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Contraception Journal
 
Contraception Highlights January 2016

Editorial

January 2016 editorial
Rebecca Allen, Carrie Cwiak
In 1996, the World Health Organization (WHO) published the first iteration of the Medical Eligibility Criteria for Contraceptive Use (MEC). The MEC goal is to decrease barriers to contraceptive use for women with chronic medical conditions by providing evidence-based guidelines regarding contraceptive safety for specific health conditions. WHO encouraged individual countries to adapt these guidelines to their own healthcare settings, and in 2010, the Centers for Disease Control and Prevention (CDC) executed this task for the United States (US).
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Reviews

Contraception in women with cystic fibrosis: a systematic review of the literature
Andrea Hsu Roe, Sarah Traxler, Courtney A. Schreiber
Objective: To perform a systematic review of the literature to examine original research on contraception in women with cystic fibrosis (CF) with a specific focus on safety, efficacy, non-contraceptive benefits, and utilization patterns in this population.
Conclusions: Data on the safety, efficacy, and non-contraceptive benefits of hormonal contraception in women with CF are scant. Based on the limited data, hormonal contraception seems to be safe and efficacious and may provide noncontraceptive benefits. Further high-quality data from disease-specific research are required to better inform contraceptive decision-making among women with CF.
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The safety of hormonal contraceptives for women living with HIV and their sexual partners
Sharon J. Phillips, Chelsea B. Polis, Kathryn M. Curtis
Background: Hormonal contraceptives are important for the health and well-being of some women living with HIV, so evaluation of evidence regarding their safety vis-à-vis HIV-related risks is important.
Conclusions: Hormonal contraceptive methods do not appear to accelerate HIV disease progression. More research is needed to clarify whether HC impacts HIV transmissibility.
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Original Research Articles

Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness
Maura K. Whiteman, Gary Jeng, Anna Samarina, Natalia Akatova, Margarita Martirosyan, Dmitry M. Kissin, Kathryn M. Curtis, Polly A. Marchbanks, Susan D. Hillis, Michele G. Mandel, Denise J. Jamieson
Objective: To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness.
Implications: Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.
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Oral and injectable contraceptive use and HIV acquisition risk among women in four African countries: a secondary analysis of data from a microbicide trial
Jennifer E. Balkus, Elizabeth R. Brown, Sharon L. Hillier, Anne Coletti, Gita Ramjee, Nyaradzo Mgodi, Bonus Makanani, Cheri Reid, Francis Martinson, Lydia Soto-Torres, Salim S. Abdool Karim, Zvavahera M. Chirenje
Objective: To assess the effect of oral and injectable contraceptive use compared to nonhormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial.
Implications: Among Southern African women participating in an HIV prevention trial, women using injectable hormonal contraceptives had a modest increased risk of HIV acquisition; however, this association was not statistically significant. Continued research on the relationship between widely used hormonal contraceptive methods and HIV acquisition is essential.
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Multipurpose prevention technologies for sexual and reproductive health: mapping global needs for introduction of new preventive products
Erin Schelar, Chelsea B. Polis, Timothy Essam, Katharine J. Looker, Laia Bruni, Cara J. Chrisman, Judy Manning
Objectives: Worldwide, women face sexual and reproductive health (SRH) risks including unintended pregnancy and sexually transmitted infections (STIs) including HIV. Multipurpose prevention technologies (MPTs) combine protection against two or more SRH risks into one product. Male and female condoms are the only currently available MPT products, but several other forms of MPTs are in development. We examined the global distribution of selected SRH issues to determine where various risks have the greatest geographical overlap.
Implications: MPTs are products in development with the potential to empower women to prevent two or more SRH risks. Geographic analysis of overlapping SRH risks demonstrates particularly high need in Sub-Saharan Africa. This study can help to inform strategic planning for MPT introduction, market segmentation and demand generation.
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Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar
Alison B. Comfort, Slavea Chankova, Randall Juras, C. Natasha Hsi, Lauren A. Peterson, Payal Hathi
Objectives: To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs.
Implications: No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs’ services.
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Body mass index does not affect the efficacy or bleeding profile during use of an ultra-low-dose combined oral contraceptive
Steven T. Nakajima, Jennifer Pappadakis, David F. Archer
Objectives: Safe and effective contraceptive options for obese women are becoming more important due to the obesity epidemic within the United States. This study evaluated the impact of body mass index (BMI) on efficacy, safety and bleeding patterns during use of an ultra-low-dose combined oral contraceptive (COC).
Implications: Our analysis of an ultra-low ethinyl estradiol dose COC did not find clinically important differences in contraceptive failure rates, adverse events or bleeding profile with increasing BMI. An ultra-low-dose COC provides another safe and effective contraceptive option for obese women.
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Impact on hepatic estrogen-sensitive proteins by a 1-year contraceptive vaginal ring delivering Nestorone® and ethinyl estradiol
D.F. Archer, M.A. Thomas, J. Conard, R.B. Merkatz, G.W. Creasy, K. Roberts, M. Plagianos, D. Blithe, R. Sitruk-Ware
Objectives: Estrogen-sensitive hepatic proteins were assessed in women using a contraceptive vaginal ring (CVR) delivering 150 mcg Nestorone® (NES) and 15 mcg ethinyl estradiol (EE).
Implications: Recent use of CHCs demonstrated significant changes in all four measured hepatic proteins at baseline compared to nonusers. Use of the NES/EE CVR further changed these hepatic protein markers, but values remained within the normal range. Prebaseline exposure to estrogen can obscure interpretation of hepatic proteins changes associated with a second CHC.
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Effect of oral contraceptives and doxycycline on endometrial MMP-2 and MMP-9 activity
Bliss Kaneshiro, Alison Edelman, Chandravanu Dash, Jui Pandhare, Faapisa M. Soli, Jeffrey T. Jensen
Objectives: To describe the effect of combined oral contraceptives (COCs) on matrix metalloproteinases MMP-2 and MMP-9 activity and compare MMP activity in women taking a COC with or without doxycycline.
Conclusions: Unscheduled bleeding with COCs may be the result of increased endometrial MMPs. Sample size limitations prevent us from determining how doxycycline affects MMP activity in COC users.
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Clotting factor changes during the first cycle of oral contraceptive use
Carolyn L. Westhoff, Andrew Eisenberger, Rosalind Tang, Serge Cremers, Lisa V. Grossman, Malcolm C. Pike
Objectives: The risk of venous thromboembolism (VTE) is highest during the initial months of oral contraceptive (OC) use. We sought to evaluate the extent of hemostatic variable changes during the initial OC cycle and if such changes are related to systemic ethinyl estradiol (EE2) exposure.
Implications: This study showed that increases in D-dimer are clearly evident in the first cycle of OC use and may be larger than are seen after a longer duration of use and thus provide biological support for the increased VTE risk during initial OC use found in epidemiological studies.
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An educational intervention on drug interactions and contraceptive options for epilepsy patients: a pilot randomized controlled trial
Sheila K. Mody, Carolyn Haunschild, John Paul Farala, Gordon Honerkamp-Smith, Vivian Hur, Leena Kansal
Objective: This pilot study investigates whether an educational handout could increase short-term information retention about drug interactions between antiepileptic drugs (AEDs) and hormonal contraceptives among female epilepsy patients of reproductive age.
Implications: This pilot study highlights the need for further larger studies to evaluate the impact of educational interventions on improving patient knowledge about the drug interaction of AEDs and hormonal contraceptives.
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Case Report

Transmural migration and perforation of a levonorgestrel intrauterine system: a case report and review of the literature
Carrie Anne Ferguson, Dustin Costescu, Mary Anne Jamieson, Lisa Jong
Introduction: Uterine perforation is an uncommon yet well-known complication of copper intrauterine devices and the levonorgestrel intrauterine system (IUS). While initial extrauterine placement at the time of insertion is felt to be the cause of perforation in most cases, some hypothesize that delayed transmural migration and subsequent perforation can occur with slightly malpositioned or even properly placed devices.
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Erratum

Erratum for “Misoprostol in women's hands: a harm reduction strategy for unsafe abortion" Contraception 2013 Feb; 87(2): 128–130
Alyson Hyman, Kelly Blanchard, Francine Coeytaux, Daniel Grossman, Alexandra Teixeira
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