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Contraception Journal
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Contraception Highlights October 2016

Commentary

Moving towards the goals of FP2020 — classifying contraceptives
Mario Philip R. Festin, James Kiarie, Julie Solo, Jeffrey Spieler, Shawn Malarcher, Paul F.A. Van Look, Marleen Temmerman
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Review

The birth control pill, thromboembolic disease, science and the media: a historical review of the relationship
Elyse Lackie, Amy Fairchild
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Original Research Articles

Interest in self-administration of subcutaneous depot medroxyprogesterone acetate in the United States
Ushma D. Upadhyay, Vera M. Zlidar, Diana Greene Foster
Objective: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a low-dose formulation of depot medroxyprogesterone acetate (DMPA) that nonmedical personnel can administer safely and effectively. We sought to determine United States women's interest in self-administration of DMPA-SC to understand whether such use can overcome barriers to contraceptive access.
Implications: There is substantial interest in self-administration of DMPA-SC among current DMPA users, women who have recently had an abortion and women reporting difficulty returning to a family planning provider. Offering self-administration of DMPA-SC could potentially increase contraceptive continuation, reduce unintended pregnancies and enhance reproductive autonomy among DMPA users.
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The role of training in effective simulated self-injection of subcutaneous depot medroxyprogesterone acetate: observations from a usability study
Irina Kaplan, Douglas Ross, Fiona Hilton, Diana Morgenstern, Kevin Wolter
Objectives: The need for quarterly clinic visits is a barrier to use of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) contraception. The ability to self-inject at home may enhance method acceptance. Since efficacy depends on proper administration, we evaluated whether women could correctly perform simulated injections of DMPA-SC in a Uniject™ injection system using printed Instructions for Use (IFU), with and without hands-on training.
Implications: After initial training, women performed simulated self-injections of DMPA-SC in the Uniject system proficiently using printed instructions. Women who are motivated and demonstrate competent injection technique during training can be relied upon to self-inject correctly at home. DMPA-SC users not suitable for self-injection should continue receiving injections at the clinic.
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The Effect of Depo Medroxyprogesterone Acetate (DMPA) on Cerebral Food Motivation Centers: A Pilot Study using Functional Magnetic Resonance Imaging
Tania Basu, Pinglei Bao, Alexander Lerner, Lindsey Anderson, Kathleen Page, Frank Stanczyk, Daniel Mishell Jr., Penina Segall-Gutierrez
Objective: The primary objective is to examine activation of food motivation centers in the brain before and 8 weeks after depo medroxyprogesterone acetate (DMPA) administration.
Implications: These data support a neural origin as one of the mechanisms underlying weight gain in DMPA users and may guide future research examining weight gain and contraception.
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Impact of estrogen type on cardiovascular safety of combined oral contraceptives
Jürgen Dinger, Thai Do Minh, Klaas Heinemann
Objectives: The International Active Surveillance study “Safety of Contraceptives: Role of Estrogens” (INAS-SCORE) investigated the cardiovascular risks associated with the use of a combined oral contraceptive (COC) containing dienogest and estradiol valerate (DNG/EV) compared to established COCs in a routine clinical setting.
Implication Statement: A COC containing DNG and EV is associated with similar or even lower cardiovascular risk compared to COCs containing levonorgestrel or other progestogens.
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Four aspects of the scope and quality of family planning services in US publicly funded health centers: Results from a survey of health center administrators
Marion W. Carter, Loretta Gavin, Lauren B. Zapata, Marta Bornstein, Nancy Mautone-Smith, Susan B. Moskosky
Objectives: This study aims to describe aspects of the scope and quality of family planning services provided by US publicly funded health centers before the release of relevant federal recommendations.
Implication Statement: As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess change as implementation of recent family planning service recommendations continues.
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Advancing non-directive pregnancy options counseling skills: A pilot Study on the use of blended learning with an online module and simulation
Carla Lupi, Melissa Ward-Peterson, Winnie Chang
Objective: Limitations on didactic time pose barriers to teaching non-directive pregnancy options counseling. This study set out to explore the use of an online module to support trainee performance in a pregnancy options counseling standardized-patient exercise implemented among third-year medical students, and to examine the effect of clinical experience on student performance.
Implications: Students agreed that an online module facilitates simulated performance of non-directive pregnancy options counseling skills. Future work should compare the impact of this approach to others, and explore the additional training needed to maintain and build on initial learning.
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Levonorgestrel release rates over 5 years with the Liletta® 52-mg intrauterine system Mitchell D. Creinin, Rolf Jansen, Robert M. Starr, Joga Gobburu, Mathangi Gopalakrishnan, Andrea Olariu
Objective: To understand the potential duration of action for Liletta®, we conducted this study to estimate levonorgestrel (LNG) release rates over approximately 5½ years of product use.
Implications Statement: Liletta LNG content and release rates are comparable to published data for another LNG 52-mg IUS. The release rate at 5 years is more than double the published release rate at 3 years with an LNG 13.5-mg IUS, suggesting continued efficacy of Liletta beyond 5 years.
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“She just told me to leave it”: Women's experiences discussing early elective IUD removal
Jennifer R. Amico, Ariana H. Bennett, Alison Karasz, Marji Gold
Objective: The objective of this study is to describe the thoughts and experiences of women who report discussing intrauterine device (IUD) removal within 9 months of insertion.
Implications: Though IUDs are highly effective and well-liked contraceptives, some patients choose to discontinue the method. Because provision of patient-centered contraceptive care includes IUD removal when requested, providers must ensure that their counseling is unbiased and that they do not place perceived or real barriers to IUD removal.
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Safety and efficacy of the NuvaRing® Applicator in healthy females: a multicenter, open-label, randomized, 2-period crossover study
Robert Feldman, Tara L. Frenkl, Carol Yacik, Yinna Wang, Michelle C. Fox
Introduction: We assessed performance and safety of the NuvaRing® Applicator.
Conclusion: NuvaRing Applicator is effective and well-tolerated (NCT02275546).
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Bleeding pattern and cycle control with estetrol-containing combined oral contraceptives: results from a phase II, randomised, dose-finding study (FIESTA)
Dan Apter, Yvette Zimmerman, Louise Beekman, Marie Mawet, Catherine Maillard, Jean-Michel Foidart, Herjan J.T. Coelingh Bennink
Objectives: This study aims to assess vaginal bleeding patterns and cycle control of oral contraceptives containing estetrol (E4) combined with either drospirenone (DRSP) or levonorgestrel (LNG).
Implications: Due to its favourable bleeding pattern and cycle control, the 15 mg E4/DRSP combination is the preferred combination for further phase III clinical development.
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Correspondence

The pitfalls of using selective data to represent the effectiveness, relevance and utility of the Standard Days Method (SDM) of contraception
Kelsey Q. Wright, Karen Hardee, John W. Townsend
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Standard Days Method effectiveness: opinion disguised as scientific review
Irit Sinai
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Response to Letters to the Editor from Irit Sinai “Standard Days Method Effectiveness: opinion disguised as scientific review” and Kelsey Wright, Karen Hardee, and John Townsend “The pitfalls of using selective data to represent the effectiveness, relevance and utility of the Standard Days Method of contraception”
Cicely Marston, Kathryn Church
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Mifepristone by prescription: not quite a reality in the Northern Territory of Australia
Suzanne Belton, Ea Mulligan, Felicity Gerry, Paul Hyland, Virginia Skinner
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Reply to: “mifepristone by prescription: not quite a reality in Australia”
Daniel Grossman, Philip Goldstone
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Questions to the LASS study group
Øjvind Lidegaard
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Reply to letter to the editor: “questions to the LASS study group”
Jürgen Dinger
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Conference Abstracts

North American Forum on Family Planning Scientific Abstracts
The Society of Family Planning, Planned Parenthood Federation of America and the Association of Reproductive Health Professionals are delighted to host the sixth annual North American Forum on Family Planning (the Forum) in Denver, CO, from November 5 to 7, 2016. The Forum is an opportunity to hear the latest in research in family planning and abortion, where investigators in the areas of contraception, abortion and reproductive health present and discuss results of new studies that help us think about family planning and abortion care in innovative ways.
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