Comparing options for women seeking permanent contraception in high-resource countries: a protocol for a systematic review

Background Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle–Ottawa Scale to assess risk of bias and excluded studies with medium–high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. Results Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium–high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. Conclusions Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. Systematic review registration PROSPERO [CRD42016038254].

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“…We pre-specified and previously published [26] objectives and analyses in a protocol registered on PROSPERO (CRD42016038254).…”

Section: Protocol Registrationmentioning

confidence: 99%

“…We defined all data items, including definitions of the variables sought, in detail in our protocol [26].…”

Section: Data Itemsmentioning

confidence: 99%

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

et al. 2021

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“…We pre-speci ed and previously published 18 objectives and analyses in a protocol registered on PROSPERO (CRD42016038254).…”

Section: Protocol Registrationmentioning

confidence: 99%

“…We de ned all data items, including de nitions of the variables sought, in detail in our protocol. 18…”

Section: Data Itemsmentioning

confidence: 99%

Comparing Female Permanent Contraception Options in High Resource Countries: A Systematic Review

Gormley

Vickers

Cheng

et al. 2020

Preprint

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Background: Multiple options for permanent or long-acting contraception are available, each with adverse effects and non-contraceptive benefits. A comprehensive comparison of methods to support decision-making for people seeking to end their fertility and their healthcare providers is needed. We aimed to understand what is known from high quality studies about the comparability of options for permanent contraception. We sought studies comparing these methods of permanent or long-acting contraception: laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and levonorgestrel-releasing intrauterine contraception (LNG-IUC), for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods: We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional relevant studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We assessed risk of bias using the Newcastle-Ottawa Scale, excluding studies with high risk of bias. Due to considerable heterogeneity, we performed a narrative synthesis. Results: Our search identified 6,612 articles. We reviewed the full text of 154 studies, yielding 35 studies which met inclusion criteria. We excluded 10 studies with high risk of bias, retaining 25 at low or medium risk for bias in our synthesis. Most studies assessed hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events, with fewer reporting tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs. No comparisons reported accessibility, eligibility, or follow-ups required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No medium or high-quality studies compared LNG-IUC to other methods.Conclusions: High-quality studies comparing outcomes relevant for those seeking female permanent contraception are needed to support informed decision-making. Research is needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception.Systematic review registration: PROSPERO [CRD42016038254].

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“…Recently, various aspects in this direction are devoted different works on the choice of a long-term method of contraception (Gormley et al 2019), the implementation of condom distribution programs in the United States (Mc-Cool-Myers 2019), the role of the drug store in family planning and possible programs in this direction (Chin-Quee et al 2018), social marketing campaigns strengthening the promotion of condoms and other contraceptives to prevent pregnancy (Ali Mohamed and Cleland 2018), the economic benefits of contraceptives (Mavranezouli 2009). Ukrainian scientists do not lag behind in this direction (Zaliska and Stasiv 2020).…”

Section: Introductionmentioning

confidence: 99%

Conjoint analysis to understand preferences of contraceptives among women of reproductive age in Ukraine

Mahanova¹,

Tkachenko²

2021

PHAR

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This article describes the results of marketing research using conjoint analysis that was conducted to establish the preferences of contraceptives among women of reproductive age in Ukraine to further use the results for effective marketing decisions making in the pharmaceutical industry. It was established that the women`s choice differs significantly depending on their main socioeconomic characteristics: age, income level, and level of education. Priority contraceptives from hormonal, non-hormonal contraceptives, as well as contraceptive medical devices for different age groups of women, was identified. Alfred Marshall’s main economic law was confirmed and the existence of price elasticity according to preferences was established. The results obtained on women’s preferences for certain types of contraceptives will improve the level of compliance, women’s pharmaceutical safety and promote a balance between women’s needs and the capabilities of the contraception supply system.

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Comparing options for women seeking permanent contraception in high-resource countries: a protocol for a systematic review

Cited by 3 publications

References 17 publications

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Comparing Female Permanent Contraception Options in High Resource Countries: A Systematic Review

Conjoint analysis to understand preferences of contraceptives among women of reproductive age in Ukraine

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