Objective To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing (CuT380A) intrauterine devices (IUD), as compared with those using depot medroxyprogesterone acetate (DMPA) or sterilization for birth control. Methods Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18–44 with a prior diagnosis of bipolar disorder (n = 849), who were using the levonorgestrel intrauterine system, CuT380A, DMPA, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression. Results Women using an IUD were more likely than those using DMPA to continue the method for at least 12 months (CuT380A, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated DMPA received three more injections during the following year (p<0.0001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups. Conclusions More women with bipolar disorder continued using IUDs at one year than women using DMPA. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, DMPA, or sterilization.

INTRODUCTION:The transgender and gender-nonconforming community long has been marginalized in society. As transgender individuals become more visible, obstetrician-gynecologists should direct educational initiatives to enhancing clinical templates that ensure inclusive, competent, and sensitive health services for this population, incorporating partner, culture, and community implications. Gender-unbiased health services are necessary to eliminate real and perceived barriers to care. METHODS: A review of literature on transgender medicine on PubMed over the past 5 years was conducted.RESULTS: There is scant research on transgender patients in obstetric and gynecologic health care settings, especially outside of hormonal and surgical transition. There are few studies on barriers to quality transgender health care, fewer quantitative studies on transgender patients' experiences in health care settings, and still fewer studies dealing with cultural and interpersonal practices that can help improve experiences for the patient and health care team. One non-peer-reviewed survey reports that 24% of transgender respondents were denied equal treatment in doctor's offices or hospitals, 19% were refused treatment owing to their gender identity, 28% were verbally harassed and 2% physically attacked in a medical setting, and 28% postponed or avoided necessary medical care owing to discrimination. A "gender-equal" gynecologic template of care will be presented. CONCLUSION/IMPLICATIONS: More quantitative and qualitative studies should be performed assessing the needs of the transgender and gender-nonconforming community in obstetric and gynecologic practice. Existing statistics indicate that unacceptable bias and discrimination are occurring, making transgender patients less likely to seek care. Care templates on gender-equal patient encounters should be implemented to better address global and specific health needs in this population in a nonbiased manner.INTRODUCTION: Increased operative time has been shown to increase the risk of postoperative venous thromboembolism (VTE) in women undergoing hysterectomy for malignancy. The purpose of this study is to determine whether increased operative time increases the risk of VTE after hysterectomy or myomectomy performed for benign indications. METHODS: Electronic medical records were reviewed for women who underwent hysterectomy or myomectomy for benign indications at the University of Illinois hospital between January 1, 2009, and December 31, 2013. The case group was comprised of women diagnosed with VTE within 42 days of surgery. Women who underwent the same procedures during the same time period but did not develop VTE made up the control group. Student t-tests and odds ratios with 95% confidence intervals were calculated to determine the risk of VTE based on operative time.RESULTS: There were 16 women in the case group and 64 in the control group. All women had received intraoperative mechanical thromboprophylaxis. The mean age of those in the case and control groups was 41.4 ye...

Objective Determine the risk of late gastrointestinal (GI) and bladder toxicities in women treated for Stage I uterine cancer with postoperative beam, implant, or combination radiation. Methods The Surveillance, Epidemiology, and End Results (SEER) tumor registry and Medicare claims were used to estimate the risk of developing late GI and bladder toxicities by type of radiation received. Bladder and GI diagnoses were identified 6–60 months after cancer diagnosis. Cox-proportional hazard models were used to estimate risk of any late GI or bladder toxicity due to type of radiation received. Results A total of 3,024 women with uterine cancer diagnosed from 1992–2005 were identified for analysis with a mean age of 73.9 (Standard Deviation (SD) ± 6.5). Bladder and GI toxicities occurred most frequently in the combination group, and least in the implant group. After controlling for demographic characteristics, tumor grade, diagnosis year, SEER region, comorbidities, prior GI and bladder diagnosis, and chemotherapy, women receiving implant radiation had a 21% absolute decrease in GI toxicities compared to women receiving combination radiation (Hazard Ratio (HR) 0.79, 95% confidence interval (CI) 0.68–0.92). No differences were observed between those receiving beam and combination in GI (HR 1.01 (0.89–1.14)) and bladder (HR 0.95 (0.80–1.11)) toxicities. Conclusions Older women receiving combined radiation had the highest rates of GI and bladder toxicities, while women receiving implant radiation alone had the lowest rates. When selecting type of radiation for a patient, these toxicities should be considered. Counseling older women surviving cancer on late toxicities due to radiation must be a priority for physicians caring for them.

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