Contraception最新文献

{"title":"A statewide analysis of uptake of highly effective contraception offered immediately postpartum in Massachusetts, 2017–2021","authors":"Preetha Nandi ,&nbsp;Devika Lekshmi ,&nbsp;Alysa St. Charles ,&nbsp;Erika Werner ,&nbsp;Megan L. Evans","doi":"10.1016/j.contraception.2024.110785","DOIUrl":"10.1016/j.contraception.2024.110785","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate provision of immediate postpartum (iPP) highly effective contraception in Massachusetts.</div></div><div><h3>Study design</h3><div>We performed logistic regressions evaluating contraceptive implant, intrauterine device, and permanent contraception procedures occuring during delivery admissions between 2017 and 2021, analyzing outcomes by method reversibility and delivery type.</div></div><div><h3>Results</h3><div>Hispanic and privately-insured patients had higher odds of receiving any iPP method, whereas patients delivered at non-teaching hospitals had lower odds of receiving any method. Patients who were Hispanic, publicly-insured, or delivered at non-teaching hospitals had lower odds of receiving reversible compared to permanent methods.</div></div><div><h3>Conclusion</h3><div>Differential uptake of iPP contraception suggests programming opportunities to address unmet postpartum contraception needs.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"144 ","pages":"Article 110785"},"PeriodicalIF":2.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New endocrine method of oral male contraception","authors":"Herjan J.T. Coelingh Bennink","doi":"10.1016/j.contraception.2024.110782","DOIUrl":"10.1016/j.contraception.2024.110782","url":null,"abstract":"<div><div>Essential for hormonal male contraception (HMC) is the inhibition of follicle-stimulating hormone (FSH), the hormone responsible for spermatogenesis. No drugs exist that can selectively suppress FSH without also inhibiting luteinizing hormone (LH), the hormone responsible for the biosynthesis of testosterone (T) and estradiol (E2) in men. The consequences are a loss of T and E2, with the accompanying symptoms and signs of T deficiency and E2 deficiency, respectively. The loss of T causes sexual function problems, including reduced libido and problems with erection and ejaculation. Moreover, T is not orally bioavailable, and there is a lack of suitable, orally bioavailable androgens to replace the loss of T. This has led to the use of nonoral T replacements, such as patches, gels, or parenteral administration of T or other androgens in current methods for HMC under development. In case these new HMC methods do not contain a testosterone preparation that is metabolized into E2, the suppression of LH will cause loss of E2 and symptoms of estrogen deficiency.</div><div>We propose to investigate a new oral endocrine approach for HMC using a triple hormone drug called MANTE (Male oral contraception by a GnRH ANtagonist, Testosterone and an Estrogen). This method combines three novelties: (1) the use of an oral gonadotrophin-releasing hormone antagonist to suppress FSH and spermatogenesis, (2) a high dose of the natural adrenal androgen dehydroepiandrosterone to replace T, and (3) a low dose of an orally bioavailable estrogen, preferably estetrol (E4), to prevent signs and symptoms of estrogen deficiency.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"145 ","pages":"Article 110782"},"PeriodicalIF":2.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemiplegic migraine associated with etonogestrel 68 mg implant insertion case report","authors":"Hallie N. Nelson,&nbsp;Rebekah Sugarman,&nbsp;Melissa L. Wong","doi":"10.1016/j.contraception.2024.110783","DOIUrl":"10.1016/j.contraception.2024.110783","url":null,"abstract":"<div><div>We present a case of suspected induced intractable headaches and paralysis after receiving an etonogestrel 68 mg implant. After extensive neurological evaluation, the etonogestrel implant was removed and neurological symptoms resolved.</div><div>The case raises concerns about a potential rare risk of progestin-containing contraceptives in patients with migraines with aura warranting further investigation.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110783"},"PeriodicalIF":2.8,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and obstetrician-gynecologist perspectives on considering long-acting reversible contraception for postpartum patients who desire permanent contraception","authors":"Madeline Thornton ,&nbsp;Brooke W. Bullington ,&nbsp;Kristen A. Berg ,&nbsp;Kari White ,&nbsp;Suzanna Larkin ,&nbsp;Margaret Boozer ,&nbsp;Tania Serna ,&nbsp;Emily S. Miller ,&nbsp;Jennifer L. Bailit ,&nbsp;Kavita S. Arora","doi":"10.1016/j.contraception.2024.110781","DOIUrl":"10.1016/j.contraception.2024.110781","url":null,"abstract":"<div><h3>Objective(s)</h3><div>We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference.</div></div><div><h3>Study design</h3><div>We interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (<em>n</em> = 67) from four US institutions to explore patient and obstetrician-gynecologist (OBGYN) perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software.</div></div><div><h3>Results</h3><div>Our analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body.</div></div><div><h3>Conclusion(s)</h3><div>These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.</div></div><div><h3>Implications</h3><div>Our study revealed a large discrepancy between patient and obstetrician-gynecologist priorities in seeking or recommending permanent contraception. Clinicians must avoid making assumptions about a patient’s priorities for a contraceptive choice to engage in truly patient-driven contraceptive counseling.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110781"},"PeriodicalIF":2.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(24)00476-1","DOIUrl":"10.1016/S0010-7824(24)00476-1","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"141 ","pages":"Article 110762"},"PeriodicalIF":2.8,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential bone calcium retention with the use of oral versus vaginal hormonal contraception: A randomized trial using calcium-41 radiotracer","authors":"Emily A. Ricker ,&nbsp;Mary Jane De Souza ,&nbsp;Michael S. Stone ,&nbsp;George S. Jackson ,&nbsp;George P. McCabe ,&nbsp;Linda D. McCabe ,&nbsp;Connie M. Weaver","doi":"10.1016/j.contraception.2024.110778","DOIUrl":"10.1016/j.contraception.2024.110778","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess if hormonal contraception administered orally (combined oral contraceptive pill, COC) or vaginally (contraceptive vaginal ring) differentially affected bone calcium retention in young females.</div></div><div><h3>Study design</h3><div>Reproductive aged females (18–35 years) not using hormonal contraception were dosed with 50 nCi ⁴¹Ca as CaCl₂ in 10 mL of sterile saline (0.9%). Following an equilibration phase of ≥100 days and a baseline of two menstrual cycles, participants used COC and the ring for two cycles (49 days) each, in a randomized order, separated and followed by washouts of two menstrual cycles. Twenty-four-hour urine samples were collected monthly during equilibration and every around 10 days during baseline, interventions, and washouts to assess bone calcium retention through accelerator mass spectrometry analysis of the ⁴¹Ca:Ca ratio in urine. The effect of each contraception was determined by comparing ⁴¹Ca:Ca measured during each contraception intervention to ⁴¹Ca:Ca measured during the “control” (baseline and washout) phases using linear models and generalized linear mixed models.</div></div><div><h3>Results</h3><div>Eight reproductive aged females were studied. Compared with control phases (baseline and washouts), COC resulted in greater bone calcium retention (11.3%, 95% CI: 6.7%, 15.6%). The ring did not alter bone calcium retention (4.2%, 95% CI: −6.6%, 13.9%). COC produced a greater change in calcium retention than the ring (<em>p</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>Although many factors contribute to bone health, short-term COC improved bone calcium retention, suggesting a potential benefit of COC to bone in females. Conversely, the ring did not alter calcium retention, and may be neither beneficial nor deleterious for bone.</div></div><div><h3>Implications</h3><div>In this study, the effects of oral (pill) vs. vaginal (ring) hormonal contraception on bone calcium retention were assessed in young females. The pill improved bone calcium retention, suggesting a potential beneficial effect on bone health; the ring did not change bone calcium retention compared with control (no contraception).</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110778"},"PeriodicalIF":2.8,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142775612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-year efficacy, safety, and tolerability outcomes from a phase 3 study of a low-dose copper intrauterine device","authors":"Mitchell D. Creinin ,&nbsp;Lori M. Gawron ,&nbsp;Andrea H. Roe ,&nbsp;Paul D. Blumenthal ,&nbsp;Christy M. Boraas ,&nbsp;Melody Y. Hou ,&nbsp;Colleen McNicholas ,&nbsp;Mary Jo Schreifels ,&nbsp;Kevin Peters ,&nbsp;Kelly Culwell ,&nbsp;David K. Turok ,&nbsp;on behalf of the Copper 175mm2 IUD Phase 3 Clinical Investigator Group","doi":"10.1016/j.contraception.2024.110771","DOIUrl":"10.1016/j.contraception.2024.110771","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to assess 3-year efficacy, safety, and tolerability of the Cu 175 mm² intrauterine device (IUD).</div></div><div><h3>Study design</h3><div>This single-arm trial recruited participants at risk of pregnancy aged 17 to 45 years at 42 U.S. centers to receive a Cu 175 mm² IUD with a flexible nitinol frame. We assessed efficacy in participants aged ≤35 years at enrollment and assessed all other outcomes in the entire population. We calculated the Pearl Index (pregnancies/100 person-years) through 3 years as the primary efficacy outcome. The secondary outcomes included pregnancy percentages by life-table analysis, placement success, safety (adverse events), and tolerability.</div></div><div><h3>Results</h3><div>Of 1620 enrollees, 1601 (98.8%) had successful IUD placement, with 1397 aged ≤35 years at enrollment. We observed a 1-year Pearl Index of 0.94 (95% CI 0.43–1.78) and 1-year and cumulative 3-year life-table pregnancy rates of 1.26% (95% CI 0.57%–1.95%) and 2.47% (95% CI 1.34%–3.60%), respectively. The most common adverse events included bleeding and pain. Over 3 years, 15.4% of participants discontinued due to bleeding or pain. Device expulsions occurred in 36 (2.2%) and 63 (3.9%) participants over 1 and 3 years, respectively. Eight related serious adverse events occurred, including five ectopic pregnancies and one each of uterine perforation, anemia, and uterine hemorrhage. One- and three-year continuation rates were 78.9% and 49.6%, respectively.</div></div><div><h3>Conclusions</h3><div>These data support efficacy, safety, and tolerability of the Cu 175 mm² IUD during the first 3 years of use.</div></div><div><h3>Implications</h3><div>In this Phase 3 trial, the investigational Cu 175 mm² demonstrated efficacy, safety, and tolerability with low rates of expulsion and discontinuation for bleeding and pain-related symptoms. This flexible, nitinol-framed, low-dose copper IUD comes preloaded and would expand contraceptive options beyond the single nonhormonal IUD currently available in the United States.</div></div><div><h3>Clinical Trial</h3><div>NCT03633799</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110771"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright info/Contents","authors":"","doi":"10.1016/S0010-7824(24)00453-0","DOIUrl":"10.1016/S0010-7824(24)00453-0","url":null,"abstract":"","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"140 ","pages":"Article 110741"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immigration policy climate and contraceptive use among Mexican-origin women in the United States: Support for the “spill-over” hypothesis","authors":"Blair G. Darney ,&nbsp;Emily R. Boniface ,&nbsp;Fernando Riosmena ,&nbsp;Evelyn Fuentes-Rivera ,&nbsp;Biani Saavedra-Avendaño ,&nbsp;Kate Coleman-Minahan","doi":"10.1016/j.contraception.2024.110773","DOIUrl":"10.1016/j.contraception.2024.110773","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association between state-level Immigration Policy Climate (IPC) and the use of most or moderately effective contraceptive methods among US-born White, US-born Mexican-origin, and foreign-born Mexican-origin women.</div></div><div><h3>Study design</h3><div>We linked nationally representative survey data from three waves of the National Survey of Family Growth (2013–2019) with a novel and dynamic state-level measure of IPC. We compared the use of a most or moderately effective contraceptive method at the time of the survey among the three ethnicity and nativity groups alone and as an interaction with state IPC index score above or below the national mean in the year of the survey. We used multivariable logistic regression to adjust for individual- and state-level characteristics and test for heterogeneity of the effect of IPC.</div></div><div><h3>Results</h3><div>Weighted study sample included 31,528,602 respondents: 26,029,129 (82.5%; unweighted <em>n</em> = 5441) non-Latina White, 2,958,960 (9.4%; unweighted <em>n</em> = 971) US-born Mexican-origin, and 2,540,513 (8.1%; unweighted <em>n</em> = 719) foreign-born Mexican-origin. After adjusting for confounders, living in a state with a more inclusive immigration policy environment was associated with higher use of moderately or most effective contraception among Mexican-origin respondents, both US- (59.8% vs 52.2% less inclusive) and foreign-born (62.1% vs 55.9% less inclusive), but not US-born White (65.2% vs 67.8% less inclusive) respondents.</div></div><div><h3>Conclusions</h3><div>Our results support the “spillover” hypothesis; more exclusionary immigration policies were associated with lower utilization of effective contraceptive methods among both US-born Mexican-origin and Mexican immigrant women.</div></div><div><h3>Implications</h3><div>Mexican-origin women in states with more inclusive immigration policies are more likely to use effective contraception than those in states with exclusionary policies; this suggests that immigration policy climate may “spill over” into US-born Mexican-origin populations.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110773"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of body mass index on time to fetal expulsion for individuals undergoing medication abortion over 13 weeks gestational duration","authors":"Megan Fuerst,&nbsp;Kristin C. Prewitt,&nbsp;Bharti Garg,&nbsp;Shaalini Ramanadhan,&nbsp;Leo Han","doi":"10.1016/j.contraception.2024.110752","DOIUrl":"10.1016/j.contraception.2024.110752","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the association of body mass index (BMI, kg/m²) with time to fetal expulsion for individuals undergoing medication abortion over 13 weeks.</div></div><div><h3>Study design</h3><div>This is a retrospective cohort study of singleton pregnancies undergoing medication abortion &gt;13 weeks at a single academic medical center between 2020 and 2024. Our primary outcome was time to fetal expulsion. We categorized BMI into three groups (&gt;25, 25–29.9, and ≥30) and compared median time to fetal expulsion. We used multivariable logistic regression models to assess the association of BMI with time to delivery ≥24hours.</div></div><div><h3>Results</h3><div>Of the 428 charts reviewed, 382 patients met the inclusion criteria with an average gestational duration of 25.0 weeks. Of these, 162 (42.4%) had a BMI &gt;30 kg/m²; 120 individuals fell into the BMI 25 to 29.9 group (31.4%), and the remaining 100 individuals made up the BMI &lt;25 group (26.2%). The median time to expulsion differed significantly among BMI categories (12 hours for BMI &lt;25 [IQR 8–18], 14 hours for BMI 25–29.9 [IQR 8–22], 20 hours for BMI ≥30 [IQR 12–28], <em>p</em> &lt; 0.001). After adjusting for gestational duration, history of cesarean section, or prior vaginal deliveries, individuals with a BMI ≥30 had 6.62 times the odds (95% CI 3.27–13.44) of having a time to expulsion ≥24 hours compared to BMI &lt;25.</div></div><div><h3>Conclusions</h3><div>Individuals with a BMI &gt;30 had significantly longer second and third trimester time to fetal expulsion. Induction protocols and counseling may need to be adjusted based on body size.</div></div><div><h3>Implications</h3><div>Individuals with a BMI &gt;30 undergoing a medication abortion &gt;13 weeks have longer time to fetal expulsion than those with a BMI &lt;25. More research is needed to optimize induction protocols and abortion care for high BMI individuals.</div></div>","PeriodicalId":10762,"journal":{"name":"Contraception","volume":"143 ","pages":"Article 110752"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}