Innovations in post-pregnancy contraception.

Canadian Contraception Consensus (Part 2 of 4).

Canadian Contraception Consensus (Part 1 of 4).

Making the Most of the Affordable Care Act's Contraceptive Coverage Mandate for Privately-Insured Women

In general, nephrologists give little thought to contraception, leaving this task to other practitioners, but the significant risks associated with drugs routinely prescribed to treat kidney disease; the potential for pregnancy-associated adverse outcomes in women with CKD; and the effect that

Examining intendedness among pregnancies ending in spontaneous abortion

Confidentiality and Cost: Barriers to Adolescent Contraception

Background: Young women with breast cancer need highly effective contraception given the potential implications of unplanned pregnancy for optimal treatment, and the teratogenic risks. We sought to determine the contraceptive methods used by young women after diagnosis (dx) of breast cancer and factors associated with use of less effective methods or no contraceptive method, which confers a 6-90% annual risk of pregnancy in sexually active women in contrast to highly effective methods (risk <1%). Methods: As part of a randomized trial conducted in 54 sites to test an education and support intervention for young women with breast cancer and their oncologists, we surveyed women about their pre-dx, current, and planned contraceptive use, and about communication with their providers regarding contraception. Women enrolled within 3 months of dx; contraception items were included on 3- and 12-month post-enrollment surveys. Intrauterine device (IUD) use, tubal sterilization, hysterectomy or bilateral salpingo-oophorectomy (hyst/BSO) after dx, or male partner vasectomy were classified as highly effective methods; all other methods and non-use were categorized as less effective. We excluded women not at risk of pregnancy: hyst/BSO prior to dx, or no indication for contraception. We used logistic regression to explore factors associated with use of less effective methods. Results: Of 424 women who completed the 3-month post-enrollment survey, median age at dx was 39 (range 22-45). 312 women at risk of pregnancy were included in this analysis, including 291 reporting sexual activity with a male partner within the last 6 months, and 21 reporting no recent sexual activity but reporting use of birth control. 123 women (39%) used highly effective contraceptive methods prior to dx; after dx, 161 (52%) reported current use of or a plan to use a highly effective method. 19 women (6%) reported use of a hormonal birth control method since dx; 7 (2%) reported withdrawal as their only contraceptive method; 25 (8%) reported no contraception. 30% of women did not recall a discussion of avoiding pregnancy or need for contraception during treatment with their providers. In multivariable analyses (N=310), desire for additional biologic children (OR 7.54, 95% CI 3.88-14.66) and provider discussion of contraception and pregnancy (OR 2.13 95% CI 1.20-3.78) were associated with use of less effective contraception. Age, race/ethnicity, disease stage, and partner status were not significantly associated with use of less effective methods. Conclusion: About half of women who are at risk of pregnancy reported use or planned use of less effective contraceptive methods or no method of contraception following dx of breast cancer. Women with breast cancer and their providers may benefit from targeted education on contraceptive options and method effectiveness. Citation Format: Rosenberg SM, Dutton CR, Ligibel J, Barry W, Ruddy KJ, Sprunck-Harrild K, Emmons KM, Partridge AH. Contraception use in young women with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-18.

The present study was carried out to describe contraceptive adoption following pregnancy terminations that resulted in outcomes other than live birth. Retrospective calendar data on 31486 women who had experienced a pregnancy loss within the last 60 months prior to the survey date were drawn from a nationally representative dataset. Logistic regression was employed to model the associated factors with contraceptive uptake. Overall, 57.8% reported not adopting any method following the end of the recent pregnancy. There was a significant association between the choice of contraceptive method and timing of adoption. Women with living children were significantly more likely to adopt contraception as compared to women without any child. Contraceptive uptake following a non-live birth is considerably low in India. Interventions in reproductive health should focus on provision of different contraceptive methods and counseling emphasizing on effectiveness and correct use of the methods at the end of any pregnancy.

The key role of hepatology providers in optimizing reproductive care in patients with liver disease: A call to action.

Society of Family Planning Clinical Recommendation: Emergency contraception

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPА).
 These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPА at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPА use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

Simplifying contraception requirements for iPLEDGE: A decision analysis

Contraceptive options for women with metabolic syndrome

OBJECTIVE: Half of pregnancies in the United States are unintended. We hypothesized a high-risk pregnancy might represent a teachable moment regarding contraceptive options. METHODS: This was a retrospective study of women delivering at a university hospital during 2009-2010 who received prenatal care in the faculty or resident clinics. High-risk status was defined by Society of Maternal-Fetal Medicine guidelines; subject categorizations were agreed on by all authors. Documentation of contraceptive plan was abstracted from clinic and hospital records. Subsequent pregnancies through 2012 were abstracted. chi tests assessed correlations between risk status and both contraceptive choice and subsequent pregnancy. Binary logistic regression was performed for the outcomes of Tier 1 contraceptive choice at last contact and for subsequent pregnancy during the follow-up period. RESULTS: A total of 3063 women were included 2048 low risk and 1015 high risk. The index pregnancy was slightly more likely to be unintended among low-risk than high-risk women (48% compared with 43% P=.02). When contraceptive methods were categorized according to World Health Organization tiers intention to use tier 1 (most effective) contraceptives was high for both groups antepartum (54% low risk compared with 58% high risk) slightly decreased at hospital discharge (42% compared with 51% P<.001) and significantly decreased postpartum (27% compared with 32% P=.004). During follow-up 656 women (21.4%) had a second pregnancy lasting more than 20 weeks. These were unintended among 36.6% of low-risk and 32.4% of high-risk women which was not statistically different. CONCLUSION: Women experiencing high-risk pregnancy were no more likely to have planned their index pregnancy. Although their uptake of highly effective contraception was higher immediately postpartum they were as likely to have an unplanned pregnancy during follow-up. New strategies are needed to counsel all women about pregnancy planning and contraception.

Ovarian activity decreases, menstrual cycles are disrupted and fertility declines in women over 40 years old. Although the risk of conception gradually diminishes, it does not disappear. Women in older ages have to use an effective contraceptive method in order to avoid unwanted pregnancies. The frequency of sexual intercourses, sexual problems, non-contraceptive benefits, menstrual irregularities and health status of women will have an influence on selection of contraceptives. Age alone is not a contraindication for any contraceptive methods. Before a combined hormonal contraceptive is initiated, women should be exposed to a complete examination and those with obesity, migraine or hypertension and smokers should not be offered combined methods. Combined hormonal contraception can be recommended to perimenopausal women since it treats vasomotor symptoms, protects against bone losses, reduces the risk of some cancers and treats heavy menstrual bleeding. Perimenopausal women with excessive menstrual bleeding are recommended progestin-only intrauterine devices after abnormal vaginal bleeding is excluded. Many perimenopausal women use barrier methods with confidence and good adherence. However, male condoms, a barrier method, may create problems for couples when male partners have erectile dysfunctions. In such cases, another barrier method, female condoms can be preferable. Perimenopausal women need contraception counseling so that they can select an appropriate contraceptive method. They should be informed about the time to give up contraceptive methods during contraception counseling.