Browsing by Subject "contraception"
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Item Adolescents’ Perceptions of Contraception Access through Pharmacies(MDPI, 2020-03-28) Meredith, Ashley H.; Vahary, Emily B.; Wilkinson, Tracey A.; Meagher, Carolyn G.; Vielott, Thomas; Ott, Mary A.; Pediatrics, School of MedicineAdolescent pregnancy is an important public health issue, and pharmacist prescribing has the potential to expand contraceptive access and decrease unintended pregnancy. However, little is known about acceptability and uptake of pharmacist prescribing among adolescents, particularly among youth in socially and politically conservative regions of the country. The study objective was to identify how young women in Indiana perceive pharmacist contraceptive prescribing. Participants were recruited from clinics and completed a simulated pharmacist contraception-prescribing encounter; a demographic and behavioral questionnaire; and an in-depth qualitative interview focused on adolescent perspectives on pharmacist prescribing. Data were analyzed using thematic analysis. Sixty young women aged 14–21 years (mean age 17.0 ± 1.7 years) completed in-depth interviews. The majority expressed interest in pharmacist contraceptive prescribing (n = 33, 55.9%). Three overarching themes were identified, focusing on accessibility; quality of care; and pharmacist knowledge and youth friendliness. Subthemes highlighted the need for improved confidential access; a desire for additional pharmacist training in contraception; and interactions with a pharmacist that can relate to the young person. Increased awareness of the perceptions of young people can inform state policies and pharmacy protocols. Pharmacists, because of their accessibility, are well poised and equipped to assist in this public health concern.Item Combined Hormonal Contraceptives: The Culprit of Acute Portal Vein Thrombosis(2021-06-10) Ayala Castillo, Crystal; Lugo, Adrian; Lingamurthy, Manjesh; Rascon-Aguilar, IvanOral contraceptive medications are known to increase the risk of developing blood clots. Most commonly, these thrombi are found as deep vein thrombi (DVTs) or pulmonary emboli (PEs). The incidence of portal vein thrombosis is much rarer in patients without comorbidities like liver cirrhosis, malignancies, and hematologic disorders. In this case report, we present the cause of a female's epigastric abdominal pain to stem from portal vein thrombosis while on combination oral contraceptive pills (OCPs). A 34-year-old Caucasian female with a history of hypothyroidism, obesity, and oral contraceptive use presented to the emergency room complaining of epigastric abdominal pain for two days. The pain radiated to her back, and she described it as pressure-like in nature with intermittent episodes of nausea. She reported taking norethindrone-ethinyl estradiol for contraception for several years prior. No history of blood clots in the past. Physical examination was pertinent for tenderness in the epigastric area. Vital signs were stable. A blood pregnancy test was negative. Liver enzymes were within normal limits. A complete abdominal ultrasound was unremarkable. Computerized tomography of the abdomen without contrast revealed left portal vein hyperattenuation which was suggestive for acute portal vein thrombosis (Figure 1). Serological testing performed to rule out inherited thrombophilia were negative (Table 1). The patient was subsequently started on anticoagulation and was discharged hemodynamically stable with close outpatient follow up. Portal vein thrombosis can present acutely or exist in chronic states in a broad array of underlying causes. Risk factors include: liver cirrhosis, malignancy, hematologic disorders, thrombophilia, inflammatory disease, and while on hormonal therapies. In the current literature, the most typical sites to find venous thromboembolisms while on OCPs are in the deep veins of the legs and the pulmonary vasculature. Finding a thrombus in the portal vasculature is rare when there is no associated liver disease. Other contributing factors in our patient were obesity and the presence of hypothyroidism. We believe this case report is noteworthy as it helps clinicians suspect portal vein thrombi in patients that are chronically on OCPs. This will help decrease morbidity and mortality and will help guide future management of birth control, possibly by helping form a guideline for contraceptive use in the setting of unusual thrombus locations.Item Contraception and Ectopic Pregnancy Risk: A Prospective Observational Analysis(Elsevier, 2021-02) Schultheis, Paige; Montoya, Melissa Natalie; Zhao, Qiuhong; Archer, Johanna; Madden, Tessa; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of MedicineItem Contraception Options and Provision to Adolescents(2017-10) Robbins, Cynthia L.; Ott, Mary A.; Department of Pediatrics, School of MedicineAdolescent pregnancy is a significant cause of global morbidity and mortality. Adolescents who become pregnancy have lower educational attainment, are more likely to live in poverty, and have lower wellbeing. Increasing access to hormonal contraceptives and long acting reversible contraception is highly effective in reducing adolescent pregnancies. This narrative review covers key aspects of the provision of contraception to adolescents, including confidentiality, counseling, and data supporting expanded access to adolescents. We provide information for pediatric providers to start adolescent patients on contraceptives, including a detailed description of each method, including effectiveness, use, starting, side effects and benefits. Tools for counseling and prescribing are provided.Item Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study(Elsevier, 2021-08) Peipert, Jeffrey F.; Zhao, Qiuhong; Schreiber, Courtney; Teal, Stephanie; Turok, David K.; Natavio, Melissa; Cordon, Sabrina; Daggy, Joanne; Obstetrics and Gynecology, School of MedicineBackground In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device led to a perception that all intrauterine devices cause upper genital tract infection and infertility. Objective This study aimed to assess the association between intrauterine device use and time to conception. Study Design The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; and Salt Lake City, UT. Women were eligible if they stopped their contraceptive method within the past 120 days before enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were observed longitudinally for up to 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios and their respective 95% confidence intervals. Results Of the 461 participants, mean age was 28.2 years, 178 (38.7%) were Black, 157 (34.1%) were considered as low socioeconomic status, and 275 (59.7%) had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) than participants who never used an intrauterine device (7.5 months). After controlling for potential confounders, the association of past intrauterine device use with time to conception was not statistically significant (adjusted hazard ratio, 1.25; 95% confidence interval, 0.99–1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection were associated with longer times to conception (hazard ratio, 0.76; 95% confidence interval, 0.58–0.99). Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% vs 80% without past infection; P=.019). Conclusion We found no impairment of fertility with ever use of an intrauterine device. Serologic evidence of past Mycoplasma genitalium infection was associated with longer times to conception and higher rates of infertility. Mycoplasma genitalium infection is a potential modifiable cause of infertility.Item Long-Acting Reversible Contraception(2017-02) Curtis, Kathryn M.; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of MedicineThis Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. A 17-year-old high school student who has never been pregnant presents for advice regarding contraception. She has an unremarkable medical history and is planning to become sexually active with her boyfriend in the near future. Her primary concern is an unintended pregnancy, and she inquires about methods of contraception that are highly effective. How would you counsel her about options for contraception?Item 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.Item Long-acting reversible contraception in adolescents: a systematic review and meta-analysis(Elsevier, 2017-04) Diedrich, Justin T.; Klein, David A.; Peipert, Jeffrey F.; Obstetrics and Gynecology, School of MedicineBackground Among adolescent pregnancies, 75% are unintended. Greater use of highly-effective contraception can reduce unintended pregnancy. Although multiple studies discuss adolescent contraceptive use, there is no consensus regarding the use of long-acting reversible contraception as a first-line contraception option. Objective We performed a systematic review of the medical literature to assess the continuation of long-acting reversible contraceptives among adolescents. Study Design Ovid-MEDLINE, Cochrane databases, and Embase databases were searched using key words relevant to the provision of long-acting contraception to adolescents. Articles published from January 2002 through August 2016 were selected for inclusion based on specific key word searches and detailed review of bibliographies. For inclusion, articles must have provided data on method continuation, effectiveness, or satisfaction of at least 1 long-acting reversible contraceptive method in participants <25 years of age. Duration of follow-up had to be ≥6 months. Long-acting reversible contraceptive methods included intrauterine devices and the etonogestrel implant. Only studies in the English language were included. Guidelines, systematic reviews, and clinical reviews were examined for additional citations and relevant points for discussion. Of 1677 articles initially identified, 90 were selected for full review. Of these, 12 articles met criteria for inclusion. All studies selected for full review were extracted by multiple reviewers; inclusion was determined by consensus among authors. For studies with similar outcomes, forest plots of combined effect estimates were created using the random effects model. The meta-analysis of observational studies in epidemiology guidelines were followed. Primary outcomes measured were continuation of method at 12 months, and expulsion rates for intrauterine devices. Results This review included 12 studies, including 6 retrospective cohort studies, 5 prospective observational studies, and 1 randomized controlled trial. The 12 studies included 4886 women age <25 years: 4131 intrauterine device users and 755 implant users. The 12-month continuation of any long-acting reversible contraceptive device was 84.0% (95% confidence interval, 79.0–89.0%). Intrauterine device continuation was 74.0% (95% confidence interval, 61.0–87.0%) and implant continuation was 84% (95% confidence interval, 77.0–91.0%). Among postpartum adolescents, the 12-month long-acting reversible contraceptive continuation rate was 84.0% (95% confidence interval, 71.0–97.0%). The pooled intrauterine device expulsion rate was 8.0% (95% confidence interval, 4.0–11.0%). Conclusion Adolescents and young women have high 12-month continuation of long-acting reversible contraceptive methods. Intrauterine devices and implants should be offered to all adolescents as first-line contraceptive options.Item 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, JeffreyOBJECTIVES: 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.Item Providing Contraception for Young People During a Pandemic is Essential Healthcare(AMA, 2020) Wilkinson, Tracey A.; Kottke, Melissa J.; Berlan, Elise D.; Pediatrics, School of Medicine