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Steinfeldt M, Lora Matos AD, Cu C, Heinrich C, Hartman C, Gibson E, Becerra Mateus JC, Al Abosy J, Abedi P, Jahanfar S. Treatments of unscheduled vaginal bleeding due to progestin-only contraception. Cochrane Database Syst Rev 2024; 9:CD015441. [PMID: 39221618 PMCID: PMC11367686 DOI: 10.1002/14651858.cd015441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness, safety, and side effects associated with the usage of different treatments for unscheduled vaginal bleeding in premenopausal women using progestin-only pills.
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Affiliation(s)
- Meredith Steinfeldt
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Alejandro D Lora Matos
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Cassandra Cu
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Christina Heinrich
- Hirsh Health Sciences Library, Tufts University, Boston, Massachusetts, USA
| | - Ciana Hartman
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Emily Gibson
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Jude Al Abosy
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- College of Medicine, University of Illinois, Chicago, USA
| | - Parvin Abedi
- Midwifery Department, Menopause Andropause Research center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shayesteh Jahanfar
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Curtis KM, Nguyen AT, Tepper NK, Zapata LB, Snyder EM, Hatfield-Timajchy K, Kortsmit K, Cohen MA, Whiteman MK. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-77. [PMID: 39106301 PMCID: PMC11340200 DOI: 10.15585/mmwr.rr7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
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Affiliation(s)
- Kathryn M. Curtis
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Antoinette T. Nguyen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kendra Hatfield-Timajchy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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3
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Olaifa BT, Okonta HI, Mpinda JB, Govender I. Reasons given by women for discontinuing the use of progestogen implants at Koster Hospital, North West province. S Afr Fam Pract (2004) 2022; 64:e1-e7. [PMID: 36331205 PMCID: PMC9724037 DOI: 10.4102/safp.v64i1.5471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND In 2014, the South African National Department of Health introduced a new addition to the long-acting reversible contraceptive (LARC) options available in the country. This was a single rod subdermal progestogen implant (Implanon®NXT) which provided 3 years of effective contraception cover. However, the new contraceptive device uptake and general acceptance amongst women quickly diminished, with a slew of requests for its removal. The aim of this study was to explore the reasons given by women for discontinuing the use of their progestogen implants at Koster Hospital, North West province, South Africa. METHODS A qualitative study was conducted using semistructured interviews. Thirteen women were purposively selected and interviewed at Koster Hospital Family Planning Unit. The transcriptions of the audio-taped interviews were analysed thematically. RESULTS The following themes emerged from the interviews as reasons the women discontinued their progestogen implants: side effects such as menstrual problems, arm discomfort and weight gain. Other themes were family or social factors and the desire to conceive. CONCLUSION The reasons for discontinuation of Implanon by women at Koster Hospital were the undesirable side effects they experienced whilst using the contraceptive device. These side effects were mainly menstrual problems, arm discomfort and weight gain. Family and other social dynamics also influenced some of the participants' decision to discontinue their contraceptive implants.
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Affiliation(s)
- Bolarinwa T Olaifa
- Department of Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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Vilk Ayalon N, Segev L, Samson AO, Yagel S, Cohen SM, Green T, Hochler H. Norethisterone Reduces Vaginal Bleeding Caused by Progesterone-Only Birth Control Pills. J Clin Med 2022; 11:3389. [PMID: 35743459 PMCID: PMC9224784 DOI: 10.3390/jcm11123389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Progesterone-only pills (POP) are widely used contraceptives. About 40% of women taking these pills report vaginal bleeding/spotting; 25% find this a reason for cessation. To date, no effective remedy has been described. We aimed to examine the therapeutic approaches offered by health providers. (2) Methods: A prospective questionnaire-based study of women experiencing vaginal bleeding due to POP, comparing the effectiveness of prescribed therapies. Women were recruited through social networks, and subsequently divided into groups according to the treatment offered: (1) POP with norethisterone (n = 36); (2) double dose POP (n = 19); (3) single dose POP (continuing initial treatment, n = 57); and (4) different POP formula (n = 8). Women rated bleeding quantity and frequency at four intervals, at weeks 0, 2, 4, and 6. (3) Results: Women who added 5 mg norethisterone acetate reported a significant decrease in bleeding frequency compared to the other groups, observed after 2, 4, and 6 weeks (p-values 0.019, 0.002, and 0.002, respectively). Women also reported an overall decrease in combined bleeding quantity and frequency (p-values 0.028, 0.003, and 0.005, respectively). There was no difference in the rate of side effects among groups. (4) Conclusions: Adding 5 mg norethisterone acetate (Primolut-nor) to progesterone-only pills significantly reduces bleeding and spotting associated with POP contraception.
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Affiliation(s)
- Naama Vilk Ayalon
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel; (N.V.A.); (S.Y.); (S.M.C.)
| | - Lior Segev
- Science and Halacha Program, General History Department, Bar-Ilan University, Ramat-Gan 5290002, Israel
- Puah Institute, Jerusalem 9547735, Israel
| | | | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel; (N.V.A.); (S.Y.); (S.M.C.)
| | - Sarah M. Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel; (N.V.A.); (S.Y.); (S.M.C.)
| | - Tamar Green
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem 9103102, Israel;
| | - Hila Hochler
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel; (N.V.A.); (S.Y.); (S.M.C.)
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5
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Friedman JC, Buyers E, Laurin J, Hampanda K, Alaniz VI. Tamoxifen for the Treatment of Etonogestrel Implant-Associated Bleeding in an Adolescent Gynecology Practice. J Pediatr Adolesc Gynecol 2022; 35:341-345. [PMID: 34780932 DOI: 10.1016/j.jpag.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe clinical outcomes in a cohort of adolescent female patients using tamoxifen for the treatment of bothersome etonogestrel (ENG) implant-associated bleeding. DESIGN Retrospective chart review SETTING: A tertiary children's hospital PARTICIPANTS: Adolescent female patients ages 12-21 seen between August 2016 and August 2019 with an ENG implant in place who received a tamoxifen prescription for the indication of implant-associated bleeding. INTERVENTIONS None MAIN OUTCOME MEASURES: Main outcome measures were implant continuation rates, average time to implant discontinuation after tamoxifen prescription, reasons for implant removal, number of doses and timing of tamoxifen use, bleeding patterns, and adverse effects. RESULTS A total of 67 patients met the inclusion criteria. The mean age of patients was 16.7 years old. Of the patients with available follow-up data, 49 out of 60 (81.7%) were still using the implant at 12 months, 29 out of 53 (54.7%) at 24 months, and 9 out of 40 (22.5%) at 36 months. The average time from tamoxifen prescription to implant removal was 12.1 months. Bothersome bleeding was the primary reason for ENG implant discontinuation (68.6%). No side effects from tamoxifen use were reported. CONCLUSION Tamoxifen was well-tolerated among this cohort of patients and can be considered a treatment option to manage bothersome implant bleeding in adolescents.
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Affiliation(s)
- Julie C Friedman
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado.
| | - Eliza Buyers
- Children's Hospital of Colorado Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
| | - Jaime Laurin
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Karen Hampanda
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado
| | - Veronica I Alaniz
- University of Colorado Department of Obstetrics and Gynecology, Aurora, Colorado; Children's Hospital of Colorado Section of Pediatric and Adolescent Gynecology, Aurora, Colorado
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6
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Abstract
Abnormal uterine bleeding (AUB) is a common diagnosis in the adolescent female population. In recent years, changes have been made to standardize nomenclature, evaluation and management of AUB in adolescents. The terms "abnormal uterine bleeding" and "heavy menstrual bleeding" have replaced terms including "dysfunctional uterine bleeding," "menorrhagia," "metrorrhagia", and "menometrorrhagia." Due to a high prevalence of these diagnoses in this population and resulting effects on quality of life, clinicians should understand and practice current evidence-based care, yet variability continues to exist. Evaluation should be focused on common etiologies of AUB in adolescents, namely non-structural causes, rather than those etiologies more common in adult females. The aim of this article is to review the existing definition, etiologies, pathophysiology, evaluation and management of AUB in adolescent females, with an emphasis on current universally accepted nomenclature and guidelines for use in clinical care.
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Affiliation(s)
- Rashi Kabra
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York, USA.
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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7
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Chodankar RR, Munro MG, Critchley HOD. Historical Perspectives and Evolution of Menstrual Terminology. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:820029. [PMID: 36303670 PMCID: PMC9580747 DOI: 10.3389/frph.2022.820029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
Abnormal uterine bleeding (AUB) in the reproductive years in non-pregnant women comprises a group of symptoms that include abnormal frequency and the irregular onset of flow as well as prolonged and heavy menstrual bleeding. It is a common, chronic, and debilitating condition affecting women worldwide with an adverse impact on their quality of life. Until the last decade, the "menstrual" terminology used to describe both normal and abnormal uterine bleeding and its underlying causes was inconsistent, creating considerable confusion. Using standardized terminology may potentially improve clinical management as well as help designing and interpreting basic, translational, epidemiological, and clinical research in women with menstrual problems. In this article, we explore the history and evolution of menstrual terminology and discuss the two International Federation of Gynecology and Obstetrics (FIGO) systems on i.e., (A) menstrual terminology and definitions (B) and the causes of AUB, achieved through international consensus of relevant stakeholders through a long multistage journey.
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Affiliation(s)
- Rohan R. Chodankar
- Department of Obstetrics and Gynaecology, NHS Lothian, Edinburgh, United Kingdom
| | - Malcolm G. Munro
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Hilary O. D. Critchley
- Medical Research Council Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
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8
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Leyland N, Estes SJ, Lessey BA, Advincula AP, Taylor HS. A Clinician's Guide to the Treatment of Endometriosis with Elagolix. J Womens Health (Larchmt) 2021; 30:569-578. [PMID: 32975461 PMCID: PMC8064963 DOI: 10.1089/jwh.2019.8096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Pain associated with endometriosis is a considerable burden for women, permeating all aspects of their lives, from their ability to perform daily activities to their quality of life. Although there are many options for endometriosis-associated pain management, they are often limited by insufficient efficacy, inconvenient routes of administration, and/or intolerable side effects. Elagolix, a nonpeptide, small-molecule gonadotropin-releasing hormone (GnRH) receptor antagonist, is the first new oral therapy to be approved for the treatment of endometriosis-associated pain in the United States in more than a decade. Modulation of estradiol with elagolix is dose dependent and ranges from partial to full suppression. Clinical evidence has shown that elagolix at both approved doses (150 mg once daily and 200 mg twice daily) is effective for reducing symptoms of pelvic pain (dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia), improving quality of life, and decreasing use of rescue analgesics (nonsteroidal anti-inflammatory drugs and/or opioids). The availability of two dosing options allows for individualization of treatment based on baseline clinical factors and response to therapy. Elagolix is well tolerated, with less pronounced hypoestrogenic effects compared with GnRH agonists. This review provides an overview of elagolix, highlighting currently available treatment options and the application of this new treatment for women with endometriosis-associated pain.
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Affiliation(s)
- Nicholas Leyland
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie J. Estes
- Department of Obstetrics and Gynecology, Penn State Health, Hershey, Pennsylvania, USA
| | - Bruce A. Lessey
- Wake Forest Health, Center for Fertility, Endocrine and Menopause, Winston-Salem, North Carolina, USA
| | - Arnold P. Advincula
- Department of Obstetrics and Gynecology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Hugh S. Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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9
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Critchley HOD, Maybin JA, Armstrong GM, Williams ARW. Physiology of the Endometrium and Regulation of Menstruation. Physiol Rev 2020; 100:1149-1179. [DOI: 10.1152/physrev.00031.2019] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The physiological functions of the uterine endometrium (uterine lining) are preparation for implantation, maintenance of pregnancy if implantation occurs, and menstruation in the absence of pregnancy. The endometrium thus plays a pivotal role in reproduction and continuation of our species. Menstruation is a steroid-regulated event, and there are alternatives for a progesterone-primed endometrium, i.e., pregnancy or menstruation. Progesterone withdrawal is the trigger for menstruation. The menstruating endometrium is a physiological example of an injured or “wounded” surface that is required to rapidly repair each month. The physiological events of menstruation and endometrial repair provide an accessible in vivo human model of inflammation and tissue repair. Progress in our understanding of endometrial pathophysiology has been facilitated by modern cellular and molecular discovery tools, along with animal models of simulated menses. Abnormal uterine bleeding (AUB), including heavy menstrual bleeding (HMB), imposes a massive burden on society, affecting one in four women of reproductive age. Understanding structural and nonstructural causes underpinning AUB is essential to optimize and provide precision in patient management. This is facilitated by careful classification of causes of bleeding. We highlight the crucial need for understanding mechanisms underpinning menstruation and its aberrations. The endometrium is a prime target tissue for selective progesterone receptor modulators (SPRMs). This class of compounds has therapeutic potential for the clinical unmet need of HMB. SPRMs reduce menstrual bleeding by mechanisms still largely unknown. Human menstruation remains a taboo topic, and many questions concerning endometrial physiology that pertain to menstrual bleeding are yet to be answered.
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Affiliation(s)
- Hilary O. D. Critchley
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Jacqueline A. Maybin
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Gregory M. Armstrong
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Alistair R. W. Williams
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, United Kingdom
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10
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Cohen MA, Simmons KB, Edelman AB, Jensen JT. Tamoxifen for the prevention of unscheduled bleeding in new users of the levonorgestrel 52-mg intrauterine system: a randomized controlled trial. Contraception 2019; 100:391-396. [PMID: 31226322 PMCID: PMC6875606 DOI: 10.1016/j.contraception.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if a course of oral tamoxifen initiated following placement of a levonorgestrel 52-mg intrauterine system (IUS) reduces bleeding/spotting days over 30 days. STUDY DESIGN In this single-center, double-blind, placebo-controlled trial, we recruited women ages 15-45 years initiating the levonorgestrel 52-mg IUS. We randomized eligible women to tamoxifen 10 mg or placebo twice daily for 7 days starting 21 days after levonorgestrel 52-mg IUS insertion. Participants tracked bleeding/spotting days via daily electronic diaries for 30 days after starting drug treatment. We assessed participant satisfaction with their bleeding pattern and the IUS using a visual analog scale (0-100 mm). A sample size of 42 provided 80% power to detect a difference of 7 bleeding/spotting days in 30 days by two-sample t test, accounting for an expected 20% dropout rate. RESULTS From September 2016 to January 2018, 42 women enrolled. A total of 34 women provided complete bleeding/spotting data, and 30 women provided satisfaction data. Mean bleeding/spotting days over 30 days did not differ between tamoxifen (12.0±5.8 days) and placebo users (16.8±9.0 days), p=.08. We found no significant differences in mean satisfaction with bleeding profiles (51 mm tamoxifen vs. 59 mm placebo, p=.48) or with the IUS (83 mm vs. 75 mm, p=.36) between groups. Both groups reported similar rates of adverse events, with no serious adverse events reported. CONCLUSION A course of oral tamoxifen did not improve early breakthrough bleeding or satisfaction in new users of the levonorgestrel 52-mg IUS. IMPLICATIONS Although tamoxifen treatment caused a trend toward modest bleeding/spotting day reduction in new levonorgestrel 52-mg IUS users, bleeding satisfaction did not improve. Future studies of tamoxifen treatment for IUS-related bleeding issues may be best targeted toward users with ongoing bleeding irregularities or lower-dose IUS products which cause more bleeding irregularities.
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Affiliation(s)
- Megan A Cohen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239.
| | - Katharine B Simmons
- The Permanente Medical Group, Department of Obstetrics & Gynecology, 2500 Merced Street, San Leandro, CA 94577
| | - Alison B Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239
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11
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Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF). J Gynecol Obstet Hum Reprod 2019; 48:441-454. [PMID: 31051299 DOI: 10.1016/j.jogoh.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
Abstract
The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.
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12
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Chabbert-Buffet N, Marret H, Agostini A, Cardinale C, Hamdaoui N, Hassoun D, Jonville-Bera AP, Lambert M, Linet T, Pienkowski C, Plu-Bureau G, Pragout D, Robin G, Rousset-Jablonski C, Scheffler M, Vidal F, Vigoureux S, Hédon B. [Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]. ACTA ACUST UNITED AC 2018; 46:760-776. [PMID: 30416023 DOI: 10.1016/j.gofs.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 12/26/2022]
Abstract
The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.
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Affiliation(s)
- N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpitaux universitaires Est parisien, hôpital Tenon, Assistance publique des hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; UMRS_938, Inserm Sorbonne université, 75012 Paris, France.
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, centre hospitalier universitaire de Bretonneau, pôle de gynécologie-obstétrique, 2, boulevard Tonnellé, 37044 Tours cedex 1, France
| | - A Agostini
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - C Cardinale
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - N Hamdaoui
- Service de gynécologie-obstétrique, hôpital de la Conception, boulevard Baille, 13005 Marseille, France
| | - D Hassoun
- 38, rue Turenne, 75003 Paris, France
| | - A P Jonville-Bera
- Centre régional de pharmacovigilance, centre Val-de-Loire, CHRU de Tours, 37044 Tours cedex, France
| | - M Lambert
- Service de gynécologie et de médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - T Linet
- Service de gynécologie-obstétrique, centre hospitalier de Loire-Vendée-Océan, 85302 Challans, France
| | - C Pienkowski
- Unité d'endocrinologie et de gynécologie médicale, TSA 70034, centre de référence de pathologies gynécologiques rares (PGR Toulouse), hôpital des Enfants, CHU de Toulouse, 31000 Toulouse, France
| | - G Plu-Bureau
- Unité de gynécologie endocrinienne, hôpital Port-Royal, 53, avenue de l'Observatoire, 75679 Paris, France; Université Paris Descartes, 75005 Paris, France; Inserm UMR 1153, Obstetrical, perinatal and paediatric epidemiology research team (Épopé), Centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), 75005 Paris, France
| | - D Pragout
- Unité d'orthogénie, service de gynécologie-obstétrique, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - G Robin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, centre hospitalier universitaire de Lille, hôpital Jeanne de Flandre, 59000 Lille, France; EA 4308, gamétogenèse et qualité du gamète, centre hospitalier universitaire de Lille, 59000 Lille, France
| | - C Rousset-Jablonski
- Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France; Centre hospitalier de Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - M Scheffler
- Service de gynécologie, CHU, 10, rue du Dr-Heydenreich, 54000 Nancy, France
| | - F Vidal
- CHU de Purpan, hôpital Paule-de-Viguier, pôle femme-mère-couple, 330, avenue Grande-Bretagne, 31059 Toulouse, France
| | - S Vigoureux
- Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique des Hôpitaux de Paris (AP-HP), 94276 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94276 Le Kremlin-Bicêtre, France; U1018, Inserm, reproduction and child development, Centre for research in epidemiology and population health (CESP), 94805 Villejuif, France
| | - B Hédon
- Département de gynécologie-obstétrique, faculté de médecine université de Montpellier (France), centre hospitalier universitaire Arnaud-de-Villeneuve, 34000 Montpellier, France
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Bleeding Associated with Hormonal Contraceptives: Understanding and Managing a Common Problem. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Unscheduled Bleeding on Hormonal Contraceptives: Pathophysiology, Evaluation, and Management Options. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Healthy sexual development is important for adolescents with and without disabilities, yet the topic of sexuality is often ignored in the disabled population. Adolescents with mild or moderate degrees of disability have rates of sexual activity and reproductive health needs comparable to their typically developing peers. Their need for support, risk reduction, and education in sexual health may exceed that of their peers. The medical provider may support healthy sexual development through education, anticipatory guidance, menstrual and contraceptive management, and by expanding the notion of sexuality to include a broader conceptualization of sexual behavior and expression.
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Affiliation(s)
- Cynthia Holland-Hall
- Section of Adolescent Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Elisabeth H Quint
- Obstetrics and Gynecology, University of Michigan Medical School, 1500 East Medical Center Drive, Women's L 4000, Ann Arbor, MI 48109, USA
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Jain V, Wotring VE. Medically induced amenorrhea in female astronauts. NPJ Microgravity 2016; 2:16008. [PMID: 28725726 PMCID: PMC5516549 DOI: 10.1038/npjmgrav.2016.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 12/28/2022] Open
Abstract
Medically induced amenorrhea can be achieved through alterations in the normal regulatory hormones via the adoption of a therapeutic agent, which prevents menstrual flow. Spaceflight-related advantages for medically induced amenorrhea differ according to the time point in the astronaut's training schedule. Pregnancy is contraindicated for many pre-flight training activities as well as spaceflight, therefore effective contraception is essential. In addition, the practicalities of menstruating during pre-flight training or spaceflight can be challenging. During long-duration missions, female astronauts have often continuously taken the combined oral contraceptive pill to induce amenorrhea. Long-acting reversible contraceptives (LARCs) are safe and reliable methods used to medically induce amenorrhea terrestrially but as of yet, not extensively used by female astronauts. If LARCs were used, daily compliance with an oral pill is not required and no upmass or trash would need disposal. Military studies have shown that high proportions of female personnel desire amenorrhea during deployment; better education has been recommended at recruitment to improve uptake and autonomous decision-making. Astronauts are exposed to similar austere conditions as military personnel and parallels can be drawn with these results. Offering female astronauts up-to-date, evidence-based, comprehensive education, in view of the environment in which they work, would empower them to make informed decisions regarding menstrual suppression while respecting their autonomy.
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Affiliation(s)
- Varsha Jain
- National Institute for Health Research, London, UK
- King's College London, London, UK
- Queen Mary's University, London, UK
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Virginia E Wotring
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine, Houston, TX, USA
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17
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