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BJOG. 2018 Feb; 125(3):288.Against a background of an increasing demand for surgical intervention for the treatment of FGM/C related complications, Berg et al
Note for typesetter: Please update reference when assigned to an issue.have conducted a systematic review of 62 studies involving 5829 women, to assess the effectiveness of defibulation, excision of cysts and clitoral reconstructive surgery. Berg et al report that defibulation showed a lower risk of Caesarean section and perineal tears; excision of cysts commonly resulted in resolution of symptoms; and clitoral reconstruction resulted in most women self-reporting improvements in their sexual health. However, Berg et al highlight that they had little confidence in the effect estimate for all outcomes as most of the studies were observational and conclude that there is currently poor quality of evidence on the benefits and/or harm of surgical interventions to be able to counsel women appropriately. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Scaling up proven innovative cervical cancer screening strategies: Challenges and opportunities in implementation at the population level in low- and lower-middle-income countries.
International Journal of Gynaecology and Obstetrics. 2017 Jul; 138 Suppl 1:63-68.The problem of cervical cancer in low- and lower-middle-income countries (LLMICs) is both urgent and important, and calls for governments to move beyond pilot testing to population-based screening approaches as quickly as possible. Experiences from Zambia, Bangladesh, Guatemala, Honduras, and Nicaragua, where scale-up of evidence-based screening strategies is taking place, may help other countries plan for large-scale implementation. These countries selected screening modalities recommended by the WHO that are within budgetary constraints, improve access for women, and reduce health system bottlenecks. In addition, some common elements such as political will and government investment have facilitated action in these diverse settings. There are several challenges for continued scale-up in these countries, including maintaining trained personnel, overcoming limited follow-up and treatment capacity, and implementing quality assurance measures. Countries considering scale-up should assess their readiness and conduct careful planning, taking into consideration potential obstacles. International organizations can catalyze action by helping governments overcome initial barriers to scale-up. (c) 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Contraception. 2011 Oct; 84(4):339-41.This editorial focuses on a strategy to expand contraceptive coverage through the development of a numerical International Statistical Classifications of Diseases (ICD) code for "unwanted fertility." It explains how this strategy would work, how to make the strategy happen through a revision process, and defining unwanted fertility as a medical problem. Copyright © 2011 Elsevier Inc. All rights reserved.
Reviews In Obstetrics and Gynecology. 2010 Spring; 3(2):55-65.Migraine affects as many as 37% of reproductive-age women in the United States. Hormonal contraception is the most frequently used form of birth control during the reproductive years, and given the significant proportion of reproductive-age women affected by migraine, there are several clinical considerations that arise when considering hormonal contraceptives in this population. In this review, key differences among headache, migraine, and migraine with aura, as well as strict diagnostic criteria, are described. The recommendations of the World Health Organization and the American College of Obstetricians and Gynecologists regarding hormonal contraception initiation and continuation in women with these diagnoses are emphasized. Finally, information about the effect of hormonal fluctuations on headache is provided with recommendations regarding contraception counseling in patients who experience headache while taking hormonal contraception.
U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition.
MMWR. Recommendations and Reports. 2010 Jun 18; 59(RR-4):1-86.CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
Obstetrics and Gynecology. 2008 Sep; 112(3):572-8.OBJECTIVE: To estimate how well a convenience sample of women from the general population could self-screen for contraindications to combined oral contraceptives using a medical checklist. METHODS: Women 18-49 years old (N=1,271) were recruited at two shopping malls and a flea market in El Paso, Texas, and asked first whether they thought birth control pills were medically safe for them. They then used a checklist to determine the presence of level 3 or 4 contraindications to combined oral contraceptives according to the World Health Organization Medical Eligibility Criteria. The women then were interviewed by a blinded nurse practitioner, who also measured blood pressure. RESULTS: The sensitivity of the unaided self-screen to detect true contraindications was 56.2% (95% confidence interval [CI] 51.7-60.6%), and specificity was 57.6% (95% CI 54.0-61.1%). The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5-86.3%), and specificity was 88.8% (95% CI 86.3-90.9%). Using the checklist, 6.6% (95% CI 5.2-8.0%) of women incorrectly thought they were eligible for use when, in fact, they were contraindicated, largely because of unrecognized hypertension. Seven percent (95% CI 5.4-8.2%) of women incorrectly thought they were contraindicated when they truly were not, primarily because of misclassification of migraine headaches. In regression analysis, younger women, more educated women, and Spanish speakers were significantly more likely to correctly self-screen (P<.05). CONCLUSION: Self-screening for contraindications to oral contraceptives using a medical checklist is relatively accurate. Unaided screening is inaccurate and reflects common misperceptions about the safety of oral contraceptives. Over-the-counter provision of this method likely would be safe, especially for younger women and if independent blood pressure screening were encouraged.
Research Triangle Park, North Carolina, FHI, 2002.  p. (FHI Research Brief No. 6; RB-02-06E)Community-based workers worldwide use checklists to determine whether women are medically eligible to use combined oral contraceptives (COCs) or depot-medroxyprogesterone acetate (DMPA). However, problems may arise when outdated and inaccurate checklists are used. With input from dozens of experts, Family Health International developed new checklists that are easily understandable and consistent with the World Health Organization's (WHO) medical eligibility requirements. (author's)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
Does use of hormonal contraceptives among women with thrombogenic mutations increase their risk of venous thromboembolism? A systematic review.
Contraception. 2006 Feb; 73(2):166-178.Because use of combined oral contraceptives (COCs) confers some risk of venous thromboembolism (VTE), there is concern that this effect may be greater among women with thrombogenic mutations. We searched the MEDLINE and EMBASE databases for all articles published from January 1966 through September 2004 for evidence relevant to hormonal contraception and thrombogenic mutations. Of 301 articles identified by the search strategy, 16 evaluated COCs, and no studies were found for other hormonal methods. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. A total of 10 studies together provided "good" evidence of a greater risk of VTE (risk ratios of 1.3-25.1) and cerebral vein or cerebral sinus thrombosis among COC users with factor V Leiden mutation when compared with nonusers who have the mutation. The evidence for prothrombin and other thrombogenic mutations was not as strong as for factor V Leiden mutation. It is unclear whether the type of COC or duration of use modifies the risk of VTE among women with thrombogenic mutations. (author's)
Contraception. 2006 Feb; 73(2):154-165.Previous research has suggested that hormonal contraceptive users, compared with nonusers, may be at increased risk for acquiring sexually transmitted infections (STIs). We searched the MEDLINE and EMBASE databases for all articles from January 1966 through February 2005 for evidence relevant to all hormonal contraceptives and STIs (including cervical chlamydial and gonococcal infection, human papillomavirus, trichomoniasis, herpes and syphilis). We used standard abstract forms and grading systems to summarize and assess the quality of 83 identified studies. Studies of combined oral contraceptive and depot medroxyprogesterone use generally reported positive associations with cervical chlamydial infection, although not all associations were statistically significant. For other STIs, the findings suggested no association between hormonal contraceptive use and STI acquisition, or the results were too limited to draw any conclusions. Evidence was generally limited in both amount and quality, including inadequate adjustment for confounding, lack of appropriate control groups and small sample sizes. The observed positive associations may be due to a true association or to bias, such as differential exposure to STIs by contraceptive use or increased likelihood of STI detection among hormonal contraceptive users. (author's)
Use of combined oral contraceptives among women with migraine and nonmigrainous headaches: a systematic review.
Contraception. 2006 Feb; 73(2):189-194.This systematic review examines evidence evaluating whether women with headaches who use combined oral contraceptives (COCs) have a greater risk of stroke than women with headaches who do not use COCs. We searched MEDLINE for articles published from 1966 through March 2005 relevant to headaches and COC use as risk factors for stroke. Of the 79 articles identified, nine met our selection criteria (eight reports of six observational studies plus one meta-analysis). All studies reported specifically on migraine headaches. Evidence from six case-control studies suggested that COC users with a history of migraine were two to four times as likely to have an ischemic stroke as nonusers with a history of migraine. The odds ratios for ischemic stroke ranged from 6 to almost 14 for COC users with migraine compared with nonusers without migraine. The three studies that provided evidence on hemorrhagic stroke reported low or no risk associated with migraine or with COC use. (author's)
Contraception. 2006 Feb; 73(2):179-188.Women with hypertension are at increased risk for cardiovascular events. Combined oral contraceptive (COC) use, even among low-dose users, has been associated with a small excess risk for cardiovascular events among healthy women. In this systematic review, we examined cardiovascular risks among COC users with hypertension. After searching MEDLINE for all articles published from 1966 through February 2005 relevant to COC use, hypertension and cardiovascular disease, we identified 25 articles for this review. Overall, these studies showed that hypertensive COC users were at higher risk for stroke and acute myocardial infarction (AMI) than hypertensive non-COC users, but that they were not at higher risk for venous thromboembolism (VTE). Women who did not have their blood pressure measured before initiating COC use were at higher risk for ischemic stroke and AMI, but not for hemorrhagic stroke or VTE, than COC users who did not have their blood pressure measured. (author's)
Does insertion and use of an intrauterine device increase the risk of pelvic inflammatory disease among women with sexually transmitted infection? A systematic review.
Contraception. 2006 Feb; 73(2):145-153.Concerns exist as to whether the insertion of copper and levonorgestrel-releasing intrauterine devices (IUDs) increases the risk of pelvic inflammatory disease (PID) among women with sexually transmitted infection (STI). We searched the MEDLINE database for all articles published between January 1966 and March 2005 that included evidence relevant to IUDs and STIs and PID. None of the studies that examined women with STIs compared the risk of PID between those with insertion or use of an IUD and those who had not received an IUD. We reviewed indirect evidence from six prospective studies that examined women with insertion of a copper IUD and compared risk of PID between those with STIs at the time of insertion with those with no STIs. These studies suggested that women with chlamydial infection or gonorrhea at the time of IUD insertion were at an increased risk of PID relative to women without infection. The absolute risk of PID was low for both groups (0-5% for those with STIs and 0-2% for those without). (author's)
Contraception. 2006 Feb; 73(2):195-204.The use of progestogen-only contraceptives among women with sickle cell anemia has generated concerns about possible hematological and other clinical complications. Based on the literature, we assessed whether use of progestogen-only contraceptives is associated with adverse health effects among women with sickle cell anemia. We searched the MEDLINE database for articles published in peer-reviewed journals between 1966 and September 2004 that were relevant to sickle cell anemia and use of progestogen-only contraceptives. Of the 70 articles identified through the search, 8 met the criteria for this review. These studies did not identify any adverse events or clinically or statistically significant adverse changes in hematological or biochemical parameters associated with the use of progestogen-only contraceptive methods. Six studies suggested that users experienced a decrease in clinical symptoms and less frequent and severe painful crises compared with nonusers. Although data are limited, these studies suggest that progestogen-only contraceptives are safe for women with sickle cell anemia. (author's)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 7. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The Expert Working Group incorporated three new contraceptive methods into the MEC—the combined hormonal contraceptive patch, the combined hormone-releasing vaginal ring, and the etonogestrel-releasing implant, Implanon. The hormone levels and patterns typical of the patch and the ring are similar to those for COCs, as are the type and frequency of side effects reported in comparative studies. Therefore, the meeting concluded, MEC classifications applying to COCs can be assumed to apply to the patch and ring as well. There is no direct evidence concerning use of either method among women with health conditions. The meeting also assumed that the MEC classifications for the 5-year levonorgestrel implant Norplant can also apply to the 3-year etonogestrel implant Implanon. (excerpt)
Criteria reaffirmed for broad-spectrum antibiotics and hormonal methods, cervical neoplasia and COCs, breastfeeding and progestins.
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 6. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Case reports have raised suspicions that broad-spectrum antibiotics in general might lower the effectiveness of hormonal contraceptives. Still, studies find that various broad-spectrum antibiotics do not lower hormone levels and, with one early exception, they have found no evidence of ovulation. Pregnancy rates are similar among women taking COCs alone and women taking both COCs and antibiotics. The 2003 Expert Working Group left broadspectrum antibiotics in MEC category 1 (use in any circumstances). The MEC previously categorized use of the antibiotics rifampicin and griseofulvin both as category 3 (not usually recommended) for most hormonal contraceptives because these drugs were thought to reduce contraceptive effectiveness. There are reports of pregnancies in users of hormonal contraceptives taking griseofulvin, and griseofulvin affects liver enzymes in mice, suggesting a possible impact on hormone metabolism. There are no published clinical or pharmacokinetic studies on interaction between griseofulvin and contraceptive hormones, however. The Expert Working Group reclassified use of griseofulvin to category 1 for users of combined or progestin- only injectables and category 2 (generally use) for users of other hormonal methods. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 5. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Considering depressive disorders for the first time, the October 2003 MEC meeting concluded that there is no need for restriction on use of hormonal contraceptives for women with depression. A variety of studies have found no increase in symptoms among depressed women using combined or progestin-only oral contraceptives, DMPA injectable, or Norplant implants. A single study reported that taking fluoxetine (Prozac) for depression did not reduce the effectiveness of combined or progestin- only oral contraceptives. Conclusions cannot be reached concerning postpartum depression or bipolar disorder because current evidence is inadequate. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 2-4. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The 2003 Expert Working Group made several changes to the MEC to indicate that women often can safely use IUDs in conditions related to HIV and other sexually transmitted infections (STIs). Taken together, these changes should help reduce some providers’ concerns about offering IUDs in areas where HIV infection and other STIs are common. At the meeting the WHO Expert Working Group concluded that a woman generally can start using an IUD, if she wishes, even if she has AIDS—provided she is receiving ARV therapy and is clinically well—or if she has HIV infection or she is at high risk of HIV infection. The Expert Working Group changed these conditions from category 3 to category 2 for starting IUD use. According to the bulk of research considered at the WHO meeting, IUD use does not increase a woman’s chances of acquiring HIV infection. Women generally can keep their IUDs if they become infected with HIV or develop AIDS while using IUDs (category 2), although IUD users with AIDS should be carefully monitored for pelvic infection. Limited evidence shows that complications of IUD use are no more common among IUD users infected with HIV than among IUD users who are not infected with HIV. Also, IUD use does not increase HIV transmission to sexual partners. (excerpt)
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 1. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)The World Health Organization (WHO) has issued new family planning guidance, including the following: Most women with HIV infection generally can use IUDs; Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs; Women with clinical depression usually can take hormonal contraceptives. More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the Medical Eligibility Criteria (MEC) for Contraceptive Use. This was the third expert meeting to consider medical eligibility criteria. WHO first issued the MEC in 1996; they were first updated in 2000. (excerpt)
International Journal of Gynecology and Obstetrics. 2004 Nov; 87(2):111-113.In May 2004, the Food and Drug Administration of the United States ruled that emergency contraception would not be available over the counter. In December 2003, two FDA expert panels overwhelmingly recommended approval of the drug by a 23 to 4 vote after reviewing more than 15,000 pages of data for over 40 studies in support of the over the counter (OTC) application. The FDA typically follows the recommendations of the government scientific committees, and the experts in this case made it clear that use of emergency contraception does not increase promiscuity or unprotected sex among teenaged women. In an unusual decision written by Dr. Steven Galson, Acting Director of FDA’s Center for Drug Evaluation and Research, and not supported by other members of the FDA staff, a decision was deferred pending further information about the safety of emergency contraception in girls under the age of 16 or on the possibility raised by the manufacturer in their proposal that the drug be used over the counter for girls over the age of 16 and that there be an age limit to those who could get it without speaking to a pharmacist or without a prescription. (excerpt)
[Unpublished] 2003. Presented at the Second South African Gender Based Violence and Health Conference, Johannesburg, South Africa, May 9, 2003.  p.[Objectives of the Multi-country Study on Women’s Health and Domestic Violence Against Women include]: Obtain valid estimates of prevalence of violence against women in several countries; Document the associations between Intimate Partner Violence (IPV) and health variables; Identify risk and protective factors for domestic violence against women, and compare them within and between settings; Explore and compare the strategies used by women who experience domestic violence Develop and test new instruments for measuring violence cross-culturally; Increase national capacity amongst researchers and women’s organizations working on violence; Increase sensitivity to violence among researchers, policy-makers and health providers; Promote new ethic/model of research. (excerpt)
Network. 2003; 22(4):18.Spermicidcs containing nonoxvnol-9 (N-9) increase the risk of HIV infection when used frequently by women at high risk of infection, but they remain a moderately effective contraceptive option for women at low risk of infection, technical experts convened by the World Health Organization (WHO) and the U.S.based CONRAD Program have concluded. (excerpt)
Network. 2003; 22(4):11.For female condom users, use of a new female condom for every act of sexual intercourse continues to be recommended by the World Health Organization (WHO). Likewise, the female condom (a potential alternative for the male condom) is approved only for one-time use by the U.S. Food and Drug Administration. Such positions by public health experts reflect, in part, concerns that women may be unable to clean the device adequately to make its reuse safe. However, female condom reuse has been reported in a number of settings, likely because many women cannot afford to buy multiple female condoms. Recognition that reuse is occurring -- and may be acceptable, feasible, and safe in some circumstances -- led WHO to declare in July 2002 that "the final decision on whether or not to support reuse of the female condom must ultimately be taken locally." (excerpt)
New York, New York, IWHC, 2003. 11 p.Internationally and domestically, in our courts and in our schools, at the UN and on Capitol Hill, it is no exaggeration to say that the White House is conducting a stealth war against women. This war has devastating consequences for social and economic development, democracy, and human rights—and its effects will be felt by women and girls worldwide. (excerpt)
Perspectives in Health. 2003; 8(2):26-29.More and more, nurses in the Caribbean have been packing their bags and heading for countries with less-than-perfect climates to get better pay and more respect. Now the region is looking for ways to keep them from leaving – and even to lure those abroad back home. (author's)