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Contraception Journal
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Contraception Highlights April 2017

Commentaries

Removing barriers to contraception through use of criteria to assess pregnancy risk
Naomi K. Tepper, Kathryn M. Curtis, Tara C. Jatlaoui, Maura K. Whiteman
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Proposed clinical guidance for excluding pregnancy prior to contraceptive initiation
John Stanback, Irina Yacobson, Lucy Harber
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Does using the “pregnancy checklist” delay safe initiation of contraception? Chelsea Morroni, Molly Findley, Carolyn Westhoff
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Immediate postpartum long-acting reversible contraception: the time is now
Michelle Moniz, Tammy Chang, Michele Heisler, Vanessa K. Dalton
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Review

Pharmacy provision of sexual and reproductive health commodities to young people: a systematic literature review and synthesis of the evidence
Lianne Gonsalves, Michelle J. Hindin
Background: We conducted a systematic review of peer-reviewed literature on youth access to, use of and quality of care of sexual and reproductive health (SRH) commodities through pharmacies.
Discussion: With training and support, pharmacy personnel can serve as critical SRH resources to young people. Further research is needed to better understand how to capitalize on the potential of pharmacy provision of SRH commodities to young people without sacrificing qualities which make pharmacies so appealing to young people in the first place.
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Original Research Articles

Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants
Molly Richards, Stephanie B. Teal, Jeanelle Sheeder
Objectives: To determine rates of luteal phase pregnancy (LPP) in young women initiating subdermal implants on any day of the menstrual cycle.
Implications: Adopting a protocol of contraceptive implant placement that includes insertion on any cycle day with a negative pregnancy test, and EC as indicated, does not increase the risk of luteal phase pregnancies, even in a young population with complex reproductive behaviors and challenging historical narratives.
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A single-arm phase III study exploring the efficacy and safety of LNG-IUS 8, a low-dose levonorgestrel intrauterine contraceptive system (total content 13.5 mg), in an Asia-Pacific population
Guangsheng Fan, Sukho Kang, Mulan Ren, Edith Weisberg, Eeva Lukkari-Lax, Katrin Roth, SoYoung Shin
Objective: The objective was to evaluate the efficacy and safety of a low-dose levonorgestrel intrauterine system with total content 13.5 mg (average approximately 8 μg/24 h over the first year; LNG-IUS 8; Jaydess®) in an Asia-Pacific population.
Implications: In this phase III study, LNG-IUS 8 was shown to be highly effective and well tolerated in an Asia-Pacific population and was not associated with any new or unexpected safety events. LNG-IUS 8 provides another contraceptive option for women in the Asia-Pacific region.
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Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series
P.S. Huguelet, C. Sheehan, R.F. Spitzer, S. Scott
Abstract: This case series reports on the safety and efficacy of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients. All patients used the device for contraception, with no documented cases of disseminated pelvic infection or unplanned pregnancy.
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Changes in body composition in women using long-acting reversible contraception
Priscilla de Nazaré Silva dos Santos, Tessa Madden, Karen Omvig, Jeffrey F. Peipert
Objective: Users of hormonal long-acting reversible contraception (LARC) report weight gain as a side effect, but few studies have assessed body composition change among LARC users. We evaluated weight and body composition of healthy women using the levonorgestrel intrauterine system (LNG-IUS), copper intrauterine device (copper IUD) or etonogestrel implant (ENG implant). We hypothesized that weight gain and body composition over 12 months would not differ between copper IUD, LNG-IUS and ENG implant users.
Implication statement: Changes in body weight and composition over 12 months did not differ between copper IUD users and LNG-IUS and ENG implant users among those with 12 months of continuous use.
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Pooled analysis of two randomized, open-label studies comparing the effects of nomegestrol acetate/17β-estradiol and drospirenone/ethinyl estradiol on bleeding patterns in healthy women
Diana Mansour, Carolyn Westhoff, Uma Kher, Tjeerd Korver
Objectives: To obtain more precise and detailed information regarding the bleeding patterns of nomegestrol acetate (NOMAC)/17β-estradiol (E2) and drospirenone/ethinyl estradiol (DRSP/EE) and to identify whether baseline demographic characteristics were associated with unscheduled bleeding, absent scheduled bleeding, or amenorrhea.
Implications: Information about the factors associated with bleeding patterns may help clinicians provide guidance to women considering use of the NOMAC/E2 oral contraceptive.
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Estimating systemic exposure to levonorgestrel from an oral contraceptive
Cale N. Basaraba, Carolyn L. Westhoff, Malcolm C. Pike, Renu Nandakumar, Serge Cremers

Objective: The gold standard for measuring oral contraceptive (OC) pharmacokinetics is the 24-h steady-state area under the curve (AUC). We conducted this study to assess whether limited sampling at steady state or measurements following use of one or two OCs could provide an adequate proxy in epidemiological studies for the progestin 24-h steady-state AUC of a particular OC.
Implications: A single time-point LNG concentration at steady state is an excellent proxy for complete and resource-intensive steady-state AUC measurement. The trough level after two single doses is a fair proxy for steady-state AUC. These results provide practical tools to facilitate large studies to investigate the relationship between systemic LNG exposure and side effects in a real-life setting.
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Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome
J. Paul Brooks, David J. Edwards, Diana L. Blithe, Jennifer M. Fettweis, Myrna G. Serrano, Nihar U. Sheth, Jerome F. Strauss III, Gregory A. Buck, Kimberly K. Jefferson
Objectives: Prior studies suggest that the composition of the vaginal microbiome may positively or negatively affect susceptibility to sexually transmitted infections (STIs) and bacterial vaginosis (BV). Some female hormonal contraceptive methods also appear to positively or negatively influence STI transmission and BV. Therefore, changes in the vaginal microbiome that are associated with different contraceptive methods may explain, in part, effects on STI transmission and BV.
Implications: COC use may positively influence gynecologic health through an increase in healthy lactobacilli and a decrease in BV-associated bacterial taxa.
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“I don’t know what I would have done.” Women's experiences acquiring ulipristal acetate emergency contraception online from 2011 to 2015
Nicole K. Smith, Kelly Cleland, Brandon Wagner, James Trussell
Objectives: This study describes women's reasons for seeking ulipristal acetate (UPA) for emergency contraception (EC) through the only authorized online retailer for UPA EC in the US.
Implications: Though physical, logistical and societal barriers can restrict women's access to EC, this study demonstrates that providing access to UPA online empowers women to obtain EC when they need it.
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Similarities and differences in contraceptive use reported by women and men in the National Survey of Family Growth
Abigail RA Aiken, Yu Wang, Jenny Higgins, James Trussell
Objective: To compare use of contraceptive methods at last heterosexual intercourse among 15–44 year-old women and men at risk of unintended pregnancy in the United States.
Implications: Characterizing the determinants of contraceptive use among men and the relationship of men's pregnancy intentions, feelings and desires to contraceptive use are important future research goals. To ensure valid results, researchers must be aware of the potential for underreporting of method use among men, particularly with respect to female sterilization.
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Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?
Jennifer A. Smith, Renee Heffron, Ailsa R. Butler, Connie Celum, Jared M. Baeten, Timothy B. Hallett

Objective: Some observational studies have suggested an association between the use of hormonal contraceptives (HC) and HIV acquisition. One major concern is that differential misreporting of sexual behavior between HC users and nonusers may generate artificially inflated risk estimates.
Implications: Considerably differential amounts of condom use misreporting by HC users and nonusers would be needed to produce entirely spurious observed levels of excess HIV acquisition risk among HC users when there is actually no true association.
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Contraception and postpartum follow-up in patients with gestational diabetes
Emily W. Rosenthal, Sarah Rae Easter, Emma Morton-Eggleston, Caryn Dutton, Chloe Zera
Objectives: We sought to review the effect of immediate provision of postpartum contraception on postpartum follow-up and screening for type 2 diabetes in women with gestational diabetes mellitus (GDM).

Conclusion: Receiving contraception while admitted postpartum did not affect follow-up for diabetes screening for women with GDM.
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Correspondence

Comments on manuscript: vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section: a randomized double-blind clinical trial
Luis Bahamondes, Ilza Monteiro
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Vaginal misoprostol prior to intrauterine device insertion in women delivered only by elective cesarean section — reply to letter to the editor
Ahmed M. Abbas, Mohamed S. Abdellah
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Revisiting contraceptive steroid hormone pharmacokinetics in obese women
Alison B Edelman, Ganesh Cherala, Jeffrey T Jensen
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