ObjectiveWe assess change in bleeding, cramping, and IUD satisfaction among new copper (Cu) IUD users during the first six months of use, and evaluate the impact of bleeding and cramping on method satisfaction.MethodsWe recruited 77 women ages 18–45 for this prospective longitudinal observational cohort study. Eligible women reported regular menses, had no exposure to hormonal contraception in the last three months, and desired a Cu IUD for contraception. We collected data prospectively for 180 days following IUD insertion. Monthly, participants reported bleeding scores using the validated pictorial blood loss assessment chart (PBAC), IUD satisfaction using a five-point Likert scale, and cramping using a six-level ordinal scale. We used multiple imputation to address nonrandom attrition. Structural equation models for count and ordered outcomes were used to model bleeding, cramping, and IUD satisfaction growth curves over the six monthly repeated assessments.ResultsBleeding significantly decreased (approximately 23%) over the course of the study from an estimated PBAC = 195 at one month post-insertion to PBAC = 151 at six months (t = -2.38, p<0.05). Additionally, IUD satisfaction improved over time (t = 2.65, p<0.01), increasing from between “Neutral” and “Satisfied” to “Satisfied” over the six month study. Cramping decreased notably over the six month study from between biweekly and weekly, to once or twice a month (t = -4.38, p<0.001). Finally, bleeding, but not cramping, was associated with IUD satisfaction across the study (t = -2.31, p<0.05) and at study end (t = -2.81, p<0.01).ConclusionsNew Cu IUD users reported decreasing bleeding and cramping, and increasing IUD satisfaction, over the first six months. Method satisfaction was negatively associated with bleeding.
Purpose of reviewMyths and misconceptions about family planning are pervasive around the world and can adversely affect both initiation and continuation of family planning services. Here, we review the current literature and identify major themes among them to better understand these myths and misconceptions. Recent findingsMyths and misconceptions regarding family planning are a global phenomenon with the most recent studies focused on sub-Saharan Africa and West Africa. The belief that family planning negatively impacts future fertility was mentioned in all studies reviewed. Other major themes include misconceptions about the adverse effects, complications, mechanisms of action, and reproductive health. SummaryMyths and misconceptions regarding family planning are widespread. Current literature suggests that there is a globally prevalent belief that family planning negatively impacts future fertility. Misconceptions related to adverse effects and mechanism of action were also identified. There is overall poor knowledge of sexual and reproductive health in the populations studied. Recent studies focus primarily on sub-Saharan Africa and West Africa. These findings and lessons learned may be helpful in customizing contraceptive counseling and increasing both global access to family planning and satisfied clients.
Purpose of review In the past few years, there have been great advances in contraceptive technology and development. Here we review advances in contraception over the past two years including new medications, and technologies. Recent findings Contraception must be discussed within the context of individual goals and context. New contraceptive options approved by the FDA in the past two years include a year-long vaginal ring, a progestin-only pill that is as effective as combined oral contraceptive pills, a new hormonal patch and a vaginal gel that may also help prevent sexually transmitted infections. There are still areas of contraceptive research that are very much unknown including biomarkers of contraceptive efficacy or side effects, how individuals or groups metabolize contraception, initiation around reproductive life events or the discontinuation of other methods. Summary There have been many new contraceptives developed over the past few years to address challenges of existing contraception and create new methods; yet, there remain many unanswered questions in contraceptive research. Contraceptive technology has far-reaching consequences, and independent of technology itself, represents a great opportunity for truly personalized medicine.
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The prevalence of obesity among females of reproductive age is increasing globally. Access to the complete range of appropriate contraceptive options is essential for upholding the reproductive rights of this population group. People with obesity can experience stigma and discrimination when seeking healthcare, and despite limited evidence for provider bias in the context of contraception, awareness for its potential at an individual provider and health systems level is essential. While use of some hormonal contraceptives may be restricted due to increased health risks in people with obesity, some methods provide noncontraceptive benefits including a reduced risk of endometrial cancer and a reduction in heavy menstrual bleeding which are more prevalent among individuals with obesity. In addition to examining systems-based approaches which facilitate the provision of inclusive contraceptive care, including long-acting reversible contraceptives which require procedural considerations, this article reviews current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy.
INTRODUCTION: To explore the frequency of preconception and contraceptive counseling and LARC use in type I diabetic women. METHODS: This retrospective cohort study identified women (16-49 years-old) with an ICD-9/ICD-10 code for type I diabetes and documented A1C level in a tertiary referral center between 1/1/2010-10/30/2017. We abstracted preconception or contraceptive counseling and LARC documentation within 1 year pre- and post-highest A1C. We identified provider type: primary care (PCP), endocrinology, obstetrics/gynecology (OB/GYN), and maternal fetal medicine (MFM). We defined advanced disease by micro- or macro-vascular complications or disease >20 years. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for age and race. RESULTS: We included 541 women. Median age was 30.7 (range 17-49), A1C was 9.1% (5%-20%), and median 4 visits (range 1-38) during the two-year span. Only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. MFMs most frequently documented preconception counseling (16%, P=0.01), while OB/GYNs most frequently documented contraceptive counseling (73%, P<0.01). LARC documentation was higher in MFM (26%) and OB/GYN (27%) visits compared to endocrinology (10%) and PCP (11%) visits (all P<0.01). Advanced disease resulted in less preconception counseling (3%, P=0.05), yet similar contraceptive counseling frequency and LARC use compared to non-advanced disease. Contraceptive counseling was highly associated with LARC use (aOR 9.87, 95% CI 5.09-19.12). CONCLUSION: Reproductive age type I diabetic women have high healthcare utilization, yet documentation of preconception and contraceptive counseling is sparse. Educating non-OB/GYN providers could avoid missed opportunities to improve pregnancy planning and outcomes.
Although most abortion care takes place in the office setting, anesthesiologists are often asked to provide anesthesia for the 1% of abortions that take place later, in the second trimester. Changes in federal and state regulations surrounding abortion services may result in an increase in second-trimester abortions due to barriers to accessing care. The need for interstate travel will reduce access and delay care for everyone, given limited appointment capacity in states that continue to support bodily autonomy. Therefore, anesthesiologists may be increasingly involved in care for these patients. There are multiple, unique anesthetic considerations to provide safe and compassionate care to patients undergoing second-trimester abortion. First, a multiday cervical preparation involving cervical osmotic dilators and pharmacologic agents results in a time-sensitive, nonelective procedure, which should not be delayed or canceled due to risk of fetal expulsion in the preoperative area. In addition, a growing body of literature suggests that the older anesthesia dogma that all pregnant patients require rapid-sequence induction and an endotracheal tube can be abandoned, and that deep sedation without intubation is safe and often preferable for this patient population through 24 weeks of gestation. Finally, concomitant substance use disorders, preoperative pain from cervical preparation, and intraoperative management of uterine atony in a uterus that does not yet have mature oxytocin receptors require additional consideration.
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