Non-contraceptive Indications Research Articles

Continuation rates of hormonal intrauterine devices in adolescents and young adults when placed for contraceptive and non-contraceptive indications

ObjectiveThis study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. Study DesignWe conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least 1-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded. ResultsA total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p = 0.74). The mean age at insertion was 18.9 years (SD = 2.4 years), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those without follow-up, the overall continuation rates were 77% at 1 year, 66% at 2 years, and 54% at 3 years. While continuation rates did not differ by indication at 1 year, at 3 years, continuation was highest among those who sought the device for menstrual management only (contraception = 53%, menstrual = 57%, both = 53%, p < 0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication. ConclusionIUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. ImplicationsAdolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at 1 year regardless of the indication for utilization.

4. Continuation Rates of Intrauterine Devices in Adolescents and Young Adults when placed for Contraceptive and Non-Contraceptive Indications

4. Continuation Rates of Intrauterine Devices in Adolescents and Young Adults when placed for Contraceptive and Non-Contraceptive Indications

Neuropsychological side effects of combined hormonal contraceptives for the treatment of mild symptoms. Bioethical assessment of its adequacy

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.

Work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training

To explore work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training. We invited educational stakeholders to participate in telephone interviews that elicited strategies for overcoming barriers to family planning training in religious settings. Eighteen out of 30 invited programs leaders participated. Work-arounds included reliance on non-contraceptive indications for contraception and permanent contraception provision, obtaining ethics committee approvals for service provision, and developing partnerships with offsite centers for training. Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions.

Non-Contraceptive Progestins and Risk of Venous Thromboembolism: A Nested Case-Control Study of the Marketscan Databases

<h3>Study Objective</h3> To evaluate for a dose-response relationship in the association between progestins used for non-contraceptive indications (e.g., endometriosis) and venous thromboembolism (VTE). <h3>Design</h3> Nested case-control study. <h3>Setting</h3> The IBM® MarketScan® Databases include routinely collected inpatient, outpatient, and pharmacy claims data among privately insured individuals in the US. <h3>Patients or Participants</h3> Records of 45 million women aged 15-49 years old were evaluated from 2009-2018. Cases with VTE (n=21,405) were identified by validated ICD-9/10 codes and excluded for recent pregnancy, recent estrogen prescription, or indications for ultra-high dose progestins (e.g., endometrial intraepithelial neoplasia). Controls (n=107,025) were individually age-matched 5:1 by risk set sampling. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Oral progestin exposures and covariates were defined by prescription claims and ICD-9/10 codes, respectively, within 1 year before the index date. Multivariate conditional logistic regression models determined odds ratios with 95% confidence intervals adjusted for VTE risk factors. The dose-response relationship was assessed by two separate exploratory analyses. The first analysis compared new and chronic use with non-use. The second analysis evaluated progestin exposure as a weighted average daily dose. Significance was set at p<0.01 to allow for multiple comparisons. Odds of VTE were significantly increased for current use of norethindrone acetate (new users aOR 4.97 [2.96-8.35], n=83; chronic users aOR 2.28 [1.48-3.51], n=118) and current use of medroxyprogesterone acetate (new users aOR 2.08 [1.47-2.96], n=194; chronic users aOR 1.76 [1.18-2.63], n=145), compared with non-use. Comparisons between new and chronic use were not significant. Odds of VTE were directly proportional to progestin dose: +22% (aOR 1.22 [1.09-1.36]) for each 2.5 mg/day increase in norethindrone acetate and +19% (aOR 1.19 [1.08-1.30]) for each 5 mg/day increase in medroxyprogesterone acetate. <h3>Conclusion</h3> Non-contraceptive progestins are associated with increased VTE risk. This study provides the first assessment and support of the dose-response relationship. Clinicians should consider using the lowest effective dose to balance risks and benefits.

Unforeseen uses of oral contraceptive pills: Exploratory study in Jordanian community pharmacies

BackgroundThe use of oral contraceptive pills (OCPs) as a birth control method is very common worldwide. OCPs have many other labeled non-contraceptive indications, and as a result there is an associated risk of improper use, as with any other medications. This study was designed to assess the unforeseen improper uses of OCPs observed by community pharmacists in Jordan.MethodA cross-sectional study design was conducted using a self-administered survey. A convenience sample (n = 380) of Jordanian community pharmacists, were recruited through social media resources. The survey included multiple-choice and open-ended questions. Descriptive statistics and correlation analyses were completed using SPSS.ResultsMore than half of the recruited pharmacists (55.3%) were female, and the mean age of the participants was 32.58 ± 9.94. The majority of the pharmacists (85%) had good knowledge about the non-contraceptive indications of OCPs. About 53% of them confirmed their exposure to cases of the improper use of OCPs. About 67.5% of the pharmacists who confirmed exposure to such cases, reported the topical use of OCPs for the enhancement of hair growth. Around 15% of those pharmacists stated that OCPs were used to give negative results for addictive drug screening tests. In the event that the pharmacists suspected improper use, more than 90% suggested they would refrain from dispensing the pills.ConclusionThis study has spotlighted many unforeseen uses of OCPs in Jordan and highlighted the need for restricted national regulations on the monitoring of OCP prescription/selling patterns in Jordan by policymakers. Moreover, there is a need for the establishment of national educational programs for the Jordanian community regarding the safe proper use of OCPs.

Timing of insertion affects expulsion in patients using the levonorgestrel 52 mg intrauterine system for noncontraceptive indications

ObjectiveTo evaluate levonorgestrel 52 mg intrauterine system (IUS) expulsion risk by menstrual cycle day of insertion (days 1–8 vs days 9 and beyond) in women using the IUS for noncontraceptive indications. Study designWe performed a retrospective cohort study of patients with a levonorgestrel IUS inserted for the management of noncontraceptive, gynecologic conditions at Kaiser Permanente-Hawaii between January 2009 and December 2010. We used multivariable logistic regression models to estimate the likelihood of IUS expulsion adjusting for demographic and clinical factors and a Kaplan-Meier curve for survival analysis. ResultsOf 176 patients identified, insertion occurred in 42 patients in cycle days 1 to 8 and 87 patients after day 8. Patient follow-up within the Kaiser system ranged from 1 to 71 months. Thirty-nine (22%) patients experienced expulsion, 16 (38%) and 15 (17%) for the 2 timing groups, respectively. Expulsion was more likely if the IUS placement occurred during the menstrual cycle days 1 to 8 (adjusted odds ratio 3.57 [95% confidence interval 1.13, 11.31]), which was consistent with the Kaplan-Meier analysis (p = 0.008). ConclusionLevonorgestrel IUS expulsion among women using the IUS for noncontraceptive indications occurred more frequently if insertion occurred during the first eight days of the menstrual cycle. ImplicationsIn women planning to use the levonorgestrel IUS to treat gynecologic conditions such as abnormal uterine bleeding, dysmenorrhea, and endometrial hyperplasia, providers should consider waiting until after cycle day 8 to perform insertion.

Levonorgestrel Intrauterine Device Use for Medical Indications in Nulliparous Adolescents and Young Adults

PurposeIntrauterine devices (IUDs) are highly effective at preventing pregnancy. Levonorgestrel (LNG) IUDs also have beneficial effects on menstrual bleeding and abdominal and pelvic pain. Although there are increasing data on use of IUDs for contraception in adolescents and for medical indications in adults, there are extremely limited data on LNG IUD use for medical indications in adolescents. Our objective is to describe the characteristics and experiences of LNG IUD use in nulliparous adolescents and young women using IUDs for medical indications. MethodsWe conducted a retrospective chart review of all nulliparous patients aged 22 years and younger who underwent LNG IUD insertion at a tertiary care children's hospital between July 1, 2004 and June 30, 2014 primarily for noncontraceptive indications. Descriptive statistical analysis was performed. ResultsWe identified 231 LNG IUDs placed in 219 nulliparous women for medical indications during this time period. Mean patient age was 16.8 years (±2.2). Only 41% reported ever being sexually active. IUD continuation rate at 1 year was 86%. The amenorrhea rate at 1 year was 51%. Approximately 80% of women reported improvements in menstrual bleeding and abdominal and pelvic pain. Side effects and complications were low. ConclusionsThis study provides evidence that LNG IUDs are effective, well-tolerated, and safe menstrual management options in young nulliparous women, including younger adolescents and those who have never been sexually active. This method is an excellent first-line therapy option for adolescents and young women for both contraceptive and noncontraceptive indications, regardless of age, parity, or sexual activity.

Experiences of Gender Minority Youth With the Intrauterine System

PurposeThe aim of the study was to evaluate the experience of menstruating adolescents identifying as male or gender nonconforming with the levonorgestrel-releasing intrauterine system (LNG-IUS) as a method of menstrual suppression and compare to that of cisgender youth (CGY) using the LNG-IUS for noncontraceptive indications. MethodsA retrospective chart review of gender minority youth (GMY), aged 12–22 years, who self-selected the 52 mg LNG-IUS for menstrual suppression between June 2014 and January 2018. GMY were then matched for age and time of insertion with CGY. Subjects were contacted by telephone to further explore LNG-IUS experience such as if the device was still in place, method satisfaction, current bleeding patterns, and for GMY improvement in menstrual distress. ResultsThirty GMY had the LNG-IUS inserted during the study period, and 20 GMY were matched with CGY for age and time of insertion. GMY were significantly more likely to receive sedation for LNG-IUS insertion (50% vs. 15%, p = .04). Otherwise, the LNG-IUS experience was similar between groups, including mean number of telephone/office visit encounters for an LNG-IUS concern, expulsion and reinsertion rates, and need for additional medications to control bleeding. On average, the mean months of use was 14.5 ± 8.6 months in GMY and 14.6±11.5 in CGY (p = .97). LNG-IUS removal was documented in three (15%) of GMY and five (25%) of CGY. Improvement in menstrual distress was reported by 80% of GMY after the insertion of the LNG-IUS. ConclusionsOverall experience with the LNG-IUS was similar for GMY and CGY, and menstrual distress and bleeding pattern improved in the majority of GMY who self-selected this method for menstrual suppression.

Antiandrogenic and antimineralocorticoid health benefits of COC containing newer progestogens: dienogest and drospirenone.

Data have demonstrated that COCs, besides offering a satisfactory and safe contraception, offer a variety of non-contraceptive health benefits and therapeutic positive aspects. Many prescribes and users, however, do not realize these positive aspects especially the non-contraceptive health benefits. While the contraceptive use is the primary indication for COC use for most women, these users should be advised in regard of the non-contraceptive benefits when contraception is discussed and prescribed.Using COCs specifically for non-contraceptive indications is an off-label use in many clinical situations (only some exceptions as e.g. acne vulgaris in some countries are allowed clinical entities for the use of these drugs). Therefore, appropriate discussions with the patient regarding this fact should performed and documented by the prescribing physicians.Independent of the off-label situation, COCs containing the newer progestogens dienogest and drospirenone with their antiandrogenic and antimineralocorticoid health benefits play an important role in the management of many diseases and their use should therefore be considered by clinician’s.This review will focus on the effects of these COCs on the endometrium, the skin, the fat tissue and the premenstrual syndrome.

Commentary on ‘Prescribing patterns of combined hormonal products containing cyproterone acetate, levonorgestrel and drospirenone in the UK’

The research undertaken by Cea-Soriano et al 1 provides for the first time analysis of the prescribing patterns of three combined hormonal contraception (CHC) products with regard to contraceptive and...

A Review of Hormonal Contraception and Venous Thromboembolism in Adolescents

BackgroundThe number of adolescents who are prescribed hormonal contraception (HC) for contraceptive and noncontraceptive indications is increasing. Approximately 1 of 4 female adolescents will use some form of HC by age 19 years. Venous thromboembolism (VTE) is a rare, but life-threatening complication associated with HC use. Although adolescents aged 15 to 19 years have the lowest absolute HC-associated VTE risk, they still account for 5.9% of HC-associated VTE. The absolute HC-associated VTE risk for those younger than 15 years of age is not well described. ObjectiveThe objectives of this report are to describe the current literature regarding HC-associated VTE in adolescents, to review the coagulation cascade and in vivo coagulation, to highlight differences between the adolescent and adult coagulation profiles, to discuss coagulation profile changes related to HC use, and to identify knowledge deficits for future study. ConclusionThe mechanisms and confounding variables that lead to HC-associated VTE in all adolescents are not well understood because many large HC studies exclude female adolescents younger than 18 years of age. Because of the paucity of data in this age group, observational studies and randomized controlled trials of VTE risk in adolescents on varying forms of HC are needed. Studies should include female adolescents across the entire adolescent age span (12-21 years) to better understand HC-associated VTE risk in this population.

The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: A prospective study

Objective To compare vaginal microflora and cervical cytology before and after insertion of a copper-containing intrauterine device (Cu-IUD) or a levonorgestrel releasing-intrauterine system (LNG-IUS).Methods Between April 2009 and February 2011, all women requesting insertion of an intrauterine contraceptive for family planning or noncontraceptive indications were enrolled. One hundred and eight Cu-IUDs and 42 LNG-IUSs were placed. Cervical cytological and vaginal microbiological findings before insertion and after 12 months were recorded.Results With regard to cervical cytology, nonspecific inflammatory changes became more frequent (but not significantly so; p = 0.062) after one year of use of a Cu-IUD, whereas their prevalence remained unchanged among women fitted with a LNG-IUS. Colonisation by Candida spp. and mycoplasma infections were diagnosed significantly more often after one year of use of the Cu-IUD than at baseline. During the study period, women wearing a Cu-IUD complained significantly more frequently of vaginal discharge, pelvic pain, and increased menstrual flow.Conclusion Use of a Cu-IUD – but not that of a LNG-IUS – was associated with an alteration of the vaginal flora and showed a trend towards a higher frequency of nonspecific inflammatory changes affecting cervical cytology.

The Use of Levonorgestrel Intrauterine Devices for Non-Contraceptive Indications and Subsequent Surgical Intervention

The Use of Levonorgestrel Intrauterine Devices for Non-Contraceptive Indications and Subsequent Surgical Intervention

Changing depot medroxyprogesterone acetate access at a faith-based institution

Background Loyola University Medical Center is a Jesuit faith-based hospital that previously offered immediate postpartum depot medroxyprogesterone acetate (DMPA) for noncontraceptive indications. Study Design We performed a historical cohort study comparing patients aged 25 years or less who received immediate postpartum DMPA versus women who did not. We used logistic regression to analyze associations between patient characteristics and repeat pregnancy within 1 year. Results There was a total of 258 women in our cohort: 105 (40.70%) exposed to DMPA. Majorities were non-Caucasian, unmarried, Catholic and received public insurance. Multivariable analysis, after adjusting for race and religion, shows a statistically significant decrease in repeat pregnancy for patients given immediate postpartum DMPA (OR 0.27, 95% CI 0.10–0.72). Conclusion Limits on access to DMPA for noncontraceptive indications during the postpartum period resulted in significant increases in pregnancy rates for adolescents and young adult women at this faith-based institution.

Intrauterine Contraceptives: A Review of Uses, Side Effects, and Candidates

This article reviews the two intrauterine devices (IUDs) available in the United States: the TCu380A, marketed as ParaGard (Duramed Pharmaceuticals, Inc. Pomona, NY), and the levonorgestrel-releasing intrauterine system (LNG-IUS), marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ). The properties of the two devices are detailed, as well as noncontraceptive indications and appropriate candidates for use. Studies consistently demonstrate that the devices are safe, effective, and provide cost savings when compared with other reversible methods. The TCu380A may be used as postcoital contraception with close to 100% effectiveness. Menstrual blood loss is likely to increase with the TCu380A and decrease with the LNG-IUS. Reduction in menstrual blood loss and endometrial suppression make the LNG-IUS an increasingly popular treatment for menorrhagia, endometriosis, adenomyosis, and as an adjunct to estrogen therapy. IUDs may be inserted immediately after a first- or second-trimester abortion, immediately postpartum, and >or=4 weeks postpartum. Candidacy for IUDs has expanded, and includes nulliparous women, adolescents, and women with immunocompromised conditions including HIV.

Consultation with the Specialist: Dysmenorrhea

1. Paula J. Adams Hillard, MD* 1. *Professor, Department of Obstetrics & Gynecology and of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio After completing this article, readers should be able to: 1. Recognize the prevalence of dysmenorrhea in adolescents and its common results. 2. Describe a menstrual history that is most consistent with primary dysmenorrhea. 3. List the mediators of uterine pain and contractions believed to be involved in the pathophysiology of primary dysmenorrhea. 4. Recommend the appropriate evaluation and management of primary dysmenorrhea, including the appropriate choice and dosing of both over-the-counter and prescription medications. 5. Recognize patients who should be referred for evaluation of possible causes of secondary dysmenorrhea. A 15½-year-old girl came to the office with complaints of the recent onset of painful menstrual periods. She experienced her first menstrual period at the age of 13 years and except for an occasional mildly uncomfortable menstrual period, had not experienced significant pain until recently. She reported regular monthly menses, although she did not write down the dates. She described additional symptoms that also had not been present previously, including headache, loose stools, and breast tenderness. She has tried several over-the-counter medications, including acetaminophen, without significant relief. She has missed 3 days of school in the last 6 weeks because of these complaints. She is otherwise healthy, having no major illnesses, no history of surgeries, and no other genitourinary complaints. There is no family history of endometriosis; severe dysmenorrhea; menorrhagia; irregular periods; infertility; uterine fibroids; or breast, ovarian, colon, or uterine cancer. Her mother recalled that she had been prescribed oral contraceptives at the age of 16 years to alleviate her severe menstrual cramps. When spoken with privately, having been assured confidentiality, the girl denied sexual activity or abuse. She was doing well in school, making As and Bs, and felt that the relationship with her parents and one sister were good. She reported that she experienced crampy midline lower abdominal pain that began with the …

Current Contraceptive Research and Development

The approval of various new contraceptive products in recent years has resulted in broadening the options available to women. Trends in contraceptive research for hormonal products include variations in dose and dosing regimens, introduction of novel compounds, evaluation of products for noncontraceptive indications, and development of nonoral delivery systems and male contraceptives. Nonhormonal areas of research include microbicidal products, dual protection methods, and contraceptive vaccines. For each of these categories, contraceptive products currently in development and the potential implications for adolescents are discussed. Ongoing contraceptive research and development activity is robust and should ensure the continued availability of various new products for adolescents.