Contraception RSS feed: Current Issue. The purpose of Contraception is to provide a medium for the rapid communication of advances and new knowledge in all areas of contraception. Manuscripts are received from researchers and clinicians in the following areas of research: chemistry, biochemistry, physiology, endocrinology, biology, the medical sciences, and demography. For more information on the Association of Reproductive Health Professionals (ARHP) visit their web page at: www.arhp.org .http://www.contraceptionjournal.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Contraception0010-7824813March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.contraceptionjournal.org/article/PIIS0010782410000338/abstract?rss=yesEditorial Board10.1016/S0010-7824(10)00033-8Contraception 81, 3 (2010)2010-03-01Contraception2010-03-01813S0010-7824(10)X0002-6iiihttp://www.contraceptionjournal.org/article/PIIS001078241000034X/abstract?rss=yesContents10.1016/S0010-7824(10)00034-XContraception 81, 3 (2010)2010-03-01Contraception2010-03-01813S0010-7824(10)X0002-6iiiivhttp://www.contraceptionjournal.org/article/PIIS0010782409005186/abstract?rss=yesOver the past four decades, the world has made substantial gains in the effort to prevent unplanned pregnancies and reduce the risk of sexually transmitted infections (STIs), including HIV, and other reproductive tract infections (RTIs). Yet, STIs and RTIs still cause a heavy health burden, especially in developing countries, and there is an equally urgent unmet need for contraception .Multipurpose prevention technologies for sexual and reproductive health: gaining momentum and promiseBethany Young Holt, Maggie Kilbourne-Brook, Alan Stone, Polly Harrison, Wayne C. Shields10.1016/j.contraception.2009.11.009Contraception 81, 3 (2010)2010-01-04Contraception2010-01-04813S0010-7824(10)X0002-6Editorial177180http://www.contraceptionjournal.org/article/PIIS0010782409004521/abstract?rss=yesIn June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and program experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable depot-medroxyprogesterone acetate (DMPA). The experts found that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers (CHWs) is safe, effective and acceptable. Such services should be part of a family planning program offering a range of contraceptive methods.Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultationJohn Stanback, Jeff Spieler, Iqbal Shah, William R Finger, The Expanding Access to Injectable Contraceptives Technical Consultation Participants(see Acknowledgments)10.1016/j.contraception.2009.10.006Contraception 81, 3 (2010)2009-12-03Contraception2009-12-03813S0010-7824(10)X0002-6Commentary181184http://www.contraceptionjournal.org/article/PIIS0010782409004454/abstract?rss=yesAbstract: Background: This article is a comprehensive overview of dysmenorrhea and a systematic review of the available literature on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives for the therapy and management of dysmenorrhea.Study Design: A comprehensive search of the PubMed database for clinical trials and observational studies of dysmenorrhea treatments from 2004 onwards.Results: Eighteen publications were identified. Ten randomized controlled trials (RCTs) assessing NSAIDs for treating primary dysmenorrhea demonstrated superior pain relief compared with placebo, but no superiority was established among different NSAIDS. Two RCTs and six nonrandomized observational or prospective studies assessing the effect of hormonal contraceptives on dysmenorrhea strongly suggest a beneficial effect for dysmenorrheic pain relief and were conducted mainly in larger populations (N=41–6169) than those in the NSAID trials (N=10–337). Ethinylestradiol/chlormadinone acetate was the only formulation that provided a more pronounced relief of dysmenorrheic pain compared with a parallel alternative or previously used hormonal contraceptive. Methodological inconsistencies were widespread between the hormonal contraceptive studies.Conclusions: The findings of this review support the use of NSAIDs as a first-line therapy for pain relief from dysmenorrhea in women without wish for contraception. For women who wish contraception, combined oral contraceptives (COCs) are the preferential therapy for pain relief from dysmenorrhea as the additional noncontraceptive benefit of pain relief from dysmenorrhea is not linked to additional risks, eliminates the risks associated with taking NSAIDs and is a more suitable long-term option. Recommendations are made to strengthen the impact of future trials through improved methodology.Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a reviewHans-Peter Zahradnik, Aida Hanjalic-Beck, Klaus Groth10.1016/j.contraception.2009.09.014Contraception 81, 3 (2010)2009-11-09Contraception2009-11-09813S0010-7824(10)X0002-6Review Articles185196http://www.contraceptionjournal.org/article/PIIS0010782409004843/abstract?rss=yesAbstract: Background: Sino-implant (II) is a subdermal contraceptive implant manufactured in China. This two-rod levonorgestrel-releasing implant has the same amount of active ingredient (150 mg levonorgestrel) and mechanism of action as the widely available contraceptive implant Jadelle. We examined randomized controlled trials of Sino-implant (II) for effectiveness and side effects.Study Design: We searched electronic databases for studies of Sino-implant (II) and then restricted our review to randomized controlled trials. The primary outcome of this review was pregnancy.Results: Four randomized trials with a total of 15,943 women assigned to Sino-implant (II) had first-year probabilities of pregnancy ranging from 0.0% to 0.1%. Cumulative probabilities of pregnancy during the 4 years of the product's approved duration of use were 0.9% and 1.06% in the two trials that presented date for 4-year use. Five-year cumulative probabilities of pregnancy ranged from 0.7% to 2.1%. In one trial, the cumulative probability of pregnancy more than doubled during the fifth year (from 0.9% to 2.1%), which may be why the implant is approved for 4 years of use in China. Five-year cumulative probabilities of discontinuation due to menstrual problems ranged from 12.5% to 15.5% for Sino-implant (II).Conclusions: Sino-implant (II) is one of the most effective contraceptives available today. These available clinical data, combined with independent laboratory testing, and the knowledge that 7 million women have used this method since 1994, support the safety and effectiveness of Sino-implant (II). The lower cost of Sino-implant (II) compared with other subdermal implants could improve access to implants in resource-constrained settings.Sino-implant (II) — a levonorgestrel-releasing two-rod implant: systematic review of the randomized controlled trialsMarkus J. Steiner, Laureen M. Lopez, David A. Grimes, Linan Cheng, Jim Shelton, James Trussell, Timothy M.M. Farley, Laneta Dorflinger10.1016/j.contraception.2009.10.013Contraception 81, 3 (2010)2009-12-07Contraception2009-12-07813S0010-7824(10)X0002-6Review Articles197201http://www.contraceptionjournal.org/article/PIIS0010782409004168/abstract?rss=yesAbstract: 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.Epidemiological and clinical aspects of migraine in users of combined oral contraceptivesRogério Bonassi Machado, Alice Pinheiro Pereira, Geórgia Perez Coelho, Larissa Neri, Larissa Martins, Daniele Luminoso10.1016/j.contraception.2009.09.006Contraception 81, 3 (2010)2009-10-21Contraception2009-10-21813S0010-7824(10)X0002-6Original Research Articles202208http://www.contraceptionjournal.org/article/PIIS0010782409004211/abstract?rss=yesAbstract: Background: This study was conducted to compare the effects of the combined contraceptive vaginal ring releasing 15 mcg of ethinylestradiol (EE) and 120 mcg of etonorgestrel daily with the effects of the contraceptive patch, a transdermal system that delivers a daily dose of 20 mcg of EE and 150 mcg of norelgestromin on bone turnover and bone mineral density (BMD) in young fertile women.Study Design: On the basis of a randomized, computer-generated list, 40 women desiring contraception were assigned to a 12-month treatment with a patch delivering a daily dose of 20 mcg of EE and 150 mcg of norelgestromin (Evra®, Janssen-Cilag, Italy) (Group A, n=20) or to a 12-month treatment with a vaginal ring releasing a daily dose of 15 mcg of EE and 120 mcg of etonorgestrel (NuvaRing®, Organon, Italy) (Group B, n=20). Twenty patients underwent no treatment and were used as healthy controls (Group C, n=20). At 3, 6, 9 and 12 months, serum and urinary calcium, osteocalcin and urinary pyridinoline (PYD) and deoxypyridinoline (D-PYD) levels were measured. At baseline and after 12 months, lumbar BMD was determined by dual-energy X-ray absorptiometry.Results: In Groups A and B, urinary PYD and D-PYD at 6, 9 and 12 months were significantly reduced in comparison with basal values and Group C values (p<.05). In Groups A and B, serum calcium levels were significantly increased after 6 months. No significant difference was detected between Group A and Group B in urinary levels of PYD and D-PYD, in calcium levels and in osteocalcin levels. At 12 months, no significant difference was detected in spinal BMD values between the three groups and in comparison with basal values.Conclusion: Both contraceptive systems exert a similar positive influence on bone turnover in young postadolescent women.Effects of the contraceptive patch and the vaginal ring on bone metabolism and bone mineral density: a prospective, controlled, randomized studyMariangela Massaro, Costantino Di Carlo, Virginia Gargano, Carmen Formisano, Giuseppe Bifulco, Carmine Nappi10.1016/j.contraception.2009.09.011Contraception 81, 3 (2010)2009-10-30Contraception2009-10-30813S0010-7824(10)X0002-6Original Research Articles209214http://www.contraceptionjournal.org/article/PIIS0010782409004569/abstract?rss=yesAbstract: Background: The objective of this study was to compare bleeding patterns of women using a contraceptive combination of 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) continuously or cyclically. Menstrual-related symptoms were also evaluated.Study Design: This open, prospective, randomized study evaluated 78 women using the EE/DRSP combination continuously for 168 days or for six 28-day cycles, each followed by a 7-day hormone-free interval. A diary with pre-established scales was used to assess the frequency and intensity of bleeding and menstrual-related symptoms.Results: Amenorrhea increased with continuous use; 62.2% of women with continuous use were amenorrheic at the end of treatment (95% CI: 46.6–77.8%). Dysmenorrhea, headache, acne, nausea, edema and increased appetite improved significantly in the continuous-use group, and mastalgia and edema in the cyclic-use group (p<.05). Six subjects in the continuous-use group (15.4%) and three in the cyclic-use group (7.7%) discontinued due to adverse events.Conclusions: Continuous use was associated with amenorrhea and fewer menstrual-related symptoms compared to cyclic use.Bleeding patterns and menstrual-related symptoms with the continuous use of a contraceptive combination of ethinylestradiol and drospirenone: a randomized studyRogério Bonassi Machado, Nilson Roberto de Melo, Hugo Maia10.1016/j.contraception.2009.10.010Contraception 81, 3 (2010)2009-11-23Contraception2009-11-23813S0010-7824(10)X0002-6Original Research Articles215222http://www.contraceptionjournal.org/article/PIIS0010782409004533/abstract?rss=yesAbstract: Background: Oral contraceptives used for extended periods of time have been extensively studied because of their potential benefits; however, there have been few publications on extended regimens of vaginal contraceptive rings. The aim of this study was to evaluate the clinical symptoms, body weight and blood pressure changes in women using the vaginal ring continuously over a 1-year period.Study Design: This prospective cohort evaluated clinical aspects (dysmenorrhea, headache, breast tenderness, leg pain and irritability), body weight and blood pressure changes in 75 women (18–37 years of age) using a vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily, over a continuous period of 84 days, followed by a 7-day ring-free interval, during 1 year. The chi-square, Wilcoxon and paired t tests were used to analyze differences in the outcomes of interest.Results: Compared to pre-enrollment status, at the end of the study period, the patients reported significantly less dysmenorrhea and irritability, a nonsignificant decrease in breast tenderness, leg pain and headaches. Blood pressure measurements remained unchanged. Although weight and body mass index increased significantly among users, they remained within the expected biological variation range.Conclusion: The vaginal ring used on an extended regimen is a well-tolerated contraceptive method and also offers noncontraceptive benefits.Extended regimens of the contraceptive vaginal ring: evaluation of clinical aspectsFernando Augusto Barreiros, Cristina Aparecida Falbo Guazzelli, Ricardo Barbosa, Francisco de Assis, Fábio Fernando de Araújo10.1016/j.contraception.2009.10.007Contraception 81, 3 (2010)2009-11-16Contraception2009-11-16813S0010-7824(10)X0002-6Original Research Articles223225http://www.contraceptionjournal.org/article/PIIS0010782409004223/abstract?rss=yesAbstract: Background: Use of the levonorgestrel-releasing intrauterine system (LNG-IUS) was compared with thermal balloon ablation (TBA) for the treatment of heavy menstrual bleeding (HMB).Study Design: A prospective randomized trial comparing the LNG-IUS (n=30 women) and TBA (n=28 women).Results: Hemoglobin levels increased (p<.001) and blood loss was reduced (p<.001) in both groups after 1 year of treatment. Menstrual bleeding was less in the LNG-IUS group compared to the TBA group at 6 and 12 months of treatment (p=.035 and p=.048, respectively). Intermenstrual bleeding was significantly less in the TBA group at 6 months compared to the LNG-IUS group (p=.044); however, there was no significant difference at 12 months (p=.129). No difference was found in psychological aspects between pre- and posttreatment variables in either of the groups (p=.537).Conclusions: Both the LNG-IUS and TBA appear to be effective in controlling HMB; however, posttreatment uterine bleeding patterns are different.A randomized prospective trial comparing the levonorgestrel-releasing intrauterine system with thermal balloon ablation for the treatment of heavy menstrual bleedingSérgio S. de Souza, Aroldo F. Camargos, Carolina P. de Rezende, Francisco A.N. Pereira, Cícero A.A. Araújo, Agnaldo L. Silva Filho10.1016/j.contraception.2009.09.012Contraception 81, 3 (2010)2009-10-30Contraception2009-10-30813S0010-7824(10)X0002-6Original Research Articles226231http://www.contraceptionjournal.org/article/PIIS0010782409004570/abstract?rss=yesAbstract: Background: New strategies are needed for preventing HIV infection in women. One potential approach is female-initiated use of an effective topical microbicidal gel in combination with a cervical barrier such as the diaphragm.Study design: Randomized, placebo-controlled safety and feasibility trial of diaphragm with vaginal gel during 6 months of use among 120 HIV-negative sexually active women in Johannesburg, South Africa.Results: Pelvic event rates were 338.3 and 247.1 per 100 women-years in the ACIDFORM gel (plus diaphragm) and K-Y® Jelly (plus diaphragm) groups, respectively, with a rate ratio of 1.37 (95% CI: 0.89–2.11). Most women found diaphragm with gel use acceptable.Conclusion: There was a trend towards more safety events in the ACIDFORM plus diaphragm group, although no primary comparisons achieved statistical significance. Adding an effective microbicidal gel to a mechanical barrier may still prove to be an important and acceptable combination method to help prevent pregnancy and HIV/sexually transmitted infection transmission.Results of a safety and feasibility study of the diaphragm used with ACIDFORM Gel or K-Y® JellyClaire E. von Mollendorf, Lut. Van Damme, Jocelyn A. Moyes, Vera Helen Rees, Marianne M. Callahan, Christine K. Mauck, Adrian J. Puren, Kathryn Tweedy, Doug Taylor10.1016/j.contraception.2009.10.011Contraception 81, 3 (2010)2009-11-23Contraception2009-11-23813S0010-7824(10)X0002-6Original Research Articles232239http://www.contraceptionjournal.org/article/PIIS0010782409004545/abstract?rss=yesAbstract: Background: We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion.Methods: We included all 120 women enrolled in a study of simultaneous oral mifepristone and buccal misoprostol for abortion through 63 days' gestation. Vaginal and abdominal ultrasound examinations were performed before and 24 h after medication administration. Visualization of a gestational sac and embryonic pole and presence or absence of cardiac activity were recorded. Sensitivity and specificity were calculated with the results from vaginal ultrasonography as the gold standard. The effect of body mass index (BMI) on ultrasound findings was also assessed.Results: Before treatment, the sensitivities of abdominal ultrasonography were 100% (95% CI 97–100) and 68% (95% CI 58–77) for presence of a gestational sac and an embryonic pole, respectively. Overall, abdominal imaging underestimated mean gestational age by 1.6 days (95% CI 1.0–2.2). After treatment, abdominal ultrasonography missed three of 34 retained gestational sacs (sensitivity 91%, 95% CI 76–98%). Fourteen women had gestational cardiac activity by vaginal ultrasound at follow-up. Abdominal imaging identified the gestational sac in all cases, but cardiac motion was only visible in 10 (71%, 95% CI 42–92%). For every 10-point increase in BMI, the odds ratio for missing an embryonic pole at baseline was 2.8 (95% CI 1.5–5.0).Conclusions: Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists.A comparison of transabdominal and transvaginal ultrasonography for determination of gestational age and clinical outcomes in women undergoing early medical abortionPatricia A. Lohr, Matthew F. Reeves, Mitchell D. Creinin10.1016/j.contraception.2009.10.008Contraception 81, 3 (2010)2009-11-16Contraception2009-11-16813S0010-7824(10)X0002-6Original Research Articles240244http://www.contraceptionjournal.org/article/PIIS0010782409004508/abstract?rss=yesAbstract: Background: The study was conducted to examine the impact of oral contraceptives (OCs) on serum antimullerian hormone (AMH) levels by obesity status in reproductive-age women.Study Design: Ovulatory women, ages 18–35 years, of normal (<25 kg/m2; n=10) and obese (>30 kg/m2; n=10) body mass index (BMI) received a low-dose OC (20 mcg ethinyl estradiol/100 mcg levonorgestrel) for two cycles. Serum samples obtained at several time points during active pill use and hormone-free intervals were analyzed for AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol and inhibin B.Results: AMH levels did not differ by OC cycle day in either BMI group. On average, AMH levels were 34% lower in the obese group (2.9±2.1 vs. 4.4±1.8 ng/mL, p<.05). Modeling to determine differences in AMH throughout the cycle based on obesity status demonstrated significantly lower levels (p<.05), whereas serum AMH, FSH, LH, estradiol and inhibin B levels revealed no correlations when all time points were included.Conclusions: In reproductive-age women, serum AMH levels do not appear to fluctuate during OC use, but AMH levels are significantly lower in obese women. Lower levels do not appear to be due to differences in gonadotropin levels or ovarian activity.Antimullerian hormone and obesity: insights in oral contraceptive usersAnne Z. Steiner, Frank Z. Stanczyk, Stan Patel, Alison Edelman10.1016/j.contraception.2009.10.004Contraception 81, 3 (2010)2009-11-16Contraception2009-11-16813S0010-7824(10)X0002-6Original Research Articles245248http://www.contraceptionjournal.org/article/PIIS0010782409004855/abstract?rss=yesAbstract: Background: Little is known about psychosocial correlates of different contraceptive methods in adolescence.Study Design: Cross-sectional analyses of 209 postmenarcheal girls [mean age (years)±SD=15.68±1.74], primarily Caucasian (62.8%) or African American (32.8%). Competence (activities and social) and rule-breaking behavior were assessed by the Youth Self Report (YSR; adolescent) and the Child Behavior Checklist (CBCL; parent). Three contraceptive-use groups were created: no hormonal contraceptive (n=142), combined oral contraceptives or the transdermal patch (COCs/patch, n=41), and depot medroxyprogesterone acetate (DMPA, n=20).Results: There was a significant effect of contraceptive-use group on competence (p=.003). The DMPA group had lower competence (CBCL activities and social; YSR social) than the no-hormonal-contraceptive and COCs/patch groups. The COCs/patch group scored lower than the no-hormonal-contraceptive group on YSR activities competence, but was not different from the DMPA group. Lastly, there was an effect of contraceptive-use group on CBCL (but not YSR) rule-breaking behavior (p=.029) with the DMPA group having higher rule-breaking behavior than the other groups.Conclusions: Type of contraceptive method was associated with parent and adolescent's perceived competence. For rule-breaking behavior, parental perception may be more relevant to contraceptive use.Perceived competence and contraceptive use during adolescenceJennifer B. Hillman, Sonya Negriff, Lorah D. Dorn10.1016/j.contraception.2009.11.001Contraception 81, 3 (2010)2009-12-07Contraception2009-12-07813S0010-7824(10)X0002-6Original Research Articles249253http://www.contraceptionjournal.org/article/PIIS0010782409004193/abstract?rss=yesAbstract: Background: Fear of side effects and previous negative experiences are common reasons for contraceptive nonuse.Study Design: We collected information about perceptions of oral contraceptive (OC) safety from 1271 women 18-49 years old in El Paso, TX, and compared their responses to a medical evaluation by a nurse practitioner. We also asked participants about their interest in obtaining OCs over the counter (OTC).Results: Among 794 women potentially at risk of unintended pregnancy, 56.0% said that OCs were medically safe for them. Reasons given for OCs being unsafe were related to fears of side effects and prior negative experiences rather than true contraindications. Older women and participants recruited at the less affluent recruitment site were significantly more likely to report that OCs were medically unsafe for them (p<.05). Nonusers who thought OCs were medically unsafe for them were as likely to be medically eligible for use as current hormonal users. Among nonusers or nonhormonal users and potential OC candidates (n=601), 60.2% said they would be more likely to use OCs if they were available OTC.Conclusions: Women's perception of OC safety does not correlate well with medical eligibility for use. More education about the safety and health benefits of hormonal contraception is needed. OTC availability might contribute to more positive safety perceptions of OCs compared to a prescription environment.Perceptions of the safety of oral contraceptives among a predominantly Latina population in TexasDaniel Grossman, Leticia Fernández, Kristine Hopkins, Jon Amastae, Joseph E. Potter10.1016/j.contraception.2009.09.009Contraception 81, 3 (2010)2009-10-30Contraception2009-10-30813S0010-7824(10)X0002-6Original Research Articles254260http://www.contraceptionjournal.org/article/PIIS0010782409004181/abstract?rss=yesAbstract: Background: Female pelvic actinomycosis may involve fallopian tubes, ovaries, uterus and bladder. This condition is often associated with the use of intrauterine contraceptive devices (IUDs), vaginal pessaries and/or tampons. The predominant causative agent of human actinomycosis is Actinomyces israelii, which has been found on copper IUDs retrieved from patients.Study Design: In this work, a biofilm of A. israelii was developed in vitro on copper surfaces immersed in a simulated uterine fluid under anaerobic conditions. The biofilm was characterized using scanning electron microscopy (SEM), energy dispersive X-ray and atomic force microscopy.Results: The capacity of A. israelii to develop a biofilm over copper surfaces in synthetic media was demonstrated. SEM micrographies illustrate the exopolysaccharides production and bacterial distribution.Conclusion: A. israelii was able to attach and grow in synthetic intrauterine media and to present on the copper surface is likely due to the production of biofilm.In vitro Actinomyces israelii biofilm development on IUD copper surfacesMónica Carrillo, Benjamín Valdez, Lidia Vargas, Lydia Alvarez, Miguel Schorr, Roumen Zlatev, Margarita Stoytcheva10.1016/j.contraception.2009.09.008Contraception 81, 3 (2010)2009-10-30Contraception2009-10-30813S0010-7824(10)X0002-6Original Research Articles261264http://www.contraceptionjournal.org/article/PIIS001078240900451X/abstract?rss=yesWe would like to support and further add to the arguments made by Shannon and Winikoff in their recent letter commenting on the meta-analysis by Lièvre and Sitruk-Ware from which the authors concluded that ‘the substitution of 200 mg [of mifepristone] for 600 mg may lead to an increased continuing pregnancy rate’. We believe that this conclusion is erroneous and that the results of the meta-analysis concerning pregnancy rates are inconclusive. The 95% confidence interval (CI) for the difference in continuing pregnancy rates between the two mifepristone doses was −0.3% to 1.0%, indicating that negative values (200 mg better than 600 mg) as well as positive values (600 mg better than 200 mg) are likely.Is there evidence for tripling the dose of 200 mg mifepristone for medical abortion?Gilda Piaggio, Paul Van Look, Helena von Hertzen, Kristina Gemzell, Oskari Heikinheimo, Allan Templeton10.1016/j.contraception.2009.10.005Contraception 81, 3 (2010)2009-11-16Contraception2009-11-16813S0010-7824(10)X0002-6Letter to the Editor265265