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Contraception Journal
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Contraception Highlights February 2015

Commentary

Sale and provision of injectable contraceptives in drug shops in developing countries: conclusions from a technical consultation
John Stanback, Elena Lebetkin, Tracy Orr, Shawn Malarcher, The Family Planning Provision in Drug Shops Technical Consultation Participants
Abstract: In September 2013, a technical consultation held in Research Triangle Park, NC, USA, concluded that, in the developing world, drug shops have the potential to play a much greater role in helping women and couples achieve their family planning intentions. Already an important source of health care products in many countries, drug shops could expand access to a range of contraceptive methods, particularly progestin-only injectable contraceptives. The group of 15 researchers and program experts found that sale of depot medroxyprogesterone acetate (DMPA) is common in drug shops in some countries and that training, policy, research and advocacy interventions should be prioritized by funders and the family planning community.
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Original Research Articles

Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception
Nathalie Kapp, Jean Louis Abitbol, Henri Mathé, Bruno Scherrer, Hélène Guillard, Erin Gainer, André Ulmann
Objectives: To further evaluate the effect of weight and body mass index (BMI) on the efficacy of levonorgestrel emergency contraception.
Conclusions: All analyses showed a significant drop in the efficacy of levonorgestrel emergency contraception with increasing body weight, with pregnancy risk in the higher weight categories similar to expected rates in the absence of contraception. Like body weight, increasing BMI was highly correlated with increased pregnancy risk.
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A comparison of bleeding patterns and cycle control using two transdermal contraceptive systems: a multicenter, open-label, randomized study
D. Gruber, A. Skřivánek, M. Serrani, V. Lanius, M. Merz
Objectives: To investigate the bleeding pattern and cycle control parameters of a contraceptive patch containing 0.55mg ethinyl estradiol (EE) and 2.1mg gestodene (GSD) compared with a patch containing 0.6mg EE and 6mg norelgestromin (NGMN).
Implications Statement: The paper presents data on the bleeding pattern and cycle control parameters of an investigational transdermal contraceptive patch containing EE and GSD compared with an approved contraceptive patch containing EE and NGMN. This descriptive study found that bleeding patterns associated with the EE/GSD patch were similar to those of an EE/NGMN patch providing higher EE exposure.
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Bleeding pattern and cycle control of a low-dose transdermal contraceptive patch compared with a combined oral contraceptive: a randomized study
M. Merz, R. Kroll, R. Lynen, K. Bangerter
Objective: The aim of this study was to investigate the bleeding pattern and cycle control of a contraceptive patch containing 0.55 mg ethinyl estradiol (EE) and 2.1 mg gestodene (GSD) compared with a combined oral contraceptive (COC) containing 0.02 mg EE and 0.1 mg levonorgestrel (LNG).
Implications Statement: The findings suggest that bleeding patterns with the EE/GSD patch are similar to an EE/LNG-containing COC, except for absence of withdrawal bleeding, which was less common in patch users. The EE/GSD patch may constitute an additional contraceptive option for women.
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Randomized comparison of bleeding patterns in women using a combined contraceptive vaginal ring or a low-dose combined oral contraceptive on a menstrually signaled regimen
Edith Weisberg, Gabriele S. Merki-Feld, Kevin McGeechan, Ian S. Fraser
Objectives: To compare bleeding patterns for 12 months continuous use of a contraceptive ring [contraceptive vaginal ring (CVR)] and pill [combined oral contraceptive (COC)] on a menstrually signaled regimen and the effectiveness of 4 days "treatment withdrawal" to stop bleeding.
Implication: This information for clinicians and women about breakthrough bleeding patterns with use of a CVR or combined pill over 12 months using a menstrually signaled regimen will give women an indication of what to expect with continuous use.
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Restoring testosterone levels by adding dehydroepiandrosterone to a drospirenone containing combined oral contraceptive: I. Endocrine effects
Y. Zimmerman, J.-M. Foidart, A. Pintiaux, J.-M. Minon, B.C.J.M. Fauser, K. Cobey, H.J.T. Coelingh Bennink
Objectives: Combined oral contraceptives (COCs) decrease testosterone (T) levels. This study investigated restoration of T and other androgen concentrations during COC use by 'co-administration' of dehydroepiandrosterone (DHEA).
Implications: When using a COC that increases SHBG considerably, a daily dose of 50 mg DHEA is insufficient to normalize free T levels completely.
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Restoring testosterone levels by adding dehydroepiandrosterone to a drospirenone containing combined oral contraceptive: II. Clinical effects
Y. Zimmerman, J.-M. Foidart, A. Pintiaux, J.-M. Minon, B.C.J.M. Fauser, K. Cobey, H.J.T. Coelingh Bennink
Objectives: Combined oral contraceptives (COCs) decrease androgen levels, including testosterone (T), which may be associated with sexual dysfunction and mood complaints in some women. We have shown that 'co-administration' of dehydroepiandrosterone (DHEA) to a drospirenone (DRSP)-containing COC restored total T levels to baseline and free T levels by 47%. Here we describe the effects on sexual function, mood and quality of life of such an intervention.
Implications: A well-balanced judgment of the clinical consequences of normalizing androgens during COC use may require complete normalization of free T.
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A checklist approach to caring for women seeking pregnancy testing: Effects on contraceptive knowledge and use
Jessica Lee, Melissa Papic, Erin Baldauf, Glenn Updike, E. Bimla Schwarz
Objective: To assess how a checklist reminding clinicians to deliver a bundled intervention affects contraceptive knowledge and use 3 months after women seek walk-in pregnancy testing.
Implications: A checklist reminding clinic staff to assess pregnancy intentions, provide scripted counseling about both emergency and highly-effective reversible contraception, and offer same-day contraceptive initiation to women seeking walk-in pregnancy testing appears to increase use of more effective contraception.
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"It just happens": a qualitative study exploring low-income women's perspectives on pregnancy intention and planning
Sonya Borrero, Cara Nikolajski, Julia R. Steinberg, Lori Freedman, Aletha Y. Akers, Said Ibrahim, Eleanor Bimla Schwarz
Objective: Unintended pregnancy is common and disproportionately occurs among low-income women. We conducted a qualitative study with low-income women to better typologize pregnancy intention, understand the relationship between pregnancy intention and contraceptive use, and identify the contextual factors that shape pregnancy intention and contraceptive behavior.
Implications: This study identified several cognitive and interpersonal pathways to unintended pregnancy among low-income women in Pittsburgh, PA, including perceptions of low reproductive control, perceptions of low fecundity and male partner reproductive coercion.
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Young adults' sources of contraceptive information: variations based on demographic characteristics and sexual risk behaviors
Atika Khurana, Amy Bleakley
Objectives: Sexual information sources used by young adults can influence their contraceptive knowledge and behaviors, yet little is known about sources most frequently used by young adults, especially by groups with histories of sexual risk involvement.
Conclusions: Young adults' use of specific contraceptive information sources can vary based on their demographic characteristics and sexual risk involvement. Future research should identify better strategies to connect young adults, especially young males, with sexual risk histories to more reliable sources of information.
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Nitrous oxide for pain management of first trimester surgical abortion — a randomized controlled pilot study
Rameet H. Singh, Eve Espey, Shannon Carr, Brenda Pereda, Tony Ogburn, Lawrence Leeman
Objective: The objective was to determine feasibility of a study comparing mean pain scores between women randomized to nitrous oxide/oxygen (NO) versus oxygen+oral analgesics for trimester surgical abortion.
Conclusions: The majority of eligible women agreed to participate in this study evaluating an uncommon pain control intervention.
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Did increasing use of highly effective contraception contribute to declining abortions in Iowa?
M.A. Biggs, C.H. Rocca, C.D. Brindis, H. Hirsch, D. Grossman
Background: Between 2006 and 2008, Iowa increased access to family planning services through a Medicaid expansion and a privately funded initiative. During this same time, Iowa expanded access to abortion through telemedicine provision of medical abortion. Despite increased access to abortion services, abortions in Iowa have declined. This study assessed whether increased provision of long-acting reversible contraception (LARC) may have contributed to the abortion decline.
Conclusions: Declines in abortion followed increases in LARC use in Iowa.
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Administration of depot medroxyprogesterone acetate on the day of mifepristone for medical abortion: a pilot study
Sarita Sonalkar, Jessica McClusky, Melody Y. Hou, Lynn Borgatta
Objective: We sought to evaluate satisfaction with timing of administration and continuation rates of depot medroxyprogesterone (DMPA) when given on the initial visit for first-trimester medical abortion.
Implications: This pilot study provides groundwork for future larger studies to assess initiation of the injectable contraceptive DMPA on the day of mifepristone for medical abortion, but low continuation rates of DMPA in our sample emphasize the importance of access to intrauterine devices and implants after abortion.
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Acceptability and feasibility of phone follow-up with a semiquantitative urine pregnancy test after medical abortion in Moldova and Uzbekistan
Ingrida Platais, Tamar Tsereteli, Rodica Comendant, Dilfuza Kurbanbekova, Beverly Winikoff
Objective: To evaluate the feasibility and acceptability of phone follow-up with a home semiquantitative pregnancy test and standardized checklist, and compare the alternative method of follow-up with in-clinic follow-up after medical abortion.
Implications: The semiquantitative pregnancy test can make home follow-up after medical abortion possible for many women and provide reassurance that ongoing pregnancies will be detected.
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