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Contraception Journal
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Contraception Highlights March 2015

Original Research Articles

Rationale and enrollment results for a partially randomized patient preference trial to compare continuation rates of short-acting and long-acting reversible contraception
David Hubacher, Hannah Spector, Charles Monteith, Pai-Lien Chen, Catherine Hart
Objectives: Most published contraceptive continuation rates have scientific limitations and cannot be compared; this is particularly true for dissimilar contraceptives. This study uses a new approach to determine if high continuation rates of long-acting reversible contraception (LARC) and protection from unintended pregnancy are observable in a population not self-selecting to use LARC.
Implications: This PRPPT will provide new estimates of contraceptive continuation rates, such that any benefits of LARC will be more easily attributable to the technology and not the user. Combined with measuring level of satisfaction with LARC, the results will help project the potential role and benefits of expanding voluntary use of LARC.
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Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial
Paula H. Bednarek, Mitchell D. Creinin, Matthew F. Reeves, Carrie Cwiak, Eve Espey, Jeffrey T. Jensen, Post-Aspiration IUD Randomization (PAIR) Study Trial Group
Objective: To evaluate if ibuprofen 800 mg reduces pain with intrauterine device (IUD) insertion among U.S. women.
Conclusions: Administration of ibuprofen 800 mg prior to IUD insertion does not reduce pain associated with the procedure for U.S. women. Overall, nulliparous women report more pain with IUD insertion than multiparous women.
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Intracesarean insertion of the Copper T380A versus 6 weeks postcesarean: a randomized clinical trial
Felicia Lester, Othman Kakaire, Josaphat Byamugisha, Sarah Averbach, Jennifer Fortin, Rie Maurer, Alisa Goldberg
Objectives: To compare rates of Copper T380A intrauterine device (IUD) utilization and satisfaction with immediate versus delayed IUD insertion after cesarean delivery in Kampala, Uganda.
Implications: This work is important because it shows the safety and efficacy of providing IUDs during cesarean section in a setting where access to any healthcare, including contraception, can be extremely limited outside of childbearing and the consequences of an unintended, closely spaced pregnancy after a cesarean section can be life threatening.
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Self-reported and verified compliance in a phase 3 clinical trial of a novel low-dose contraceptive patch and pill
Andrew M. Kaunitz, David Portman, Carolyn L. Westhoff, David F. Archer, Daniel R. Mishell, Marie Foegh
Objective: Pregnancy rates in US contraceptive clinical trials are increasing due to decreased treatment compliance. This study compared compliance with a new low-dose levonorgestrel (LNG) and ethinyl estradiol (EE) contraceptive patch (CP, Twirla™) with that of a low-dose combination oral contraceptive (COC) in a demographically diverse population.
Implications statement: This paper, based on an analysis of a phase 3 trial, shows that compliance was significantly greater with a new weekly transdermal CP than with a once-daily COC in obese as well as nonobese participants. Discrepancies between self-reported compliance and laboratory-verified compliance raise questions regarding the reliability of patient diaries.
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New contraceptive patch wearability assessed by investigators and participants in a randomized phase 3 study
Andrew M. Kaunitz, David Portman, Carolyn L. Westhoff, Daniel R. Mishell, David F. Archer, Marie Foegh
Objective: To evaluate skin irritation and patch adhesiveness of a new weekly low-dose levonorgestrel (LNG) and ethinyl estradiol (EE) contraceptive patch (LNG/EE patch).
Implication statement: This secondary analysis of a phase 3 clinical trial of a new weekly low-dose LNG and EE contraceptive patch, which used assessment by both investigators and participants, observed a low incidence of skin irritation, pruritus and patch detachment.
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Barriers to and enablers of contraceptive use among adolescent females and their interest in an emergency department based intervention
Lauren S. Chernick, Rebecca Schnall, Tracy Higgins, Melissa S. Stockwell, Paula M. Castaño, John Santelli, Peter S. Dayan
Objective: Over 15 million adolescents, many at high risk for pregnancy, use emergency departments (EDs) in the United States annually, but little is known regarding reasons for failure to use contraceptives in this population. The purpose of this study was to identify the barriers to and enablers of contraceptive use among adolescent females using the ED and determine their interest in an ED-based pregnancy prevention intervention.
Implications: Adolescents who visit the emergency department (ED) identify contraceptive side effects, mistrust in contraceptives, limited access, pregnancy ambivalence and partner pregnancy desires as barriers to hormonal contraception use. They expressed interest in an ED-based intervention to prevent adolescent pregnancy; such an intervention could target these themes to maximize effectiveness.
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Exploring abortion attitudes of US adolescents and young adults using social media
Anna L. Altshuler, Helen L. Gerns Storey, Sarah W. Prager
Objectives: To explore the use of social media for recruitment of adolescents and young adults in the United States and to describe how they learn and feel about abortion.
Implications: Web-based social media offer a novel recruiting strategy to study sensitive topics such as abortion attitudes among difficult-to-reach populations such as adolescents and young adults. The presented findings begin characterizing young people’s abortion attitudes, offering a foundation for more in-depth research.
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Grief after second-trimester termination for fetal anomaly: a qualitative study
Marguerite Maguire, Alexis Light, Miriam Kuppermann, Vanessa K. Dalton, Jody E. Steinauer, Jennifer L. Kerns
Objectives: We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time.
Implications: The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients’ suffering and offer tools to direct their grief toward positive coping.
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Effectiveness of in vitro fertilization in women with previous tubal sterilization
Eva Malacova, Anna Kemp, Roger Hart, Khadra Jama-Alol, David B. Preen
Objective: The objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization.
Conclusions: In vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.
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Oral contraceptive use and saliva diurnal pattern of metabolic steroid hormones in young healthy women
N. Vibarel-Rebot, N. Rieth, F. Lasne, C. Jaffré, K. Collomp
Objective: The impact of oral contraceptives (OCs) on the saliva diurnal pattern of metabolic steroid hormones remained unknown.
Conclusion: The clinical relevance requires further study.
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Sino-implant (II)® continuation and effect of concomitant tenofovir disoproxil fumarate-emtricitabine use on plasma levonorgestrel concentrations among women in Bondo, Kenya
Catherine S. Todd, Jennifer Deese, Meng Wang, David Hubacher, Markus J. Steiner, Sheila Otunga, Lut Van Damme, FEM-PrEP Study Group
Objective: The objective was to assess associations between tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) exposure and levonorgestrel (LNG) concentrations among Kenyan HIV prevention trial participants using Sino-implant (II) LNG implants for contraception.
Conclusion: Concomitant TDF-FTC use was not associated with a significant change in plasma LNG concentrations among women using Sino-implant (II) in the first year of use.
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Mass spectrometry identification of potential mediators of progestin-only contraceptive-induced abnormal uterine bleeding in human endometrial stromal cells
John P. Shapiro, Murat Basar, Umit A. Kayisli, Ozlem Guzeloglu-Kayisli, S. Joseph Huang, Adrian A. Suarez, Hatice Gulcin Ozer, Frederick Schatz, Charles J. Lockwood
Objective: Thrombin and hypoxia each target human endometrial stromal cells (HESCs) to mediate long-acting progestin-only contraceptive (LAPC)-induced abnormal uterine bleeding (AUB). Thus, the secretome resulting from treatment of primary cultures of HESCs with thrombin or hypoxia was screened by mass spectrometry (MS) to detect potential protein mediators that lead to AUB.
Implications: MS identified several HESC secreted proteins deregulated by thrombin and hypoxia that may mediate LAPC-induced AUB. The revelation of overexpressed STC-1 by combined in vivo and in vitro observations identifies a potential target for future studies to prevent or minimize LAPC-induced AUB.
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Case Report

Rectal perforation with an intrauterine device: a case report
Courtney Eichengreen, Haley Landwehr, Lisa Goldthwaite, Kristina Tocce
A 27-year-old woman presented for routine examination 1 year after intrauterine device (IUD) placement; strings were not visualized. The device was found to be penetrating through the rectal mucosa. It was removed easily through the rectum during an examination under anesthesia. Perforated IUDs with rectal involvement require thoughtful surgical planning to optimize outcomes.
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Letters to the Editor

Letter to the Editor re: article: “A systematic review of the safety, efficacy and acceptability of task sharing tubal sterilization to mid-level providers” by Rodriguez and Gordon-Maclean (Epub)
Diana Taylor, Amy J. Levi
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Informed choice in family planning: what do women want to know?
C. Lopez-del Burgo, A. Osorio, J. de Irala
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Thanks to reviewers
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