Browsing by Subject "Intrauterine device"

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    Association of Baseline Bleeding Pattern on Amenorrhea with Levonorgestrel Intrauterine System Use
    (Elsevier, 2016-11) MEJIA, Manuela; MCNICHOLAS, Colleen; MADDEN, Tessa; PEIPERT, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
    OBJECTIVE To evaluate the effect of baseline bleeding patterns on rates of amenorrhea reported at 12 months in LNG (levonorgestrel) 52 mg IUS (intrauterine system) users. We also assessed the effect of baseline bleeding patterns at three and six months post-insertion. STUDY DESIGN In this secondary analysis of the Contraceptive CHOICE Project, we included participants who had a LNG-IUS inserted within one month of enrollment and continued use for 12 months. Using 12-month telephone survey data, we defined amenorrhea at 12 months of use as no bleeding or spotting during the previous six months. We used chi-square and multivariable logistic regression to assess the association of baseline bleeding pattern with amenorrhea while controlling for confounding variables. RESULTS Of 1802 continuous 12-month IUS users, amenorrhea was reported by 4.9%, 14.8% and 15.4% of participants at three, six, and 12 months, receptively. Participants with light baseline bleeding or short duration of flow reported higher rates of amenorrhea at three and six months post-insertion (p<0.03), while LNG-IUS users with heavy or prolonged flow were less likely to report amenorrhea at 3 and 6 months (p<0.03). In a multivariable analysis, participants with self-reported heavy bleeding at baseline were less likely to report amenorrhea at 12 months than those who reported moderate bleeding (ORadj, 0.36; 95% CI, 0.16–0.69). CONCLUSION Women with heavier menstrual bleeding are less likely than women with moderate flow to report amenorrhea following 12 months of LNG-IUS use.
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    Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects
    (Dove Press, 2017-03-23) Rafie, Sally; Stone, Rebecca H.; Wilkinson, Tracey A.; Borgelt, Laura M.; El-Ibiary, Shareen Y.; Ragland, Denise; Pediatrics, School of Medicine
    Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.