Long acting reversible contraception

Long-acting reversible contraception (LARC) is the collective name for intrauterine contraception (copper intrauterine devices and levonorgestrel intrauterine systems) and the subdermal contraceptive implant. LARC methods are highly effective, require minimal user effort and do not require regular healthcare appointments; however the insertion and removal procedures can only be undertaken by clinicians trained to do so. The progestogen-only subdermal implant is the most effective method of reversible contraception in the United Kingdom and is licensed for 3 years. The copper intrauterine device is the most effective non-hormonal method of contraception. These devices are licensed for five or 10 years and can also be used as emergency contraception. The levonorgestrel intrauterine systems (LNG-IUS) are licensed for 3, 5, or 6 years. The Mirena LNG-IUS is also licensed for use in treating heavy menstrual bleeding and for endometrial protection as part of hormone replacement therapy.     

Do women aged over 40 need different counseling on combined hormonal contraception?

There is still a risk of pregnancy during the menopause transition, for most women after the age of 40, as occasional, spontaneous ovulation can occur. Women in this age group may therefore consider using contraception and want appropriate counseling. Aging is accompanied by changes that can increase the risks associated with the use of combined hormonal contraceptives (CHCs), but we do not have sufficient evidence to determine whether age alone increases the risks of using CHCs or whether there are additional risks if CHC use begins at an earlier age. Another issue is whether we can differentiate between initiator versus continuation influences on risk. The objective of this article is to review the risks associated with CHC to determine whether there is a need for more appropriate contraceptive counseling for women aged over 40.     

医疗网络平台服务对青少年人工流产术后选择长效可逆避孕方法的影响

目的探讨通过医疗网络平台实施健康宣教和流产后关爱(post-abortion care,PAC)服务对青少年人工流产术后选择长效可逆避孕方法(long-acting reversible contraception,LARC)避孕的影响。方法选取2018年7月至2019年6月在四川省妇幼保健院行非意愿妊娠人工流产的年龄≤25岁的青少年,随机分为对照组(实施传统的健康宣教和PAC服务)和观察组(实施医疗网络平台的健康宣教和PAC服务)。观察两组术后随访率、LARC的实施情况以及重复人工流产率。结果观察组术后1月的随访率为97.95%,与对照组(96.92%)相近,差异无统计学意义(P>0.05),但术后3月、6月的随访率分别为93.98%、89.18%,明显高于对照组(90.08%、81.25%),差异有统计学意义(P<0.05)。观察组术后即刻、术后1月时LARC的应用率分别为12.45%、13.76%,与对照组(13.00%、13.49%)比较,差异无统计学意义(P>0.05),但术后3月、6月的应用率明显增高,分别为25.10%、28.67%,明显高于对照组(15.18%、17.26%),差异有统计学意义(P<0.05)。观察组半年内重复人工流产率为0.92%,明显低于对照组(3.97%),差异有统计学意义(P<0.05)。结论实施医疗网络平台服务后术后长期随访率高、重复人工流产率低,且明显提高了术后3月和6月LARC在青少年中的应用率,但目前应用率仍不理想。     

Contraception in autoimmune diseases

Autoimmune diseases (AIDs) affect women and men with a 2:1 ratio, which suggests that hormonal contraceptives play a role in their clinical course.Combined oral contraceptives have complex, sometimes contradictory, effects on AIDs; they can worsen the situation in women with systemic lupus erythematosus and with anti-phospholipid syndrome, conditions in which they are contraindicated. Early studies indicated a positive effect on rheumatoid arthritis (RA), whereas more recent trials failed to do so, possibly because of the lowering of oestrogen content. Evidence of effects on multiple sclerosis (MS) is conflicting: risk may vary depending on the progestin used. Minor adverse effects may exist on inflammatory bowel diseases, and no significant effect was found on autoimmune thyroid diseases. Women can become sensitised to sex hormones.Progestin-only contraceptives may be used, although copper-releasing intra-uterine devices represent the best option.Finally, several organisations have issued guidelines for contraceptive use in women with AIDs.     

Hands-On Training in a Digital World: A Novel Simulation-Based Virtual Training Program for Placement and Removal of the Subdermal Contraceptive Implant

ObjectiveThe COVID-19 pandemic necessitated a shift from traditional in-person instruction for learning new technical skills to virtual delivery of medical education training. The objectives of this study were to develop and evaluate a virtual simulation-based training program for Canadian health care professionals (HCPs) on the insertion, localization, and removal of the etonogestrel subdermal contraceptive implant.MethodsA scientific committee of Canadian family planning experts developed a 2-part virtual training program during the COVID-19 pandemic. Core educational content (part 1) was provided in an asynchronous, self-directed, online format. Part 2 consisted of synchronous, simulation-based training using web conferencing. The HCPs were provided with model arms and placebo applicators; the trainers demonstrated implant insertion and removal techniques, and trainees received individual feedback. All trainees were asked to complete an online evaluation upon completion of the program.ResultsBetween September 22, 2020, and December 31, 2021, 83 trainers conducted 565 virtual training sessions. A total of 3162 HCPs completed part 1 of the training program, of whom 2740 had completed part 2 by December 31, 2021. Participants reported high levels of satisfaction with virtual simulation-based training; 96.5% of respondents (1570/1627) agreed that the virtual format was effective. Additional training prior to inserting the implant in clinical practice was requested by 4.5% of respondents (75/1671).ConclusionVirtual simulation-based learning provides effective education and technique training for etonogestrel implant insertion and removal. Online training for implant use can be scaled, as needed, to reach professionals in remote or underserved locations. This virtual training approach may be appropriate for other technical or minor surgical procedures.     

Intrauterine Device Initiation After Gonococcal and Chlamydial Infections: A Practice Workflow Initiative

Unplanned pregnancy remains an issue in the United States. The intrauterine device (IUD) is a solution. The IUD is safe for most women and is recommended for adolescents. Misconceptions exist about IUDs and sexually transmitted infections caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Accepted guidelines ensure the management of these sexually transmitted infections and subsequent, safe initiation of the IUD. The use of best practice alerts preserves the health care team’s adherence to clinical guidelines. This IUD provision initiative creates a workflow for the interprofessional team to ensure the safe initiation of an IUD to clients with a gonococcal or chlamydial infection.     

Contraception and its ethical considerations

Access to appropriate contraception not only has direct benefits for women's health and wellbeing but also has a broader positive impact on society as a whole. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women's preferences, cultural and religious beliefs as well as any co-existing medical issues.This article outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive.