The levonorgestrel intrauterine system in nulliparous women

Risk of unintended pregnancy among women with systemic lupus erythematosus

OBJECTIVE

It is recommended that women with systemic lupus erythematosus carefully time their pregnancies, but little is known about use of contraception and risk of unintended pregnancy in this population. The goal of this study was to estimate the proportion of women with lupus at risk for unintended pregnancy.

METHODS

We surveyed 309 women with lupus, ages 18-50 years, seen at the University of Pittsburgh lupus center between January and May 2007.

RESULTS

Of the women surveyed, 212 (69%) completed the survey. In the past 3 months, 97 (46% of 212) had faced some risk of unintended pregnancy. Of these, 53 (55% of 97) reported >or=1 occasion on which they had unprotected sex and 22 (23% of 97) reported that in the last 3 months they had unprotected sex "most of the time." No women reported having used emergency contraception after unprotected sex. A desire to "discuss birth control with a health care provider at the lupus center" was reported by 22 (10% of 212) respondents and 16 (17% of 94) women <or=35 years old.

CONCLUSION

Many women cared for by our lupus center are at risk of unintended pregnancy and are interested in discussing birth control with a health care provider.

Family planning and life planning reproductive intentions among individuals seeking reproductive health care

BACKGROUND

Little research has focused on men and women's reproductive intentions before pregnancy and their perceived personal and social motivations to prevent an unintended pregnancy.

METHODS

To assess the reproductive intentions of low-income men and women in California, we asked individuals seeking reproductive health services about their plans for childbearing, including an ideal timeframe and perceived advantages of delay. We also asked about their health care visit to examine how contraceptive use and services relate to reproductive intentions.

RESULTS

The majority (77%) of the 1,409 reproductive health clients surveyed wanted to have a/another child, but hoped to delay childbearing by an average of 5.4 years. The most common reasons for wanting to delay pregnancy were related to finances (24%) or education (19%), with differences by race/ethnicity and gender. We did not observe a clear relationship between the length of time the client wanted to delay pregnancy and the type of contraceptive method dispensed during the clinic visit.

CONCLUSIONS

Individuals seeking reproductive health care perceive many personal benefits to planning and timing their pregnancies, and most will need many years of contraceptive protection to achieve their reproductive goals. Providers should work with their patients to ensure that they receive a contraceptive method that is consistent with the length of pregnancy prevention they desire.

Review of the safety, efficacy and patient acceptability of the levonorgestrel-releasing intrauterine system

The levonorgestrel-containing intrauterine system is an extremely effective, reversible and safe form of long-term yet reversible birth control. In view of its efficacy, it is a safer alternative to permanent contraceptive methods such as sterilization. It is especially useful in situations where use of estrogen-containing contraceptives is contraindicated. While menstrual disturbances are a common side effect, proper counseling improves compliance. In addition to its contraceptive effect, the levonorgestrel intrauterine system offers potential therapeutic benefits in other clinical contexts, including menorrhagia, symptomatic fibroids, endometriosis, and endometrial protection.