Advances in Female Hormonal Contraception

"It Makes You Rethink Your Choice of the Pill": Theory-Based Formative Research to Design a Contraceptive Choice Campaign

Half of all pregnancies in the United States remain unplanned despite improved access to highly effective long-acting reversible contraception, including the intrauterine device and the implant. This study conducted theory-based formative research to develop a contraceptive choice campaign aimed at increasing long-acting reversible contraception uptake by women ages 18-44 years in Charleston, South Carolina, an urban area in the southeastern United States. Researchers developed and tested message concepts and designs. Six focus groups and 18 interviews were conducted among reproductive-age women (n = 79). Qualitative data analysis revealed messages and designs that resonated with these women. Emphasizing long-acting reversible contraception as the healthy option, highlighting long-acting reversible contraception effectiveness, including relatable and trustworthy characters, and using language of control emerged as themes. Women reported a preference for statistics illustrating effectiveness combined with empowering messages of control over contraceptive decision making. Findings from this study offer practical recommendations for developing contraceptive choice campaigns targeting long-acting reversible contraception use and further the goal of reducing unintended pregnancy among women.

Fifty years on "the pill": a qualitative analysis of nondaily contraceptive options

BACKGROUND

Despite widespread use of "the pill," half of all pregnancies in the United States remain unplanned. Although nondaily contraceptive options offer a safe, effective alternative to oral contraception, these methods are not widely used.

STUDY DESIGN

A total of 18 women aged 18-23 years completed in-depth interviews. Data analysis included a grounded theory approach and constant-comparative method using open and axial coding to reduce the data and identify themes across the data.

RESULTS

Social norms, health uncertainty and limited knowledge emerged as barriers to use of nondaily contraceptive options. Participants understood birth control as "the pill," and nondaily options were perceived as new and untested. Participants reported a lack of knowledge about the differences between methods and the effectiveness of nondaily options.

CONCLUSIONS

These findings offer practical suggestions to health communication campaign planners and health care providers to increase uptake of nondaily contraceptive options to improve method satisfaction and reduce unplanned pregnancies among young women.

Hereditary breast and ovarian cancer (HBOC): clinical features and counseling for BRCA1 and BRCA2, Lynch syndrome, Cowden syndrome, and Li-Fraumeni syndrome

This article provides an overview of the molecular changes associated with inherited gynecologic malignancies and the incorporation of this information in the counseling of individuals at increased risk for developing malignancies, as well as conventional and emerging approaches to the screening of the general population. Cancer genetic counseling and its role in women's health care is examined. The focus is hereditary breast and ovarian cancer; however, cancer predisposition caused by genes other than BRCA1 and BRCA2 is also considered. The aim is to provide a foundation for counseling based on fundamental knowledge of the genes and their clinical consequences. The reader is then guided through the mechanics of risk assessment for individual patients, concluding with the psychosocial implications of counseling.

Long-term progestin-only contraceptives result in reduced endometrial blood flow and oxidative stress

CONTEXT

Because of their safety and efficacy, long-term progestin-only contraceptives (LTPOCs) are well-suited for women with restricted access to health care. However, abnormal uterine bleeding (AUB) causes half of all users to discontinue therapy within 12 months. Endometria of LTPOC-treated patients display aberrant angiogenesis with abnormally enlarged, thin-walled, fragile blood vessels, inflammation, and focal hemorrhage. In this study, similar effects were observed with a new third-generation implantable LTPOC.

OBJECTIVE

We hypothesized that LTPOC reduces uterine and endometrial blood flow, leading to hypoxia/reperfusion, which triggers the generation of reactive oxygen species. The latter induce aberrant angiogenesis, causing AUB.

DESIGN

Endometrial perfusion was measured by laser-Doppler fluxmetry in women requesting LTPOCs. Endometrial biopsies were obtained for in vivo and in vitro experiments.

SETTING

The study was conducted in the Yale University School of Medicine and Family-Planning Center in Western Australia.

PATIENTS

Seven women 18 yr or older requesting implantable LTPOCs were recruited in Western Australia.

INTERVENTION

Women received etonorgestrel implants.

MAIN OUTCOME

LTPOC treatment resulted in reduced endometrial perfusion and increased endometrial oxidative damage.

CONCLUSIONS

We propose that LTPOCs result in hypoxia reperfusion, which leads to aberrant angiogenesis resulting in AUB.