RESUMEN
PURPOSE OF REVIEW: Combined oral contraceptive pills are among the most widely used contraceptive methods globally. Despite their popularity, the potential risks and side effects can lead to both high discontinuation rates and adverse outcomes including thromboembolic events. The quest for a safer alternative to the traditional ethinyl estradiol/progestin combination has led to the use of newer oestrogens. Ethinyl oestradiol alternatives will be reviewed including the newest option, estetrol, as it enters clinical use. RECENT FINDINGS: Oestradiol, when combined with a progestin with strong endometrial activity, is a viable alternative to ethinyl estradiol in the form of oestradiol valerate and estradiol, which have been available since 2008 and 2011, respectively. Estetrol is the newest oestrogen available and is found naturally in the foetal liver. Estetrol was approved for use in 2021. All three of these alternatives have high contraceptive efficacy, similar if not improved cycle control and decreased impact on haemostatic factors as compared to ethinyl estradiol. SUMMARY: Alternatives to ethinyl oestradiol, including the newest option of estetrol, show promise in providing comparable contraceptive efficacy with potentially lower risk of side effects and thromboembolic events.
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Estrógenos , Etinilestradiol , Anticoncepción , Anticonceptivos Orales Combinados/efectos adversos , Endometrio , Estradiol , Etinilestradiol/efectos adversos , Femenino , HumanosRESUMEN
OBJECTIVE: To evaluate whether a 12-mL paracervical block is noninferior to a 20-mL block in reducing pain with osmotic dilator insertion. METHODS: In this single-blinded noninferiority trial, we randomized individuals undergoing insertion of osmotic dilators before second-trimester abortion to receive either a 12-mL or 20-mL 1% lidocaine paracervical block. The primary outcome was pain immediately after insertion of osmotic dilators. Prespecified secondary outcomes included pain with paracervical block administration, overall pain, and side effects, with 88 participants being required for a noninferiority margin of 15 mm on a 100-mm visual analog scale assuming an SD of 28. We analyzed data using Wilcoxon rank sum, χ2, and t tests and performed analysis of variance to account for repeated measures. Secondary analysis included multivariable regression to explore potential confounders. RESULTS: From January 2018 to October 2020, of 232 eligible individuals, 174 were approached and 96 randomized (48 participants to each group); 91 were available for analysis (45: 12 mL, 46: 20 mL). Group demographics were similar, with a mean gestation of 21 weeks and four osmotic dilators placed. The 12-mL paracervical block was noninferior to the 20-mL paracervical block for pain with osmotic dilator insertion with a difference in means of -1.36 (95% CI -12.56 to 9.85) favoring 12 mL. Median pain scores after dilator placement were 47 mm (interquartile range 22-68) and 50 mm (interquartile range 27-67) in 12-mL compared with 20-mL paracervical block, respectively (P=.81). No difference was seen in median pain at baseline, with paracervical block administration, postprocedure or with overall pain or experience. At least one lidocaine-related side effect occurred in 4% of participants in the 12-mL group compared with 13% for those receiving 20 mL (P=.15), with metallic taste, ringing in ears, and lightheadedness being most common. CONCLUSION: A 12-mL paracervical block is noninferior to a 20-mL block for pain reduction with osmotic dilator insertion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03356145.
Asunto(s)
Aborto Inducido , Anestésicos Locales/administración & dosificación , Lidocaína/administración & dosificación , Dolor/prevención & control , Atención Prenatal , Adulto , Cuello del Útero , Femenino , Humanos , Dimensión del Dolor , Embarazo , Segundo Trimestre del Embarazo , Método Simple Ciego , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate individuals' ability to perform and comprehend low-sensitivity and multilevel urine pregnancy tests during medication abortion follow-up. STUDY DESIGN: We conducted a pilot study of individuals using mifepristone and misoprostol for medication abortion through 63-days gestation. We randomly assigned participants to use a 1000 mIU/mL low-sensitivity pregnancy test or a five-level multilevel pregnancy test. Seven days after mifepristone, participants performed their test and completed a questionnaire. One week later, participants performed another test if day 7 low-sensitivity test had been positive or day 7 multilevel test had not shown a one-level drop. We assessed comprehension of abortion status based on participants' final test interpretation, and defined correct comprehension when patient report of pregnancy status was consistent with pregnancy test result. We also assessed usability with a 100-mm Visual Analogue Scale (0 'very easy'; 100 'very difficult') and satisfaction. RESULTS: We enrolled and randomized 88 participants to low-sensitivity (n = 43) and multilevel (n = 45) test groups. Comprehension was correct in 38/39 (97%) and 41/45 (91%) of low-sensitivity and multilevel test users, respectively (p = 0.37). When the test indicated a possible ongoing pregnancy, all three low-sensitivity test users and two of three multilevel test users accurately comprehended their results. Participants rated ease of use as 7.5 (range 0-68) for low-sensitivity and 9.0 (range 0-52) for multilevel (p = 0.24) tests. Most participants were likely or very likely to recommend use of their test (32/36 [89%] low-sensitivity and 42/44 [95%] multilevel test users, p = 0.66). CONCLUSIONS: Patients could comprehend and use low-sensitivity and multilevel tests during medication abortion follow-up with similar satisfaction. IMPLICATIONS: Individuals are able to independently use both the low-sensitivity and multilevel tests for medication abortion follow-up. Both are acceptable for medication abortion follow-up without in-person contact, but future, larger studies to compare comprehension of both tests may be necessary.
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Aborto Inducido , Misoprostol , Pruebas de Embarazo , Femenino , Humanos , Mifepristona , Proyectos Piloto , EmbarazoRESUMEN
PURPOSE OF REVIEW: To evaluate the recent literature on mobile health applications available to patients for contraception and abortion care. RECENT FINDINGS: Women are increasingly interested in contraceptive tools utilizing mobile technology, and a majority of women expect them to be science-based. The largest number of available mobile apps supports natural family planning methods, which is recognized as the least effective contraceptive method. Many available apps cannot be relied on for accurate, science-based pregnancy prevention methods. Further, there is a paucity of data regarding use of mobile technology for women seeking or receiving abortion. SUMMARY: Further research is needed to evaluate mobile health apps and how they can best provide patient consumers with accurate, evidence-based information to support the prevention of unintended pregnancy.
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Aborto Inducido/tendencias , Anticoncepción/tendencias , Anticonceptivos/uso terapéutico , Servicios de Planificación Familiar/métodos , Aplicaciones Móviles , Adolescente , Adulto , Femenino , Humanos , Métodos Naturales de Planificación Familiar/métodos , Embarazo , Embarazo no Planeado , Teléfono Inteligente , Telemedicina , Adulto JovenRESUMEN
PURPOSE OF REVIEW: Medical abortion offers a well tolerated and effective method to terminate early pregnancy, but remains underutilized in the United States. Over the last decade, 'telemedicine' has been studied as an option for medical abortion to improve access when patients and providers are not together. A number of studies have explored various practice models and their feasibility as an alternative to in-person service provision. RECENT FINDINGS: A direct-to-clinic model of telemedicine medical abortion has similar efficacy with no increased risk of significant adverse events when compared with in-person abortion. A direct-to-consumer model is currently being studied in the United States. International models of direct-to-consumer medical abortion have shown promising results. SUMMARY: The introduction of telemedicine into abortion care has been met with early success. Currently, there are limitations to the reach of telemedicine because of specific restrictions on mifepristone in the United States as well as laws that specifically prohibit telemedicine for abortion. If these barriers are removed, telemedicine can potentially increase abortion access.
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Abortivos Esteroideos/administración & dosificación , Aborto Inducido/métodos , Atención Ambulatoria/métodos , Atención a la Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Atención Dirigida al Paciente/estadística & datos numéricos , Telemedicina , Adulto , Atención Ambulatoria/tendencias , Instituciones de Atención Ambulatoria , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Embarazo , Telemedicina/tendencias , Resultado del Tratamiento , Estados UnidosRESUMEN
PURPOSE OF REVIEW: Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. RECENT FINDINGS: Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available. SUMMARY: It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
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Terapia Antirretroviral Altamente Activa/efectos adversos , Anticoncepción/métodos , Anticonceptivos Femeninos/administración & dosificación , Dispositivos Anticonceptivos Femeninos , Efectividad Anticonceptiva , Infecciones por VIH/tratamiento farmacológico , Estudios Transversales , Progresión de la Enfermedad , Femenino , Salud Global , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Prioridad del Paciente , Embarazo , Medición de RiesgoRESUMEN
PURPOSE OF REVIEW: Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. RECENT FINDINGS: Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3âmg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG. Repeated use of both LNG and ulipristal acetate (UPA) is well tolerated. Hormonal contraception can be immediately started following LNG use, but should be delayed for 5 days after UPA use to avoid dampening the efficacy of UPA. The copper intrauterine device (IUD) is the only IUD approved for emergency contraception (and the most effective method of emergency contraception), but use of LNG IUD as emergency contraception is currently being investigated. Accurate knowledge about emergency contraception remains low both for patients and healthcare providers. SUMMARY: Emergency contraception is an important yet underutilized tool available to women to prevent pregnancy. Current options including copper IUD and emergency contraceptive pills are safe and well tolerated. Significant gaps in knowledge of emergency contraception on both the provider and user level exist, as do barriers to expedient access of emergency contraception.