Pericoital contraception.

PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception. RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data. SUMMARY: Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.

Assessment of the use of two new low-dose levonorgestrel-releasing intrauterine systems as contraceptives.

Evaluation of: Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, Phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil. Steril. 97(3), 616-622.e3 (2012). A randomized, open-label, Phase II study was conducted in 37 centers in five European countries to assess the optimal dose for a new contraceptive levonorgestrel intrauterine system (LNG-IUS). Overall, 742 parous or nulliparous women aged 21-40 years were allocated to receive a LNG-IUS that initially releases 12 µg/day (LNG-IUS(12)) or 16 µg/day (LNG-IUS(16)) in vitro or the currently available device that releases 20 µg/day (LNG-IUS(20)). The two new devices are shorter than the current one. Pearl Indices of 0.17, 0.82 and 0.00 for the LNG-IUS(12), LNG-IUS(16) and LNG-IUS(20), respectively, reflect the contraceptive efficacy of these devices. The mean number of bleeding and spotting days decreased in all three groups; however, this decrease was more significant in LNG-IUS(20) users. Placement of the new shorter devices was considered simple by providers, while patients reported significantly less pain with the two new devices compared with the current one. This study provided further insight into the development of two new LNG-IUS devices as contraceptives, with the additional possibility of using them to treat heavy menstrual bleeding or as endometrial protection during estrogen therapy.

Young women's knowledge, attitudes, and behaviors related to long-acting reversible contraceptives.

BACKGROUND: The present study explored 18- to 30-year-old women's knowledge and perceptions of the long-acting, reversible contraceptives (LARCs) Mirena and Implanon in a Midwestern state in the United States. METHODS: A telephone survey (n = 543) and 18 focus groups (n = 106) were conducted with women across a rural, Midwestern state. During the telephone survey, women answered questions related to their awareness and knowledge of two LARCs. During the focus groups, participants were asked to respond to questions related to their awareness, knowledge, behaviors, and perceptions of LARCs. RESULTS: In the telephone survey, half of the women reported hearing of Mirena. Only 8.0% of women had heard of Implanon. In the focus groups, most women reported knowing little about LARCs. Benefits associated with other contraceptives were not associated with LARCs. Women were concerned about potential side effects and problems stemming from using a contraceptive that is new to them. CONCLUSION: Increased use of LARCs would likely reduce the unintended pregnancy rate. As described, although some young women are aware of these long-term contraceptive options, there is still a need to educate women on their availability, use, and potential benefit.

Increasing access to emergency contraception through online prescription requests.

OBJECTIVE: To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. STUDY DESIGN: We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. RESULTS: Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. CONCLUSION: If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

College students' perceptions of emergency contraception provision.

BACKGROUND AND OBJECTIVE: The authors examined college students' perceptions regarding emergency contraception (EC) provision in light of the then pending U.S. Food and Drug Administration (FDA) decision about the over-the-counter (OTC) status of EC. METHODS: We randomly sampled 7000 male and female students who were enrolled full-time at the University of Michigan during the winter 2006 semester. A total of 1585 (22.6%) students responded to our web-based survey and were included in these descriptive analyses. RESULTS: Nearly all (94%) respondents knew of EC. When asked whether EC should be made available OTC, 60% of respondents agreed, 23% disagreed, and 17% were unsure. If EC were to be made available OTC, 34% of respondents indicated that they (or their partner) would purchase EC in advance of need, and 44% stated that they would purchase it only after unprotected sexual intercourse or contraceptive failure. Advance discussion and provision of EC is underused. Only 10% of all female respondents indicated that their current healthcare provider had spoken to them about EC in a routine health visit, and just 5% of female respondents were offered a supply of EC in advance of need. CONCLUSIONS: Continued efforts are needed to ensure timely access to EC in this population.

Awareness of emergency contraception among female college students in Chandigarh, India.

UNLABELLED: Adolescents and young women are at the greatest risk of unintended pregnancy because they are unlikely to see a family planning provider before or immediately after the sexual activity. Therefore, preventing unintended pregnancy among them is the important concern. Sexually active young women are clients with special needs for contraception. They are eligible to use a variety of the available contraceptives. Introduction of emergency contraception (EC) in the recent past can help them avoid such unintended pregnancies. OBJECTIVE: To investigate the awareness of emergency contraception in female college students. STUDY DESIGN: Cross-sectional, questionnaire-based study. MATERIALS AND METHODS: This study was conducted among college-going undergraduate and graduate female students of Punjab University, Chandigarh. Systematic random sampling was used to select the respondents. RESULTS: Of the 1,017 college students included in the study, 507 (49.9%) knew about different contraceptive methods. Maximum awareness was regarding oral contraceptive pills (239, 47.1%). Only 74 (7.3%) had knowledge about emergency contraceptive pills (ECP). Of them, 10 (14.7%) students knew the correct time for use of ECP and the side effects of ECP were known to 48 (88.9%) respondents. CONCLUSIONS: Awareness about ECP was very low among female college students of Chandigarh, especially regarding correct timing of its use and its side effects. Appropriate awareness programs on EC are needed for them.

Emergency contraception - a human rights issue.

Emergency contraception is the only resource that women can use to avoid becoming pregnant after having sexual intercourse without contraceptive protection. It could be a powerful means to prevent unwanted pregnancies and their devastating consequences for women's health, social wellbeing and life project, and for the unwanted child, if all people had ample access to good quality information, education and services for sexual and reproductive health. In spite of the preventive medicine value of emergency contraception, conservative sectors oppose its availability, appealing to moral values that are not universally shared in pluralistic societies. Excluding the only contraceptive that can be used after intercourse because some consider the mechanism of action to be unacceptable would mean restricting the right of choice of others, and imposing one particular belief or set of values on all members of the community, thus violating the freedom of conscience. Authorities have a moral obligation to protect human rights.

An assessment of the first 3 years' use of Implanon in Luton.

OBJECTIVES: Implanon was introduced in the UK in September 1999. We present here the results of our first 106 Implanon insertions, performed over a period of 18 months. The aims of the study were to study the clinical and demographic profile of Implanon users, to assess the continuation rates of Implanon in the local population, and to identify the reasons for removal. METHODS: This was a case note-based study in which the data were transferred to a standardised pre-tested proforma. RESULTS: The age range of the 106 Implanon users was 15-43 years. Eighty-six of these clients had their Implanon removed and the Implanon status of 20 clients is not known since they were lost to follow-up by our service. Of these 86 cases, 26 had completed the full 3-year period; therefore, the continuation rate at 3 years was 30.2%. The continuation rate at the end of 1 year was 69.8% and at 2 years was 44.1%. Of the 60 women who had their Implanon removed before the recommended 3-year period, the most common reason was for bleeding irregularity (24 cases, 40%). CONCLUSIONS: This is the first published study set in the UK within a real-life setting to follow up a cohort of Implanon users for the full 3-year period. No contraceptive failures were found, replicating previous clinical trials. The continuation rate in this real-life situation was quite low compared to clinical trials. This is frequently the case when comparing real-life situations with clinical trials and may be in part due to higher motivation on the part of clinical trial participants.

A quantitative biometrological assessment of acne and hormonal evaluation in young women using a triphasic low-dose oral contraceptive containing gestodene.

OBJECTIVE: To investigate the effect of a triphasic low-dose oral contraceptive pill containing gestodene on acne severity and hormone levels in young women over 13 menstrual cycles. METHODS: A total of 33 subjects aged 16-25 years with moderate facial acne were enrolled in the study. The primary efficacy end-points used in the clinical assessment of acne were the overall severity and number of lesions, sebum secretion and superficial follicular biopsy. Both physicians and patients evaluated acne status. Blood levels of sex hormone binding globulin (SHBG), estradiol, progesterone and androgens were monitored. RESULTS: By cycle 13, the total lesion count had been reduced by 80%. Physicians and patients assessed acne status in 90% and 95% of cases, respectively, as better or much better (p < 0.001). At the end of the study, SHBG levels had increased by 229% and total and free testosterone levels had decreased by 41% and 70%, respectively. CONCLUSION: An oral contraceptive containing triphasic gestodene has a beneficial effect on the severity ofacne, decreases major circulating androgen levels and is well tolerated.

A cost-benefit analysis of four hormonal contraceptive methods.

This paper presents the results of a cost-benefit analysis conducted for pregnancy prevention treatment with four hormonal methods of contraception using a managed-care viewpoint. The therapies analyzed are medroxy-progesterone acetate injection (Depo-Provera), levonorgestrel subdermal implants (Norplant), progestogenonly oral tablets (Nor-QD), and combination progestogen/estrogen oral tablets (Ortho-Novum 7/7/7). Cost and benefits associated with the use of therapies are identified and analyzed based on the cost per patient-day of effective pregnancy prevention. The analysis demonstrates that all four methods have a positive net benefit, with Depo-Provera having the highest net benefit. This information can provide decision makers within a pharmacy and therapeutics committee of a managed-care organization the framework on which to base formulary decisions.

[Doctors and injectable contraception. Analysis of the logistics of prescribing in accordance with the views expressed by doctors]. / Médecins et contraception injectable. Analyse des logiques de prescription à partir des discours de médecins.

Injectable contraception (IC) using medroxyprogesterone acetate (Depoprovera) and norethisterone enanthate (Noristerat) has been discussed in numbers of publications since the Food and Drug Administration (FDA) of the USA have refused to authorize the use of Depoprovera as a contraceptive in America. This has provoked a large number of publications in the international literature. The refusal was based on the potential oncogenic risk of the molecule. The distribution of this product as a contraceptive in developing countries and its restricted authorisation in many industrialised countries including France has brought about contradictory debates about the assessment of this method (secondary effects, risks of developing cancer and teratogenesis). In 1986 we started a research using close collaboration between the health teams of Seine-Saint-Denis (which control clinics, family planning clinics and hospitals) in order to try to find some solution to this problem "for or against IC". The object of this research was to find out how acceptable this method was as compared with other contraceptive methods. The fact that many disciplines were involved (gynaecologists, sociologists, epidemiologists and pharmacologists) in this work made it possible first to find out the conditions under which IC was prescribed (by sociological analysis and discussions with doctors). And the socio-cultural features in which the doctors who prescribed this method of contraception were situated also came into play. The criteria under which ICs are prescribed are not mainly medical but are narrowly linked to socio-cultural factors and the socio-economic factors of the women for whom it is prescribed: and this is in comparison with other methods of contraception. Prescribing this substance has a degree of urgency about it.