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Contraception Journal
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Contraception Highlights May 2012

This month’s featured editorials

Emergency contraception: global challenges, new opportunities
Elizabeth Westley, Eleanor Bimla Schwarz
pages 429-431
Emergency contraception (EC) is unique among modern contraceptive methods in its capacity to prevent pregnancy after sex. Perhaps for this reason, from the days of its earliest introduction, EC has engendered extraordinary anxiety and opposition in multiple settings around the world. This was most recently demonstrated by the US Secretary for Health and Human Services Kathleen Sibelius' unprecedented interference with US drug regulatory processes when she overruled the US Food and Drug Administration's approval of full over-the-counter status for all ages of a brand of levonorgestrel EC. Subsequently, President Obama added that he agreed with the decision, commenting that 11-year-olds should not be able to access EC as easily as “bubblegum and batteries”. read more >

Avoiding controversy in international provision of subdermal contraceptive implants
David Hubacher, Laneta Dorflinger
pages 432-433
International agencies work with host country governments to estimate contraceptive needs and to procure commodities at affordable public-sector prices. Depending on the agency and the registration status of the commodity in the given country, three subdermal contraceptive implants are options for purchase: Jadelle® is a two-rod levonorgestrel implant approved for 5 years of continuous use (Bayer HealthCare, Berlin, Germany), Implanon® (Merck & Co., Inc., Whitehouse Station, NJ, USA) is a one-rod etonogestrel implant (approved for 3 years) and Sino-implant (II) (Shanghai Dahua Pharmaceutical Co., Ltd., China) is another two-rod levonorgestrel implant (approved for 4 years). read more >

Review Articles

Controversies in family planning: first trimester uterine evacuation for the anticoagulated patient
Sara Pentlicky, Tabetha Harken, Courtney A. Schreiber
pages 434-436
I have a patient who is dosed therapeutically on low-molecular-weight heparin (LMWH), is 6 weeks from her last menstrual period and is requesting an abortion. I know that some have experience with doing first trimester abortions up to about 12 weeks while patients are on warfarin without complication. I am assuming the same would be true for the safety of the procedure on LMWH, but I wanted to see if anybody had experience with this. Any recommendations?
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An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndrome
Ellen W. Freeman, Uriel Halbreich, Gary S. Grubb, Andrea J. Rapkin
pages 437-445
This article presents an overview of four studies that evaluated a continuous oral contraceptive (OC) containing levonorgestrel (90 mcg) and ethinyl estradiol (20 mcg; LNG/EE) for managing premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS).
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Original research articles

The effect of obesity and low-dose oral contraceptives on carbohydrate and lipid metabolism
Anitra Beasley, Christopher Estes, Jacqueline Guerrero, Carolyn Westhoff
pages 446-452
Background: Combination oral contraceptives (OCs) have little effect on carbohydrate and lipid metabolism in normal-weight women. Based on lack of change in intermediate markers, as well as results of epidemiologic studies, low-dose OCs do not increase the risk of diabetes or cardiovascular disease. Obesity is a risk factor for impaired glucose tolerance, diabetes and coronary artery disease, and most previous OC studies excluded these women; thus, we have limited information about carbohydrate and lipid metabolism in obese OC users.
Conclusions: Obesity had little effect on any OC-induced changes in carbohydrate or lipid metabolism except for a borderline adverse interaction between obesity and OC dose with respect to fasting glucose and a positive interaction between obesity and OC use with respect to LDL cholesterol.
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Self-administration of subcutaneous depot medroxyprogesterone acetate for contraception: feasibility and acceptability
Sujatha Prabhakaran, Ashley Sweet
pages 453-457
Background: The objectives of the study were to assess feasibility, continuation rates and patient satisfaction with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC).
Conclusions: Continuation was high with DMPA-SC self-injection. Participants reported injection to be easy and convenient and are likely to recommend self-administration to other women. Device issues are one potential deterrent.
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Pilot study of home self-administration of subcutaneous depo-medroxyprogesterone acetate for contraception
Sharon T. Cameron, Anna Glasier, Anne Johnstone
pages 458-464
Background: Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) offers the possibility of self-administration.
Conclusions: Self-administration of DMPA-SC for contraception is feasible and is associated with similar continuation rates and satisfaction to clinician-administered DMPA-IM.
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Predictors of noncompliance in an oral contraceptive clinical trial
Carolyn L. Westhoff, Anupama T. Torgal, Elizabeth R. Mayeda, Noa'a Shimoni, Frank Z. Stanczyk, Malcolm C. Pike 
pages 465-469
Background: This analysis was conducted to identify the participant characteristics associated with noncompliance in an oral contraceptive (OC) clinical trial.
Conclusion: We found that noncompliance was strongly associated with residential poverty level, an indirect measure of individual income. In the United States, poverty is associated with female obesity, Hispanic ethnicity and low education, which were also associated here with noncompliance. Study compensation may motivate poor individuals to participate in clinical trials for income. Noncompliance in clinical trials, particularly differential noncompliance, jeopardizes study validity.
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Relation of androgen receptor sensitivity and mood to sexual desire in hormonal contraception users
Els Elaut, Ann Buysse, Petra De Sutter, Griet De Cuypere, Jan Gerris, Ellen Deschepper, Guy T'Sjoen
pages 470-479
Background: Since very little research in this field is available, this study aims to assess the role of psychosexual, relationship, hormonal and genetic measures in the sexual desire of users of three hormonal contraceptive products [low-dose combined oral contraceptive (20 mcg ethinylestradiol/150 mcg desogestrel), progestin-only pill (75 mcg desogestrel) and vaginal ring (daily dose of 15 mcg ethinylestradiol/120 mcg etonogestrel)].
Conclusions: The current study found evidence for a role of androgen receptor sensitivity and mood in the sexual desire of hormonal contraceptive users.
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Effects of a novel estrogen-free, progesterone receptor modulator contraceptive vaginal ring on inhibition of ovulation, bleeding patterns and endometrium in normal women
Vivian Brache, Regine Sitruk-Ware, Alistair Williams, Diana Blithe, Horacio Croxatto, Narender Kumar, Sushma Kumar, Yun-Yen Tsong, Irving Sivin, Anita Nath, Heather Sussman, Leila Cochon, Maria Jose Miranda, Verónica Reyes, Anibal Faundes, Daniel Mishell 
pages 480-488
Background: Progesterone receptor modulators (PRMs) delivered by contraceptive vaginal rings provide an opportunity for development of an estrogen-free contraceptive that does not require daily oral intake of steroids. The objective of this proof-of-concept study was to determine whether continuous delivery of 600–800 mcg of ulipristal acetate (UPA) from a contraceptive vaginal ring could achieve 80% to 90% inhibition of ovulation.
Conclusion: In this study, the minimum effective contraceptive dose was not established. Further studies are required testing higher doses of UPA to attain ovulation suppression in a higher percentage of subjects.
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Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion
Sloane York, E. Steve Lichtenberg
pages 489-495
Background: Disseminated intravascular coagulation (DIC) is a serious and relatively uncommon complication of induced or spontaneous abortion or delivery. Occasionally, it has been reported in the absence of predisposing conditions. Little information in the literature describing idiopathic DIC or the treatment of patients with DIC exists.
Conclusions: The abnormal bleeding of presumptive DIC typically begins to appear within 2 h after uncomplicated D&E and is more likely to occur at 17 weeks' estimated gestational age and more. With rapid diagnosis and treatment, most patients were able to be treated in an outpatient setting with up to 6 to 8 units of FFP and rehydration.
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Music for surgical abortion care study: a randomized controlled pilot study
Justine Wu, William Chaplin, Jennifer Amico, Mark Butler, Mary Jane Ojie, Dina Hennedy, Lynn Clemow
pages 496-502
Background: The study objective was to explore the effect of music as an adjunct to local anesthesia on pain and anxiety during first-trimester surgical abortion. Secondary outcomes included patient satisfaction and coping.
Conclusions: Music as an adjunct to local anesthesia during surgical abortion is associated with a trend toward less anxiety postprocedure and better coping while maintaining high patient satisfaction. Music does not appear to affect abortion pain.
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Evaluation of oxidative stress after treatment with low estrogen contraceptive either alone or associated with specific antioxidant therapy
Annarosa Finco, Gianni Belcaro, Maria Rosaria Cesarone
pages 503-508
Background: The aim of the study is to analyze the effect of low estrogen contraceptives (OC) on oxidative stress (OS) and concomitantly also the changes produced by different treatments using physiological modulators (PMs) with antioxidant action.
Conclusions: We conclude that to control the OS generated by OC, specific types of PMs are needed. In particular MF Templar® was able to induce a significant reduction of OS levels.
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In vitro cytotoxicity of Cu2+, Zn2+, Ag+ and their mixtures on primary human endometrial epithelial cells
Jing Wu, Luyao Wang, Jing He, Changhong Zhu
pages 509-518
Background: To avoid the inherent disadvantages of copper-containing intrauterine device (Cu-IUD) induced by free Cu2+, two other well-performing metal ions, namely, Ag+, with long-effective antimicrobial properties, and Zn2+, as an essential trace element, are being considered for use in the future as multifunctional IUDs. The purpose of this study was to assess the cytotoxicity of these metal ions and their mixtures on primary human endometrial epithelial cells (HEECs) cultured in vitro and to provide several choices of alternative potential materials for creating excellent IUDs in the future.
Conclusions: To avoid the inherent disadvantages of copper-containing intrauterine device (Cu-IUD) induced by free Cu2+, two other well-performing metal ions, namely, Ag+, with long-effective antimicrobial properties, and Zn2+, as an essential trace element, are being considered for use in the future as multifunctional IUDs. The purpose of this study was to assess the cytotoxicity of these metal ions and their mixtures on primary human endometrial epithelial cells (HEECs) cultured in vitro and to provide several choices of alternative potential materials for creating excellent IUDs in the future.
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Letters From The Editor

When did family planning become a risky proposition?
Jon O'Brien
pages 519
In “Title X: A Proud Past, An Uncertain Future,” Coleman and Jones describe a robust family planning network that was created and maintained in a politically divisive environment. The legislators who crafted Title X 40 years ago kept the focus on their constituents and were able to create centers where “no one is turned away.” This is a true safety net—policy that delivers on the promise of bringing family planning to all who need it and want it. If they could do it then, why has contraception become such a divisive issue today?
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Comment on: Li HW, Wong CY, Yeung WS, Ho PC, Ng EH. Serum anti-Mullerian hormone level is not altered in women using hormonal contraceptives. Contraception 2011;83:582–5
Marleen H. van den Berg, Annelies Overbeek, Eline van Dulmen-den Broeder, Cornelis B. Lambalk
pages 519-520
Anti-Müllerian hormone (AMH) can serve as a valuable marker to assess ovarian reserve status or predict age at menopause in normo-ovulatory women. The issue of measuring AMH may also be of relevance for women using hormonal contraceptives. Therefore, the recent publication by Li et al. on AMH levels in women using several types of hormonal contraceptives can be considered a valuable addition to the sparse literature on this topic. However, we are concerned that the study design used as well as the type of data analyses performed may have distorted the study's conclusions
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Response to letter to the editor: Serum anti-Mullerian hormone level is not altered in women using hormonal contraceptives
Hang Wun Raymond Li, Ching Yin Grace Wong, William Shu Biu Yeung, Pak Chung Ho, Ernest Hung Yu Ng 
pages 520-521
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