Long-Acting Reversible Contraception

Curtis, Kathryn M.; Peipert, Jeffrey F.

doi:10.1056/nejmcp1608736

Cited by 83 publications

(74 citation statements)

References 55 publications

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“…Efficacy of contraceptive methods is, in fact, a highly important issue given that in the U.S. the percentage of pregnancy that are unwanted (49%) is considerably higher than the percentage in other countries (34% in Western Europe) [1]. In light of such data, efforts are being made by some U.S. organizations to decrease the number of pregnancies by suggesting the use of certain methods of birth control, especially Long Acting Reversible Contraceptive (LARC) methods which are hailed as "the most highly effective" methods [1]. However, accurate information on the efficacy of these contraceptive methods is difficult to obtain, and ratings according to efficacy are controversial.…”

Section: The Effects Of Hormones and Contraceptive Methods Based On Cmentioning

confidence: 99%

“…The copper-containing IUD, ParaGard, is a nonhormonal device containing 380 mm 2 of copper around the arms and stem. "The four levonorgestrel-releasing IUDs (LNG-IUDs) include two devices that contain 52 mg of levonorgestrel (Mirena and Liletta), one device that contains 19.5 mg (Kyleena), and a slightly smaller device that contains 13.5 mg (Skyla)" [1]. Regarding the mechanisms of action of the IUDs it is claimed that "IUDs do not cause the destruction of an implanted embryo but rather work primarily by preventing fertilization.…”

Section: Adverse Events Side Effects Risks Contraindications and mentioning

confidence: 99%

“…In order to appreciate the complexity of adverse events associated with the use of both, implants and intrauterine devices a detailed analysis of the mechanism of action of some of the most frequently used LARCs seems in place [1,9].…”

Section: Or "Coitus Interruptus" (8-38)mentioning

confidence: 99%

“…What must be borne in mind also in evaluating the accuracy of data presented in the various surveys and rankings is the fact that they focus almost exclusively on efficacy, and there is no ranking available that takes into account both crucial variables, i.e., efficacy plus safety. Although some publications make reference to the issue of safety by mentioning medical eligibility criteria, adverse events, side effects, risks, and complications, their primary goal seems to be emphasis on efficacy, as can be seen from publications on LARCs [1] or on implantable contraception [8].…”

Section: Or "Coitus Interruptus" (8-38)mentioning

confidence: 99%

“…Efforts are made in the U.S. to reduce the percentage of unwanted pregnancies, i.e., 49%, which compares unfavorably with Western Europe's percentage of 34% [1,2]. Despite a vast and steadily-increasing literature on the issues of family planning and birth control, several questions are still awaiting clarification, especially with regard to medicinal chemistry, i.e., effects of chemical substances on human endocrinology.…”

Section: Introductionmentioning

confidence: 99%

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Medicinal Chemistry as Foundation for Contraception, Birth Control, Family Planning and Fertility

Kraetschmer¹

2017

Med chem

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Contraception plays a pivotal role in birth control and family planning and thus affects millions of women not only in the U.S. but also world-wide. Efforts are made in the U.S. to reduce the percentage of unwanted pregnancies, i.e., 49%, which compares unfavorably with Western Europe's percentage of 34% [1,2]. Despite a vast and steadily-increasing literature on the issues of family planning and birth control, several questions are still awaiting clarification, especially with regard to medicinal chemistry, i.e., effects of chemical substances on human endocrinology. The following analysis aims at identifying problem areas in contemporary research and draws attention to flawed data in scholarly publications. Hormones: Endocrinology and ChemistryThe menstrual cycle of the female reproductive system is primarily under the control of the hypothalamic Gonadotropin Releasing Hormon (GnRH) and the hormons released by the anterior pituitary, i.e., Luteinizing Hormon (LH) and Follicle Stimulating Hormon (FH). The uterine cycle is divided into a proliferative phase and a secretory or luteal phase. The proliferative phase, also called preovulatory or follicular, is under the influence of estrogens stemming from the developing follicle and lasts from the 5th to the 14th day of the menstrual cycle. The secretory phase is under the influence of estrogen and progesterone from the corpus luteum and lasts from the 15th day to the 28th day. Late in the luteal phase the anterior pituitary and the endometrium produce prolaktin, whose function is not fully understood. The ovarian steroids like cholesterol, bile acids, and vitaminD contain the cyclopentanoperhydrophenanthrene nucleus. Figures 1 and 2 shows the biosynthesis and metabolism of estrogens as well as the precursor steroids Cholesterol and Pregnenolone. Ovarian Hormones: 17beta-estradiol, estrone, and estriol.The naturally occurring estrogens secreted by the theca interna and granulosa cells of the ovarian follicles, the corpus luteum, and the placenta are the following C 18 steroids: 17beta-estradiol, estrone, and estriol. These steroids do not have an angular methyl group attached to the 10 position or a Delta -3-keto configuration in the A ring [3,4].In the biosynthetic pathway they are formed from androgens, but they are also formed in the circulation by aromatization of androstenedione. The enzyme aromatase catalyzes both, the conversion of androstenedione to estrone and the conversion of testosterone to 17beta-estradiol (E2) [2]. 17beta-estradiol (E2), the major secreted estrogen, is in equilibrium in the circulation with estrone. Estrone ist metabolized to estriol, probably primarily in the liver. Estradiol is the most potent and estriol the least potent of the three estrogens.Estrogens: secretion and metabolism. The concentration of estradiol in the plasma during the menstrual cycle varies and reaches a first peak of approximately 200 pg/mL around day 13, i.e., just before ovulation, and a second peak of about 110 pg/mL around day 19-22, i.e., during the m...

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Section: The Effects Of Hormones and Contraceptive Methods Based On Cmentioning

confidence: 99%

Section: Adverse Events Side Effects Risks Contraindications and mentioning

confidence: 99%

Section: Or "Coitus Interruptus" (8-38)mentioning

confidence: 99%

Section: Or "Coitus Interruptus" (8-38)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Medicinal Chemistry as Foundation for Contraception, Birth Control, Family Planning and Fertility

Kraetschmer¹

2017

Med chem

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Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Hale,

Lee,

de Jong

et al. 2024

JAMA Netw Open

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ImportanceEvaluating the impact of statewide contraceptive access initiatives is necessary for informing health policy and practice.ObjectiveTo examine changes in contraceptive method use among a cohort of women of reproductive age in South Carolina during the Choose Well contraceptive access initiative.Design, Setting, and ParticipantsIn this cohort study, baseline data from the initial Statewide Survey of Women administered from October 1, 2017, to April 30, 2018, to a probability-based sample of women of reproductive age in South Carolina and a peer state (Alabama) were linked with 3 follow-up surveys given in 2019, 2020, and 2021. Responses about contraception use from the initial survey were compared with responses across follow-up surveys using the regression-based differences-in-differences method. Data analysis was performed from October 2023 to February 2024.ExposureThe South Carolina Choose Well contraceptive access initiative seeks to fill contraceptive access gaps and increase provision of a full range of contraceptive methods through engagement with a wide range of health care organizations across the state.Main Outcomes and MeasuresChanges in contraceptive method use, including long-acting reversible contraception (LARC), intrauterine devices (IUDs), implants, short-acting hormonal injection, and barrier or other methods between the baseline survey (2017-2018) and 3 subsequent surveys (2019-2021).ResultsA total of 1344 female participants (mean [SD] age, 34 [7] years) completed the first survey (667 in Alabama and 677 in South Carolina). Use of LARC significantly increased in South Carolina (119 [17.6%] to 138 [21.1%]) compared with Alabama (120 [18.0%] to 116 [18.1%]; P = .004). Use of IUDs increased in South Carolina (95 [14.0%] to 114 [17.4%]) compared with Alabama (92 [13.8%] to 102 [15.9%]; P = .003). These associations persisted in the adjusted analysis, with a significant increase in the odds of LARC (adjusted odds ratio, 1.24; 95% CI, 1.06-1.44) and IUD (adjusted odds ratio, 1.19; 95% CI, 1.06-1.32) use at follow-up in South Carolina compared with Alabama.Conclusions and RelevanceIn this cohort study of 1344 participants, increases in the use of IUDs in South Carolina were noted after the implementation of the South Carolina Choose Well initiative that were not observed in a peer state with no intervention. Our findings may provide support in favor of statewide contraceptive access initiatives and their role in promoting access to reproductive health services.

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Long-Acting Reversible Contraception for Adolescents

Francis

Gold

2017

JAMA Pediatr

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IMPORTANCE Adolescents have higher rates of unintended pregnancies than any other age group. Contraceptive implants and intrauterine devices (IUDs) are long-acting reversible contraceptives (LARCs) that are known to be highly effective in preventing pregnancy. New devices have recently been approved for use in adolescents, yet pediatricians may be less familiar with how to counsel adolescents about implants and IUDs.OBSERVATIONS LARC methods should be described in basic terms to adolescents, including hormone dose, method of insertion, and method of pregnancy prevention. Clinicians should appreciate the developmental stages of adolescents, discuss the most effective methods of contraception, and ensure confidentiality from their parents. Short-acting contraception methods (eg, oral contraceptives) can be used as a temporary bridge to provide coverage until a LARC method can be placed. The most common adverse effect of LARC is nuisance bleeding, which can be managed with short courses of oral contraceptives or nonsteroidal anti-inflammatory drugs.CONCLUSIONS AND RELEVANCE LARC devices constitute first-line contraceptive methods for adolescents. All clinicians, including pediatricians, can counsel about LARC even before suggesting an oral contraceptive or another less effective contraceptive method. Effective, confidential communication with sensitive language to inform adolescents of the different types of LARC is necessary to normalize offering LARC as a contraceptive option and improve its uptake among adolescents. Special clinical populations can also be offered appropriate contraceptive options inclusive of LARC.

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Long-Acting Reversible Contraception

Cited by 83 publications

References 55 publications

Medicinal Chemistry as Foundation for Contraception, Birth Control, Family Planning and Fertility

Medicinal Chemistry as Foundation for Contraception, Birth Control, Family Planning and Fertility

Contraceptive Method Use Among a Population-Based Cohort During the South Carolina Choose Well Initiative

Long-Acting Reversible Contraception for Adolescents

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