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Contraception Across the Reproductive Life-Course
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Emergency contraception, used after unprotected sex to prevent pregnancy, plays an important role. There are two main types of emergency contraceptive pills (aka ‘morning-after’ pills), both of which work by preventing ovulation (Faculty of Sexual & Reproductive Healthcare, 2017c). The copper IUD can also be used to prevent pregnancy if it is inserted within five days of unprotected sex. Emergency contraception is subject to many myths, such as the mistaken belief that it is actually an abortion pill or that it is harmful to health or future fertility. Emergency contraceptive pills are available at pharmacies without a prescription in many countries, and even at supermarkets and vending machines in some high schools, but moral concern that increasing accessibility will lead to reckless sexual behaviour continues to curb its availability across the globe.
Adolescent contraception
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Hanna Goldberg, Jasmine Multani, Sari Kives
Both types of IUCs (LNG-IUS and copper IUD) are highly effective and reversible methods of contraception. Overall contraceptive failure is reported to be 1.26 per 100 women-years for the copper IUD and 0.09 per 100 woman-years for the LNG-IUS.20,21 The mechanism of action for both IUCs includes prevention of fertilization and potential inhibition of implantation.22,23 The copper IUD also affects sperm transport and sperm motility so that fertilization rarely occurs.24–26 The LNG-IUS causes endometrial decidualization and glandular atrophy, and thickening of cervical mucus, which may create a barrier to sperm penetration.27,28 Ovulation may also be suppressed.29,30
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
In the United States, women can choose a hormonal or nonhormonal IUD. TCu380A is the available copper IUD (Paragard), and there are four hormonal IUDs: Mirena, Liletta, Skyla, and Kyleena. Perfect use efficacy and typical use are extremely high for all IUDs, as they are long-acting reversible methods of contraception with little need for patient compliance. The copper IUD was approved for use in 1984. It is a T-shaped polyethylene frame with 380 mm2 of exposed surface consisting of fine copper wire and an attached polyethylene monofilament string. The device is radiopaque and latex free, and clinically significant allergy to copper is very rare. The primary mechanism of action is the release of copper ions that inhibit sperm function, preventing fertilization.47 Experimental evidence suggests that the copper IUD does not routinely work after fertilization.7 Copper IUDs are highly recommended for emergency contraception because they work immediately upon insertion. When inserted within five days of unprotected intercourse or method failure, they are a more successful emergency contraception method than pills. During the first year of use, the pregnancy rate is approximately 0.6%. Cumulative pregnancy rates of 2.5 women per 100 after seven years are expected. Average monthly blood loss increases by up to 50% but may be diminished with regular NSAID use. Dysmenorrhea may also increase with the copper IUD.7 Discontinuation rates are mainly due to increased flow of menses.48
Lactic acid, citric acid, and potassium bitartrate non-hormonal prescription vaginal pH modulator (VPM) gel for the prevention of pregnancy
Published in Expert Review of Clinical Pharmacology, 2022
The current rate of unintended pregnancy, 45% of all pregnancies, is unacceptably high; the addition of new contraceptive methods with various mechanisms of action and available in different formulations has great potential to improve this rate. The majority of effective contraceptive options available in the U.S. contain hormones. While offering highly effective contraception, many women have concerns about using hormonal contraception and desire to avoid previously-experienced or perceived side effects. Additionally, many women have contraindications to use of hormonal contraception due to medical history or smoking. Non-hormonal reversible methods are limited to the copper intrauterine device (IUD), barrier methods, and spermicides. The copper IUD, although highly effective and long-acting, can worsen heavy menstrual bleeding and dysmenorrhea, and requires a clinician for insertion in the uterus, a procedure that is associated with discomfort and which is considered by some to be invasive. Spermicides and barrier methods, while easily accessible over-the-counter and typically requiring little advanced planning, have a higher failure rate, while the increased risk of HIV transmission further limits use of spermicides. Some methods may be difficult to find, such as the female condom or sponge. Other methods such as the IUD, and the conventional fitted and Caya diaphragms and cervical cap require a doctor’s visit and advance planning prior to use.
Contraception in cancer survivors: insights from oncofertility follow-up visits
Published in Gynecological Endocrinology, 2021
Claudia Massarotti, Lorenzo Lo Monaco, Paola Scaruffi, Fausta Sozzi, Valentino Remorgida, Angelo Cagnacci, Paola Anserini
As for hormonal contraception, breast cancer, one of the most common neoplasms of the young woman, poses an absolute contraindication. The ideal method in this cohort is a non-hormonal one, with good efficacy and tolerability, like the copper IUD can be used during and after cancer therapies [21]. In our study, copper IUD was constantly proposed, but only three patients (who reported no pregnancy desire for the future) accepted it. In all the other patients the most common reaction was a strong refusal of more medicalization, followed by fear of collateral effects. Hormonal adjuvant therapy for breast cancer that include also GnRH analogues injections produces a reversible hypophysectomy and therefore has a de facto contraceptive effect, after the initial flare up of the first injection [22]. However, it is not licensed as contraception, therefore, currently most physicians recommend barrier methods or a copper IUD to these patients. The actual need for this recommendation should, in our opinion, be better discussed in the scientific community.
Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights
Published in Sexual and Reproductive Health Matters, 2021
Lucy C Wilson, Kate H Rademacher, Julia Rosenbaum, Rebecca L Callahan, Geeta Nanda, Sarah Fry, Amelia C L Mackenzie
All hormonal contraceptives, as well as the non-hormonal copper-bearing IUD, affect menstruation, with variations in menstrual effects among individuals and within individuals over time. Contraceptive methods can cause changes in bleeding duration, volume, frequency and predictability; they may also affect uterine cramping, pain, mood, and other menstrual cycle symptoms. Combined hormonal methods, including combined oral contraceptives (COCs), generally result in more predictability and lighter bleeding.44 Progestin-only methods, such as implants, injectables, and the LNG IUD, also generally result in a lightening of menstruation. Most users experience spotting and irregular bleeding initially, but such irregularities may reduce over time, and some users may experience a pause in bleeding with these methods.45–47 The copper IUD typically results in heavier periods.48