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Contraception Journal
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Contraception Highlights 2014

Thinking (Re)Productively
Expert analysis on pressing issues from the Association of Reproductive Health Professionals

Putting the man in contraceptive mandate
Brian T. Nguyen, Grace Shih, David K. Turok
Announced on January 20, 2012, and made effective August 1, 2012, the “contraceptive mandate” is an extension of the Patient Protection and Affordable Care Act (ACA) that sanctioned the provision of contraceptives and sterilization services to women at no cost. While the mandate is a landmark for women's health care, it has not yet directly addressed a role for men. Male involvement is often either absent or a late addition to reproductive policies, as seen with past developments in sexual health such as emergency contraception, the human papillomavirus vaccine and expedited partner therapy for sexually transmitted infections. As written currently, the ACA does not direct insurance carriers to reimburse for vasectomy nor prospective male contraceptives or counseling. Read More>>

Editorial

Journal update: what's new for 2014
Carolyn L. Westhoff
In 2013, Contraception published a record number of articles. That is great news demonstrating increasing research productivity in this field. This great news is particularly remarkable in this era of limited funding when investigators often have too little time to complete projects and to write the articles describing their research. Articles in the journal have increased, not just in number but in quality, as evidenced in part by the most recent impact factor of 3.090, which is the highest ever achieved by the journal, and which places Contraception as no. 12 of 77 journals in the field of obstetrics and gynecology. Congratulations to all of the recent authors whose work is being more often cited, and congratulations to Dr. Mishell for his leadership — the latest impact factor reflects articles published during his most recent years as editor-in-chief.
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Commentary

Interview with Dan Mishell
Carole Joffe
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Original Research Articles

IUD use in France: women's and physician's perspectives
Caroline Moreau, Aline Bohet, Danielle Hassoun, Virginie Ringa, Nathalie Bajos, the FECOND group
Objective: While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives.
Implications: This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs.
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Reasons for Brazilian women to switch from different contraceptives to long-acting reversible contraceptives
Jéssica M. Ferreira, Fabiana R. Nunes, Waleska Modesto, Mayara P. Gonçalves, Luis Bahamondes
Objectives: Long-acting reversible contraceptives (LARCs) include the copper-releasing intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants. Despite the high contraceptive efficacy of LARCs, their prevalence of use remains low in many countries. The objective of this study was to assess the main reasons for switching from contraceptive methods requiring daily or monthly compliance to LARC methods within a Brazilian cohort.
Conclusions: Most women chose a LARC method for its safety and for practical reasons, and after 1 year of use, most women continued with the method.
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Accuracy of providers' assessment of pain during intrauterine device insertion
Karla Maguire, Kathleen Morrell, Carolyn Westhoff, Anne Davis
Background: Providers often underestimate patient pain. This study investigated if providers accurately assess pain during intrauterine device (IUD) insertion.
Implications: To our knowledge, this is the first paper to compare provider and patient perceptions of pain during IUD insertion. Understanding this relationship will help guide further research about IUD insertion pain and techniques and could improve patient counseling.
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Comparison of pregnancy rates in users of extended and cyclic combined oral contraceptive (COC) regimens in the United States: a brief report
Brandon Howard, James Trussell, ElizaBeth Grubb, Maureen J. Lage
Objective: To evaluate pregnancy rates with 84/7, 21/7, and 24/4 combined oral contraceptives (COCs).
Implications: While newer COCs, including 84/7 and 24/4 regimens, potentially improve efficacy and alter bleeding profiles compared to 21/7 regimens, few data on comparative pregnancy rates with these regimens are available. In this retrospective claims analysis, real-world pregnancy rates were lower with 84/7 regimens versus 21/7 and 24/4 regimens.
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Skipping the pill-free interval: data from a Dutch national sample
Charles Picavet
Introduction: A monthly pill-free interval is unnecessary and many women prefer to have fewer bleeding episodes.
Implications: Women who use OCPs can and do skip pill-free intervals, either with or without consulting a physician. If bleeding preferences were structurally discussed with patients, the number of women who skip intervals may increase even further.
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Pharmacokinetics of subcutaneous depot medroxyprogesterone acetate injected in the upper arm
Vera Halpern, Stephanie L. Combes, Laneta J. Dorflinger, Debra H. Weiner, David F. Archer
Background: The abdomen and thigh are recommended injection sites in the label for Depo-SubQ Provera 104™. We evaluated the pharmacokinetic profile of medroxyprogesterone acetate (MPA) following injection of Depo-SubQ Provera 104 in the upper arm, a preferred injection site in developing countries.
Conclusions: Injection of Depo-SubQ Provera 104™ in the upper arm provided sufficient MPA levels for contraceptive protection for 3 months (13 weeks). The uptake and metabolism of MPA when injected in the upper arm may be different from the abdomen and thigh.
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Understanding women's desires for contraceptive counseling at the time of first-trimester surgical abortion
Melissa Matulich, Catherine Cansino, Kelly R. Culwell, Mitchell D. Creinin
Objective: The objective was to investigate whether or not women presenting for a first-trimester surgical abortion want to discuss contraception on the day of their procedure.
Conclusion: The majority of women seeking first-trimester surgical abortion may not desire additional information about contraception on the day of the procedure.
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Immediate versus delayed initiation of the contraceptive patch after abortion: a randomized trial
Jody E. Steinauer, Abby Sokoloff, Elizabeth M. Roberts, Eleanor A. Drey, Christine E. Dehlendorf, Sarah W. Prager
Background: Immediate start of the contraceptive patch has not been studied in women after surgical abortion.
Conclusion: Immediate initiation of the contraceptive patch after surgical abortion was not associated with increased use of patch at 2 or 6 months.
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Oral anticoagulant therapy does not modify the bleeding pattern associated with the levonorgestrel-releasing intrauterine system in women with thrombophilia and/or a history of thrombosis
Giordana Campos Braga, Milena Bastos Brito, Rui Alberto Ferriani, Luciana Correa Oliveira, Andrea Aparecida Garcia, Maria Carolina Pintão, Carolina Sales Vieira
Background: Progestogen-only contraceptives (POCs) are suitable for women with thrombophilia and/or a history of venous thromboembolism (VTE). Several of these women, however, use oral anticoagulant therapy (OAT), which can impair the bleeding pattern associated with POC use. We evaluated the effects of OAT use on the bleeding pattern associated with the levonorgestrel-releasing intrauterine system (LNG-IUS) in women with thrombophilia and/or a history of VTE.
Conclusion: OAT users and nonusers had similar bleeding patterns after insertion of the LNG-IUS. Hemoglobin and hematocrit levels increased in both groups.
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Variation in prescription contraceptive pricing across Florida ZIP code income groups
Nikki B. Zite, Audrey D. Barry, Lorraine S. Wallace
Background: The purpose of this study was to explore average monthly cost of commonly prescribed oral and transvaginal contraceptives, across ZIP code income groups, in Florida.
Conclusion: Overall, while there was little variability in retail pharmacy prices in Florida for seven commonly prescribed contraceptives, monthly costs of individual contraceptives varied widely.
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Variation in postpartum contraceptive method use: results from the Pregnancy Risk Assessment Monitoring System (PRAMS)
Kari White, Joseph E. Potter, Kristine Hopkins, Daniel Grossman
Objective: The National Survey of Family Growth has been a primary data source for trends in US women’s contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms.
Conclusions: The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix.
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Case Report

Does an intraabdominally placed LNG-IUS have an adverse effect on fertility? a case report
Nadine Doris, Gihad Shabib, Shannon Corbett, Arthur Leader, Amanda Black
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Letters to the Editor

Response to Guzman et al.: The use of fertility awareness methods (FAM) among young adult Latina and black women
Irit Sinai, Victoria Jennings
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Reply to letter to the editor
Lina Guzman, Shelby Hickman, Elizabeth Wildsmith
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Endogenous female prostate-specific antigen from female ejaculate may confound the use of prostate-specific antigen as a biomarker of exposure to semen
Gwinyai Masukume
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