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Andrew M Kaunitz - One of the best experts on this subject based on the ideXlab platform.

  • Injectable Contraception issues and opportunities
    Contraception, 2014
    Co-Authors: Andrew M Kaunitz, Jeffrey F Peipert, David A Grimes
    Abstract:

    Beginning in the 1960s depot medroxyprogesterone acetate (DMPA) Injectable Contraception has been widely used in family planning programs abroad especially in Africa and Southeast Asia [1]. Approved in the US for the treatment of endometrial cancer in the mid-1960s it was also used off-label for Contraception [2]. In 1992 DMPA received Food and Drug Administration (FDA) approval for Contraception and began to have a noticeable impact in preventing unintended pregnancies in the US particularly among teens. By 2002 some 2 million US women used Injectable Contraception [3]. Whereas US teen births increased 23% from 1986 peaking in 1991 rates then declined 35% by 2005 [4]. The authors of the 2002 National Survey of Family Growth (NSFG) reported that “Teens were more likely in 2002 to use Contraception at first sex and at most recent sex than in 1995 and were more likely to have used highly effective methods such as Injectable Contraception” [5]. Copyright © 2014 Elsevier Inc. All rights reserved.

  • does Injectable Contraception lower risk for ovarian cancer
    NEJM Journal Watch, 2012
    Co-Authors: Andrew M Kaunitz
    Abstract:

    Several studies have shown that oral contraceptive use lowers risk for epithelial ovarian cancer (EOC), but the association between use of Injectable Contraception (depot medroxyprogesterone acetate [DMPA]) and EOC risk has not been well studied. In a multicenter case-control study, investigators enrolled 330 women (age range, 20–70) with EOC who were …

  • does Injectable Contraception raise fracture risk
    NEJM Journal Watch, 2010
    Co-Authors: Andrew M Kaunitz
    Abstract:

    Current use of depot medroxyprogesterone acetate (DMPA) contraceptive injections temporarily lowers ovarian estradiol production, prompting concerns that DMPA might raise fracture risk. Investigators used the U.K. General Practice Research Database to conduct a case-control study of 17,527 women (age range, 20–44) with …

  • bone density recovery after depot medroxyprogesterone acetate Injectable Contraception use
    Contraception, 2008
    Co-Authors: Andrew M Kaunitz, Raquel D Arias, Michael Mcclung
    Abstract:

    While depot medroxyprogesterone acetate (DMPA) is a highly effective contraceptive used by millions of women, its use is associated with bone mineral density (BMD) loss, raising concerns about long-term risk of osteoporosis and/or fractures.

  • current options for Injectable Contraception in the united states
    Seminars in Reproductive Medicine, 2001
    Co-Authors: Andrew M Kaunitz
    Abstract:

    Two Injectable forms of hormonal Contraception depot medroxyprogesterone acetate (DMPA Depo-Provera) and medroxyprogesterone acetate/estradiol cypionate (MPA/E2C Lunelle) are now available to American women. Both formulations have demonstrated high degrees of efficacy safety and ease of use in international and U.S. trials. Data on DMPA have shown a number of noncontraceptive and therapeutic benefits the most prominent of which is an 80% reduction in the risk of endometrial cancer. Although such benefits are less documented for MPA/E2C they are expected to be similar to those seen with DMPA and oral contraceptives. Minor side effects of both formulations include menstrual irregularities in the early months of treatment and amenorrhea with DMPA. Patient counseling about the potential for these side effects as well as possible risks is important to long-term successful use of these contraceptive methods. (authors)

Grace Nagendi - One of the best experts on this subject based on the ideXlab platform.

  • introduction of subcutaneous depot medroxyprogesterone acetate dmpa sc Injectable Contraception at facility and community levels pilot results from 4 districts of uganda
    Global health science and practice, 2018
    Co-Authors: George Odwe, Kate Gray, Annet Kyarimpa, Francis Obare, Grace Nagendi
    Abstract:

    Reproductive Health Uganda (RHU), a local NGO, introduced subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana Press) in 4 districts of Uganda between April 2016 and March 2017. RHU trained public and private facility providers on all family planning methods including DMPA-SC; trained community health workers (known as village health teams, VHTs) to give family planning counseling, provide short-acting methods including DMPA-SC, and make referrals for long-acting and permanent methods; conducted mobile outreach and raised awareness of family planning; and provided family planning commodities. We used a retrospective cross-sectional evaluation design drawing on data from (1) in-depth interviews with 32 facility- and community-based providers; (2) key informant interviews with 7 policy makers and program staff; and (3) family planning program statistics from 4 RHU clinics, 26 mobile outreach sites, and 40 VHTs in 4 study districts. Data collection took place between April and June 2017. Over 12 months, 14,273 units of DMPA-SC were provided in RHU clinics, by mobile outreach teams, and by VHTs. DMPA-SC units were mostly administered in community settings either by VHTs (70%) or at mobile outreach events (26%). A substantial proportion (43%) of DMPA-SC units were administered to young people (<25 years), a significantly higher proportion compared with other methods provided to this age group through the project (P<.001), except condoms. In addition, a greater proportion of DMPA-SC units provided at the community level by VHTs were used by young people (45%) compared with units provided at outreach (36%) or in clinics (35%). Overall, Injectables (DMPA-SC and intramuscular DMPA combined) came to represent 43% of all contraceptive methods provided, up from a baseline of 20%. This shift occurred despite significant increases in the volume of all other methods provided (P<.001). Qualitative data revealed various factors that facilitated introduction, including comprehensive training, commodity availability, strong referral links, and early community engagement. RHU's experience supports the viability of community-based delivery of DMPA-SC and identifies opportunities to strengthen this approach. There is further evidence that DMPA-SC may be popular with young people, especially in community settings.

  • Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda
    Global health science and practice, 2018
    Co-Authors: George Odwe, Kate Gray, Annet Kyarimpa, Francis Obare, Grace Nagendi
    Abstract:

    Reproductive Health Uganda (RHU), a local NGO, introduced subcutaneous depot medroxyprogesterone acetate (DMPA-SC, brand name Sayana Press) in 4 districts of Uganda between April 2016 and March 2017. RHU trained public and private facility providers on all family planning methods including DMPA-SC; trained community health workers (known as village health teams, VHTs) to give family planning counseling, provide short-acting methods including DMPA-SC, and make referrals for long-acting and permanent methods; conducted mobile outreach and raised awareness of family planning; and provided family planning commodities. We used a retrospective cross-sectional evaluation design drawing on data from (1) in-depth interviews with 32 facility- and community-based providers; (2) key informant interviews with 7 policy makers and program staff; and (3) family planning program statistics from 4 RHU clinics, 26 mobile outreach sites, and 40 VHTs in 4 study districts. Data collection took place between April and June 2017. Over 12 months, 14,273 units of DMPA-SC were provided in RHU clinics, by mobile outreach teams, and by VHTs. DMPA-SC units were mostly administered in community settings either by VHTs (70%) or at mobile outreach events (26%). A substantial proportion (43%) of DMPA-SC units were administered to young people (

Ida Ndione - One of the best experts on this subject based on the ideXlab platform.

  • expanding access to Injectable Contraception results from pilot introduction of subcutaneous depot medroxyprogesterone acetate dmpa sc in 4 african countries
    Global health science and practice, 2018
    Co-Authors: Anna Stout, Siri Wood, George Barigye, Alain Kabore, Daouda Siddo, Ida Ndione
    Abstract:

    PATH partnered with the United Nations Population Fund (UNFPA) and country ministries of health (MOHs) to coordinate pilot introductions of subcutaneous depot medroxyprogesterone acetate (subcutaneous DMPA or DMPA-SC, brand name Sayana Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016 in order to expand the range of methods available to women, particularly in remote locations. The pilot introductions aimed to answer key questions that would inform decisions about future investments in DMPA-SC and scaling up product availability and service-delivery innovations nationally. These questions included the extent to which DMPA-SC would appeal to first-time users of modern Contraception, as well as adolescent girls and young women; whether DMPA-SC would add value to family planning programs or simply replace DMPA-IM or other modern methods; and the trends in Injectables use when introducing DMPA-SC (or any Injectable) at the community level for the first time. We implemented a multicountry monitoring system to track key indicators, including the number of doses administered by category of user (e.g., new users, by client age group) or delivery channel. Providers generally collected these data using their national programs' standard family planning registers. Data were analyzed for cumulative information and to examine trends over time using Microsoft Power Query for Excel and Tableau. Across the 4 countries, nearly half a million DMPA-SC doses were administered and approximately 135,000 first-time users of modern Contraception were reached. Furthermore, 44% of the doses administered in 3 of the countries with data were to adolescent girls and young women under age 25. Switching from DMPA-IM to DMPA-SC was not widespread, ranging from 7% in Burkina Faso to 16% in Uganda. Results from these pilot introductions demonstrate that DMPA-SC has the potential to expand community-level access to Injectables, maximize task-sharing strategies, and reach young women and new acceptors of family planning. Considered within the context of each country's setting, training approach, and introduction strategy, these results can help stakeholders in other countries make informed decisions about whether and how to include this contraceptive option in their family planning programs.

Abbey B Berenson - One of the best experts on this subject based on the ideXlab platform.

  • physiologic and psychologic symptoms associated with use of Injectable Contraception and 20 μg oral contraceptive pills
    American Journal of Obstetrics and Gynecology, 2008
    Co-Authors: Abbey B Berenson, Susan D Odom, Carmen Radecki Breitkopf, Mahbubur Rahman
    Abstract:

    Objective The objective of the study was to compare menstrual, physiologic, and psychologic symptoms over 2 years among women initiating use of depot medroxyprogesterone acetate or an oral contraceptive pill with a reduced pill-free interval and those not using hormonal Contraception. Study Design A total of 608 women reported their experience regarding 17 symptoms prior to initiating Contraception and every 6 months thereafter for 24 months. Longitudinal relationships between symptoms and contraceptives were assessed after adjusting for age, visits, and baseline status of symptoms. Results Oral contraceptive pills were protective against mastalgia (odds ratio [OR], 0.7), cramping (OR, 0.5), hair loss (OR, 0.6), acne (OR, 0.4), nervousness (OR, 0.5), and mood swings (OR, 0.7). Depot medroxyprogesterone acetate (DMPA) was protective against bloating (OR, 0.5) and mood swings (OR, 0.7) but caused weight gain (OR, 2.3), bleeding episodes more than 20 days (OR, 13.4), and missed periods (OR, 96.9). Both methods caused intermenstrual bleeding. Conclusion Evidence-based data regarding beneficial and adverse symptoms associated with these methods may help clinicians counsel patients appropriately prior to contraceptive initiation.

  • Physiologic and psychologic symptoms associated with use of Injectable Contraception and 20 microg oral contraceptive pills.
    American journal of obstetrics and gynecology, 2008
    Co-Authors: Abbey B Berenson, Susan D Odom, Carmen Radecki Breitkopf, Mahbubur Rahman
    Abstract:

    The objective of the study was to compare menstrual, physiologic, and psychologic symptoms over 2 years among women initiating use of depot medroxyprogesterone acetate or an oral contraceptive pill with a reduced pill-free interval and those not using hormonal Contraception. A total of 608 women reported their experience regarding 17 symptoms prior to initiating Contraception and every 6 months thereafter for 24 months. Longitudinal relationships between symptoms and contraceptives were assessed after adjusting for age, visits, and baseline status of symptoms. Oral contraceptive pills were protective against mastalgia (odds ratio [OR], 0.7), cramping (OR, 0.5), hair loss (OR, 0.6), acne (OR, 0.4), nervousness (OR, 0.5), and mood swings (OR, 0.7). Depot medroxyprogesterone acetate (DMPA) was protective against bloating (OR, 0.5) and mood swings (OR, 0.7) but caused weight gain (OR, 2.3), bleeding episodes more than 20 days (OR, 13.4), and missed periods (OR, 96.9). Both methods caused intermenstrual bleeding. Evidence-based data regarding beneficial and adverse symptoms associated with these methods may help clinicians counsel patients appropriately prior to contraceptive initiation.

  • a prospective study of the effects of oral and Injectable Contraception on bone mineral density
    Obstetrics & Gynecology, 2000
    Co-Authors: Abbey B Berenson
    Abstract:

    Abstract Objective: To compare the effects of different hormonal contraceptives on bone mineral density (BMD) in reproductive age women. Methods: We conducted a prospective, longitudinal study on 100 women aged 18–33 years who initiated use of Injectable depot medroxyprogesterone acetate (DMPA), norethindrone-containing oral contraceptives, or desogestrel-containing oral contraceptives to compare their effects on BMD. Bone mineral density was measured by dual energy X-ray absorptiometry at baseline and after 1 year of contraceptive use. Data on other factors that could affect BMD (smoking status, alcohol use, body mass index, exercise habits, and race) were obtained by interview or examination. An analysis of covariance was performed to test for differences in BMD among the three groups after 1 year of contraceptive use, controlling for potential confounding variables. Results: No significant differences were noted in age, race, body mass index, smoking status, alcohol use, exercise habits, or BMD between the three groups at baseline. After 1 year of contraceptive use, DMPA users experienced a 2.5% decrease in BMD, compared with a 2.8% increase among users of norethindrone-containing pills and a 0.9% increase among users of desogestrel-containing pills (P Conclusions: These data demonstrate that different methods of hormonal Contraception have significantly different effects, at least temporarily, on BMD after only 1 year of use.

Nancy S Padian - One of the best experts on this subject based on the ideXlab platform.

  • oral and Injectable Contraception use and risk of hiv acquisition among women in sub saharan africa
    AIDS, 2013
    Co-Authors: Sandra I Mccoy, Wenjing Zheng, Elizabeth T Montgomery, Kelly Blanchard, Ariane Van Der Straten, Guy De Bruyn, Nancy S Padian
    Abstract:

    Objective: To evaluate the effect of oral and Injectable hormonal Contraception on the risk of HIV acquisition among women in South Africa and Zimbabwe. Design: Secondary data analysis of 4913 sexually active women aged 18-49 years followed for up to 24 months in the Methods for Improving Reproductive Health in Africa (MIRA) phase III effectiveness trial of the diaphragm and lubricant gel for HIV prevention. Methods: Participants were interviewed quarterly about Contraception and sexual behavior and were tested for pregnancy HIV and other sexually transmitted infections. We used a Cox proportional hazards marginal structural model weighted by the inverse probability of hormonal Contraception use to compare the risk of HIV acquisition among nonpregnant women reporting use of combined oral contraceptive pills (COC) progestin-only pills (POP) and/or Injectable hormonal Contraception to women not using these methods. Results: During the study 283 participants seroconverted. Use of oral contraceptives (POP or COC) was not associated with HIV risk [adjusted hazard ratio (HRa = 0.86 95% confidence interval (CI) 0.32 1.78]. Injectable hormonal Contraception was associated with a small nonsignificant risk of HIV infection (HRa = 1.34 95% CI 0.75 2.37). The effect of Injectable hormonal Contraception was similar in the unweighted site-adjusted only (HRa = 1.32 95% CI 1.00 1.74) and baseline factor adjusted models (HRa = 1.27 95% CI 0.94 1.72). Conclusions: In this study oral contraceptives were not associated with HIV acquisition. There is substantial uncertainty in the effect of Injectable hormonal Contraception on HIV risk. These findings underscore the importance of dual protection with condoms and the need for diverse contraceptive options for women at risk of HIV infection.