Form Of Reversible Contraception Research Articles

Thrombotic and Vascular Complications of Oral Contraceptives.

The oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2-9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors.

Hubungan Lama Penggunaan Kontrasepsi Suntik Dmpa Dengan Kenaikan Tekanan Darah Di Puskesmas Baruga Kabupaten Bantaeng Tahun 2023

The contraceptive injection is one of the highly effective, safe, convenient, and reversible forms of contraception, but it can lead to irregular menstruation, increased blood pressure, depression, vaginal discharge, acne, changes in weight, and hematomas. The aims of this research is to examine the correlation between the use of DMPA contraception and the increase in blood pressure at Baruga Health Center in 2023. This research method utilizes an observational cross-sectional study and employs Accidental sampling technique for sample collection. This analytical study uses Chi-Square Test analysis. The research results show that the chi-square test analysis was p=0.05, so it can be interpreted that there is a relationship between the use of DMPA injections and an increase in blood pressure.

Association of intrapartum severe maternal morbidity with receipt of postpartum contraception among Medicaid recipients

ObjectivesWe sought to determine the association between intrapartum severe maternal morbidity and receipt of postpartum contraception within 60 days among Medicaid recipients in Oregon and South Carolina. Study designWe conducted a historical cohort study of all Medicaid births in Oregon and South Carolina from 2011 to April 2018. Intrapartum severe maternal morbidity was measured using diagnosis and procedure codes according to the Center for Disease Control’s classifications. Our primary outcome of interest was receipt of postpartum contraception within 60 days of birth. We captured permanent and reversible forms of contraception. We examined the association of intrapartum severe maternal morbidity with receipt of postpartum contraception, and whether this varied by type of Medicaid (Traditional vs Emergency). We used Poisson regression models with robust (sandwich) estimation of variance to calculate relative risk (RR) for each model. ResultsOur analytic cohort included 347,032 births. We identified 3079 births with evidence of intrapartum severe maternal morbidity (0.9% of all births). When adjusted for maternal age, rural vs urban status, and state of residence, Medicaid beneficiaries with births complicated by intrapartum severe maternal morbidity are 7% less likely to receive any contraception (RR 0.93, 95% CI (0.91, 0.95)) by 60 days postpartum. Among births complicated by severe maternal morbidity we found that Emergency Medicaid recipients were 92% less likely than Traditional Medicaid recipients to receive any method of contraception (RR 0.08, 95% CI (0.08, 0.08)). ConclusionsMedicaid recipients experiencing intrapartum severe maternal morbidity are less likely to receive contraception within 60 days than Medicaid beneficiaries with uncomplicated births. ImplicationsEfforts are needed to improve access to post partum contraception for people experiencing severe maternal morbidity.

Catholic sole community hospitals are associated with decreased receipt of postpartum permanent contraception among Medicaid recipients

ObjectivesTo examine the association of Catholic hospitals with receipt of postpartum tubal ligation and long acting, reversible contraception among Medicaid recipients. Study designWe conducted a retrospective cohort study of live births from January 1, 2016 to October 31, 2016 to female Medicaid beneficiaries in the United States between ages 21 and 44. Our main exposure was the presence of a Catholic-affiliated sole community hospital, and our primary outcome was highly effective postpartum contraception. We examined rates of postpartum permanent contraception, along with the use of a long acting, reversible form of contraception (LARC) at 3 and 60 days are postpartum. We compared counties that had only a Catholic-affiliated hospital with counties with only a non-Catholic hospital. ResultsOur study population included 14,545 postpartum Medicaid beneficiaries. Study participants came from 88 counties across 10 United States states. Only 7.7% of women in counties with Catholic sole community hospitals received permanent contraception by 3 days postpartum, compared to 11.3% in counties with non-Catholic sole community hospitals (RD: -3.92%; 95% CI: -6.01%, -1.83%). This difference was not mitigated by receipt of outpatient procedures or long-acting, reversible contraception. Importantly, women residing in counties with Catholic sole community hospitals were much less likely to return postpartum for an outpatient visit between 8 and 60 days postpartum than women in counties with non-Catholic sole community hospitals (35.4% vs 45.4%, RD: -9.29%; 95% CI: -16.71%, -1.86%). ConclusionsIn counties where the only hospital was Catholic, Medicaid recipients giving birth were significantly less likely to receive permanent contraception and to return for postpartum care. ImplicationsCatholic hospitals are increasing in the United States, which may restrict access to postpartum contraception, particularly in rural areas. We found that Medicaid recipients giving birth at a Catholic sole community hospital were less likely to receive permanent contraception and to return for care.

Concordance of Desired and Administered Postpartum Contraceptives among Emergency and Full Scope Medicaid Patients.

To determine if concordance of contraceptive preference and uptake differ between postpartum recipients of emergency versus full scope Medicaid. We performed a historical cohort study of patients who delivered at a safety-net hospital in Denver, Colorado in 2016. In our public system, all patients had access to immediate postpartum tubal ligation and all forms of reversible contraception in outpatient clinics. We used data from electronic health records to compare contraceptive preferences and uptake between patients with full scope and emergency Medicaid at hospital discharge and by 12weeks postpartum. We then compared contraceptive concordance (use of the same method as desired during delivery admission) between the groups at time of postpartum discharge and by 12weeks postpartum. We examined 693 women; 349 (50.1%) had emergency Medicaid and 344 (49.9%) had full scope Medicaid. The mean age at delivery was 27.9years, and most patients were Hispanic (74%). Women with emergency Medicaid were less likely to receive their desired method of postpartum contraception before hospital discharge (53.6% vs. 66.9%; p<.01). One-half of the patients with emergency Medicaid who did not receive their desired method of immediate postpartum contraception were unable to obtain it based on insurance ineligibility. By 12weeks postpartum, the rates of concordance did not differ by insurance status: 52.4% of patients with emergency Medicaid and 55.2% of patients with full scope Medicaid received their desired method of contraception (p=.46). Emergency Medicaid recipients, largely recent and/or unauthorized immigrants, have high demand for highly effective postpartum contraceptives. Although emergency Medicaid recipients initially had lower rates of receipt of their desired contraceptive during the hospital stay compared with those with full scope Medicaid, they ultimately had similar concordance rates by 12weeks postpartum. We suspect this finding was in part due to free access to all methods of contraception in our outpatient clinics during the postpartum course. Systemic barriers should be reduced to ensure better access to postpartum contraceptives for all patients, regardless of insurance coverage, to improve reproductive equity.

One successful intrauterine device into a uterus, didelphys: a case report and literature review

Uterus didelphys represents a uterus malformation where the uterus is present as a double organ due to embryonic fusion failure of the mullerian ducts. As a result, there is a double uterus with separated cervices. This congenital malformation used to be a controversial contraindication of an intrauterine device (IUD) insertion. It is a category 4 WHO medical eligibility criteria: not being used because of its association with a high risk of IUD expulsion, malposition into the uterus, uterine perforation and its migration into the abdominal cavity and viscera. We present and discuss the case of a 35-year-old woman, P4+6, known with uterus didelphys who came to our outpatient clinic for family planning. She was counselled about all available methods and opted for a levonorgestrel IUD (LNG-IUD). We inserted the device into one of her double uterus and she is fully satisfied with the method now one year and three months ago. Levonorgestrel IUD is a long acting, highly effective and reversible form of contraception that works mainly by thickening of the cervical mucus and also by thinning the endometrial lining. Considering its effect on the endometrium and the cervical mucus; and its high level of progesterone pelvic release, we think one LNG-IUD contraception into one of the double uterus is enough and effective in individualized and known women with such condition instead of two IUDs, one being into each uterus, such published in all articles we read through. The purpose of this case report is to demonstrate that only one LNG-IUD contraception can be sufficient and effective method in known and selective women with uterus didelphys. However a case-series study is needed for more evidence.

Corrigendum to: Cost-benefit analysis of enhancing the uptake of long-acting reversible contraception in Australia.

ObjectiveLong-acting reversible contraception (LARC) is the most effective form of reversible contraception, but its use in Australia is low compared with other countries. The aim of this study was to evaluate the economic effect of an increase in LARC uptake to international rates.MethodsAn economic model was designed to assess two scenarios, namely increasing the current rate of LARC uptake of 12.5% to the international benchmark of 14.8% among: (1) women currently using the oral contraceptive pill (OCP); and (2) women at risk of pregnancy and not using contraception. Model inputs included cost of contraceptive methods, discontinuation rates and abortion and miscarriage costs associated with unintended pregnancies.ResultsWomen who switch from an OCP to LARC would save A$114-157 per year. Those not currently using any contraception who adopt LARC would incur costs of A$36-194 per year, but would reap savings from the reduction in unintended pregnancies. Over 5 years there would be a net saving of A$74.4 million for Scenario 1 and A$2.4 million for Scenario 2.ConclusionGreater use of LARC would result in a net gain in economic benefits to Australia. These benefits are largely driven by women switching from an OCP to LARC who have reduced costs, as well as women wishing to avoid pregnancy who choose to use LARC rather than no method. This evidence will support women making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.What is known about the topic?LARC is the most effective form of reversible contraception, but uptake in Australia is relatively low.What does this paper add?There are economic benefits to society for women who switch from an OCP to LARC, as well as for women who switch from no contraception to LARC.What are the implications for practitioners?The findings of this study will support women in making an informed contraceptive choice and policy makers in increasing the accessibility of LARC.

Pharmacists' and prescribers' neonatal abstinence syndrome (NAS) prevention behaviors: a preliminary analysis.

Background Maternal opioid use and neonatal abstinence syndrome (NAS) incidence have increased markedly in the US in recent years. Objectives (1) To assess prescribers' and community pharmacists' guideline-based NAS prevention behaviors; (2) to describe providers' perceptions of contraceptive appropriateness in female patients of childbearing age. Method Cross-sectional study of 100 randomly selected primary care physicians, 100 prescribers authorized to engage in in-office treatment of opioid use disorders with buprenorphine, 100 pain management clinic directors, and 100 community pharmacists in Tennessee (N=400 providers total) to evaluate self-reported engagement in 15 NAS prevention behaviors and perceived appropriateness of 8 contraceptive methods in opioid using women of childbearing age. Results An overall response rate of 17.5% was obtained. Pain clinic directors reported the most engagement in NAS prevention, engaging 80% or more of female patients of childbearing age prescribed an opioid in 11 prevention behaviors, followed by buprenorphine prescribers (8 behaviors), primary care physicians (5 behaviors), and community pharmacists (2 behaviors). Pain clinic directors, primary care physicians, and community pharmacists perceived oral contraceptive pills and patches to be as appropriate as long-acting, reversible forms of contraception (e.g., implants, injectable depots, intrauterine devices). Conclusion Provider engagement in behaviors that could prevent NAS is variable. Interventions should be implemented that equip providers to engage patients in conversations about long-acting, reversible contraception.

LNG-IUS 12: a 19.5 levonorgestrel-releasing intrauterine system for prevention of pregnancy for up to five years

ABSTRACTIntroduction: Globally, intrauterine devices (IUDs) are the second most commonly used form of reversible contraception because of their high efficacy, safety, convenience and cost effectiveness. The levonorgestrel releasing intrauterine system with daily average release of 20 mcg (LNG-IUS 20) is the popular choice because of its favorable bleeding patterns and many noncontraceptive benefits. A three year (LNG-IUS 8) became available three years ago. More recently, the LNG-IUS 12 was added. This new IUD shares a smaller frame, narrow inserter and lower rate of amenorrhea with the LNG-IUS 8, but it offers the five years of contraceptive protection of the LNG-IUS 20.Areas covered: This article provides information on the contraceptive efficacy, safety and tolerability of this new IUS based on approximately 60,000 cycles of use. Where available, the impacts of subject age, parity and body mass index (BMI) on study outcomes are reported.Expert opinion: This new LNG-IUS 12 with mid-dose hormone levels, smaller frame and longer effective life fills a niche that may better meet the needs of women who might appreciate the narrow insertion tube and/or the lower rates of amenorrhea. Cost will ultimately help determine success.

Generic or Branded? Oral Contraception Prescription Patterns in an Academic Medical Center [18A

INTRODUCTION: Oral contraceptive pills (OCPs) are the most widely used form of reversible contraception in the United States. Most OCPs are no longer patent-protected and are available in FDA-approved generic forms, demonstrating bioequivalence and interchangeability with branded OCPs. This study analyzes OCP prescription patterns within the University of California Los Angeles (UCLA) Health System. METHODS: Information on electronically-generated OCP prescriptions within UCLA Health was collected and de-identified. The data was then analyzed using univariate statistics for prescription patterns based on physician specialty, estrogen dose, progestin dose and type. RESULTS: 43,719 prescriptions for OCPs were generated by physicians from 7/1/14-6/30/15. Physicians most frequently prescribing OCPs belonged to internal medicine, family medicine and obstetrics and gynecology. 63-65% of these prescriptions were generic. Outside of these three primary care departments, other departments accounted for 8% of total OCP prescriptions. These other specialties prescribed generics 57% of the time. The most common progestin forms were norethindrone acetate, norgestimate, and levonorgestrel. 99% of all OCPs prescribed contained ethinyl estradiol and 56% were low dose (from 0.01mg to 0.025 mg) while 44% were high dose pills (0.03 mg to 0.05mg). CONCLUSION: The proportion of generic OCP prescriptions was similar in all three of the departments that accounted for the majority of all OCP prescriptions. In specialties with lesser volumes of OCP prescription, physicians tend to prescribe generic OCPs at a lower rate. Regulations establishing bioequivalence between generic and branded OCPs have been in place for over 20 years, yet lack of awareness over bioequivalence continues.

Postponing menstruation: choices and concerns

Since writing an editorial for this journal in 20141 I have been repeatedly asked about my views on postponing menstruation. Women in the 21st century want to avoid periods when...

Intrauterine contraception.

Intrauterine devices (IUDs) are effective, reversible forms of contraception with high patient satisfaction and continuation. IUDs can be safely used by most women and should be considered the first-line method of contraception for all women. This descriptive review will discuss the clinical issues associated with IUDs - including management of side effects, noncontraceptive uses and insertion and removal. When the burdens of cost are removed, women are more likely to select and IUDs. Health policy changes that increase insurance coverage for contraception will improve access to IUDs. IUDs remain an underutilized form of contraception in USA and efforts to improve availability and access to long-acting reversible contraception methods is needed to optimize their use.

Positive Testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the Risk of Pelvic Inflammatory Disease in IUD Users.

Unintended pregnancies are a major public health problem in the United States, and intrauterine devices (IUDs) are among the most effective reversible birth control methods available. Historically, there have been concerns about IUD use and infection among young and/or high-risk women that may increase the risk of pelvic inflammatory disease (PID) and subsequent infertility. The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study of over 9,000 women 14-45 years of age residing in the St. Louis area who were interested in initiating a new form of reversible contraception. At enrollment, participants were counseled regarding long-acting contraceptive methods with the goal of increasing awareness of all reversible methods available. Participants were also tested for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) during enrollment and were provided with contraception at no cost for 2-3 years. We estimate the frequency of self-reported PID in new IUD users compared with women using other contraceptive methods. Among both new IUD users who tested positive for GC and/or CT and those who tested negative, the PID rate was 1% or below. Our results demonstrate that IUD use is safe for all women, including women at high risk for sexually transmitted infections.

Ultrasonography of intrauterine devices.

The intrauterine device (IUD) is gaining popularity as a reversible form of contraception. Ultrasonography serves as first-line imaging for the evaluation of IUD position in patients with pelvic pain, abnormal bleeding, or absent retrieval strings. This review highlights the imaging of both properly positioned and malpositioned IUDs. The problems associated with malpositioned IUDs include expulsion, displacement, embedment, and perforation. Management considerations depend on the severity of the malposition and the presence or absence of symptoms. Three-dimensional ultrasonography has proven to be more sensitive in the evaluation of more subtle findings of malposition, particularly side-arm embedment. Familiarity with the ultrasonographic features of properly positioned and malpositioned IUDs is essential.

Forgotten Intrauterine Contraceptive Device - An Unusual Cause Of Enterouterine Fistula

Intrauterine contraceptive device is one of the most popular forms of reversible contraception. Though considered as a safe method, uterine perforation and migration of IUCD into the peritoneal cavity or invasion into one of the adjacent viscera has been reported in English literature. We are presenting the case of an elderly lady presenting with persistent vaginal discharge which on investigations was found to be due to enterouterine fistula. As the lady had forgotten about the IUCD placed more than 20 year back, diagnosis could only be established only on examination of the resected specimen of entero uterine fistula. This case stresses the importance of creating awareness among the users of IUCD regarding the need for periodic examination to confirm the normal position of IUCD as well as its timely removal once family is complete.

Role of the levonorgestrel intrauterine system in effective contraception

Norgestrel, a synthetic progestin chemically derived from 19-nortestosterone, is six times more potent than progesterone, with variable binding affinity to various steroid receptors. The levonorgestrel-releasing intrauterine system (LNG IUS) provides a long-acting, highly effective, and reversible form of contraception, with a pearl index of 0.18 per 100 women-years. The locally released hormone leads to endometrial concentrations that are 200–800 times those found after daily oral use and a plasma level that is lower than that with other forms of levonorgestrel-containing contraception. The contraceptive effect of the LNG IUS is achieved mainly through its local suppressive effect on the endometrium, leading to endometrial thinning, glandular atrophy, and stromal decidualization without affecting ovulation. The LNG IUS is generally well tolerated. The main side effects are related to its androgenic activity, which is usually mild and transient, resolving after the first few months. Menstrual abnormalities are also common but well tolerated, and even become desirable (eg, amenorrhea, hypomenorrhea, and oligomenorrhea) with proper counseling of the patient during the choice of the method of contraception. The satisfaction rates after 3 years of insertion are high, reaching between 77% and 94%. The local effect of the LNG IUS on the endometrium and low rates of systemic adverse effects have led to its use in other conditions rather than contraception, as for the treatment of endometrial hyperplasia, benign menorrhagia, endometriosis, adenomyosis, and uterine fibroids.

Risk of Cardiovascular Events with Hormonal Contraception: Insights from the Danish Cohort Study

Hormonal contraception in the form of combined oral contraceptive pills is the most widely used reversible form of contraception in the US. Oral contraceptive (OC) pills have long been associated with risk of venous thromboembolism (VT) and arterial thrombosis (AT). There are more recent publications on risk of venous thromboembolism than arterial thrombosis. Many of the studies on AT have been contradictory in terms of results. The Danish cohort study is the largest study to date on the risk of AT in users of oral contraceptive pills. The study suggests that a lower estrogen dose may be better for preventing myocardial infarction and possibly thrombotic stroke but there is no significant difference according to progestin type for risk of thrombotic stroke or myocardial infarction. It challenges results of previous studies that show incremental risk of arterial thrombosis with smoking. The absolute and relative risks of arterial thrombosis in Danish women who used hormonal contraception were shown to be low. VT is more common than AT in women of reproductive age but AT is associated with a higher risk of mortality and disability. The decision to use hormonal contraceptives and the choice of formulation should be individualized based on patient's age and known risk factors for both VT and AT.

MOST WOMEN USE LESS‐EFFECTIVE CONTRACEPTIVE METHODS

In the Journal of Midwifery and Woman’s Health’s “Updates from the Literature” several recent studies are discussed. The Contraceptive CHOICE Project was designed to promote use of long-acting reversible contraception (LARC): intrauterine devices (IUDs) and subdermal implants. This article presents results of their prospective cohort study designed to determine failure rates for different forms of reversible contraception and to identify women at greatest risk for contraceptive failure. A second article presents results from the Pesario Cervical para Evitar Prematurida (PECEP) trial which examined cervical pessary use for women with short cervix gathering data from 5 hospitals in Spain. The PECEP trial supplies strong evidence that routine ultrasounds for cervical length followed by pessary placement in women with short cervix might be a relatively noninvasive and low-cost way to decrease the rate of preterm birth. A third article describes a study compared the normal progress of spontaneous and induced labors the finding of which support an unhurried approach to labor induction. Other literature of interest to midwives includes studies showing that women with hypertensive disorders of pregnancy are at greater risk for cardiovascular disease and that children born before 39 weeks’ gestation have lower school achievement in third grade. An additional study calls for more research needed on nonnutritive sweeteners and cardiovascular health.

PROMOTION OF COMPREHENSIVE AND PREVENTION-DRIVEN APPROACHES TO DRUG USE AND UNINTENDED PREGNANCY

In this response to a research article about the ethical issues related to incentivizing drug-using women to use long-acting forms of contraception the author examines the researchers claims for incentives and their lack of a discussion against these morally and ethically questionable programs using the example of Project Prevention. While the author agrees that it is ethically possible to provide moderate incentives for reversible forms of contraception to drug-using individuals only reversible methods should be recommended as opposed to sterilization procedures. Recommendations for amending incentive programs involve the inclusion of incentive payment contingent on receiving treatment for their substance abuse as well as modest incentives for beginning their trial of long-acting contraception for continued use of reversible forms of contraception and for continued sobriety. The author expresses the need for more research to determine specific incentive amounts that would be sufficient to promote healthy behavior change while protecting womens right to make informed decisions about their bodies.

Misconceptions about Contraceptive Effectiveness

Birth control pills remain the most commonly used form of reversible contraception among U.S. women, despite the difficulty of remembering to take daily medication. Intrauterine devices (IUDs) and implants are much more effective than pills in typical use, but fewer than 6% of U.S. women currently use these long-acting reversible contraceptives. To assess women's perceptions of contraceptive effectiveness, investigators surveyed …