Open access journal of contraception最新文献

Introduction: Few studies have examined the transfer of Ethinylestradiol (EE) into breastmilk in women using Combined Hormonal Contraception (CHC). Most studies are decades old, from when EE doses (≈50 μg) were higher than today (≤35 μg).

Methods: Here, we asses EE levels in milk from breastfeeding women on CHC with low-dose EE (15-35 µg/day EE) using mass spectrometry (MS). Our study included 14 breastfeeding women: 6 using oral CHC (15, 20, or 30 µg/day EE), 7 using a vaginal ring (15 µg/day EE), and 1 using a transdermal patch (35 µg/day EE). A control group of 8 breastfeeding women not using hormonal contraceptives was also included. All participants completed a background questionnaire and provided 5mL of breast-milk. Samples were lyophilized and extracted with methyl tert-butyl ether (MTBE) for Liquid Chromatography-Mass Spectrometry (LC-MS) analysis. EE levels were assessed using high-resolution LC-MS, with a limit of quantification (LOQ) of 3.5 ng/mL.

Results: No measurable peak of the compound was found in any of the CHC users. To confirm that EE was not lost during sample preparation, pure EE was added to control breast milk and successfully detected.

Conclusion: These findings suggest that EE transfer into breastmilk is less than 3.5 ng/mL, and therefore negligible compared to endogenous estradiol. This first LC-MS-based study provides novel evidence supporting the lactation safety of modern low-dose CHC, though larger studies with lower detection limits are needed for confirmation.

Background: Although the safety profile of hormonal contraceptives (HCs) in African populations is still unclear, their use is growing in Sub-Saharan Africa (SSA) to lower unwanted pregnancies. Hematological, cardiometabolic, endocrine, immunological, and psychological consequences are among the reported negative outcomes. This scoping review summarizes the most recent data on the pathophysiological consequences associated with the use of HCs in SSA.

Methods: A comprehensive search via PubMed, African Journal Online, Wiley Online Library, and Google Scholar, following PRISMA-ScR guidelines, identified studies published between 2000 and 2025 on adverse outcomes of HCs in SSA. Eligible studies involved laboratory analysis, cross-sectional surveys, cohort studies, and randomized controlled trials and were conducted in English. Data were charted by country, design, contraceptive type, and adverse outcomes.

Results: Fifty-one eligible studies from SSA were analyzed, revealing diverse pathophysiological consequences. Hematological effects were reported in 7 studies, showing a higher hematological profile and reduced anemia risk among users of HCs. Cardiometabolic impacts were noted in 17 studies, with dyslipidemia (40-60% prevalence), hypertension, and weight gain (1-3 kg/m² BMI increase) linked to depot medroxyprogesterone acetate (DMPA) and combined oral contraceptives (COCs). Endocrine effects were observed in 3 studies, while 12 studies showed vulnerability of HCs users to sexually transmitted and other forms of infections. Immune dysregulation and microbiota changes were reported in 5 studies. A study each reported varying consequences, including anthropometry, bone density, sexual dysfunction and depression, bleeding irregularities, electrocardiogram, spermatotoxicity, and biochemical changes.

Conclusion: Use of HCs in SSA is linked to a variety of diseases in the immunological, metabolic, endocrine, hematologic, and psychological domains. To inform safe contraceptive usage and reproductive health policy in SSA, these findings highlight the necessity of integrated contraceptive counseling, clinical monitoring for comorbidities, and additional region-specific research.

Purpose: To find out the differences in the use of contraceptive methods in millennials and zillennials.

Methods: This study employed a cross-sectional comparative design using secondary data from the National Socio-Economic Survey 2012 and 2022. A total of 31,345 women (2012) and 23,942 women (2022) were included. Generations were defined as follows: Millennials (born 1981-1996) and Zillennials (born 1997-2012). Descriptive statistics, chi-square and multinomial logistic regression were used to assess differences in contraceptive use between the two generations.

Results: Age, residence, education, household expenditure, age at first marriage, number of living children, and internet access were significantly associated with contraceptive preferences. Among Millennials, education and internet access were most associated with SARC use. Among Zillennials, education and fewer living children were most associated with SARC use. Regarding traditional methods, among Millennials, age group and internet access were most associated with use, and among Zillennials, residence and education were most associated with traditional method use.

Conclusion: Strengthening communication, information dissemination, and education tailored to the characteristics of the generation is essential to address their specific needs and preferences.

Introduction: Immediate postpartum modern contraceptive uptake among postpartum women gives over 95% assurance of contraception and reduced chances of short interval pregnancies resulting in improved maternal and child health outcomes. The drivers of its uptake among women are vital in designing interventions aimed at improving and scaling up its uptake. The study therefore explored the drivers of uptake of immediate postpartum modern contraceptives by postpartum women in Lira City, northern Uganda.

Methods: A descriptive qualitative approach was used. A face-to-face key informant interview was used to collect data from 15 key informants (healthcare providers) working in the department of Obstetrics and Gynecology of Lira Regional Referral Hospital. Data were analyzed using Atlas.Ti and thematic analysis was done. The approach enabled an in-depth understanding of the phenomenon from service providers.

Results: The barriers to uptake of immediate postpartum modern contraceptives were health system constraints like commodity unavailability, lack of staff training, and inadequate staffing, knowledge and skills gaps of providers. Limited knowledge, religious and cultural beliefs, male partners objection, inadequate access to information, peer influence and fear of side effects were key barriers from recipients of care. The major facilitators include availability of commodities, improved staffing level, staff training, and timely education and counselling.

Conclusion: This study highlights that the uptake of immediate postpartum modern contraceptives is hindered by both health system and client-related barriers. Presence of trained staff, availability of contraceptive commodities, improved staffing levels, and timely counselling and education were identified as key facilitators. Addressing both health system and individual barriers through strengthening health systems, targeted provider training, male involvement, and enhanced community education may improve the uptake of immediate postpartum modern contraceptives.

Abnormal uterine bleeding (AUB) is a common side effect of hormonal contraceptive (HC) use and represents a significant cause of treatment discontinuation. Two main types of bleeding are recognized: withdrawal bleeding, which occurs during the hormone-free interval following a sudden drop in hormone levels, and breakthrough bleeding (BTB), defined as unscheduled bleeding during active hormone administration. Combined oral contraceptives (COCs) may induce BTB due to hormonal fluctuations or insufficient endometrial stabilization, while progestin-only contraception (POC) is commonly associated with abnormal bleeding due to endometrial changes induced by continuous progestin exposure. A structured and clinically oriented framework for the management of AUB in the context of HC is presented, highlighting the importance of appropriate counseling. Some strategies to improve adherence have been proposed, recognizing non-compliance as a major contributor to unscheduled bleeding. Contraceptive choice is addressed as an individualized process, involving adjustments to hormone type and dosage based on woman-specific needs. The aim is to provide clinicians with a clear and structured tool to address a highly prevalent yet often overlooked issue, still marked by significant uncertainty and inconsistency in the current literature.

Introduction: Heavy menstrual bleeding (HMB) is usually treated with the levonorgestrel 52-mg intrauterine device (IUD), but if a lower-dose IUD would have similar efficacy on bleeding control mainly in the first years of use, the benefits of its dimensions could be attractive to women with narrow cervical canal. The purpose of our study was to evaluate clinical outcomes and satisfaction over one year in women with subjective complaints of HMB treated with the levonorgestrel 19.5-mg IUD.

Methods: We conducted a pilot study at the Department of Obstetrics and Gynaecology, University of Campinas, Faculty of Medical Sciences, Campinas, SP, Brazil. We enrolled 73 women who consulted with complaints of HMB and accepted the use of the levonorgestrel 19.5-mg IUD. We assessed satisfaction with the IUD one year after device placement using a questionnaire that subjectively evaluated HMB through quantity, predictability, cramps, overall satisfaction, desire to continue using the IUD and the possibility of recommending it to others. Additionally, healthcare providers (HCPs) reported on the ease of insertion during device placement, and we obtained data on women's opinions regarding pain during insertion.

Results: Most women were satisfied or very satisfied with the levonorgestrel 19.5-mg IUD as a treatment for HMB, regarding bleeding quantity (n=51; 96.2%), predictability (n=43; 81.1%), and cramps (n=42; 79.2%) one year after device placement. Overall satisfaction was 98.1%. Furthermore, HCPs reported that it was easy to place (n=66; 90.4%) with varied pain at insertion.

Conclusion: The levonorgestrel 19.5-mg IUD was easy to insert with varied pain at insertion, and the satisfaction of women with their bleeding pattern one year after the device placement was high or very high.

Background: Adolescents aged 10-19 in sub-Saharan Africa face overlapping sexual, reproductive, and mental health challenges, exacerbated by stigma, poverty, and limited youth-friendly services. Despite the documented intersection between adolescent sexual and reproductive health (SRH) and mental health, integrated interventions remain scarce, especially in resource-limited settings like Northern Uganda. Hair salons serve as culturally accepted social spaces where hairdressers often engage adolescents in personal discussions, suggesting their potential as informal mental health gatekeepers within SRH contexts.

Methods: A qualitative exploratory study was conducted in Lira City and peri-urban Northern Uganda using in-depth interviews (IDIs) and focus group discussions (FGDs) with adolescent girls and hairdressers. Purposive sampling was employed until thematic saturation. Data were analyzed thematically, focusing on adolescents' experiences, hairdressers' perspectives, and emerging opportunities for integration.

Results: Hair salons were identified as trusted, non-judgmental environments where adolescents disclosed mental health and SRH concerns. Hairdressers provided informal emotional support and advice, and adolescents valued their confidentiality and empathy. Challenges such as stigma, restrictive gender norms, and limited referral pathways constrained this role. Both groups expressed readiness for training to strengthen psychosocial support and linkage to formal health services.

Conclusion: Hairdressers in Northern Uganda act as critical informal gatekeepers for adolescent mental health and SRH, providing culturally relevant support in trusted community spaces. These findings highlight the need for structured training and referral mechanisms to harness this potential and improve adolescent health outcomes.

Introduction: Combined Oral Contraceptives are associated with enhanced procoagulant effects, decreased anticoagulant effects, and equivocal effects on fibrinolysis. The main aim of this study was to compare the mean value of platelet count, PT, and APTT among COC users and non-users and to determine factors associated with coagulopathy among COC users attending Family Guidance Association (FGAE), Jigjiga Medium clinic, Eastern Ethiopia.

Methods: A comparative cross-sectional study was conducted at the FGAE, Jigjiga Medium clinic. A total of 393 women were enrolled using a systematic random sampling method. Socio-demographic and clinical data were obtained via face-to-face interviews and extracted from the medical chart, respectively. To determine PT, APTT, and platelet count, 6.7 milliliters of venous blood was collected. The data were entered into Epi Info version 7.2.4.0 and then transferred to SPSS version 20 for analysis. The Shapiro-Wilk test was used to examine the distribution of the data. Data comparisons between the two groups were conducted using an independent t-test and the Mann-Whitney U-test. To determine factors associated with coagulopathy among COC users, Bivariable and multivariable logistic regression analyses were employed. P-values below 0.05 were regarded as statistically significant.

Results: A sum of 393 subjects (131 COC users and 262 age-matched non-COC-user women) were enrolled in this study. The mean age was 27.67±4.14 (28.12±4.49 years old for COC users and 27.45±3.94 years old for non-COC users. The mean difference indicated that PT and APTT were lower by -1.14 (-1.36,-0.92) and -2.48 (-3.04, -1.91), respectively, in COC user women compared to non-COC users. However, platelet count was significantly elevated in the COC users group (P-value <0.001). The mean ±SD values were 259.5±79.00 and 191.1±27.98 in COC users and non-COC users, respectively. The overall prevalence of coagulopathy was 38.9% (51/131): from this abnormality, 40.5% (53/131) of the COC users showed shortened PT, and 27.5% (36/131) showed shortened APTT. Long-term use of COC (>5 years) was significantly associated with Coagulopathy (AOR = 0.035; 95% CI: 0.004-0.343).

Conclusion: This study showed that COC users exhibited a greater tendency toward hypercoagulability, placing these women at an increased risk of thromboembolic effects compared to COC non-users. There is a high prevalence of coagulopathy among COC users, and long-term usage of COC can lead to hypercoagulation and thrombotic abnormalities.

Background: Conventional top-down health interventions often exclude adolescents and community stakeholders from service design and implementation, resulting in low uptake and a mismatch with young people's needs. The CAFFP-PAC initiative in Northern Uganda sought to explore how a community-led, adolescent-centered inception process could support integration of adolescent-friendly family planning and post-abortion care into primary healthcare services.

Methods: A participatory qualitative design was employed during an inception meeting in Lira City on April 1, 2025, guided by principles of community-based participatory research and citizen science. A total of 110 purposively selected stakeholders including adolescents, youth mentors, parents, educators, health professionals, and cultural and religious leaders engaged in dialogue circles, breakout sessions, simulations, and visual storytelling to co-develop integration strategies. Data were collected through audio recordings, field notes, and participatory tools, and analyzed using Braun and Clarke's thematic analysis framework.

Results: Six themes emerged: (1) meaningful participation of adolescents and stakeholders; (2) adolescent-friendly and confidential service environments; (3) health system readiness and provider attitudes; (4) addressing socio-cultural and gender norms; (5) integration strategies for CAFFP-PAC in primary care; and (6) sustained engagement and feedback mechanisms. Adolescents emphasized safe, private, and respectful care environments, while stakeholders stressed community ownership, trust-building, and reliance on local structures. Youth mentors, cultural leaders, and school clubs were identified as key enablers for service uptake.

Conclusion: A community-led inception process centered on adolescents and local voices is feasible and essential for successful CAFFP-PAC integration in Northern Uganda. Findings highlight the need to shift from provider-centered models to inclusive, participatory approaches that leverage community assets, foster adolescent agency, and ensure sustained engagement. Such approaches are vital for enhancing service accessibility, responsiveness, and sustainability in resource-constrained settings.

Background: Family planning is a key public health priority that supports informed reproductive choices. This study examined the socio-demographic determinants influencing contraceptive method preferences among women of reproductive age in Rwanda.

Methods: This study employed a cross-sectional design through analysis of data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS). The analysis included 5,578 women aged 15-49 years who were using any contraceptive methods. Logistic regression was applied to identify factors associated with the choice between modern and traditional contraceptive methods. A significance level of 5% (p < 0.05) was used to determine the associations.

Results: Overall, 91.1% of contraceptive users reported using modern methods, with implants being the most commonly used (42.9%) and female condoms the least used (0.05%). Factors significantly associated with modern methods choice included living in female-headed households (AOR = 1.22), older age (AOR = 2.68 for ages 30-34), married women (AOR = 1.92), and those in higher wealth quintile (AOR = 1.71). In contrast, living in rural areas (AOR = 0.77) and identifying as Adventist (AOR = 0.68), were associated with lower odds of modern contraceptive choice.

Conclusion: The findings underscore a strong preference for modern contraceptive methods among Rwandan women. However, sociodemographic disparities remain, particularly among rural population and specific religious groups. Tailored family planning policies are needed to address these gaps and ensure equitable access to modern contraceptive methods accross all population subgroups.