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1.
Background
Women diagnosed with gestational trophoblastic disease (GTD) need safe and effective contraception because they are advised to delay a subsequent pregnancy.Study Design
We searched MEDLINE and The Cochrane Library for articles in any language on use of combined oral contraceptives (COC), copper-bearing or levonorgestrel-releasing IUDs among women with benign or malignant GTD, from database inception through November 2008. One review and nine articles were identified and evaluated.Results
Incidence of postmolar trophoblastic disease was lower among COC users compared with nonusers in six studies, but higher among COC users in three studies. Five studies reported shorter human chorionic gonadotropin (hCG) regression duration among COC users compared with other methods. Development of postmolar trophoblastic disease did not differ significantly among IUD users compared with COC users or nonusers in three studies.Conclusions
Evidence shows that postmolar trophoblastic disease risk does not increase among women using COCs or an IUD following molar pregnancy evacuation compared with use of other contraceptive methods or no method. 相似文献2.
Background
Providing combined oral contraceptives (COCs) following surgical or medical induced abortion offers women an opportune moment to initiate a reliable contraceptive method.Study Design
We conducted a systematic review, searching MEDLINE and The Cochrane Library for articles in any language concerning COC use following spontaneous, induced (medical or surgical) or septic abortion, from 1966 through June 2008. Seven articles were identified and evaluated using the United States Preventive Services Task Force system.Results
Immediate COC initiation after first-trimester medical or surgical induced abortion did not increase side effects or prolong vaginal bleeding compared with use of a placebo, copper-bearing intrauterine device (IUD), nonhormonal contraceptive method or COC initiation at a later time. Initiating COCs after first-trimester surgical abortion produced small increases in coagulation parameters compared with IUD use; although they are statistically significant, their clinical relevance is unlikely. No study examined second-trimester induced or spontaneous abortion, or septic abortion.Conclusions
Evidence shows that COCs can be safely initiated immediately following surgical and medical abortion in the first-trimester of pregnancy. 相似文献3.
Jéssica M. Ferreira Fabiana R. NunesWaleska Modesto Mayara P. GonçalvesLuis Bahamondes 《Contraception》2014
Objectives
Long-acting reversible contraceptives (LARCs) include the copper-releasing intrauterine device (IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and implants. Despite the high contraceptive efficacy of LARCs, their prevalence of use remains low in many countries. The objective of this study was to assess the main reasons for switching from contraceptive methods requiring daily or monthly compliance to LARC methods within a Brazilian cohort.Study Design
Women of 18–50 years of age using different contraceptives and wishing to switch to a LARC method answered a questionnaire regarding their motivations for switching from their current contraceptive. Continuation rates were evaluated 1 year after method initiation. Sample size was calculated at 1040 women. Clinical performance was evaluated by life table analysis. The cutoff date for analysis was May 23, 2013.Results
Overall, 1167 women were interviewed; however, after 1 year of use, the medical records of only 1154 women were available for review. The main personal reason for switching, as reported by the women, was “fear of becoming pregnant” while the main medical reasons were nausea and vomiting and unscheduled bleeding. No pregnancies occurred during LARC use, and the main reasons for discontinuation were expulsion (in the case of the IUD and LNG-IUS) and a decision to undergo surgical sterilization (in the case of the etonogestrel-releasing implant). Continuation rate was ~ 95.0/100 women/year for the three methods.Conclusions
Most women chose a LARC method for its safety and for practical reasons, and after 1 year of use, most women continued with the method. 相似文献4.
Jinna Zhao Yulin Wu Jian Zhou Lei Ba Xiaoping Gu Weidong Wang Naixiu Ren Lianfang Xu 《Contraception》2009,80(2):180-186
Background
The combined oral contraceptives (COCs) and intrauterine devices (IUDs) are the most common contraceptive methods used by women. Women's choices of contraceptive method are largely affected by the safety and efficacy of contraceptive methods as well as by change in women's quality of life. However, there are still scanty data focusing on the impact of COC or IUD on quality of life in women, especially in China. The aim of this study was to evaluate the impact of desogestrel and ethinyl estradiol tablets (Marvelon) and Yuangong-Cu220 IUD (YCu220 IUD) on quality of life in rural women of the Jiangsu province in China.Study Design
In this prospective cohort study, 784 COC users and 910 YCu220 IUD users were included. The women filled up quality-of-life questionnaires (Quality of Life Enjoyment and Satisfaction Questionnaire) before and after use of contraceptive methods.Results
Significant score changes in physical health, mood, work/school/labor, living situation, vision, general well-being and overall satisfaction were noted as significant improvements after COC use in women (p<.05), and the largest improvements were in physical health and living situation; all item scores except for work/school/labor, household activities and leisure time activities had improved statistically from baseline in YCu220 IUD users (p<.05). For COC users, the proportions of women with total quality-of-life scores ≥57 before and after COC use were 11.50% and 11.79%, respectively; but the proportion of YCu220 IUD users with total quality-of-life scores ≥57 increased from 4.40% to 12.04%. Compared to women without contraceptive use history, women with past OC and/or IUD use had a significantly higher difference in the total quality-of-life scores.Conclusions
COC and YCu220 IUD could significantly improve overall quality of life in rural women of the Jiangsu province. 相似文献5.
Background
The purpose of this study was to explore average monthly cost of commonly prescribed oral and transvaginal contraceptives, across ZIP code income groups, in Florida.Study Design
In March, 2011, the MyFloridarx.com database was searched to assess monthly prices of seven commonly prescribed contraceptives charged by Florida pharmacies.Results
With the exception of TNRG/EE 35 (χ2[4, N= 401]=18.72, p=.00), monthly costs of contraceptives did not vary significantly across Florida ZIP code median income quintile groups.Conclusion
Overall, while there was little variability in retail pharmacy prices in Florida for seven commonly prescribed contraceptives, monthly costs of individual contraceptives varied widely.Implications
This report found little variability, across ZIP codes, in retail pharmacy prices in Florida for seven commonly prescribed contraceptives, but the monthly costs of individual contraceptives varied widely. It is paramount that clinicians consider costs when discussing contraceptive options with their patients. 相似文献6.
E. Bimla Schwarz Melissa Papic Sara M. Parisi Erin Baldauf Rachel Rapkin Glenn Updike 《Contraception》2014
Objective
To compare contraceptive knowledge and use among women seeking emergency contraception (EC) before and after an inner-city clinic began providing structured counseling and offering same-day intrauterine device (IUD) or implant placement to all women seeking EC.Study design
For 8 months before and 21 months after this change in clinic policy, women aged 15–45 who wanted to avoid pregnancy for at least 6 months were asked to complete surveys immediately, 3 and 12 months after their clinic visit. In addition, we abstracted electronic medical record (EMR) data on all women who sought EC (n= 328) during this period. We used chi-squared tests to assess pre/post differences in survey and EMR data.Results
Surveys were completed by 186 women. After the clinic began offering structured counseling, more women had accurate knowledge of the effectiveness of IUDs, immediately and 3 months after their clinic visit. In addition, more women initiated IUD or implant use (survey: 40% vs. 17% preintervention, p=0.04; EMR: 22% vs. 10% preintervention, p=0.01), and fewer had no contraceptive use (survey: 3% vs. 17% preintervention, p<0.01; EMR: 32% vs. 68%, p<0.01) in the 3 months after seeking EC. EMR data indicate that when same-day placement was offered, 11.0% of women received a same-day IUD. Of those who received a same-day IUD, 88% (23/26) reported IUD use at 3-months and 80% (12/15) at 12 months.Conclusions
Routine provision of structured counseling with the offer of same-day IUD placement increases knowledge and use of IUDs 3 months after women seek EC.Implications
Women seeking EC from family planning clinics should be offered counseling about highly effective reversible contraceptives with the option of same-day contraceptive placement. 相似文献7.
Objective
The objective was to investigate changes in luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) during the hormone-free interval (HFI) of 6 combined oral contraceptives (COCs).Design
Blood samples were obtained from 62 women.Results
When COCs were grouped by ethinyl estradiol (EE) dose, there was a significant positive mean slope for LH and FSH during the HFI for the 30- and 35 mcg-EE doses, whereas 20 showed a gradual nonsignificant slope. All E2 slopes were significant. P remained suppressed with all doses.Conclusion
A more rapid rebound of gonadotropin levels is found with higher doses of EE during the HFI.Implications
This study showed a more rapid rebound of pituitary hormone levels among women using higher-EE-dosage formulations, which was demonstrated by the statistically significant slope for mean LH and FSH from day 1 to day 7 of the HFI. The degree of suppression did not vary across progestin generations. It remains to be established whether women who experience side effects during their HFI may benefit from using a COC with a lower EE dose to minimize changes in endogenous pituitary hormone levels. 相似文献8.
Background
Negative mood symptoms remain one of the major reasons for discontinuation of combined oral contraceptive pills (COCs). The primary aim of this study was to compare the prevalence of mood and anxiety disorders in women with different experience of COCs.Study Design
Thirty women currently on COCs with no report of adverse mood symptoms, 28 women currently on COCs and experiencing mood-related side effects, 33 women who had discontinued COC use due to adverse mood effects and 27 women who had discontinued COC use for reasons other than adverse mood symptoms were included. Ongoing psychiatric disorders were evaluated by a structured psychiatric interview and prevalence rates of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) were assessed by daily prospective ratings on the Cyclicity Diagnoser scale.Results
Women with ongoing or past experience of COC-induced adverse mood, more often suffered from mood disorders than women with no reports of adverse mood while on COC. The prevalence of prospectively defined PMS or PMDD did not differ between prior users with positive or negative experience. Women who had discontinued COC use due to adverse mood symptoms more often had had a legal abortion in the past.Conclusion
Women with ongoing or past self-reported adverse mood effects from COCs had a significantly increased prevalence of mood disorders. 相似文献9.
Background
Drug interactions between hormonal contraceptives and anticonvulsants, resulting in reduced contraceptive effectiveness and/or increased seizure activity, have been published.Study design
We conducted a systematic review, searching PUBMED and The Cochrane Library for articles in any language on use of hormonal contraceptive methods among women taking anticonvulsant therapy from 1966 through 3 May 2010. Forty-three articles were identified and evaluated.Results
Evidence suggests drug interactions occur when combined oral contraceptives (COCs), the levonorgestrel implant (Norplant), or the etonogestrel implant (Implanon) are used concomitantly with carbamazepine, phenobarbital, phenytoin, topiramate or lamotrigine. Significant drug interactions were not observed during sodium valproate intake and COC use nor among women using progestogen-only contraceptives and taking lamotrigine.Conclusions
To avoid contraceptive failure or increased seizure activity, women with epilepsy should be offered contraceptive methods that do not interact with anticonvulsant medication. 相似文献10.
Objective
To examine the levels and determinants of switching to any reversible modern contraceptive method following intrauterine device (IUD) discontinuation due to method-related reasons among women in developing countries.Study Design
We analysed 5-year contraceptive calendar data from 14 Demographic and Health Surveys, conducted in 1993–2008 (n= 218,092 women; 17,151 women contributed a total of 18,485 IUD episodes). Life-table methods were used to determine overall and cause-specific probabilities of IUD discontinuation at 12 months of use. For IUD episodes discontinued due to method-related reasons, the probability of switching to another reversible modern method within 3 months was estimated, overall and by place of residence, education level, motivation for use, age category and wealth tertiles. Country-specific rate ratios (RR) were estimated using generalized linear models, and pooled RRs using meta-analyses.Results
The median duration of uninterrupted IUD use was 37 months. At 12 months, median probability of discontinuation was 13.2% and median probability of discontinuation due to method-related reasons was 8.9%. Within 3 months of discontinuation due to method-related reasons, half of the women had switched to another reversible modern method, 12% switched to traditional methods, 12% became pregnant, and 25% remained at risk for pregnancy. More educated women were more likely to switch to another reversible modern method than women with primary education or less (pooled RR 1.47; 95% CI 1.10–1.96), as were women in the highest wealth tertile (pooled RR 1.38; 95% CI 1.04–1.83) and women who were limiting births (pooled RR 1.35; 95% CI 1.08–1.68).Conclusion
Delays to switching and switching to less reliable methods following IUD discontinuation remain a problem, exposing women to the risk of unwanted pregnancy. Family planning programmes should aim to improve quality of services through strengthening of counselling and follow-up services to support women's continuation of effective methods.Implications
The risk of unintended pregnancy following IUD discontinuation remains high in developing countries. The quality of family planning services may be an important factor in switching to alternative modern contraceptive methods. Service providers should focus on counselling services and follow-up of women to support the continued use of effective methods. 相似文献11.
Zevidah Vickery Tessa Madden Qiuhong Zhao Gina M. Secura Jenifer E. Allsworth Jeffrey F. Peipert 《Contraception》2013
Background
Concerns about weight gain may influence contraceptive use. We compared the change in body weight over the first 12 months of use between women using the etonogestrel (ENG) implant, the levonorgestrel intrauterine system (LNG-IUS) or depot medroxyprogesterone acetate (DMPA) with women using the copper intrauterine device (IUD).Study Design
This was a substudy of the Contraceptive CHOICE Project, a prospective cohort study of 9256 women provided no-cost contraception. Women who had been using the ENG implant, LNG-IUS, DMPA or copper IUD continuously for at least 11 months were eligible for participation. We obtained body weight at enrollment and at 12 months and compared the weight change for each progestin-only method to the copper IUD.Results
We enrolled a total of 427 women: 130 ENG implant users, 130 LNG-IUS users, 67 DMPA users and 100 copper IUD users. The mean weight change (in kilograms) over 12 months was 2.1 for ENG implant users [standard deviation (SD)=6.7]; 1.0 for LNG-IUS users (SD=5.3); 2.2 for DMPA users (SD=4.9) and 0.2 for copper IUD users (SD=5.1). The range of weight change was broad across all contraceptive methods. In the unadjusted linear regression model, ENG implant and DMPA use were associated with weight gain compared to the copper IUD. However, in the adjusted model, no difference in weight gain with the ENG implant, LNG-IUS or DMPA was observed. Only Black race was associated with significant weight gain (1.3 kg, 95% confidence interval=0.2–2.4) when compared to other racial groups.Conclusions
Weight change was variable among women using progestin-only contraceptives. Black race was a significant predictor of weight gain among contraceptive users. 相似文献12.
Giovanni Grandi Anjeza XholliAntonella Napolitano Ilaria PiacentiManuela Bellafronte Angelo Cagnacci 《Contraception》2014
Objective
Combined oral contraceptives (COCs) containing ethinyl-estradiol are known to increase blood pressure (BP). We evaluated whether COCs containing estradiol (E2) influence 24-h ambulatory BP and heart rate (HR) in normotensive and normal-weight women.Study design
Twenty-four-hour BP and HR were measured every 30 min with an ambulatory BP device in 18 normotensive healthy non-smoking women prior to (Days 3–6 of menstrual cycle) and after 6 months of use (Days 20–24 of cycle 6) of a COC containing either a quadriphasic combination of E2 valerate plus dienogest (n=11) or a monophasic association of micronized E2 plus nomegestrol acetate (n=7).Results
Mean age and body mass index of the final sample were 32.50±7.49 years and 22.87±4.08, respectively. E2-based COCs induced no modification of 24-h systolic BP (+ 1.65±8.34 mmHg; p=.41), diastolic BP (+ 0.04±7.36 mmHg; p=.98), mean BP (+ 0.64±6.42 mmHg; p=.68) or HR (− 0.72±5.86 beats/min; p=.61). Differences were not observed even when daytime or nighttime values were separately considered. Though this was not a comparative study, we did not find differences between the effects of the two formulations (24-h mean BP; p=.699).Conclusions
These data suggest a neutral effect of estradiol-based COCs on independent risk factors for cardiovascular diseases such as BP or HR.Implications
BP and HR of normotensive women are not increased by E2-based COCs. 相似文献13.
Natália Dal'Ava Luis BahamondesM. Valeria Bahamondes Bruna F. BotturaIlza Monteiro 《Contraception》2014
Objectives
Weight gain is a concern with the contraceptive depot-medroxyprogesterone acetate (DMPA); however, this issue remains controversial. The objective of this study was to compare body weight (BW) and body composition (BC) in DMPA and copper intrauterine device (IUD) users at baseline and after one year of use.Study Design
We enrolled new DMPA users and age and weight matched new IUD users into this prospective study. Weight and height were measured, BC (fat and lean mass) was evaluated using dual-energy X-ray absorptiometry, and physical activity was assessed at baseline and at 12 months. Student's paired t test and the Wilcoxon paired test for matched samples were used.Results
Ninety-seven women were enrolled for the study; 26 matched pairs continued using the initial method for at least one year, and completed the baseline and 12 month assessments. An increase of 1.9 kg occurred in BW (p=.02) in DMPA users at 12 months of use, resulting from an increase in fat mass of 1.6 kg (p=.03). Weight remained stable in IUD users; however, there was an increase in lean mass at 12 months of use (p=.001). The number of women practicing physical activity increased in this group. There was a significant difference between the groups regarding the variation in the percentage of central fat (p=.04).Conclusion
Weight gain in the DMPA group after the first year of use resulted from an increase in fat mass. Weight remained stable in the IUD group; however, an increase in lean mass and a reduction in localized abdominal fat mass occurred, possibly because more users were practicing physical activity.Implications statement
There was a greater increase in body weight in DMPA users compared to TCu380A IUD users in the first year of use of the contraceptive method. Furthermore, the weight increase in users of DMPA occurred principally as the result of an increase in fat mass. Physical activity probably could increase the lean mass in the users of TCu380A IUD. 相似文献14.
Rogério Bonassi Machado Alice Pinheiro Pereira Geórgia Perez Coelho Larissa Neri Larissa Martins Daniele Luminoso 《Contraception》2010,81(3):202-208
Background
Migraine was assessed in users of combined oral contraceptives (COCs).Study Design
This study had a cross-sectional design. Women with headaches were evaluated according to International Headache Society criteria and subsequently allocated to a “migraine” or “non-migraine” group.Results
Migraine was detected in 80/480 women (16.6%), while other types of headache not classified as migraine were observed in 400 women (83.4%). Following COC use, headaches worsened in 32.5% and 19.3% [odds ratio (OR)=3.02; 95% confidence interval (CI)=1.68-5.4] and improved in 30% and 13.8% (OR=3.9; 95% CI=2.12-7.18) of the “migraine” and “non-migraine” groups, respectively. In the migraine group only, headache episodes occurred predominantly during or around the hormone-free interval (OR=2.05; 95% CI=1.26-3.35). The combination of ethinylestradiol (EE) and drospirenone (DRS) was significantly associated with an improvement in the frequency and/or intensity of migraine-type headaches, compared with other types of COCs.Conclusions
The prevalence of migraine in COC users appears similar to that found in the general population. Migraines, but not other types of headache, were significantly affected by COCs. The EE/DRS combination was associated with a greater likelihood of improvement in migraine compared with other types of COCs. 相似文献15.
Rameet H. Singh Rebecca G. Rogers Lawrence Leeman Noelle Borders Jessica Highfill Eve Espey 《Contraception》2014
Objective
The objective of the study was to determine if postpartum contraceptive choices by primiparous women differ by ethnicity.Study design
Retrospective nested cohort study analyzing women’s characteristics and contraceptive choice.Results
Of 652 participants, 312 (47.8%) were Hispanic, 287 (44.0%) were non-Hispanic white, and 53 (8.1%) were American Indian (AI). In multivariate analysis, depot medroxyprogesterone acetate (DMPA) and intrauterine device (IUD)/implant choice was related to AI [DMPA: odds ratio (OR) 15.28, confidence interval (CI) 4.49–52.04; IUD/implant: OR 0.46, CI 0.22–0.92] and Hispanic (DMPA: OR 3.44, CI 1.12–10.58) ethnicity.Conclusion
DMPA use was higher among Hispanic and AI women and IUD/implant use lower in AI women compared to non-Hispanic white women. 相似文献16.
Objective
Subdermal contraceptive implant continuation has not been well studied in Africa. We conducted a secondary data analysis to compare baseline characteristics of Kenyan women who continued to use the subdermal implant at 12 months to those who did not.Study Design
Kenyan women aged 18–24 years who presented to a family planning clinic for short-acting hormonal contraception were offered a two-rod subdermal implant instead. Participants were followed for 12 months after initiation of their contraceptive method. Statistical analysis included Pearson's chi-square or Fisher's exact tests for comparisons of proportions. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to determine factors associated with continuation.Results
Eighty-six (89%) of the 97 women who chose the implant were followed for 12 months. Of these women, 68 (79%) continued to use the implant. None of the factors we examined had a statistically significant association with continued use of the implant. Duration of intended use was the only strong factor; 83% of women with 3 + years of need continued using the implant, compared to 56% of those with shorter needs (Risk ratio = 1.48, 95% CI = 0.94–2.31). No substantive continuation differences were found when comparing other participant characteristics including months with their current partner, personal desire and partner preference for future children, previous use of modern birth control and other factors.Conclusion
High implant continuation rates were noted regardless of previous use of modern birth control, partner preference for children or baseline concern for menstrual change.Implications
Contraceptive use in Africa continues to focus on short-acting contraceptives despite the proven superior efficacy of long-acting reversible contraceptives in other settings. The high subdermal implant continuation among Kenyan women in this prospective study, regardless of baseline characteristics, supports the need for increasing access and future research in this population. 相似文献17.
Background
Postpartum women need effective contraception, but using hormonal contraceptives may affect breastfeeding performance and infant health outcomes.Study design
We searched the MEDLINE and Cochrane databases for all articles published through May 2009 for primary research studies that investigated clinical outcomes among breastfeeding women who used hormonal contraception or their infants.Results
Three randomized controlled trials reported decreased mean duration of breastfeeding and higher rates of supplemental feeding among combined oral contraceptive (COC) users than among nonusers, while one multicountry trial found no differences in these parameters. Only one study demonstrated lower average weights during the first year of life for infants whose mothers used COCs while breastfeeding. None of the eight studies, four of which were observational, included in this review documented adverse infant health outcomes.Conclusions
Limited evidence demonstrates an inconsistent effect of COC on breastfeeding duration and success. The evidence is inadequate to determine whether a mother's use of these drugs affects breastfeeding duration or the infant's health. 相似文献18.
Daniel Westreich Naiomi Jamal Jennifer S. Smith Doreen Schulze Sophie Williams Pam Michelow Simon Levin Cynthia Firnhaber 《Contraception》2014
Background
Few data exist regarding the effect of hormonal contraception (HC) on incidence and progression of cervical disease (e.g., cervical dysplasia, squamous intraepithelial lesions, cervical intraepithelial neoplasia) in HIV-infected African women.Study Design
We conducted an observational study of HIV-seropositive women in Johannesburg, South Africa. The effect of individual HC types on the incidence and progression of cervical disease was determined using Poisson regression to obtain adjusted incidence rate ratios.Results
We evaluated 594 HIV-infected women, with median follow-up time of 445 days; 75 of these women were receiving some form of HC (largely DMPA, NET-EN, or COCs) at baseline. Risks of incidence and progression of cervical disease were similar comparing women not receiving HCs to women receiving DMPA, NET-EN, or COCs both individually by HC-type and considering all HC together.Conclusions
There was no statistically significant effect of particular HC methods or of HC use in general on rates of incidence or progression of cervical disease in this study. These results should reassure us that use of HC is unlikely to substantially increase risks of cervical disease among HIV-positive women. 相似文献19.
Diana Greene Foster Daniel Grossman David K. Turok Jeffrey F. Peipert Linda Prine Courtney A. Schreiber Andrea V. Jackson Rana E. Barar Eleanor Bimla Schwarz 《Contraception》2014
Objectives
In the United States, the popularity of intrauterine devices (IUDs) is low despite many positive attributes such as high effectiveness and ease of use. The requirement that a clinician remove the IUD may limit US women's interest in the method. Our objective was to describe women's experience with self-removal and its effect on attitudes toward the method.Study design
We assessed interest in attempting and success in IUD self-removal among women seeking IUD discontinuation from five US health centers. Women were given the option of attempting self-removal of the IUD. Participants were asked to complete two surveys about their reasons for desiring IUD removal, attitudes toward IUD use and experience with self-removal and/or clinician removal.Results
Three hundred twenty-six racially diverse women participated (mean age, 28 years; body mass index, 27; duration of IUD use, 3 years); more than half were willing to try self-removal [95% confidence interval (CI): 45–65%], and among those who tried, one in five was successful (95% CI: 14–25%). More than half of participants (54%) reported they were more likely to recommend IUD use to a friend now that they know that it might be possible to remove one's own IUD; 6% reported they were less likely to recommend the IUD to a friend. African American women were particularly interested in the option of IUD self-removal.Conclusions
Many women are interested in the concept of IUD self-removal, although relatively few women currently succeed in removing their own IUD.Implications
Health educators, providers and advocates who inform women of this option potentially increase IUD use, reducing rates of undesired pregnancy. 相似文献20.