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Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic.
Journal of Pediatric and Adolescent Gynecology. 2016 Jul 14;STUDY OBJECTIVE: To estimate long-acting reversible contraception (LARC) discontinuation rates. Secondary aims were to determine risk factors for discontinuation, describe reasons for discontinuation, evaluate complications related to placement, and estimate pregnancy rates after discontinuation. DESIGN: We conducted a retrospective cohort study of LARC method use through review of electronic medical record data. SETTING: Our program is housed in an academic primary care pediatric and adolescent clinic in Baltimore, Maryland. PARTICIPANTS: One hundred sixty women ages 12-24 years who received an intrauterine device or subdermal implant through our program between December 10, 2012 and December 10, 2015. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Complications from LARC insertion, device discontinuation, reason(s) for discontinuation, pregnancies resulting from device failure, and occurrence of pregnancy within 1 year of discontinuation. RESULTS: Thirty-five women discontinued their LARC method. The 6-month discontinuation rate was 11.3% and the 12-month rate was 21.9%. Discontinuation was associated with history of sexually transmitted infection (adjusted hazard ratio, 3.21; 95% confidence interval, 1.49-6.90). The most common reason for discontinuation was bleeding for the implant and expulsion for the intrauterine device. CONCLUSION: Our results support the safety and low discontinuation rates of LARC provision to adolescents and young adult women in a primary care setting. Discontinuation rates and reasons are consistent with those described in other studies. Copyright (c) 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
Causes and consequences of contraceptive discontinuation: evidence from 60 Demographic and Health Surveys.
Geneva, Switzerland, World Health Organization [WHO], 2012. 193 p.This compendium provides detailed information on the dynamics of contraceptive use from 60 surveys, conducted from 1990 to 2009, in 25 countries participating in the Demographic and Health Surveys (DHS) Programme. A more in-depth analysis is based on most recent surveys during 2002–09 in 19 countries. The compendium makes available by far the largest amount of information and tabulations, covering 422 478 episodes of contraceptive use in countries of Africa, Asia, eastern Europe and Latin America, reported by women who were either married or in cohabiting unions at the time of use. The report provides information on key indicators of the dynamics of contraceptive use, including the probability of discontinuing use for any reason and by specific reasons; and resumption of use within three months of discontinuing the method because of method-related reasons. Perhaps more important, it provides indicators on reproductive consequences of contraceptive failure and discontinuation as assessed by the percentage of unwanted or mistimed births and abortions following the cessation of use. The compendium includes a detailed set of tables and highlights the key findings.
Contraception. 2015 Dec; 92(6):575-7.OBJECTIVE: To assess baseline dysmenorrhea and insertion-related pain as predictors of intrauterine device (IUD) removal within 1 year following insertion. STUDY DESIGN: System-wide medical record abstraction 1 year after IUD insertion to identify removals and comparison of baseline characteristics (dysmenorrhea, insertion pain) among women with a removal versus women who continued IUD use was used. Baseline data came from a randomized trial of pain control during insertion. RESULTS: Among 199 insertions, we identified 21 removals and 7 expulsions, a continuation rate of 85.9%. Women with IUD removal had higher median dysmenorrhea scores before insertion than those who continued (42 vs. 25.5, p=.03). Insertion pain and other characteristics were not associated with removal. CONCLUSIONS: Preexisting dysmenorrhea may predict IUD removal within 1 year. Copyright (c) 2015 Elsevier Inc. All rights reserved.
MSI mobile outreach services: retrospective evaluations from Ethiopia, Myanmar, Pakistan, Sierra Leone and Viet Nam.
London, Marie Stopes International, 2010 Oct. 23 p.Over the last two decades, MSI has pioneered innovative approaches to reaching men and women with high quality contraceptive services. A promising model which reaches areas where traditional health services cannot reach is the use of mobile outreach health teams. The MSI outreach model generally consists of a team of nurses, healthcare assistants, counselors and a driver visiting rural, hard-to-reach areas and providing a range of high quality contraceptive services. In 2009, MSI provided services to over 1,200,000 men and women through its outreach services. To ensure that MSI mobile outreach services are consistently providing high quality services for poor women living in rural settings, we conducted a retrospective cohort study to measure: the demographic characteristics of women attending outreach; their satisfaction levels; their level of knowledge of removal options; reasons for discontinuation; the availability of follow-up services. This outreach evaluation took place in April 2010 across five MSI mobile outreach programmes (Ethiopia, Myanmar, Pakistan, Sierra Leone and Viet Nam) focusing on women who had IUDs and implants fitted between March 2008 and September 2009. The ultimate aim of this report is to provide information to programmes on the type of women served through outreach and whether or not they are providing a quality service, in particular with regards to the counselling provided and availability of follow-up mechanisms in case of complications or adverse side effects or for removal. (excerpt)
Effect of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD) and evaluating changes in BMD after discontinuation of DMPA in adolescent women.
Journal of Reproduction and Contraception. 2015 Sep; 26(3):151-159.Objective: To compare bone mineral density (BMD) between users of intramuscular depot medroxyprogesterone acetate (DMPA) and nonhormonal subjects and evaluated the changes in BMD after discontinuation of DMPA. Methods: The study included 102 women aged 16-18 years using DMPA for 24 months and 97 same-age nonusers. BMD of the lumbar spine and femoral neck were measured using dual-energy X-ray absorptiometry. The mean BMD values were compared between DMPA users (DMPA group) and nonusers (control group) and the changes of BMD during 36 months after discontinuation of DMPA were observed. Results: Mean BMD at the spine and femoral neck did not differ significantly between DMPA group and control group over 12 months, but the BMD values at both anatomical sites were significantly lower in DMPA group than in control group after 24 months treatment. After DMPA discontinuation, the mean BMD values in DMPA users increased substantially. At 24 months after DMPA discontinuation, there were no significant differences between DMPA group and control group. But the values of the lumbar spine and femoral neck BMD in DMPA group were still 1.70% and 1.87%, respectively, below nonusers at 36 months after DMPA discontinuation. Conclusion: The use of DMPA for short-term (=12 months) had no significant effects on BMD at spine and femoral neck, but long-term exposure to DMPA had significant loss in BMD in adolescents. Bone loss occurring with DMPA use is reversible after DMPA discontinuation.
A qualitative analysis of women's explanations for changing contraception: the importance of non-contraceptive effects.
Journal of Family Planning and Reproductive Health Care. 2016 Oct; 42(4):256-262.Background Women commonly report changing contraceptive methods because of side-effects. However, there is a lack of literature that has thoroughly examined women's perspectives, including why they changed contraception. Aim Using qualitative data from a contraceptive survey of young Australian women, we explored women's explanations for their recent changes in contraception. Method A thematic analysis of 1051 responses to a question about why women recently changed contraception was conducted. Results Themes reflected reasons for changing contraception which included: both contraceptive and non-contraceptive (4%); relationship/sexual (9%); medical (11%); contraceptive (18%); non-contraceptive (41%). A minority of responses were uncoded (17%). Non-contraceptive effects (effects unrelated to pregnancy prevention) featured most frequently in women's reasons for changing contraception. Conclusions While cessation of various contraceptives due to unwanted side-effects is a well-known phenomenon, this analysis provides evidence of the changing of contraception for its non-contraceptive effects and reframes the notion of ‘side-effects’.
European Journal of Contraception and Reproductive Health Care. 2015 Jun; 20(3):223-230.Background Despite high efficacy, only 7.7% of women in the United States currently using contraception use an IUD. There is little published contemporary data about fertility rates after IUD use, especially in nulliparous women and women using the hormonal IUD. Study Design We recruited sexually active women 18 to 35 years of age enrolled in the Contraceptive CHOICE Project who had discontinued a contraceptive method and desired pregnancy. Results In this pilot project, we enrolled 69 former IUD users (19 copper and 50 levonorgestrel) and 42 former non-IUD users. Pregnancy rates at 12 months were similar between the two groups; 81% of IUD users became pregnant compared to 70% of non-IUD users (p = 0.18). In the Cox model, there was no difference in the time to pregnancy in IUD users compared to non-IUD users (HRadj 1.19, 95% CI 0.74-1.92). African American race was the only variable associated with reduced fertility (HRadj 0.40, 95% CI 0.24-0.67). Conclusions We found no difference in 12-month pregnancy rates or time to pregnancy between former IUD users and users of other contraceptive methods. However, there was a clinically and statistically significant reduction in fertility in African American women.
Young Women's Perceptions of the Benefits Of Childbearing: Associations with Contraceptive Use and Pregnancy.
Perspectives On Sexual and Reproductive Health. 2013 Mar; 45(1):23-31.CONTEXT: High unintended pregnancy rates, and inconsistencies between reported pregnancy intentions and contraceptive behaviors, have been well documented among young U.S. women. Women's beliefs about the benefits of childbearing and motherhood may be related to the apparent disconnect between pregnancy intentions and reproductive outcomes. METHODS: Perceived benefits of childbearing and feelings about a potential pregnancy were assessed among 1,377 women aged 15-24 (most of them black or Latina) participating in a longitudinal study in 2005-2008. The women, who were initiating hormonal contraception at public family planning clinics and did not want to become pregnant for one year, were followed for 12 months. Differences in perceived benefits of childbearing by participant characteristics were examined with linear regression, using a new multi-item measure. Cox proportional hazard regression was used to investigate the association of perceived benefits of childbearing with subsequent contraceptive discontinuation and pregnancy. RESULTS: Perceptions of the benefits of childbearing decreased with increasing age (coefficient, -0.04), and white women perceived fewer benefits to childbearing than blacks (-0.2). As women's perception of the benefits of childbearing increased, their one-year pregnancy rates increased, after demographic characteristics and feelings about a potential pregnancy were controlled for (hazard ratio, 1.2). Benefits of childbearing were not associated with contraceptive discontinuation. CONCLUSIONS: To better assess pregnancy risk among young women wanting to avoid pregnancy, it may be useful to acknowledge that they hold not only explicit pregnancy desires, but also beliefs about the benefits of childbearing, which may influence sexual behavior and pregnancy. Copyright (c) 2013 by the Guttmacher Institute.
CMAJ: Canadian Medical Association Journal. 2013 Apr 16; 185(7):565-573.Although fertility declines with age, effective contraception is still required in women over 40 years of age who wish to avoid pregnancy. According to international guidelines, there are no contraceptive methods that are contraindicated based on age alone. Effective non-hormonal and progestin-only methods provide safe options for women who should avoid estrogen-containing contraceptives. For women who are using hormonal contraceptives, menopausal status and lack of need for contraception can be assumed at age 55.
An exploratory analysis of associations between eating disordered symptoms, perceived weight changes, and oral contraceptive discontinuation among young minority women.
Journal of Adolescent Health. 2013 Jan; 52(1):58-63.PURPOSE: To explore associations between eating-disordered (ED) symptoms, perceived oral contraceptive (OC)-related weight changes, and OC discontinuation among young minority women. METHODS: We conducted a prospective substudy of a randomized controlled trial evaluating the impact of a pill pack supply (3 vs. 7 months) on OC continuation among young urban women presenting to a university-affiliated community-based family planning clinic for OC management. Participants (n = 354) were adolescent (n = 173) and young adult (n = 181) women aged 13-24 years, predominantly underinsured and largely Hispanic (92%). We conducted a structured baseline interview that included an ED screening instrument. At the 6-month follow-up, we conducted a telephone interview to determine OC continuation and dimensions of perceived OC-related weight changes during the study period. RESULTS: At baseline, 24% of the subjects fulfilled the moderate/severe ED symptom screen criteria (n = 60). By 6 months, 57% of the subjects (n = 200) reported weight changes and 62% (n = 218) had discontinued OC use. Unadjusted discontinuation rates were similar across age- and ED symptom groups. In multivariate analysis, both ED symptoms (odds ratio = .49, 95% confidence interval = .25-.96, p = .04) and perceived weight changes (odds ratio = .60, 95% confidence interval = .38-.94, p = .03) were negatively associated with OC continuation. CONCLUSIONS: ED symptoms and perceived weight changes were associated with an increased likelihood of OC discontinuation among these young women. Reproductive health practitioners should consider psychological symptoms when managing OC. Copyright (c) 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Journal of Adolescent Health. 2013 Jan; 52(1):77-82.PURPOSE: To describe women's condom use patterns over time and assess predictors of dual method use 12 months after initiating hormonal contraceptives. METHODS: We conducted a prospective cohort study among women aged 15-24 years initiating oral contraceptive pills, patch, ring, or depot medroxyprogesterone and attending public family planning clinics. Participants completed questionnaires at baseline and 3, 6, and 12 months after enrollment. We used multivariable logistic regression to assess baseline factors associated with dual method use at 12 months among 1,194 women who were sexually active in the past 30 days. RESULTS: At baseline, 36% were condom users, and only 5% were dual method users. After initiation of a hormonal method, condom use decreased to 27% and remained relatively unchanged thereafter. Dual method use increased to a peak of 20% at 3 months but decreased over time. Women who were condom users at baseline had nearly twice the odds of being a dual method user at 12 months compared with nonusers (adjusted odds ratio [AOR] = 2.01, 95% CI: 1.28-3.14). Women who believed their main partner thought condoms were "very important," regardless of perceived sexually transmitted infection risk or participant's own views of condoms, had higher odds of dual method use (AOR = 2.89, 95% CI: 1.47-5.71). CONCLUSIONS: These results highlight a potential missed opportunity for family planning providers. Providers focus on helping women initiate hormonal methods, however, they may improve outcomes by giving greater attention to method continuation and contingency planning in the event of method discontinuation and to the role of the partner in family planning. Copyright (c) 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Nigerian Journal of Medicine. 2012 Jul-Sep; 21(3):266-71.CONTEXT: Contraception with Depot Medroxyprogesterone Acetate (Depo provera) is quite effective though not without side effects that may cause discontinuation amongst acceptors. OBJECTIVE: To evaluate client characteristics, their experiences and acceptability of Depo provera in Enugu and compare these with previous experiences elsewhere. MATERIALS AND METHOD: A review of the family planning records of new acceptors who used Depo provera between 1st January 2000 and 31st December 2005 at the family planning clinic of University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. RESULTS: Within the study period, 684 new clients accepted Depo provera, accounting for 21.4% of all new acceptors for various forms of contraception. The mean [+/- SD] age and parity of the 590 acceptors whose records were available were 34.40 +/- 6.03 years and 5.52 +/- 2.02 respectively. Seventy percent (70%) of the clients had 5 or more children. Most (51.6%) had primary education. Seventy percent of clients with 5 or more children wanted no more children while 30% of those gainfully employed use of Depo provera for child spacing. Fifty seven percent of clients accepted Depo provera within a year following confinement and 80.2% of them were breast feeding. Complications occurred in 54.2% of all acceptors, with menstrual abnormalities occurring in 94.4% of them. Secondary amenorrhoea was the commonest menstrual anomaly occurring in 81.1% of clients with menstrual problems. Discontinuation in use Depo provera was 51.5% after the first one year. Irregular injection schedules and default were common with a continuation rate of 25.6% at the end of they observation period. However, the complaints of side effects appeared to wane beyond the second year of use. Three accidental pregnancies (0.5%) occurred during the study period. CONCLUSION: Depot medroxyprogesterone acetate injectable contraceptive is an effective method of contraception in Enugu. It is accepted mainly by clients that have completed their family and are breast feeding. Awareness of its side effects obviously enhances continuation.
International Quarterly of Community Health Education. 2011-2012; 32(2):101-13.Unintended pregnancies are associated with unsafe abortion and greater risk of maternal morbidity and maternal deaths. In Bangladesh, approximately one-third of pregnancies are unintended. Considering the magnitude of the situation and its consequences, this article explores factors associated with the prevalence of unintended pregnancies in rural Bangladesh with implications for policy intervention. A total of 3300 women were interviewed from 22 sub-districts to collect information on unintended pregnancy related issues. Findings reveal that about 29% of the pregnancies were unintended and the frequency of unintended pregnancy was higher among the older, less educated, higher parity, and poor women. Findings also suggest that unintended pregnancy rate was higher (33%) among women who used contraceptive before their last pregnancy than women (23%) who did not use any contraceptive. The rate of unintended pregnancy also varied, by the types of contraceptive methods used before their last pregnancy. The women who were using traditional methods or temporary modern methods were more likely to experience unintended pregnancy than longer acting method users. The findings underscore the importance of measuring contraceptive discontinuation rates in addition to prevalence of all modern methods. When discussing policy interventions to generate demand for family planning, consideration of differences in method-specific discontinuation rates is important if policy objectives to reduce unintended pregnancies are to be achieved.
Use of the levonorgestrel-releasing intrauterine system in renal transplant recipients: a retrospective case review.
Contraception. 2012 Sep; 86(3):288-9.Our objective was to report on the use of the levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena(R)) in renal transplant recipients. A retrospective case review was done to identify renal transplant recipients for whom a LNG-IUS had been inserted. All of the women had been seen in the Gynecology Department, Beaumont Hospital, during the period 2000 to 2010. Parameters including age, year of transplantation, indication for insertion, duration of use, discontinuation and complications were documented. The main outcome measure was discontinuation of the LNG-IUS due to pelvic infection. Eleven women were identified who had undergone renal transplantation and were using the LNG-IUS. The mean duration of use was 38 (range 1-84) months. Four women were using the LNG-IUS for contraception and seven were using it for the treatment of menorrhagia, either alone or in conjunction with endometrial ablative procedures. One woman discontinued use in order to conceive. There were no unplanned pregnancies. There were no documented cases of pelvic infection in women using the device. Renal transplant recipients have a critical need for safe and effective contraception. The use of the LNG-IUS has been avoided in the patients due to the theoretical risk of intrauterine device-related pelvic infection in immune-suppressed patients. However, on the basis of our results, we believe that it is acceptable to use the LNG-IUS in renal transplant recipients for both contraception and for the treatment of menorrhagia as the theoretical risk of infection in these immune-suppressed patients does not appear to be increased. Copyright (c) 2012 Elsevier Inc. All rights reserved.
Qualitative study of reasons for discontinuation of injectable contraceptives among users and salient reference groups in Kenya.
African Journal of Reproductive Health. 2011 Jun; 15(2):67-78.Discontinuation of contraception is a major problem in Kenya. Even though they want to space or limit their births, over a quarter of contraceptive injectable users discontinue use of the method within 12 months of beginning use. Fourteen focus group discussions were conducted in Nyando District, Kenya among current contraceptive injectable users and their salient reference groups (e.g. husbands, mothers-in-law, community leaders, service providers) to understand why women discontinue using contraceptives (with a focus on injectables). Thematic analysis was performed using NVivo 8 software. Discontinuation of contraceptives in Nyando District occurs for logistical, social and medical reasons. Common reasons for discontinuation include side effects, husbands' opposition, provider and/or clinic restrictions, misconceptions about injectables, stock outs, and lack of cash to pay for family planning services. This research expands the literature by examining social influences on discontinuation by incorporating the perspectives of salient reference groups. The results suggest points of intervention for increasing continuation in this community and similar resource-poor settings.
Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants.
Contraception. 2012 Nov; 86(5):511-517.BACKGROUND: Subdermal contraceptive implants have low discontinuation rates but are underused among young women in Africa. This study aimed to isolate the role initial contraceptive method has on preventing unintended pregnancy. STUDY DESIGN: We recruited 399 Kenyan women aged 18-24 years into a prospective cohort study if they wanted short-acting hormonal methods (injectable or oral contraceptives). We offered an implant and formed two study groups: implant and short-acting. For contraceptive discontinuation/pregnancy, we used log-rank tests and proportional hazards models. We applied intent-to-treat principles to evaluate the role of initial method choice on future pregnancy. RESULTS: Twenty-four percent opted for an implant (n=97), and the remainder opted for a short-acting method (n=299). The 18-month discontinuation probability was 21 per 100 for implant users and 43 per 100 for the short-acting method group (p=.001). Twenty-two unintended pregnancies occurred; all were among the short-acting group. The adjusted relative risk of pregnancy among the short-acting group vs. implant group was 7.4 (95% confidence interval: 1.6-34.5). CONCLUSIONS: Many young Kenyan women found implants to be a reasonable alternative to short-acting methods. Having choice is essential, and starting on implants provides substantial and clear protection from unintended pregnancy relative to short-acting methods. Copyright (c) 2012 Elsevier Inc. All rights reserved.
Influence of depressed mood and psychological stress symptoms on perceived oral contraceptive side effects and discontinuation in young minority women.
Contraception. 2012 Nov; 86(5):518-525.BACKGROUND: We examined the influence of depressed mood and psychological stress on oral contraceptive (OC) side effects and discontinuation. STUDY DESIGN: We administered standard psychological instruments to 354 young women (13-24 years old) beginning a 6-month OC continuation intervention trial and questions on OC side effects and use at 6 months. Logisitic regression determined the relationships between psychological conditions, perceived OC side effects and continuation rates. RESULTS: Baseline depressed mood (21%) and stress (19%) and 6-month mood (25%) and weight changes (57%) were relatively common. Only 38% continued OCs at 6 months. Depressed mood [odds ratio (OR) 2.27, confidence interval (CI) 1.25-4.15, p=.007] and stress (OR 2.07, CI 1.12-3.82, p=.02) were associated with perceived OC-related moodiness; depressed mood was associated with perceived weight loss (OR 1.89, CI 1.01-3.55, p=.05). Depressed mood (OR 0.54, CI 0.29-0.99, p=.04), stress (OR 0.48, CI 0.25-0.91, p=.03) and perceived weight change (OR 0.60, CI 0.38-0.94, p=.03) all reduced the likelihood of OC continuation. CONCLUSION: Young women with adverse psychological symptoms are at risk for perceived OC side effects and discontinuation. Copyright (c) 2012 Elsevier Inc. All rights reserved.
Dhaka, Bangladesh, NIPORT, 2012 Apr.  p.Bangladesh Demographic and Health Survey (BDHS) 2011 is a nationwide sample survey of men and women of reproductive age designed to provide information on fertility and childhood mortality levels; fertility preferences; use of family planning methods; maternal, child and newborn health, including breastfeeding practices, nutrition levels including anemia and presence of iodine in cooking salt; knowledge and attitudes toward HIV / AIDS and other sexually transmitted infections (STI); and community-level data on accessibility and availability of health and family planning services. BDHS 2011 is the sixth survey of its kind conducted in Bangladesh. The special feature of this survey is to provide biomarker indices of adult male and female population which is instrumental in determining increasing risk of non-communicable diseases. The wealth of demographic and health data that BDHS 2011 provides is essential and instrumental in monitoring and evaluating the performance of Health Population Nutrition Sector Development Programme (HPNSDP). BDHS 2011 presents estimates for 18 indicators of result framework of HPNSDP and is considered as baseline for the programme to be implemented during 2011-2016. We hope this information will assist policymakers and programme managers in monitoring and designing programmes and strategies for improving health and family planning services in the country. This report presents the preliminary results for the major findings of the survey. A more comprehensive and detailed report is scheduled to be published later in 2012. (Excerpt)
The discontinuation rate and reasons for discontinuation of implanon at the family planning clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria.
Nigerian Journal of Medicine. 2011 Oct-Dec; 20(4):448-50.BACKGROUND: In spite of the popularity and effectiveness of the Implanon among family planning clients at University of Nigeria Teaching Hospital (U.N.T.H) Enugu Nigeria, some users discontinued its use for a variety of reasons. OBJECTIVE: To determine the Implanon discontinuation rate and reasons for discontinuation among women attending University of Nigeria Teaching Hospital (U.N.T.H) Enugu, Nigeria. MATERIALS AND METHODS: This retrospective survey comprised 63 women who had Implanon implant discontinued out of 295 women who had Implanon inserted between 2006 and 2008. The records of patient at the Family Planning Clinic of the hospital were analysed. The main outcome measured was Implanon discontinuation. RESULTS: Sixty-three (21.4%) of women who had Implanon implant during this period discontinued its use. The discontinuation rate within six months of use was 3.0%, within one year, 8.1% and within two years, 19.3%. Thirty-six (12.2%) discontinued Implanon because of side effects while 27 (9.2%) discontinued because of desire for pregnancy. Fifteen (41.7%) out of the 36 women who discontinued because of side effects had menstrual abnormalities. Headache and dizziness accounts for the majority (38.1%) of non-menstrual reasons for discontinuation. There was no pregnancy recorded. All those who discontinued Implanon within six months ofuse were because of side effects. CONCLUSION: The discontinuation of Implanon before its expiration is low once the users are adequately counseled. Implanon is well accepted among our clients but cost affect its wider use.
Annals of African Medicine. 2012 Jan; 11(1):27-31.Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To determine the characteristics of women accepting the method, complications and indications for discontinuation. Materials and Methods: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January, 2001 and 31 st December, 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05. Results: A total of 1,967 women used contraception during the study period and 433 (22.1%) made progestogen-only injectable their method of choice. 199(45.96%) used NET-EN, while DMPA was used by234 (54.04%) women. Many of the women (197, 45.5%) used the method for terminal fertility control. Menstrual abnormality was the commonest (264, 71.4%) complaint about progestogen-only injectable contraceptive, of which amenorrhea was experienced by constituted 176(66.7%). Eighty-three (22.4%) women had discontinued the contraceptive, and menstrual abnormality was the commonest reason for the discontinuation (68, 81.9%). No pregnancy was reported among the women that came for follow up while on the method. Conclusion: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities, hence the need for effective education of the women about this side effect, thus increasing the acceptance and continuation rate of the contraceptive method.
Cochrane Database of Systematic Reviews. 2011 Nov 9; 11:CD003553.BACKGROUND: Side effects of oral contraceptive (OC) pills discourage adherence to and continuation of OC regimens. Strategies to decrease adverse effects led to the introduction of the triphasic OC in the 1980s. Whether triphasic OCs have higher accidental pregnancy rates than monophasic pills is unknown. Nor is it known if triphasic pills give better cycle control and fewer side effects than the monophasic pills. OBJECTIVES: To compare triphasic OCs with monophasic OCs in terms of efficacy, cycle control, and discontinuation due to side effects. SEARCH STRATEGY: We searched the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, POPLINE, EMBASE, and LILACS, as well as clinical trials databases (ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform (ICTRP)) in May 2011. Additionally, we searched the reference lists of relevant articles. We also contacted researchers and pharmaceutical companies to identify other trials not found in our search. SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparing any triphasic OC with any monophasic pill used to prevent pregnancy. Interventions had to include at least three treatment cycles. DATA COLLECTION AND ANALYSIS: We assessed the studies found in the literature searches for possible inclusion and for their methodological quality. We contacted the authors of all included studies and of possibly randomized trials for supplemental information about the methods used and outcomes studied. We entered the data into RevMan and calculated odds ratios for the outcome measures of efficacy, breakthrough bleeding, spotting, withdrawal bleeding and discontinuation. MAIN RESULTS: Of 23 trials included, 19 examined contraceptive effectiveness. The triphasic and monophasic preparations did not differ significantly. Several trials reported favorable bleeding patterns, that is less spotting, breakthrough bleeding or amenorrhea, in triphasic versus monophasic OC users. However, meta-analysis was generally not possible due to differences in measuring and reporting the cycle disturbance data as well as differences in progestogen type and hormone dosages. No significant differences were found in the numbers of women who discontinued due to medical reasons, cycle disturbances, intermenstrual bleeding or adverse events. AUTHORS' CONCLUSIONS: The available evidence is insufficient to determine whether triphasic OCs differ from monophasic OCs in effectiveness, bleeding patterns or discontinuation rates. Therefore, we recommend monophasic pills as a first choice for women starting OC use. Large, high-quality RCTs that compare triphasic and monophasic OCs with identical progestogens are needed to determine whether triphasic pills differ from monophasic OCs. Future studies should follow the recommendations of Belsey or Mishell on recording menstrual bleeding patterns and the CONSORT reporting guidelines.
Health-related quality of life changes among users of depot medroxyprogesterone acetate for contraception.
Contraception. 2011 Nov; 84(5):e17-22.BACKGROUND: Depot medroxyprogesterone acetate (DMPA) may have other noncontraceptive effects that could impact on the quality of life. The objective of this study was to assess the health-related quality of life changes associated with the use of DMPA for contraception. STUDY DESIGN: A prospective, observational study using the Short Form-36 quality of life questionnaire. RESULTS: After 6 months of use, the participants had an improved physical summary score, mean change [5.64 (95% confidence interval [CI], 1.87-9.4), p=.054]. There was no significant change in sexual function [5.33 (95% CI, -2.15 to 12.81), p=.0858] and mental summary score [-0.51 (95% CI, -1.90 to 2.92), p=.432]. The main side effect of DMPA was menstrual irregularity (32.5%); 17.2% of the participants found amenorrhea desirable. CONCLUSION: Besides its contraceptive efficacy, DMPA is associated with an improvement in perceived physical health with no apparent adverse effect on mental health and sexual function. Copyright (c) 2011 Elsevier Inc. All rights reserved.
Contraception. 2012 Jan; 85(1):56-62.BACKGROUND: We examined 12-month hormonal contraceptive continuation and pregnancy rates by abortion history. STUDY DESIGN: Women who wanted to avoid pregnancy for at least 1 year were recruited at four San Francisco Bay area family planning clinics on regular service days and on abortion care days. Participants completed baseline and follow-up questionnaires. Multivariable Cox models assessed the factors associated with method discontinuation and pregnancy. RESULTS: Women who were enrolled into the study on the day of their abortion were 20% more likely to discontinue their contraceptive method than women who never had an abortion [adjusted hazard ratio (AHR)=1.21, 95% confidence interval (CI)=1.03-1.42]. Women who had a recent abortion or previous abortion were 60% more likely to have a pregnancy during follow-up than women who never had an abortion (AHR=1.63, 95% CI =1.21-2.20, and AHR=1.66, 95% CI=1.18-2.33, respectively). CONCLUSION: The experience of having an unintended pregnancy and abortion does not lead to behavioral changes that protect against another unintended pregnancy. Copyright (c) 2012 Elsevier Inc. All rights reserved.
American Family Physician. 2011 Jan 1; 83(1):35-6.Highly effective contraception is essential to reduce unintended pregnancies and the effect these pregnancies have on individual persons, society, and public health resources. Intrauterine devices (IUDs) and depot medroxyprogesterone acetate (Depo Provera) are two commonly used long-acting, reversible contraceptive methods with different risk and benefit profiles. Two studies were included in this review. In the populations studied, the IUD was more effective than hormonal contraception with respect to pregnancy prevention. High-quality research is urgently needed to compare the effects, if any, of these two commonly used contraception methods on HIV acquisition or seroconversion and HIV and AIDS disease progression.
Archives of Gynecology and Obstetrics. 2011 Jun; 283(6):1325-8.BACKGROUND: The main cause for discontinuation of depot medroxyprogesterone acetate (DMPA) use is irregular menstrual bleeding. The exact pathophysiological mechanisms of irregular bleeding have remained unclear. Transvaginal Doppler is a non-invasive method for studying changes in blood flow which may highlight the underlying pathology in those cases with irregular uterine bleeding. The aim of this study was to quantify the uterine and subendometrial microvasculature in DMPA users with irregular bleeding pattern in comparison to DMPA users with amenorrhea. STUDY DESIGN: This is a case control study. Forty users of DMPA were divided into two groups: one group included 20 users with irregular uterine bleeding and the second group included 20 amenorrheic users. Pulsatility index (PI) and resistance index (RI) of uterine and subendometrial blood vessels were determined. Power Doppler Energy was used to quantify the signal percentage of the subendometrial area. RESULTS: There is significant reduction of PI and RI in the uterine artery and subendometrial microvasculature in cases of irregular uterine bleeding. CONCLUSION: Irregular uterine bleeding with DMPA associated with increased perfusion of uterine and subendometrial blood vessels.