Contraceptive Management Research Articles

Missed Opportunities and Barriers to Human Papillomavirus Vaccination Among Young Adult Women [220

INTRODUCTION: Significant gaps exist in utilization of the human papillomavirus (HPV) vaccine. The purpose of this study is to assess rates of and missed opportunities for HPV vaccination among young adult women. METHODS: We reviewed medical records of women ages 18–26 years seeking care at an urban, hospital-based obstetrics and gynecology clinic from February 2013 to January 2014. Demographic and clinical data were abstracted to determine rates of HPV vaccine initiation and completion and frequency of missed vaccination opportunities. χ2 tests and logistic regression were used to identify independent risk factors for poor vaccine coverage. RESULTS: Among 1,184 young adult women seeking care during the study period, 30% were ages 17–20 years, 49% ages 21–24 years, and 21% ages 25–26 years. Forty-three percent of women were non-Hispanic blacks, 9% non-Hispanic whites, 37% reported Hispanic ethnicity with other or unreported race. Most reported English as their preferred language (88%) and had Medicaid insurance (78%). Human papillomavirus vaccination rates were low (14% completed, 11% incomplete). Vaccine completion and initiation rates were higher among English-preferring (P<.001), insured (P=.008 and <.001, respectively), and black female patients (P<.001). The frequency of missed vaccination opportunities among non-initiators included: 47 women with at least one visit for a well-woman examination, 120 for contraception management, 194 for postpartum visits, and 105 for urgent gynecologic visits. A total of 112 women received medroxyprogesterone acetate, and 257 women were administered vaccinations or other medications. CONCLUSION: Young adult women receiving care at a hospital-based obstetrics and gynecology clinic have low rates of HPV vaccination. Targeted interventions addressing missed opportunities could significantly improve HPV vaccine coverage.

Men's contraceptive practices in France: evidence of male involvement in family planning

ObjectiveTo describe contraceptive practices of men in a relationship in France, where use of female-controlled methods is predominant, and to explore their involvement in managing contraception within the couple. Study designData are drawn from a national probability cross-sectional survey on sexual and reproductive health conducted in France in 2010. The study sample comprised 3373 men aged 15–49, 1776 of whom were asked about their current contraceptive practices after they reported that they were fecund and sexually active and did not currently want a child. Analyses were performed with logistic regression models. ResultsFew men aged 15–49 with a partner did not use contraception (3.4%). Most reported using only a female method (71.7%), 20.4% only cooperative methods, such as condoms, withdrawal and the rhythm method and 4.5% both. Among contraceptive users, withdrawal (7.7%) was more likely to be used by men with low incomes or low educational levels. Condom use was reported as a contraceptive method by 18.9% of men. Its prevalence was higher for those in new and noncohabiting relationships (36.1%) and lower for those in cohabiting relationships (12.4%), in which STIs/HIV prevention is less of a concern. ConclusionMen's high awareness of contraceptive practices and their use of some cooperative methods reveal their involvement in contraceptive practices within the context of relationships. Condom use is associated with the prevention of STIs/HIV for noncohabiting men, but men who live with their female partner seem to use condoms mainly as a contraceptive method. Withdrawal appears to be associated with low level of education and financial difficulties. Finally, having engendered a pregnancy that was terminated appears to influence men's contraceptive practices. ImplicationsStudying men's contraceptive practices helps to understand their involvement in contraceptive management within relationships.

Epilepsy: Special Consideration in Women

ABSTRACT Epilepsy is one of the most common chronic neurological disorder complicating pregnancy. The article reviews various management issues in women in preconceptional, antenatal and postnatal period. An online search was carried out for articles on epilepsy in women and different aspects relating to contraception, conception, antenatal, intranatal and postnatal management. The available guidelines on the subject were also reviewed. How to cite this article Ahmad A, Rabbani TK, Kumar S. Epilepsy: Special Consideration in Women. Int J Infertil Fetal Med 2015; 6(1):11-14.

Different modalities in the management of functional ovarian cysts

Objective The aim of this work is to compare the different modalities in the management of functional ovarian cysts. Background A functional ovarian cyst is a growth on an ovary that develops during a woman's ovulation cycle. Women who develop a functional ovarian cyst generally remain asymptomatic and only learn of its presence during their annual female examination. Most functional ovarian cysts are small and benign, require no treatment, and dissolve on their own. If the cyst is small to moderate in size and causes no symptoms, a watchful approach will usually be adopted. Materials and methods This study included 80 patients with functional ovarian cysts: 40 patients followed up by transvaginal ultrasound only (expectant group) and 40 patients who received combined oral contraceptive pills (oral contraceptive group) and followed up by transvaginal ultrasound for 3 months. Persistent functional ovarian cysts will be managed by transvaginal ultrasound-guided needle cyst aspiration and then followed up by transvaginal ultrasound for 3 months. Results There was no statistically significances between different modalities of management as regards short-term expectant management (31\40) and combined oral contraceptive management (34\40) for functional ovarian cysts. Persistent functional ovarian cysts were managed by transvaginal-guided ultrasound needle aspiration, which showed a high recurrence rate in both groups, 5\9 and 3\6, respectively, after short-term follow-up. Conclusion The results of the study suggest that optimal management for functional ovarian cysts in reproductive age is expectant management.

Contraception and mental health: a commentary on the evidence and principles for practice

Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. For women with these common mental health conditions who want to avoid an unintended pregnancy, effective contraception can be an important strategy to maintain and even improve health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. In this commentary, we review the literature on relationships between mental health and contraception and describe considerations for the clinical management of contraception among women with depression and anxiety. We discuss issues related to contraceptive method effectiveness and adherence concerns, mental health-specific contraceptive method safety and drug interaction considerations, and clinical counseling and management strategies. Given important gaps in current scientific knowledge of mental health and contraception, we highlight areas for future research.

Trends and patterns of hormonal contraceptive prescribing for adolescents in primary care in the UK

BackgroundHormonal contraceptives are the most common method used worldwide by teenagers to prevent unwanted pregnancies. To date there are limited data about such use by teenagers in the UK. This...

Maternity care provider knowledge, attitudes, and practices regarding provision of postpartum intrauterine contraceptive devices at a tertiary center in Ghana

ObjectiveTo assess knowledge, attitudes, and practices of maternity care providers regarding the provision of postpartum intrauterine contraceptive devices (IUDs) in Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. MethodsA descriptive, cross-sectional study was conducted between June 28 and July 15, 2011. Specialists, residents, house officers, and nurse midwives who had been working in the Department of Obstetrics and Gynecology for at least 3months were included. Self-administered questionnaires assessed formal training, current proficiency in IUD insertion, and attitudes toward postpartum IUD provision. ResultsOf 91 providers surveyed, 70 (77%) reported previous training in contraceptive counseling. Fewer than one in three respondents had ever inserted an IUD: 17 (44%) of 39 physicians and 9 (17%) of 52 midwives reported ever having inserted an IUD. A total of 33 (36%) respondents reported that they would recommend an IUD in the immediate postpartum period. ConclusionAlthough most maternity care providers at KATH had received training in contraceptive counseling, few felt confident in their ability to insert an IUD. Further training in postpartum contraceptive management is needed.

Contraception for women with medical disorders

Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article.

Contraception and hormonal management in the perimenopause.

This literature review focuses on contraception in perimenopausal women. As women age, their fecundity decreases but does not disappear until menopause. After age 40, 75% of pregnancies are unplanned and may result in profound physical and emotional impact. Clinical evaluation must be relied on to diagnose menopause, since hormonal levels fluctuate widely. Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is 55%. Older gravidas experience higher rates of diabetes, hypertension, and death. Many safe and effective contraceptive options are available to perimenopausal women. In addition to preventing an unplanned and higher-risk pregnancy, perimenopausal contraception may improve abnormal uterine bleeding, hot flashes, and menstrual migraines. Long-acting reversible contraceptives, including the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant (ESI), and the copper intrauterine device (Cu-IUD), provide high efficacy without estrogen. LNG-IUS markedly decreases menorrhagia commonly seen in perimenopause. Both ESI and LNG-IUS provide endometrial protection for women using estrogen for vasomotor symptoms. Women without cardiovascular risk factors can safely use combined hormonal contraception. The CDC's Medical Eligibility Criteria for Contraceptive Use informs choices for women with comorbidities. No medical contraindications exist for levonorgestrel emergency-contraceptive pills, though obesity does decrease efficacy. In contrast, the Cu-IUD provides reliable emergency and ongoing contraception regardless of body mass index (BMI).

Emergency contraception in Australia: the desired source of information versus the actual source of information.

To determine long-term trends in emergency contraception (EC) management by general practitioners in Australia. Data from April 2000 to March 2012 were drawn from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous cross-sectional survey of GP activity. We analysed consultations involving EC management, unwanted pregnancy management and emergency contraceptive pill (ECP) prescribing per 1000 GP encounters with women aged 14-54 years. Summary statistics were calculated with 95% confidence intervals. In 2000-2001, GPs managed EC problems at a rate of 5.50 per 1000 encounters (95% CI, 4.37-6.63). From 2004, after the ECP became available over the counter (OTC) in pharmacies, EC management, which includes ECP prescription, progressively declined. By 2011-2012, only 1.43 EC problems were managed per 1000 encounters (95% CI, 0.84-2.02) and only 0.48 ECP prescriptions were provided per 1000 encounters (95% CI, 0.14-0.82). Yet the management rate of unwanted pregnancy problems stayed relatively constant (rate in 2000-2001, 0.95 per 1000 encounters; 95% CI, 0.40-1.50; rate in 2011-2012, 0.88 per 1000 encounters; 95% CI, 0.41-1.36). Low rates of EC management by GPs since ECP became available OTC suggest that women may be obtaining information on EC elsewhere. Further investigation is needed to uncover the sources of this information and its acceptability and application by Australian women.

U.S. Selected Practice Recommendations for Contraceptive Use, 2013

Unintended pregnancy rates remain high in the United States and these pregnancies may carry increased risks for negative health outcomes. Lack of contraceptive use and inconsistent use are important contributors to the high rate of unintended pregnancies. Women may face certain barriers to starting contraception and using it effectively. The Centers for Disease Control and Prevention has recently developed the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, which provides guidance for common yet sometimes complex issues in contraceptive management. This guidance aims to reduce barriers to contraceptive use by providing clear recommendations for providers to assist women in initiating and using contraceptive methods to maximize effectiveness and decrease risk of unintended pregnancy.

Contraceptive use by Iranian women with hypertension, diabetes or obesity

Women with chronic medical conditions require careful contraceptive management. The aim of this cross-sectional study in Tehran was to determine the pattern of contraception use by women with diabetes, hypertension or obesity. A sample of 264 women aged 18-53 years old was recruited; 81 (30.7%) had diabetes type 2,100 (37.9%) were obese/overweight (BMI > 25 kg/m2) and 83 (31.5%) had hypertension. Across all 3 groups, the rate of use of contraceptive methods was significantly different before and after diagnosis. Before diagnosis of disease the most common method was hormonal contraception in all women (55.0%, 71.6% and 78.3% of diabetic, overweight and hypertensive women respectively), whereas after diagnosis coital withdrawal was the most common method in diabetic and obese/overweight women (41.2% and 28.0% respectively) and almost the most common method for hypertensive women (35.4%). Use of safe and modern methods of contraception in women with certain chronic medical conditions was low and needs more attention.

Young women’s consistency of contraceptive use — does depression or stress matter?

BackgroundWe prospectively examined the influence of young women’s depression and stress symptoms on their weekly consistency of contraceptive method use. Study DesignWomen ages 18-20 years (n=689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n=8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression. ResultsConsistent contraceptive use (72% of weeks) was 10–15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p<.001). Controlling for covariates, women with depression and stress symptoms had 47% and 69% reduced odds of contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31–0.91 and OR 0.31, CI 0.18–0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12–0.58), condoms (OR 0.40, CI 0.23–0.69) and withdrawal (OR 0.12, CI 0.03–0.50). ConclusionWomen with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods. ImplicationsOur study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women’s psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women’s dynamic mental health symptoms impact family planning behaviors and outcomes over time.

Evaluation of Ovulation Inhibition Properties of a Phytoestrogen Isolated from Momordica charantia Linn. Seeds

Background and objectives: Momordica charantia Linn. has been used as a dietary / medicinal supplement for health care. The plant has a long history in worldwide people for the usage of vaginal discharge, to promote menstruation and to induce abortions. However, the mechanism of action for its ovulation inhibition effects is not clearly known. Therefore, the present study was carried out to evaluate the ovulation inhibition properties of phytoestrogenic molecule isolated from M. charantia seeds in albino rats as an experimental model. Methods: Ovulation inhibition properties of fractions of ethanol extract and phenolphthalein a phytoestrogenic molecule isolated from seeds of Momordica charantia Linn. were evaluated in fertile female albino rats. In the first batch of animals having groups I, II, III, IV were treated with 15 and 25mg/100g oral doses of Fraction I and Fraction II and group V served as control. In the second batch of animals having groups I, II, III was treated with 10, 15 &amp; 20mg/100g isolated phenolphthalein and group IV served as control. Results: At autopsy on day 31st, decrease in ovarian weight and histological studies shows highly significant decrease in number of developing follicles, Graafian follicles, corpora lutea and significant increased in number of atreatic follicles is observed in Fraction I and phenolphthalein treatment. There are no appreciable changes are observed in the above parameters when both the doses of Fraction II administration. Interpretation and Conclusions: The study results suggested that M. charantia seed fractions and phenolphthalein possess ovulation inhibition properties in experimental animals. Interestingly, in recent years, the popularity of different kinds of pharmaceutical preparations containing phytoestrogens has constantly increasing. Therefore, studies of the influence of the above mentioned plant components on female reproduction have become more and more important. This leads to discovery of newer phytoconstituents with better activities and provide source of new biomolecules for biologists to work on. The studies explore the utilization of medicinal plants for effective management of contraception. It gives a larger platform for the medicinal plant growers by providing scientific support and data to the traditional invalidated herbal drugs. Taking account of all these facts, the present study was undertaken in albino rats.

146. Quality Improvement: Contraception Management in Detained Adolescent Women

To improve contraception screening, counseling and initiation among detained adolescent women at the Harris County Juvenile Justice System (HCJJC) clinic. We aimed to improve contraception initiation rate from 13 percent to greater than 20 percent.

Field testing of single-administration porcine zona pellucida contraceptive vaccines in white-tailed deer (Odocoileus virginianus)

Context Many contraceptive agents have demonstrated effectiveness in wild species, most notably immunocontraceptives such as GnRH conjugates and porcine zona pellucida (PZP). The major challenge in using these agents to control deer and other wildlife populations in the field now lies with safe, effective and efficient delivery to a large-enough proportion of the population to suppress growth. Aims Because deer and other wildlife are typically difficult to access for treatment, contraceptives that require multiple or repeated treatments will be of limited management value. To address this constraint, we conducted a field study of white-tailed deer (Odocoileus virginianus) on Fripp Island, SC, USA, to test two different technologies for achieving single-administration, multi-year efficacy in PZP vaccines. Methods Between 2005 and 2010, we captured, ear-tagged and blood-sampled a total of 245 individual adult and yearling female deer. Deer were hand-injected at capture with one of two preparations of SpayVac or a combination native PZP–adjuvant emulsion plus PZP–adjuvant incorporated into lactide–glycolide polymer pellets engineered to release at 1, 3 and 12 months post-treatment. Pregnancy was determined from serum assays of pregnancy-specific protein B sampled from captured deer. Key results Aqueous SpayVac, and the PZP–adjuvant-containing polymer pellets manufactured through a heat extrusion (H/X) method administered simultaneously with PZP–AdjuVac or modified Freund’s complete adjuvant emulsions reduced pregnancy rates from control levels by 95–100% in the first year after treatment, and by 65–70% in the second year after treatment. Conclusions A single, hand-injected vaccination with SpayVac or PZP–adjuvant emulsion combined with H/X PZP pellets reduced fertility for multiple years. Implications Single-treatment, multi-year immunocontraceptive vaccines bring contraceptive management of wildlife populations one step closer. Future efforts should focus on improving handling and storage, developing technologies for remote delivery, and addressing remaining regulatory and management concerns.

Divergent practices among Catholic hospitals in provision of direct sterilization.

The Ethical and Religious Directives for Catholic Health Catholic Care Services (ERDs) are designed to promote uniform practice of health care in accordance with human and Catholic values. The aim of this study was to determine whether the ERDs are being uniformly interpreted and applied. Directive 53 prohibits the provision of direct sterilization. Hospital data were reviewed to determine whether direct sterilizations on women are being performed within Catholic hospitals and their frequency. A significant diversity of practice regarding sterilization would indicate that the ERDs are not uniformly interpreted and applied by Catholic hospitals in the United States. All Catholic hospitals in seven states-California, Illinois, Indiana, New Jersey, New York, Texas, and Washington-were studied to determine whether diversity of practice existed in the provision of direct female sterilization. Inpatient discharge data were requested from the respective departments of health for each state for three years (2007-2009). Data from 1,734 hospitals, secular and Catholic, within the states were procured and analyzed. Of the hospitals from the seven states, 239 Catholic hospitals were identified of which 176 provided obstetric services. The patient records of these 176 hospitals were searched for those records containing the diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system for sterilization for contraceptive management. Eighty-five or 48 percent of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERDs. The entire results of the study are available on the website catholichospitals.org. There is a significant diversity of practice in the provision of direct female sterilization within Catholic hospitals. Such diversity of practice indicates that there is no uniform interpretation or application of the ERDs by Catholic hospitals. Uniformity could be fostered if the ERDs mandated best practices for accountability and made use of the ICD-9-CM codes where possible to monitor actual practices. In the case of direct sterilizations reference to ICD-9-CM codes in the ERDs would minimize subjective criteria in the implementation of the ERDs.

Pharmacokinetic study of single and multiple oral administrations of 2 mg dienogest in healthy Korean women

BackgroundThe progestin dienogest was developed for oral contraception, endometriosis treatment and menopause management. Dienogest's pharmacokinetics have been primarily studied in Caucasian women. This study evaluated the single- and multiple-dose pharmacokinetics of dienogest in Korean women. Study DesignSixteen healthy Korean adult women received a single administration of 2 mg dienogest, followed by multiple once-daily administrations for 14 days. The single-dose administration and the final dose of the multiple administrations were each followed by blood sampling over 60 h. ResultsThe mean (SD) maximum serum concentration after multiple doses of dienogest was slightly increased compared with that after a single dose [from 51.6 (9.6) to 56.6 (11.9) ng/mL], as was the area under the concentration–time curves (AUC)0–24h [from 503 (56.3) to 613 (90.7) ng∙h/mL]. The linearity factor calculated by AUCs of single and multiple doses is 1.00±0.14, and the terminal half-life remained unchanged when single dosing and multiple dosing were compared. ConclusionsThe present study described the single- and multiple-dose pharmacokinetic profiles of dienogest in Korean women and showed linear pharmacokinetics of dienogest at steady state.

Module 17. The effective management of contraception

Overview This module is focused on commonly used contraceptive methods. The module contains an overview of currently available methods in different age groups, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the management of contraception.

Adaptation of the World Health Organization's Selected Practice Recommendations for Contraceptive Use for the United States

BackgroundThe Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the US Selected Practice Recommendations for Contraceptive Use (US SPR). The WHO guidance includes evidence-based recommendations on common, yet sometimes complex, contraceptive management questions. Study DesignWe determined the need and scope for the adaptation, conducted 30 systematic reviews of the scientific evidence and convened a meeting of health care professionals to discuss translation of the evidence into recommendations. ResultsThe US SPR provides recommendations on contraceptive management issues such as how to initiate contraceptive methods, what regular follow-up is needed, and how to address problems, including missed pills and side effects such as unscheduled bleeding. ConclusionThe US SPR is intended to serve as a source of clinical guidance for providers in assisting women and men to initiate and successfully use contraception to prevent unintended pregnancy.