Pharmacokinetic, biologic, and epidemiologic differences in MPA- and NET-based progestin-only injectable contraceptives relative to the potential impact on HIV acquisition in women Access to safe and effective contraceptive choices is a reproductive right and contributes tremendously to improvements in maternal and child health. Progestin-only injectables, particularly intramuscularly injected depot medroxyprogesterone acetate (DMPA-IM), have received increased attention given findings suggesting a potential association with increased HIV risk. For women at high risk of HIV, the World Health Organization's Medical eligibility criteria for contraceptive use (MEC) currently aggregate recommendations for all progestin-only injectables, including DMPA-IM, subcutaneously injected DMPA (DMPA-SC) and intramuscularly injected norethindrone/ norethisterone enanthate (NET-EN), except in the case of some drug interactions.
An in-depth analysis of the use of shared decision making in contraceptive counseling Objective(s).Shared Decision Making (SDM) has emerged as a useful tool to promote patient-centered communication and is highly applicable to contraceptive decision making. Little is known about how SDM is operationalized in contraceptive counseling. This study aimed to explore and describe how SDM is used in the contraceptive counseling context.
Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care Postpartum contraceptive decision making is complex, and recommendations may be influenced by breastfeeding intentions. While biologically plausible, concerns about the adverse impact of hormonal contraception on breast milk production have not been supported by the clinical evidence to date. However, the data have limitations, which can lead providers with different priorities around contraception and breastfeeding to interpret the data in a way that advances their personal priorities. Discrepancies in interpretations can lead to divergent recommendations for individual women and may cause conflict.
Response to the letter to the editor We appreciate Dr. Nelson's thoughtful comments on our article assessing the PATH questions (Parenting/Pregnancy Attitudes, Timing and How important is pregnancy prevention) and contraceptive method selection. We acknowledge that many clinicians and researchers want well-defined risks and benefits to guide precise treatments. However, the everyday reality of patient care is more nuanced, especially concerning the multidimensional issues of reproduction, contraceptive method choice and use.
Response to “study of contraceptive mobile app fails to provide convincing findings” Before we respond to the comments from the letter by Freundl et al., we would like to clarify a few points. It is in large parts a repetition from a previous letter published by that group, relating to our first contraceptive effectiveness study in the European Journal of Contraception, to which we responded . Since the authors do not refer to our response  in this letter, our response here will by necessity be repetitive. All of their comments can be addressed and stem primarily from misunderstandings of our manuscript.
A PATH to action perhaps? The article by Geist et al. creatively continues to advance our collective understanding of both pregnancy intendedness and cessation of contraception utilizing PATH questions (Pregnancy, Attitudes, Timing and How important is pregnancy prevention) . From more abstract perspective, however, this work seems to replace one close ended question “Would you like to become pregnant in the next year?” with four other closed-ended questions. One wonders, why do we not just ask one open ended question: “How do you think you would feel if you got pregnant in the coming year?” A happy response should prompt clinicians to direct their counseling toward preconception care.
Estimating six-cycle efficacy of the Dot app for pregnancy prevention To assess six-cycle perfect and typical use efficacy of Dynamic Optimal Timing (Dot), an algorithm-based fertility app that identifies the fertile window of the menstrual cycle using a woman's period start date and provides guidance on when to avoid unprotected sex to prevent pregnancy.
Society of Family Planning clinical recommendations: contraception after surgical abortion These recommendations present an evidence-based assessment of provision of contraceptives at the time of surgical abortion. Most methods of contraception, including the intrauterine devices (IUD), implant, depot medroxyprogesterone injection, oral contraceptive pill, contraceptive patch, monthly vaginal ring, barrier methods and some permanent methods, can be safely initiated immediately after first- or second-trimester surgical abortion. Provision of postabortion contraceptives, particularly IUDs and implants, substantially reduces subsequent unintended pregnancy.
How soon is too soon or watch the donut not the hole Edelman AB et al. are to be congratulated for reporting the results of yet another well designed, meaningful study — this time studying the impact early administration of oral contraceptives might have on the ability of ulipristal acetate to delay ovulation . The only concern I have is with the paper's conclusion: “This study demonstrates that UPA's efficacy as an emerging contraceptive is reduced with early exposure to COC.”
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