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Contraception Journal
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Contraception Highlights February 2012

ARHP Commentary - February 2013

Misoprostol in women's hands: a harm reduction strategy for unsafe abortion
Alyson Hyman, Kelly Blanchard, Francine Coeytaux, Daniel Grossman, Alexandra Teixeira
On any given day in Cuernavaca, Cape Town, Quezon City or Calcutta, a woman with an unwanted pregnancy seeks out misoprostol to have an abortion. She does not visit a doctor or clinic but seeks a pill that she has heard can help her end her pregnancy without the risks of more dangerous self-induction methods. Women living in legally restricted settings where they do not have access to high-quality safe services or where stigma, cost or other barriers prevent them from accessing existing services are increasingly using misoprostol to self-induce abortion instead of using sticks, acid, brute force or unproven herbal remedies. In doing so, they are significantly reducing the harms caused by unsafe abortion. read more >

Editorial

The evidence mounts on the benefits of preventing unintended pregnancy
Lawrence B. Finer, Adam Sonfield
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Commentary

Revisiting optimal hormonal contraception following bariatric surgery
Zaher O. Merhi
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Estimating contraceptive efficacy: the case of spermicides
Elizabeth G. Raymond, James Trussell, Mark A. Weaver, Matthew F. Reeves
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Review article

Controversies in family planning: contraceptive counseling in the solid organ transplant recipient
Priya R. Patel, Courtney A. Schreiber
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Original research articles

Extending contraceptive coverage under the Affordable Care Act saves public funds
Suzanne Burlone, Alison B. Edelman, Aaron B. Caughey, James Trussell, Stella Dantas, Maria I. Rodriguez
Background: The Affordable Care Act (ACA) will expand health care coverage to low-income Americans. Contraception services are a mandated component of ACA plans.
Conclusions: Expanding contraceptive coverage under the Affordable Health Act is cost-effective for Oregon state insurance providers.
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Unintended pregnancies in England in 2010: costs to the National Health Service (NHS)
Calypso Montouchet, James Trussell
Introduction: Here we estimate the direct medical costs to the National Health Service (NHS) of unintended pregnancies in 2010 and identify populations at risk for unintended pregnancies.
Discussion: London, the North West and the West Midlands should be targeted in efforts to reduce unintended pregnancies. More specifically, women between the ages of 20 and 34 years produce the greatest costs.
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Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception
James Trussell, Nathaniel Henry, Fareen Hassan, Alexander Prezioso, Amy Law, Anna Filonenko
Background: This study evaluated the total costs of unintended pregnancy (UP) in the United States (US) from a third-party health care payer perspective and explored the potential role for long-acting reversible contraception (LARC) in reducing UP and resulting health care expenditure.
Conclusions: Imperfect contraceptive adherence leads to substantial UP and high, avoidable costs. Improved uptake of LARC may generate health care cost savings by reducing contraceptive non-adherence.
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Contraception access and use among US servicewomen during deployment
Kate Grindlay, Daniel Grossman
Background: Approximately 12% of active duty US servicewomen have an unintended pregnancy each year; however, little is known about contraception use during deployment.
Conclusions: Given the high prevalence of unintended pregnancy among servicewomen, efforts should focus on improving contraceptive counseling prior to deployment and ensuring refill access during deployment, as well as expanding access to long-acting reversible methods.
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Revitalizing long-acting reversible contraceptives in settings with high unmet need: a multicountry experience matching demand creation and service delivery
Paul D. Blumenthal, Nirali M. Shah, Kriti Jain, Aleen Saunders, Corina Clemente, Brad Lucas, Krishna Jafa, Maxine Eber
Background: Contraception in many developing countries is characterized by high unmet need, irregular access, low utilization and presumed demand for long-acting reversible contraceptives (LARCs).
Conclusions: Convenient, quality, affordable services with demand creation can result in significant uptake of LARCs in settings with low use.
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Using changes in binding globulins to assess oral contraceptive compliance
Carolyn L. Westhoff, Kelsey A. Petrie, Serge Cremers
Background: Validity of oral contraceptive pill (OCP) clinical trial results depends on participant compliance. Ethinyl estradiol (EE2) induces increases in hepatic binding globulin (BG) levels. Measuring these BG increases may provide an effective and convenient approach to distinguish noncompliant from compliant OCP users in research settings. This analysis evaluated the usefulness of measuring increases in corticosteroid-, sex-hormone- and thyroxine-binding globulins (CBG, SHBG and TBG, respectively) as measures of OCP compliance.
Conclusions: EE2-induced increases in CBG and TBG provide a sensitive integrated marker of compliance with an LNG-containing OCP.
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Failed IUD insertions in community practice: an under-recognized problem?
Amna I. Dermish, David K. Turok, Janet C. Jacobson, Marie E.S. Flores, Molly McFadden, Kathy Burke
Background: The data analysis was conducted to describe the rate of unsuccessful copper T380A intrauterine device (IUD) insertions among women using the IUD for emergency contraception (EC) at community family planning clinics in Utah.
Conclusion: The high rate of unsuccessful IUD insertions reported here, particularly for nulliparous women, suggests that the true insertion failure rate of providers who are not employing additional tools for difficult insertions may be much higher than reported in clinical trials. Further investigation is necessary to determine if this is a common problem and, if so, to assess if the use of adjuvant measures will reduce the number of unsuccessful IUD insertions.
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An exploratory, randomized, crossover MRI study of microbicide delivery with the SILCS diaphragm compared to a vaginal applicator
Sara Pentlicky, Mark Rosen, Patricia S. Coffey, M. Kilbourne-Brook, A. Shaunik, Courtney A. Schreiber, Kurt Barnhart
Background: Microbicide gels studied for HIV prevention often are delivered via a single-use vaginal applicator. Using a contraceptive diaphragm such as the SILCS diaphragm for gel delivery could have advantages, including lower cost and additional pregnancy prevention.
Conclusions: Gel coverage was similar with all three methods. These results suggest that the SILCS microbicide delivery system is comparable to vaginal applicators for delivery of gel products intravaginally.
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Pharmacokinetic profile of nomegestrol acetate and 17-estradiol after multiple and single dosing in healthy women
Mireille G.F. Gerrits, Peter G. Schnabel, Teun M. Post, Pierre A.M. Peeters Background: The pharmacokinetics of the monophasic oral contraceptive nomegestrol acetate (NOMAC) plus 17-estradiol (E2) were investigated after a single dose and multiple dosing.
Conclusions: These data demonstrate that NOMAC/E2 has a pharmacokinetic profile consistent with once-daily dosing.
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Ovarian activity in obese and nonobese women treated with three transdermal contraceptive patches delivering three different doses of ethinyl estradiol and levonorgestrel
Marie Foegh, David F. Archer, Frank Z. Stanczyk, Arkady Rubin, Daniel R. Mishell
Background: The effect of obesity on ovarian follicular suppression in women using low-estrogen dose contraceptive patches has not been determined.
Conclusions: AG200-15 suppresses ovulation in obese and nonobese women. All three patches found increased progesterone in the follicular phase, albeit more in obese versus nonobese women.
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Pharmacokinetics and adhesion of the Agile transdermal contraceptive patch (AG200-15) during daily exposure to external conditions of heat, humidity and exercise
David F. Archer, Frank Z. Stanczyk, Arkady Rubin, Marie Foegh
Background: This study compares the pharmacokinetic profile, adhesion and safety of the AG200-15 Agile Patch (AP), a novel contraceptive patch releasing low-dose ethinyl estradiol (EE) and levonorgestrel (LNG), during wear under external conditions of heat, humidity and exercise versus normal activities.
Conclusions: Although slightly lower mean drug concentration levels were observed for whirlpool, treadmill and sauna, drug concentrations under all conditions were well within therapeutic ranges established for the AP during normal wear and within ranges reported for low-dose combination oral contraceptives. Patch adhesion was excellent; the AP was safe and well tolerated under all conditions.
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Prolonged monitoring of ethinyl estradiol and levonorgestrel levels confirms an altered pharmacokinetic profile in obese oral contraceptives users
Alison B. Edelman, Ganesh Cherala, Myrna Y. Munar, Barent DuBois, Martha McInnis, Frank Z. Stanczyk, Jeffrey T. Jensen
Background: Pharmacokinetic (PK) parameters based on short sampling times (48 h or less) may contain inaccuracies due to their dependency on extrapolated values. This study was designed to measure PK parameters with greater accuracy in obese users of a low-dose oral contraceptive (OC) and to correlate drug levels with assessments of end-organ activity.
Conclusions: Obesity results in significant alterations in OC steroid PK parameters, but the severity of these alterations did not correlate with end-organ suppression. A longer PK sampling interval (168 h vs. 48 h) improved the accuracy of PK testing.
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Pituitary, ovarian and additional contraceptive effects of an estradiol-based combined oral contraceptive: results of a randomized, open-label study
Jan Endrikat, Susanne Parke, Dietmar Trummer, Marco Serrani, Ingrid Duijkers, Christine Klipping
Background: The estrogen step-down/progestogen step-up 28-day estradiol valerate/dienogest (E2V/DNG) oral contraceptive effectively inhibits ovulation; however, limited data are available regarding its effects on estradiol (E2), progesterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) or its additional extraovarian contraceptive effects.
Conclusion: E2V/DNG provides extraovarian contraceptive effects (reducing endometrial thickness and cervical mucus production) in addition to inhibiting ovulation, assuring contraceptive efficacy.
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Fallopian tube occlusion with a shape memory polymer device: evaluation in a rabbit model
Shuai Tang, Chan-Yu Zhang, Mei-Na Huang, Yan-Feng Luo, Zhi-Qing Liang Background: The present study evaluates the feasibility of a shape memory polymer (SMP) device for fallopian tube occlusion in rabbits.
Conclusion: Biodegradable and biocompatible SMP devices could provide reliable, instant and permanent tubal occlusion.
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Computer-assisted provision of hormonal contraception in acute care settings
Eleanor B. Schwarz, Elizabeth J. Burch, Sara M. Parisi, Kathleen P. Tebb, Daniel Grossman, Ateev Mehrotra, Ralph Gonzales
Background: We evaluated whether computerized counseling about contraceptive options and screening for contraindications increased women's subsequent knowledge and use of hormonal contraception.
Conclusion: Patient-facing computers appear to increase access to prescription contraception for women seeking acute care.
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Evaluating feasibility, reach and potential impact of a text message family planning information service in Tanzania
Kelly L. L'Engle, Heather L. Vahdat, Elizabeth Ndakidemi, Christine Lasway, Trinity Zan
Background: The objective of this research was to evaluate the feasibility, reach and potential behavioral impact of providing automated family planning information via mobile phones to the general public in Tanzania.
Conclusions: Reaching younger people, women and men of reproductive age with family planning information delivered via mobile phone is recommended.
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