Long-acting Reversible Methods Research Articles

Medical eligibility, contraceptive choice, and intrauterine device acceptance among HIV-infected women receiving antiretroviral therapy in Lilongwe, Malawi

ObjectiveTo determine medical eligibility for contraceptive use, contraceptive preference, and acceptance of a copper intrauterine device (IUD) among a cohort of HIV-infected women receiving antiretroviral therapy (ART). MethodsAll HIV-infected women who received ART and sought contraceptive services at the Lighthouse clinic, an integrated HIV/ART clinic in Lilongwe, Malawi, between August and December 2010 were invited to participate in a structured interview. Eligibility and preference for the following contraceptive methods were assessed: combined hormonal contraceptives, progestogen-only pills, copper IUD, injectable depot medroxyprogesterone acetate (DMPA), and contraceptive implants. ResultsThe final sample included 281 women; five were pregnant. The remaining 276 women were eligible for at least three contraceptive methods, with 242 (87.7%) eligible for all five methods evaluated. After counseling, 163 (58.0%) selected DMPA and 98 (34.9%) selected an IUD as their preferred contraceptive method. Regardless of their method of choice, 222 (79.0%) women agreed to have an IUD placed on the same day. ConclusionMost methods of contraception are safe for use by HIV-infected women. Approximately 80% of the women were willing to receive an IUD. Efforts must be made to increase education about, and access to, long-acting reversible methods that may be acceptable and appropriate contraceptive options for HIV-infected women.

Provider counseling to young women seeking family planning services.

Contraceptive nonuse and misuse contribute to rates of unintended pregnancy and STDs among young women in the United States. Clinical providers assume an important role in guiding youths' contraceptive method choices. Sixty-seven women aged 16-21 were recruited as part of a cohort study, conducted in 2009-2012, that examined provider-patient interactions during family planning visits at six San Francisco clinics. Interactions between patients and providers were audio-recorded. Participants completed questionnaires about method preference immediately before seeing the provider; they reported on method choice immediately after the visit and by telephone three and six months later. Transcripts were analyzed to examine providers' strategies for guiding decision making and addressing youths' contraceptive concerns. Missed opportunities for promoting young women's reproductive health were identified. Twenty-one percent of young women who did not report desiring a hormonal or long-acting reversible method (IUD or implant) before seeing their provider chose one after counseling. Use of a hormonal or long-acting reversible contraceptive method at follow-up was more common among women who had received interactive counseling by providers who guided them to consider contextual influences than among those who had not received such counseling. Attention to relationship characteristics, sexual behavior patterns and STD risk was largely absent from contraceptive counseling. High-quality strategies used by providers to guide contraceptive decision making were tailored to adolescents' developmental and environmental needs. Several areas of counseling require increased attention and seem vital to providing comprehensive reproductive health care to adolescents.

Midwives’ experiences and views of giving postpartum contraceptive advice and providing long-acting reversible contraception: a qualitative study

BackgroundNational sexual health frameworks in the UK advise that women in maternity units who are at risk of unintended pregnancy should receive contraceptive advice and supplies of the most effective...

Intrauterine contraception after cesarean section and during lactation: a systematic review.

BackgroundAll postpartum women, including those who are breastfeeding or have had a cesarean section, appear potentially suited to intrauterine contraception, a long acting reversible contraceptive (LARC). Like any other method used after delivery, it should not interfere with lactation or be affected by cesarean section.Study designWe searched the MEDLINE, PubMed, Popline, Google Scholar, and Clinicaltrials.gov databases from January 1968 through to December 2012. Studies were included if they reported event rates in women who had a cesarean section and event rates and clinical outcomes in lactating women or their infants in the breastfeeding group. Summary odds ratios were not calculated because of the diverse methods of reporting event rates in the cesarean section group and the heterogeneity of the results in the breastfeeding group.ResultsWe found 26 articles on event rates in interval and post-placental intrauterine device (IUD) use, and 18 on event rates and clinical outcomes in breastfeeding IUD users. Four prospective studies and one retrospective study showed an increased expulsion rate in interval insertion. There were 19 studies, of which five were controlled in post-placental IUD insertion after cesarean section. Four studies had expulsion rates of 10 or more per 100 woman-years of use and 15 expulsion rates below 10 per 100 woman-years of use. Three studies showed that event rates for lactating IUD users are the same as those for non-lactating users. Fifteen controlled studies showed that the IUD had no effect on milk production and seven of these showed no effect on infant growth. Pharmacovigilance databases report an increased rate of IUD perforations in lactating women, while the event rate studies report that insertion is generally easier and less painful than expected. These were uncontrolled reports.ConclusionThe IUD is a long-acting reversible method of contraception with expulsion rates of 5–15 per 100 woman-years of use when used as a post-placental method immediately after cesarean section. As an interval procedure (6 or more weeks after cesarean section) it appears to have a high expulsion rate (5% or higher) notably in older devices. The IUD does not affect breastfeeding and is easy to insert in these women, but appears to be associated with a higher perforation rate (>1 per 100). Providers should not be deterred from using this contraception method, especially in developing countries, but should be attentive to preventing these potential problems.

Histological study of hysteroscopy-guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

Introduction The intrauterine device (IUD) is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. Aim of the work This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Patients and methods Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups: the control group (10 patients), with no past history of IUD insertion, and the IUD group (20 patients), with a history of copper IUD insertion for 6 months to 3 years (subgroup B1) or for more than 3 years (subgroup B2). Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Results Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Conclusion Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal.

Estimates of unintended pregnancy rates over the last decade in France as a function of contraceptive behaviors

ObjectiveWe investigate trends in contraceptive behaviors in France and how they may have contributed to fluctuations in unintended pregnancy rates over time and across subgroups of the population between 2000 and 2010. Study DesignData are drawn from three national surveys in France, comprising 4714 women ages 15 to 49 in 2000, 8613 in 2005 and 5260 in 2010. We used multinomial and simple logistic regression models to explore trends in contraceptive behaviors over time. We estimated trends in unintended pregnancy rates in relation to population shifts in contraceptive behaviors between 2000 and 2010. ResultsA third of women were not using contraception at the time of the surveys. However, only 2.4% in 2000, 3.2% in 2005 and 2.4% in 2010 had an unmet need for contraception (p=.002). Among contraceptive users, user-dependent hormonal methods decreased from 59% in 2000 to 52% in 2010 (p<.0001), while long-acting reversible methods increased from 22% to 24% (p=.04). Changes in contraceptive behaviors resulted in fluctuations in unintended pregnancy rates estimated to have risen from 3.16% to 3.49% between 2000 and 2005, and to have decreased to 3.26% in 2010. Small changes in unmet need for contraception exerted the largest effects. ConclusionThis study indicates that changes in contraceptive behaviors over the past decade in France have potentially resulted in significant fluctuations in unintended pregnancy rates. Our results also demonstrate that a simple algorithm combining contraceptive behaviors and typical-use failure rates may be an acceptable proxy for monitoring trends in unintended pregnancies. ImplicationsThis study offers a framework towards assessing trends in unintended pregnancies, when data on abortions and unintended births are not available. In the context of high contraceptive coverage, gaps of use undermine efforts to improve contraceptive effectiveness, as small fluctuations in unmet need contribute significantly to trends in unintended pregnancy rates.

The Impact of Out-of-Pocket Costs on the Use of Intrauterine Contraception Among Women With Employer-sponsored Insurance

Long-acting reversible contraception (LARC) is highly effective but also has higher initiation costs than oral contraceptive methods, which may contribute to relatively low use. The Affordable Care Act requires most private insurance plans to cover contraceptive services without patient cost-sharing. Whether this mandate will increase LARC use is unknown. To assess the relationship between cost-sharing and use of LARC among privately insured women. Cross-sectional analysis using Truven Health MarketScan data from January 2011 to December 2011. Women aged 14-45 years with continuous insurance coverage enrolled in health plan products that covered branded and generic oral contraceptive pills (OCPs) and intrauterine devices (IUDs). We selected women using OCPs and IUDs as these are the most commonly used short-acting and long-acting reversible methods, respectively (N=1,682,425). Multivariable regression was used to assess the association of the level of out-of-pocket costs for IUDs for each patient's plan and IUD initiation, adjusting for out-of-pocket costs for branded and generic OCPs and patient characteristics. Overall, 5.5% of women initiated an IUD in 2011. After adjustment, IUD initiation was less likely among women with higher versus lower co-pays (adjusted risk ratio=0.65; 95% CI, 0.64-0.67). Women who saw an obstetrician/gynecologist during 2011 were more likely to initiate an IUD (adjusted risk ratio=2.49; 95% CI, 2.45-2.53). Rates of IUD use are low among privately insured women in the United States, and higher cost-sharing is associated with lower rates of IUD use. Together with other measures to promote LARC use, eliminating co-pays for contraception could promote the use of these more effective and cost-effective methods.

Annualized costs of contraceptive products in the united states: a comparison of long-acting and short-acting reversible methods

Annualized costs of contraceptive products in the united states: a comparison of long-acting and short-acting reversible methods

Knowledge of long-acting reversible contraception among women presenting for induced abortion

Objectives: Scant quantitative data exist on contraceptive knowledge among women obtaining an abortion. We sought to determine contraceptive knowledge in this population. Methods: We surveyed women presenting for induced abortion to an urban academic medical center, using a 15–30-min self-administered written survey. We reviewed medical records to determine choice of contraceptive method postabortion.Inadditiontodescriptivestatistics,weperformedbivariateanalysis to determine correlates of awareness of long-acting reversible (LARC) methods. Results: We surveyed 167 women from March 2012 to March 2013. The median age was 27 years (range 15–42), 73.9% were black and 71.1% were parous. Although 71.9% (120/167) had heard of the IUD and 64.2% (106/165) had heard of the implant, only 13.2% and 1.8% had used them, respectively. Parous women were more likely to have heard of the IUD than nulliparous women (83.1% vs. 43.8%, pb.001), and there was a similar trend for the implant (68.1% vs. 54.2%, p=.09). Of those who had heard of the IUD, only 49.2% (59/ 120) and 36.7% (44/120) perceived the levonorgestrel IUD and copper IUD to be effective, respectively. Assessment of the implant was even poorer, with only 34.0% (36/106) of those who had heard of it perceiving it to be effective. Approximately half (51.5%) of the participants planned to use a LARC method after their abortion. Conclusions: Although the majority of women had heard of LARC methods, knowledge about their efficacy was low, and a minority had used them. By learning women's current knowledge about contraceptive methods, contraceptive counseling interventions can be better directed.

Use of the etonogestrel-releasing contraceptive implant

The single-rod, etonogestrel-releasing, subdermal implant (ENG implant) is the most effective, long-acting reversible method of contraception available. The failure rate of the ENG implant is 0.05%, which makes it more effective than female sterilization. It is discreet, easy to insert and remove, has no effect on future fertility and is associated with a number of noncontraceptive health benefits. The ENG implant is safe and effective when used in the postpartum and postabortion setting, and in women who have contraindications to estrogen. The most common reason cited for discontinuation is irregular and unpredictable bleeding. However, structured, preinsertion counseling can increase continuation and user satisfaction.

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.

Racial and ethnic differences in men's knowledge and attitudes about contraception

BackgroundLittle is known about racial/ethnic differences in men's contraceptive knowledge and attitudes. Study DesignWe used multivariable logistic regression to examine racial/ethnic differences in contraceptive knowledge and attitudes among 903 men aged 18–29 in the 2009 National Survey of Reproductive and Contraceptive Knowledge. ResultsBlack and Hispanic men were less likely than Whites to have heard of most contraceptive methods, including female and male sterilization, and also had lower knowledge about hormonal and long-acting reversible methods. They were less likely to know that pills are ineffective when 2–3 pills are missed [Blacks: adjusted odds ratio (aOR)=0.42; Hispanics: aOR=0.53] and that fertility was not delayed after stopping the pill (Blacks: aOR=0.52; Hispanics: aOR=0.27). Hispanics were less likely to know that nulliparous women can use the intrauterine device (aOR=0.47). Condom knowledge was similar by race/ethnicity, but Blacks were less likely to view condoms as a hassle than Whites (aOR=0.46). ConclusionsEfforts to educate men, especially men of color, about contraceptive methods are needed.

Should we Do more to Improve Oral Contraceptive Continuation?

Oral contraceptives are commonly chosen methods whose contraceptive effectiveness is very user-dependent. Approaches to significantly improving oral contraceptive continuation have been largely unsuccessful. Long-acting reversible methods are the most highly effective reversible contraceptives, with the highest continuation rates, and should be the first-line methods offered to reproductive-aged women.

Contraception access and use among US servicewomen during deployment

BackgroundApproximately 12% of active duty US servicewomen have an unintended pregnancy each year; however, little is known about contraception use during deployment. Study DesignFrom April to November 2010, we conducted an online survey with a convenience sample of 281 servicewomen who had been deployed overseas to assess access to and use of contraception for deployment. ResultsSixty-three percent of respondents used birth control for part or all of their last deployment. Although military health insurance covers most contraceptive methods, one third reported that they were unable to access a method they might want for deployment, and 59% did not speak with a military provider about contraceptive options prior to deployment. Certain methods were reportedly discouraged or not available for some women, including intrauterine devices and sterilization, and 41% of women requiring refills found them difficult to obtain. ConclusionsGiven the high prevalence of unintended pregnancy among servicewomen, efforts should focus on improving contraceptive counseling prior to deployment and ensuring refill access during deployment, as well as expanding access to long-acting reversible methods.

Young Adults' Contraceptive Knowledge, Norms and Attitudes: Associations with Risk Of Unintended Pregnancy

Women aged 18-29 have higher rates of unintended pregnancy than any other age-group. Information is needed to understand what characteristics are associated with risky contraceptive use practices among this population and to develop new strategies for reducing these women's risk of unintended pregnancy. Data related to unintended pregnancy risk were collected from a nationally representative sample of 1,800 unmarried women and men aged 18-29 surveyed by telephone in 2009. Among those at risk of unintended pregnancy, multiple logistic regression was used to assess associations between contraceptive knowledge, norms and attitudes and selected risky contraceptive behaviors. More than half of young men and a quarter of young women received low scores on contraceptive knowledge, and six in 10 underestimated the effectiveness of oral contraceptives. Among women, for each correct response on a contraceptive knowledge scale, the odds of expecting to have unprotected sex in the next three months decreased by 9%, of currently using a hormonal or long-acting reversible method increased by 17%, and of using no method decreased by 17%. Fear of side effects, norms and attitudes that favor nonmarital pregnancy or undervalue the importance of contraception, pregnancy ambivalence and mistrust of government's role in promoting contraception were also associated with one or more risky contraceptive use behaviors. Programs to increase young adults' knowledge about contraceptive methods and use are urgently needed. Given the demonstrated link between method knowledge and contraceptive behaviors, such programs may be useful in addressing risky behavior in this population.

Lack of insurance and parity influence choice between long-acting reversible contraception and sterilization in women postpregnancy

BackgroundDisparities in postpregnancy contraception utilization exist, with low-income women disproportionately undergoing sterilization. We assessed the impact of increased intrauterine device (IUD) availability on rates of female sterilization. Study DesignHospital billing records were used to identify women with an IUD placement or sterilization within 1 year of a pregnancy at a university hospital between Oct 2005 and Jun 2007. Demographic data were compared between women receiving either an IUD or sterilization. ResultsThere were 365 sterilizations and 223 IUD placements during the study period. IUD placements doubled over the study period from 6% to 12% of all deliveries, while sterilizations remained stable at 11% (p<.001). Demographic variables were examined for women with either public or private insurance who had financial access to both sterilization (n=253) and IUD (n=223). Women receiving sterilization were slightly older (mean age 31 years versus 30 years, p=.03), of higher parity (median three versus two, p<.01), more likely to have had cesarean delivery (69% versus 31%, p<.001) and more likely to have public insurance (77% versus 23%, p<.001) than women who received IUD. Approximately 45% of women delivering in Oregon in 2007 were publicly insured (2010 Maternal and Child Health Update: States Make Progress Towards Improving Systems of Care. National Governor's Association, Table 6. Available at http://www.nga.org/files/live/sites/NGA/files/pdf/MCHUPDATE2010.PDF, accessed Nov 2011). After adjusting for age, parity and type of delivery, women choosing sterilization were more likely to have public insurance than women choosing IUD (odds ratio 8.4, 95% confidence interval 4.7–14.9, p<.0001). ConclusionsWomen choosing sterilization are more likely to have public insurance than women choosing IUD and may represent a continued trend toward nonreversible contraception among women of lower socioeconomic status despite available long-acting reversible methods.

Contraceptive considerations in overweight teens

The purpose of this review is to explore the efficacy and safety of contraceptives in overweight adolescents. There are few studies exploring hormonal contraceptive efficacy and safety in overweight and obese adults and almost none addressing these issues in adolescents. Luckily for teens, in terms of safety, many of the comorbidities associated with obesity are yet to transpire and their options for contraception remain relatively unrestricted. Studies of the combined oral contraceptive pill and patch in adults suggest that efficacy may be decreased in overweight adolescents. There is no evidence to suggest that the efficacy of the contraceptive implant or intrauterine device (IUD) is decreased in overweight adolescents. Indeed, these long-acting reversible methods will be the best choice for many adolescents because of their high efficacy. Although the literature is not definitive, there is probably a subset of adolescents who are susceptible to weight gain with use of depot medroxyprogesterone acetate. Although there is little research regarding contraceptive efficacy in overweight adolescents, IUDs and implants will be the best methods for many adolescents because of their high efficacy, reversibility, and safety.

Women Want Postabortion Contraception, But Clinics Face Barriers Adding Services

This article explains the interest of United States women in receiving contraceptive methods including long-acting reversible methods as part of a visit to an abortion care facility but insurance and high cost may be barriers to integrating abortion and contraceptive services. It discusses survey findings of womens attitudes toward receiving contraceptive services as part of abortion care as well as the provider-perceived barriers in integrating contraceptive and abortion services.

Correlates of long-acting reversible methods of contraception use among young women from 2002 to 2008

Correlates of long-acting reversible methods of contraception use among young women from 2002 to 2008

Continuation and satisfaction of reversible contraception: A preliminary analysis from the Contraceptive CHOICE project

The primary objectives of the Contraceptive CHOICE Project are to promote the use of long-acting reversible methods of contraception (LARC) and to determine continuation rates and levels of satisfaction with all reversible methods.