Association of Reproductive Health Professionals
Association of Reproductive Health Professionals
Reproductive Health Topics Publications & Resources Professional Education Newsroom Membership Policy & Advocacy About Us
Contraception Journal
Send To A Friend Send To A Friend Bookmark this Page Share this page
Contraception Highlights April 2016

Clinical Guidelines

Cervical dilation before first-trimester surgical abortion (<14 weeks' gestation)
Rebecca H. Allen, Alisa B. Goldberg
Read abstract
Login to read full article

Original Research Articles

Women's experiences seeking abortion care shortly after the closure of clinics due to a restrictive law in Texas
Liza Fuentes, Sharon Lebenkoff, Kari White, Caitlin Gerdts, Kristine Hopkins, Joseph E. Potter, Daniel Grossman
Objective: In 2013, Texas passed legislation restricting abortion services. Almost half of the state's clinics had closed by April 2014, and there was a 13% decline in abortions in the 6 months after the first portions of the law went into effect, compared to the same period 1 year prior. We aimed to describe women's experiences seeking abortion care shortly after clinics closed and document pregnancy outcomes of women affected by these closures.
Implications: The restrictions on abortion facilities that resulted in the closure of clinics in Texas created significant burdens on women that prevented them from having desired abortions. These laws may also adversely affect public health by moving women who would have had abortions in the first trimester to having second-trimester procedures.
Read abstract
Login to read full article

Women's experiences after Planned Parenthood's exclusion from a family planning program in Texas
C. Junda Woo, Hasanat Alamgir, Joseph E. Potter
Objective: We assessed the impact on depot medroxyprogesterone continuation when a large care provider was banned from a state-funded family planning program.
Implications: Requiring low-income family planning patients to switch healthcare providers has adverse consequences.
Read abstract
Login to read full article

Maintenance of ovulation inhibition with a new progestogen-only pill containing drospirenone after scheduled 24-h delays in pill intake
Ingrid J.M. Duijkers, Doris Heger-Mahn, Dominique Drouin, Enrico Colli, Sven Skouby
Objectives: Traditional progestogen-only pills (POPs) have stringent daily timing and missed pill rules that might affect contraceptive reliability. A new-generation oestrogen-free pill has been developed, containing 4-mg drospirenone with a unique regimen of 24 active treatment days followed by four placebo tablets. A previous study showed that this new drospirenone-only pill effectively inhibited ovulation. Clinical efficacy, however, can be affected by compliance, and delayed or forgotten pill intake often occurs in daily life. The aim of this study was to investigate if inhibition of ovulation was maintained after four scheduled 24-h delays in tablet intake.
Implications: Delayed or forgotten pill intake is very common. Ovulation inhibition by the new-generation oestrogen-free pill, containing 4-mg drospirenone for 24 days followed by a 4-day treatment-free period, was maintained despite four 24-h delays in tablet intake, so the impact of delayed intake on contraceptive reliability will be low.
Read abstract
Login to read full article

A prospective, open-label, multicenter study to assess the pharmacodynamics and safety of repeated use of 30mg ulipristal acetate
C. Jesam, L. Cochon, A.M. Salvatierra, A. Williams, N. Kapp, D. Levy-Gompel, V. Brache
Objective: Ulipristal acetate (UPA) 30 mg is safe and effective for emergency contraception (EC). This prospective open-label exploratory study was conducted to obtain additional data on the pharmacodynamic effects of repeated dose of UPA 30 mg during an 8-week period (effects on ovulation inhibition, hormonal levels, endometrium and cervical mucus). Safety and tolerability data of repeated use of UPA EC were also collected.
Implications: These data demonstrate that repeated use of UPA 30 mg is safe. However, ovulation eventually occurs in a high proportion of women in spite of repeated treatments in both studied regimens. Nevertheless, since the stage of follicular development of women seeking initial or repeat EC use is generally unknown, the repeated use of UPA may still delay follicular rupture and prevent an unintended pregnancy in the event of further unprotected intercourse.
Read abstract
Login to read full article

The impact of short-term depot-medroxyprogesterone acetate treatment on resting metabolic rate
Ryan G. Steward, Lori A. Bateman, Cris Slentz, Frank Z. Stanczyk, Thomas M. Price
Objective: This study examines the effect of a progestogen (depot-medroxyprogesterone acetate, DMPA) on resting metabolic rate (RMR) in a cohort of young, normal-weight healthy women. We hypothesize an increase in RMR and nonshivering thermogenesis (NST) resulting in increased body temperature by DMPA.
Implication: DMPA increases RMR and thermogenesis independent of changes in body mass. An increase in weight with chronic DMPA may result from a combination of hyperphagia and abnormal NST in predisposed individuals.
Read abstract
Login to read full article

The effect of 7 days of letrozole pretreatment combined with misoprostol on the expression of progesterone receptor and apoptotic factors of placental and decidual tissues from first-trimester abortion: a randomized controlled trial
Sofie Shuk Fei Yung, Vivian Chi Yan Lee, Philip Chi Ngong Chiu, Hang Wun Raymond Li, Ernest Hung Yu Ng, William Shu Biu Yeung, Pak Chung Ho
Objective: To evaluate if letrozole-induced suppression of estradiol reduces progesterone receptor expression and apoptosis in the first-trimester placenta.
Implications: We did not confirm the hypothesis that letrozole reduces progesterone receptor expression and induces apoptosis in the first-trimester placenta. Further studies are required to allow better understanding of the mechanism by which estrogen suppression following the use of letrozole can lead to improved abortion rate in the first trimester.
Read abstract
Login to read full article

Feasibility of radiolabeled small molecule permeability as a quantitative measure of microbicide candidate toxicity
Jenell S. Coleman, Edward Fuchs, Wutyi S. Aung, Mark A. Marzinke, Rahul P. Bakshi, Hans M.L. Spiegel, Jennifer Robinson, Craig W. Hendrix
Objective: To determine the feasibility of using quantitative changes in vaginal permeability to small molecules as a measure of candidate microbicide toxicity.
Implications: Establishing the safety of both vehicle and active pharmaceutical ingredient is an essential task in microbicide development, to be determined as soon as possible. This study suggests that a combination of microbicide toxicity assessments, that is, cervicovaginal permeability, inspection and histopathology, may need to be studied simultaneously.
Read abstract
Login to read full article

Engineering and characterization of simplified vaginal and seminal fluid simulants
Rachna Rastogi, Jonathan Su, Alamelu Mahalingam, Justin Clark, Samuel Sung, Thomas Hope, Patrick F. Kiser
Background: Reported vaginal and seminal fluid simulants have complex compositions with multiple preparatory steps that contribute to physical instability. We report the design and characterization of stable and simplified buffers that mimic the salient physical/chemical properties of the physiological fluids.
Implications: To support research in reproductive health and in particular drug delivery, we have designed and characterized stable new media to mimic these important fluids that can be used in a variety of in vitro studies.
Read abstract
Login to read full article

Comparison of outcomes at 6weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case–control study
Vivek Yadav, Sudharsanam Balasubramaniam, Saswati Das, Ashish Srivastava, Ashish Srivastava, Somesh Kumar, Bulbul Sood
Objective: As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions — expulsion and infection — for physicians and nurses/midwives to generate evidence for task sharing.
Implications: Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.
Read abstract
Login to read full article

Intrauterine device placement at 3 versus 6weeks postpartum: a randomized trial
Maureen K. Baldwin, Alison B. Edelman, Jeong Y. Lim, Mark D. Nichols, Paula H. Bednarek, Jeffrey T. Jensen
Objective: To investigate whether early placement of an intrauterine device (IUD) at 3 weeks after delivery, compared to placement at 6 weeks, is associated with greater use at 3 months postpartum.
Implications: This study demonstrates that IUD placement as early as 3 weeks postpartum is feasible. Larger studies are needed to evaluate risks and benefits of IUD placement at this early interval. While earlier timing does not result in increased IUD uptake, early placement should be explored as an option since many women resume intercourse before 6 weeks.
Read abstract
Login to read full article

Discontinuation rates and acceptability during 1year of using the intrauterine ball (the SCu380A)
Ellen Wiebe, James Trussell
Objective: To characterize method-related discontinuation rates and acceptability over 1 year of SCu380A use.
Implications: More research is needed before we know if it is the spherical design, the size of the device or some other factor that led to the high expulsion rate. There are currently three different IUBs (12, 15 and 18 mm) approved and being investigated.
Read abstract
Login to read full article

One year quality of life measured with SEC-QoL in levonorgestrel 52mg IUS users
Ignacio Cristobal, Luis Ignacio Lete, Esther de la Viuda, Nuria Perulero, Agnes Arbat, Ignasi Canals
Objectives: The present study aims to prospectively evaluate quality of life (QoL) of women using 52-mg levonorgestrel intrauterine system (LNG-IUS) for contraception determined through the Sociedad Española de Contracepción (Spanish contraception Society) (SEC)-QoL, a questionnaire specifically designed to assess the impact of contraceptive methods on QoL of fertile women.
Implications: The present study prospectively evaluated QoL of women using LNG-IUS for contraception through the SEC-QoL questionnaire. Participants claimed increased QoL 12 months afterwards, implying that women using LNG-IUS for contraception in usual clinical practise also benefit from the reduction of period-related symptoms, overall leading to very low discontinuation rates.
Read abstract
Login to read full article

Letters to the Editor

Letter to the Editor, re: article “Factors influencing women’s satisfaction with surgical abortion” by Tilles, Denny, Cansino and Creinin
Monica R. McLemore, Sheila Desai, Evelyn Angel James, Diana Taylor
Login to read letter

Factors influencing women's satisfaction with surgical abortion — reply
Mitchell D. Creinin, Candice Tilles, Ashleigh Denny, Catherine Cansino
Login to read letter