Effective Contraception Research Articles

Contraception use and HIV outcomes among women initiating dolutegravir-containing antiretroviral therapy in Kenya: a retrospective cohort study.

The rollout of dolutegravir (DTG) in low- and middle-income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited. We conducted a retrospective cohort analysis of WLHIV 15-49 years initiating DTG-containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated ≤180 days post-guideline (Group 1) or post-DTG initiation (Group 2). We determined the proportions of all women who switched from DTG- to non-nucleoside reverse transcriptase inhibitor (NNRTI)- (efavirenz or nevirapine) containing ART ≤12 months post-DTG initiation, compared their viral suppression (<1000 copies/ml) and conducted multivariable logistic regression to determine factors associated with switching from DTG to NNRTI-containing ART. Among 5155 WLHIV in the analysis (median age 43 years), 89% initiated DTG after transitioning from an NNRTI. Baseline effective and very effective contraception use, respectively, by the group were: Group 1 (12% and 13%) and Group 2 (41% and 35%). Incident contraception use in each group was <5%. Overall, 498 (10%) women switched from DTG to an NNRTI. Viral suppression among those remaining on DTG versus switched to NNRTI was 95% and 96%, respectively (p = 0.63). In multivariable analysis, incident effective and very effective contraception use was not associated with switching. Baseline, but not incident, effective contraception use was higher during the interim guideline period compared to before it, suggesting women already using effective contraception were preferentially selected to initiate DTG after the guideline was released. These findings reveal challenges in the implementation of policy which ties antiretroviral access to contraceptive use. Future guidance should capture nuances of contraception decision-making and support women's agency to make informed decisions.

Contraception in Women with Sexually Transmitted Infections

Contraception in Women with Sexually Transmitted Infections Abstract. The use of contraception in sexually active women has two main functions; the prevention of unwanted pregnancy and the protection against sexually transmitted infections (STIs). In both cases, contraception does not guarantee complete protection. Unfortunately, the most effective contraceptive method against pregnancy offers minimal protection against STIs and the best contraceptive method against STIs, namely the condom, is not popular amongst many and when typically used does not offer the most effective prevention against pregnancy. In addition, there are a number of factors to consider when choosing a contraceptive method for women who already have a STI. For example, which contraceptive methods may be used safely and if there are any interactions to be aware of between medication and the contraceptive in question. Thus, the choice of the most suitable contraceptive method depends heavily on the individual and needs to be carefully considered. It is the balance between prevention of pregnancy, the protection against STIs as well as minimising the risk of STI transmission to an uninfected partner. These considerations must be discussed with the woman and if required and appropriate for the woman, with her partner as well.

REVIEW ARTICLE ON PPIUCD

The intrauterine contraceptive device is a long acting reversible contraceptive, it is one of the most effective and safe method of contraception. Immediate postpartum IUCD service program approved by government of India in 2010. In most developing countries delivery time is the primary opportunity for women to access postpartum family planning method. PPIUCD it is of two types: IUCD 375 and IUCD 380-A. It is interfere with the ability of sperm to survive and to ascent the fallopian tubes where fertilization occurs and it alters sperm migration, ovum transport and fertilization. There are different timing of PPIUCD insertion such as Post placental insertion, Intra-Cesarean and within 48 hours after delivery. PPIUCD has no hormonal side-effects, but sometimes may lead to abnormal menstrual bleeding.

Oral combined contraceptives induce liver mitochondrial reactive oxygen species and whole-body metabolic adaptations in female mice.

Compared to age-matched men, pre-menopausal women show greater resilience against cardiovascular disease (CVD), hepatic steatosis, diabetes and obesity - findings that are widely attributed to oestrogen. However, meta-analysis data suggest that current use of oral combined contraceptives (OC) is a risk factor for myocardial infarction, and OC use further compounds with metabolic disease risk factors to increase CVD susceptibility. While mitochondrial function in tissues such as the liver and skeletal muscle is an emerging mechanism by which oestrogen may confer its protection, effects of OC use on mitochondria and metabolism in the context of disease risk remain unexplored. To answer this question, female C57Bl/6J mice were fed a high fat diet and treated with vehicle or OCs for 3, 12 or 20weeks (n=6 to 12 per group) at a dose and ratio that mimic the human condition of cycle cessation in the low oestrogen, high progesterone stage. Liver and skeletal muscle mitochondrial function (respiratory capacity, H2 O2 , coupling) was measured along with clinical outcomes of cardiometabolic disease such as obesity, glucose tolerance, hepatic steatosis and aortic atherosclerosis. The main findings indicate that regardless of treatment duration, OCs robustly increase hepatic mitochondrial H2 O2 levels, likely due to diminished antioxidant capacity, but have no impact on muscle mitochondrial H2 O2 . Furthermore, OC-treated mice had lower adiposity and hepatic triglyceride content compared to control mice despite reduced wheel running, spontaneous physical activity and total energy expenditure. Together, these studies describe tissue-specific effects of OC use on mitochondria as well as variable impacts on markers of metabolic disease susceptibility. KEY POINTS: Oestrogen loss in women increases risk for cardiometabolic diseases, a link that has been partially attributed to negative impacts on mitochondria and energy metabolism. To study the effect of oral combined contraceptives (OCs) on hepatic and skeletal muscle mitochondria and whole-body energy metabolism, we used an animal model of OCs which mimics the human condition of cessation of hormonal cycling in the low oestrogen, high progesterone state. OC-treated mice have increased hepatic mitochondrial oxidative stress and decreased physical activity and energy expenditure, despite displaying lower adiposity and liver fat at this time point. These pre-clinical data reveal tissue-specific effects of OCs that likely underlie the clinical findings of increased cardiometabolic disease in women who use OCs compared to non-users, when matched for obesity.

Identifying and addressing barriers to contraception uptake among adolescent girls in urban Burkina Faso: Evidence from a qualitative study.

Several barriers drive low uptake of contseraception among adolescents. This study investigates the effectiveness of (re)solve, a school-based program in Burka Faso, to overcome barriers to contraception uptake and facilitate the development of intention to use it. This paper presents qualitative endline findings from a mixed-methods longitudinal study conducted between 2019 and 2020 in two urban sites using in-depth interviews with girl participants and implementers, and key informant interviews with local stakeholders. We found that adolescent girls in the target group are likely to soon become sexually active but may be underestimating this risk. We also identified three key barriers to access to contraception in the study sites: misinformation and fear of side effects of contraception, stigma and negative attitudes, and a lack of youth-friendly sexual and reproductive health services. We conclude that the school-based (re)solve program was able to address barriers and spark contraceptive interest among participant girls.

IS CONTRACEPTIVE INJECTION CAUSE BREAST CANCER? : META ANALYSIS

Background: Injectable hormonal contraception was a major risk factor for breast cancer. The content of the progestin hormone in injection hormonal contraceptives can affect the uncontrolled growth of breast tissue, leading to breast cancer. This study aims to analyze the magnitude of the effect of injection hormonal contraception on the incidence of breast cancer with a meta-analysis study. Method: This research is a systematic review and used a Prisma flow diagram. The process of searching for articles through a database of journals which includes: PubMed, Science Direct, and Google Scholar by selecting articles published in 2010-2020. Keywords used include: “ Women Aged 15-80 Years” OR “Women of Menopause” AND “Birth control injections” AND “Breast Cancer”. The inclusion criteria included full-text articles with a case-control study design, articles using English, and multivariate analysis with adjusted odds ratios. Artikel fulfills the requirements for analysis using Revman 5.3 Result: There were 6 articles with the case-control study. A meta-analysis of 6 case-control studies showed that the use of injectable hormonal contraception had a 1.37 times risk of developing breast cancer compared with women using non-hormonal contraception (aOR 1.37; 95% CI 1.09 to 1.71; p = 0.006). Conclusion: Injectable hormonal contraceptives can increase the incidence of breast cancer.&#x0D;

Biochemical Effects of Oral Contraceptive Pill On Total Serum Protein, Hemoglobin and Antioxidants Capacity among Females Athletes

Total serum protein, hemoglobin and antioxidant system are essential to the body's physiological activities. Oral contraceptive pills influence the level of proteins of both types present in the blood; thus, it is found to change among pregnant women. Objectives: To scrutinize oral contraceptive pills' effects (OCP) on total serum protein, hemoglobin and antioxidant capacity among females. Methods: The participants were divided into the experimental group (EG-60) and control group (CG,-24). 5 ml of blood was collected from each subject and marked with a different identification code. The collected blood samples were processed through laboratory protocols, and thus the targeted tests were performed to achieve the desired results. The results of tests were processed through a statistical package for social sciences (SPSS, version-26), and thus appropriate statistical tools were applied for analysis. Results: Total number of subjects in both groups were 84. Mean of CG in term of hemoglobin was 13.91 ±.92 and Mean of EG in term of hemoglobin was 14.18 ±.84. Mean of CG in term of total serum protein was 6.75 ±.48 and Mean of EG in term of total serum protein was 6.62 ±..31. Conclusion: Based on the analysis, the researcher concluded that contraceptive pills significantly affect total serum protein, hemoglobin and antioxidant capacity among females.

Relationship between occupation and education with the choice of IUD contraception in Pauh District, Padang City, West Sumatra.

High population growth is a significant problem faced by the Indonesian people in the field of population. Efforts to create quality families are primarily targeted at controlled population growth and increasing the quality of small families, as indicated by the increased use of rational, effective, and efficient contraceptive methods, namely the use of Long-Term Contraceptive Methods (MKJP). Referring to the 2020-2024 BKKBN Strategic Plan, the BKKBN vision has been set: "Creating quality families and balanced population growth to support the achievement of an advanced Indonesia that is sovereign, independent, and has a personality based on mutual cooperation" (BKKBN, 2021).&#x0D; The purpose of this research was to determine the relationship of education and occupation with the selection of IUD contraceptives in the work area of ​​Pauh Health Center. This research was a cross-sectional comparative. The populations in this research were all women of childbearing age (WUS), current family planning acceptors aged 15-49 years who used IUD and non-IUD contraception. The samples of this research were 49 IUD users and 149 non-IUD users. The instruments were a questionnaire.&#x0D; The bivariate analysis used Chi-Squere. The results the bivariate study found that there was a not significant relationship between occupation with the selection of IUD contraceptives (p = 0.251) and there was a significant relationship between education and the selection of IUD contraceptives (p = 0.001)&#x0D; This study concludes that there is no relationship between occupation with the choice of IUD contraceptives and there is a relationship between education and the choice of IUD contraceptives

Exploring the Role of Levonorgestrel Intrauterine System (LNG-IUS) as a Method of Emergency Contraception (EC).

Copper T 380-A (CuT380A) intrauterine device (IUD) has been an effective method of emergency contraception (EC). Levonorgestrel intrauterine system (LNG-IUS) has not been approved by the Food and Drug Association for EC till now. There are few studies that provide data regarding the efficacy of LNG-IUS as EC. This systematic review tried to explore the efficacy of LNG-IUS in preventing accidental pregnancies up to five days of unprotected intercourse. A systematic review of the published studies on the use of LNG-IUS as EC was done. All randomized trials, prospective cohorts, retrospective cohorts. and case-control study designs pertaining to this topic were included in this review. Abstracts were retrieved and reviewed by two authors independently. Variables pertaining to socio-demographic parameters, EC use-related variables (reason for use, frequency, time elapsed since coitus), and those associated with sexual habits were selected and recorded. A total of six articles were rendered for the review. High school students and those attending college accounted for 36.8%-51.8% of the study population. Data on the reason for seeking EC showed noncompliance to routine contraception as the most common reason, followed by failure of withdrawal method, breach of barrier contraception, and unplanned intercourse. With a negligible failure rate, LNG-IUS seemed to be a good alternative to the existing copper EC. Considering the plethora of noncontraceptive benefits associated, LNG-IUS can be safely provided as an option of EC in the cafeteria approach within five days of unprotected intercourse.

P083The impact of federal and state-level contraceptive coverage policies on contraceptive cost and use among privately insured women

<h3>Objectives</h3> The landscape of contraceptive coverage has greatly changed in recent years due to federal- and state-level policymaking, yet the long-term effects on contraceptive use and costs remain largely unknown. <h3>Methods</h3> A retrospective analysis was performed using the IBM MarketScan® Commercial Claims and Encounters database to identify contraceptive claims and out-of-pocket costs among privately insured women aged 13–49 between 2006 and 2018. Long-acting reversible contraception (LARC) and non-LARC contraception claims were determined. Out-of-pocket costs included both contraceptive and insertion fees. Policies were categorized at the national level as pre-post Affordable Care Act (ACA), and at the state level as pre-post having a parity law requiring contraceptive coverage and pre-post having a law codifying the ACA at the state level. Descriptive statistics and visual plots assessed for trends between policies and outcomes. <h3>Results</h3> By 2018, seven states had both contraceptive parity laws and codification of the ACA contraceptive coverage; 22 states and the District of Columbia had only a parity law; and 21 states had neither policy. Claims data showed an upward trend in LARC insertion rates from 0.7% in 2006 to 4.6% in 2018, while non-LARC use remained relatively unchanged. The mean out-of-pocket expenditures for each contraceptive method declined each year after the ACA took effect, and there was an increase in the percentage of users who paid $0 for contraception. <h3>Conclusions</h3> This is the first study to investigate the impact of federal and state policies regarding contraceptive coverage. Findings show that contraceptive policies have an impact on use of the most effective contraceptive methods and on costs to the consumer.

P076Contraceptive use by females with chronic medical conditions in a large integrated healthcare system

<h3>Objectives</h3> Females with chronic medical conditions (CMCs) face greater risk of pregnancy complications yet have higher risk of unplanned pregnancy than healthy females. To identify opportunities to optimize care, we investigated differences in contraceptive use among those with CMCs vs. those without these conditions within Kaiser Permanente Mid-Atlantic States (KPMAS). <h3>Methods</h3> We conducted a retrospective cohort study using electronic medical record data. We included females aged 15–44 enrolled within KPMAS between January 1, 2021 and December 31, 2021 without hysterectomy or bilateral oophorectomy. We defined CMCs using the US Medical Eligibility Criteria for Contraceptive Use and identified contraception through ICD-10 and CPT codes for intrauterine device (IUD), implant, female sterilization, and injectables; and pharmacy dispensing data for pills, patches, and rings. Controlling for sociodemographic differences, we used multinomial logistic regression to determine the odds of using each tier of contraception vs. none of the specified tiers for those with CMCs versus those without. <h3>Results</h3> Of 128,340 patients, 13,672 (10.7%) had CMCs with hypertension, diabetes, and sickle cell disease most common. 44% of those with CMCs used one of the specified methods versus 40% of those without (OR, 1.19; 95% CI, 1.15–1.23). Those with CMCs were more likely to be >35yo, Black, and have Medicaid (p<0.01) and to use female sterilization (aOR 1.79, 95% CI 1.66-1.93) or long-acting reversible contraception (aOR 1.32, 95% CI 1.26-1.39). <h3>Conclusions</h3> In our diverse cohort, females with CMCs were more likely to use effective contraception than their healthy counterparts, although there may be room for improvement given their unique health risks.

Evaluating the impact of three progestin-based hormonal contraceptive methods on immunologic changes in the female genital tract and systemically (CHIME Study): a prospective cohort study protocol

BackgroundGonadal hormones can modify immune function, which may impact susceptibility to infectious diseases, including Human Immunodeficiency Virus (HIV). There is limited knowledge about how hormonal contraceptives (HC) influence the immune response during the course of use. The CHIME study aims to evaluate the effect of long-acting progestin-based hormonal contraceptives (depot medroxyprogesterone acetate, etonogestrel implant, and levonorgestrel intrauterine device) on immunologic changes in the female genital tract (FGT) and systemic compartment.MethodsCHIME is an observational cohort study where participants attend 2 visits prior to initiating the HC method of their choice, and then attend 6 visits over 12 months with biological sampling (vaginal swabs, cervicovaginal lavage, cytobrush and blood) for immunological, bacteriological, and virological analyses at each visit. Immune profiling will be evaluated by multi-color flow cytometry to determine how different T-cell subsets, in particular the CD4 T-cell subsets, change during the course of contraceptive use and whether they have different profiles in the FGT compared to the systemic compartment. The study aims are (1) to characterize the alterations in FGT and systemic immune profiles associated with three long-acting progestin-only HC and (2) to evaluate the vaginal microenvironment, determined by 16 s rRNA sequencing, as an individual-level risk factor and moderator of genital and systemic immune profile changes following exposure to three commonly used HC. Data collection started in March 2019 and is scheduled to be completed in October 2024.DiscussionThe CHIME study aims to contribute to the body of research designed to evaluate the comparative impact of three long-acting progestin-only HC on innate and adaptive immune functions to understand how immunologic effects alter STI and HIV susceptibility.

P072Preferred contraceptive use and barriers to care in mississippi

<h3>Objectives</h3> To evaluate preferred contraceptive use and barriers to contraceptive care among Mississippi residents. <h3>Methods</h3> We recruited Mississippi residents for an online survey about contraceptive use and access to reproductive healthcare using social media advertisements. Eligible participants were people assigned female at birth, aged 18–45, and not pregnant or desiring pregnancy. Among respondents who had sexual intercourse with a man in the past year, we assessed the percentage who would use a different method if they could get it at no cost and who reported barriers getting contraception, including inconvenient clinic hours and difficulty paying for services. We assessed the association between reporting at least one barrier to care and preference to use a different method using multivariable-adjusted Poisson regression with robust standard errors. <h3>Results</h3> Of 457 respondents, 93% were using contraception and 37% would change methods if they could do so for no cost. Overall, 82% reported at least one barrier to contraceptive care, the most common being difficulty paying for services (41%) and inconvenient clinic hours (36%). In multivariable-adjusted Poisson regression (PR), respondents were more likely to prefer a different method if they reported at least one barrier to care (PR, 1.99; 95% CI, 1.27–3.13) or were using less-effective or no (vs. highly effective) contraception (PR, 1.68; 95% CI, 1.33–2.12). <h3>Conclusions</h3> A majority of reproductive-aged Mississippi residents experience barriers to care, and one-third want to change contraceptive methods. Reducing barriers to preferred method use is essential for supporting Mississippi residents' reproductive autonomy, especially as abortion access decreases.

P086Documentation status and contraceptive use among women in california

<h3>Objectives</h3> Studies indicate that contraceptive use is low among immigrant women. Few studies examine the intersection of race and documentation status. This study assesses if contraceptive use and contraceptive type is linked to documentation status. <h3>Methods</h3> We analyzed data from a racially diverse sample of reproductive-aged women (n=6,417) from the 2017–2020 waves of the California Health Interview Survey, which is the largest state-level health survey. Bivariate and multivariate analyses were conducted to assess the relationships between documentation status, current contraceptive use, and type of method used (highly to moderately effective method use vs. less-effective method use). <h3>Results</h3> Contraceptive use was highest among US-born citizens (74%) and lowest among legal permanent residents (LPRs) (59%). Adjusted regression models indicated that LPRs had lower odds of contraceptive use compared to non-citizens without a green card (p<0.05). US-born and naturalized citizens also had greater odds of using a highly to moderately effective method of contraception over a less effective method compared to non-citizens without a green card (p<0.01). Documentation status and race had significant interaction effects on type of contraceptive method use, evidenced in lower odds of highly to moderately effective method use for Latina and non-Latina White US-born and naturalized citizens compared with Asian non-citizens without a green card. <h3>Conclusions</h3> Documentation status is associated with contraceptive care, but patterns differ for Latina, and non-Latina Asian and White women. Further research should examine mechanisms that underlie links between documentation status and contraceptive use.

Contraceptives and cancer risks in BRCA1/2 pathogenic variant carriers: a systematic review and meta-analysis.

Increasing numbers of BReast CAncer (BRCA) 1 or 2 pathogenic variant (PV) carriers, who have an inherited predisposition to breast and ovarian cancer, are being identified. Among these women, data regarding the effects of contraception on cancer risks are unclear and various guidelines provide various recommendations. We aim to optimize counselling regarding contraception for BRCA1/2-PV carriers. Therefore, we performed a systematic review and meta-analysis. We investigated the risk ratio for developing breast cancer or ovarian cancer in BRCA1/2-PV carriers who have used any form of contraception versus non-users. Second, we analysed breast and ovarian cancer risk among BRCA1/2-PV carriers as influenced by the duration of contraceptive use and by the time since last use. In addition, we provide an overview of all relevant international guidelines regarding contraceptive use for BRCA1/2-PV carriers. A systematic search in the Medline database and Cochrane library identified studies describing breast and/or ovarian cancer risk in BRCA1/2-PV carriers as modified by contraception until June 2021. The search included medical subject headings, keywords and synonyms related to BRCA and contraceptives (any kind). PRISMA guidance was followed. Risk Of Bias In Non-randomized Studies of Interventions and Grading of Recommendations, Assessment, Development and Evaluations assessments were performed. Random-effects meta-analyses were used to estimate pooled effects for breast and ovarian cancer risk separately. Subgroup analyses were conducted for BRCA1 versus BRCA2 and for the various contraceptive methods. Results of the breast cancer risk with oral contraceptive pill (OCP) analysis depended on the outcome measure. Meta-analyses of seven studies with 7525 women revealed a hazard ratio (HR) of 1.55 (95% CI: 1.36-1.76) and of four studies including 9106 women resulted in an odds ratio (OR) of 1.06 (95% CI: 0.90-1.25), heterogeneity (I2) 0% and 52%, respectively. Breast cancer risk was still increased in ever-users compared with never-users >10 years after last OCP use. In contrast, ovarian cancer risk was decreased among OCP users: HR 0.62 (95% CI: 0.52-0.74) based on two studies including 10981 women (I2: 0%), and OR 0.49 (95% CI: 0.38-0.63) based on eight studies including 10390 women (I2: 64%). The protective effect vanished after cessation of use. Tubal ligation also protects against ovarian cancer: one study including 3319 women (I2: 0%): HR: 0.44 (95% CI: 0.26-0.74) and three studies with 7691 women (I2: 44%): OR: 0.74 (95% CI: 0.53-1.03). Data regarding other contraceptives were unavailable. No differences were observed between BRCA1 and BRCA2-PV carriers. The quality of evidence was either low or very low. The OCP potentially increases breast cancer risk, while ovarian cancer risk decreases with either the OCP and tubal ligation in BRCA1/2-PV carriers. Counselling of BRCA1/2-PV carriers should be personalized; the genetic and non-genetic factors (like prior risk-reducing surgeries, prior breast cancer and age) and patients' preferences (reversibility, ease of use, reliability and effect on menstrual cycle) should be balanced. To further optimize counselling for high-risk women, future research should focus on other (commonly used) contraceptive methods and cancer risks in this specific population, and on the potential impact of changing formulations over time.

Hormonal Contraceptive Use and Association with Thromboembolism in Women with Sickle Cell Disease

Introduction Women with sickle cell disease (SCD) require broad access to highly effective contraceptive methods due to high rates of unplanned pregnancy and adverse maternal and fetal outcomes. Combined (estrogen-containing) hormonal contraception carries a known risk of thromboembolism (TE) in the general population, and women with SCD have higher baseline risk of TE, thus use of these agents in women with SCD may further increase that risk. The paucity of safety data on hormonal contraceptive use in women with SCD limits the ability of providers and patients to make informed decisions. Objectives This study aims to use population-level administrative claims data of publicly insured women with SCD in the United States (US) to assess patterns of hormonal contraception use and evaluate risk of TE during the first year of use. We hypothesized that TE rates are higher in women prescribed combined hormonal contraceptives (CHC) as compared to women prescribed progestin-only contraceptives (POC). Methods We obtained data using the Centers for Medicare and Medicaid Services Analytic eXtract (CMS MAX) from 2006-2018. Study population included females of reproductive age (12-44 years) with >3 ICD-9 or ICD-10 codes consistent with SCD. Women had to have ≥12 months of continuous enrollment with at least 6 months of data as 'washout period' prior to enrollment period. A new prescription for hormonal contraception was identified using national drug codes in pharmaceutical claims or ICD-9 or 10 procedure codes. CHC included the combined oral contraceptive pill (OCP), transdermal patch, and vaginal ring. POC included the progestin-only pill, depot medroxyprogesterone acetate (DMPA) injection, intrauterine device (IUD) and subdermal implant. TE was defined as the presence of ≥2 ICD-9 or ICD-10 codes for venous TE (deep vein thrombosis (DVT) or pulmonary embolism (PE)) or arterial TE (stroke or myocardial infarction (MI)). Arterial TE was also required to have an associated inpatient admission. Women were included in the analysis for 12 months after contraception initiation, or censored in the event of either contraceptive switch, pregnancy or abortion, or TE occurrence. Data were summarized descriptively and TE incidence rates were calculated as events per 1,000 person-years. Results We identified a total of 41,012 reproductive-aged women with SCD enrolled in CMS MAX, of whom 22.6% (n=9,261) had received ≥1 new prescription for hormonal contraception. Among women with new contraceptive use, 58.5% (n=5,420) initiated CHC and 41.5% (n=3,841) initiated POC. Median age at the start of contraception was 22.3 years (range: 12.0-43.9) and median age at the start of CHC and POC were 22.1 and 22.7 years respectively. Among CHC users, 84.6% (n=4,584) of women were prescribed the combined OCP, 7.7% (n=419) the transdermal patch, and 7.7% (n=417) the vaginal ring. For POC users, DMPA was prescribed to 72.3% (n=2,777), progestin-only pills to 21.2% (n=816), IUD to 4.2% (n=163) and subdermal implant to 2.2% (n=85) of women. A total of 141 (1.5%) new contraceptive users with SCD were identified to have a TE during the follow-up period. The median time from contraception initiation to TE diagnosis was 183 days (IQR: 82-244). The most common TE event was PE (46.1%) followed by DVT (41.8%), stroke (6.4%), and MI (2.1%); 3.5% of women had multiple TE events. TE rate was 16.4 events per 1,000 person-years in CHC users, and the TE event rate was 17.0 events per 1,000 person-years in POC users (p=0.84). Rates of TE did not differ between the two most commonly used methods in each group, the combined OCP (15.5 events per 1,000 person-years ) and DMPA (17.7 events per 1,000 person-years) (p=0.48). Conclusion Our work provides population-level data regarding contraceptive practices for women with SCD in the US. We found that CHC was more frequently prescribed than POC, and identified low rates of long-acting reversible contraception use. The most frequently prescribed agents were the combined OCP and the DMPA injection. TE rates after initiation of the combined OCP and DMPA did not differ. Although limited by the retrospective study design and use of administrative claims data, this study suggests a similar safety profile for CHC and POC in women with SCD with respect to risk of TE.

The Importance of Developing Online Counseling Services for Family Planning Programs in Indonesia

One of the reasons for the high of contraceptive acceptors drop out is the low number of contraceptive information received by clients. Indonesian Population Demographic Survey in 2017 stated that only 29% of women in Indonesia received contraceptive information including contraceptive side effects, how to deal with side effects, and alternative contraception that can be used. This is due to a limited number of family planning instructors, and a large number of tasks that health workers must carry out, especially midwives as the largest source of contraceptive services in Indonesia. The solution to overcome the low level of contraceptive information services is to build an online counseling service for family planning programs. Online counseling services based on digital technology are flexible and can be accessed by anyone who needs information. For this reason, this technology must be built on an evidence-based basis and a good reputation, so it is hoped that in addition to meeting the need for family planning information, it is also able to change behavior for the use of appropriate contraception.

Summaries of safety labeling changes approved by FDA-Boxed warnings highlights, July-September 2022.

As part of FDA’s MedWatch program, important changes to the safety labeling of drugs and therapeutic biologicals, including boxed warnings, are posted on the agency’s website. Boxed warnings are ordinarily used to highlight (1) an adverse reaction so serious in proportion to the potential benefit from the drug that it is essential that the reaction be considered in assessing the risks and benefits of using the drug, (2) serious adverse reactions that can be prevented or reduced in frequency or severity by appropriate use of the drug, and (3) situations in which FDA approved a drug with restrictions to ensure safe use because FDA concluded that the drug can be safely used only if distribution or use is restricted.1 The following revisions to warnings were implemented in the 3 months ending September 2022. The revised boxed warning emphasizes that diclofenac sodium/misoprostol is contraindicated during pregnancy and is not recommended for use by women of childbearing potential. Prescribers should verify the pregnancy status of females of reproductive potential before initiating therapy and advise them to use effective contraception during treatment.

Determination of possible contraceptive potential of methanolic leaf extract of Mentha longifolia L. in adult male rats: a biochemical and histological study.

Mentha longifolia L (ML) is locally used as an herbal contraceptive. We aim to assess the toxicity profile and validate the antifertility effects of its leaves in male rats. Adult male Sprague Dawley rats (n=10 animals/group) were divided into four groups. The Control group received .9% saline, while groups II, III, and IV received 50, 75, and 100mg/kg/day ML doses for 28days. ML induced a dose-dependent decrease in percent fertility as well as the number of pups born in ML preexposed pairs, with maximum change observed in the ML3 group (60%, 3.75±1.25) as compared to control (100%, 8.75±.48) group. A significant (P<.01) decrease in the rate of daily sperm production was observed in the ML3 group (.86±.16) in contrast to the control (2.93±.05). The levels of catalase and superoxide dismutase declined significantly in treatment groups (ML1-P<.001, ML2-P<.05, and ML3-P<.01). A significant increase in the production of reactive oxygen species (P<.001) was found in all treatment groups. The concentrations of LH (P<.001), FSH (P<.001), and testosterone (P<.001) were significantly reduced in a dose-dependent manner among ML-treated groups. Decreases in spermatogonial populations, mature spermatids, seminiferous tubule diameter, lumen diameter, and epithelial height were noticed at higher doses. The reversibility study depicted a reduction in both pregnancy outcomes and litter size. Besides contraceptive effects, M. longifolia L usage is associated with oxidative stress; therefore, it is important to consume this herb appropriately and its excessive usage should be prohibited.

Spermicidal, Antifertility and Contraceptive Effect of Azadirachta indica A. Juss. Seed Extract in Female and Male Wistar Rats

This study investigates the spermicidal and contraceptive effect of Azadirachta indica seed aqueous extract in male and female Wistar rats. The animals were divided into four groups (n=6), graded doses (2.5, 5, and 10 mg/kg) of the extract. They were exposed to female rats in a ratio of 2:1 after 24 hours, 7, and 14 days of administration. The spermicidal properties were evaluated. The female contraceptive study involved 14 days of pre-coital and post-coital administration of the neem seed extract, and contraceptive indexes were investigated. The results obtained from the spermicidal activity showed a significant decrease in male hormonal levels at 2.5, 5, and 10 mg/kg of A. indica (0.73, 0.50, and 1.08 ng/ml); and the sperm cells (102.5, 111.5, and 97 counts) after 24 hours. Administration and mating, compared to the control. Also, the histopathology of the testes showed normal testicles. The contraceptive study elicited a significant decrease in estrogen (1.46 ng/ml), luteinizing hormone (0.094 mg/dl) µand progesterone (1.82 ng/ml), at 5 mg/kg in day 14 post-coital study compared with the control. The histopathology of the treated uterus had no deteriorating effect compared with the control. The extract elicited spermicidal and contraceptive potential at a reduced dose, validating its folklore claim.