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Contraception Journal
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Contraception Highlights October 2012

This month’s featured editorial

Communicating Risk: Does Scientific Debate Compromise Safety?
Jeffrey T. Jensen, James Trussell
pages 327-329
A recent publication in the influential British Medical Journal (BMJ) using the Danish National Registry databases reported an increased risk of venous thrombosis (VT) in women using the combination contraceptive ring and patch, and suggested that the risk may also be increased among users of the etonogestrel implant. read more >

Commentary

Conducting high-quality research on the psychological impact of oral contraceptive use
Kelly D. Cobey, Abraham P. Buunk
pages 330-331
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Original research articles

Effect of two kinds of different combined oral contraceptives use on bone mineral density in adolescent women
Ling Gai, Yifang Jia, Meihua Zhang, Ping Gai, Sumei Wang, Hong Shi, Xiaojie Yu, Yonghong Liu
pages 332-336
Background: Steroid hormonal contraceptives are highly effective and widely used. Most studies have shown a negative effect of combined oral contraceptives (COCs) on the bone mineral density (BMD) of adolescents. The study was conducted to compare BMD among users of ethinylestradiol/desogestrel, users of ethinylestradiol/cyproterone acetate and nonhormonal control subjects in women aged 16–18 years.
Conclusions: Our study indicates that 2 years of COCs therapy had no significant effect on bone density in adolescents, but it remains unknown whether therapy longer than 2 years has a significant adverse effect on the attainment of peak bone mass.
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Evaluation of the effects of rifampicin, ketoconazole and erythromycin on the steady-state pharmacokinetics of the components of a novel oral contraceptive containing estradiol valerate and dienogest in healthy postmenopausal women
Hartmut Blode, Susan Zeun, Susanne Parke, Torsten Zimmermann, Beate Rohde, Uwe Mellinger, Michael Kunz
pages 337-344
Background: We evaluated the effects of cytochrome P450 3A4 (CYP3A4) induction and inhibition on steady-state pharmacokinetics of the components of a novel oral contraceptive (OC) containing estradiol valerate (E2V) and dienogest (DNG).
Conclusions: Significant drug–drug interactions are apparent when CYP3A4 modulators are coadministered with the components of a novel OC containing E2V/DNG. Coadministration of CYP3A4 modulators should be avoided where possible, and another type of contraception should be used when coadministration of CYP3A4 inducers like rifampicin is unavoidable.
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Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system
Beata Seeber, Stephanie C. Ziehr, Aandrea Gschlieβer, Christina Moser,Verena Mattle, Christoph Seger, Andrea Griesmacher, Nicole Concin, Hans Concin, Ludwig Wildt 
pages 345-349
Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is well accepted as an easy-to-use contraceptive with an excellent side-effect profile. It contains a reservoir of 52 mg of levonorgestrel (LNG) with continuous release of the steroid. Its contraceptive use is approved for 5 years. The aim of this study was to determine the plasma concentration of LNG and its variation with time in patients with in-dwelling LNG-IUS Mirena®.
Conclusions: Systemic LNG concentrations can be found in all patients with LNG-IUS IUS. However, concentrations are much lower than in other forms of LNG application. Moreover, this study demonstrates that a systemic effect of LNG-IUS can also be found after the recommended contraceptive lifespan of 5 years.
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Body weight and composition in users of levonorgestrel-releasing intrauterine system
Natália Dal'Ava, Luis Bahamondes, M. Valeria Bahamondes, Allan de Oliveira Santos,Ilza Monteiro
pages 350-353
Background: There is little information about body weight and body composition (BC) among users of the levonorgestrel-releasing intrauterine system (LNG-IUS). The aim of this study was to evaluate body weight and BC in LNG-IUS users compared to users of the TCu380A intrauterine device (IUD).
Conclusion: Although an increase in mean fat mass among LNG-IUS users at 12 months of use was observed, it should be noted that an increase of body weight was also observed in both groups after 1 year of insertion of the device. However, a study with a larger number of women and long-term evaluation is necessary to evaluate these body changes.
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Management of missing strings in users of intrauterine contraceptives
Nádia M. Marchi, Sara Castro, M. Margarete Hidalgo, Creusa Hidalgo,Cecília Monteiro-Dantas, Marina Villarroeal, Luis Bahamondes
pages 354-358
Background: A common question among health care professionals is how to manage nonvisible strings in users of intrauterine contraceptives (IUCs) at repeat follow-up visits. This study assessed the position of the IUCs in women who consulted repeatedly with nonvisible IUC strings.
Conclusions: Missing IUC strings are an uncommon finding, and ultrasonography confirmed that the device was in situ in the majority of these cases. For women with persistent missing IUC strings after one ultrasound scan that has verified appropriate intrauterine position, given the 2.4% likelihood that expulsion may have occurred at the time of subsequent visits, repeating the ultrasound (if available) should be considered for at least one (and possibly two) additional women's visit.
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Evaluation of efficacy, safety and effects on symptoms of androgenization of a generic oral contraceptive containing chlormadinone acetate 2 mg/ethinylestradiol 0.03 mg 
Peyman Hadji, Jutta Biskup, Jelena Boekhoff, May Ziller, Michael Bonn, Lucio Rovati 
pages 359-365
Background: This prospective noninterventional study assessed the contraceptive efficacy, safety and the effects on signs of androgenization of the generic oral contraceptive containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol (CMA/EE) in a real-world setting.
Conclusion: Generic CMA/EE exhibits very good contraceptive efficacy, cycle control and dysmenorrhea reduction. Furthermore, treatment with generic CMA/EE led to a favorable reduction of skin and hair problems in our study.
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The effect on use of making emergency contraception available free of charge 
Sharon T. Cameron, Rosemary Gordon, Anna Glasier
pages 366-369
Background: Cost is a barrier to use of emergency contraception (EC). Since 2008, EC has been available free of charge without restriction in pharmacies throughout Scotland. A survey of EC use among women requesting abortion in 2010 allows comparison of use reported in earlier surveys, when EC was only available on prescription and when EC was available from the pharmacy but at a cost.
Conclusions: Neither availability from the pharmacy nor removal of a charge for EC has increased its use among women having an abortion in Scotland.
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The role of pharmacists and emergency contraception: are pharmacists' perceptions of emergency contraception predictive of their dispensing practices? 
Alice R. Richman, Ellen M. Daley, Julie Baldwin, Jeff Kromrey, Kathleen O'Rourke, Kay Perrin
pages 370-375
Background: Pharmacists can play a critical role in the access to emergency contraception (EC). We assessed if knowledge and attitudes were predictive of EC dispensing among a statewide sample of Florida pharmacists, who have legal authority to refuse to dispense medications.
Conclusions: Correct information about EC was the most important predictor of pharmacists' dispensing EC. To expand availability of EC, pharmacists will have to become better informed.
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Reproductive health preventive screening among clinic vs. over-the-counter oral contraceptive users
Kristine Hopkins, Daniel Grossman, Kari White, Jon Amastae, Joseph E. Potter
pages 376-382
Background: Interest is growing in moving oral contraceptives over-the-counter (OTC), although concerns exist about whether women would continue to get preventive health screening.
Conclusions: Results suggest that most women would obtain reproductive health preventive screening if oral contraceptives were available OTC, and also highlight the need to improve access to preventive screening for all low-income women.
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Randomized controlled trial of a computer-based module to improve contraceptive method choice
Samantha Garbers, Allison Meserve, Melissa Kottke, Robert Hatcher,Alicia Ventura, Mary Ann Chiasson
pages 383-390
Background: Unintended pregnancy is common in the United States, and interventions are needed to improve contraceptive use among women at higher risk of unintended pregnancy, including Latinas and women with low educational attainment.
Conclusions: The findings support prior research suggesting that patient-centered interventions can positively influence contraceptive method choice.
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Condom type may influence sexual behavior and ejaculation and complicate the assessment of condom functionality
Lisa Haddad, Maria F. Gallo, Denise J. Jamieson, Maurizio Macaluso
pages 391-396
Background: Studies that evaluate condom effectiveness are affected by factors related to how the condom was used, and these factors may not be consistent between different types of condoms. Also, subjective assessments of the sexual act may be unreliable.
Conclusions: We found that sexual behaviors appear to differ by the type of condom used for the coital act. Studies should consider sexual behavior when evaluating condom effectiveness. Furthermore, studies would be strengthened by the use of a biological marker of semen to determine whether ejaculation, and therefore a true risk of exposure, occurred.
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Eliminating the routine postoperative surgical abortion visit
Mary Gatter, Nitzan Roth, Catherin Safarian, Deborah Nucatola
pages 397-401
Background: The objective of this study was to determine whether replacing the “routine” postoperative visit after surgical abortion with an “as indicated” visit is associated with an increase in the rates of either failed abortion (continuing pregnancy) or repeat abortion.
Conclusions: We conclude that elimination of the routine postoperative visit after a surgical abortion and the substitution of an “as indicated” postoperative visit are not associated with an increase in either continuing pregnancies or repeat abortion.
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Complications of surgical termination of second-trimester pregnancy in obese versus nonobese women
Lisbeth A. Murphy, Loralei L. Thornburg, J. Christopher Glantz, Emilie C. Wasserman, Nancy L. Stanwood, Sarah J. Betstadt
pages 402-406
Background: Obesity is becoming increasingly common in obstetric and gynecologic populations, which may affect the safety of surgical termination of pregnancy.
Conclusions: Both anesthesia and operative times were modestly increased in obese women versus nonobese women undergoing second-trimester surgical termination, without significant differences in complication rates. For patients at advanced GA with prior cesarean delivery, clinicians should be aware of the potential increase in complications as well as increased operative time in obese women, and counsel appropriately.
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Ob/Gyn training in abortion care: results from a national survey
Courtney B. Jackson, Angel M. Foster
pages 407-412
Background: Abortion is one of the most common health services utilized by women in the USA. Training new providers is an important factor in ensuring an adequate supply of clinicians to provide comprehensive reproductive health services.
Discussion: As the vast majority of abortions in the USA occur during the first trimester, exposure to the full array of common first-trimester abortion procedures, including both medication abortion and aspiration abortion procedures, warrants attention. These findings suggest that residency education guidelines may need to be revised to ensure adequate training in medication abortion.
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The antifertility effectiveness of a novel copper-containing composite used in intrauterine contraceptive devices and the releasing behavior of cupric ions contained in the composite in rats
Xiangchi Peng, Shanshan Hu, Tianqing Meng, Jinping Suo,Chengliang Xiong
pages 413-418
Background: This study was conducted to investigate the antifertility effectiveness of a novel copper-containing composite used in intrauterine contraceptive devices (IUDs) that contain cupric chloride/silicon dioxide/poly(vinyl alcohol) (CuCl2/SiO2/PVA) and the releasing behavior of cupric ions in the composite into the serum and uterine fluid in rats.
Conclusions: The novel copper-containing composite used in intrauterine contraceptive devices (CuCl2/SiO2/PVA composite IUD) had a low pregnancy rate and high contraceptive efficacy without a burst release of cupric ions in the initial days of application.
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Effect of letrozole on uterine tonus and contractility: A randomized controlled trial
Helena Kopp Kallner, Pak Chung Ho, Kristina Gemzell-Danielsson
pages 419-424
Background: Letrozole inhibits estrogen production. It has been shown to increase efficacy in medical abortion when used with misoprostol. This study investigated if letrozole acts as an abortifacient due to a synergistic effect with misoprostol on uterine contractility.
Conclusions: Letrozole does not appear to act as an abortifacient through an effect on uterine contractility or increased sensitivity to misoprostol of the uterine myometrium.
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Letters to the editor

Intervene earlier to help women maintain control of reproductive decision making
Kate L. Lapane, Brianna M. Magnusson
page 425
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Addressing reproductive autonomy to prevent repeat unintended pregnancy
Ushma D. Upadhyay
pages 425-426
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