consulting LLC, Plymouth, Michigan, United States
| | - Mark A Milad
- Milad Pharmaceutical Consulting LLC, Plymouth, Michigan, United States
| | - Louis L Radulovic
- Innovative Pharma Consulting LLC, Superior Township, Michigan, United States
| | - Don Gibson
- DMG III Pharma Project Management Consulting LLC, East Lyme, Connecticut, United States
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13
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Stabile G, Foti C, Mordeglia D, De Santo D, Mangino FP, Laganà AS, Ricci G. Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature. J Clin Med 2022; 11:jcm11113226. [PMID: 35683613 PMCID: PMC9181553 DOI: 10.3390/jcm11113226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Correspondence:
| | - Carmelina Foti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Denise Mordeglia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
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Chattopadhyay P, Magdanz V, Hernández-Meliá M, Borchert KBL, Schwarz D, Simmchen J. Size‐Dependent Inhibition of Sperm Motility by Copper Particles as a Path toward Male Contraception. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Veronika Magdanz
- Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute for Science and Technology 08028 Barcelona Spain
| | - María Hernández-Meliá
- Institute for Bioengineering of Catalonia (IBEC) Barcelona Institute for Science and Technology 08028 Barcelona Spain
| | - Konstantin B. L. Borchert
- Nanostructured Materials Leibniz-Institut für Polymerforschung Dresden e.V. Hohe Str. 6 01069 Dresden Germany
| | - Dana Schwarz
- Nanostructured Materials Leibniz-Institut für Polymerforschung Dresden e.V. Hohe Str. 6 01069 Dresden Germany
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15
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Recent progress in advanced biomaterials for long-acting reversible contraception. J Nanobiotechnology 2022; 20:138. [PMID: 35300702 PMCID: PMC8932341 DOI: 10.1186/s12951-022-01329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
Unintended pregnancy is a global issue with serious ramifications for women, their families, and society, including abortion, infertility, and maternal death. Although existing contraceptive strategies have been widely used in people's lives, there have not been satisfactory feedbacks due to low contraceptive efficacy and related side effects (e.g., decreased sexuality, menstrual cycle disorder, and even lifelong infertility). In recent years, biomaterials-based long-acting reversible contraception has received increasing attention from the viewpoint of fundamental research and practical applications mainly owing to improved delivery routes and controlled drug delivery. This review summarizes recent progress in advanced biomaterials for long-acting reversible contraception via various delivery routes, including subcutaneous implant, transdermal patch, oral administration, vaginal ring, intrauterine device, fallopian tube occlusion, vas deferens contraception, and Intravenous administration. In addition, biomaterials, especially nanomaterials, still need to be improved and prospects for the future in contraception are mentioned.
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16
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Benefits and Risks of Bilateral Salpingectomy Compared With Standard Tubal Ligation During Cesarean Delivery for Permanent Postpartum Contraception. Obstet Gynecol Surv 2022; 77:167-173. [PMID: 35275215 DOI: 10.1097/ogx.0000000000000995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited. Objective We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation. Evidence Acquisition Original research articles, review articles, and guidelines on contraception were reviewed. Conclusions and Relevance Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely.
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17
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Association between Oral Contraceptive Use and the High-Sensitivity C-Reactive Protein Level in Premenopausal Korean Women. Healthcare (Basel) 2022; 10:healthcare10020361. [PMID: 35206975 PMCID: PMC8872382 DOI: 10.3390/healthcare10020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
Although oral contraceptives (OCs) are widely used, few national epidemiological studies have evaluated the association between OC use and serum high-sensitivity C-reactive protein (hs-CRP) levels in Korean women. This population-based cross-sectional study was conducted with data from the 2015–2018 National Health and Nutrition Examination Survey. In the sample of 5332 premenopausal women aged ≥19 years, hs-CRP concentrations were 1.087 mg/L among OC users and 0.953 mg/L among OC non-users. After adjustment for confounders, OC users had an increased likelihood of having risky (>1.0 mg/L) hs-CRP levels (adjusted odds ratio (aOR) = 1.58; 95% confidence interval (CI), 1.25–1.98) compared with OC non-users. In addition, the aOR for high-risk (>3.0 mg/L) hs-CRP levels in OC users compared with non-users was 1.51 (95% CI, 1.06–2.16). These findings demonstrate that OC use alters the concentration of hs-CRP, a biomarker of chronic low-grade inflammation, and suggest that long-term OC use is a risk factor in the pathogenesis of inflammatory diseases, including cardiovascular diseases.
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18
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Li L, Gatto GJ, Brand RM, Krovi SA, Cottrell ML, Norton C, van der Straten A, Johnson LM. Long-acting biodegradable implant for sustained delivery of antiretrovirals (ARVs) and hormones. J Control Release 2021; 340:188-199. [PMID: 34678316 DOI: 10.1016/j.jconrel.2021.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 12/14/2022]
Abstract
Women worldwide confront two major reproductive health challenges: the need for contraception and protection from sexually transmitted infections, including Human Immunodeficiency Virus (HIV). Multipurpose Prevention Technologies (MPTs) that simultaneously prevent unintended pregnancy and HIV could address these challenges with a single product. Here, we developed a long-acting (LA) subcutaneously administered and biodegradable implant system that provides sustained delivery of contraceptive and antiretroviral (ARV) with zero-order release kinetics. The MPT system involves two implants comprising an extruded tube of a biodegradable polymer, poly(ε-caprolactone) (PCL). Each implant is filled with a formulation of progestin [levonorgestrel (LNG) or etonogestrel (ENG)], or a formulation of a potent ARV [tenofovir alafenamide (TAF), or 4'-Ethynyl-2-fluoro-2'-deoxyadenosine (EFdA)]. We demonstrated sustained in-vitro release of LNG, ENG, and EFdA from the implant system for 13-17 months, while maintaining high stability of the drugs (>99%) within the implant reservoirs. We further elucidated the controlled release mechanism of the implant and leveraged several tunable parameters (e.g., type and quantity of the excipient, PCL properties, and implant wall thickness) to tailor the release kinetics and enhance the mechanical integrity of the MPT implant. The optimized MPT showed sustained in-vitro release of ENG and EFdA over 1 year while maintaining a high level of formulation stability and structural integrity. The MPT implant system was further evaluated in a preclinical study using a rodent model and demonstrated sustained release of EFdA (6 months) and ENG (12 months) with high stability of the drug formulation (>95%). This manuscript supports the continued advancement of LA delivery systems for MPTs.
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Affiliation(s)
- Linying Li
- Biomedical Technologies Group, RTI International, Research Triangle Park, NC 27709, USA
| | - Gregory J Gatto
- Global Public Health Impact Center, RTI International, Research Triangle Park, NC 27709, USA
| | - Rhonda M Brand
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Sai Archana Krovi
- Biomedical Technologies Group, RTI International, Research Triangle Park, NC 27709, USA
| | - Mackenzie L Cottrell
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Chasity Norton
- Biomedical Technologies Group, RTI International, Research Triangle Park, NC 27709, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Dept of Medicine, University of California San Francisco, San Francisco, CA 94104, USA; ASTRA consulting, Kensington, CA 94708, USA
| | - Leah M Johnson
- Biomedical Technologies Group, RTI International, Research Triangle Park, NC 27709, USA.
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19
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Park H, Kim K. Trends and Factors Associated with Oral Contraceptive Use among Korean Women. Healthcare (Basel) 2021; 9:healthcare9101386. [PMID: 34683066 PMCID: PMC8544440 DOI: 10.3390/healthcare9101386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in Korea. We used secondary data from the 2010–2019 National Health and Nutrition Examination Survey to examine trends in the annual prevalence of OC use between 2010 and 2019, and factors influencing OC use. Based on data from 14,386 premenopausal women, the average annual prevalence of OC use was 8.2–10.7% between 2010 and 2014; it increased to 12.6–14.4% during 2015–2019. The prevalence of OC use was significantly higher in women with higher (≥5) than lower gravidity (<5). In addition, among sociodemographic factors, education level, household income, cigarette smoking, and alcohol drinking were significantly associated with OC use in Korean women. As OC use is affected by sociodemographic factors, a contraceptive plan that considers sociodemographic factors is needed to establish an effective family planning policy.
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Affiliation(s)
- Hyejin Park
- Department of International Healthcare Administration, Daegu Catholic University, Gyeongsan 38430, Korea;
| | - Kisok Kim
- College of Pharmacy, Keimyung University, Daegu 42601, Korea
- Correspondence: ; Tel.: +82-53-580-5932
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20
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Association of levonorgestrel intrauterine devices with stress reactivity, mental health, quality of life and sexual functioning: A systematic review. Front Neuroendocrinol 2021; 63:100943. [PMID: 34425187 DOI: 10.1016/j.yfrne.2021.100943] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Levonorgestrel-intrauterine-devices (LNG-IUD) are one of the most used contraceptive methods worldwide. While several reviews exist on how LNG-IUDs impact physiology and gynaecological functions, this systematic review focuses on stress, mental health, quality of life, sexual functioning, and effects on brain architecture. While data on stress is scarce, results on mental health are ambiguous. More consistently, LNG-IUD use seems to improve quality of life and sexual functioning. No studies highlighting the consequences of LNG-IUD use on the brain were found. The reviewed studies are characterized by a substantial variation in approaches, participant groups, and study quality. More high-quality research assessing the effects of LNG-IUD on mental health, including response to stressors and brain function and structure, is needed to identify women vulnerable to adverse effects of LNG-IUD, also in comparison to oral contraceptives, and to empower women to make more informed choices concerning hormonal contraception.
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21
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Kurvits K, Laius O, Uusküla M, Laanpere M. Trends in the use of hormonal contraception in Estonia 2005-2019 and the risk of arterial and venous thromboembolism: a population-based study. EUR J CONTRACEP REPR 2021; 26:413-420. [PMID: 34160334 DOI: 10.1080/13625187.2021.1931839] [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: 10/21/2022]
Abstract
PURPOSE To describe trends in hormonal contraceptive use, incidence of thromboembolism and presence of risk factors for thromboembolism among the users in Estonia. MATERIAL AND METHODS Data of 223 312 female patients aged 15-49 years in 2005-2019 from national health insurance databases was derived. Annual prevalence rates of hormonal contraceptive users, incidence rates of thromboembolism and prevalence rates of risk factors were calculated. RESULTS Between 2005-2019 usage of progestogen-only contraceptives (POCs) increased steadily (from 24 to 135 users per 1000 population), whereas combined hormonal contraceptive (CHC) use declined (from 209 in 2012 to 161 users per 1000 population in 2019). During the study period, 390 cases of venous thromboembolism and 108 arterial thromboembolism coincided with hormonal contraceptive use. Incidence rate for venous thromboembolism was 5.0 (95% CI 4.5-5.5) and for arterial thromboembolism 1.4 per 10 000 person-years (95% CI 1.1-1.7) among hormonal contraceptive users. Age adjusted incidence of venous thromboembolism among CHC users was 5.8 (95% CI 4.1-8.2) times higher than in POC users. Among CHC users, 10.3% had more than one risk factor for thrombosis. CONCLUSIONS In regards to the risk of thromboembolism, wider use of POCs and declining prevalence of CHCs in Estonia is positive trend. Still, women with history of thrombosis receiving CHC is a serious concern.
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Affiliation(s)
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | | | - Made Laanpere
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Tartu University Hospital Women's Clinic, Tartu, Estonia
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22
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Frutos-Balibrea I, Sánchez-Núñez MI, Pedrero-Pérez EJ, Haro-León A, Benítez-Robredo MT. [Long-acting reversible contraception methods in women under 26 years of age]. Semergen 2021; 47:457-464. [PMID: 34148782 DOI: 10.1016/j.semerg.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Long-acting reversible contraception (LARC) methods have proven their high safety and efficacy for pregnancy prevention and they are specially indicated in young and vulnerable population, but their use encounter barriers both between providers and users due to lack of information or to the economic cost. The aim of this study was to assess the use of two LARC methods, intrauterine device (IUD) and implant, in minors under 26 years old after giving an adequate contraceptive advice and subsidizing them in vulnerability situations. To analyze the population that chooses them, the side effects, the reasons for abandoning and the permanence time. MATERIAL AND METHODS Retrospective descriptive study of IUD and implants inserted to minors under 26 years old from January 2016 to December 2019 at the Municipal Health Center of Usera belonging to Madrid Salud. Data is collected from n=266 women who started using IUD or implant. 87 copper IUD, 37 medicated IUD and 142 implants have been placed. RESULTS Increased prescription of both methods, with significant implant use in the last year of the study. There has been vulnerability in 91.7% of women. The average age of IUD users is about 21.4 years, almost 2 years older than that of the implant and they have more children. The side effects frequency has been similar with both methods, being abnormal bleeding as the most frequent side effect. 31% of copper IUD, 32% of medicated IUD and 12% of implants have been removed early. The average permanence time was 19.3 months (SD=13.3), 89.1% remained at the end of the first year, 81.2% at two years and 77.4% at three years. CONCLUSIONS An adequate contraceptive advice and free access are essential keys for increasing the LARC methods use in this particularly vulnerable population. Few and minor side effects and high continuity rate have been found, especially for the implant.
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Affiliation(s)
- I Frutos-Balibrea
- Centro Municipal de Salud Comunitaria de Usera (Organismo Autónomo Madrid Salud, Ayuntamiento de Madrid), Madrid, España
| | - M I Sánchez-Núñez
- Centro Municipal de Salud Comunitaria de Usera (Organismo Autónomo Madrid Salud, Ayuntamiento de Madrid), Madrid, España
| | | | - A Haro-León
- Departamento de Evaluación y Calidad, Madrid Salud, Madrid, España
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Paredes AJ, Ramöller IK, McKenna PE, Abbate MT, Volpe-Zanutto F, Vora LK, Kilbourne-Brook M, Jarrahian C, Moffatt K, Zhang C, Tekko IA, Donnelly RF. Microarray patches: Breaking down the barriers to contraceptive care and HIV prevention for women across the globe. Adv Drug Deliv Rev 2021; 173:331-348. [PMID: 33831475 DOI: 10.1016/j.addr.2021.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Despite the existence of a variety of contraceptive products for women, as well as decades of research into the prevention and treatment of human immunodeficiency virus (HIV), there is still a globally unmet need for easily accessible, acceptable, and affordable products to protect women's sexual and reproductive health. Microarray patches (MAPs) are a novel platform being developed for the delivery of hormonal contraception and antiretroviral drugs. MAPs provide enhanced drug delivery to the systemic circulation via the transdermal route when compared to transdermal patches, oral and injectable formulations. These minimally invasive patches can be self-administered by the user, reducing the burden on health care personnel. Since MAPs represent needle-free drug delivery, no sharps waste is generated after application, thereby eliminating possible MAP reuse and risk of needle-stick injuries. This review discusses the administration of contraceptive and antiretroviral drugs using MAPs, their acceptability by end-users, and the future perspective of the field.
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24
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Khin YP, Nawa N, Fujiwara T, Surkan PJ. Access to contraceptive services among Myanmar women living in Japan: A qualitative study. Contraception 2021; 104:538-546. [PMID: 34051243 DOI: 10.1016/j.contraception.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite relatively poor health outcomes of migrants in Japan, little is known about their access to reproductive healthcare. We conducted qualitative research to explore perceived barriers to access, with a specific focus on contraceptive services, and their consequences among Myanmar migrants in Japan. STUDY DESIGN From January to April 2020, we conducted 17 in-depth interviews with Myanmar migrant women and 4 key informant interviews with Myanmar interpreters working in health services in Tokyo, Saitama, and Chiba prefectures. We transcribed interviews and coded them in ATLAS.ti primarily using a deductive approach based on the 5 components of Levesque et al.'s conceptual framework of healthcare access. We also used inductive coding to allow for other themes outside of the framework to emerge. RESULTS Among the 17 women, almost half stated that they were using periodic abstinence based on the presumed fertility window or the withdrawal method. Furthermore, slightly over half of the women had a history of unintended pregnancy. Language barriers, limited health information sources, cultural and health beliefs and financial factors played important roles in access to contraceptives among Myanmar migrant women. Women described how these barriers resulted in feeling lack of control over family planning and unintended pregnancies. CONCLUSIONS Findings suggested that Myanmar migrants in Japan are faced with limited contraceptive access. Language barriers, limited information sources, health beliefs, and cultural and financial factors affected access. IMPLICATIONS Results suggest that to increase public awareness and contraceptive access of Myanmar women in Japan nonprofit support programs would benefit from the help of existing social networks of Myanmar migrants, interpreters, and Japanese doctors and researchers in reproductive health.
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Affiliation(s)
- Yu Par Khin
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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25
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Kanadys W, Barańska A, Malm M, Błaszczuk A, Polz-Dacewicz M, Janiszewska M, Jędrych M. Use of Oral Contraceptives as a Potential Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis of Case-Control Studies Up to 2010. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4638. [PMID: 33925599 PMCID: PMC8123798 DOI: 10.3390/ijerph18094638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/11/2023]
Abstract
Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic database MEDLINE and EMBASE, and reference lists of identified articles were searched, with no language restrictions, from the start of publication to August 2010. We performed a reanalysis and overall estimate of 79 case-control studies conducted between 1960-2010, including a total of 72,030 incidents, histologically confirmed cases of breast cancer and 123,650 population/hospital controls. A decrease was observed in cancer risk in OC users before age 25 years (0.91, 0.83-1.00). However, the use of OCs before the first full-term pregnancy had a significant increased risk of breast cancer (OR, 1.14, 1.01-1.28, p = 0.04), as did OC use longer than 5 years (1.09, 1.01-1.18, p = 0.02). Pooled crude odds ratios of breast cancer in ever-users of oral contraceptives was 1.01 [95% confidence interval (CI), 0.95-1.07], compared with never-users. There was no significant increase in risk among premenopausal women (1.06, 0.92-1.22), postmenopausal women (0.99, 0.89-1.10), or nulliparous women (1.02, 0.82-1.26). Oral contraceptives do not appear to increase the risk of breast cancer among users. However, OC use before a first full-term pregnancy or using them longer than 5 years can modify the development of the breast cancer.
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Affiliation(s)
- Wiesław Kanadys
- Specialistic Medical Center “Czechów” in Lublin, 20-848 Lublin, Poland;
| | - Agnieszka Barańska
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University, 20-090 Lublin, Poland; (A.B.); (M.J.); (M.J.)
| | - Maria Malm
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University, 20-090 Lublin, Poland; (A.B.); (M.J.); (M.J.)
| | - Agata Błaszczuk
- Department of Virology with SARS Laboratory, Medical University, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Małgorzata Polz-Dacewicz
- Department of Virology with SARS Laboratory, Medical University, 20-093 Lublin, Poland; (A.B.); (M.P.-D.)
| | - Mariola Janiszewska
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University, 20-090 Lublin, Poland; (A.B.); (M.J.); (M.J.)
| | - Marian Jędrych
- Department of Medical Informatics and Statistics with E-learning Lab, Medical University, 20-090 Lublin, Poland; (A.B.); (M.J.); (M.J.)
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Women’s socioeconomic status and choice of birth control method: an investigation for the case of Turkey. J Biosoc Sci 2020; 53:137-156. [DOI: 10.1017/s0021932020000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThis study investigated whether woman’s education, labour market status and the status within the household have any impact on their birth control behaviour in Turkey. Empirical analyses were implemented using the 2013 Demographic and Health Survey dataset, which includes information on women’s socioeconomic status and their current choice of contraceptives: whether they used any method, and if so, what method they used. Using a bivariate probit model with selection to control for any possible selection bias, the results suggest that whether a woman uses any birth control method, and whether the woman chooses modern methods over traditional methods, are primarily explained by education level and urban/rural residence, and that the determinants of contraceptive use vary across college-educated and non-college-educated women. The results also indicate that non-employed women are less likely to use any birth control method compared with women with regular, full-time jobs. However the effect was statistically insignificant.
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Baram I, Aharon A, Klein R, Shkolnik K. Real-world experience with the IUB Ballerine MIDI copper IUD: an observational, single-centre study in Israel. EUR J CONTRACEP REPR 2019; 25:49-53. [PMID: 31852282 DOI: 10.1080/13625187.2019.1699048] [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: 10/25/2022]
Abstract
Objective: The aim of the study was to assess the acceptability of the intrauterine ball IUB Ballerine MIDI copper intrauterine device (IUD), using real-world data collected from users and physicians in Israel.Methods: In this retrospective, observational study, conducted in a single clinic in Israel, healthy women (n = 175) who had had the device inserted ≥12 months prior to enrolment, and their physician, completed questionnaires relating to device insertion, user experience and performance.Results: The mean age at insertion was 32.8 ± 6.7 years; most women were married (80.6%) and multigravid (89.1%). At the time of the study, 131 (74.9%) women were still using the device; in 13 cases (7.4%), premature removal was due to desire to conceive. The 12 month continuation rate, excluding the women seeking to conceive, was 90.1%. The expulsion rate was 3.4% (n = 6) and the pregnancy rate was 0.57% (n = 1). Most of the women still using the device reported no to moderate pain or cramps (90.0%) and moderate to high (72.6%) satisfaction with the device; 76.3% said they would recommend it to friends and relatives. Most of the insertion procedures (86.9%) were uneventful and none required cervical dilation.Conclusion: The IUB Ballerine MIDI raised no major safety concerns and was both effective and highly accepted in a cohort of women, covering a broad age range, treated in a gynaecology clinic in Israel.
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Affiliation(s)
- Ilan Baram
- Maccabi Healthcare Services, Modiin, Israel.,OCON Healthcare, Clinical Development, Modiin, Israel
| | - Arnon Aharon
- OCON Healthcare, Clinical Development, Modiin, Israel
| | - Rinat Klein
- OCON Healthcare, Clinical Development, Modiin, Israel
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Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol 2019; 66:28-40. [PMID: 32014434 DOI: 10.1016/j.bpobgyn.2019.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023]
Abstract
Unplanned pregnancy (UP) is a public health problem, which affects millions of women worldwide. Providing long-acting reversible contraceptive (LARC) methods is an excellent strategy to avoid or at least reduce UP, because the effectiveness of these methods is higher than other methods, and is indeed comparable to that of permanent contraception. As the initial introduction of the inert plastic intrauterine device (IUD) and of the six-rod implant, pharmaceutical companies have introduced a copper IUD (Cu-IUD), different models of levonorgestrel-releasing intrauterine system (LNG IUS), and one and two-rod implants, which certainly improved women's LARC options. The main characteristic of LARCs is that they provide high contraceptive effectiveness with a single intervention, and that they can be used for a long time. Emerging evidence from the last few years has demonstrated that it is possible to extend the use of the 52 mg LNG IUS and of the etonogestrel-implant beyond five- and three years, respectively, which adds new value to these LARCs.
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Zgliczynska M, Szymusik I, Sierocinska A, Bajaka A, Rowniak M, Sochacki-Wojcicka N, Wielgos M, Kosinska-Kaczynska K. Contraceptive Behaviors in Polish Women Aged 18-35-a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2723. [PMID: 31366184 PMCID: PMC6695758 DOI: 10.3390/ijerph16152723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
The aim was to evaluate contraceptive behaviors, and factors affecting them, in the population of Polish-speaking women. A cross-sectional study was performed on 6763 women, current contraceptive users, aged 18 to 35. An anonymous and voluntary questionnaire written in Polish, containing 33 questions, was distributed online from January to February 2017. The Internet and doctors were the most popular sources of information about contraception (82% and 73%, respectively). Upon choosing contraception, women paid the most attention to its efficacy (85%) and its impact on health (59%). The most common methods were combined oral contraceptives (38%) and condoms (24%). In total, 51% had chosen hormonal contraception, of which 68% experienced side effects. The most frequent were decreased libido (39%) and weight gain (22%). Factors associated with the usage of hormonal or non-hormonal contraception were: education, relationship status, parenthood, number of sexual partners, frequency of intercourses, sources of information about contraception, and factors considered most important when choosing a contraceptive method. The choice between short-acting and long-acting reversible contraception was influenced by age, relationship status, parenthood, smoking, sources of information about contraception, and factors considered most important when choosing a contraceptive method. Wide access to contraception, high-quality education, and counselling should become priorities in family planning healthcare.
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Affiliation(s)
- Magdalena Zgliczynska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Iwona Szymusik
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland.
| | - Aleksandra Sierocinska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Armand Bajaka
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Martyna Rowniak
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Nicole Sochacki-Wojcicka
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Miroslaw Wielgos
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Katarzyna Kosinska-Kaczynska
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
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Yaron M, Viviano M, Guillot C, Aharon A, Shkolnik K. Real-world experience with the IUB Ballerine MIDI copper IUD: an observational study in the French-speaking region of Switzerland. EUR J CONTRACEP REPR 2019; 24:288-293. [PMID: 31169412 DOI: 10.1080/13625187.2019.1618447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The aim of the study was to assess the acceptability of the intrauterine ball IUB Ballerine MIDI copper intrauterine device (IUD), using real-world data collected from users and physicians. Methods: In this retrospective, observational study, conducted in the French-speaking region of Switzerland, healthy women (n= 207) who had had an IUB Ballerine MIDI inserted ≥12 months before enrolment, and their physicians completed questionnaires relating to device insertion, user experience and outcome. Questions relating to current menstrual patterns, physical comfort and product satisfaction were only posed to women still using the device. Results: The mean age at insertion was 30.8 ± 7.2 years, with an average 14.2 ± 2.9 month lapse from time of insertion until study commencement. At the time of the study, 140 (67.6%) women were still using the device. The expulsion rate was 5.3% (n= 11) and the pregnancy rate was 1.4% (n= 3). Most of the women still using the device reported no to moderate pain or cramps (80.7%). The majority of women reported moderate to high (65.7%) satisfaction with the device, with 81.4% claiming they would recommend it to friends and relatives. Over 84.8% of physicians reported that the device was easy to insert, with no difficulties encountered during the procedure. Conclusions: The IUB Ballerine MIDI was demonstrated to be safe and acceptable in different clinical settings and risk groups among a socioeconomically and demographically diverse study population.
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Affiliation(s)
- Michal Yaron
- a Department of Women-Children-Teenagers , Geneva University Hospitals , Geneva , Switzerland
| | - Manuela Viviano
- a Department of Women-Children-Teenagers , Geneva University Hospitals , Geneva , Switzerland
| | - Cecile Guillot
- a Department of Women-Children-Teenagers , Geneva University Hospitals , Geneva , Switzerland
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Ihalainen JK, Hackney AC, Taipale RS. Changes in inflammation markers after a 10-week high-intensity combined strength and endurance training block in women: The effect of hormonal contraceptive use. J Sci Med Sport 2019; 22:1044-1048. [PMID: 31186194 DOI: 10.1016/j.jsams.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The influence of hormonal contraceptives (HC) on inflammation and body composition after high-intensity combined strength and endurance training was investigated. DESIGN Active healthy women formed two training groups: HC users (HCU, n = 9) and those who had never used HC (NHC, n = 9). Training included two strength training sessions and two high-intensity interval training sessions per week for 10 weeks. METHODS Before (PRE) and after (POST) the training intervention, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1beta (IL-1β) concentrations were measured. Dual-energy X-ray absorptiometry was used to estimate fat mass (FM), abdominal fat mass (aFM), and lean mass (LM). RESULTS Circulating concentrations of hs-CRP decreased significantly in the NHC from pre to post with -0.46 mg l-1 (95% CI: -0.78, -0.14, p = 0.009, ES = 0.434), whereas a significant increase was observed in HCU from pre to post with 0.89 mg l-1 (95% CI: 1.66, 0.12, p = 0.048, ES = 1.988) with a significant between-group difference (p = 0.015). In addition, hs-CRP concentration was significantly higher in HCU than in NHC after training (p = 0.036) at post. Lean mass increased significantly more in NHC than in HCU (p = 0.049). CONCLUSIONS High-intensity combined strength and endurance training can modify inflammation and body composition of women. The present study showed that inflammation, in terms of hs-CRP was higher post training in HCU than NHC, which may be associated with smaller gains in lean mass in response to training.
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Affiliation(s)
- J K Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Sweden.
| | - A C Hackney
- University of North Carolina at Chapel Hill, USA
| | - R S Taipale
- Kajaani University of Applied Sciences, Finland
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Buckner LR, Drobnis EZ, Augustine MS, Rogers LK, Akers J, Mott PD, Hope TJ, Quayle AJ, Schust DJ. Cervical and systemic concentrations of long acting hormonal contraceptive (LARC) progestins depend on delivery method: Implications for the study of HIV transmission. PLoS One 2019; 14:e0214152. [PMID: 31095572 PMCID: PMC6522049 DOI: 10.1371/journal.pone.0214152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/07/2019] [Indexed: 11/28/2022] Open
Abstract
Progestin-only long-acting reversible contraceptives (LARCs) are increasingly popular among women seeking contraception; however, recent epidemiological studies suggest that systemically administered medroxyprogesterone acetate (MPA) may increase HIV acquisition. In order to determine the exact mechanisms underlying increases in transmission specific to MPA use and to test safer, alternative contraceptive progestin types and delivery methods, in vitro modeling studies must be performed. To achieve this, it is imperative that accurate hormone concentrations be utilized when modeling progestin-mediated outcomes, as the down-stream effects are dose-dependent. The local concentrations of progestins to which the lower female genital tract tissues are exposed after initiation of LARCs are unknown, but they likely differ from peripheral concentrations, dependent upon the progestin type and delivery method. Here, we measured in vivo endocervical and plasma concentrations of (1) systemically-delivered depo MPA (DMPA), (2) levonorgestrel (LNG) delivered via intrauterine system (IUS) and (3) etonogestrel (ETG) delivered via vaginal ring in women who recently initiated contraception treatment. Levels of ETG and LNG in cervical secretions were 100-200 fold higher than plasma levels. In contrast, measurable MPA levels were approximately 10-fold higher in plasma compared to cervical secretions. These results will inform the design of accurate in vitro studies on the influence of progestins on epithelial cells, tissue explants, and peripheral blood cells, to be able to better predict in vivo outcomes. Subsequent observations will aid in determining how MPA might influence HIV acquisition and may facilitate identification of optimal progestin-containing LARC alternatives for women at high risk for HIV infection.
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Affiliation(s)
- Lyndsey R. Buckner
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Erma Z. Drobnis
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, MO, United States of America
| | - Molly S. Augustine
- The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, United States of America
| | - Lynette K. Rogers
- The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, United States of America
| | - Jill Akers
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, MO, United States of America
| | - Patricia D. Mott
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Thomas J. Hope
- Cell and Molecular Biology, Northwestern University, Chicago, IL, United States of America
| | - Alison J. Quayle
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Danny J. Schust
- Department of Obstetrics, Gynecology, and Women's Health, University of Missouri, Columbia, MO, United States of America
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Safety of levonorgestrel 52 mg intrauterine system compared to copper intrauterine device: a population-based cohort study. Contraception 2019; 99:345-349. [PMID: 30871933 DOI: 10.1016/j.contraception.2019.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the risk of all-cause death, hospitalizations (any cause), ectopic pregnancy, pelvic inflammatory disease or infection, uterine perforation, device removal, neuro-psychiatric drugs initiation, or new psychiatric visit(s) between levonorgestrel (LNG) 52 mg intrauterine system (IUS) and copper intrauterine device (IUD) users in France. STUDY DESIGN We identified a historical cohort of women aged 20-55 years with a first dispensing of either LNG 52 mg IUS or copper-IUD between January 1, 2010, and December 31, 2014, in the French National Claims database, SNDS. We used propensity score matching to balance the two groups on baseline sociodemographic and clinical characteristics to minimize confounding. We estimated Cox proportional hazards models to compare health outcomes between LNG 52 mg IUS and copper-IUDs users. RESULTS We matched 9318 LNG 52 mg IUS users (mean age 36.2±6.8 years) to 10,185 copper-IUD users (mean age 35.4±7.1 years). After matching and age-adjustment, LNG 52 mg IUS users had a slightly higher risk of anxiolytic drugs initiation (HR 1.08, 95%CI 1.01-1.15) and device removal (HR 1.05, 95%CI 1.01-1.10) compared to copper-IUD users, with no differences for other studied outcomes. CONCLUSION French IUS users report slightly more anxiolytic treatment initiation and IUD removal compared to copper-IUD users. These results are consistent with a potential pharmacovigilance signal of anxiety-related disorders in LNG 52 mg IUS users. IMPLICATIONS STATEMENT In French LNG 52 mg IUS users, there was slightly more anxiolytic treatment initiation and IUD removal compared to copper-IUD users. No risk difference was found for all-cause death, hospitalizations, ectopic pregnancy, pelvic disorders, and uterine perforation. We cannot exclude that the associations are related to differences in characteristics of women who chose each type of type of IUD.
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Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery. Am J Obstet Gynecol 2019; 220:106.e1-106.e10. [PMID: 30170036 DOI: 10.1016/j.ajog.2018.08.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Removal of the fallopian tubes at the time of hysterectomy or interval sterilization has become routine practice to prevent ovarian cancer. While emerging as a strategy, uptake of this procedure at the time of cesarean delivery for pregnant women seeking permanent sterilization has not been widely adopted due to perceptions of increased morbidity and operative difficulty with a lack of available data in this setting. OBJECTIVE We sought to conduct a cost-effectiveness analysis comparing strategies for long-term sterilization and ovarian cancer risk reduction at the time of cesarean delivery, including bilateral tubal ligation, opportunistic salpingectomy, and long-acting reversible contraception. STUDY DESIGN A decision-analytic and cost-effectiveness model was constructed for pregnant women undergoing cesarean delivery who desired permanent sterilization in the US population, comparing 3 strategies: (1) bilateral tubal ligation, (2) bilateral opportunistic salpingectomy, and (3) postpartum long-acting reversible contraception. This theoretic cohort consisted of 110,000 pregnant women desiring permanent sterilization at the time of cesarean delivery and ovarian cancer prevention at an average of 35 years who were monitored for an additional 40 years based on an average US female life expectancy of 75 years. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured as quality-adjusted life years. Secondary outcomes included: the number of ovarian cancer cases and deaths, procedure-related complications, and unintended and ectopic pregnancies. The 1-, 2-, and 3-way and Monte Carlo probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set at $100,000. RESULTS Both bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery have favorable cost-effectiveness ratios. In the base case analysis, salpingectomy was more cost-effective with an incremental cost-effectiveness ratio of $23,189 per quality-adjusted life year compared to tubal ligation. Long-acting reversible contraception after cesarean was not cost-effective (ie, dominated). Although salpingectomy and tubal ligation were both cost-effective over a wide range of cost and risk estimates, the incremental cost-effectiveness ratio analysis was highly sensitive to the uncertainty around the estimates of salpingectomy cancer risk reduction, risk of perioperative complications, and cost. Monte Carlo probabilistic sensitivity analysis estimated that tubal ligation had a 49% chance of being the preferred strategy over salpingectomy. If the true salpingectomy risk of perioperative complications is >2% higher than tubal ligation or if the cancer risk reduction of salpingectomy is <52%, then tubal ligation is the preferred, more cost-effective strategy. CONCLUSION Bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery are both cost-effective strategies for permanent sterilization and ovarian cancer risk reduction. Although salpingectomy and tubal ligation are both reasonable strategies for cesarean patients seeking permanent sterilization and cancer risk reduction, threshold analyses indicate that the risks and benefits of salpingectomy with cesarean delivery need to be better defined before a preferred strategy can be determined.
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Makins A, Arulkumaran S. Institutionalization of postpartum intrauterine devices. Int J Gynaecol Obstet 2018; 143 Suppl 1:1-3. [PMID: 30225872 DOI: 10.1002/ijgo.12597] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anita Makins
- International Federation of Gynecology and Obstetrics, London, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sabaratnam Arulkumaran
- International Federation of Gynecology and Obstetrics, London, UK.,St George's, University of London, London, UK
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Steel A, Wardle J, Frawley J, Adams J, Sibbritt D, Lauche R. Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey. Complement Ther Clin Pract 2018; 33:100-106. [PMID: 30396606 DOI: 10.1016/j.ctcp.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method. MATERIALS AND METHODS A secondary analysis of a cross-sectional survey of Australian Women aged 34-39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression. RESULTS Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception. CONCLUSION There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.
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Affiliation(s)
- A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Office of Research, Endeavour College of Natural Health, Level 2, 269 Wickham Street, Fortitude Valley, QLD, 4006, Australia.
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Frawley
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - D Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - R Lauche
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
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Mome RK, Wiyeh AB, Kongnyuy EJ, Wiysonge CS. Effectiveness of female condom in preventing HIV and sexually transmitted infections: a systematic review protocol. BMJ Open 2018; 8:e023055. [PMID: 30082362 PMCID: PMC6078242 DOI: 10.1136/bmjopen-2018-023055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/29/2018] [Accepted: 06/29/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The HIV pandemic continues to evolve with young women being the most vulnerable group to acquire infection. The presence of sexually transmitted infections (STIs) further enhances HIV susceptibility and also leads to long-term complications such as infertility and cervical cancer. The female condom is a self-initiated method for STI and HIV prevention but there are controversies on its effects. We aim to assess the effectiveness, safety and acceptability of the use of female condoms for prevention of STI and HIV acquisition among women. METHODS AND ANALYSIS We will search Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Scopus, WHO International Clinical Trials Registry and reference lists of relevant publications for potentially eligible studies. We will screen search outputs, select eligible studies, extract data and assess risk of bias in duplicate; resolving discrepancies through discussion and consensus or arbitration. We will combine data from clinically homogenous studies in a fixed effect meta-analysis and assess the certainty of the evidence using the method for Grading of Recommendations Assessment, Development and Evaluation. We registered the planned systematic review with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2018 and will finalise the search strategy in August 2018; conduct the searches and select eligible studies between August and October 2018; and collect data, conduct statistical analyses and prepare and submit the manuscript for consideration by a peer-reviewed journal between November 2018 and April 2019. ETHICS AND DISSEMINATION We will use publicly available data; hence no formal ethical approval is required for this review. We will disseminate the findings of this review through conference presentations and publication in an open-access peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018090710.
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Affiliation(s)
- Ruth Kb Mome
- Department of Internal Medicine, Ottumwa Regional Health Center, Ottumwa, Iowa, USA
| | - Alison B Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Eugene J Kongnyuy
- School of Global Health and Bioethics, Euclid University, Banjul, Gambia
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Kavanagh ON, Albadarin AB, Croker DM, Healy AM, Walker GM. Maximising success in multidrug formulation development: A review. J Control Release 2018; 283:1-19. [DOI: 10.1016/j.jconrel.2018.05.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 12/20/2022]
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Perkins MS, Louw-du Toit R, Africander D. A comparative characterization of estrogens used in hormone therapy via estrogen receptor (ER)-α and -β. J Steroid Biochem Mol Biol 2017; 174:27-39. [PMID: 28743541 DOI: 10.1016/j.jsbmb.2017.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/10/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023]
Abstract
Conventional hormone therapy (HT) containing estrogens such as ethinylestradiol (EE) have been associated with an increased risk of breast cancer and cardiovascular disease resulting in women seeking safer alternatives that are claimed to have fewer health risks. One such alternative gaining popularity, is custom-compounded bioidentical (b)HT formulations containing bioidentical estradiol (bE2) and estriol (bE3). However, the preparation of these custom-compounded estrogens is not regulated, and depending on the route of synthesis, steroid mixtures with differing activities may be produced. Thus, an investigation into the activities of estrogens prepared by custom-compounded pharmacies is warranted. The aim of this study was therefore to directly compare the pharmacological properties of bE2 and bE3 of unknown purity relative to commercially available, pure E2, E3 and estrone (E1) standards as well as synthetic EE used in conventional HT via the human estrogen receptor (ER)-α and -β. We determined precise equilibrium dissociation constants (Kd or Ki values) and showed that bE2 and bE3 display similar binding affinities to the E2 and E3 standards, while EE had a higher affinity for ERα, and E1 a lower affinity for ERβ. Furthermore, all the estrogens display similar agonist efficacies, but not potencies, for transactivation on a minimal ERE-containing promoter via the individual ER subtypes. Although E2 and E3 were equally efficacious and potent on the endogenous ERE-containing pS2 promoter in the MCF-7 BUS breast cancer cell line co-expressing ERα and ERβ, E1 was less efficacious and potent than E2. This study is the first to demonstrate that the bioidentical estrogens, commercially available estrogen standards and synthetic EE are full agonists for transrepression on both minimal and endogenous NFκB-containing promoters. Moreover, we showed that these estrogens all increase proliferation and anchorage-independent growth of MCF-7 BUS cells to a similar extent, suggesting that custom-compounded bHT may in fact not be a safer alternative to conventional HT. Furthermore, our results showing that E3 and E1 are not weak estrogens, and that E3 does not antagonize the activity of E2, suggest that the rationale behind the use of E3 and E1 in custom-compounded bHT formulations should be readdressed. Taken together, the results indicating that there is mostly no difference between the custom-compounded bioidentical estrogens, commercially available estrogen standards and synthetic EE, at concentrations reflecting serum levels in women using estrogen-containing HT, suggest that there is no clear advantage in choosing bHT above conventional HT.
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Affiliation(s)
- Meghan S Perkins
- Department of Biochemistry, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa.
| | - Renate Louw-du Toit
- Department of Biochemistry, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa.
| | - Donita Africander
- Department of Biochemistry, Stellenbosch University, Private Bag X1, Matieland 7602, South Africa.
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López-Picado A, Lapuente O, Lete I. Efficacy and side-effects profile of the ethinylestradiol and etonogestrel contraceptive vaginal ring: a systematic review and meta-analysis. EUR J CONTRACEP REPR 2017; 22:131-146. [PMID: 28256919 DOI: 10.1080/13625187.2017.1287351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the efficacy and tolerability (side-effects profile), and compliance of the combined contraceptive vaginal ring (CCVR) compared with combined oral hormonal contraceptives (COC). DATA SOURCES The PubMed, Embase, POPLINE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, ClinicalTrials.gov, Clinical Trials Registry Platform (ICTRP) and CINAHL databases were searched. METHODS OF STUDY SELECTION Electronic databases were searched for randomised clinical trials comparing the CCVR with COC with a duration of at least 3 months between 01 December and 15 December 2015. The primary outcome was efficacy. The secondary outcomes were compliance, absence of withdrawal bleeding, breakthrough bleeding, nausea and headache. Heterogeneity was assessed using I2 statistic and Cochran's Q statistic. Results were expressed as odds ratios (OR) with 95% confidence intervals (CIs) using random-effects models or fixed-effects models depending on the heterogeneity. RESULTS 4368 records were identified, 2844 of which were removed after duplicates and 1524 records were screened. Of these, 1503 were excluded and 21 full text articles were assessed for eligibility. After removing another 7 articles, 14 records were finally included in the qualitative and quantitative analysis. The results show a trend to higher efficacy for the CCVR in preventing pregnancy (Peto OR: 0.52 [95% CI: 0.26-1.04]) and a significantly lower presence of nausea (Peto OR: 0.66 [95% CI: 0.46-0.93]). More cycles were compliant in the CCVR group (Peto OR: 1.22 [95% CI: 1.12-1.32]) and fewer women reported breakthrough bleeding (Peto OR: 0.68 [95% CI: 0.51-0.91]). CONCLUSIONS Our findings demonstrate that the CCVR is as effective and tolerable as the COC but with a better bleeding profile.
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Affiliation(s)
- Amanda López-Picado
- a Araba Research Unit , Araba University Hospital , Vitoria , Spain.,b Bioaraba Research Institute , Vitoria , Spain
| | - Oihane Lapuente
- b Bioaraba Research Institute , Vitoria , Spain.,c Obstetrics and Gynecology Clinical Management Unit , Araba University Hospital , Vitoria , Spain
| | - Iñaki Lete
- b Bioaraba Research Institute , Vitoria , Spain.,c Obstetrics and Gynecology Clinical Management Unit , Araba University Hospital , Vitoria , Spain.,d School of Medicine, University of the Basque Country , Vitoria , Spain
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McConville C, Major I, Devlin B, Brimer A. Development of a multi-layered vaginal tablet containing dapivirine, levonorgestrel and acyclovir for use as a multipurpose prevention technology. Eur J Pharm Biopharm 2016; 104:171-9. [PMID: 27163243 DOI: 10.1016/j.ejpb.2016.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 12/18/2022]
Abstract
Multipurpose prevention technologies (MPTs) are preferably single dosage forms designed to simultaneously address multiple sexual and reproductive health needs, such as unintended pregnancy, HIV infection and other sexually transmitted infections (STIs). This manuscript describes the development of a range of multi-layered vaginal tablets, with both immediate and sustained release layers capable of delivering the antiretroviral drug dapivirine, the contraceptive hormone levonorgestrel, and the anti-herpes simplex virus drug acyclovir at independent release rates from a single dosage form. Depending on the design of the tablet in relation to the type (immediate or sustained release) or number of layers, the dose of each drug could be individually controlled. For example one tablet design was able to provide immediate release of all three drugs, while another tablet design was able to provide immediate release of both acyclovir and levonorgestrel, while providing sustained release of Dapivirine for up to 8h. A third tablet design was able to provide immediate release of both acyclovir and levonorgestrel, a large initial burst of Dapivirine, followed by sustained release of Dapivirine for up to 8h. All of the tablets passed the test for friability with a percent friability of less than 1%. The hardness of all tablet designs was between 115 and 153N, while their drug content met the European Pharmacopeia 2.9.40 Uniformity of Dosage units acceptance value at levels 1 and 2. Finally, the accelerated stability of all three actives was significantly enhanced in comparison with a mixed drug control.
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Affiliation(s)
- Christopher McConville
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Ian Major
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Brid Devlin
- International Partnership for Microbicide, Silver Spring, MD, USA
| | - Andrew Brimer
- International Partnership for Microbicide, Silver Spring, MD, USA
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Triple combination MPT vaginal microbicide using curcumin and efavirenz loaded lactoferrin nanoparticles. Sci Rep 2016; 6:25479. [PMID: 27151598 PMCID: PMC4858693 DOI: 10.1038/srep25479] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/19/2016] [Indexed: 11/09/2022] Open
Abstract
We report that a combination of anti-HIV-1 drug efavirenz (EFV), anti-microbial-spermicidal curcumin (Cur) and lactoferrin nanoparticles (ECNPs) act as MPT formulation. These nanoparticles are of well dispersed spherical shape with 40–70 nm size, with encapsulation efficiency of 63 ± 1.9% of Cur & 61.5% ± 1.6 of EFV, significantly higher than that of single drug nanoparticles (Cur, 59 ± 1.34%; EFV: 58.4 ± 1.79). ECNPs were found to be sensitive at pH 5 and 6 and have not effected viability of vaginal micro-flora, Lactobacillus. Studies in rats showed that ECNPs delivers 88–124% more drugs in vaginal lavage as compared to its soluble form, either as single or combination of EFV and Cur. The ECNPs also shows 1.39–4.73 fold lower concentration of absorption in vaginal tissue and plasma compared to soluble EFV + Cur. Furthermore, ECNPs show significant reduction in inflammatory responses by 1.6–3.0 fold in terms of IL-6 and TNF-α in vaginal tissue and plasma compared to soluble EFV + Cur. ECNPs showed improved pharmacokinetics profiles in vaginal lavage with more than 50% of enhancement in AUC, AUMC, Cmax and t1/2 suggesting longer exposure of Cur and EFV in vaginal lavage compared to soluble EFV + Cur. Histopathological analysis of vaginal tissue shows remarkably lower toxicity of ECNPs compared to soluble EFV + Cur. In conclusion, ECNPs are significantly safe and exhibit higher bioavailability thus constitute an effective MPT against HIV.
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Friend DR. An update on multipurpose prevention technologies for the prevention of HIV transmission and pregnancy. Expert Opin Drug Deliv 2016; 13:533-45. [PMID: 26742698 DOI: 10.1517/17425247.2016.1134485] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Multipurpose Prevention Technologies (MPTs) are designed to address two or more indications from a single product. The overall goal is to prevent unintended pregnancy and transmission of one or more STIs including HIV-1. AREAS COVERED The topics covered herein are advances in over the past three years. Advances include development of novel intravaginal rings capable of releasing microbicides to prevent transmission of HIV-1 and unintended pregnancy. These rings include the potential to prevent transmission of more than one STI and unintended pregnancy. There are also gels that can potentially accomplish the same thing. Finally, combination of a drug and barrier device are also covered. EXPERT OPINION There has been considerable advance in this field over the past three years. There is one ring currently in a Phase I clinical trial and others are soon to follow. Some of these drug delivery systems are by necessity rather complicated and hence could be prohibitively expensive in the developing world. Conducting multiple clinical trials to support regulatory approval of two or more indications represents a significant barrier. It remains unclear that women will be more motivated to use MPT products than has been observed in recent microbicide-only clinical trials. Despite these challenges, the need for MPTs remain acute hopefully ensuring they will continue to be developed over the coming years.
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Miller D. Guest Editorial: Equity in sexual and reproductive health – an ongoing challenge. J Prim Health Care 2016; 8:3-4. [DOI: 10.1071/hcv8n1_ed2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Can an electronic health record system be used for preconception health optimization? Matern Child Health J 2015; 18:2134-40. [PMID: 24627232 DOI: 10.1007/s10995-014-1461-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To explore the potential of an integrated outpatient electronic health record (EHR) for preconception health optimization. An automated case-finding EHR-derived algorithm was designed to identify women of child-bearing age having outpatient encounters in an 85-site, integrated health system. The algorithm simultaneously cross-referenced multiple discrete data fields to identify selected preconception factors (obesity, hypertension, diabetes, teratogen use including ACE inhibitors, multivitamin supplementation, anemia, renal insufficiency, untreated sexually transmitted infection, HIV positivity, and tobacco, alcohol or illegal drug use). Surveys were mailed to a random sample of patients to obtain their self-reported health profiles for these same factors. Concordance was assessed between the algorithm output, survey results, and manual data abstraction. Between 8/2010-2/2012, 107,339 female outpatient visits were identified, from which 29,691 unique women were presumed to have child-bearing potential. 19,624 (66 %) and 8,652 (29 %) had 1 or ≥2 health factors, respectively while only 1,415 (5 %) had none. Using the patient survey results as a reference point, health-factor agreement was similar comparing the algorithm (85.8 %) and the chart abstraction (87.2 %) results. Incorrect or missing data entries in the EHR encounters were largely responsible for discordances observed. Preconception screening using an automated algorithm in a system-wide EHR identified a large group of women with potentially modifiable preconception health conditions. The issue most responsible for limiting algorithm performance was incomplete point of care documentation. Accurate data capture during patient encounters should be a focus for quality improvement, so that novel applications of system-wide data mining can be reliably implemented.
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Gambera A, Corda F, Papa R, Bastianelli C, Bucciantini S, Dessole S, Scagliola P, Bernardini N, de Feo D, Beligotti F. Observational, prospective, multicentre study to evaluate the effects of counselling on the choice of combined hormonal contraceptives in Italy--the ECOS (Educational COunselling effectS) study. BMC WOMENS HEALTH 2015; 15:69. [PMID: 26329464 PMCID: PMC4557636 DOI: 10.1186/s12905-015-0226-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 08/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adequate counselling on contraceptive methods can help users choose the most appropriate method. The aim of this study was to assess the effects of structured counselling provided by gynaecologists on selection of a combined hormonal contraception method. METHODS Women aged 18-40 years (n = 1871) who were considering the use of a combined hormonal contraception method (pill, transdermal patch or vaginal ring) underwent a structured counselling session in which gynaecologists provided comprehensive information. Pre- and post-counselling questionnaires on combined hormonal contraception choice were completed by participants. RESULTS After counselling, many women (38 %) selected a combined hormonal contraception method that was different from the originally intended one. Preferences for the transdermal patch approximately doubled (from 3.2 % pre-counselling to 7 %; p < 0.0001) and those for the vaginal ring increased four-fold (from 5.2 to 21.2 %; p < 0.0001), while preference for the pill remained unchanged (from 64.5 % [pre-] to 64.1 % [post-counselling]). The proportion of undecided women decreased from 18 to 2.1 % (p < 0.0001). The main reasons for choosing a method were related to ease of use (all methods), and preferences for administration frequency (daily, weekly or monthly). The number of patients requiring post-counselling contact with the physician's office was low (5.1-6.9 %), as was the incidence of adverse events (1.8-3.1 %). CONCLUSIONS Counselling has a significant impact on women's choice of combined hormonal contraception and encourages them to consider alternative methods to combined oral contraceptives. Moreover, it also enables women to use their chosen method with confidence. TRIAL REGISTRATION NCT01181778 , Trial registration date: August 12, 2010.
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Affiliation(s)
| | - Fedela Corda
- Centro Donna c/o Ospedale Binaghi, Cagliari, Italy.
| | - Rosetta Papa
- UOC Tutela Salute Donna- ASL Napoli 1 CENTRO, Naples, Italy.
| | - Carlo Bastianelli
- Policlinico Umberto I, Dipartimento di Ginecologia e Ostetricia, Rome, Italy.
| | - Sandra Bucciantini
- Azienda Universitaria Careggi, Divisione Clinica Ostetrica, Florence, Italy.
| | - Salvatore Dessole
- A.O.U. di Sassari Macrostruttura Materno Infantile Clinica Ostetrico Ginecologica, Sassari, Italy.
| | | | - Nadia Bernardini
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
| | - Daniela de Feo
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
| | - Fabiola Beligotti
- MSD Italia S.r.L., a subsidiary of Merck & Co., Inc., Whitehouse Station, NJ, USA.
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Part K, Ringmets I, Laanpere M, Rahu M, Karro H. Contraceptive use among young women in Estonia: Association with contraceptive services. EUR J CONTRACEP REPR 2015; 21:132-40. [PMID: 26098563 DOI: 10.3109/13625187.2015.1057699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Our study aimed to explore the association between the use of effective contraceptive methods and access to different contraceptive services, as well as to describe accessibility-related obstacles when using contraceptive services and satisfaction with those services. METHODS From a population-based cross-sectional study carried out in 2004 (response rate 53.8%), the data of 16- to 24-year-old women requiring contraception (N = 868) were analysed. Factors associated with the use of effective contraceptive methods and, specifically, hormonal methods, were explored using multiple logistic regression analysis. RESULTS Effective contraception was used by 75.1% of the respondents. The use of effective contraceptive methods was associated with school-based sexuality education (adjusted prevalence odds ratio 2.69; 95% confidence interval 1.32 - 5.50), visiting a youth-friendly clinic (YFC) (1.82; 1.03-3.23) or a private gynaecologist (2.08; 1.11-3.92). The use of hormonal methods was additionally associated with being a native Estonian speaker and visiting a family doctor. More than half of the respondents reported some obstacle in accessing contraceptive services. The highest satisfaction ratings were given to YFCs. CONCLUSIONS Steps to promote the use of services that are youth-friendly and associated with better uptake of effective contraceptive methods are needed among all 16- to 24-year-old women.
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Affiliation(s)
- Kai Part
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia.,c Tartu Sexual Health Clinic , Tartu , Estonia
| | - Inge Ringmets
- d Department of Public Health , University of Tartu , Tartu , Estonia
| | - Made Laanpere
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia.,c Tartu Sexual Health Clinic , Tartu , Estonia
| | - Mati Rahu
- e Department of Epidemiology and Biostatistics , National Institute for Health Development , Tallinn , Estonia
| | - Helle Karro
- a * Department of Obstetrics and Gynaecology , University of Tartu , Tartu , Estonia.,b Tartu University Hospital Women's Clinic , Tartu , Estonia
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Kakaire O, Byamugisha JK, Tumwesigye NM, Gemzell-Danielsson K. Clinical versus laboratory screening for sexually transmitted infections prior to insertion of intrauterine contraception among women living with HIV/AIDS: a randomized controlled trial. Hum Reprod 2015; 30:1573-9. [PMID: 25979373 DOI: 10.1093/humrep/dev109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does laboratory testing after syndromic screening for sexually transmitted infections (STIs) reduce the rate of intrauterine contraception (IUC) removal among women living with HIV/AIDS (WLHA)? SUMMARY ANSWER Additional laboratory testing after syndromic screening for STIs did not affect the likelihood that a woman would remove an IUC immediately or within 1 year of IUC use or the frequency of post-insertion unscheduled clinic visits. In low-risk WLHA, the incidence rate of IUC removal is low with or without laboratory testing. WHAT IS KNOWN ALREADY Fear of infectious morbidity remains an obstacle to uptake of IUC by WLHA. The value of laboratory testing after syndromic screening for STI before the insertion of IUC remains uncertain. STUDY DESIGN, SIZE, DURATION We enrolled WLHA from 2 September to 6 December 2013 and followed them up to 31 December 2014. After syndromic screening, 703 women free of STIs were randomized to either additional laboratory screening or no additional screening for STI before IUC insertion. The randomization sequence was generated by an independent statistician and randomization numbers placed in opaque sequentially numbered sealed envelopes. All women randomized had an IUC inserted and in all 672 participants completed the 1-year follow-up. The study staff who followed up the participants were blinded to the study allocation groups. Incidence rate ratios (IRRs) were used to compare the incidence rates of IUC removal, unscheduled clinic attendance and IUC continuation between the two groups. PARTICIPANTS/MATERIALS, SETTING, METHODS Women eligible to participate were 18-49 years old at study entry, in a relationship with a male partner, wanted to avoid pregnancy for at least 1 year and were undergoing HIV/AIDS care at Mulago Hospital, Uganda. Participants completed a baseline questionnaire and up to four follow-up questionnaires until discontinuation of IUC, loss to follow-up or end of study observation after 12 months. MAIN RESULTS AND THE ROLE OF CHANCE The rate of IUC removal was 8.8% (29/331) in the no additional screening group and 8.0% (27/341) in the additional laboratory screening group [IRR 1.1 (95% CI 0.63-1.93)]. Unscheduled clinic attendances were similar in the two groups at 1 year of IUC insertion: 13.6% (45/331) in the no additional screening group and 12.3% (42/241) in the additional laboratory screening group. During the 1-year follow-up, only five women, three from the no additional screening group and two from the additional laboratory screening group, developed pelvic inflammatory disease (PID), as defined by established diagnostic criteria. LIMITATIONS, REASONS FOR CAUTION We were not able to carry out STI risk assessment directly from the men thus women with high-risk partners could have been included in the study and this may be responsible for the lack of a demonstrable effect of additional laboratory screening on incidence rates of IUC removals and unscheduled clinic attendance. The diagnosis of PID was based on clinical signs and symptoms; therefore, subclinical PID could have been missed. WIDER IMPLICATIONS OF THE FINDINGS Among WLHA, the incidence rate of IUC removal is low and IUC continuation high. Syndromic screening for STIs could be sufficient in indentifying WLHA who are suitable for IUC use. However, our findings are only generalizable to women in HIV/AIDS care who have access to good follow-up. STUDY FUNDING/COMPETING INTERESTS The study was supported by Medical Education for Equitable Services to all Ugandans, a Medical Education Partnership Initiative grant number 5R24TW008886 from the office of Global AIDS Coordinator and the US Department of Health and Human Services, Health Resources and Services Administration and National Institutes of Health. Additional funding was from the Swedish International Development Agency, Swedish Research Council (SIDA/VR). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER This trial was registered at Pan African Clinical Trial, Registry. PACTR 201308000561212.
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Affiliation(s)
- Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Old Mulago Hill, Kampala, Uganda
| | - Josaphat Kayogoza Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Mulago Hospital Complex, PO Box 7072, Old Mulago Hill, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- School of Public Health, Makerere University College of Health Sciences, Mulago Hospital Complex, Old Mulago Hill, Kampala, Uganda
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Heinemann K, Reed S, Moehner S, Do Minh T. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception 2015; 91:280-3. [DOI: 10.1016/j.contraception.2015.01.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
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