Adrenoleukodystrophy (ALD) is a peroxisomal disorder affecting the nervous system, adrenal cortical function, and testicular function. Newborn screening for ALD has the potential to identify patients at high risk for life-threatening adrenal crisis and cerebral ALD. The current understanding of the natural history of endocrine dysfunction is limited. Surveillance guidelines for males with ALD were developed to address the unpredictable nature of evolving adrenal insufficiency. Early recognition and management of adrenal insufficiency can prevent adrenal crisis. While testicular dysfunction in ALD is described, the natural history and complications of low testosterone, as well as the management, are not well described.
weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).CONCLUSION: There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.
INTRODUCTION:The effect of intrauterine device (IUD) malposition on subsequent contraceptive choice is not well characterized. We aimed to evaluate contraceptive choice after removal or expulsion of IUDs identified as malpositioned or non-malpositioned on ultrasound imaging.METHODS:We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected via medical record review. Descriptive statistics were reported for contraceptive choice after removal or expulsion of malpositioned and non-malpositioned IUDs. Institutional review board (IRB) approval was obtained for this study.RESULTS:Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9 years old respectively, P=.02). Contraceptive use after IUD expulsion or removal was available for 677 participants. Of the participants who had their non-malpositioned IUDs removed or expulsed, 29.4% used no contraceptive method compared to 19.4% of participants with malpositioned IUDs. The contraceptive implant or another IUD was used by 2.7% and 22.2% of participants after removal or expulsion of a non-malpositioned IUD, whereas these methods were used by 5.2% and 25.9% of participants who initially had a malpositioned IUD.CONCLUSION:Individuals with malpositioned IUDs had higher contraceptive use and higher use of long-acting reversible contraceptive methods after IUD removal or expulsion compared to those with non-malpositioned IUDs. This difference could be due to a difference in pregnancy desires which was not captured with this study design.
weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).CONCLUSION: There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.
Postpartum women are at high risk for unintended pregnancies and subsequent adverse perinatal outcomes often due to insufficient pregnancy intervals. There is a high burden of unmet family planning need caused by factors including inadequate education on postpartum contraception, limited access to healthcare professional in the immediate postpartum period, and lack of access to contraceptive options. This chapter will discuss the different contraceptive methods that can be utilized and their respective efficacies, venous thromboembolism (VTE) risk, and impact on lactation. Tubal ligation, lactation amenorrhea, barrier methods, the copper intrauterine device (IUD), and progestin-only pills (POP) have no clinically significant impact on VTE risk or lactation for the majority of women postpartum. Depot medroxyprogesterone acetate (DMPA) injection, implants, and levonorgestrel (LNG) IUDs are considered to have no impact on breastfeeding based on limited clinical evidence. Contraceptive methods that contain estrogens may increase a woman's risk for VTE in the peri-partum period and should be deferred approximately 30 days postpartum. Sterilization and long acting reversible contraceptives (LARC), including IUDs and contraceptive arm implants, have been proven to be the most reliable and cost-effective methods, which also have high rates of patient satisfaction and continuation. Women have a range of safe contraceptive choices they can use to prevent pregnancy or to space their pregnancies. Health care systems should empower women to become educated about and gain access to postpartum contraception so as to address unintended pregnancy disparities among this group of women. Above all, counseling should be patient-centered when choosing the right method for the woman.
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