1.  Title: Expanding access to injectable contraception. Author: Family Health International [FHI] Source: [Unpublished] [2009]. 12 p. Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt) Language: English Keywords: GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 331838 |
| 2. Title: Expanding access to injectable contraceptives. Author: United States. Agency for International Development [USAID] Source: [Washington, D.C.], USAID, [2009]. [2] p. Abstract: A technical consultation, co-sponsored by the World Health Organization (WHO), USAID, and Family Health International (FHI), was held June 15-17, 2009, at the WHO in Geneva to review the evidence and programmatic experience for community-based provision of injectable contraceptives. Thirty technical and program experts from countries and organizations reviewed the scientific evidence and experiences from programs that provided injectable contraceptives through community-based health workers (CHWs). This evidence and programmatic experience came from Africa, Asia, and Latin America and focused on depotmedroxyprogesterone acetate (DMPA). The evidence consistently showed that given appropriate training, CHWs can screen clients effectively, provide DMPA injections safely, and counsel on side effects appropriately, demonstrating competence equivalent to higher level facility-based providers of DMPA. Continuation of use of DMPA by clients of CHWs was as long as those of clients receiving injections at clinics. In addition, the vast majority of clients expressed satisfaction with CHW provision of DMPA. The Consultation concluded that sufficient evidence existed for national policies to support the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives, especially DMPA. Provision of DMPA by CHWs will expand choice for underserved populations and contribute to reducing the unmet need for family planning. Operational guidelines for family planning should therefore reflect that appropriately trained CHWs can safely initiate use of DMPA and provide reinjection. (Excerpt) Language: English Keywords: GLOBAL | SUMMARY REPORT | CONFERENCES AND CONGRESSES | COMMUNITY WORKERS | WHO | INJECTABLES | DEPO-PROVERA | SAFETY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | COUNSELING | FAMILY PLANNING POLICY | Health Personnel | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Public Health | Contraceptive Usage | Training Programs | Education | Clinic Activities | Program Activities | Programs | Organization and Administration | Population Policy | Social Policy | Policy Document Number: 331839 |
| 3. Title: Community-based health workers can safely and effectively administer injectable contraceptives: Conclusions from a technical consultation. Author: World Health Organization [WHO]; United States. Agency for International Development [USAID]; Family Health International [FHI] Source: Research Triangle Park, North Carolina, FHI, 2009. 4 p. Abstract: In June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and programme experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable, depot-medroxyprogesterone acetate (DMPA). The experts found that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers (CHWs) is safe, effective, and acceptable. Such services should be part of a family planning programme offering a range of contraceptive methods. (Excerpt) Language: English Keywords: GLOBAL | CONFERENCES AND CONGRESSES | COMMUNITY WORKERS | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | MONITORING | FAMILY PLANNING POLICY | Health Personnel | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Contraceptive Usage | Training Programs | Education | Evaluation | Population Policy | Social Policy | Policy Document Number: 331834 |
4.  Peer Reviewed Title: Bone mineral density in a cohort of adolescents during use of norethisterone enanthate, depot-medroxyprogesterone acetate or combined oral contraceptives and after discontinuation of norethisterone enanthate. Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM Source: Contraception. 2009 May;79(5):345-9. Abstract: BACKGROUND: Depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and combined oral contraceptives (COCs) have been shown to have a negative effect on bone mineral density (BMD) in adolescents. The aim of this study was to investigate BMD in 15- to 19-year-old new users of DMPA, NET-EN and COCs. STUDY DESIGN: This 5-year longitudinal study followed up new users of DMPA (n=115), NET-EN (n=115) and COCs (n=116) and 144 nonuser controls. BMD was measured at the distal radius using dual-energy X-ray absorptiometry. RESULTS: BMD increased in all groups (annual percent increase: nonusers, 1.49%; DMPA, 1.39%; NET-EN, 1.03%; COCs, 0.84%) during follow-up (p<.001). There was evidence for lower BMD increases per annum in NET-EN (p=.050) and COC (p=.010) users compared to nonusers but no difference between DMPA and nonusers (p=.76). In 14 NET-EN discontinuers, an overall reduction of 0.61% per year BMD was followed upon cessation by an increase of 0.69% per year (p=.066). CONCLUSION: This study suggests that BMD increases in adolescents may be less in NET-EN and COC users; however, recovery of BMD in NET-EN users was found in the small sample of adolescents followed post-discontinuation. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | COMPARATIVE STUDIES | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | SKELETAL EFFECTS | CONTRACEPTION TERMINATION | NORETHINDRONE ENANTHATE | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Physiology | Biology | Contraception | Family Planning | Norethindrone | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Medroxyprogesterone Acetate | Oral Contraceptives | Contraceptive Methods | Safety | Public Health | Health Document Number: 330938 |
| 5. Peer Reviewed Title: Bone mineral density in young women aged 19-24 after 4-5 years of exclusive and mixed use of hormonal contraception. Author: Beksinska ME; Kleinschmidt I; Smit JA; Farley TM; Rees HV Source: Contraception. 2009 Aug;80(2):128-32. Abstract: BACKGROUND: Use of depot-medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN) and low-dose combined oral contraceptives (COCs) has been associated with loss of bone mineral density (BMD) in adolescents. However, the effect of using a combination of these methods over time in this age group is limited. The aim of this cross-sectional study was to investigate BMD in young women (aged 19-24 years) with a history of mixed hormonal contraceptive use. STUDY DESIGN: BMD was measured at the spine, hip and femoral neck using dual X-ray absorptiometry. Women were classified into three groups: (1) injectable users (DMPA, NET-EN or both) (n=40), (2) mixed COC and injectable users (n=13) and (3) non-user control (n=41). RESULTS: Women in the injectables-only user group were found to have lower BMDs compared to the non-user group at all three sites, and there was evidence of a difference in BMD between these two groups at the spine after adjusting for body mass index (p=.042), hip (p=.025) and femoral neck (p=.023). The mixed COC/injectable user group BMD values were lower than those for controls; however, there was no evidence of a significant difference between this group and the non-user group at any of the three sites. CONCLUSION: This study suggests that BMD is lower in long-term injectable users but not when women have mixed injectable and COC use. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | WOMEN | YOUTH | INJECTABLES | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, SIDE EFFECTS | SKELETAL EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | Age Factors | Population Characteristics | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Oral Contraceptives | Physiology | Biology Document Number: 342307 |
| 6. Peer Reviewed Title: Contraceptive failure with Depo-Provera® [letter] Author: Bhathena R Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):130. Abstract: I have a concern regarding the recent case report where a 28-year-old woman was given a subsequent (second) injection of Depo-Provera® by a practice nurse when she attended after 13 weeks, and when no precautions were advised, nor documentation done. The patient subsequently again reported with a positive pregnancy test and opted for a termination of pregnancy. My personal feeling is that although by and large consultation times are often too short for practising doctors to cover all aspects of counselling at all times, when a patient is using a contraceptive method outside the terms of the product licence, to ensure that optimal service is offered and also in view of the remote possibility of litigation following failure of the method, it should be mandatory for the practising doctor to also get involved and appropriately counsel, and to adequately document such an episode. (full-text) Language: English Keywords: INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PHYSICIANS | NURSES AND NURSING | DEPO-PROVERA | CONTRACEPTION FAILURE | ABORTION | REFERRAL AND CONSULTATION | COUNSELING | TIME FACTORS | FAMILY PLANNING EDUCATION | Asia, Southern | Asia | Developing Countries | Research Methodology | Studies | Economic Development | Economic Factors | Health Personnel | Delivery of Health Care | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Usage | Fertility Control, Postconception | Program Activities | Programs | Organization and Administration | Clinic Activities | Population Dynamics | Demographic Factors | Population | Education Document Number: 330946 Notification |
| 7. Peer Reviewed Title: A longitudinal comparison of body composition changes in adolescent girls receiving hormonal contraception. Author: Bonny AE; Secic M; Cromer BA Source: Journal of Adolescent Health. 2009 Oct;45(4):423-5. Abstract: The objective of this study was to examine body composition changes in adolescent girls initiating depot medroxyprogesterone acetate (DMPA), oral contraceptives, or no hormonal contraceptive method. At 6 months, DMPA resulted in significant increases in adiposity with concomitant decreases in lean body mass. Supplemental estrogen may lessen these DMPA effects. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | LONGITUDINAL STUDIES | CONTROL GROUPS | ADOLESCENTS, FEMALE | DEPO-PROVERA | ORAL CONTRACEPTIVES | BODY WEIGHT | OBESITY | ESTROGENS | Developed Countries | North America | Americas | Studies | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Physiology | Biology | Hormones | Endocrine System Document Number: 342847 |
| 8. Peer Reviewed Title: Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review. Author: Culwell KR; Curtis KM Source: Contraception. 2009 Oct;80(4):337-45. Abstract: BACKGROUND: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use. STUDY DESIGN: We conducted a systematic review of the literature regarding use of contraceptive methods in women with current VTE on anticoagulant therapy. Due to the limited direct evidence that was identified, we expanded our search to include women on anticoagulant therapy for indications other than VTE and women with bleeding disorders. RESULTS: Six articles met our inclusion criteria. Three observational studies found the levonorgestrel-releasing IUD (LNG-IUD) was an effective treatment for menorrhagia for women on anticoagulation therapy or with bleeding disorders. Prevention of recurrent hemorrhagic ovarian cysts was seen in women on chronic anticoagulation treated with depot-medroxyprogesterone acetate (DMPA) in one small observational study. Among women with bleeding disorders, no complications were seen in 16 women with placement of the LNG-IUD. One pharmacokinetic study found no statistically significant interaction between combined oral contraceptives and warfarin. Other than one case report, no evidence was found regarding the risk of recurrent thrombosis in women on anticoagulation therapy using a contraceptive method. CONCLUSION: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management. Language: English Keywords: GLOBAL | LITERATURE REVIEW | THROMBOSIS | COMPLICATIONS | DRUGS | IUD, HORMONE RELEASING | IUD SIDE EFFECTS | INSERTION | DEPO-PROVERA | BLOOD COAGULATION EFFECTS | HEREDITARY DISEASES | MENSTRUATION DISORDERS | CONTRACEPTIVE SAFETY | Thromboembolism | Embolism | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hematological Effects | Hemic System | Physiology | Biology | Safety | Public Health Document Number: 342773 |
| 9. Peer Reviewed Title: Progestogen-only contraceptive use in obese women. Author: Curtis KM; Ravi A; Gaffield ML Source: Contraception. 2009 Oct;80(4):346-54. Abstract: BACKGROUND: The objective of this systematic review is to determine whether obese women who use progestogen-only contraceptives are more likely to experience weight gain or serious adverse events as compared to nonobese users. STUDY DESIGN: We searched PubMed for all articles (in all languages) published in peer-reviewed journals from database inception through October 2008, for evidence relevant to obesity and progestogen-only contraceptives. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. RESULTS: From 579 articles, we identified nine studies fitting our selection criteria. Evidence from five studies suggests that among adult women, baseline weight or body mass index is not associated with weight gain among depot medroxyprogesterone acetate (DMPA) users (Level II-2, Fair). Evidence from three studies suggests that among adolescent women, overweight or obese DMPA users may gain more weight than normal weight DMPA users or overweight/obese nonusers (Level II-2, Fair). Evidence from one small study of Norplant users showed no differences in weight gain by baseline weight (Level II-3, Poor). We did not identify studies of other progestogen-only contraceptive methods that examined weight change by baseline weight, nor did we identify studies that reported on any serious adverse events by baseline weight. CONCLUSIONS: Adolescent DMPA users who are obese may gain more weight than normal weight users. This observation was not seen in adult DMPA users or adolescent Norplant users. Language: English Keywords: GLOBAL | LITERATURE REVIEW | ADULTS | ADOLESCENTS, FEMALE | CONTRACEPTIVE AGENTS, PROGESTIN | PROGESTERONE | DEPO-PROVERA | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | OBESITY | BODY WEIGHT | Age Factors | Population Characteristics | Demographic Factors | Population | Adolescents | Youth | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Progestational Hormones | Hormones | Endocrine System | Physiology | Biology | Medroxyprogesterone Acetate | Contraceptive Methods Document Number: 342772 |
| 10. Peer Reviewed Title: Contraceptive failure of Depo-Provera®: long-acting reversible contraceptive (LARC) methods do fail too. Author: Farmer L; Patel E Source: Journal of Family Planning and Reproductive Health Care. 2009 Jan;35(1):59-60. Abstract: This article reports on a case report of a 28-year-old woman, gravida 4 para 1, presenting to primary care for contraception. She opted for Depo-Provera. The patient re-presented with symptoms of nausea 6 weeks following her second Depo-Provera injection. A pregnancy test was positive. A dating ultrasound scan was arranged. This took place 7 weeks after her second Depo-Provera injection and showed a viable pregnancy at 9 weeks 2 days estimated gestation, indicating that conception would have occurred around the time of the second injection. The patient opted for a termination of pregnancy and had a copper-bearing intrauterine device fitted at the time of abortion. Language: English Keywords: UNITED KINGDOM | SUMMARY REPORT | CASE STUDIES | CONTRACEPTION FAILURE | DEPO-PROVERA | PREGNANCY | ADMINISTRATION AND DOSAGE | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Contraceptive Usage | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Reproduction | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 329635 |
| 11. Title: Effect of Depot Medroxyprogesterone Acetate (DMPA) on bone mineral density in women of reproductive age Author: Gai L; Zhang JL; Zhang HZ; Gai P; Liu YH Source: Journal of Reproduction and Contraception. 2009 Mar;20(1):51-56. Abstract: Objective To compare bone mineral density (BMD) between users of intramuscular depot medroxyprogesterone acetate (DMPA) and nonhormonal control subjects. Methods The study included 68 women aged between 25 and 40 years using depot medroxyprogesterone acetate for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results At 24 months of treatment, as compared with baseline, the mean BMD in lumbar spine and femoral neck was decreased by 5.5% and 5.9%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA were significantly decreased compared with the subjects in nonuser (P<0.001). Conclusion These results show BMD declined during using DMPA in women aged 25-40 years old. Language: English Keywords: CHINA | RESEARCH REPORT | CONTROL GROUPS | WOMEN | DEPO-PROVERA | REPRODUCTIVE AGE | SKELETAL EFFECTS | OSTEOPOROSIS | Asia, Eastern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Reproduction | Physiology | Biology Document Number: 341511 |
| 12. Peer Reviewed Title: Depo-Provera and skeletal health: reviewing the evidence; developing and disseminating a consensus [editorial] Author: Guilbert ER; Kaunitz AM Source: Contraception. 2009 Mar;79(3):165-6. Abstract: Since the approval of injectable medroxyprogesterone acetate (DMPA, Depo-Provera®) in the United States in 1992 and Canada in 1997 and the subsequent "black box" warnings in both countries, DMPA has been the object of more than a hundred publications, including many focusing on its impact on bone mineral density. Apart from these scientific publications, articles in the Canadian lay media have raised concerns, potentially influencing clinician behavior and women's contraceptive choices and usage. (excerpt) Language: English Keywords: CANADA | CRITIQUE | RECOMMENDATIONS | CLINICAL RESEARCH | WOMEN | PHYSICIANS | DEPO-PROVERA | INJECTABLES | CONTRACEPTIVE PREVALENCE | COUNSELING | FAMILY PLANNING POLICY | SKELETAL EFFECTS | PEER REVIEW | OSTEOPOROSIS | Developed Countries | North America, Northern | Americas | Research Methodology | Demographic Factors | Population | Health Personnel | Delivery of Health Care | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Contraceptive Usage | Clinic Activities | Program Activities | Programs | Organization and Administration | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Physiology | Biology | Evaluation Document Number: 341130 |
| 13. Peer Reviewed Title: Depot-medroxyprogesterone acetate and combined oral contraceptive use and cervical neoplasia among women with oncogenic human papillomavirus infection. Author: Harris TG; Miller L; Kulasingam SL; Feng Q; Kiviat NB; Schwartz SM; Koutsky LA Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):489.e1-8. Abstract: OBJECTIVE: The objective of the study was to examine the relationship of depot-medroxyprogesterone acetate (DMPA) and combined oral contraceptive (COC) use with cervical intraepithelial neoplasia (CIN). STUDY DESIGN: Two case-control studies of women who presented for gynecologic care and underwent cytologic and human papillomavirus (HPV) testing were performed. The first included oncogenic HPV-positive women grouped based on histology: negative (n = 152), CIN1 (n = 133), and CIN2-3 or greater (n = 173). For the second, 2 groups were identified: negative HPV/negative histology (n = 107) and positive oncogenic HPV/negative histology (n = 152). RESULTS: Among oncogenic HPV-positive women, DMPA use was inversely associated with CIN2-3 or greater (adjusted odds ratio [OR(adj)], 0.4; 95% confidence interval [CI], 0.2-1.1) and CIN1 (OR(adj), 0.1; 95% CI, 0.01-0.6); COC use was not associated with either. Among histologically negative women, DMPA use was associated with oncogenic HPV (OR(adj), 4.7; 95% CI, 1.4-15.8). CONCLUSION: Among women with oncogenic HPV, hormonal contraceptive use was not associated with an increased risk of CIN2-3 or greater. Longer-term DMPA use may attenuate the colposcopic and histologic features of CIN because women reporting such use were more likely than others to have cervical oncogenic HPV without evidence of CIN. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | WOMEN | PREVALENCE | HPV | CERVICAL CANCER | RISK FACTORS | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | RISK ASSESSMENT | COLPOSCOPY | HISTOLOGY | Developed Countries | North America | Americas | Research Methodology | Studies | Demographic Factors | Population | Measurement | Viral Diseases | Diseases | Cancer | Neoplasms | Health | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods | Evaluation | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Biology Document Number: 331078 |
| 14. Peer Reviewed Title: Menstrual pattern changes from levonorgestrel subdermal implants and DMPA: systematic review and evidence-based comparisons. Author: Hubacher D; Lopez L; Steiner MJ; Dorflinger L Source: Contraception. 2009 Aug;80(2):113-8. Abstract: BACKGROUND: Many women want a lengthy duration of contraception but are wary of the menstrual changes from depot medroxyprogesterone acetate (DMPA). A subdermal levonorgestrel (LNG) implant may be a reasonable alternative. However, information on menstrual changes from these methods has not been summarized and compared in an easy-to-understand form. STUDY DESIGN: We systematically reviewed the published literature on these contraceptives to find research that used menstrual diaries and standard World Health Organization definitions. We attempted to find information on amenorrhea, number of bleeding or spotting episodes, number of bleeding or spotting days and normal patterns, as reported in four consecutive 90-day reference periods. RESULTS: We found 16 published articles meeting our criteria and involving diaries of up to 1600 DMPA users and 2300 LNG implant users. We were able to compare the two methods on only three outcomes. For DMPA use, the weighted prevalence of amenorrhea at successive 90-day periods was 12%, 25%, 37% and 46%. The comparable estimates for the LNG implant were 11%, 13%, 9% and 13%. Levonorgestrel implant users experienced a higher average number of bleeding or spotting days compared to DMPA users, but this average was similar to what is expected naturally. At 12 months, normal menstrual patterns were experienced by 23% of LNG implant users compared to 11% of DMPA users. CONCLUSIONS: Like most hormonal contraception, LNG implants usually produce menstrual changes; however, the changes do not appear to deviate from normal patterns as much as the changes from DMPA. Understanding these differences and other method attributes might help women make an informed choice about which contraceptive to use. Language: English Keywords: GLOBAL | LITERATURE REVIEW | COMPARATIVE STUDIES | CONTRACEPTIVE IMPLANTS | LEVONORGESTREL | DEPO-PROVERA | CONTRACEPTIVE AGENTS, SIDE EFFECTS | MENSTRUATION DISORDERS | AMENORRHEA | Studies | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Medroxyprogesterone Acetate | Diseases Document Number: 342394 |
| 15. Title: The effects of hormonal contraception. Author: Kent A Source: Reviews In Obstetrics and Gynecology. 2009 Winter;2(1):66. Abstract: There are many claims made about the beneficial effects of hormonal contraceptives other than their ability to prevent pregnancy. Studies have tracked women's responses to oral contraceptives (OCs) or depot medroxyprogesterone acetate (DMPA), but few have taken into account the woman's entry status or baseline symptoms, and fewer still have looked at control groups on nonhormonal contraception. Another problem has been the duration of follow-up, which should be longer than 1 year to properly assess the steady state of a changed hormonal environment. A study by Berenson and colleagues deals with the issues of baseline status and prolonged use in a series of women using injectable DMPA and low-dose OCs (typically 20 microg estrogen-containing pills). The first important finding was that symptoms are common in the absence of contraceptive use, such as acne, cyclical mastalgia, cramping, and mood swings. They found these symptoms improved on sustained use of OCs compared with control groups, and therewas no evidence that depression was a problem, despite lowered mood being a commonly quoted negative effect among those prescribing OCs. The most frequent side effect was intermenstrual bleeding with OCs and an increased risk of bleeding for more than 20 days, amenorrhea, weight gain, and loss of energy and libido on DMPA. Most of these effects resolved after 6 months and almost all resolved by 12 months, with amenorrheaic women often welcoming the side effect. Finally, the researchers found that women were not clearly informed of the potential side effects, or of their resolution with ongoing use. They recommend careful counseling about what to expect and more frequent follow-up after initiation to provide reassurance or a change to another method if required. (full-text) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | INJECTABLES | PSYCHOLOGICAL FACTORS | PHYSIOLOGY | CONTRACEPTIVE AGENTS, SIDE EFFECTS | DEPO-PROVERA | ORAL CONTRACEPTIVES, LOW-DOSE | CONTRACEPTIVE AGENTS, ESTROGEN | METRORRHAGIA | ADMINISTRATION AND DOSAGE | BREAST CANCER | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Contraceptive Methods | Contraception | Family Planning | Behavior | Biology | Contraceptive Agents | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Oral Contraceptives | Bleeding | Signs and Symptoms | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Cancer | Neoplasms Document Number: 331284 |
| 16. Title: Hormonal contraception and bone mineral density. Author: Kent A Source: Reviews In Obstetrics and Gynecology. 2009 Winter;2(1):66-7. Abstract: Hormonal contraceptives negatively affect bone mass density (BMD), but the effect is small and reversible. Low-dose OCs in young women are associated with less than 0.5% BMD loss in the hip and spine. Berenson and colleagues also looked at BMD changes with DMPA and found up to a 5% loss. This is potentially significant in young women. They discovered that the effect was temporary and those who stopped using DMPA gained BMD at about 2.5% per year. Overall, the benefits of hormonal contraception far outweigh the risks. (full-text) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | DEPO-PROVERA | SKELETAL EFFECTS | OSTEOPOROSIS | ORAL CONTRACEPTIVES, LOW-DOSE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Physiology | Biology | Oral Contraceptives | Contraceptive Methods Document Number: 331285 |
| 17. Peer Reviewed Title: Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women. Author: Lizarelli PM; Martins WP; Vieira CS; Soares GM; Franceschini SA; Ferriani RA; Patta MC Source: Contraception. 2009 Jan;79(1):35-40. Abstract: BACKGROUND: The study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function. STUDY DESIGN: The study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile. RESULTS: A significant difference in FMD was observed between the COC and control groups (6.4+/-2.2% vs. 8.7+/-3.4%, p<.01) and between the DMPA and control groups (6.2+/-2.1% vs. 8.7+/-3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-densitylipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9+/-21.5 mg/dL vs. controls=167.1+/-29.2 mg/dL vs. COC=168.2+/-37.5, p=.001; LDL-C: DMPA=85.3+/-20.1 mg/dL vs. controls=102+/-24.5 mg/dL vs. COC=106.7+/-33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4+/-14.1 mg/dL vs. DMPA=42.2+/-7.2 mg/dL vs. COC=45.4+/-9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables. CONCLUSIONS: FMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction. Language: English Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | CASE CONTROL STUDIES | EVALUATION INDEXES | WOMEN IN DEVELOPMENT | ORAL CONTRACEPTIVES, COMBINED | DEPO-PROVERA | SIDE EFFECTS | HEALTH STATUS INDEXES | CHOLESTEROL | ADMINISTRATION AND DOSAGE | BLOOD PRESSURE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Economic Development | Economic Factors | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Lipids | Physiology | Biology | Drugs | Hemic System Document Number: 330537 |
| 18. Title: Steroidal contraceptives: effect on bone fractures in women. Author: Lopez LM; Grimes DA; Schulz KF; Curtis KM Source: Cochrane Database of Systematic Reviews. 2009;(2):CD006033. Abstract: BACKGROUND: Steroidal contraceptive use has been associated with changes in bone mineral density in women. Whether such changes increase the risk of fractures later in life is not clear. However, osteoporosis is a major public health concern. Age-related decline in bone mass increases the risk of fracture, especially of the spine, hip, and wrist. Concern about bone health influences the recommendation and use of these effective contraceptives globally. OBJECTIVES: To evaluate the effect of using hormonal contraceptives before menopause on the risk of fracture in women SEARCH STRATEGY: We searched for studies of fracture or bone health and hormonal contraceptives in MEDLINE, POPLINE, CENTRAL, EMBASE, and LILACS, as well as in clinical trials databases (ClinicalTrials.gov and ICTRP). We wrote to investigators to find additional trials. SELECTION CRITERIA: Randomized controlled trials were considered if they examined fractures, bone mineral density (BMD), or bone turnover in women with hormonal contraceptive use prior to menopause. Studies were excluded if hormones were provided for treatment of a specific condition rather than for contraception. Interventions could include comparisons of a hormonal contraceptive with a placebo or with another hormonal contraceptive. Interventions could also include the provision of a supplement versus a placebo. DATA COLLECTION AND ANALYSIS: We assessed for inclusion all titles and abstracts identified through the literature searches with no language limitation. The mean difference was computed with 95% confidence interval (CI) using a fixed-effect model. MAIN RESULTS: We found 13 RCTs, 2 of which used a placebo. No trial had fracture as an outcome but most measured BMD. Combination contraceptives did not appear to affect bone health. Of progestin-only methods, depot medroxyprogesterone acetate (DMPA) was associated with decreased bone mineral density, while results were inconsistent for implants. The two placebo-controlled trials showed BMD increases for DMPA plus estrogen supplement and decreases for DMPA plus placebo. AUTHORS' CONCLUSIONS: Whether steroidal contraceptives influence fracture risk cannot be determined from existing information. Due to different interventions, no trials could be combined for meta-analysis. Many trials had small numbers of participants and some had large losses to follow up. Health care providers and women should consider the costs and benefits of these effective contraceptives. For example, injectable contraceptives and implants provide effective, long-term birth control yet do not involve a daily regimen. Progestin-only contraceptives are considered appropriate for women who should avoid estrogen due to medical conditions. Language: English Keywords: LITERATURE REVIEW | CLINICAL TRIALS | WOMEN | SKELETAL EFFECTS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | HORMONES | ACCIDENTS AND INJURIES | OSTEOPOROSIS | CONTRACEPTIVE AGENTS, PROGESTIN | DEPO-PROVERA | CONTRACEPTIVE IMPLANTS | CONTRACEPTIVE AGENTS, ESTROGEN | Clinical Research | Research Methodology | Demographic Factors | Population | Physiology | Biology | Contraceptive Agents | Contraception | Family Planning | Endocrine System | Health | Contraceptive Agents, Female | Medroxyprogesterone Acetate | Contraceptive Methods Document Number: 330973 |
| 19. Peer Reviewed Title: Rates of follow-up and repeat pregnancy in the 12 months after first-trimester induced abortion. Author: Madden T; Westhoff C Source: Obstetrics and Gynecology. 2009 Mar;113(3):663-8. Abstract: OBJECTIVE: To estimate the proportion of women who returned for a routine follow-up visit after elective abortion and to identify factors associated with repeat pregnancy in the subsequent year. METHODS: We performed a historical cohort study of 865 women who underwent first-trimester surgical abortion at a hospital-based family planning clinic between March 2003 and February 2004. We collected demographic and clinical data from procedure notes and a computerized hospital patient database. We used univariable and multivariable logistic regression to analyze associations between patient characteristics and repeat pregnancy within 1 year. RESULTS: There were a total of 865 women in our cohort. Of these, 753 (87%) returned to the medical center for care; 485 women returned on time, 268 women returned late, and 112 had no further visit. There were 161 repeat pregnancies; 87 (17.9%) in the on-time group and 74 (27.6%) in the late group (P<.001). There were 85 repeat abortions; 42 (8.7%) in the on-time group and 43 (16.0%) in the late group (P<.001). Multivariable analysis demonstrated that on-time follow-up was associated with a reduction in repeat pregnancy (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.37-0.77) and repeat abortion (OR 0.53, 95% CI 0.33-0.86). A total of 130 women received injectable depot medroxyprogesterone acetate (DMPA) at the time of abortion. The rates of repeat pregnancy and abortion in these women were 13.7% and 6.2%, respectively. Women who received DMPA had a decrease in rates of repeat pregnancy (OR 0.41, 95% CI 0.23-0.73) and repeat abortion (OR 0.45, 95% CI 0.20-0.99). CONCLUSION: Timely follow-up and immediate administration of DMPA are associated with a decrease in repeat pregnancy in the 12 months after first-trimester elective abortion. Language: English Keywords: NEW YORK | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | MULTIVARIATE ANALYSIS | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | POSTABORTION CARE | TIME FACTORS | PREGNANCY RATE | DEPO-PROVERA | POSTABORTAL PROGRAMS | Developed Countries | United States of America | North America | Americas | Research Methodology | Data Analysis | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Population Dynamics | Fertility Measurements | Fertility | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Family Planning Programs Document Number: 331068 |
| 20. Title: A review of the evidence developed for a technical consultation on expanding access to injectable contraception. Author: Malarcher S Source: [Research Triangle Park, North Carolina], Family Health International [FHI], 2009 Jun. 48 p. Abstract: The document was prepared to facilitate deliberations for the Technical Consultation on Expanding Access to Injectable Contraceptives sponsored by the World Health Organization, the United States Agency for International Development, and Family Health International, scheduled to be held from 15-17 June 2009 in Geneva, Switzerland. This document summarizes the results of a literature review conducted to identify research evidence and program experience relevant to the objectives of the Technical Consultation: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely. Use of community-based injectable services was significant in all studies reviewed. This evidence suggests that community-based delivery of injectable services by CHW is acceptable in a wide variety of settings. (Excerpts) Language: English Keywords: GLOBAL | LITERATURE REVIEW | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTIVE USAGE | PROGRAM ACCESSIBILITY | CONTRACEPTION CONTINUATION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | TRAINING ACTIVITIES | COUNSELING | MONITORING | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Health | Program Evaluation | Programs | Organization and Administration | Training Programs | Education | Clinic Activities | Program Activities | Evaluation Document Number: 331835 |
| 21. Title: Residential care centers for persons with intellectual disability in Israel: Trends in contraception methods 1999-2006. Author: Morad M; Kandel I; Merrick J Source: Medical Science Monitor. 2009 May 29;15(6):PH37-39. Abstract: Background: The past 100 years has revealed a controversial history around the menstrual and contraceptive management of women with intellectual disability in residential care settings. The present study was conducted to examine the trends of contraceptive methods for females with intellectual disability in residential care centers in Israel. Material/Methods: An annual survey of all medical clinics in residential care centers in Israel has been conducted since 1998 by the Office of the Medical Director of the Ministry of Social Affairs and data were extracted from the national surveys for 1999-2006. Results: In the 1999-2006 period, 11-16% of females in residential care centers in Israel used oral or injected contraceptives. Depot medroxyprogesterone acetate (DMPA) was the most used method due to its convenience and effectiveness. Conclusions: It is recommended that a more detailed study of contraceptive methods be conducted in Israel to get a clearer picture since the data collected from annual surveys only give a rudimentary picture of the actual situation in the field. Language: English Keywords: ISRAEL | RESEARCH REPORT | DISABLED PERSONS AND DISABILITIES | CONTRACEPTION | DEPO-PROVERA | CONTRACEPTIVE METHODS | Developed Countries | Middle East | Population Characteristics | Demographic Factors | Population | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents Document Number: 341369 |
| 22. Peer Reviewed Title: Highly effective contraception and acquisition of HIV and other sexually transmitted infections. Author: Morrison CS; Turner AN; Jones LB Source: Best Practice and Research: Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):263-284. Abstract: A key question for clinicians is whether an aetiological association exists between highly effective contraceptive methods and women's risk of acquiring sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The authors searched the peer-reviewed literature for prospective studies published from January 1966 to August 2008 that assessed contraception and STI/HIV risk. The focus was on combined oral contraceptives (OCs), depot-medroxyprogesterone acetate (DMPA), the T380a copper intra-uterine device (IUD) and the risk of infection with HIV, Chlamydia trachomatis and Neisseria gonorrhoeae. Current data suggest that neither OCs nor DMPA increase HIV risk among women in the general population. Data are equivocal for women in high-risk groups (e.g. sex workers). Current data suggest an increased risk of chlamydial infection associated with OC use, with weaker evidence supporting a harmful effect of DMPA. Reports of OCs and gonococcal infection are inconsistent, and DMPA does not appear to be associated with gonorrhoea acquisition. Data suggest no increased STI/HIV risk among copper IUD users. Prospective data on highly effective contraceptive methods and women's STI/HIV risk are limited, and many studies have important methodological weaknesses. Additional information about the STI/HIV risks associated with these highly effective contraceptive methods is needed. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | CONTRACEPTIVE EFFECTIVENESS | HIV TRANSMISSION | SEXUALLY TRANSMITTED DISEASES | DEPO-PROVERA | IUD | CHLAMYDIA | GONORRHEA | ORAL CONTRACEPTIVES | CONTRACEPTIVE SAFETY | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Methods | Safety | Public Health | Health Document Number: 341508 |
| 23. Peer Reviewed Title: Hormonal contraception and risk of bacterial vaginosis diagnosis in an observational study of women attending STD clinics in Baltimore, MD. Author: Rifkin SB; Smith MR; Brotman RM; Gindi RM; Erbelding EJ Source: Contraception. 2009 Jul;80(1):63-7. Abstract: BACKGROUND: The protective effect of hormonal contraception may offer a potential intervention against bacterial vaginosis (BV). STUDY DESIGN: Three hundred thirty reproductive-age women enrolled in a contraceptive program from April 2005 to October 2006 at two sexually transmitted diseases clinics in Baltimore, MD. Participants were supplied with hormonal contraceptives of their choice and followed prospectively. BV was diagnosed by Amsel's criteria. Results from population-level analysis were compared to a case-crossover analysis. RESULTS: BV was diagnosed in 189 (13.0%) of the visits among 133 (40.3%) women. In the population-level analysis, the use of progestin-only and combined contraception was associated with a decreased risk of BV compared to intervals of no hormonal contraceptive use [adjusted odds ratio (AOR): 0.42 (95% CI: 0.20-0.88) and AOR: 0.66 (95% CI: 0.39-1.10), respectively]. The case-crossover analysis demonstrated a similar trend in findings. CONCLUSION: Hormonal contraception was associated with a decreased risk of BV in an STD clinic cohort. Language: English Keywords: UNITED STATES OF AMERICA | MARYLAND | RESEARCH REPORT | DATA ANALYSIS | CLINIC ACTIVITIES | WOMEN | VAGINOSIS | DEPO-PROVERA | ORAL CONTRACEPTIVES, COMBINED | CONTRACEPTIVE AGENTS, PROGESTIN | Developed Countries | North America | Americas | Research Methodology | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Vaginal Abnormalities | Diseases | Medroxyprogesterone Acetate | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Oral Contraceptives | Contraceptive Methods Document Number: 341582 |
| 24. Title: Helping women choose appropriate hormonal contraception: update on risks, benefits, and indications. Author: Spencer AL; Bonnema R; McNamara MC Source: American Journal of Medicine. 2009 Jun;122(6):497-506. Abstract: Primary care physicians frequently provide contraceptive counseling to women who are interested in family planning, have medical conditions that may be worsened by pregnancy, or have medical conditions that necessitate the use of potentially teratogenic medications. Effective counseling requires up-to-date knowledge about hormonal contraceptive methods that differ in hormone dosage, cycle length, and hormone-free intervals and are delivered by oral, transdermal, transvaginal, injectable, or implantable routes. Effective counseling also requires an understanding of a woman's preferences and medical history as well as the risks, benefits, side effects, and contraindications of each contraceptive method. This article is designed to update physicians on this information. Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | CASE STUDIES | WOMEN | DEPO-PROVERA | CONTRAINDICATIONS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CONTRACEPTIVE IMPLANTS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods Document Number: 341531 |
| 25. Title: Advantages of the “Immediate-Start” approach to initiating hormonal contraception. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Brief on Hormonal Contraception) Abstract: A new Cochrane review suggests that the "immediate-start" approach to initiating hormonal contraception may be more acceptable to clients than a standard approach. However, women who use the immediate-start approach may have different experiences depending on the contraceptive method they choose. Language: English Keywords: GLOBAL | SUMMARY REPORT | CLINICAL TRIALS | DEPO-PROVERA | VAGINAL RING | ORAL CONTRACEPTIVES | MENSTRUAL CYCLE | TIME FACTORS | CONTRACEPTIVE AGENTS, SIDE EFFECTS | PREGNANCY, UNPLANNED | Clinical Research | Research Methodology | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Contraceptive Methods | Menstruation | Reproduction | Population Dynamics | Demographic Factors | Population | Reproductive Behavior | Fertility Document Number: 331724 |
| 26. Title: Antiretroviral therapy not likely to interfere with effectiveness of popular contraceptive. Author: Family Health International [FHI] Source: Research Triangle Park, North Carolina, FHI, [2008]. [2] p. Abstract: Results of a clinical trial by scientists at Family Health International and the Universidade Estadual de Campinas, in Brazil, suggest that combination antiretroviral (ARV) therapy is not likely to affect the contraceptive effectiveness of the injectable depot medroxyprogesterone acetate (DMPA). Language: English Keywords: BRAZIL | SUMMARY REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | WOMEN | ANTIRETROVIRAL THERAPY | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | ANTIRETROVIRAL DRUGS | DRUG INTERACTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | HIV | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs Document Number: 331722 |
| 27. Title: Promoting community-based distribution / community reproductive health worker provision of DMPA. Educational visit to Uganda - summary report, 20-22 March, 2007. Author: Family Health International [FHI] Source: Kampala, Uganda, FHI, 2008. [21] p. (USAID Development Experience Clearinghouse Doc. ID / Order No. PD-ACL-828USAID Cooperative Agreement No. GPO-A-00-05-00022-00) Abstract: An educational visit to Uganda by Kenyan reproductive health professionals was held from March 20 to 22, 2007. This visit was funded by USAID under FHI's Promoting DMPA Provision by Community Health Providers project (FCO 113108). Delegates were invited from cooperating agencies (CAs) and professional associations that had participated in one-on-one advocacy meetings led by the Kenya DRH. These organizations were represented: KOGS, NNAK, The Nursing Council, the Kenya MOH/GTZ CBD programme, KCOA, and JHPIEGO. The objectives of the trip were: 1) To gain first-hand experience of Uganda's efforts at using CBDs to provide injectable Depo-Provera/DMPA at the community level; 2) To identify lessons learned from the Uganda initiative and approaches used to overcome challenges and obstacles; 3) To identify specific issues and concerns that would need to addressed in replicating a similar initiative in Kenya; and 4) To gather lessons, suggestions, and recommendations that will be presented at a larger stakeholders' meeting on CBD of DMPA in Kenya in 2007. The following key activities were carried out: 5) Sessions with key stakeholders in the Uganda CBD of DMPA project, including NGOs with RH activities and Uganda MOH officials; 6) Field visit to the Nakasongola district, where Save the Children (SC) has implemented a CBD of DMPA programme since 2004; and 7) The Kenyan team's wrap-up session and agreement on "take home" messages. The tour exposed the delegates to the details of the Uganda CBD programme and to the reality of CBDs providing DMPA. The main "take home" message was that CBD provision of DMPA was feasible and should be pilot-tested in Kenya. Each of the organizations represented pledged their support for a pilot study in Kenya and recommended that a project advisory committee be formed. This committee will be responsible for reviewing the process of conducting the pilot study, and the study's outcomes. Language: English Keywords: UGANDA | CONFERENCES AND CONGRESSES | RECOMMENDATIONS | EVALUATION | COMMUNITY WORKERS | FAMILY PLANNING PERSONNEL | COMMUNITY-BASED DISTRIBUTION WORKERS | COMMUNITY-BASED DISTRIBUTION | DEPO-PROVERA | INJECTABLES | BEST PRACTICES | PROGRAM SUSTAINABILITY | CONTRACEPTIVE DISTRIBUTION | COMMUNITY PARTICIPATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health Personnel | Delivery of Health Care | Health | Family Planning Programs | Family Planning | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Contraceptive Methods Document Number: 329880 |
| 28. Title: Promoting community-based distribution / community reproductive health worker provision of DMPA. Educational visit to Uganda - summary report, February 18 - 20, 2008. Author: Family Health International [FHI] Source: Kampala, Uganda, FHI, 2008. [32] p. (USAID Development Experience Clearinghouse Doc. ID / Order No. PD-ACL-827USAID Cooperative Agreement No. GPO-A-00-05-00022-00) Abstract: An educational tour to Uganda on February 18-20 provided delegates from other countries with an introduction to the community-based distribution (CBD) of the injectable contraceptive DMPA (depot medroxyprogesterone acetate, or Depo Provera). The goal was to learn about Uganda's experiences with the CBD of DMPA and to forge relationships between the delegates so that they could exchange information about such programs in their home countries. The tour was funded by USAID through a project-Promoting DMPA Provision by Community Health Providers-which is managed by Family Health International (FHI). The delegates hoped to achieve several objectives: 1. learn about the organizational network of the program, including the roles and responsibilities of various stakeholders; 2. identify the costs of launching a CBD of DMPA program; 3. identify and understand potential ethical and regulatory issues; 4. learn best practices for providing the service; 5. examine strategies for sustainability and ownership, including remuneration, incentives, and community involvement; 6. learn how to monitor and supervise a program; and 7. identify weaknesses, strengths, and impediments associated with implementation Delegates met key stakeholders in Uganda who have supported and implemented the CBD of DMPA program since 2003. The delegates also learned about the program in Uganda from the staff at the Uganda Ministry of Health, FHI, and Save the Children. The delegates visited the districts of Luwero and Nakaseke, where Save the Children had implemented a CBD of DMPA program. The delegates met with district health officials, local family planning champions, Save the Children staff, and CBD workers who support and implement the program in these districts. The delegates asked questions of the district officials and CBD workers, and they observed a CBD worker provide an injection to a client. On the final day, the delegates participated in group planning sessions where they outlined the steps needed to implement the CBD of DMPA in their respective countries. Language: English Keywords: UGANDA | SUMMARY REPORT | CONFERENCES AND CONGRESSES | EVALUATION | COMMUNITY WORKERS | FAMILY PLANNING PERSONNEL | COMMUNITY-BASED DISTRIBUTION WORKERS | COMMUNITY-BASED DISTRIBUTION | DEPO-PROVERA | INJECTABLES | BEST PRACTICES | PROGRAM SUSTAINABILITY | CONTRACEPTIVE DISTRIBUTION | COMMUNITY PARTICIPATION | ETHICS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Health Personnel | Delivery of Health Care | Health | Family Planning Programs | Family Planning | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Contraceptive Methods | Sociocultural Factors Document Number: 329879 |
| 29. Title: USAID-supported research influences international family planning guidelines. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Brief on Hormonal Contraception) Abstract: The World Health Organization has changed its recommendation on the timing of re-injection for depot medroxyprogesterone acetate (DMPA). The new guidelines encourage health care providers to allow a longer grace period for a woman to return for her next injection of this popular hormonal contraceptive. Language: English Keywords: SOUTH AFRICA | UGANDA | ZIMBABWE | THAILAND | SUMMARY REPORT | WHO | DEPO-PROVERA | TIME FACTORS | CLINIC VISITS | CONTRACEPTION CONTINUATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Asia, Southeastern | Asia | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Population Dynamics | Demographic Factors | Population | Service Statistics | Program Activities | Programs | Organization and Administration | Contraceptive Usage Document Number: 331727 |
| 30. Peer Reviewed Title: Depot-medroxyprogesterone acetate: An update. Author: Bakry S; Merhi ZO; Scalise TJ; Mahmoud MS; Fadiel A Source: Archives of Gynecology and Obstetrics. 2008 Jul;278(1):1-12. Abstract: Depo-Provera is a contraceptive approved by the US Food and Drug Administration (FDA) since 1992 and used worldwide by more than 90 million women. Despite the fact that progestins are endogenous hormones that are secreted by the body, its excess might lead to detrimental health eVects. Whether progestins as contraceptives are friends or foes is a questionable matter. In this manuscript, we drive the attention to both usage and side eVects Depo-Provera. Depot-medroxyprogesterone acetate (DMPA) is a highly eVective, convenient non-daily hormonal contraceptive option that has been available worldwide for many years. The experience with DMPA provides a large body of long-term data regarding the efficacy and safety of this contraceptive method; this long-term experience has established that the use of DMPA does not increase the risk of cardiovascular events, breast cancer, other gynecologic malignancy, or postmenopausal fracture; however, patients are often more concerned about the relatively immediateeVects of contraceptives such as potential changes in menstrual cycle, body weight, and mood disturbances. Concerns about such issues may lead to reluctance to initiate therapy or premature discontinuation. Counseling and understanding of women's concerns and experiences using Depo-Provera is important and could help health care providers redesign counseling strategies to improve contraceptive continuation and improve patient adherence. (author's) Language: English Keywords: GLOBAL | LITERATURE REVIEW | DEPO-PROVERA | CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE AGENTS, SIDE EFFECTS | CARDIOVASCULAR EFFECTS | OSTEOPOROSIS | GYNECOLOGIC DISEASES | BODY WEIGHT | CONTRACEPTIVE SAFETY | Medroxyprogesterone Acetate | Contraceptive Agents, Female | |