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Endometriosis survey findings show doctors aren’t asking key questions
, according to the findings of a recent survey.
The survey, conducted by HealthyWomen with support from drug-maker AbbVie, highlights some of the knowledge gaps surrounding endometriosis. They surveyed 1,211 adult women in the United States and 352 health care providers, including ob.gyns, primary care physicians, reproductive endocrinologists, gynecologic specialists, and nurse practitioners.
Another symptom that may be going unrecognized, according to the survey, is pelvic pain. Just one-third of the providers surveyed asked patients at each visit if pelvic pain interferes with their daily activities. However, among 260 women who said they had been diagnosed with endometriosis, 86% reported that their condition interferes with daily activities at least some of the time.
The survey also reinforced findings from previous research about delayed diagnosis of endometriosis. Among 260 respondents who identified themselves as diagnosed with endometriosis, 72% reported seeing two or more providers before receiving a diagnosis, and nearly a quarter saw four or more providers.
The survey was conducted online from Dec. 7, 2016, to Feb. 6, 2017.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
, according to the findings of a recent survey.
The survey, conducted by HealthyWomen with support from drug-maker AbbVie, highlights some of the knowledge gaps surrounding endometriosis. They surveyed 1,211 adult women in the United States and 352 health care providers, including ob.gyns, primary care physicians, reproductive endocrinologists, gynecologic specialists, and nurse practitioners.
Another symptom that may be going unrecognized, according to the survey, is pelvic pain. Just one-third of the providers surveyed asked patients at each visit if pelvic pain interferes with their daily activities. However, among 260 women who said they had been diagnosed with endometriosis, 86% reported that their condition interferes with daily activities at least some of the time.
The survey also reinforced findings from previous research about delayed diagnosis of endometriosis. Among 260 respondents who identified themselves as diagnosed with endometriosis, 72% reported seeing two or more providers before receiving a diagnosis, and nearly a quarter saw four or more providers.
The survey was conducted online from Dec. 7, 2016, to Feb. 6, 2017.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
, according to the findings of a recent survey.
The survey, conducted by HealthyWomen with support from drug-maker AbbVie, highlights some of the knowledge gaps surrounding endometriosis. They surveyed 1,211 adult women in the United States and 352 health care providers, including ob.gyns, primary care physicians, reproductive endocrinologists, gynecologic specialists, and nurse practitioners.
Another symptom that may be going unrecognized, according to the survey, is pelvic pain. Just one-third of the providers surveyed asked patients at each visit if pelvic pain interferes with their daily activities. However, among 260 women who said they had been diagnosed with endometriosis, 86% reported that their condition interferes with daily activities at least some of the time.
The survey also reinforced findings from previous research about delayed diagnosis of endometriosis. Among 260 respondents who identified themselves as diagnosed with endometriosis, 72% reported seeing two or more providers before receiving a diagnosis, and nearly a quarter saw four or more providers.
The survey was conducted online from Dec. 7, 2016, to Feb. 6, 2017.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
FDA approves treatment for platinum-sensitive ovarian cancer
The Food and Drug Administration approved bevacizumab (Avastin), used in combination with certain types of chemotherapy, for the treatment of patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary perioneal cancer.
The FDA approved its use in combination with either carboplatin and paclitaxel or carboplatin and gemcitabine chemotherapy, followed by bevacizumab alone. In November 2014, the FDA approved bevacizumab for use in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan chemotherapy for women with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
The GOG-0213 study showed an overall survival improvement of 5 months with bevacizumab plus chemotherapy, compared with chemotherapy alone (hazard ratio, 0.84). The study also showed improved progression-free survival of 3.4 months (HR, 0.61). In the OCEANS study, progression-free survival was 12.4 months for bevacizumab plus chemotherapy, compared with 8.4 months for placebo plus chemotherapy (HR, 0.46). Overall survival was not significantly improved by the addition of bevacizumab in the OCEANS study.
Some adverse events observed in the trials included fatigue, hypertension, febrile neutropenia, proteinuria, abdominal pain, hyponatremia, headache, nausea, and pain in the extremity.
Bevacizumab is manufactured by Genentech, and full prescribing information and a boxed warning are available on the drug’s website, www.avastin.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
The Food and Drug Administration approved bevacizumab (Avastin), used in combination with certain types of chemotherapy, for the treatment of patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary perioneal cancer.
The FDA approved its use in combination with either carboplatin and paclitaxel or carboplatin and gemcitabine chemotherapy, followed by bevacizumab alone. In November 2014, the FDA approved bevacizumab for use in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan chemotherapy for women with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
The GOG-0213 study showed an overall survival improvement of 5 months with bevacizumab plus chemotherapy, compared with chemotherapy alone (hazard ratio, 0.84). The study also showed improved progression-free survival of 3.4 months (HR, 0.61). In the OCEANS study, progression-free survival was 12.4 months for bevacizumab plus chemotherapy, compared with 8.4 months for placebo plus chemotherapy (HR, 0.46). Overall survival was not significantly improved by the addition of bevacizumab in the OCEANS study.
Some adverse events observed in the trials included fatigue, hypertension, febrile neutropenia, proteinuria, abdominal pain, hyponatremia, headache, nausea, and pain in the extremity.
Bevacizumab is manufactured by Genentech, and full prescribing information and a boxed warning are available on the drug’s website, www.avastin.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
The Food and Drug Administration approved bevacizumab (Avastin), used in combination with certain types of chemotherapy, for the treatment of patients with platinum-sensitive recurrent epithelial ovarian, fallopian tube, or primary perioneal cancer.
The FDA approved its use in combination with either carboplatin and paclitaxel or carboplatin and gemcitabine chemotherapy, followed by bevacizumab alone. In November 2014, the FDA approved bevacizumab for use in combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan chemotherapy for women with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer.
The GOG-0213 study showed an overall survival improvement of 5 months with bevacizumab plus chemotherapy, compared with chemotherapy alone (hazard ratio, 0.84). The study also showed improved progression-free survival of 3.4 months (HR, 0.61). In the OCEANS study, progression-free survival was 12.4 months for bevacizumab plus chemotherapy, compared with 8.4 months for placebo plus chemotherapy (HR, 0.46). Overall survival was not significantly improved by the addition of bevacizumab in the OCEANS study.
Some adverse events observed in the trials included fatigue, hypertension, febrile neutropenia, proteinuria, abdominal pain, hyponatremia, headache, nausea, and pain in the extremity.
Bevacizumab is manufactured by Genentech, and full prescribing information and a boxed warning are available on the drug’s website, www.avastin.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
FDA approves vaginal insert to treat dyspareunia in menopause
Prasterone (Intrarosa), a vaginal insert containing dehydroepiandrosterone (DHEA) to treat dyspareunia in menopause caused by vulvar and vaginal atrophy, has won Food and Drug Administration approval.
It’s the first FDA-approved product containing the active ingredient prasterone, known also as DHEA. It will be marketed by Endoceutics Inc., a Quebec-based pharmaceutical company focused on women’s health.
The approval is based on the results of two 12-week placebo-controlled trials of 406 healthy, postmenopausal women, ranging in age from 40 to 80 years, who identified dyspareunia as their most bothersome symptom of VVA. During the trials, prasterone reduced the severity of pain experienced during sexual intercourse, when compared with placebo. Safety of the treatment was established in four 12-week placebo-controlled trials and one 52-week open-label trial. The most common adverse events were vaginal discharge and abnormal Pap smear, according to the FDA.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Prasterone (Intrarosa), a vaginal insert containing dehydroepiandrosterone (DHEA) to treat dyspareunia in menopause caused by vulvar and vaginal atrophy, has won Food and Drug Administration approval.
It’s the first FDA-approved product containing the active ingredient prasterone, known also as DHEA. It will be marketed by Endoceutics Inc., a Quebec-based pharmaceutical company focused on women’s health.
The approval is based on the results of two 12-week placebo-controlled trials of 406 healthy, postmenopausal women, ranging in age from 40 to 80 years, who identified dyspareunia as their most bothersome symptom of VVA. During the trials, prasterone reduced the severity of pain experienced during sexual intercourse, when compared with placebo. Safety of the treatment was established in four 12-week placebo-controlled trials and one 52-week open-label trial. The most common adverse events were vaginal discharge and abnormal Pap smear, according to the FDA.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Prasterone (Intrarosa), a vaginal insert containing dehydroepiandrosterone (DHEA) to treat dyspareunia in menopause caused by vulvar and vaginal atrophy, has won Food and Drug Administration approval.
It’s the first FDA-approved product containing the active ingredient prasterone, known also as DHEA. It will be marketed by Endoceutics Inc., a Quebec-based pharmaceutical company focused on women’s health.
The approval is based on the results of two 12-week placebo-controlled trials of 406 healthy, postmenopausal women, ranging in age from 40 to 80 years, who identified dyspareunia as their most bothersome symptom of VVA. During the trials, prasterone reduced the severity of pain experienced during sexual intercourse, when compared with placebo. Safety of the treatment was established in four 12-week placebo-controlled trials and one 52-week open-label trial. The most common adverse events were vaginal discharge and abnormal Pap smear, according to the FDA.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
FDA finalizes boxed warning for Essure
The Food and Drug Administration will require the Essure permanent birth control system to carry a boxed warning about the device’s reported adverse events, including perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reactions.
The boxed warning should also state that if the device needs to be removed to address an adverse event, surgery will be necessary.
FDA officials released the final guidance Oct. 28 on labeling for permanent hysteroscopically placed tubal implants intended for sterilization, following the publication of draft labeling requirements in February 2016.
The guidance includes a Patient Decision Checklist to be signed by the patient and the physician, acknowledging that the risks and benefits of the device were discussed. The checklist is divided into sections detailing other birth control options, requirements for Essure placement (including contraindications), pregnancy risks with the device, what to expect during and after the procedure based on clinical studies, and long-term risks.
The new labeling requirements follow years of controversy about the device, which is currently the only permanent contraception option for women that can be performed without surgery.
In September 2015, the FDA Obstetrics and Gynecology Devices Panel reviewed the safety of the device after receiving more than 5,000 complaints of adverse reactions. Consensus from the 19-member panel was that there was a lack of data about the risks of the device and that patients needed better counseling before choosing it as a birth control option.
The final labeling guidance document seeks to address some of those concerns, according to the FDA.
“FDA believes this will help to ensure a woman receives and understands the benefits and risks associated with her contraceptive options so that she can make an informed decision as to whether a permanent hysteroscopically placed tubal implant intended for sterilization is the right choice for her,” according to the guidance document.
In September 2016, the FDA approved a postmarket surveillance study plan from Essure’s manufacturer, Bayer. The 3-year study will compare safety and effectiveness between women who undergo hysterocopic sterilization with Essure and those who have laparoscopic tubal sterilization.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
The Food and Drug Administration will require the Essure permanent birth control system to carry a boxed warning about the device’s reported adverse events, including perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reactions.
The boxed warning should also state that if the device needs to be removed to address an adverse event, surgery will be necessary.
FDA officials released the final guidance Oct. 28 on labeling for permanent hysteroscopically placed tubal implants intended for sterilization, following the publication of draft labeling requirements in February 2016.
The guidance includes a Patient Decision Checklist to be signed by the patient and the physician, acknowledging that the risks and benefits of the device were discussed. The checklist is divided into sections detailing other birth control options, requirements for Essure placement (including contraindications), pregnancy risks with the device, what to expect during and after the procedure based on clinical studies, and long-term risks.
The new labeling requirements follow years of controversy about the device, which is currently the only permanent contraception option for women that can be performed without surgery.
In September 2015, the FDA Obstetrics and Gynecology Devices Panel reviewed the safety of the device after receiving more than 5,000 complaints of adverse reactions. Consensus from the 19-member panel was that there was a lack of data about the risks of the device and that patients needed better counseling before choosing it as a birth control option.
The final labeling guidance document seeks to address some of those concerns, according to the FDA.
“FDA believes this will help to ensure a woman receives and understands the benefits and risks associated with her contraceptive options so that she can make an informed decision as to whether a permanent hysteroscopically placed tubal implant intended for sterilization is the right choice for her,” according to the guidance document.
In September 2016, the FDA approved a postmarket surveillance study plan from Essure’s manufacturer, Bayer. The 3-year study will compare safety and effectiveness between women who undergo hysterocopic sterilization with Essure and those who have laparoscopic tubal sterilization.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
The Food and Drug Administration will require the Essure permanent birth control system to carry a boxed warning about the device’s reported adverse events, including perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reactions.
The boxed warning should also state that if the device needs to be removed to address an adverse event, surgery will be necessary.
FDA officials released the final guidance Oct. 28 on labeling for permanent hysteroscopically placed tubal implants intended for sterilization, following the publication of draft labeling requirements in February 2016.
The guidance includes a Patient Decision Checklist to be signed by the patient and the physician, acknowledging that the risks and benefits of the device were discussed. The checklist is divided into sections detailing other birth control options, requirements for Essure placement (including contraindications), pregnancy risks with the device, what to expect during and after the procedure based on clinical studies, and long-term risks.
The new labeling requirements follow years of controversy about the device, which is currently the only permanent contraception option for women that can be performed without surgery.
In September 2015, the FDA Obstetrics and Gynecology Devices Panel reviewed the safety of the device after receiving more than 5,000 complaints of adverse reactions. Consensus from the 19-member panel was that there was a lack of data about the risks of the device and that patients needed better counseling before choosing it as a birth control option.
The final labeling guidance document seeks to address some of those concerns, according to the FDA.
“FDA believes this will help to ensure a woman receives and understands the benefits and risks associated with her contraceptive options so that she can make an informed decision as to whether a permanent hysteroscopically placed tubal implant intended for sterilization is the right choice for her,” according to the guidance document.
In September 2016, the FDA approved a postmarket surveillance study plan from Essure’s manufacturer, Bayer. The 3-year study will compare safety and effectiveness between women who undergo hysterocopic sterilization with Essure and those who have laparoscopic tubal sterilization.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
As Zika Looms, Are LARCs the Answer?
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
FROM MMWR
As Zika looms, are LARCs the answer?
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
In U.S. states where mosquito-borne Zika virus transmission is possible, adult women at risk for unintended pregnancy and sexually active high school girls are primarily using moderately effective and less effective contraceptive methods, according to a report from the Centers for Disease Control & Prevention.
Long-acting reversible contraceptives (LARCs) – considered a highly effective method – are used by fewer than a quarter of nonpregnant women, about one-third of recently postpartum women, and fewer than one-tenth of sexually active high school girls, according to a report published Aug. 2 in the Morbidity and Mortality Weekly Report (doi: 10.15585/mmwr.mm6530e2).
With locally transmitted cases of Zika virus infection increasing rapidly in Florida, the CDC is urging that the full range of FDA-approved contraceptive methods should be readily available and accessible to women who want to avoid or delay pregnancy.
“Given low rates of LARC use, states can implement strategies to remove barriers to the access and availability of LARC including high device costs, limited provider reimbursement, lack of training for providers serving women and adolescents on insertion and removal of LARC, provider lack of knowledge and misperceptions about LARC, limited availability of youth-friendly services that address adolescent confidentiality concerns, inadequate client-centered counseling, and low consumer awareness of the range of contraceptive methods available,” the CDC scientists wrote in the MMWR report.
Among nonpregnant women and recently postpartum women, the proportion not using any contraception ranged from 3.5% to 34.3%. Among sexually active high school girls, the proportion using no contraception ranged from 7.3% to 22.8%. The estimates of contraceptive use are based on 2011-2013 and 2015 survey data from four state-based surveillance systems.
The full MMWR report is available here.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
FROM MMWR
Health Officials Investigating Mysterious Zika Infection
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
Health officials investigating mysterious Zika infection
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Health officials are looking into a case of Zika virus infection in Utah, where a person was infected after caring for an elderly family member with the virus.
In the new case, the person had not recently traveled to an area with Zika and had not had sex with anyone with Zika infection or who had traveled to an area with Zika. Also, there is no current evidence that the Aedes mosquitoes, known to spread Zika virus, have been active in Utah.
The elderly Utah man who was first infected with Zika died in late June of unknown causes. He had traveled to an area with Zika, and laboratory tests revealed that he had virus levels more than 100,000 times higher than seen in other samples of infected people, according to the Centers for Disease Control and Prevention.
The Utah Department of Health and the CDC are investigating the possible cause of infection.
“We are trying to determine if the contact between the very sick elderly patient and the person played a role in how the person got sick,” Satish Pillai, PhD, deputy incident manager with CDC’s Zika response, said during a news conference. “We don’t have all of the answers right now, but we will continue to share the information as it comes available.”
CDC currently is not altering its instructions on the use of personal protective equipment.
“I think what this highlights is the fact that when you have an infection like Zika virus ... wherein a good percentage of patients don’t actually have symptoms, it means that it’s as important as ever to stick with good adherence to standard precautions,” Dr. Pillai said. “Just like we assume anybody might carry hepatitis or HIV, we don’t wait for a positive diagnosis in order to prevent blood or body fluid exposure. The same thing is true with Zika virus, and I think this is a great example of why we should never take chances, but always adhere to careful standards of touching.”
“The new case in Utah is a surprise, showing that we still have more to learn about Zika,” Erin Staples, MD, PhD, CDC medical epidemiologist on the ground in Utah, said in a statement. “Fortunately, the patient recovered quickly, and from what we have seen with more than 1,300 travel-associated cases of Zika in the continental United States and Hawaii, nonsexual spread from one person to another does not appear to be common.”
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Case study: Zika virus may persist in female genital tract
Zika virus appears to be able to persist in a woman’s genital tract even after it is no longer detectable in blood and urine, according to a new case study.
The findings raise the possibility of woman-to-man sexual transmission of the virus, as well as mother-to-child vertical transmission.
Nadia Prisant, MD, of the University Hospital Center Pointe à Pitre, Guadeloupe, France, and her colleagues reported the case of a 27-year-old woman in France who tested positive for Zika virus infection in May. The initial blood test was positive, while the urine sample was negative (Lancet Infect Dis. 2016 Jul 11. doi: 10.1016/S1473-3099[16]30193-1).
A genital swab, endocervical swab, and a cervical mucus sample were collected 3 days after symptom onset and all tested positive for Zika virus RNA. On day 11 after symptom onset, the woman’s blood and urine samples both tested negative, but her cervical mucus continued to test positive for Zika virus RNA.
The researchers stated that this is the first report of the presence of Zika virus in the genital tract of a woman, as well as its possible persistence after the virus is no longer detectable in blood and urine samples.
“Although we have not tested the infectiousness of a locally situated vaginal virus, its very presence in the female genital tract poses notable challenges, implying that sexual transmission from women to men could occur, as is the case for other viral infections,” the researchers wrote. “Zika virus presence in the female genital tract also means that vertical transmission from mother to fetus needs to be assessed, since this virus is a member of the Flaviviridae family, which includes hepatitis C, in which vertical transmission from mother to child can occur in up to 10% of pregnancies.”
The researchers reported having no relevant financial disclosures.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Zika virus appears to be able to persist in a woman’s genital tract even after it is no longer detectable in blood and urine, according to a new case study.
The findings raise the possibility of woman-to-man sexual transmission of the virus, as well as mother-to-child vertical transmission.
Nadia Prisant, MD, of the University Hospital Center Pointe à Pitre, Guadeloupe, France, and her colleagues reported the case of a 27-year-old woman in France who tested positive for Zika virus infection in May. The initial blood test was positive, while the urine sample was negative (Lancet Infect Dis. 2016 Jul 11. doi: 10.1016/S1473-3099[16]30193-1).
A genital swab, endocervical swab, and a cervical mucus sample were collected 3 days after symptom onset and all tested positive for Zika virus RNA. On day 11 after symptom onset, the woman’s blood and urine samples both tested negative, but her cervical mucus continued to test positive for Zika virus RNA.
The researchers stated that this is the first report of the presence of Zika virus in the genital tract of a woman, as well as its possible persistence after the virus is no longer detectable in blood and urine samples.
“Although we have not tested the infectiousness of a locally situated vaginal virus, its very presence in the female genital tract poses notable challenges, implying that sexual transmission from women to men could occur, as is the case for other viral infections,” the researchers wrote. “Zika virus presence in the female genital tract also means that vertical transmission from mother to fetus needs to be assessed, since this virus is a member of the Flaviviridae family, which includes hepatitis C, in which vertical transmission from mother to child can occur in up to 10% of pregnancies.”
The researchers reported having no relevant financial disclosures.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
Zika virus appears to be able to persist in a woman’s genital tract even after it is no longer detectable in blood and urine, according to a new case study.
The findings raise the possibility of woman-to-man sexual transmission of the virus, as well as mother-to-child vertical transmission.
Nadia Prisant, MD, of the University Hospital Center Pointe à Pitre, Guadeloupe, France, and her colleagues reported the case of a 27-year-old woman in France who tested positive for Zika virus infection in May. The initial blood test was positive, while the urine sample was negative (Lancet Infect Dis. 2016 Jul 11. doi: 10.1016/S1473-3099[16]30193-1).
A genital swab, endocervical swab, and a cervical mucus sample were collected 3 days after symptom onset and all tested positive for Zika virus RNA. On day 11 after symptom onset, the woman’s blood and urine samples both tested negative, but her cervical mucus continued to test positive for Zika virus RNA.
The researchers stated that this is the first report of the presence of Zika virus in the genital tract of a woman, as well as its possible persistence after the virus is no longer detectable in blood and urine samples.
“Although we have not tested the infectiousness of a locally situated vaginal virus, its very presence in the female genital tract poses notable challenges, implying that sexual transmission from women to men could occur, as is the case for other viral infections,” the researchers wrote. “Zika virus presence in the female genital tract also means that vertical transmission from mother to fetus needs to be assessed, since this virus is a member of the Flaviviridae family, which includes hepatitis C, in which vertical transmission from mother to child can occur in up to 10% of pregnancies.”
The researchers reported having no relevant financial disclosures.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
FROM THE LANCET INFECTIOUS DISEASES
Key clinical point: Zika virus RNA was found in a woman’s genital tract.
Major finding: On day 11 after symptom onset, the woman’s blood and urine samples both tested negative, but her cervical mucus continued to test positive for Zika virus RNA.
Data source: A case study of a 27-year-old woman in Guadeloupe, France with Zika virus.
Disclosures: The researchers reported having no relevant financial disclosures.
VIDEO: Expert roundtable explores 50 years of contraception
WASHINGTON – What has the increased access to contraception over the last 50 years meant for American women?
We asked Ob.Gyn. News editorial advisory board member Dr. Eve Espey, professor and chair of the department of obstetrics and gynecology at the University of New Mexico, Albuquerque, along with three experts in family planning, to explore how expanded contraception options have affected public health, what barriers still remain, and what new products are in the pipeline.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Perhaps the biggest impact for women has been the ability to participate in the workforce, and that includes women entering medical school.
“Over the last 50 years, we’ve seen a big increase in the number of women who are professionals, who are physicians,” Dr. Espey said during the roundtable. “And during that same period of time, we’ve seen the growth of more focus on family planning.”
“I think that really would not be possible without the ability to control our fertility,” said Dr. Sarah W. Prager, associate professor of obstetrics and gynecology and director of the Ryan Family Planning Program at the University of Washington, Seattle.
And the widespread availability of contraception has translated into a decrease in maternal mortality as a result of fewer unintended pregnancies. “The implications for public health – for women and children in this country – is huge,” Dr. Prager said.
LARCs
One of the big shifts in contraceptive trends has been the slow but increasing uptake of long-acting reversible contraceptives (LARCs), such as IUDs and implants. After a drop-off in the 1970s following safety problems with the Dalkon Shield, there has been a resurgence in interest.
In the last decade, the rate of LARC use has grown from about 2% to 10%, corresponding to a slight drop in rates of unintended pregnancy, said Dr. Nikki B. Zite, professor and residency program director in the department of obstetrics and gynecology at the University of Tennessee, Knoxville.
The Contraceptive CHOICE Project, which enrolled more than 9,000 women who were provided with the no-cost reversible contraceptive method of their choice, found that about three-quarters of the women chose an IUD or an implant, which was associated with significant reductions in unintended and teen pregnancies.
“What we saw was that when we removed barriers to contraception in general, that uptake of IUDs and implants really went up,” said Dr. Tessa Madden, director of the division of family planning and associate professor in the department of obstetrics and gynecology at Washington University, St. Louis.
There is no “best” contraceptive method, Dr. Madden said. “Contraception really needs to be tailored to the individual woman [ensuring] that her values and preferences about contraception are taken into consideration during counseling, to help her choose the method that’s going to be the best fit for her.”
Resources
There are resources available to aid in tailoring contraception methods to the needs of patients.
U.S. Medical Eligibility Criteria for Contraceptive Use, guidance that is available through the Centers for Disease Control and Prevention, allows physicians to tailor the method to a patient’s comorbid medical conditions, Dr. Zite said. Physicians can search by contraceptive method or patient characteristic to determine the risk for a given patient, rated on a scale of 1-4 (where 1 or 2 means generally safe, 3 means that the risks may outweigh the benefits, and 4 means that the risks clearly outweigh the benefits).
“It’s a really easy starting-off point to use with patients and physicians when trying to decide what contraceptive method is safe for their patient,” Dr. Zite said.
Common medical comorbidities, including obesity, diabetes, thyroid disease, and hypertension, are all addressed in the medical eligibility criteria.
Another resource is the U.S. Selected Practice Recommendations for Contraceptive Use, which can help in deciding when it is appropriate to start a contraceptive method, what exams and tests are needed before initiation, what follow-up is needed, and how to handle problems such as missed pills or potential side effects.
Barriers
Over the years, many of the barriers to contraceptive access have been reduced. Some forms of emergency contraception are now available over the counter to women of all ages; more states are considering laws allowing women to access up to a year’s supply of hormonal contraceptives at one time; and a few states have passed laws allowing pharmacists to prescribe hormonal birth control directly. In addition, the Affordable Care Act’s mandate for insurers to cover approved methods of contraception without cost sharing has eliminated some cost barriers.
But other systems barriers still remain, such as making women return for multiple visits for the insertion of an IUD or implant, or limiting LARC use only to women who have already had a child. “There’s not a reason to avoid use of IUDs in women that have not had babies but there are still providers out there who will not insert an IUD, so we need to still do a better job to increase access even more,” Dr. Zite said.
Future trends
What new contraceptive options are in the pipeline? Dr. Prager predicted more development in the area of longer-acting injectables and implants, potentially even biodegradable implants. Also likely is the development of nonsurgical sterilization methods for women that eliminate some of the risk and cost barriers. And male contraceptive methods are in the works, both hormonal and nonhormonal, Dr. Prager said.
There’s an increasing interested in nonhormonal longer-acting methods, beyond just the copper IUD, Dr. Madden said, and there are new products on the horizon in that area. Researchers are exploring new methods to protect against HIV and other sexually transmitted infections, while offering contraception, Dr. Zite said.
Dr. Espey reported having no relevant financial disclosures. Dr. Prager is an unpaid trainer for Nexplanon (Merck). Dr. Zite is an unpaid trainer for Nexplanon and serves on an international IUD advisory board for Bayer. Dr. Madden serves on a scientific advisory board for Bayer and on a data safety monitoring board for phase IV safety studies of Bayer contraceptive products.
Throughout 2016, Ob.Gyn. News is celebrating its 50th anniversary with exclusive articles looking at the evolution of the specialty, including the history of infertility treatment, changes in gynecologic surgery, and the transformation of the well-woman visit. Look for these articles and more special features in the pages of Ob.Gyn. News and online at obgynnews.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
WASHINGTON – What has the increased access to contraception over the last 50 years meant for American women?
We asked Ob.Gyn. News editorial advisory board member Dr. Eve Espey, professor and chair of the department of obstetrics and gynecology at the University of New Mexico, Albuquerque, along with three experts in family planning, to explore how expanded contraception options have affected public health, what barriers still remain, and what new products are in the pipeline.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Perhaps the biggest impact for women has been the ability to participate in the workforce, and that includes women entering medical school.
“Over the last 50 years, we’ve seen a big increase in the number of women who are professionals, who are physicians,” Dr. Espey said during the roundtable. “And during that same period of time, we’ve seen the growth of more focus on family planning.”
“I think that really would not be possible without the ability to control our fertility,” said Dr. Sarah W. Prager, associate professor of obstetrics and gynecology and director of the Ryan Family Planning Program at the University of Washington, Seattle.
And the widespread availability of contraception has translated into a decrease in maternal mortality as a result of fewer unintended pregnancies. “The implications for public health – for women and children in this country – is huge,” Dr. Prager said.
LARCs
One of the big shifts in contraceptive trends has been the slow but increasing uptake of long-acting reversible contraceptives (LARCs), such as IUDs and implants. After a drop-off in the 1970s following safety problems with the Dalkon Shield, there has been a resurgence in interest.
In the last decade, the rate of LARC use has grown from about 2% to 10%, corresponding to a slight drop in rates of unintended pregnancy, said Dr. Nikki B. Zite, professor and residency program director in the department of obstetrics and gynecology at the University of Tennessee, Knoxville.
The Contraceptive CHOICE Project, which enrolled more than 9,000 women who were provided with the no-cost reversible contraceptive method of their choice, found that about three-quarters of the women chose an IUD or an implant, which was associated with significant reductions in unintended and teen pregnancies.
“What we saw was that when we removed barriers to contraception in general, that uptake of IUDs and implants really went up,” said Dr. Tessa Madden, director of the division of family planning and associate professor in the department of obstetrics and gynecology at Washington University, St. Louis.
There is no “best” contraceptive method, Dr. Madden said. “Contraception really needs to be tailored to the individual woman [ensuring] that her values and preferences about contraception are taken into consideration during counseling, to help her choose the method that’s going to be the best fit for her.”
Resources
There are resources available to aid in tailoring contraception methods to the needs of patients.
U.S. Medical Eligibility Criteria for Contraceptive Use, guidance that is available through the Centers for Disease Control and Prevention, allows physicians to tailor the method to a patient’s comorbid medical conditions, Dr. Zite said. Physicians can search by contraceptive method or patient characteristic to determine the risk for a given patient, rated on a scale of 1-4 (where 1 or 2 means generally safe, 3 means that the risks may outweigh the benefits, and 4 means that the risks clearly outweigh the benefits).
“It’s a really easy starting-off point to use with patients and physicians when trying to decide what contraceptive method is safe for their patient,” Dr. Zite said.
Common medical comorbidities, including obesity, diabetes, thyroid disease, and hypertension, are all addressed in the medical eligibility criteria.
Another resource is the U.S. Selected Practice Recommendations for Contraceptive Use, which can help in deciding when it is appropriate to start a contraceptive method, what exams and tests are needed before initiation, what follow-up is needed, and how to handle problems such as missed pills or potential side effects.
Barriers
Over the years, many of the barriers to contraceptive access have been reduced. Some forms of emergency contraception are now available over the counter to women of all ages; more states are considering laws allowing women to access up to a year’s supply of hormonal contraceptives at one time; and a few states have passed laws allowing pharmacists to prescribe hormonal birth control directly. In addition, the Affordable Care Act’s mandate for insurers to cover approved methods of contraception without cost sharing has eliminated some cost barriers.
But other systems barriers still remain, such as making women return for multiple visits for the insertion of an IUD or implant, or limiting LARC use only to women who have already had a child. “There’s not a reason to avoid use of IUDs in women that have not had babies but there are still providers out there who will not insert an IUD, so we need to still do a better job to increase access even more,” Dr. Zite said.
Future trends
What new contraceptive options are in the pipeline? Dr. Prager predicted more development in the area of longer-acting injectables and implants, potentially even biodegradable implants. Also likely is the development of nonsurgical sterilization methods for women that eliminate some of the risk and cost barriers. And male contraceptive methods are in the works, both hormonal and nonhormonal, Dr. Prager said.
There’s an increasing interested in nonhormonal longer-acting methods, beyond just the copper IUD, Dr. Madden said, and there are new products on the horizon in that area. Researchers are exploring new methods to protect against HIV and other sexually transmitted infections, while offering contraception, Dr. Zite said.
Dr. Espey reported having no relevant financial disclosures. Dr. Prager is an unpaid trainer for Nexplanon (Merck). Dr. Zite is an unpaid trainer for Nexplanon and serves on an international IUD advisory board for Bayer. Dr. Madden serves on a scientific advisory board for Bayer and on a data safety monitoring board for phase IV safety studies of Bayer contraceptive products.
Throughout 2016, Ob.Gyn. News is celebrating its 50th anniversary with exclusive articles looking at the evolution of the specialty, including the history of infertility treatment, changes in gynecologic surgery, and the transformation of the well-woman visit. Look for these articles and more special features in the pages of Ob.Gyn. News and online at obgynnews.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
WASHINGTON – What has the increased access to contraception over the last 50 years meant for American women?
We asked Ob.Gyn. News editorial advisory board member Dr. Eve Espey, professor and chair of the department of obstetrics and gynecology at the University of New Mexico, Albuquerque, along with three experts in family planning, to explore how expanded contraception options have affected public health, what barriers still remain, and what new products are in the pipeline.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
Perhaps the biggest impact for women has been the ability to participate in the workforce, and that includes women entering medical school.
“Over the last 50 years, we’ve seen a big increase in the number of women who are professionals, who are physicians,” Dr. Espey said during the roundtable. “And during that same period of time, we’ve seen the growth of more focus on family planning.”
“I think that really would not be possible without the ability to control our fertility,” said Dr. Sarah W. Prager, associate professor of obstetrics and gynecology and director of the Ryan Family Planning Program at the University of Washington, Seattle.
And the widespread availability of contraception has translated into a decrease in maternal mortality as a result of fewer unintended pregnancies. “The implications for public health – for women and children in this country – is huge,” Dr. Prager said.
LARCs
One of the big shifts in contraceptive trends has been the slow but increasing uptake of long-acting reversible contraceptives (LARCs), such as IUDs and implants. After a drop-off in the 1970s following safety problems with the Dalkon Shield, there has been a resurgence in interest.
In the last decade, the rate of LARC use has grown from about 2% to 10%, corresponding to a slight drop in rates of unintended pregnancy, said Dr. Nikki B. Zite, professor and residency program director in the department of obstetrics and gynecology at the University of Tennessee, Knoxville.
The Contraceptive CHOICE Project, which enrolled more than 9,000 women who were provided with the no-cost reversible contraceptive method of their choice, found that about three-quarters of the women chose an IUD or an implant, which was associated with significant reductions in unintended and teen pregnancies.
“What we saw was that when we removed barriers to contraception in general, that uptake of IUDs and implants really went up,” said Dr. Tessa Madden, director of the division of family planning and associate professor in the department of obstetrics and gynecology at Washington University, St. Louis.
There is no “best” contraceptive method, Dr. Madden said. “Contraception really needs to be tailored to the individual woman [ensuring] that her values and preferences about contraception are taken into consideration during counseling, to help her choose the method that’s going to be the best fit for her.”
Resources
There are resources available to aid in tailoring contraception methods to the needs of patients.
U.S. Medical Eligibility Criteria for Contraceptive Use, guidance that is available through the Centers for Disease Control and Prevention, allows physicians to tailor the method to a patient’s comorbid medical conditions, Dr. Zite said. Physicians can search by contraceptive method or patient characteristic to determine the risk for a given patient, rated on a scale of 1-4 (where 1 or 2 means generally safe, 3 means that the risks may outweigh the benefits, and 4 means that the risks clearly outweigh the benefits).
“It’s a really easy starting-off point to use with patients and physicians when trying to decide what contraceptive method is safe for their patient,” Dr. Zite said.
Common medical comorbidities, including obesity, diabetes, thyroid disease, and hypertension, are all addressed in the medical eligibility criteria.
Another resource is the U.S. Selected Practice Recommendations for Contraceptive Use, which can help in deciding when it is appropriate to start a contraceptive method, what exams and tests are needed before initiation, what follow-up is needed, and how to handle problems such as missed pills or potential side effects.
Barriers
Over the years, many of the barriers to contraceptive access have been reduced. Some forms of emergency contraception are now available over the counter to women of all ages; more states are considering laws allowing women to access up to a year’s supply of hormonal contraceptives at one time; and a few states have passed laws allowing pharmacists to prescribe hormonal birth control directly. In addition, the Affordable Care Act’s mandate for insurers to cover approved methods of contraception without cost sharing has eliminated some cost barriers.
But other systems barriers still remain, such as making women return for multiple visits for the insertion of an IUD or implant, or limiting LARC use only to women who have already had a child. “There’s not a reason to avoid use of IUDs in women that have not had babies but there are still providers out there who will not insert an IUD, so we need to still do a better job to increase access even more,” Dr. Zite said.
Future trends
What new contraceptive options are in the pipeline? Dr. Prager predicted more development in the area of longer-acting injectables and implants, potentially even biodegradable implants. Also likely is the development of nonsurgical sterilization methods for women that eliminate some of the risk and cost barriers. And male contraceptive methods are in the works, both hormonal and nonhormonal, Dr. Prager said.
There’s an increasing interested in nonhormonal longer-acting methods, beyond just the copper IUD, Dr. Madden said, and there are new products on the horizon in that area. Researchers are exploring new methods to protect against HIV and other sexually transmitted infections, while offering contraception, Dr. Zite said.
Dr. Espey reported having no relevant financial disclosures. Dr. Prager is an unpaid trainer for Nexplanon (Merck). Dr. Zite is an unpaid trainer for Nexplanon and serves on an international IUD advisory board for Bayer. Dr. Madden serves on a scientific advisory board for Bayer and on a data safety monitoring board for phase IV safety studies of Bayer contraceptive products.
Throughout 2016, Ob.Gyn. News is celebrating its 50th anniversary with exclusive articles looking at the evolution of the specialty, including the history of infertility treatment, changes in gynecologic surgery, and the transformation of the well-woman visit. Look for these articles and more special features in the pages of Ob.Gyn. News and online at obgynnews.com.
mschneider@frontlinemedcom.com
On Twitter @maryellenny
