Appropriate follow up to detect potential adverse events after initiation of select contraceptive methods: a systematic review

Combined hormonal contraceptive use among women with known dyslipidemias: a systematic review of critical safety outcomes

Background This review was conducted to evaluate the evidence regarding the safety and effectiveness of intrauterine device (IUD) insertion immediately following spontaneous or induced abortion. Study Design We searched MEDLINE databases for all articles (in all languages) published in peer-reviewed journals from January 1966 through March 2010 for evidence comparing immediate postabortion IUD insertion with either no IUD insertion, insertion at a different time, insertion following first-trimester compared with second-trimester abortion or copper IUD insertion compared with hormone-releasing IUD insertion postabortion. We used standard abstraction forms to summarize and assess the quality of the evidence. Results The search strategy identified a total of 990 articles, of which 19 met our inclusion criteria for this review. Studies comparing immediate postabortion IUD insertion with no IUD insertion found that both groups experienced similar rates of pain and infection and a similar number of bleeding days, but one study reported that women with copper IUD insertion experienced a greater amount of bleeding than women without IUD insertion after abortion. Results from studies comparing immediate postabortion IUD insertion and insertion at a time not associated with pregnancy did not report differences between the two groups in the duration of bleeding, pain, expulsions or pelvic inflammatory disease (PID). One study however reported a greater amount of bleeding and another reported more removals for medical reasons among women with postabortion IUD insertion. Evidence from studies that examined immediate vs. delayed postabortion insertion reported minimal differences in bleeding, pain, expulsion and PID between groups. Studies comparing immediate IUD insertion after first- vs. second-trimester abortion reported no difference in removals for pain and bleeding, and an increased risk of expulsion among those women who had insertions after second-trimester abortion. In addition, women with insertions immediately after abortions occurring later in the first trimester had higher expulsion rates than those with insertions after early first-trimester abortions. Studies examining women using a copper IUD compared with a hormone-releasing IUD reported inconsistent results, with one paper reporting more bleeding days in the copper IUD group and another finding higher rates of removal for bleeding in the progesterone-releasing IUD group. Conclusion Intrauterine device insertion immediately after abortion is not associated with an increased risk of adverse outcomes compared with use of other contraceptive methods or with no IUD insertion after abortion and compared with IUD insertion at times other than immediately after abortion. Intrauterine device expulsion rates, while generally low, were higher with insertions that occurred after later first-trimester abortion compared with after early first-trimester abortion and higher with IUD insertion after second-trimester abortion compared with after first-trimester abortion.

Combined hormonal contraceptive use among obese women and risk for cardiovascular events: A systematic review

Nonoral combined hormonal contraceptives and thromboembolism: a systematic review

To evaluate the relationship between Neisseria gonorrhea and Chlamydia trachomatis screening strategies and risk of pelvic inflammatory disease (PID) after intrauterine device (IUD) insertion. We conducted a retrospective cohort study of all IUD insertions at Kaiser Permanente Northern California from January 2005 to August 2009. The PID incidence within 90 days after insertion was compared among women who were and were not screened for N gonorrhea and C trachomatis. The study was powered for equivalence with a PID risk difference of -0.006 to 0.006 between two groups considered to be clinically insignificant. Risk difference was calculated by subtracting the proportion of females with PID in one screening group from the proportion of females with PID in the comparison screening group. Of 57,728 IUD insertions, 47% were unscreened within 1 year of insertion; of screened women, 19% were screened on the same day. The overall risk of PID was 0.54% (95% confidence interval [CI] 0.48-0.60%). Nonscreening had an equivalent risk of PID as any screening (risk difference -0.0034, 95% CI -0.0045 to -0.0022), and same-day screening was equivalent to prescreening (risk difference -0.0031, 95% CI -0.0049 to -0.0008). The equivalence persisted when adjusted for age and race and when stratified by age younger than 26 years and older than 26 years. The risk of PID in women receiving IUDs was low. These results support IUD insertion protocols in which clinicians test women for N gonorrhea and C trachomatis based on risk factors and perform the test on the day of insertion. These findings have potential to reduce barriers to IUD use for women seeking highly effective, long-term, reversible contraception.

The safety of intrauterine devices among young women: a systematic review

Retention of intrauterine devices in women who acquire pelvic inflammatory disease: a systematic review

This study aimed to identify potential differences in alcohol consumption and craving among users of combined oral contraceptives (COCs), intrauterine devices (IUDs), and naturally cycling (NC) women. Previous studies have often grouped COC and IUD users together, and so potentially overlooked behavioural differences between these two groups. We conducted a cross-sectional observational study, collecting data from 101 Danish women aged 20-30 through a web-based survey. Participants provided demographic information, details on use of hormonal contraceptives (HCs), menstrual history, and self-reported alcohol consumption. Additionally, the participants completed the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol Craving Questionnaire-Short Form-Revised (ACQ-SF-R). All participants reported alcohol consumption and were well matched in age, body mass index (BMI), and education. A higher proportion of IUD users were smokers, but the difference in smoking rates among the groups were not statistically significant. One-way ANOVA revealed significant differences in alcohol consumption among the groups, with IUD users consuming more alcohol than NC women and COC users. No significant differences in alcohol consumption were found between NC women and COC users. While there were trends towards higher AUDIT and ACQ-SF-R scores among IUD users, these differences did not reach statistical significance across the groups. IUD users reported higher alcohol consumption than both COC users and NC women, while no substantial differences were observed between NC women and COC users. These findings provide valuable insights into the correlation between contraceptive methods and alcohol use. Although causality cannot be inferred, the results may aid healthcare professionals in developing tailored counselling strategies and identifying women who may be at increased risk of alcohol abuse.

This review provides an update of knowledge regarding venous thromboembolism (VTE) and combined hormonal contraceptives (CHCs) in the light of new progestins and new administration routes for CHCs. Practical recommendations are also offered. The association between the use of combined oral contraceptives (COCs) and an increased risk of VTE has been known about for many years, it being related mainly to the dose of oestrogen; however, recent research has also shown the influence of the type of progestin. When compared to COCs containing levonorgestrel or norethisterone, those containing desogestrel or gestodene present a two-fold greater risk of VTE; for COCs containing cyproterone acetate, the risk is four-fold greater, while there are no or insufficient data for those containing norgestimate, chlormadinone acetate or drospirenone. With regard to the contraceptive patch, the available data suggest that the risk of VTE is similar to that observed with COCs. There are no data concerning vaginal rings. The greatest risk of COC-associated VTE occurs during the first year of use, thus suggesting the existence of a predisposing condition, such as being a carrier of a thrombogenic mutation with which the COCs would exert a synergistic effect. Routine screening for such conditions is not justified. Changes in haemostatic variables produced by COCs, for example, acquired resistance to protein C, could be linked to VTE, although it has yet to be demonstrated that such alterations are related to a clinical risk of VTE among COC users. At present there are no laboratory tests able to detect an increased risk of VTE in asymptomatic women. The key procedures in terms of ensuring the safe use of this contraceptive method are a full clinical, personal and family history, in order to evaluate risk factors for VTE and cardiovascular disease, along with the recording of blood pressure and body mass index prior to the prescription of COCs.

One half of pregnancies in the United States are unintended and associated with adverse pregnancy outcomes. The postpartum period is an important, yet underutilized, time to initiate contraception. The<em> U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 </em>provides evidence-based guidelines for choosing a contraceptive method and an update in 2011 specifically addresses contraceptive method use in the puerperium. The variety of contraceptive methods include hormonal contraception, lactational amenorrhea, barrier contraception, natural family planning, and sterilization. Ideally, counseling about contraceptive choice should begin early in pregnancy care and continue postpartum; it should also include a variety of teaching modalities. Specifically we recommend LARC options such as intrauterine devices and etonorgestrel implants, postpartum tubal sterilization, and progestin-only pills for those desiring an oral method.

Venous Thrombosis in Users of Non-Oral Hormonal Contraception: Follow-Up Study, Denmark 2001-10

It is believed that much of the small increased risk for developing pelvic inflammatory disease (PID) associated with the use of an intrauterine device (IUD) appears to be caused by bacterial contamination of the endometrial cavity at the time of insertion. Previous research suggests that use of prophylactic antibiotics immediately prior to IUD insertion may reduce the risk of developing PID. This paper presents results from a randomized clinical trial of 1485 women in Ibadan, Nigeria evaluating the effectiveness of 200 mg of doxycycline (versus placebo) given orally at the time of IUD insertion in reducing the incidence of PID during the first three months of IUD use. Rate of PID infection in the doxycycline-treated group was not significantly lower than that in the placebo-treated group. The rate of unscheduled IUD-related visits to the clinic also was not significantly lower among the doxycycline-treated group. However, the incidence of PID was low (21 cases) for both study groups. Aseptic conditions during IUD insertion, follow-up visits with short intervals to monitor health, and treatment of opportunistic infections may have reduced the potential of PID within this population.

Comparison of the incidence of pelvic inflammatory disease in intrauterine devices users by gonorrhea and chlamydia screening strategies

Contraception for women in selected circumstances

Objectives. To find out pelvic inflammatory disease (PID) incidence and distribution among different age groups at a tertiary referral hospital. Methods. Subjects were gathered prospectively from the electronic medical files of female patients seen as inpatients over a period of 4 years (between 2008 and 2012). A total of 2,235 patients were included within the study and were reviewed in depth. The main outcome measures were the incidence and distribution among different age groups. Results. Out of 2,235 women included within the study 43.4% were above 35 years of age, 18.2% were between 30-35 years of age, 23% were between 25-30 years of age, 9.3% were between 20-24 years of age and 6% were less than 20 years of age. The percentages of contraceptive methods being used were 18% intrauterine device (IUD), 5.2% combined oral contraceptives (OC), 10% condom, 3.2% surgical sterilization and 26.1% coitus interruptus (CI). Vaginal douching (VD) incidence was 57% with 59% performing this practice after the coitus. The distribution of vaginal douching for age groups were 40.4% for adolescents (<20 y) and 59.6% for those above 20 years of age. Conclusion. We found a lower incidence of PID in adolescents in contrast to the rates reported for Western populations. Older age at first coitus and monogamy in the collectivist societies may be responsible for these findings. Practice of VD might also contribute to these rates. More accurate monitoring of incidence in well-defined populations in both urban and rural areas of Turkeyshould be conducted to find out actual distribution of PID among age groups.