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Contraception Journal
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Contraception Highlights November 2012

This month’s featured editorial

The Supreme Court Rules, and it's Both Good and Bad News for Reproductive Health
Adam Sonfield, Rachel Benson Gold
pages 427-429
The US Supreme Court settled one of the nation's loudest political arguments on June 28 when it ruled that the “individual mandate” and almost all of the other provisions of the Affordable Care Act (ACA) are constitutional. Policy-makers, pundits and the general public will continue to argue over whether the ACA is good or bad policy and whether it should be retained and tweaked over time or repealed. Despite all the heated rhetoric, everyone should keep their eyes on the central fact that if the law is fully implemented on schedule, tens of millions of Americans who otherwise would remain uninsured will instead be able to gain comprehensive health coverage, including strong coverage of reproductive health care. read more >


Fatal flaws in a recent meta-analysis on abortion and mental health
Julia R. Steinberg, James Trussell, Kelli S. Hall, Kate Guthrie
pages 430-437
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Controversies in family planning: retained products of conception
Jennefer A. Russo, Teresa DePiñeres, Laura Gil
pages: 438-442
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Original research articles

Adolescent experience with intrauterine device insertion and use: a retrospective cohort study
Lisa L. Bayer, Jeffrey T. Jensen, Hong Li, Mark D. Nichols, Paula H. Bednarek
pages 443-451
Background: Adolescents contribute disproportionately to the epidemic level of unintended pregnancy in the USA. Intrauterine devices (IUDs) are highly effective but underutilized in this age group.
Conclusions: Overall, adolescents experience minimal complications with IUD use, with similar rates of successful insertion as adults. IUD discontinuation rates were not significantly different between nulliparous and parous teens. While discontinuation was higher than reported in adults, it was lower than reported among teens using other forms of contraception.
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Levonorgestrel-releasing intrauterine system for heavy menstrual bleeding improves hemoglobin and ferritin levels
Andrew M. Kaunitz, François Bissonnette, Ilza Monteiro, Eeva Lukkari-Lax, Yoriko DeSanctis, Jeffrey Jensen
pages 452-457
Background: We compared the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) with cyclic oral medroxyprogesterone acetate (MPA) on hemoglobin and serum ferritin levels in women with heavy menstrual bleeding (HMB).
Conclusions: Women treated with the LNG-IUS had greater increases in median hemoglobin and serum ferritin levels, and higher rates of subjective improvement than women treated with oral MPA.
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Effects of levonorgestrel-releasing intrauterine system and T380A intrauterine copper device on dysmenorrhea and days of bleeding in women with and without adenomyosis
Sefa Kelekci, Kiymet Handan Kelekci, Bulent Yilmaz
pages 458-463
Background: The study was conducted to compare the levonorgestrel intrauterine system (LNG-IUS) and Copper T380A intrauterine device (IUD) in women with and without adenomyosis and to investigate the effects on menstruation and dysmenorrhea.
Conclusions: The LNG-IUS results in significant improvements in adenomyosis-associated heavy menstrual bleeding and dysmenorrhea. Moreover, this study also shows that it is an effective contraceptive method with significantly lower side effects compared to CuT 380A IUD except for acne.
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Reproductive health experiences of women with cardiovascular disease
Julie Chor, Lora Oswald, Joan Briller, Allison Cowett, Nadine Peacock, Bryna Harwood
pages 464-469
Background: Limited research exists exploring contraceptive and pregnancy experiences of women with cardiovascular diseases.
Conclusion: Providers must better understand how women perceive and consider their reproductive and cardiovascular health in order to optimize contraceptive care of women with cardiovascular disease and help them make safe, informed decisions about future fertility.
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Further evidence for lack of negative associations between hormonal contraception and mental health
Elena Toffol, Oskari Heikinheimo, Päivikki Koponen, Riitta Luoto, Timo Partonen
pages 470-480
Background: There is limited and inconsistent information concerning the effects of hormonal contraception [oral contraceptives (OCs) and the levonorgestrel-releasing intrauterine system (LNG-IUS)] on mental health. The aim of this work was to further study the association(s) between the use of OCs and the LNG-IUS and psychopathology.
Conclusions: The use of hormonal contraception is not associated with negative influence on mental health. Current OC use seems to be associated with better mood, whereas the associations between duration of use of hormonal contraception and mental health effects are not clear.
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Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density
Abbey B. Berenson, Mahbubur Rahman
pages 481-487
Background: The study was conducted to estimate the effect of depot medroxyprogesterone acetate (DMPA) and oral contraceptives (OC) containing 20 mcg ethinyl estradiol on serum B12 and whether observed changes impact bone mineral density (BMD).
Conclusion: Hormonal contraception causes B12 levels to decrease, but this does not appear to be clinically significant or affect BMD.
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Tubal sterilization during cesarean section or as an elective procedure? Effect on the ovarian reserve
Şebnem Özyer, Özlem Moraloğlu, Cavidan Gülerman, Yaprak Engin-Üstün, Özlem Uzunlar, Rana Karayalçın, Mustafa Uğur
pages 488-493
Background: The purpose of this study is to compare the effects of tubal sterilization on the ovarian reserve by means of hormonal and ultrasonographic evaluation during a cesarean section or when performed as a planned interval procedure..
Conclusions: Intraoperative cesarean section tubal sterilization seems to be a practical and safe method, and has less effect on the ovarian reserve when compared with planned tubal sterilization by minilaparotomy.
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Reproductive factors in relation to ovarian cancer: a case–control study in Northern Vietnam
Duc-Cuong Le, Tatsuhiko Kubo, Yoshihisa Fujino, David C. Sokal,Trinh Huu Vach, Truong-Minh Pham, Shinya Matsuda
pages 494-499
Background: Ovarian cancer, one of the most common cancers in women and the most serious gynecologic cancer, is known to be influenced by reproductive factors, but these factors have not previously been examined in Vietnamese women.
Conclusions: Parity and intrauterine device use were associated with a reduced risk of ovarian cancer in Vietnamese women, whereas induced abortion, late menopause and years of ovulation were associated with an increased risk.
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Effect of oral contraceptive use on lipid profile in Korean women aged 35–55 years
Kisok Kim, Hyejin Park
pages 500-505
Background: Although oral contraceptives (OCs) are widely used, their effects on lipid profile need monitoring according to current usage in different populations.
Conclusions: These data suggest that the use of OCs may reduce the risk of dyslipidemia, mainly due to the decreased risk of low HDL-C, in Korean women.
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Drospirenone and levonorgestrel in combination with either 30 or 20 mcg ethinylestradiol reduce soluble adhesion molecules in Brazilian women; cross-sectional study
Bianca Stocco, Helen Figueiredo Fumagalli, Silvio Antônio Franceschini, Edson Zangiacomi Martinez, Cleni Mara Marzocchi - Machado, Maria Regina Torqueti Toloi
pages 506-510
Background: The objective of this study was to evaluate the effect of three contraceptive pills containing ethinylestradiol (EE) (20 or 30 mcg) in combination with drospirenone (DRSP) and levonorgestrel (LNG) on plasma concentration of adhesion molecules vascular cell adhesion molecule -1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and E-selectin.
Conclusions: DRSP/20 EE and LNG/30 EE induce favorable changes in endothelial function.
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Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants
David Hubacher, Alice Olawo, Carolyne Manduku, James Kiarie, Pai-Lien Chen
pages 511-517
Background: Subdermal contraceptive implants have low discontinuation rates but are underused among young women in Africa. This study aimed to isolate the role initial contraceptive method has on preventing unintended pregnancy.
Conclusions: Many young Kenyan women found implants to be a reasonable alternative to short-acting methods. Having choice is essential, and starting on implants provides substantial and clear protection from unintended pregnancy relative to short-acting methods.
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Influence of depressed mood and psychological stress symptoms on perceived oral contraceptive side effects and discontinuation in young minority women
Kelli Stidham Hall, Katharine O'Connell White, Vaughn I. Rickert, Nancy Reame, Carolyn Westhoff
pages 518-525
Background: We examined the influence of depressed mood and psychological stress on oral contraceptive (OC) side effects and discontinuation.
Conclusions: Young women with adverse psychological symptoms are at risk for perceived OC side effects and discontinuation.
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Effects of hormonal contraception on vaginal flora
Francesco De Seta, Stefano Restaino, Davide De Santo, Guglielmo Stabile,Rubina Banco, Marina Busetti, Giulia Barbati, Secondo Guaschino
pages 526-529
Background: The sector of the market that deals with contraception offers a long list of different contraceptive methods. Within the estroprogestinic choice, the routes of administration are oral, transdermic and vaginal one. Even though efficacy is comparable with these methods, secondary and adverse effects are directly involved in the acceptability of the method.
Conclusions: At the end of follow-up, there was a little change of vaginal milieu in both groups. We noted an increase of lactobacilli in the CCVR users and an increase of GBS in COC users.
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Chronicity of partner violence, contraceptive patterns and pregnancy risk
Heidi Collins Fantasia, Melissa A. Sutherland, Holly B. Fontenot, Terrence J. Lee-St. John
pages 530-535
Background: Partner violence may interfere with a woman's ability to maintain continuous contraception and therefore contribute to increased risk of pregnancy among childbearing women.
Discussion: A history of partner violence was common among women utilizing family planning services. The chronicity of violence appeared to play a significant role in contraceptive method changes, types of methods used and pregnancy risk. These results may be one explanation for increased pregnancies among women who experience partner violence.
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Tailored health messaging improves contraceptive continuation and adherence: results from a randomized controlled trial
Samantha Garbers, Allison Meserve, Melissa Kottke, Robert Hatcher,Mary Ann Chiasson
pages 536-542
Background: Discontinuation and incorrect use of contraceptive methods may contribute to as many as 1 million unintended pregnancies annually in the United States. Interventions to improve contraceptive method continuation and adherence are needed.
Conclusions: Tailored health materials significantly improved contraceptive method continuation and adherence. Additional research on the impact of the intervention on continuation and adherence in a larger sample and over a longer follow-up period is merited.
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A qualitative study of contraceptive understanding among young adults
Marion W. Carter, Anna R. Bergdall, Dare Henry-Moss, Kendra Hatfield-Timajchy, Linda Hock-Lon
pages 543-550
Background: This study describes contraceptive understanding, sources of information and consequences of contraceptive misunderstandings among urban, young adults.
Conclusions: Contraceptive understanding is a powerful determinant of contraceptive use and limits the options perceived by young adults to prevent pregnancy. Research is needed to strengthen contraceptive counseling and outreach in ways that better leverage peer influence.
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Suspect online sellers and contraceptive access
Bryan A. Liang, Tim K. Mackey, Kimberly M. Lovett
pages 551-556
Background: Issues surrounding contraception access have been a national focus. During this debate, adolescent and adult women may seek these products online. Due to safety concerns, including potential counterfeit forms, we wished to assess whether online “no prescription” contraceptives were available.
Conclusions: Online contraceptive sales represent patient safety risks and a parallel system of high-risk product access absent professional guidance. Providers should educate patients, while policy makers employ legal strategies to address these systemic risks.
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Long-acting reversible contraception method use among Title X providers and non-Title X providers in California
Hye-Youn Park, Maria I. Rodriguez, Denis Hulett, Philip D. Darney, Heike Thiel de Bocanegra
pages 557-561
Background: Publicly funded family planning services play an important role in reducing unintended pregnancy by providing access to effective contraception. We assessed whether California family planning providers receiving federal Title X funds are more likely to offer on-site long-acting reversible contraception (LARC) methods than those who do not receive these funds.
Conclusions: On-site utilization of LARC is a potential quality indicator for family planning programs. Title X resources are associated with increased use of LARC.
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Antiabortion violence in the United States
Jennefer A. Russo, Kristin L. Schumacher, Mitchell D. Creinin
pages 562-566
Background: This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning.
Conclusions: Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence.
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Mifepristone vs. osmotic dilator insertion for cervical preparation prior to surgical abortion at 14–16 weeks: a randomized trial
Lynn Borgatta, Danielle Roncari, Sarita Sonalkar, Alice Mark, Melody Y. Hou, Molly Finneseth, Olivera Vragovic
pages 567-571
Background: Cervical preparation is recommended before second-trimester abortion. We investigated the use of a pharmacologic method of preparation, mifepristone, as compared to osmotic dilators for surgical abortions at 14–16 weeks.
Conclusions: Mifepristone did not increase the time for abortion by more than the prespecified margin (3 min). Women preferred mifepristone to osmotic dilators.
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Interest of simultaneous Chlamydia trachomatis and Neisseria gonorrhoeae screening at the time of preabortion consultation
Anne-Lise Toyer, Nathalie Trignol-Viguier, Laurent Mereghetti, Bruno Joly, Elisabeth Blin, Gilles Body, Alain Goudeau, Philippe Lanotte
pages 572-576
Background: This study was conducted to estimate the prevalence and risk factors of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection among women consulting for abortion and to discuss screening for these pathogens in this population.
Conclusions: This population had a high prevalence of CT infection and a low prevalence of NG infection. Most infections were asymptomatic, which could justify systematic simultaneous screening for these two pathogens.
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The New York City mayoral abortion training initiative at public hospitals
Maryam Guiahi, Corey Westover, Sahnah Lim, Carolyn L. Westhoff
pages 577-582
Background: We set out to describe and understand the first-ever abortion training political initiative on the provision of abortion services and abortion residency training.
Conclusions: This NYC political initiative can be a model for other city governments to influence obstetrics and gynecology resident training and the provision of abortion services.
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Case Reports

A novel medical device for removal of intrauterine devices under direct vision
Shili Su, Zhen Zhao, Shiyan Feng, Baihua Dong
pages 583-586
Background: Evaluation of the efficacy of a novel medical device for removal of retained intrauterine devices (IUDs) under direct vision without uterine distention is reported.
Conclusions: The device is effective for the removal of incarceration IUDs under direct vision without uterine distention.
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Ultrasound-guided hysteroscopy to remove a levonorgestrel intrauterine system in early pregnancy
Elizabeth A. McCarthy, Nisha Jagasia, Peter Maher, Miranda Robinson
pages 587-590
Background: Correctly placed levonorgestrel-releasing intrauterine systems (LNG-IUSs) are rarely associated with intrauterine pregnancy when pregnancy occurs. LNG-IUS retrieval, termination of pregnancy and conservative management if retracted strings prevent ready removal are the usual clinical options given to women. The conservative course raises concerns about teratogenesis related to high local progestin exposure for the developing fetus.
Conclusions: Intrauterine LNG-IUS exposure is associated with a low frequency of congenital anomalies. Combining hysteroscopy with ultrasound facilitates surgically precise LNG-IUS removal despite retracted strings.
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Neuropathy associated with etonogestrel implant insertion
Matthew Brown, John Britton
pages 591-593
Background: The etonogestrel contraceptive implant (Implanon®) is an effective, long-acting subdermal method of hormonal contraception for women.
Conclusions: Care should be taken to avoid nerve injury during insertion of subdermal contraceptive implants. An understanding of regional anatomy and the correct insertion technique will prevent insertion-related complications. Nexplanon® has been developed to replace Implanon®. It has a redesigned applicator intended to increase insertion accuracy.
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Letters to the editor

Comment on research article: “Co-prescription of Antiepileptic Drugs and Contraceptives”
Alyson Elliman, Louise Melvin
page 594
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Reply to the Letter to the Editor on “Co-prescription of Antiepileptic Drugs and Contraceptives”
Hao Wang, Jens H. Bos, Lolkje T. de Jong-van den Berg
pages 594-595
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