Reliable Contraception Research Articles

Contraceptive counseling and choices in pregnancies with maternal cardiac disease

Objective Unplanned pregnancies in women with maternal cardiac disease (MCD) are associated with increased morbidity and mortality, but the majority of these individuals do not use highly reliable contraception on postpartum hospital discharge. Contraceptive counseling in this population outside of pregnancy is incomplete and counseling during pregnancy remains poorly characterized. Our objective was to evaluate the provision and quality of contraceptive counseling for individuals with MCD during pregnancy. Methods All individuals with MCD who delivered between 2008 and 2021 at a tertiary care institution with a multidisciplinary cardio-obstetrics team were sent a 27-question survey. A subset of questions were derived from the validated Interpersonal Quality in Family Planning (IQFP) survey, which emphasizes interpersonal connection, adequate information, and decision support for the individual. Each participant received a $15 gift card for survey completion. We performed chart review for clinical and demographic details, including cardiac risk score. Results Of 522 individuals to whom the survey was sent, 133 responded and met inclusion criteria. Overall, 67% discussed contraception with their general obstetrician, 36% with their maternal-fetal medicine (MFM) specialist, and 24% with their cardiologist. Compared to individuals with low cardiac risk scores, those with high cardiac risk scores had a nonsignificant trend toward being more likely to discuss contraception with a MFM provider (52% vs 33%, p = .08). 65% reported that their provider was ‘excellent’ or ‘good’ in all IQFP domains. Respondents valued providers who respected their autonomy and offered thorough counseling. Respondents disliked feeling pressured or uninformed about the safety of contraceptive options. Conclusion Most individuals with MCD reported excellent contraceptive counseling during pregnancy. Additional work is needed to understand barriers to and enablers for effective, patient-centered contraceptive counseling and use in this population.

Study on injectable DMPA (Depomedroxy Progesterone Acetate) and effect of its use as a short term contraception in immediate postpartum women

Background and Aim: Contraception in the postpartum period is a significant problem. When used correctly, injectable hormonal contraceptives are one of the most reliable methods of contraception currently available. The purpose of the present study was to assess the effect of injectable DMPA as a short term contraceptive in immediate postpartum women. Patients and Methods: This prospective observational study was conducted on 130 postpartum women in the Gynaecology Department of Ayub Teaching Hospital, Abbottabad from December 2018 to December 2019. The study group of 130 postpartum women were given injectable DMPA 150 mg intramuscularly during discharge from hospital and after three months. The mother was subjected to a complete general physical examination. The need of exclusive breast feeding was emphasized. Fasting blood samples were collected for liver function testing (LFT), lipid profile, blood sugar, haemoglobin (Hb). About 130 postpartum women who were not taking any hormonal contraceptive were considered a control group. All the patients were followed-up for six weeks, three months, and six months. Data analysis was done using SPSS version 27. Results: The overall mean age of study group was 24.6±2.9 years with an age range 20 to 34 years.

Fertility, Contraception, and Fertility Preservation in Trans Individuals.

An increasing number of persons around the world are receiving the diagnosis of gender incongruence, and most of them are in their reproductive years. Safe contraception and fertility preservation are important issues for counseling. This review is based on pertinent publications retrieved by a systematic search in the PubMed and Web of Science databases, employing the search terms "fertility," "contraception," "transgender," "gender-affirming hormone therapy" (GAHT), "ovarian reserve," and "testicular tissue." 908 studies were included, 26 of which entered the final analysis. Most of the available studies on fertility in trans persons undergoing GAHT reveal a marked effect on spermatogenesis, but no impairment of ovarian reserve. No studies are available on trans women; the data show that 59-87% of trans men use contraceptives, often mainly in order to suppress menstrual bleeding. Fertility preservation measures are mainly used by trans women. GAHT mainly impairs spermatogenesis; thus, counseling on fertility preservation should always be given before GAHT. More than 80% of trans men use contraceptives, mainly for their other effects such as suppression of menstrual bleeding. GAHT is not in itself a reliable method of contraception, and persons about to undergo GAHT should always receive contraceptive counseling.

The Implications of the Recent Economic Crisis on Fertility in Greece

A systematic review of past economic recessions occurred in developed countries confirms that social and economic crises often have serious effects on fertility while, beyond national differentiations, these effects have certain characteristics, e. g. a weak effect on generational fertility;an postponement on the timing of first birth, closely related to a late marriage or union;a close relationship between unemployment and age-specific fertility. The sensitivity of fertility behavior to economic crises is less marked in countries with longstanding family policies and strong social security systems. The recent social and economic recession in Greece took place under different social conditions than many recessions in the past. More women than ever are participating in the labor market, most couples use reliable contraception that enables them to postpone childbearing, while social security and health costs are burdened from the rapidly expanding numbers of elderly. All these factors can affect reproductive decisions and potentially aggravate the negative effects of the recession on fertility. This work, using the latest available official data of Greece, provides an investigation of the impact of the current economic crisis on fertility levels, as well as the evolution of these levels through time.

Reproductive Health Practices in Spanish Women Who Underwent Voluntary Termination of Pregnancy.

Background: The incidence of Voluntary Termination of Pregnancy (VTP) is an important indicator of unplanned pregnancies and the differences in the functioning of contraceptive services and the effectiveness of their use. Its analysis is essential for monitoring the well-being of women and their partners. Our aim was to analyse the socio-demographic profile of women who request voluntary termination of pregnancy in the province of Salamanca, as well as their satisfaction with the intervention and its influence on their contraceptive methods. Methods: An intervention study (before-after) designed without a control group, including all women requesting a voluntary termination of pregnancy through the Salamanca Public Health System. Socio-demographic and reproductive health variables were used. After the termination of pregnancy, a satisfaction survey and analysis of consequences were carried out. Results: A total of 176 surveys were obtained. Women who underwent VTP in Salamanca were between 20 and 25 years old, had secondary education but were still studying or working, lived alone and had no children. The most commonly used contraceptive method was the condom (55%), followed by the pill (25%). The most frequent reason for termination of pregnancy was economic (47.7%). The abortion entailed a significant change in contraception. Whereas before the abortion only 34% used a hormonal method, 66% were willing to use one afterwards (p = 0.006). Conclusion: Reproductive health education needs to be improved so that couples use reliable contraceptive methods appropriately. Although women are generally satisfied with the care received during abortion, they would prefer better accessibility to the procedure and more comprehensive information about the process from a neutral stance.

Factors Affecting Early Intrauterine Device Expulsion Inserted Immediately After Voluntary Termination of Pregnancy

Background: Post-abortion insertion of an intrauterine device (IUD) is recommended for the prevention of repetitive voluntary termination of pregnancy (VTOP) in women who choose to have a reliable contraceptive method. Aim: This study aimed to analyze the incidence of IUD dislocation and its factors in patients who had an IUD immediately inserted after VTOP. Methods: In this retrospective study, 288 consequent patients who came to our hospital for VTOP between August 1st, 2018 to August 26th, 2019, and had given signed consent for immediate IUD insertion were taken as the study group. The demographic characteristics, obstetric history, and gestational age at the time of the procedure were obtained from the patient records. On the 10th day of post-abortion, the localization of the IUD was evaluated by speculum examination and transvaginal ultrasonography. The effects of obstetric history and gestational age at the time of termination on IUD dislocation rates were analyzed statistically. Results: The overall incidence of IUD dislocation was 16.3 % at the 10th-day follow-up visit. The incidence of IUD dislocation was similar in patients with gestational age < 5w, 5-7w, and 7-10w (21 %, 14.5 %, and 13 %, respectively, p=0.36). However, the incidence increased with high gravity and parity. The gravity, parity, number of vaginal deliveries, and cesarean section were higher in patients with an IUD dislocation than the ones with an IUD in place. Conclusion: The IUD insertion after voluntary legal termination of pregnancy is suitable for all gestational ages. A high number of previous pregnancies and deliveries are risk factors for IUD expulsion after immediate IUD insertion.

Репродуктивные потери при эндометриозе. Принципы постабортной контрацепции и реабилитации

The prevalence of endometriosis is still high and amounts to 10% of women of reproductive age in the population; unfortunately, there is a continuing negative trend towards its increase. Early reproductive losses in endometriosis contribute to the risk of several subsequent obstetric and gynecological complications. The presence of post-traumatic syndrome and some other psycho-emotional disorders in the patients of this cohort demonstrates the need for a thorough and efficient rehabilitation. One of the most effective means of rehabilitation in the post-abortion period, in addition to psychological correction, are dienogestcontaining combined oral contraceptives, which provide a woman with reliable contraception, improve the recovery process before planning next pregnancy, and preserve a reproductive potential. Key words: endometriosis, reproductive loss, abortion, contraception

Acceptability, Safety and Compliance of Copper T 380A as a Postpartum Intrauterine Contraceptive Device Inserted via Vaginal or Intracaesarean Route: A Cohort Study

Introduction: Considering the high unmet need for family planning in India, especially in postpartum mothers, there is a necessity for reliable, long-term, highly efficacious, safe and reversible contraception like Intrauterine Device (IUD) in these women. Copper T 380A (CuT 380A) as a Postpartum Intrauterine Contraceptive Device (PPIUCD) can reduce maternal and perinatal mortality by decreasing unintended and closely spaced pregnancies in the postpartum period. Despite many advantages, the acceptability and utilisation of PPIUCD still remain very low due to lack of information about it. Aim: To determine the acceptance, safety, and efficacy of Copper T 380A; its association with socio-demographic factors and to compare the clinical outcomes between vaginal and intracaesarean insertions of this device. Materials and Methods: A hospital-based prospective cohort study was conducted in the Department of Obstetrics and Gynaecology, RG Kar Medical College and Hospital, Kolkata, India, from February 2021 to July 2021 among the cohort of 210 consecutive eligible postpartum mothers delivered either vaginally or by caesarean section. Primarily, acceptance rate was assessed. Postinsertion follow-up was done till six months after delivery to note various clinical outcomes and complications measuring safety of the device in terms of cramping pain abdomen, irregular vaginal bleeding, abnormal vaginal discharge, string problems, and perforation; compliance in terms of pregnancy and expulsion; and continuation of the device. All the follow-up results were compared between two modes of insertions. Comparison between categorical variables was done by Chi-square test. Results: Out of 210 counselled mothers, Copper T 380A insertions were done in 178 (84.8%) postpartum mothers. The acceptance rate was slightly higher in intracaesarean group (n=87, 85.3%). The mean±Standard Deviation (SD) age of acceptance of IUCD in partcipants was 25.59±4.06 years with the highest rate observed in the age group of 21-25 years (n=82, 46.1%). Acceptance of the device was significantly associated with multipara and the clients completed primary education (p-value <0.05). On follow-up, overall complications are low. No case of perforation was reported. Significantly higher incidences of abnormal vaginal bleeding, foul smelling vaginal discharge, string problems, and expulsions were observed in the vaginal group (p-value <0.05). Pregnancy was recorded in five (5.5%) clients and all of them were in the vaginal group. Out of 178 acceptors, compliance-continuation of the device was shown by 151 (84.8%), with significantly higher in the caesarean group (p-value <0.000051). A significantly higher continuation rate was observed among the clients of low socio-economic status (p-value <0.000207). Abdominal pain (33.33%) was reported to be the most common reason for discontinuation of Copper T 380A. Conclusion: Regardless of the mode of delivery, Copper T 380A is quite an acceptable, safe, effective, and convenient contraceptive method with a good continuation rate in the immediate postpartum period.

Kardiyovasküler hastalığı olan kadınlarda kontrasepsiyon ve danışmanlık

The risk of maternal and neonatal morbidity and mortality is high in pregnancies of women that they have cardiovascular disease (CVD). Unplanned pregnancies are very risky if health cannot be optimized before conception. Despite the known risks of unplanned pregnancies, 25% to 54% of women with cardiovascular heart disease continue to have unplanned pregnancies. It is important to provide reliable contraception counseling and pregnancy planning before pregnancy to optimize the health of both mother and baby in this population. Early and accurate contraceptive counseling for women of reproductive age with cardiovascular heart disease is must to prevent unplanned pregnancies in this population. The purpose of this review; To define contraceptive method options in women with cardiovascular heart disease, to examine the risks, benefits and contraceptive method medical eligibility criteria within the scope of counseling in line with the literature. Keywords: cardiovascular disease, pregnancy, contraception, medical eligibility criteria, consultancy

Emerging concepts in male contraception: a narrative review of novel, hormonal and non-hormonal options.

Access to reliable contraception is a pillar of modern society. The burden of unintended pregnancy has fallen disproportionately on the mother throughout human history; however, recent legal developments surrounding abortion have sparked a renewed interest in male factor contraceptives beyond surgical sterilization and condoms. Modern efforts to develop reversible male birth control date back nearly a century and initially focused on altering the hypothalamic-pituitary-testes axis. These hormonal contraceptives faced multiple barriers, including systemic side effects, challenging dosing regimens, unfavorable routes of delivery, and the public stigma surrounding steroid use. Novel hormonal agents are seeking to overcome these barriers by limiting the side effects and simplifying use. Non-hormonal contraceptives are agents that target various stages of spermatogenesis; such as inhibitors of retinoic acid, Sertoli cell-germ cell interactions, sperm ion channels, and other small molecular targets. The identification of reproductive tract-specific genes associated with male infertility has led to more targeted drug development, made possible by advances in CRISPR and proteolysis targeting chimeras (PROTACs). Despite multiple human trials, no male birth control agents have garnered regulatory approval in the United States or abroad. This narrative review examines current and emerging male contraceptives, including hormonal and non-hormonal agents.

Addressing postpartum contraception practices utilizing a multidisciplinary Pregnancy Heart Team approach

BACKGROUNDCardiovascular disease has emerged as the leading cause of maternal morbidity and mortality, making planned pregnancy, and thereby reliable contraception among people with cardiovascular disease, vital. OBJECTIVEThis study aimed to compare postpartum contraceptive practices among people with cardiovascular disease (cardiac cohort) cared for by a Pregnancy Heart Team to people with other chronic comorbidities (high-risk cohort), and people without comorbidities (low-risk cohort). We hypothesized that the Pregnancy Heart Team influenced baseline contraception counseling and practices among those with cardiovascular disease. STUDY DESIGNThis was a retrospective cohort study comparing postpartum contraceptive practices between a cardiac cohort who received care by a multidisciplinary team between 2012 and 2020 and high-risk and low-risk cohorts delivering at a single academic center between 2016 and 2019. We investigated presence of a contraceptive plan (at birthing admission, discharge, and postpartum visit) and uptake of reliable contraception by 8 weeks postpartum. RESULTSWe included 1464 people: 189 with cardiovascular disease, 197 with other chronic comorbidities, and 1078 low-risk people. At birth hospitalization admission, reliable contraception was planned among 42% of the cardiac cohort, 40% of the high-risk cohort, and 31% of the low-risk cohort, with similar distributions at the time of discharge and at 8 weeks postpartum. Compared with the cardiac cohort, by 8 weeks postpartum, the high-risk cohort had similar odds of using highly reliable forms of contraception (39% vs 36%; adjusted odds ratio, 0.78; 95% confidence interval, 0.50–1.21) and similar odds of having a plan to use the most reliable forms of contraception (intrauterine device, implant, bilateral tubal ligation) at the time of birthing admission (42% vs 40%; adjusted odds ratio, 0.78; 95% confidence interval, 0.50–1.22), discharge (47% vs 45%; adjusted odds ratio, 0.95; 95% confidence interval, 0.61–1.48), and postpartum visit (35% vs 29%; adjusted odds ratio, 0.76; 95% confidence interval, 0.49–1.17). The low-risk cohort had lower odds of using a reliable form of contraception (39% vs 27%; adjusted odds ratio, 0.53; 95% confidence interval, 0.37–0.75) and was less likely to have a plan for reliable contraception at the time of birthing admission (42% vs 31%; adjusted odds ratio, 0.54; 95% confidence interval, 0.38–0.76), discharge (47% vs 33%; adjusted odds ratio, 0.58; 95% confidence interval, 0.4–0.82), and postpartum visit (35% vs 21%; adjusted odds ratio, 0.50; 95% confidence interval, 0.35–0.71). CONCLUSIONPeople with cardiovascular disease cared for by a Pregnancy Heart Team had higher odds of reliable postpartum contraception planning and uptake compared with a low-risk cohort and similar odds compared with a high-risk cohort. Pregnancy could serve as a critical period for contraception counseling and family planning among people with cardiovascular disease. A multidisciplinary team should be used to address postpartum contraception as a modifiable risk factor to reduce maternal morbidity and mortality among those with cardiovascular disease.

Experiences of a dedicated Heart and Maternal Health Service providing multidisciplinary care to pregnant women with cardiac disease in a tertiary centre in Namibia.

ObjectivesFirst, to describe the implementation process, benefits and challenges of a multidisciplinary service for pregnant women with cardiac disease in Namibia. Second, to assess pregnancy outcomes in this population.MethodsIn a tertiary hospital in Namibia, a multidisciplinary service was implemented by staff of obstetric and cardiology departments and included preconception counselling, provision of antenatal care and reliable contraception. Management guidelines developed for high‐income settings were used, since no locally adapted guidelines were available. A cohort study was performed to assess cardiac, obstetric and fetal outcomes. Included were pregnant women with cardiac disease, referred to this service between 1 August 2016 and 31 July 2018.ResultsImportant benefits of this service were the integrated approach, improved access to reliable contraception and insight into drivers of poor outcome. Several challenges with use of available guidelines were encountered, as contextual factors specific to lower‐income settings were not taken into consideration, such as higher rates of infection or barriers to access care. The cohort consisted of 65 women. Cardiac disease was diagnosed for the first time in 16 (24.6%) women, of whom 11 had pre‐existing cardiac disease. These women presented more often with heart failure than women with known heart disease (75.0% vs. 6.1%, RR 12.5, 95% CI 3.9–38.0). Five women died. Cardiac events occurred in twenty‐two women of whom eight developed thromboembolic events and two endocarditis. The majority had no indication for prophylaxis, based on available guidelines. Fetal events occurred in 36 pregnancies. After pregnancy more than half of women (35/65, 53.8%) were using long‐acting reversible contraception.ConclusionsDespite several barriers, it was possible to implement a multidisciplinary service in a high‐burden setting. Cardiac and fetal event rates in this cohort were high. To improve outcomes the focus should be on availability of context‐specific guidelines and better detection of cardiac disease.

Contraception and Hormone Replacement Therapy in Healthy Carriers of Germline BRCA1/2 Genes Pathogenic Variants: Results from an Italian Survey.

Simple SummaryBeing a healthy carrier of a BRCA1/2 pathogenetic variant is not a contraindication to hormonal contraception and menopause hormonal therapy; however, insufficient knowledge on the topic frequently translates into suboptimal counseling and care. The results of this nationwide Italian survey show that, after being diagnosed as healthy carriers, only 24.5% used hormonal contraception and 28.4% menopause therapy, even though this reduced their quality of life, and the majority were not satisfied with the counseling received. Several misconceptions on the topic persisted, for example, 58.2% were not aware of the protective effect of hormonal contraception on the risk of ovarian cancer. These results highlight the need for educational initiatives on the topic, directed to both healthcare professionals and the population.Several myths and misconceptions exist about hormones in women with familial predisposition to cancer, and there are few real-life data on their prescription and uptake. To better understand how they are prescribed and accepted in healthy carriers of a BRCA1/2 pathogenetic variant, an online survey was uploaded on Google Forms and shared through social media closed groups of patients’ associations, aBRCAcadabra and ACTO Campania. A total of 241 questionnaires were collected. Sexual quality of life was considered of the utmost importance by most of the respondents (mean score of 7 ± 2.8/10), but they felt the counseling they received by healthcare professionals on the topic was insufficient (4.9 ± 3.2/10). Only 57 women out of 233 (24.5%) had used hormonal contraception after being diagnosed as carriers of a BRCA pathogenetic variant, and 42 out of 148 (28.4%) underwent menopause hormonal therapy. The majority of women (53.6% for contraception and 61.5% for menopause) reported being dissatisfied with the counseling received, and 58.2% were not aware of the protective effect of hormonal contraception on the risk of ovarian cancer. An educational effort is desirable to guarantee healthy BRCA carriers reliable contraception and evidence-based menopause counseling.

Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex. This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14-15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12-14-months. We analysed the data using intention-to-treat mixed effects regression models. Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12-14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58-1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported. The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced. National Institute for Health Research.

An early return to fertility resulting in ectopic pregnancy 10 weeks post vaginal birth: A case report

Background: There exists an unmet need for timely initiation of reliable postpartum contraception among mothers. This could result in unplanned and closely spaced pregnancies that may endanger the lives of the mother and the unborn baby.
 Case presentation: A 22-year-old para 1+0 presented to the emergency department with gradual onset of lower abdominal pains, per vaginal spotting, and bloating 10 weeks after childbirth. She reported full-time breastfeeding and regular and consistent use of male condoms for contraception. A diagnosis of ectopic pregnancy was established following a positive urine pregnancy test and a transabdominal ultrasound that revealed features of right tubal pregnancy. Exploratory laparotomy and partial salpingectomy were performed. The patient was stable and was discharged on the second postoperative day.
 Conclusion: Early return of fertility in exclusively breastfeeding mothers is possible; hence, an effective family planning method is needed during the postpartum period to minimize the complications of short interpregnancy intervals.

Placing abortion in historical, legal, and clinical context in American medical school classrooms

AbstractAbortion is one of the most commonly performed medical procedures in the United States. In 2018, physicians in the United States performed 189 abortions for every 1000 births. Abortion is also common in other countries; across the globe, tens of millions of women seek abortions annually. In the countries that have legalized abortion, ready access to the procedure, along with access to reliable contraception, have improved women's economic status, their health, their longevity, and their ability to care for their children. Yet, despite its prevalence and benefits, abortion has also been a magnet for political controversy in the United States and elsewhere. In the United States, where the controversy has not ebbed for 50 years, abortion laws in some states have become increasingly restrictive, particularly in the last decade. This commentary describes an innovative way to teach medical students about abortion and argues that teaching abortion to medical students in the United States and throughout the world has become more, rather than less, important. This article also argues that, given the importance of access to safe abortions for women's health and well‐being, medical schools are obligated to provide medical students with the comprehensive medical knowledge that will allow them, after becoming physicians, to accurately advise, and sensitively counsel, women seeking abortions. Medical schools are also obligated to arm medical students with the relevant historical and legal knowledge that will allow them to advocate for the comprehensive reproductive services that all women need—services that include safe, legal abortion.

Sexual behavior of Lithuanian high school students

ObjectiveTo evaluate the sexual behavior of Lithuanian high school students. Study designSchool-based anonymous self-administered survey of high school students, conducted from February to June 2017. ResultsOf 167 invited schools, 113 (67.7%) agreed to participate in the survey with a response rate of 75% among invited students (8143/10,811). Respondents’ median age was 18 (range 16–20) years. Nearly one-third of students (31.3%) reported sexual intercourse with a median age at coitarche of 17 years. Most (82.9%) used contraception at coitarche. Contraception at coitarche was more common among those who were sober at coitarche (aOR 2.2, 95% CI 1.5–3.2). Students whose parents had discussed sex with them were more likely to plan coitarche (aOR 1.3, 95% CI 1.1–1.5). Students searching for information about sexual life more often had their coitarche sober than those not searching for information (29.7% (n = 60) vs 21.1% (n = 497, p = 0.006). ConclusionsEvery fifth high school student reported contraceptive nonuse; however, only 6% indicated the use of reliable dual contraception during the first sexual intercourse. ImplicationsEfforts are needed to improve the sexual education offered to Lithuanian adolescents to ensure the many sexually active adolescents are aware of how to protect themselves from infection and undesired pregnancy.

Factors associated with the uptake of long-acting reversible contraception among female sex workers in post-conflict Northern Uganda: a cross-sectional study

BackgroundLong-acting reversible contraception (LARC) is the most effective and reliable contraception option for female sex workers (FSWs) who desire future fertility. Unlike the other reversible contraceptive methods, LARC use requires only periodic users’ involvement at the time of application and re-application. However, only a few studies on LARC uptake among FSWs are available in Uganda. To fill this knowledge gap, we examined factors associated with the uptake of LARC among FSWs in post-conflict Northern Uganda.MethodsWe conducted a cross-sectional study among adult FSWs operating in the post-conflict Gulu district in Northern Uganda. We collected quantitative data among 280 FSWs of reproductive ages (18–49 years) who were neither pregnant nor using permanent contraception. We utilized a pretested semi-structured questionnaire to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex work-related characteristics, obstetric history, HIV status, and LARC uptake. Data were then entered into EPI INFO 7, cleaned, and analyzed using multivariable Poisson regression in STATA 14.0 to obtained adjusted prevalence ratios (PR).ResultsAmong the study participants: the mean age (SD, range) was 26.5 (5.9, 18–45) years, 48.6% reported at least one unintended pregnancy during sex work, and 37.4% had at least one induced abortion. Meanwhile, only less than two in three (58.6%) participants were using LARC. At multivariable level, factors that remained independently associated with LARC uptake included: longer duration of sex work (adjusted PR = 1.44, 95% CI: 1.03–2.02), higher parity (adjusted PR = 1.13, 95% CI: 1.02–1.26), history of unintended pregnancies during sex work (adjusted PR = 1.24 CI: 1.01–1.51), and being a brothel/lodge-based FSWs (adjusted PR = 1.28, 95% CI: 1.01–1.63).ConclusionsThe above findings revealed a gap in the uptake of LARC among FSWs in post-conflict Northern Uganda influenced by duration of sex work, parity, unintended pregnancies during sex work, and place of sex work. Interventions to improve LARC uptake should target the newly recruited FSWs with low parity and the non-brothel/lodge-based FSWs.

Персонализированный подход к пациентам с обильными менструальными кровотечениями в репродуктивном возрасте

The number of women suffering from heavy menstrual bleeding, according to various publications, is not decreasing and makes up about 20% of gynecological patients. Such patients, in the absence of predictive intervention by a gynecologist, are at risk of developing somatic diseases associated primarily with iron deficiency. At the same time, the correction of heavy menstrual bleeding requires a differential approach to the choice of treatment, considering the patient’s age and reproductive plans, the cause of bleeding, as well as an assessment of the benefit-risk ratio of the drug and its additional advantages. Objective. To study the efficacy of using a combined oral contraceptive (COC) containing 2 mg chlormadinone acetate / 0.03 mg ethinylestradiol in patients of reproductive age with idiopathic heavy menstrual bleeding leading to iron deficiency who need reliable contraception. Patients and methods. The study included 67 women of reproductive age between 18 and 45 years (mean age 27.2 ± 0.5 years) who visited a gynecologist with a complaint of heavy menstrual bleeding accompanied by latent iron deficiency. After considering the safety of COC according to the Medical Eligibility Criteria for Contraceptive Use (World Health Organization, 2015), all women were prescribed Belara (2 mg chlormadinone acetate / 0.03 mg ethinylestradiol) for 6 months with an assessment of efficacy, safety, and possible prolongation of its use. Results. The administration of Belara containing 2 mg chlormadinone acetate/0.03 mg ethinylestradiol demonstrated its efficacy as means of contraception and reducing menstrual blood loss, which contributes to the normalization of iron indices in women. Among 51 (76.1%) patients with latent iron deficiency, 49 (96%) had recovery of ferritin levels (>30 mg/dL) after taking Belara. Meanwhile, the frequency of adverse reactions did not exceed 15%. They were represented by scanty acyclic uterine bleeding (4.5%), increased sensitivity of the breasts (7.5%), nausea (1.5%), and headache (1.5%). All adverse reactions did not require additional therapy or drug withdrawal. Conclusion. Belara may be recommended for women of reproductive age with heavy menstrual bleeding accompanied by latent iron deficiency who need reliable contraception. Key words: heavy menstrual bleeding, latent iron deficiency, combined oral contraceptives, ethinylestradiol, chlormadinone acetate

Эндокринно-метаболические эффекты оральных контрацептивов, содержащих эстетрол и дроспиренон

To this day, combined oral contraceptives (COCs) remain one of the most reliable methods of contraception. Besides the obvious advantages, COCs can also have several adverse health effects associated with metabolic disorders. Therefore, it has become necessary to search for COCs with the most favorable endocrine and metabolic profile. Studies have appeared investigating the metabolic effects of a new COC containing estetrol and drospirenone, potentially capable of producing a range of positive metabolic and risk-reducing effects. Key words: estetrol, drospirenone, metabolic effects, carbohydrate metabolism, lipid profile, bone mineralization