Browsing by Subject "LARC"

Now showing 1 - 7 of 7
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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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    Comparison of an additional early visit to routine postpartum care on initiation of long-acting reversible contraception: A randomized trial
    (Elsevier, 2018) Bernard, Caitlin; Wan, Leping; Peipert, Jeffrey F.; Madden, Tessa; Obstetrics and Gynecology, School of Medicine
    Objective To investigate whether an early 3-week postpartum visit in addition to the standard 6-week visit increases long-acting reversible contraception (LARC) initiation by 8 weeks postpartum compared to the routine 6-week visit alone. Study design We enrolled pregnant and immediate postpartum women into a prospective randomized, non-blinded trial comparing a single 6-week postpartum visit (routine care) to two visits at 3 and 6 weeks postpartum (intervention), with initiation of contraception at the 3-week visit, if desired. All participants received structured contraceptive counseling. Participants completed surveys in-person at baseline and at the time of each postpartum visit. A sample size of 200 total participants was needed to detect a 2-fold difference in LARC initiation (20% vs. 40%). Results Between May 2016 and March 2017, 200 participants enrolled; outcome data are available for 188. The majority of LARC initiation occurred immediately postpartum (25% of the intervention arm and 27% of the routine care arm). By 8 weeks postpartum, 34% of participants in the intervention arm initiated LARC, compared to 41% in the routine care arm (p=.35). Overall contraceptive initiation by 8 weeks was 83% and 84% in the intervention and routine care arms, respectively (p=.79). There was no difference between the arms in the proportion of women who attended at least one postpartum visit (70% vs. 74%, p=.56). Conclusion The addition of a 3-week postpartum visit to routine care does not increase LARC initiation by 8 weeks postpartum. The majority of LARC users desired immediate rather than interval postpartum initiation.
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    Condom use and incident sexually transmitted infection after initiation of long-acting reversible contraception
    (Elsevier, 2017-12) McNicholas, Colleen P.; Klugman, Jessica B.; Zhao, Qiuhong; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
    Background Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection. Objective The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods. Study Design This is a secondary analysis of the Contraceptive CHOICE Project. We included 2 sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, and 3, 6, and 12 months) (long-acting reversible contraceptive users: N = 2371; other methods: N = 575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: N = 2102; other methods: N = 592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using χ2 tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression. Results Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%; P < .001). There was no difference in change of condom use at 3, 6, and 12 months compared to baseline condom use regardless of method type (P = .65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs 2.0%; P = .03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (odds ratio, 2.0; 95% confidence ratio, 1.07–3.72). Conclusion Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to preinitiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.
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    Dual method use among long-acting reversible contraceptive users
    (Taylor & Francis, 2018-04) Bernard, Caitlin; Zhao, Qiuhong; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of Medicine
    OBJECTIVE: To compare rates of dual method use (concurrent use of condoms and an effective method of contraception) in long-acting reversible contraceptive (LARC) and non-LARC hormonal contraceptive users, and to determine factors associated with dual method use. METHODS: We conducted a secondary analysis of the Contraceptive CHOICE Project, an observational, prospective cohort study of 9256 women in St. Louis, MO, USA. Our sample included 6744 women who initiated a contraceptive method within 3 months of enrollment, continued use at 6 months post-enrollment, and responded regarding dual method use. Our primary outcome was the rate of dual method use at 6 months post-enrollment. RESULTS: Dual method use was reported by 32% of LARC and 45% of non-LARC hormonal contraceptive users (p < .01). After adjusting for other covariates and comparing to non-LARC hormonal contraceptive users, LARC users were less likely to report dual method use (RRadj 0.76, 95% CI 0.70-0.83). Factors associated with dual method use in our multivariable analysis were age <25 years, black race, lower education, single relationship status, baseline dual method use, baseline diagnosis of sexually transmitted infection (STI), greater partner willingness to use a condom, and higher condom self-efficacy score. CONCLUSIONS: LARC users are less likely to report dual method use compared to non-LARC hormonal contraceptive users, but other factors also impact dual method use. Further studies should be performed to determine whether this lower dual method use increases the risk of STI.
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    Long-Acting Reversible Contraception (LARC) Knowledge and Intent to Use among IUPUI Students
    (2019-08) Asdell, Stephanie M.; Bennett, Rachel D.; Cordon, Sabrina A.; Zhao, Qiuhong; Peipert, Jeffrey F.
    BACKGROUND AND HYPOTHESIS: More than 50% of births to women in their early 20s are unintended, and unintended pregnancies have adverse consequences on students’ education. Long-acting reversible contraceptives (LARC), including hormonal and copper intrauterine devices (IUDs) and the contraceptive implant, offer highly-effective, long-term prevention of pregnancy, yet are utilized at low rates. Thus, we sought to assess students’ LARC knowledge and intent to use LARC at Indiana University-Purdue University in Indianapolis (IUPUI) to inform a campus family planning initiative. We hypothesized that students with higher levels of LARC knowledge are more likely to intend to use LARC in the future. We also hypothesized that a lower proportion of students utilize LARC compared to the US rate of 15.8% of all contraceptive users in 2017. EXPERIMENTAL DESIGN AND PROJECT METHODS: We designed a cross-sectional survey for undergraduates, graduate students, and resident physicians assessing sexual experiences, contraceptive use, LARC knowledge, and intent to use LARC. We summarized participants’ characteristics using descriptive statistics, compared awareness of LARC methods using McNemar’s test, and evaluated association between LARC knowledge and future intent to use a LARC method using Fisher exact. RESULTS: Thus far, we have recruited 126 participants with a response rate of 88.7%. Mean score on the 10-question LARC assessment was 5.2/10; higher levels of LARC knowledge were positively associated with future intent to use LARC (P < 0.05). Only 7.9% of contraceptive users surveyed used LARC, compared to 15.8% of US contraceptive users in 2017. Differences in awareness of the copper IUD (61.1%), hormonal IUD (74.6%) and implant (88.9%) were statistically significant (P < 0.05). The most common reason cited for not considering LARC use was “need for more information.” CONCLUSION AND POTENTIAL IMPACT: Low LARC knowledge and use and high desire for LARC education further supports need for a campus contraceptive initiative that will empower students to make informed reproductive decisions.
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    Long-acting reversible contraception knowledge & intent to use among US university students.
    (European Society of Contraception and Reproductive Health, 2020-03) Asdell, Stephanie; Bennett, Rachel; Cordon, Sabrina; Zhao, Qiuhong; Peipert, Jeffrey
    OBJECTIVES: More than 50% of births to women in the United States in their early 20s are unintended, and unintended pregnancies have adverse consequences on students’ education.Long-acting reversible contraceptives (LARC) offer highly-effective, long-term prevention of pregnancy, yet are utilized at low rates. Thus, we sought to assess the level of students’ LARC knowledge and any association with intent to use LARC at a large, urban university in the Midwest United States. We hypothesized that students with higher levels of LARC knowledge would be more likely to intend to use LARC in the future. We also hypothesized that fewer students would use LARC compared to the US rate of 15.8% of all contraceptive users in 2017. Data on student knowledge and attitudes regarding LARC will be used to inform a campus LARC initiative. METHODS: We designed and administered a cross-sectional survey to 300 undergraduates, graduate students, and resident physicians that assessed sexual experiences, contraceptive use, LARC knowledge, and intent to use LARC. The survey was administered at the university’s student center and student health facility in Indianapolis, Indiana. Participants’ demographic characteristics and LARC knowledge were summarized using descriptive statistics. Awareness of different LARC methods was assessed using McNemar’s test. The association between students’ reported LARC knowledge and future intent to use a LARC method was calculated with Fisher’s exact test. RESULTS: Our preliminary analysis includes 126 students. The mean age was 20.2 years. Mean score on the 10-question LARC assessment was 5.2/10. Higher levels of LARC knowledge were positively associated with future intent to use LARC (P < 0.05). Only 7.9% of contraceptive users surveyed used LARC, compared to 15.8% of US contraceptive users in 2017. Differences in awareness of the copper IUD (61.1%), hormonal IUD (74.6%) and implant (88.9%) were statistically significant (P < 0.05). The most common reason cited for not considering LARC use was “need for more information.” Conclusions: University students surveyed displayed low LARC knowledge, low LARC use, and a need for more information on LARC. A positive association between LARC knowledge and future intent to use LARC amongst students at this university further supports need for a campus-wide contraceptive initiative that will empower students to make informed reproductive decisions. Understanding student use and knowledge of LARC could also provide a model for starting other university LARC initiatives across the United States, at which uptake of LARC has been historically low.
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    Long-acting reversible contraception use among residents in obstetrics/gynecology training programs
    (Dove Press, 2017-01-10) Zigler, Rachel E.; Peipert, Jeffrey F.; Zhao, Qiuhong; Maddipati, Ragini; McNicholas, Colleen; Obstetrics and Gynecology, School of Medicine
    Background: The objective of the study was to estimate the personal usage of long-acting reversible contraception (LARC) among obstetrics and gynecology (Ob/Gyn) residents in the United States and compare usage between programs with and without a Ryan Residency Training Program (Ryan Program), an educational program implemented to enhance resident training in family planning. Materials and methods: We performed a web-based, cross-sectional survey to explore contraceptive use among Ob/Gyn residents between November and December 2014. Thirty-two Ob/Gyn programs were invited to participate, and 24 programs (75%) agreed to participate. We divided respondents into two groups based on whether or not their program had a Ryan Program. We excluded male residents without a current female partner as well as residents who were currently pregnant or trying to conceive. We evaluated predictors of LARC use using bivariate analysis and multivariable Poisson regression. Results: Of the 638 residents surveyed, 384 (60.2%) responded to our survey and 351 were eligible for analysis. Of those analyzed, 49.3% (95% confidence interval [CI]: 44.1%, 54.5%) reported current LARC use: 70.0% of residents in Ryan Programs compared to 26.8% in non-Ryan Programs (RRadj 2.14, 95% CI 1.63-2.80). Residents reporting a religious affiliation were less likely to use LARC than those who described themselves as non-religious (RRadj 0.76, 95% CI 0.64-0.92). Of residents reporting LARC use, 91% were using the levonorgestrel intrauterine device. Conclusion: LARC use in this population of women's health specialists is substantially higher than in the general population (49% vs. 12%). Ob/Gyn residents in programs affiliated with the Ryan Program were more likely to use LARC.