Contraception

Editorial Board

2010-02-01

Abortion jabberwocky: the need for better terminology

David A. Grimes, Gretchen Stuart — 2009-10-21

‘Twas brillig, and the slithy toves Did gyre and gimble in the wabe: All mimsy were the borogoves, And the mome raths outgrabe….Lewis CarrollJabberwocky, 1871 The contentious issue of abortion is riddled with jabberwocky…terminology that is contradictory, obsolete, ambiguous and misleading . Both the lay and professional literature uses obstetrical terms improperly, including “abortion.” Recent press coverage of Dr. George Tiller's murder has added to this confusion, with misleading language such as “late-term” abortion .

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

2009-11-13

Abstract: Background: This study was conducted to explore the effect of gestational age (GA) on the induction-to-abortion interval of mifepristone–misoprostol midtrimester termination of pregnancy (TOP) regimen.Study Design: This study involved a consecutive series of 270 pregnancies between 12.0 and 22.6 weeks that have undergone legal TOP from April 2006 to June 2009. All women received a single oral dose of 200 mg mifepristone and, 36–48 h later, a course of misoprostol (an initial vaginal dose of 800 mcg plus four oral doses of 400 mcg at 3-hourly intervals). Treatment was considered to be a failure if abortion did not occur within 24 h. The impact of GA, parity and maternal age on the induction-to-abortion interval was assessed by means of Cox regression.Results: Overall, the mean GA at TOP was 18.0 weeks. The mean induction-to-abortion interval was 9.8 h (SD=8.2 h; range=1–50 h), and 246 women (91%) aborted successfully within 24 h. GA at TOP and parity were the only two variables independently associated with the induction-to-abortion interval. The mean induction-to-abortion interval was increased by about 50% in patients undergoing TOP between 20.0 and 22.6 weeks (12.9 h, SD=8.9), as compared with those at 16.0–19.6 weeks (7.8 h, SD=5.9) and 12.0–15.6 weeks (8.2 h, SD=8.3) (p<.001). The effect of parity on the induction-to-abortion interval was more modest, with a 20% increase in induction-to-abortion interval in nulliparous (10.1 h, SD=9.1), as compared with women with a previous live birth (8.1 h, SD=6.7).Conclusions: The mean induction-to-abortion interval increases by 4 h after 20 weeks GA. This information may be relevant for counseling and planning of the procedure.

Effect of a continuous regimen of contraceptive combination of ethinylestradiol and drospirenone on lipid, carbohydrate and coagulation profiles

2009-10-05

Abstract: Background: The objective of this study was to evaluate the effects of a contraceptive pill containing ethinylestradiol (30 mcg) and drospirenone (3 mg) in a continuous regimen on lipid, carbohydrate and coagulation parameters.Study Design: This open, prospective, randomized study included 78 participants (mean age 27.8 years) who were randomized into two groups to use the pill continuously for 168 days or for six 28-day cycles with a 7-day hormone-free interval between cycles. Markers of lipid, carbohydrate and coagulation profiles were measured prior to initiation and after the 6 months of pill use.Results: No statistically significant differences were found between the two contraceptive regimens with respect to carbohydrate or lipid profiles or in the parameters related to coagulation.Conclusions: The contraceptive combination of ethinylestradiol and drospirenone used in a continuous regimen was associated with metabolic alterations similar to those found during the traditional cyclic regimen of oral contraceptive use.

Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive

2009-12-03

Abstract: Background: Weight gain is a frequent reason for discontinuing the contraceptive with depot-medroxyprogesterone acetate (DMPA).Study Design: This 3-year retrospective cohort study assessed body mass index (BMI; kg/m2) variations in 379 current or past DMPA users compared to TCu380A intrauterine device (IUD) users matched for age and BMI, categorized into G1 (normal weight), G2 (overweight) or G3 (obese) according to baseline BMI. Variations in weight and BMI were evaluated using analysis of variance.Results: BMI increased progressively in all groups but significantly more in G1 and G2 DMPA users compared to nonusers and according to duration of use. In the G3 subgroup, weight trends were similar in the DMPA and IUD users.Conclusions: Normal and overweight women increased BMI with DMPA use; however, obese women did not increase weight. Weight increase in DMPA users could be associated with metabolic alterations related to duration of use in normal and overweight women and to alterations already present in obese women. Prospective studies are required to determine triggering factors. DMPA use ≤3 years was not associated with weight increase in women with BMI (kg/m2) ≥30.

Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes

2009-09-17

Abstract: Background: Many obstacles to intrauterine contraception (IUC) use exist, including provider and patient misinformation, high upfront cost and clinician practice patterns. The aim of our study was to investigate knowledge and attitudes about IUC among obstetricians and gynecologists in the area of Saint Louis.Study Design: We mailed a self-administered, anonymous survey to 250 clinicians who provide obstetric and gynecologic care in Saint Louis City and County which included questions about demographics, training, family planning visits and intrauterine contraceptive knowledge and use.Results: The overall survey response rate among eligible clinicians was 73.7%. Clinicians who had recently finished training or saw higher numbers of contraceptive patients per week were more likely to insert IUC than clinicians who completed training prior to 1989 or saw fewer contraceptive patients. Several misconceptions among clinicians were identified, including an association between intrauterine contraceptives and an elevated risk of pelvic inflammatory disease.Conclusions: Physician misconceptions about the risks of IUC continue to occur. Improved clinician education is greatly needed to facilitate the use of these highly effective, long-acting, reversible methods of contraception.

Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue

2009-09-17

Abstract: Background: The study was conducted to evaluate the cardiovascular risk markers associated with endometriosis and the influence of the levonorgestrel intrauterine system (LNG-IUS) compared with the GnRH analogue (GnRHa) leuprolide acetate on these risk markers after 6 months of treatment.Study Design: This was a randomized, prospective, open clinical study, with 44 patients with laparoscopically and histologically confirmed endometriosis. Patients were randomized into two groups: the LNG-IUS group, composed of 22 patients who underwent LNG-IUS insertion, and the GnRHa group, composed of 22 patients who received a monthly GnRHa injection for 6 months. Body mass index; systolic and diastolic arterial blood pressure; heart rate; and laboratory cardiovascular risk markers such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP), homocysteine (HMC), lipid profile, total leukocytes and vascular cell adhesion molecule (VCAM) were measured before and 6 months after treatment.Results: After 6 months of treatment, a significant reduction in pain score occurred in both groups with no significant difference in improvement between the two medications evaluated. In the LNG-IUS group, from pretreatment to posttreatment period, there was a significant reduction in the levels (mean±SD) of VCAM (92.8±4.2 to 91.2±2.7 ng/mL, p=.04), CRP (0.38±0.30 to 0.28±0.21 mg/dL, p=.03), total cholesterol (247.0±85.0 to 180.0±31.0 mg/dL, p=.0002), triglycerides (118.0± 76.0 to 86.5±41.5 mg/dL, p=.003), low-density lipoprotein cholesterol (160.5±66.0 to 114.5±25.5 mg/dL, p=.0005) and high-density lipoprotein cholesterol (63.0±20.5 to 48.5±10.5 mg/dL, p=.002). The GnRHa group showed an increase in HMC levels (11.5±2.9 to 13.0±2.7 μmol/L, p=.04) and a reduction in IL-6 levels (4.3±3.9 to 2.3±0.8 pg/mL, p=.005), VCAM (94.0±3.8 to 92.0±1.6 ng/mL, p=.03) and total leukocytes (7330±2554 to 6350±1778, p=.01). In the GnRH group, the remaining variables, including lipid profile, did not show any statistical difference.Conclusions: This study shows that some cardiovascular risk markers are influenced by both GnRHa and the LNG-IUS, but the latter had a greater positive impact on the lipid profile, which could lead to a favorable effect during long-term treatment.

Intrauterine contraception for adolescents aged 14–18 years: a multicenter randomized pilot study of Levonorgestrel-releasing intrauterine system compared to the Copper T 380A

2009-10-09

Abstract: Background: Intrauterine contraception can provide adolescents with effective, long-term contraception as well as with other health benefits. In adult populations, intrauterine contraception rates highly in patient satisfaction and safety. It is rarely prescribed to adolescents because of limited data.Study Design: Multicenter, randomized, controlled, participant-blinded pilot study of 14–18-year-old females assigned to the Copper T 380A intrauterine device or the Levonorgestrel Intrauterine System. Participants were followed up for 6 months following insertion.Results: We enrolled 23 participants; 12 received the Levonorgestrel Intrauterine System, and 11 received the Copper T 380A. At 6 months, the continuation rates were 75% for the Levonorgestrel Intrauterine System users and 45% for the Copper T 380A users (p=.15). Two Copper T 380A users experienced partial expulsion. Heavy bleeding and pelvic pain were the most commonly reported side effects. Participants rated both methods favorably.Conclusions: This study shows that at 6 months, though not statistically significant, adolescent continuation rates trended towards being greater with the Levonorgestrel Intrauterine System compared to the Copper T 380A. These pilot data will be helpful in the design of a larger trial of intrauterine contraception use among adolescents.

There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception

Rachel Johnson, Montsine Nshom, Andrea M. Nye, Alwyn T. Cohall — 2009-10-05

Abstract: Background: It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention.Methods: This qualitative study consisted of 18 in-depth interviews and four focus groups (n=29) with adolescents and young adults ages 15 to 21 years, conducted in New York City between August and December 2006.Results: While respondents seemed generally aware of EC's existence, most were unclear about circumstances warranting its use and its mechanism of action. The FDA change to behind-the-counter availability appeared to increase knowledge and access to EC, although substantial barriers to EC access and use remain, including price.Conclusions: Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.

Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica

2009-10-05

Abstract: Background: Emergency contraception research has shifted from examining the public health effects of increasing access to emergency contraceptive pills (ECPs) to bridging ECP users to a regular contraceptive method as a way of decreasing unintended pregnancies.Study design: In a randomized controlled trial in Jamaica, we tested a discount coupon for oral contraceptive pills (OCPs) among pharmacy-based ECP purchasers as an incentive to adopt (i.e., use for at least 2 months) this and other regular contraceptive methods. Women in the intervention and control arms were followed up at 3 and 6 months after ECP purchase to determine whether they adopted the OCP or any other contraceptive method. Condom use was recorded but was not considered a regular contraceptive due to its inconsistent use.Results: There was no significant difference in the proportion of women who adopted the OCP, injectable or intrauterine device in the control group or the intervention group (p=.39), and only 14.6% of the sample (mostly OCP adopters) used one of these three methods. Condom use was high (44.0%), demonstrating that ECP users were largely a condom-using group.Conclusions: The discount coupon intervention was not successful. Although a small proportion of ECP users did bridge, the coupon did not affect the decision to adopt a regular contraceptive method. The study highlighted the need for bridging strategies to consider women's reproductive and sexual behaviors, as well as their context. However, in countries like Jamaica where HIV/AIDS is of concern and condom use is appropriately high, bridging may not be an optimal strategy.

Assessment of a disposable trocar for insertion of contraceptive implants

Markus J. Steiner, Tania Boler, George Obhai, David Hubacher — 2009-10-05

Abstract: Background: Reusable stainless steel trocars have traditionally been used to insert levonorgestrel-releasing contraceptive implants, yet they are cumbersome to maintain because of sterilization requirements. In addition, sterilization equipment is not always available in many settings and inadequate cleaning could lead to HIV transmission.Study Design: A new disposable trocar for two-rod implants [i.e., Sino-implant (II) and Jadelle] was compared to a traditional reusable two-rod trocar. Clinicians in Kenya assessed the trocars in terms of ease of use, malfunctions and adverse events.Results: Eighty insertions were done with the new disposable trocar and 80 insertions were done with the traditional reusable trocar; no differences in performance were found. The disposable trocar was easy to use, did not malfunction and did not cause adverse patient events. These clinical data, combined with the review of the product technical file and an inspection of the manufacturing facility by a Norwegian certification body (Det Norske Veritas), resulted in obtaining the CE Mark, a mandatory conformity mark for the distribution of this medical device in European Union member states.Conclusions: Disposable trocars eliminate the need for sterilization; this will facilitate provision of contraceptive implants in resource-constrained settings and may decrease the risk of HIV transmission. Combined with recent reduction in prices of implants, these new developments should increase access to this important contraceptive technology in many parts of the world.

Feasibility of telephone follow-up after medical abortion

2009-10-05

Abstract: Background: This study was conducted to assess the feasibility of using telephone calls combined with high-sensitivity urine pregnancy testing as a primary method of follow-up after medical abortion.Methods: We enrolled 139 women up to 63 days of gestation to receive mifepristone 200 mg orally and misoprostol 800 mcg vaginally or buccally, per their choice. Participants were contacted by phone one week after mifepristone administration and interviewed using standardized questions. If the subject or clinician thought the pregnancy was not expelled, the subject returned for an ultrasound examination. Otherwise, subjects performed high-sensitivity home urine pregnancy testing 30 days after the mifepristone and were called within 3 days of the test. Those with positive pregnancy tests returned for an ultrasound examination. Those with negative tests required no further follow-up.Results: Six of the 139 (4.3%, 95% CI 1.6–9.1%) subjects presented prior to Phone Call 1 for an in-person visit. All 133 (100%, 95% CI 97.8–100%) subjects eligible for their first telephone follow-up were contacted. Eight of the 133 (6.1%, 95% CI 2.6–11.5%) women were asked to return for evaluation and all did so (100%, 95% CI 63.1–100%). Eight of the 133 women eligible for the 30 day phone call presented for an interim visit prior to the call. After 30 days, 116 of the 117 (99.1%, 95% CI 97.5–100%) eligible subjects were contacted. One subject was not reached for the day 30 phone call. Twenty-seven of the 116 (23.3%, 95% CI 15.6–31.0%) subjects had a positive pregnancy test and required follow-up. Two of these subjects (7.4%, 95% CI 1.0–24.2%) did not return for in-person follow-up. Two of the 116 (1.7%, 95% CI 0.2–6.1%) subjects had inconclusive pregnancy tests and were asked to return for follow-up. One of these subjects (50%, 95% CI 1.2–98.7%) did not return. Complete follow-up was achieved in 135 of the 139 subjects (97.1%, 95% CI 94.3–99.9%). None of the 26 women evaluated for a positive or inconclusive pregnancy test had a gestational sac or continuing pregnancy.Conclusion: Telephone follow-up combined with urine pregnancy testing after medical abortion is a feasible alternative to routine ultrasonography or serial serum hCG measurements.

Early molar pregnancy: experience in a large abortion service

2009-10-05

Abstract: Background: With 1.1 million US women having first-trimester abortions annually, clinicians have an opportunity to diagnose molar pregnancy early. Early moles, however, may lack “classic” diagnostic hallmarks.Study Design: This study aimed to assess the accuracy of the diagnosis of hydatidiform mole in women seeking abortion services at a large Planned Parenthood affiliate. We retrospectively identified women with a histopathologic diagnosis of mole from the affiliate's risk management database. The tissue specimens were reviewed by an expert independent pathologist and analyzed by flow cytometry and p57KIP2 immunohistochemical staining to clarify the diagnosis.Results: Of 21 patients who received an initial histopathologic diagnosis of mole, only six proved to have the condition. The interobserver correlation coefficient (kappa) for pathology examination was (−) 0.353. Overdiagnosis of partial moles was the most common error.Conclusions: Improved, cost-effective strategies for detection of early moles would benefit patients and providers.

The effect of phloroglucinol on pain in first-trimester surgical abortion: a double-blind randomized controlled study

Yaling Zhuang, Xiufang Zhu, Li-Li Huang — 2009-12-03

Abstract: Background: First-trimester surgical abortion is a common procedure. Pain control during this procedure is still an unsolved problem.Study Design: In this randomized, double-blind placebo-controlled study, women presenting for first-trimester surgical abortion received intramuscular phloroglucinol (4 mL) or placebo (normal saline, 4 mL). Visual analog scales (VAS) for pain immediately and 30 min after the procedure and side effects of the drug were recorded.Results: There was no significant difference between groups in the pain level immediately and 30 min after the procedure; 70.7% of the phloroglucinol group (n=58 cases) and 56.9% of the placebo group (n=58 cases ) reported mild pain; 27.6% and 34.5%, respectively, reported moderate pain; and 1.7% and 8.6%, respectively, reported severe pain. Thirty minutes after the procedure, the median pain score was reduced to 1.3 in both groups. Postoperative side effects were reported, but there was no significant difference between groups for nausea or vomiting and blood pressure.Conclusion: The use of this dose of phloroglucinol, during first-trimester abortion by suction evacuation under local anesthesia with lidocaine, did not relieve pain, but caused no side effects.

Buccal misoprostol for cervical ripening prior to first trimester abortion

Hemang B. Panchal, Emily M. Godfrey, Ashlesha Patel — 2009-11-13

Abstract: Background: Cervical priming prior to uterine suction evacuation softens the cervix and lessens the force needed for dilation, thereby potentially reducing the probability of procedural complications. The use of buccal misoprostol has been shown to be an adequate cervical primer in second trimester surgical procedures, but its use in first trimester aspiration procedures is not well documented. Our objective was to assess the necessity of manual dilation of the cervix when buccal misoprostol is used for cervical priming prior to first trimester uterine aspiration procedures.Study Design: Retrospective case review of 685 patients who underwent a first trimester aspiration abortion with buccal misoprostol cervical priming from August 24, 2006, to February 23, 2007. All procedures were performed by three experienced physicians.Results: Adequate dilatation of the cervix was achieved in 44.2% patients. The proportion of patients with adequate dilation decreased with increasing gestational age. Patients requiring additional mechanical dilatation differed significantly between those who were parous (51.0%) and those who were nulliparous (72.4%) (p<.001).Conclusion: Buccal misoprostol appeared to decrease our need for manual dilation prior to first trimester aspiration abortion. Earlier gestations and parous patients showed less need for manual dilitation than later gestations or nulliparous women. A larger study with a control group is needed to confirm the benefit of the use of buccal misoprostol in first trimester aspiration abortion.

Evaluation of the phosphodiesterase 3 inhibitor ORG 9935 as a contraceptive in female macaques: initial trials

Jeffrey T. Jensen, Richard L. Stouffer, Jessica E. Stanley, Mary B. Zelinski — 2009-11-09

Abstract: Background: The study was conducted to determine whether a phosphodiesterase (PDE) 3 inhibitor has potential as a novel contraceptive in primates.Methods: Regularly cycling adult female cynomolgus macaques of proven fertility (n=16) were treated for 7 months with placebo (controls) or the PDE3 inhibitor ORG 9935 as a daily food treat (150 mg/kg) or as a weekly depot injection (150 mg/kg, sc). After 1 month, a male of proven fertility was introduced into each group. Females underwent weekly monitoring of progesterone (P) and ultrasound evaluation for pregnancy if P remained elevated (1.0 ng/mL) >3 weeks. ORG 9935 values were evaluated using high-performance liquid chromatography.Results: Overall, the pregnancy rate in ORG 9935-treated monkeys (4/8, 50%) did not differ from controls (7/8, 88%; p=.5). However, no animal became pregnant in a cycle when the serum level of ORG 9935 exceeded 300 nmol/L. Moreover, two treated monkeys who mated throughout the treatment phase and did not conceive became pregnant within four cycles after stopping ORG 9935. The other two animals were discontinued prematurely from the protocol.Conclusions: These results demonstrate that ORG 9935 may prevent pregnancy in primates at serum concentrations above 300 nmol/L and that the effect is reversible.

Commentary — A historical note on the development of the frameless IUD

Dirk Wildemeersch, Amaury Andrade — 2009-11-16

We would like to make a comment on the article which was published recently: “The frameless copper IUD (GyneFix) and the TCu380A IUD: results of an 8-year multicenter randomized comparative trial” .

Meta-analysis of 200 or 600 mg mifepristone in association with two prostaglandins for termination of early pregnancy

Michel Lièvre, Regine Sitruk-Ware — 2009-11-27

In 2004, Kulier et al. published the first meta-analysis which indicated that reducing the dosage of mifepristone from 600 mg to 200 mg did not change the efficacy of the medical method of termination of pregnancy when mifepristone was used with oral misoprostol or vaginal gemeprost regimens. This publication led to widespread use of 200 mg mifepristone in association with approved and unapproved prostaglandin regimens. The objectives of our study were clearly defined in our paper and our analysis addressed only a more in-depth assessment of the nature of the criteria used to assess efficacy and safety of regimens studied, using the only available studies where head-to-head comparisons were assessed. Shannon and Winikoff claim that “the effectiveness of medical abortion practice has overtaken the probabilities presented.” Randomized clinical trials were precisely designed to overcome the multiple biases that plague the observation of the efficacy and safety of treatments in medical practice. Estimates of complications (including continuing pregnancy) of medical abortion made by the Planned Parenthood Federation of America (PPFA) are based on spontaneous reporting, which is always poised by underreporting for different reasons. One of these reasons is a usually high proportion of lost to follow-up patients. The estimation made by PPFA in 2005 is no exception to this rule, and the authors acknowledged a 31% loss to follow-up rate. They consequently corrected their estimation by reducing the denominator by 31%, so that the rate of complications would be calculated on the followed population. This is incorrect, however, because it supposes that complications occurred in the same proportion in women who failed to or did report to the follow-up visits. This is unlikely, especially as far as continuing pregnancy is considered. Furthermore, the indirect comparison of complication rates observed in different trials using mifepristone at either 200 or 600 mg is observational in nature, even if the data were obtained during randomized trials. Although it can be expected that all adverse events were reported in these trials, selection biases cannot be ruled out.

Caitlin Shannon, Beverly Winikoff — 2009-10-05

We were surprised by the publication of Lievre and Sitruk-Ware's recent meta-analysis, specifically by their assertion that the efficacy of 200 mg vs. 600 mg mifepristone with a prostaglandin for early pregnancy termination is unsettled controversy. The effectiveness of medical abortion practice has overtaken the probabilities presented, primarily because the researched regimens are not those used in current practice. Statistical reviews of clinical trials project an approximation of the “real world.” Tested in the real world of the Planned Parenthood Federation of America (PPFA), in several hundred thousand patients, a regimen of 200 mg mifepristone and 800 mcg vaginal or buccal misoprostol yields success rates that are higher and ongoing pregnancy rates lower than those achieved in the four studies reviewed by Lievre and Sitruk-Ware .

BMI and OCP failure

Susan Richman — 2009-10-09

The article by Burkman et al. adds to the growing body of evidence exonerating obesity as a risk factor for hormonal contraceptive failure. Consistent with the majority of previous case reports and cohort studies, the association between BMI and unintended pregnancy is either nonsignificant or very weak. With most self-reported data, there is no attempt to control for pill compliance. We performed a secondary analysis of a cohort of 2205 women enrolled in a preterm labor study, using the same methodology, examining the obesity question from a slightly different perspective: calculating the time to pregnancy, stratified by BMI, and controlled for confounders such as smoking, exercise, age and race/ethnicity . There was no difference by either BMI category or obese/nonobese dichotomy. Despite its many endocrine perturbations, adipose tissue appears not to affect conception, either desired or undesired.

Response to Letter to the Editor by Susan Richman regarding Burkman RT, et al. Contraception 2009;79:424–7

Ronald T. Burkman — 2009-10-05

I would agree that the risk of hormonal contraceptive failure may be low among obese women, but this is supposition not based on a firm scientific basis. As noted, the literature to date has been conflicting regarding the role of obesity in hormonal contraception failure. Almost all of the published data is from observational studies with their inherent confounding and biases. Most studies are underpowered, including our study, to thoroughly answer the question. The study of Richman , although interesting, is also observational and does not directly address whether hormonal contraceptives with therapeutic levels of steroids are associated with a higher failure rate among obese women. In addition, adding to the confusion is the variation in types of hormones particularly progestins, the various dosages formats, the length of hormone-free periods and the use of progestin without estrogen. As we note in our article , to better answer the question will require a randomized clinical trial with a large sample size. Because of the growing rate of obesity in this country, it is an important question to answer along with whether the risk of serious sequelae is substantially different.

Letter in response to the article “Accuracy of information given by Los Angeles County pharmacies about emergency contraception to sham patient in need”

Belle Taylor-McGhee — 2009-12-07

The recent article titled “Accuracy of information given by Los Angeles County pharmacies about emergency contraception to sham patient in need” raises serious questions about pharmacists' knowledge about emergency contraception (EC) and the consumers' access to timely and accurate information. Yet, it cannot be overstated that the majority of pharmacists who were available to respond to the sham patient's call took time to ensure that accurate information was provided. Clearly, the survey highlights the need for more EC education regarding its use and benefit to women trying to prevent an unintended pregnancy. And as cited in the January/February issue of the Journal of American Pharmacists Association , most US pharmacists view access to contraceptive information as an important health care issue. Still, it is imperative that pharmacists, as well as all medical professionals, have the tools necessary to give women timely and accurate information about EC. The Pacific Institute for Women's Health and Pharmacy Access Partnership have long held that access to EC is not only about education and awareness; it is about cost and availability — a reproductive justice issue that cries out for a recommitment of needed resources from the public health and philanthropic communities.

Letter to the Editor in response to Belle Taylor-McGhee

Anita L. Nelson — 2009-05-12

I want to thank Belle Taylor-McGhee for her comments. However, we do not want to choose between education and of rapid accessibility; our patients need them both. The approval of Plan B without a prescription has definitely increased the potential availability of emergency contraception (EC) to women in need. As a condition of approval for the so-called behind-the-counter status, the FDA required that the manufacturer work closely with pharmacy groups to ensure that their members provided accurate information to potential users. These extensive education efforts have borne fruit. As our survey demonstrated, the vast majority of pharmacies we contacted provided accurate information; some were so deeply concerned about timely patient access to Plan B that they offered to stay open late. However, some of the pharmacy staff (not necessarily the pharmacist themselves) were rude and/or provided misinformation. As clinicians, this work should remind us not to rely on the patient to seek out her EC in her moment of need. We need to continue to educate our patients about their need for EC and to write prescriptions for it in advance of need. As Dr. Taylor-McGhee points out, cost is an important part of the equation. In most cases, women have to pay out-of-pocket for EC when they buy it without a prescription, but often insurance will help defray the cost if it is purchased with a prescription. Of course, another way to solve the huge problem of unplanned/unprepared for pregnancies would be to prescribe to more women the more reliable methods—such as IUDs and implants. But that is another study….

Contraception

Editorial Board

Contents

Abortion jabberwocky: the need for better terminology

Mifepristone–misoprostol midtrimester abortion: impact of gestational age on the induction-to-abortion interval

Effect of a continuous regimen of contraceptive combination of ethinylestradiol and drospirenone on lipid, carbohydrate and coagulation profiles

Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive

Intrauterine contraception in Saint Louis: a survey of obstetrician and gynecologists' knowledge and attitudes

Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue

Intrauterine contraception for adolescents aged 14–18 years: a multicenter randomized pilot study of Levonorgestrel-releasing intrauterine system compared to the Copper T 380A

There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception

Bridging emergency contraceptive pill users to regular contraception: results from a randomized trial in Jamaica

Assessment of a disposable trocar for insertion of contraceptive implants

Feasibility of telephone follow-up after medical abortion

Early molar pregnancy: experience in a large abortion service

The effect of phloroglucinol on pain in first-trimester surgical abortion: a double-blind randomized controlled study

Buccal misoprostol for cervical ripening prior to first trimester abortion

Evaluation of the phosphodiesterase 3 inhibitor ORG 9935 as a contraceptive in female macaques: initial trials

Commentary — A historical note on the development of the frameless IUD

Meta-analysis of 200 or 600 mg mifepristone in association with two prostaglandins for termination of early pregnancy

BMI and OCP failure

Response to Letter to the Editor by Susan Richman regarding Burkman RT, et al. Contraception 2009;79:424–7

Letter in response to the article “Accuracy of information given by Los Angeles County pharmacies about emergency contraception to sham patient in need”

Letter to the Editor in response to Belle Taylor-McGhee