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• W2529004364 abstract "After decades of having the developed world's highest rates of unintended pregnancy, the United States finally shows signs of improvement. This progress is likely due in large part to increased use of highly effective long-acting reversible methods of contraception. These methods can be placed and do not require any maintenance to provide years of contraception as effective as sterilization. Upon removal, fertility returns to baseline rates. This article addresses advances in both software—improved use and elimination of barriers to provide these methods; and hardware—novel delivery systems and devices. After decades of having the developed world's highest rates of unintended pregnancy, the United States finally shows signs of improvement. This progress is likely due in large part to increased use of highly effective long-acting reversible methods of contraception. These methods can be placed and do not require any maintenance to provide years of contraception as effective as sterilization. Upon removal, fertility returns to baseline rates. This article addresses advances in both software—improved use and elimination of barriers to provide these methods; and hardware—novel delivery systems and devices. Discuss: You can discuss this article with its authors and with other ASRM members at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/12159-22748 Discuss: You can discuss this article with its authors and with other ASRM members at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/12159-22748 The United States has the highest rates of unintended pregnancy and abortion in the developed world, resulting in an imperative to improve these public health measures. Fortunately we are beginning to see declining rates at urban region, state, and national levels associated with removal of access barriers to long-acting reversible contraception (LARC), including intrauterine devices (IUDs) and contraceptive implants. Methods of LARC share the following attributes: they function for an extended period of time (at least 1 year), do not require any user action to maintain efficacy, and are as effective as sterilization (pregnancy rates are less than 1 per 100 women years), but unlike sterilization, they are completely reversible. Significant advances in LARC service delivery over the past decade and new and future LARC methods will continue to favorably change the contraceptive landscape. Paul Blumenthal, M.D., M.P.H., at Stanford University refers to these two different forms of contraceptive developments as improvements in software (programmatic approaches and service delivery) and hardware (new methods) (1Blumenthal P.D. Update in family planning: hardware and software improvements.Curr Opin Obstet Gynecol. 2015; 27: 449-450Crossref PubMed Scopus (1) Google Scholar). This article will follow this approach in addressing both forms of LARC improvements. The central theme in recent and future LARC software developments is increasing access by breaking down initiation barriers. Barriers may include cost, clinical care access restrictions, unwarranted safety concerns, or expansion to previously restricted populations. Ongoing, multi-pronged software development will set the stage for future hardware successes. Several studies promoting LARC devices documented declines in unintended pregnancy and abortion rates, fueling an intense interest in broadening LARC access and use. These studies featuring LARC methods have two important issues in common: [1] removing cost barriers to IUDs and implants; and [2] counseling patients on the superior efficacy and satisfaction associated with these devices. However, to avoid possible coercion while providing easy access to LARC devices, care must include the full range of contraceptive options (2Gubrium A.C. Mann E.S. Borrero S. Dehlendorf C. Fields J. Geronimus A.T. et al.Realizing reproductive health equity needs more than long-acting reversible contraception (LARC).Am J Public Health. 2016; 106: 18-19Crossref PubMed Scopus (111) Google Scholar, 3Higgins J.A. Celebration meets caution: LARC’s boons, potential busts, and the benefits of a reproductive justice approach.Contraception. 2014; 89: 237-241Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar). At the urban region level, the CHOICE project in St. Louis enrolled 9,256 women, offering no-cost access to their desired contraception for 3 years, and 75% chose LARC methods. Contraceptive pill, patch, or ring users were more than 20 times more likely to have an unintended pregnancy than LARC users (4Winner B. Peipert J.F. Zhao Q. Buckel C. Madden T. Allsworth J.E. et al.Effectiveness of long-acting reversible contraception.N Engl J Med. 2012; 366: 1998-2007Crossref PubMed Scopus (829) Google Scholar). Moreover, teenage study participants had pregnancy and abortion rates less than half the rates St. Louis residents and the nation (5Peipert J.F. Madden T. Allsworth J.E. Secura G.M. Preventing unintended pregnancies by providing no-cost contraception.Obstet Gynecol. 2012; 120: 1291-1297Crossref PubMed Scopus (365) Google Scholar). At the state level in Iowa and Colorado, similar experiments showed remarkable decreases in teen pregnancies, unintended pregnancies, abortions, and preterm births (6Biggs M.A. Rocca C.H. Brindis C.D. Hirsch H. Grossman D. Did increasing use of highly effective contraception contribute to declining abortions in Iowa?.Contraception. 2015; 91: 167-173Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 7Ricketts S. Klingler G. Schwalberg R. Game change in Colorado: widespread use of long-acting reversible contraceptives and rapid decline in births among young, low-income women.Perspect Sex Reprod Health. 2014; 46: 125-132Crossref PubMed Scopus (175) Google Scholar, 8Goldthwaite L.M. Duca L. Johnson R.K. Ostendorf D. Sheeder J. Adverse birth outcomes in Colorado: assessing the impact of a statewide initiative to prevent unintended pregnancy.Am J Public Health. 2015; 105: e60-e66Crossref PubMed Scopus (24) Google Scholar). Nationally, among women using contraception, a significant rise in the use of LARC devices from 2.4% in 2002 to 11.6% in 2012 occurred (9Kavanaugh M.L. Jerman J. Finer L.B. Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009-2012.Obstet Gynecol. 2015; 126: 917-927Crossref PubMed Scopus (211) Google Scholar). Over this period, rates of unintended pregnancies and abortions declined (10Finer L.B. Zolna M.R. Declines in unintended pregnancy in the United States, 2008-2011.N Engl J Med. 2016; 374: 843-852Crossref PubMed Scopus (1282) Google Scholar). These successes may have contributed to the foundation for evidenced-based, professional organization guidelines to support increasing availability of LARC methods to all women (11Committee on Gynecologic Practice Long-Acting Reversible Contraception Working GroupCommittee opinion no. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.Obstet Gynecol. 2015; 126: e44-e48PubMed Google Scholar, 12Committee on AdolescenceContraception for adolescents.Pediatrics. 2014; 134: e1244-e1256Crossref PubMed Scopus (285) Google Scholar). More recently, counseling and clinic service provision focused on LARC methods demonstrated reductions in unintended pregnancy rates (13Harper C.C. Rocca C.H. Thompson K.M. Morfesis J. Goodman S. Darney P.D. et al.Reductions in pregnancy rates in the USA with long-acting reversible contraception: a cluster randomised trial.Lancet. 2015; 386: 562-568Abstract Full Text Full Text PDF PubMed Scopus (146) Google Scholar). In all settings where same-day LARC is provided, women are more likely to initiate the device than if a return visit is required. This increased uptake was demonstrated in post-abortion (14Bednarek P.H. Creinin M.D. Reeves M.F. Cwiak C. Espey E. Jensen J.T. Immediate versus delayed IUD insertion after uterine aspiration.N Engl J Med. 2011; 364: 2208-2217Crossref PubMed Scopus (130) Google Scholar, 15Cremer M. Bullard K.A. Mosley R.M. Weiselberg C. Molaei M. Lerner V. et al.Immediate vs. delayed post-abortal copper T 380A IUD insertion in cases over 12 weeks of gestation.Contraception. 2011; 83: 522-527Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar) as well as postpartum settings (16Chen B.A. Reeves M.F. Hayes J.L. Hohmann H.L. Perriera L.K. Creinin M.D. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial.Obstet Gynecol. 2010; 116: 1079-1087Crossref PubMed Scopus (127) Google Scholar, 17Gurtcheff S.E. Turok D.K. Stoddard G. Murphy P.A. Gibson M. Jones K.P. Lactogenesis after early postpartum use of the contraceptive implant: a randomized controlled trial.Obstet Gynecol. 2011; 117: 1114-1121Crossref PubMed Scopus (74) Google Scholar, 18Ogburn J.A. Espey E. Stonehocker J. Barriers to intrauterine device insertion in postpartum women.Contraception. 2005; 72: 426-429Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar). In a clinical setting requiring an initial visit to complete an order form and second visit IUD placement, only half (54%) actually returned for the device (19Bergin A. Tristan S. Terplan M. Gilliam M.L. Whitaker A.K. A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.Contraception. 2012; 86: 694-697Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar). More importantly, women who receive same-day IUD or implant insertions have lower short-term pregnancy rates than those with delayed insertions (14Bednarek P.H. Creinin M.D. Reeves M.F. Cwiak C. Espey E. Jensen J.T. Immediate versus delayed IUD insertion after uterine aspiration.N Engl J Med. 2011; 364: 2208-2217Crossref PubMed Scopus (130) Google Scholar, 20Langston A.M. Joslin-Roher S.L. Westhoff C.L. Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice.Contraception. 2014; 89: 103-108Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 21Tocce K.M. Sheeder J.L. Teal S.B. Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?.Am J Obstet Gynecol. 2012; 206 (e1–7): 481Abstract Full Text Full Text PDF PubMed Scopus (160) Google Scholar). The most rigorous evidence supporting immediate first-trimester post-abortion IUD placement comes from a randomized, controlled trial (RCT) of 575 women (14Bednarek P.H. Creinin M.D. Reeves M.F. Cwiak C. Espey E. Jensen J.T. Immediate versus delayed IUD insertion after uterine aspiration.N Engl J Med. 2011; 364: 2208-2217Crossref PubMed Scopus (130) Google Scholar). All of the women randomized to immediate postprocedure insertion received their IUD, compared with 71% randomized to delayed insertion. Within 6 months there were no pregnancies in the immediate insertion group, compared with five in the delayed insertion participants, none of whom received their IUD (14Bednarek P.H. Creinin M.D. Reeves M.F. Cwiak C. Espey E. Jensen J.T. Immediate versus delayed IUD insertion after uterine aspiration.N Engl J Med. 2011; 364: 2208-2217Crossref PubMed Scopus (130) Google Scholar). Evidence documenting the benefits of LARC use in the postpartum period is abundant. An assessment of 2006–2010 National Survey of Family Growth data found that 13% of postpartum women using short-acting hormonal contraception had a pregnancy within 18 months, compared with 0.5% of LARC users (adjusted hazard ratio 21.2, 95% confidence interval [CI] 6.2–72.8) (22White K. Teal S.B. Potter J.E. Contraception after delivery and short interpregnancy intervals among women in the United States.Obstet Gynecol. 2015; 125: 1471-1477Crossref PubMed Scopus (98) Google Scholar). During the in-hospital postpartum period, the IUD expulsion rate is lowest with an immediate post-placental insertion (within 10 minutes) (23Chi I.C. Farr G. Postpartum IUD contraception–a review of an international experience.Adv Contracept. 1989; 5: 127-146Crossref PubMed Scopus (35) Google Scholar, 24Lopez L.M. Bernholc A. Hubacher D. Stuart G. Van Vliet H.A. Immediate postpartum insertion of intrauterine device for contraception.Cochrane Database Syst Rev. 2015; : CD003036Google Scholar). Expulsion rates among women obtaining immediate post-placental hormonal IUDs seem to be higher than for those receiving copper IUDs (25Chen B.A. Reeves M.F. Creinin M.D. Schwarz E.B. Postplacental or delayed levonorgestrel intrauterine device insertion and breast-feeding duration.Contraception. 2011; 84: 499-504Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar). Future research initiatives investigating optimal insertion approaches will address postpartum LARC delivery software adjustments to decrease expulsion rates. Another area where LARC methods can greatly benefit women at high risk of unintended pregnancy is among emergency contraception (EC) users. The copper T380 IUD is the most effective method of EC (0.1% risk of pregnancy) (26Cleland K. Zhu H. Goldstuck N. Cheng L. Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.Hum Reprod. 2012; 27: 1994-2000Crossref PubMed Scopus (174) Google Scholar), while providing ongoing contraception, regardless of insertion timing in the menstrual cycle or days since unprotected intercourse (27Turok D.K. Godfrey E.M. Wojdyla D. Dermish A. Torres L. Wu S.C. Copper T380 intrauterine device for emergency contraception: highly effective at any time in the menstrual cycle.Hum Reprod. 2013; 28: 2672-2676Crossref PubMed Scopus (46) Google Scholar). One barrier to IUD insertion for EC is the preference by many women for a hormonal IUD, such as the 20-μg levonorgestrel (LNG20) IUD, over the copper T380 IUD (28Turok D.K. Sanders J.N. Thompson I.S. Royer P.A. Eggebroten J. Gawron L.M. Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study.Contraception. 2016; 93: 526-532Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar). A recent study found a low risk of pregnancy when the LNG20 IUD was placed with use of oral LNG for EC (28Turok D.K. Sanders J.N. Thompson I.S. Royer P.A. Eggebroten J. Gawron L.M. Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study.Contraception. 2016; 93: 526-532Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar). To further break down obstacles to the LNG20 IUD, data are needed to assess the risk of pregnancy when LNG20 IUDs are inserted alone for EC. Data are amassing supporting extending the use of IUDs and implants beyond their US Food and Drug Administration (FDA) approval. Prospective monitoring of CHOICE study participants identified one pregnancy among 108 LNG IUD users beyond 5 years of use and no pregnancies in 123 contraceptive implant users reaching 4 years of use (29McNicholas C. Maddipati R. Zhao Q. Swor E. Peipert J.F. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration.Obstet Gynecol. 2015; 125: 599-604Crossref PubMed Scopus (56) Google Scholar, 30Rowe P. Farley T. Peregoudov A. Piaggio G. Boccard S. Landoulsi S. et al.Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A.Contraception. 2016; 93: 498-506Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar). These data add to a large LNG 52 mg IUD study reporting no pregnancies among women followed from 5 to 7 years after insertion (30Rowe P. Farley T. Peregoudov A. Piaggio G. Boccard S. Landoulsi S. et al.Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A.Contraception. 2016; 93: 498-506Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar). Additional data are forthcoming on use of an LNG 52 mg IUD through 7 years from the ACCESS intrauterine system (IUS) phase 3 FDA study (31Eisenberg D.L. Schreiber C.A. Turok D.K. Teal S.B. Westhoff C.L. Creinin M.D. et al.Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system.Contraception. 2015; 92: 10-16Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar). Concerns for upper genital tract infection and subsequent infertility have limited the widespread use of IUDs in the United States. Historically, the inappropriate selection of a comparison group, the overdiagnosis of pelvic inflammatory disease in IUD users, and the failure to control for confounding sexual behavior effects contributed to the misunderstanding of evidence and overestimation of infection risk (32Grimes D.A. Intrauterine device and upper-genital-tract infection.Lancet. 2000; 356: 1013-1019Abstract Full Text Full Text PDF PubMed Scopus (284) Google Scholar). This misperception of increased risk is outdated, not well-supported by evidence, and should not be a barrier to utilization. The American College of Obstetricians and Gynecologists supports IUD placement and supports routine screening for sexually transmitted infections (STIs) but does not require screening before IUD insertion (11Committee on Gynecologic Practice Long-Acting Reversible Contraception Working GroupCommittee opinion no. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.Obstet Gynecol. 2015; 126: e44-e48PubMed Google Scholar, 33American College of Obstetricians and GynecologistsACOG committee opinion no. 392. Intrauterine device and adolescents.Obstet Gynecol. 2007; 110: 1493-1495Crossref PubMed Scopus (168) Google Scholar, 34American College of Obstetricians and GynecologistsACOG practice bulletin no. 121: long-acting reversible contraception: implants and intrauterine devices.Obstet Gynecol. 2011; 118: 184-196Crossref PubMed Scopus (292) Google Scholar). The safety of a single visit IUD insertion with simultaneous STI testing is demonstrated by an evaluation of 57,728 Kaiser Permanente Northern California patients (35Sufrin C.B. Postlethwaite D. Armstrong M.A. Merchant M. Wendt J.M. Steinauer J.E. Neisseria gonorrhea and Chlamydia trachomatis screening at intrauterine device insertion and pelvic inflammatory disease.Obstet Gynecol. 2012; 120: 1314-1321Crossref PubMed Scopus (83) Google Scholar). The overall rate of pelvic inflammatory disease in this study was 0.5%. There were no differences in infection rates between those receiving same-day STI testing, those screened within 3 months, or women without screening. Other recent large, prospective studies also demonstrate pelvic infection rates of 0.5% with IUD use (36Turok D.K. Eisenberg D.L. Teal S.B. Keder L.M. Creinin M.D. A prospective assessment of pelvic infection risk following same-day sexually transmitted infection testing and levonorgestrel intrauterine system placement.Am J Obstet Gynecol. 2016 May 12; ([Epub ahead of print])Google Scholar) and low infection rates for all women, including those at a high risk for STIs (37Birgisson N.E. Zhao Q. Secura G.M. Madden T. Peipert J.F. Positive testing for Neisseria gonorrhoeae and Chlamydia trachomatis and the risk of pelvic inflammatory disease in IUD users.J Womens Health (Larchmt). 2015; 24: 354-359Crossref PubMed Scopus (31) Google Scholar). An evidence-based approach to STI screening at the time of IUD insertion should follow current guidelines (38LeFevre M.L. US Preventive Services Task Force. Screening for chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 161: 902-910Crossref PubMed Scopus (200) Google Scholar, 39Workowski K.A. Bolan G.A. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015.MMWR Recomm Rep. 2015; 64: 1-137Crossref PubMed Scopus (30) Google Scholar) and should not delay or interfere with LARC initiation (40Curtis K.M. Jatlaoui T.C. Tepper N.K. Zapata L.B. Horton L.G. Jamieson D.J. et al.U.S. selected practice recommendations for contraceptive use, 2016.MMWR Recomm Rep. 2016; 65: 1-66Google Scholar). Wide application of this evidence-based guideline is an important software update. Provider concerns regarding the safety and acceptability of LARC devices limited uptake by both US adolescents and nulliparous women for decades. Fortunately, recent studies, including CHOICE (41Secura G.M. Madden T. McNicholas C. Mullersman J. Buckel C.M. Zhao Q. et al.Provision of no-cost, long-acting contraception and teenage pregnancy.N Engl J Med. 2014; 371: 1316-1323Crossref PubMed Scopus (271) Google Scholar) and ACCESS IUS (31Eisenberg D.L. Schreiber C.A. Turok D.K. Teal S.B. Westhoff C.L. Creinin M.D. et al.Three-year efficacy and safety of a new 52-mg levonorgestrel-releasing intrauterine system.Contraception. 2015; 92: 10-16Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar), consciously included these women in their study designs, leading to evidence turning the tide on these outdated concerns. The recent, unprecedented decline in the US teen birth rate is a direct result of improved access to LARC methods (41Secura G.M. Madden T. McNicholas C. Mullersman J. Buckel C.M. Zhao Q. et al.Provision of no-cost, long-acting contraception and teenage pregnancy.N Engl J Med. 2014; 371: 1316-1323Crossref PubMed Scopus (271) Google Scholar, 42Kost K. Maddow-Zimet I. U.S. teenage pregnancies, births and abortions, 2011: national trends by age, race and ethnicity. Guttmacher Institute, New York2016Google Scholar). The American Academy of Pediatrics (12Committee on AdolescenceContraception for adolescents.Pediatrics. 2014; 134: e1244-e1256Crossref PubMed Scopus (285) Google Scholar) and American College of Obstetricians and Gynecologists (11Committee on Gynecologic Practice Long-Acting Reversible Contraception Working GroupCommittee opinion no. 642: increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy.Obstet Gynecol. 2015; 126: e44-e48PubMed Google Scholar, 34American College of Obstetricians and GynecologistsACOG practice bulletin no. 121: long-acting reversible contraception: implants and intrauterine devices.Obstet Gynecol. 2011; 118: 184-196Crossref PubMed Scopus (292) Google Scholar) now support LARC methods as first-line choices for adolescents and recommend LARC without restriction for nulliparous women. There are few populations in which improved LARC access could drastically decrease the risk of costly, adverse pregnancy outcomes more than in women with complex medical conditions. An unintended pregnancy in the setting of a poorly controlled disease increases risk of preterm delivery, congenital malformations, exposure to teratogens, and other maternal and fetal risks, which could be mitigated by disease control before conception (43Mahadevan U. Sandborn W.J. Li D.K. Hakimian S. Kane S. Corley D.A. Pregnancy outcomes in women with inflammatory bowel disease: a large community-based study from Northern California.Gastroenterology. 2007; 133: 1106-1112Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 44Hellerstedt W.L. Pirie P.L. Lando H.A. Curry S.J. McBride C.M. Grothaus L.C. et al.Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.Am J Public Health. 1998; 88: 663-666Crossref PubMed Scopus (164) Google Scholar, 45Schwarz E.B. Parisi S.M. Handler S.M. Koren G. Shevchik G. Fischer G.S. Counseling about medication-induced birth defects with clinical decision support in primary care.J Womens Health (Larchmt). 2013; 22: 817-824Crossref PubMed Scopus (21) Google Scholar, 46Bell R. Glinianaia S.V. Tennant P.W. Bilous R.W. Rankin J. Peri-conception hyperglycaemia and nephropathy are associated with risk of congenital anomaly in women with pre-existing diabetes: a population-based cohort study.Diabetologia. 2012 Feb 8; ([Epub ahead of print.])https://doi.org/10.1007/s00125-012-2455-yCrossref Scopus (142) Google Scholar). As the prevalence of chronic medical conditions rises in US reproductive-age women, removing LARC access barriers could have an important public health impact. Women with chronic diseases are more likely to experience an unintended pregnancy and less likely to use LARC than healthy women (47Chor J. Rankin K. Harwood B. Handler A. Unintended pregnancy and postpartum contraceptive use in women with and without chronic medical disease who experienced a live birth.Contraception. 2011; 84: 57-63Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar, 48Champaloux S.W. Tepper N.K. Curtis K.M. Zapata L.B. Whiteman M.K. Marchbanks P.A. et al.Contraceptive use among women with medical conditions in a nationwide privately insured population.Obstet Gynecol. 2015; 126: 1151-1159Crossref PubMed Scopus (28) Google Scholar). Areas for improvement are evident in literature on disease-specific populations. Solid organ transplant patients and women with inflammatory bowel diseases are most likely to avoid any contraceptive method or rely only on condoms, despite desire to avoid pregnancy (49Rafie S. Lai S. Garcia J.E. Mody S.K. Contraceptive use in female recipients of a solid-organ transplant.Prog Transplant. 2014; 24: 344-348Crossref PubMed Scopus (23) Google Scholar, 50Gawron L.M. Gawron A.J. Kasper A. Hammond C. Keefer L. Contraceptive method selection by women with inflammatory bowel diseases: a cross-sectional survey.Contraception. 2014; 89: 419-425Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar). Women undergoing bariatric surgery are rarely referred for contraceptive counseling (51Mody S.K. Hacker M.R. Dodge L.E. Thornton K. Schneider B. Haider S. Contraceptive counseling for women who undergo bariatric surgery.J Womens Health (Larchmt). 2011; 20: 1785-1788Crossref PubMed Scopus (32) Google Scholar). Breast cancer patients experienced unintended pregnancies within 1 year of diagnosis owing to low contraceptive uptake (52Guth U. Huang D.J. Bitzer J. Moffat R. Unintended pregnancy during the first year after breast cancer diagnosis.Eur J Contracept Reprod Health Care. 2016; 21: 1-5Crossref Scopus (9) Google Scholar). Collaborative care models to meet the needs of reproductive-age women managing complex conditions tend to be institutional endeavors, but epileptologists and rheumatologists are leading the way to broader improvements (53Herzog A.G. Mandle H.B. Cahill K.E. Fowler K.M. Hauser W.A. Davis A.R. Contraceptive practices of women with epilepsy: findings of the epilepsy birth control registry.Epilepsia. 2016; 57: 630-637Crossref PubMed Scopus (30) Google Scholar, 54Guettrot-Imbert G. Morel N. Le Guern V. Plu-Bureau G. Frances C. Costedoat-Chalumeau N. Pregnancy and contraception in systemic and cutaneous lupus erythematosus.Ann Dermatol Venereol. 2016 Apr 26; ([Epub ahead of print].)Google Scholar). These initiatives are key: women with chronic conditions desire contraceptive counseling from their medical subspecialist and often see them more frequently than reproductive health providers. Unfortunately, many providers do not have the contraceptive knowledge to meet these needs, leading to misinformation and unfounded safety concerns (49Rafie S. Lai S. Garcia J.E. Mody S.K. Contraceptive use in female recipients of a solid-organ transplant.Prog Transplant. 2014; 24: 344-348Crossref PubMed Scopus (23) Google Scholar, 55Toomey D. Waldron B. Family planning and inflammatory bowel disease: the patient and the practitioner.Fam Pract. 2013; 30: 64-68Crossref PubMed Scopus (37) Google Scholar, 56Jatlaoui T.C. Cordes S. Goedken P. Jamieson D.J. Cwiak C. Family planning knowledge, attitudes and practices among bariatric healthcare providers.Contraception. 2016; 93: 455-462Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 57Dirksen R.R. Shulman B. Teal S.B. Huebschmann A.G. Contraceptive counseling by general internal medicine faculty and residents.J Womens Health (Larchmt). 2014; 23: 707-713Crossref PubMed Scopus (18) Google Scholar). To address knowledge gaps regarding contraceptive method safety for chronic conditions in reproductive-age women, the Centers for Disease Control and Prevention published expert guidance in the US Medical Eligibility Criteria for Contraceptive Use 2010 (US MEC) (58Curtis K.M. Tepper N.K. Jatlaoui T.C. Berry-Bibee E. Horton L.G. Zapata L.B. et al.U.S medical eligibility criteria for contracepive use.MMWR Recomm Rep. 2016; 65: 1-103Google Scholar). Nearly all of the chronic diseases listed in the US MEC have safety rankings for LARC methods as category 1 (“no restriction”) or category 2 (“advantages outweigh theoretical or proven risks”). This guidance supports LARC methods as not only the most effective but also the safest options for these high-risk populations. A companion guide to the US MEC, the US Selective Practice Recommendations, was published in 2013 to reduce barriers to contraceptive initiation and effective use (40Curtis K.M. Jatlaoui T.C. Tepper N.K. Zapata L.B. Horton L.G. Jamieson D.J. et al.U.S. selected practice recommendations for contraceptive use, 2016.MMWR Recomm Rep. 2016; 65: 1-66Google Scholar). The US Selective Practice Recommendations provides evidence-based guidance to support same-day contraceptive provision and avoidance of unnecessary tests or examinations before initiation. Integration of these evidence-based resources into practice will allow women with a chronic disease to avoid barriers to care. Although contraceptive method selection is multifaceted for all women, recommendations based on safety" @default.
• W2529004364 created "2016-10-14" @default.
• W2529004364 creator A5010920285 @default.
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• W2529004364 date "2016-11-01" @default.
• W2529004364 modified "2023-09-27" @default.
• W2529004364 title "New developments in long-acting reversible contraception: the promise of intrauterine devices and implants to improve family planning services" @default.
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• W2529004364 doi "https://doi.org/10.1016/j.fertnstert.2016.09.034" @default.
• W2529004364 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/6861013" @default.
• W2529004364 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/27717553" @default.
• W2529004364 hasPublicationYear "2016" @default.
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