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Contraception Journal
 
Contraception Highlights December 2015

Editorial

December 2015
Carolyn L. Westhoff
In this month's issue of Contraception, we publish 11 original research articles and 1 review paper about contraceptive implants and intrauterine devices (IUDs). This extraordinary number of papers regarding long-acting reversible contraception (LARC) methods is an accurate reflection of the increasing interest in using highly effective and long-acting methods.
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Review

Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review
Rebecca Callahan, Irina Yacobson, Vera Halpern, Kavita Nanda
Objective: Use of contraception lowers a woman's risk of experiencing an ectopic pregnancy. In the case of method failure, however, progestin-only contraceptives may be more likely to result in ectopic pregnancies than some other methods such as combined hormonal and barrier contraceptives.
Conclusion: Progestin-only contraceptive implants and injectables protect against ectopic pregnancy by being highly effective in preventing pregnancy overall; however, the absolute risk of ectopic pregnancy varies by type of progestin. Risk of ectopic pregnancy should not be a deterrent for use or provision of these methods.
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Original Research Articles

Characterization of Medicaid policy for immediate postpartum contraception
Michelle H. Moniz, Vanessa K. Dalton, Matthew M. Davis, Jane Forman, Bradley Iott, Jessica Landgraf, Tammy Chang
Objective: Long-acting reversible contraception (LARC) is safe, effective and cost-saving when provided immediately postpartum but currently underutilized due to nonreimbursement by Medicaid and other insurers. The objectives of this study were to (a) determine which state Medicaid agencies provide specific reimbursement for immediate postpartum LARC and (b) identify modifiable policy-level barriers and facilitators of immediate postpartum LARC access.
Implications: Medicaid policy for reimbursement of immediate postpartum LARC is evolving rapidly across the US. Our findings suggest several concrete strategies to remove policy-level barriers and promote facilitators of immediate postpartum LARC.
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Six-month and 1-year continuation rates following postpartum insertion of implants and intrauterine devices
Irene Woo, Sara Seifert, Dacia Hendricks, Roxanne M. Jamshidi, Anne E. Burke, Michelle C. Fox
Objective: Studies show immediate postpartum (PP) insertion increases use of contraceptive implants and intrauterine devices (IUDs). Our objective was to compare the satisfaction and continuation rates of the two types of devices at 6 months and 1 year following PP insertion.
Conclusions: Placement of implants and IUDs immediately PP can lead to high satisfaction. Despite early IUD expulsions, continuation rates were similar to those placed outside of the immediate PP period.
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Immediate postpartum initiation of etonogestrel-releasing implant: A randomized controlled trial on breastfeeding impact
Giordana Campos Braga, Eduardo Ferriolli, Silvana Maria Quintana, Rui Alberto Ferriani, Karina Pfrimer, Carolina Sales Vieira
Background: Breast milk volume has never been evaluated when the etonogestrel (ENG) implant was inserted immediately postpartum. Thus, this study evaluated if the immediate postpartum insertion of the ENG implant alters breast milk volume.
Implications: Considering the benefits of immediate postpartum initiation of ENG implant on reducing unintended pregnancy and pregnancy recurrence, especially in vulnerable populations, our study adds safety data on breastfeeding effect of this practice.
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Projections and opinions from 100 experts in long-acting reversible contraception
Diana Greene Foster, Rana Barar, Heather Gould, Ivette Gomez, Debbie Nguyen, M. Antonia Biggs
Objective: This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.
Implications: Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women’s reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use.
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Choice of the levonorgestrel intrauterine device, etonogestrel implant or depot medroxyprogesterone acetate for contraception after aspiration abortion
Jody E. Steinauer, Ushma D. Upadhyay, Abby Sokoloff, Cynthia C. Harper, Justin T. Diedrich, Eleanor A. Drey
Objective: Women who have abortions are at high risk of contraception discontinuation and subsequent unintended pregnancy. The objective of this analysis was to identify factors associated with choice of highly effective, long-acting, progestin-only contraceptive methods after abortion.
Implications: In contraceptive counseling, after screening for IPV, assessing patient’s stress and taking a history about past contraceptive use, clinicians should discuss whether these factors might affect a patient’s choice of method.
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Effects of initiating a contraceptive implant on subsequent condom use: A randomized controlled trial
Carole Rattray, Jeffrey Wiener, Jennifer Legardy-Williams, Elizabeth Costenbader, Karen Pazol, Natalie Medley-Singh, Margaret C. Snead, Markus J. Steiner, Denise J. Jamieson, Lee Warner, Maria F. Gallo, Tina Hylton-Kong, Athena P. Kourtis
Objective: To evaluate whether initiation of a contraceptive implant, a method of long-acting reversible contraception, reduces condom use, as measured by a biomarker of recent semen exposure [prostate-specific antigen (PSA)].
Implications: Sex unprotected by a condom was not higher over 3 months in women receiving a contraceptive implant, compared with those not receiving the implant.
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Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial
Nora Doty, Laura MacIsaac
Introduction: Intrauterine devices (IUDs) are used by only 5.6% of contraceptive users in the United States. One barrier to IUD uptake is fear of pain during insertion, particularly among nulliparous women. Many interventions to reduce pain during IUD insertion have proven unsuccessful. Comparisons of different tenaculae have not been previously reported.
Conclusion: This is the first randomized trial comparing tenaculae. There was no difference in reported pain, but the vulsellum may be associated with less bleeding than a single-tooth tenaculum. Women with higher preprocedure anxiety may experience more pain during IUD insertion. Future research could investigate an anxiolytic's effect on pain during IUD insertion.
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Acceptability of randomization to levonorgestrel versus copper intrauterine device among women requesting IUD insertion for contraception
Sharon L. Achilles, Beatrice A. Chen, Jessica K. Lee, Aileen M. Gariepy, Mitchell D. Creinin
Objective: Assess feasibility of randomizing women to intrauterine device (IUD) type.
Conclusions: Randomization to IUD type is feasible, and few women change their IUD.
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IUDs at 1year: predictors of early discontinuation
Karla Maguire, Sophie Joslin-Roher, Carolyn L. Westhoff, Anne R. Davis
Objective: To assess baseline dysmenorrhea and insertion-related pain as predictors of intrauterine device (IUD) removal within 1 year following insertion.
Conclusions: Preexisting dysmenorrhea may predict IUD removal within 1 year.
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A randomized controlled trial of daily text messages versus monthly paper diaries to collect bleeding data after intrauterine device insertion
Siripanth Nippita, Johana D. Oviedo, Margarita G. Velasco, Carolyn L. Westhoff, Anne R. Davis, Paula M. Castaño
Objective: Bleeding data in contraceptive trials are often collected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection.
Implications: Depending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.
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Controlled release of copper from an intrauterine device using a biodegradable polymer
Reshmi Ramakrishnan, Bharaniraja B, Abi Santhosh Aprem
Background: The adverse effects of copper intrauterine devices (IUDs) such as abnormal bleeding, pain and cramps may be due in part to the burst release of copper ions during the first few months of usage. This study focuses on controlling the initial burst release of copper ions.
Conclusion: Coating a CuT380 IUD with biodegradable polymer reduced the initial copper release without affecting release at 1 year. Clinical trials are required to determine whether this could reduce side effects such as bleeding and pain associated with copper containing IUDs.
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Unintended pregnancy among active-duty women in the United States military, 2011
Kate Grindlay, Daniel Grossman
Objectives: To estimate unintended pregnancy rates among a representative sample of active-duty women in the U.S. military aged 18–44 years in 2011.
Implications: Unintended pregnancy is high in the military, including during deployment; further efforts to improve evidence-based provision of contraception and education are needed.
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Meaning-making matters in product design: users’ sensory perceptions and experience evaluations of long-acting vaginal gels and intravaginal rings
Rochelle K. Rosen, Jacob J. van den Berg, Sara E. Vargas, Natali Senocak, Julia G. Shaw, Robert W. Buckheit Jr., Kelley Alison Smith, Kate Morrow Guthrie
Objective: Users’ sensory perceptions and experiences of intravaginal products can inform acceptability and adherence. Focusing on the meanings women derive from formulation/device characteristics facilitates developers’ design iterations toward optimizing user experience. We investigated how users of long-acting gels and intravaginal rings (IVRs) impute meaning to characteristics that may affect future product use.
Implications: Long-acting and sustained-release drug delivery systems will be part of the multipurpose prevention continuum. Developers must consider how sensory experiences and culturally salient assumptions shape the meanings users make of product design characteristics. Those meanings will ultimately impact use and effectiveness.
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Correspondence

Effect of obesity on the effectiveness of hormonal contraceptives
James Trussell, Abigail Aiken
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Response to Contraception Letter to the Editor (CONTRACEPTION_2015_94)
Michiyo Yamazaki, Kate Dwyer, Mahboob Sobhan, Daniel Davis, Myong-Jin Kim, Lisa Soule, Gerald Willett, Chongwoo Yu
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