Association of body mass index with removal of etonogestrel subdermal implant

Casey, Petra M.; Long, Margaret E.; Marnach, Mary L.; Fleming-Harvey, J.; Drozdowicz, Linda B.; Weaver, Amy L.

doi:10.1016/j.contraception.2012.08.001

Cited by 19 publications

(29 citation statements)

References 11 publications

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“…Most pertained to a specific contraceptive method (implants: 20, IUDs: 12, combined OCPs: 10, progestin-only and combined injectables: 4, vaginal ring: 2), while 13 addressed multiple methods and 10 were not method-specific. While bleeding changes may have been inconsistently defined (by researchers and study participants) across studies, spotting, unpredictable, frequent or irregular bleeding were defined as negative side effects in 42 studies [ 43 , 48 – 50 , 52 – 54 , 72 , 75 , 77 , 78 , 81 , 82 , 84 , 86 , 88 – 92 , 94 , 97 , 98 , 100 , 102 , 105 , 106 , 108 – 111 , 116 – 119 , 122 , 123 , 127 – 129 , 132 ], 22 studies noted that heavy or prolonged bleeding were poorly tolerated [ 49 , 53 , 54 , 77 , 83 , 84 , 91 , 92 , 98 , 101 , 103 , 104 , 106 , 110 , 111 , 113 – 115 , 123 , 129 , 131 ], and 22 studies found contraceptive-induced amenorrhea to be problematic [ 44 , 48 – 50 , 76 , 78 , 79 , 84 , 86 , 90 , …”

Section: Resultsmentioning

confidence: 99%

“…Sixty studies [ 44 , 47 , 48 , 50 , 52 , 54 , 72 , 75 – 81 , 83 – 91 , 93 – 103 , 105 , 107 – 123 , 125 – 131 ] reported at least one subject discontinuing or switching a contraceptive method specifically due to bleeding changes, and 40 measured the proportion of subjects doing so [ 48 , 54 , 72 , 75 – 81 , 83 – 86 , 88 , 89 , 91 , 93 – 96 , 98 , 100 – 102 , 105 , 107 – 110 , 112 – 115 , 121 , 123 , 125 – 128 , 130 ]. Several included studies (40) found that CIMBCs were either the leading cause or among the top reasons for discontinuation [ 44 , 48 , 52 , 54 , 75 – 79 , 83 – 87 , 89 , 91 , 94 – 100 , 102 , 105 , 107 , 108 , 110 , 112 , 113 , 115 , 121 – …”

Section: Resultsmentioning

confidence: 99%

“…Several included studies (40) found that CIMBCs were either the leading cause or among the top reasons for discontinuation [ 44 , 48 , 52 , 54 , 75 – 79 , 83 – 87 , 89 , 91 , 94 – 100 , 102 , 105 , 107 , 108 , 110 , 112 , 113 , 115 , 121 – 123 , 125 – 129 , 131 ]. Three studies reported that between 0 and 10% of discontinuers did so due to CIMBCs [ 81 , 112 , 114 ], 9 reported 11–25% [ 48 , 54 , 88 , 94 , 108 – 110 , 128 , 130 ], 13 reported 26–50% [ 75 , 77 , 78 , 80 , 84 , 89 , 101 , 102 , 105 , 109 , 115 , 121 , 129 ] and 15 reported over 50% [ 54 , 76 , 79 , 83 – 86 , 95 , 96 , 98 , 100 , 121 , 123 , 125 , 126 ]. Detailed information on studies assessing discontinuation according to specific contraceptive method is available in Additional file…”

Section: Resultsmentioning

confidence: 99%

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There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes

2018

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IntroductionConcern about side effects and health issues are common reasons for contraceptive non-use or discontinuation. Contraceptive-induced menstrual bleeding changes (CIMBCs) are linked to these concerns. Research on women’s responses to CIMBCs has not been mapped or summarized in a systematic scoping review.MethodsWe conducted a systematic scoping review of data on women’s responses to CIMBCs in peer-reviewed, English-language publications in the last 15 years. Investigator dyads abstracted information from relevant studies on pre-specified and emergent themes using a standardized form. We held an expert consultation to obtain critical input. We provide recommendations for researchers, contraceptive counselors, and product developers.ResultsWe identified 100 relevant studies. All world regions were represented (except Antarctica), including Africa (11%), the Americas (32%), Asia (7%), Europe (20%), and Oceania (6%). We summarize findings pertinent to five thematic areas: women’s responses to contraceptive-induced non-standard bleeding patterns; CIMBCs influence on non-use, dissatisfaction or discontinuation; conceptual linkages between CIMBCs and health; women’s responses to menstrual suppression; and other emergent themes. Women’s preferences for non-monthly bleeding patterns ranged widely, though amenorrhea appears most acceptable in the Americas and Europe. Multiple studies reported CIMBCs as top reasons for contraceptive dissatisfaction and discontinuation; others suggested disruption of regular bleeding patterns was associated with non-use. CIMBCs in some contexts were perceived as linked with a wide range of health concerns; e.g., some women perceived amenorrhea to cause a buildup of “dirty” or “blocked” blood, in turn perceived as causing blood clots, fibroids, emotional disturbances, weight gain, infertility, or death. Multiple studies addressed how CIMBCs (or menstruation) impacted daily activities, including participation in domestic, work, school, sports, or religious life; sexual or emotional relationships; and other domains.ConclusionsSubstantial variability exists around how women respond to CIMBCs; these responses are shaped by individual and social influences. Despite variation in responses across contexts and sub-populations, CIMBCs can impact multiple aspects of women’s lives. Women’s responses to CIMBCs should be recognized as a key issue in contraceptive research, counseling, and product development, but may be underappreciated, despite likely – and potentially substantial – impacts on contraceptive discontinuation and unmet need for modern contraception.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0561-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes

2018

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“…36 Removal rate for bleeding is lower in women with a BMI > 30 kg/m 2 as compared to those with a lower BMI. 37 Reported management strategies for unacceptable bleeding with ESI include doxycycline, mefenamic acid, and CHC, though lack of clarity persists regarding the relative efficacy of each intervention. [38][39][40] Non-LARC hormonal contraception Developments in CHC have offered women more choices than ever while maintaining contraceptive efficacy.…”

Section: Larcmentioning

confidence: 99%

Contraception and Hormonal Management in the Perimenopause

Long

Faubion

MacLaughlin

et al. 2015

Journal of Women's Health

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This literature review focuses on contraception in perimenopausal women. As women age, their fecundity decreases but does not disappear until menopause. After age 40, 75% of pregnancies are unplanned and may result in profound physical and emotional impact. Clinical evaluation must be relied on to diagnose menopause, since hormonal levels fluctuate widely. Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is 55%. Older gravidas experience higher rates of diabetes, hypertension, and death. Many safe and effective contraceptive options are available to perimenopausal women. In addition to preventing an unplanned and higher-risk pregnancy, perimenopausal contraception may improve abnormal uterine bleeding, hot flashes, and menstrual migraines. Long-acting reversible contraceptives, including the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant (ESI), and the copper intrauterine device (Cu-IUD), provide high efficacy without estrogen. LNG-IUS markedly decreases menorrhagia commonly seen in perimenopause. Both ESI and LNG-IUS provide endometrial protection for women using estrogen for vasomotor symptoms. Women without cardiovascular risk factors can safely use combined hormonal contraception. The CDC's Medical Eligibility Criteria for Contraceptive Use informs choices for women with comorbidities. No medical contraindications exist for levonorgestrel emergency-contraceptive pills, though obesity does decrease efficacy. In contrast, the Cu-IUD provides reliable emergency and ongoing contraception regardless of body mass index (BMI).

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“…In this study, we observed a baseline BMI significantly lower in patients with an unfavourable bleeding profile. According to these data, Casey et al [20] demonstrated that obese women were 2.6 times less likely to have implant removal for bleeding as compared with normal weight women after adjusting for age and parity. It could be hypothesised that the effect of higher endogenous oestrogen levels in women with higher BMI stabilizes the endometrium.…”

Section: Discussionmentioning

confidence: 95%