Contraception最新文献

{"title":"Uses of ulipristal acetate beyond emergency contraception: a narrative review.","authors":"Ashley M Ebersole, Abigail Liberty, Alison Edelman, Elizabeth Lyman, Kelly Cleland","doi":"10.1016/j.contraception.2025.110862","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110862","url":null,"abstract":"<p><strong>Objectives: </strong>Ulipristal acetate (UPA) is a selective progesterone receptor modulator and the most effective oral EC method available in the United States (US). The aim of this review is to identify and describe uses of UPA beyond EC and to further discuss the concerns regarding the possible off-target liver effects.</p><p><strong>Study design: </strong>We conducted a literature search in August 2024, using Embase, Medline (PubMed), and Cochrane, utilizing a combination of MeSH and keywords for UPA, excluding animal studies, and limiting to English language publications. After excluding duplicates using Covidence, two authors reviewed the remaining 610 results and identified 340 studies. We further excluded case reports and case series.</p><p><strong>Results: </strong>UPA has shown significant promise for indications outside of EC, most notably treatment of uterine leiomyomas, but also ongoing contraception, prevention and treatment of breast cancer, and abnormal uterine bleeding. While UPA has extensive potential for use both within and beyond reproductive health, unfortunately any ongoing development is at a standstill due to concerns regarding its possible role in causing serious liver injury. The role of UPA in causing drug-induced liver injury (DILI) is not confirmed and pre-clinical studies during development did not demonstrate a concern that UPA causes DILI.</p><p><strong>Conclusions: </strong>Access to UPA is crucial not only for EC but for the treatment of many other gynecologic and non-gynecologic conditions.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110862"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estetrol/Drospirenone Safety in a Population with Cardiovascular Risk Factors.","authors":"Mitchell D Creinin, Jean Michel Foidart, Kristina Gemzell-Danielsson, Nina C Flerin, Ali Kubba, Ulysse Gaspard, Jonathan Douxfils","doi":"10.1016/j.contraception.2025.110861","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110861","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate cardiovascular safety outcomes in estetrol 15mg/drospirenone 3mg users with cardiovascular risk factors.</p><p><strong>Study design: </strong>We performed a secondary analysis of two open-label contraceptive phase-3 trials that enrolled participants 16 to 50 years to use estetrol/drospirenone for up to 13 cycles. Study exclusion criteria included >35 years and smoking, body mass index (BMI) >35 kg/m², and baseline blood pressure (BP) >140/90 mmHg. We compared adverse event rates in participants with and without cardiovascular risk factors and assessed discontinuation rates for cardiovascular adverse events.</p><p><strong>Results: </strong>Of 3417 participants, 1410 (41.3%) had one or more and 309 (9.0%) had two or more cardiovascular risk factors. We found no difference in discontinuation for any adverse events in participants with and without cardiovascular risk factors. Six (0.18%) participants discontinued for a cardiovascular complaint including four with risk factors: three (0.09%) due to hypertension (all had baseline BP ≥130/85 mmHg and one or more additional risk factors) and one due to venous thrombosis (BP ≥130/85 mmHg). Of 375 participants with baseline BP ≥130/85 mmHg, 0.8% (95% CI 0-1.7%) discontinued for hypertension while among the 192 participants with baseline BP ≥130/85 mmHg and one or more additional cardiovascular risk factors, 1.6% (95% CI 0-3.3%) discontinued for hypertension.</p><p><strong>Conclusion: </strong>Among >1400 study participants with cardiovascular risk factors using estetrol/drospirenone, only three (0.2%) discontinued for hypertension, all of whom had high-normal baseline BP and at least one other risk cardiovascular risk factor.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110861"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with severe pain during medication abortion at ≤9 weeks' gestation: A secondary analysis of a multicenter, randomized, placebo-controlled trial.","authors":"Kelsey B Loeliger, Monica V Dragoman, Nathalie Kapp, Anand Tamang, Tshegofatso Bessenaar, Duong Lan Dung, Jageshwor Gautam, Jean-Louis Yoko, Nguyen Hong Minh, Daniel Grossman","doi":"10.1016/j.contraception.2025.110859","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110859","url":null,"abstract":"<p><strong>Objective: </strong>To identify covariates other than pain management regimen associated with severe pain during medication abortion at ≤9 weeks' gestation.</p><p><strong>Study design: </strong>This is a secondary analysis of a randomized trial in Vietnam, Nepal, and South Africa investigating two prophylactic pain management regimens during medication abortion. We used multivariable logistic regression models to identify factors associated with severe pain within 8 hours after taking misoprostol.</p><p><strong>Results: </strong>During June 2016-October 2017, 273 of 556 (49.1%) participants experienced severe pain (score >8 out of 10). In multivariable analyses, controlling for study center and prophylactic treatment arm, multiparity (OR 0.35, 95% CI 0.23-0.53) was associated with reduced odds of severe pain while dysmenorrhea (OR 1.16, 95% CI 1.07-1.26) and higher gestational duration (OR 1.05, 95% CI 1.01-1.09) were associated with increased odds of pain. Higher anticipated pain score (OR 1.10, 95% CI 0.99-1.23) was marginally associated with severe pain. Among multiparous patients, history of cesarean delivery (OR 3.49, 95% CI 1.24-9.77), severe pain in childbirth (OR 2.36, 95% CI 1.03-5.42), and dysmenorrhea (OR 1.22, 95% CI 1.08-1.39) were significantly associated with severe pain. Higher gestational duration (OR 1.05, 95% CI 0.99-1.11) trended toward an association with severe pain. Sociodemographic variables including younger age, marital status, financial stability, and anxiety or depression were not associated with pain.</p><p><strong>Conclusions: </strong>Beyond known risk factors of parity, dysmenorrhea, and gestational duration, this analysis demonstrates that severe pain during medication abortion is significantly associated with history of cesarean delivery and severe pain in childbirth. Depression and anxiety were not associated with severe pain. These findings can inform counseling for patients seeking medication abortion.</p><p><strong>Clinical trial registration number: </strong>ACTRN126130 0 0 017729.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110859"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pennsylvania Medicaid policy and rural hospital implementation of immediate postpartum contraception.","authors":"Sarah Horvath, Emma G Guare, Grace Ferguson, Cynthia H Chuang","doi":"10.1016/j.contraception.2025.110858","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110858","url":null,"abstract":"<p><strong>Objective: </strong>To assess the importance of Pennsylvania Medicaid immediate postpartum long-acting reversible contraception (IPLARC) reimbursement policy changes for hospital implementation of IPLARC by rurality.</p><p><strong>Study design: </strong>We surveyed clinician leaders at 51/82 (62.2%) Pennsylvania hospitals with L&D units in 2022, including 10/51 (19.6%) rural and 17/51 (33.3%) academic.</p><p><strong>Results: </strong>Six years after Pennsylvania Medicaid began covering IPLARC outside the obstetrical care bundle, only 3/10 (30.0%) rural and 18/41 (43.9%) non-rural L&D units had implemented IPLARC.</p><p><strong>Conclusions: </strong>Fewer than half of delivering hospitals in Pennsylvania offered access to IPLARC, even after favorable Medicaid reimbursement policy changes. Non-rural hospitals are more likely to offer IPLARC than rural hospitals.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110858"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interest in Rh testing and Rh immunoglobulin treatment among patients obtaining telehealth medication abortion.","authors":"Linda J Shin, Leah R Koenig, Jennifer Ko, Karen Meckstroth, Ushma D Upadhyay","doi":"10.1016/j.contraception.2025.110856","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110856","url":null,"abstract":"<p><strong>Objective: </strong>Despite an absence of evidence that Rhesus (Rh) immunoglobulin is necessary before first-trimester medication abortion, many providers require routine Rh testing and Rh immunoglobulin. We sought to assess knowledge of blood type, receipt of Rh immunoglobulin, and interest in Rh testing and Rh immunoglobulin among patients seeking direct-to-patient telehealth medication abortion care and who may not otherwise need to travel to a clinic.</p><p><strong>Study design: </strong>We used data from the California Home Abortion by Telehealth (CHAT) Study, which included patients who sought medication abortion through telehealth in 20 states and Washington, D.C., in 2021-2022. We analyzed data from two CHAT study samples: survey data from 3 virtual clinics and electronic medical records (EMRs) obtained from one of those clinics. Patients were counseled on low risk of Rh sensitization at early pregnancy durations and referred for testing or treatment as preferred.</p><p><strong>Results: </strong>Among 1,779 survey participants and 2,803 patients with EMR records, 51% and 52% respectively knew their blood type, of which 21% and 18% were Rh-negative. Among 189 Rh-negative survey participants, 6 (0.4%) obtained Rh immunoglobulin. In the EMR sample, among 1,341 patients with unknown blood type, 3% indicated interest in Rh testing, and 10% of the 263 Rh-negative patients indicated interest in receiving Rh immunoglobulin.</p><p><strong>Conclusions: </strong>Most patients who choose telehealth services for medication abortion opt out of Rh testing and treatment. Guidelines that mandate Rh testing and Rh immunoglobulin for first-trimester abortions should consider low patient interest alongside the lack of demonstrated clinical necessity.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110856"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contraception and nonalcoholic fatty liver disease in women with prior gestational diabetes mellitus.","authors":"Supatsri Sethasine, Sasiwan Suthasmalee, Siriwan Tangjitgamol, Chadakarn Phaloprakarn","doi":"10.1016/j.contraception.2025.110860","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110860","url":null,"abstract":"<p><strong>Objectives: </strong>Nonalcoholic fatty liver disease (NAFLD) is an increasing concern among women with a history of gestational diabetes mellitus (GDM). Hormonal contraceptives may affect liver metabolism, potentially increasing NAFLD risk. This study examined the association between different contraceptive methods and NAFLD risk approximately one year postpartum in women with prior GDM.</p><p><strong>Study design: </strong>We conducted a prospective cohort study involving 130 women with prior GDM. We categorized these women into three groups based on their contraceptive use: no contraception or non-hormonal methods (n = 86); progestin-only contraceptives (POCs), including progestin-only pills (POPs), depot medroxyprogesterone acetate (DMPA), and implants (n = 29); and combined oral contraceptives (COCs) (n = 15). At one year postpartum, we measured the controlled attenuation parameter to assess hepatic steatosis and diagnose NAFLD. We used multivariable logistic regression analyses to evaluate the association between contraceptive methods and NAFLD risk.</p><p><strong>Results: </strong>The POC group had the highest median controlled attenuation parameter (307 dB/m) and NAFLD prevalence (55.2%), followed by the no contraception or non-hormonal group (237 dB/m; 30.2%), with the lowest values in the COC group (213 dB/m; 13.3%). POCs, particularly POPs and DMPA, significantly increased the risk of NAFLD compared to no contraception or non-hormonal methods (adjusted odds ratio 4.28, 95% confidence interval 1.55-11.85). In contrast, COCs did not show a significant association with NAFLD risk.</p><p><strong>Conclusions: </strong>POCs, particularly POPs and DMPA, significantly increased NAFLD risk, whereas COCs showed no such association. These findings have important implications for contraceptive counseling in women with prior GDM.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110860"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Race-Ethnicity and Sex Disparities in the Use of Pregnancy Prevention Methods Among U.S. High School Students.","authors":"Jamille Nagtalon-Ramos, Tyshaneka L Saffold, Nancy Pontes, Manuel Pontes","doi":"10.1016/j.contraception.2025.110857","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110857","url":null,"abstract":"<p><strong>Objective: </strong>To examine race-ethnicity and sex differences in the reported use of pregnancy prevention methods at the last sexual encounter among sexually active high school students.</p><p><strong>Study design: </strong>Three waves of cross-sectional data from the nationally representative Youth Risk Behavior Survey (2015-2019) were used to analyze sexually active students who exclusively had sex with opposite-sex partners. R, with its survey package, was used to estimate average marginal percentages, risk differences, and confidence intervals.</p><p><strong>Results: </strong>Results showed significant sex differences in the use of contraceptives. Females (52.4%) were significantly less likely to report condom use than males (61.4%). Females were significantly more likely than males to report the use of oral contraceptive pills (23.2% vs 19.1%) or long-acting reversible contraception (11.8% vs 5.4%). Black (23.2%), Hispanic (21.0%), and Asian (23.0%) females were significantly less likely than White (45.6%) females to use oral contraceptive pills or long-acting reversible contraception. There were significant race-ethnicity differences in not using pregnancy prevention or a reliable pregnancy prevention method. About 37% of Asian female students did not use condoms or any reliable form of contraception.</p><p><strong>Conclusions: </strong>Overall, the use of contraceptives among U.S. female high school students was low. Except for condom use, male high school students underreported the use of contraceptives. Black, Hispanic, and Asian female students are significantly less likely to use reliable contraception compared to White students.</p><p><strong>Implications for policy and practice: </strong>Efforts are needed to close the race-ethnicity gap in contraceptive use and increase contraceptive use among all sexually active students.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110857"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Hemostasis with the Jada System after Induced Abortion at 12 weeks: A Case Report.","authors":"Serena Ly, Sheeva Yazdani, Nicole Economou","doi":"10.1016/j.contraception.2025.110855","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110855","url":null,"abstract":"<p><p>The JADA system is safe and effective for control of abnormal postpartum bleeding and hemorrhage at gestational ages (GA) greater than 34 weeks. This report describes successful use of the JADA to control significant uterine atony and hemorrhage in a patient undergoing procedural abortion at 12 weeks 3 days gestation.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110855"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International Contraceptive Access Foundation's Model for Improving Access to the Hormonal Intrauterine Device.","authors":"Lorna Begg, James Sailer, Kai Risse, Kendal Danna, Joanna Holopainen, Milly Kaggwa, Anne Pfitzer, Saumya Ramarao, Juhani Syrjala, Nahla Tawab, Marcel Van Valen, Maria Mercedes Vivas, Carolyn Westhoff, Frank Strelow","doi":"10.1016/j.contraception.2025.110854","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110854","url":null,"abstract":"<p><p>The International Contraceptive Access Foundation is a partnership between Bayer AG and Population Council Inc. with a mission to provide levonorgestrel-releasing intrauterine contraceptive systems at no charge to providers in low- and middle-income countries. For twenty years, the Foundation has enhanced knowledge of and access to this innovative contraceptive method. The Foundation has been critical to facilitating global access to hormonal intrauterine devices (IUDs). This Foundation model should be considered for the introduction of future methods of contraception.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110854"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcervical foley balloon versus osmotic dilators for cervical preparation.","authors":"Patrice Trowbridge, Mitchell D Creinin","doi":"10.1016/j.contraception.2025.110841","DOIUrl":"10.1016/j.contraception.2025.110841","url":null,"abstract":"","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110841"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}