Contraception in Adolescents

Adolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception.

A cross-sectional national questionnaire survey assessing the views of members of the British Menopause Society on the management of patients with unscheduled bleeding on hormone replacement therapy

Objective To explore the views of members of the British Menopause Society on the management of women with unscheduled bleeding on hormone replacement therapy. Study design An electronic cross-sectional questionnaire survey. Main outcome measures Investigations, treatment options and preferences for the management of women with unscheduled bleeding on hormone replacement therapy. Results A total of 91/178 (51%) clinicians investigate patients with unscheduled bleeding within three to six months of starting sequential hormone replacement therapy (seq-HRT) versus 83/178 (47%) for continuous combined hormone replacement therapy (con-HRT). A total of 52/178 (29%) versus 54/178 (30%) would investigate unscheduled bleeding continuing beyond six months while 18/178 (10%) versus 26/178 (15%) would investigate within three months. Assessment is requested as urgent by 88/176 (50%) clinicians, routine by 47/176 (27%) and a two-week-wait-suspected cancer referral by 41/176 (23%). A total of 97/178 (55%) clinicians would continue seq-HRT and refer versus 117/178 (66%) for con-HRT. A total of 46/178 (26%) clinicians would change the progestogen preparation in women with unscheduled bleeding on seq-HRT. For women on con-HRT, 12/178 (7%) clinicians would change to seq-HRT and 8/178 (5%) to the Mirena IUS. The Mirena IUS is the preferred progestogen for 81/178 (45%) of clinicians when prescribing hormone replacement therapy. Conclusions There is a varied approach in the practise amongst British Menopause Society members to managing women with unscheduled bleeding on hormone replacement therapy. Further research is needed to determine the optimal assessment pathways for women with unscheduled bleeding on hormone replacement therapy.

A multicenter, double-blind, randomized trial on the bleeding profile of a drospirenone-only pill 4 mg over nine cycles in comparison with desogestrel 0.075 mg

Purpose A typical compliance problem in the use of traditional progestin-only pills is the irregular bleeding pattern and the strict daily intake. Desogestrel 75 mg has a 12-h missed-pill window; however, its poor cycle control limits a more common use. Methods A drospirenone (DRSP)-only pill was developed to improve the bleeding profile. Setting A phase III study in healthy women aged 18–45 years was performed to compare the bleeding profile and safety of a DRSP-only pill in a regime of 24 days of 4 mg of DRSP tablets followed by 4 days of placebo versus desogestrel 0.075 mg per day continuously over nine cycles. Population A total of 858 women with 6691 drospirenone and 332 women with 2487 desogestrel treatment cycles were analyzed. Main outcome measures The primary end point was the proportion of women with unscheduled bleeding/spotting in each cycle from cycles 2 to 9 and cumulative in cycles 2–4 and cycles 7–9. Results In each cycle, up to cycle 7, the proportion of women with unscheduled bleeding was statistically significantly lower in the DRSP group than in the DSG group (p = 0.0001, Chi-square test). Conclusions This report describes the improvement in bleeding profile of women using the new DRSP-only oral contraceptive in comparison to DSG, providing a better quality of live and adherence to the contraceptive method. EudraCT Registration Number: 2011-002396-42.

Non-interventional retrospective study to evaluate menstrual bleeding profiles, tolerability and quality of life of women using the new vaginal ring Ornibel® delivering etonogestrel 0.120 mg and ethinylestradiol (EE) 0.015 mg per day

Background: To assess the menstrual cycle profile, tolerability, quality of life and sexual wellbeing in women using the vaginal contraceptive ring Ornibel®. Method: Non-interventional, retrospective, multi-center study on 103 women between 18 and 45 years old that used Ornibel® for at least 6 months. Menstrual cycle characteristics, vaginal infections and quality of life parameters were analyzed. Change in menstrual bleeding profiles and menstrual bleeding associated pain were assessed via visual analogue scales (VAS). Results: Menstrual flow and dysmenorrhea reduced significantly. The VAS score reductions were 16 and 22,5 points respectively (p < 0.001). No differences were observed between women that changed from another contraceptive method to the vaginal ring. The percentage of women without unscheduled bleedings or spotting increased from 79% to 88%. The percentage of women with unscheduled bleeding or spotting significantly decreased from 21% to 12%. Women rated the ring as very comfortable or comfortable (97%) as well as easy to insert (91%). The continuation of the usage of the ring and a recommendation for the ring were significantly associated with these two parameters. Conclusions: Ornibel® improved the menstrual cycle profile, reduced dysmenorrhea and shows a very high adherence to the use. Clinical trial register: DRKS-ID: DRKS00014982

Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy

Objective This study correlates the transvaginal ultrasound findings with histopathology results in women who present with unscheduled bleeding on hormone replacement therapy. Study design Retrospective analysis of 469 consecutive cases with unscheduled bleeding on hormone replacement therapy (203 patients on sequential hormone replacement therapy (seq-HRT) and 266 patients on continuous combined hormone replacement therapy (con-HRT)). Main outcome measures Outcomes of endometrial assessment in women with unscheduled bleeding on hormone replacement therapy. Results Normal appearance of the endometrium on pelvic ultrasound was seen in 62% patients on seq-HRT and 43% of women on con-HRT. These women required no further assessment and were discharged. Histological assessment showed normal endometrial tissue in 22% of women on seq-HRT and 22% of con-HRT group. Benign endometrial polyps were noted in 8% of women on seq-HRT versus 18% of women on con-HRT. Hyperplasia without atypia was noted in 0.5% of woman on seq-HRT versus 0.4% of women on con-HRT while atypical hyperplasia/endometrial cancer was noted in 2% of women on seq-HRT versus 1% of women on con-HRT. Conclusion Women who present with unscheduled bleeding on hormone replacement therapy both on sequential and continuous combined regimens can be reassured that the risk of pathology is low.