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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (20 May 2022) | Viewed by 44782

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Prof. Dr. Giuseppe Benagiano

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Guest Editor

Department of Maternal and Child Health, Gynaecology and Urology, Sapienza University of Rome, Rome, Italy
Interests: reproductive endocrinology; adenomyosis; contraception; endometriosis; placental pathophysiology.
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Francesco Maria Primiero

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Guest Editor

Department of Medical–Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
Interests: reproductive endocrinology; contraception; endometriosis

Special Issue Information

Dear Colleagues,

After gaining front pages, even in the lay press, toward the end of the last millennium, contraception is now sort of taken for granted and is no longer a major topic. However, the estimated incidence of unintended pregnancies worldwide remains very high and, in this context, far from being nothing new to report, progress continues to be made toward methods specially designed for women with particular problems, be it because of their health or their living conditions, in order to improve both acceptance and continuation rate.

New estrogen–progestin oral combinations that contain the natural estrogen 17β-estradiol have been developed and marketed. New preparations utilizing another natural estrogen, estetrol (15α-hydroxy-estriol), are now under evaluation and will, hopefully, demonstrate better safety and tolerability, with special emphasis on lipid metabolism and effects on the hemostatic system. On the “minipill” front, a drospirenone-only preparation is at an advanced stage of development and there are indications that it may provide a better bleeding profile, with higher quality of life and adherence to this contraceptive method.

Research on vaginal contraception is currently exploring the consequences of the local administration of steroid hormones on the vaginal microbiome; new rings releasing the antiviral compound used in treating HIV, tenofovir, associated with levonorgestrel have been developed and are being tested. Meanwhile, in the area of intrauterine contraception, the recently developed three-dimensional, spherical, copper intrauterine device (IUD), seems to offer a significant reduction in the rates of perforation, malposition, and expulsion, while it can be inserted and removed in the same fashion as two-dimensional T-shaped IUDs.

The aim of this Special Issue is to highlight recent advances in meeting the needs of specific groups of women, especially those with contraindications to commonly used methods. We are happy to receive contributions in these fields.

Prof. Dr. Giuseppe Benagiano
Prof. Dr. Francesco Maria Primiero
Guest Editors

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Keywords

Combined oral contraceptives
Natural estrogens
Progestin-only pills
Drospirenone
Contraceptive vaginal rings
Intrauterine devices

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Published Papers (12 papers)

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Editorial

Jump to: Research, Review

4 pages, 197 KiB

Open AccessEditorial

Special Issue “New Insights into Contraception”

by Giuseppe Benagiano and Francesco M. Primiero

J. Clin. Med. 2022, 11(22), 6651; https://doi.org/10.3390/jcm11226651 - 9 Nov 2022

Viewed by 1038

Abstract

Today, a diverse range of contraceptive techniques is available to women; this, coupled with continued positive trends in female children and adults’ educational attainment, will hasten declines in fertility and continue to slow population growth [...] Full article

(This article belongs to the Special Issue New Insights into Contraception)

Research

Jump to: Editorial, Review

22 pages, 1547 KiB

Open AccessArticle

Utility of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Abnormal Uterine Bleeding and Dysmenorrhea: A Narrative Review

by Paola Bianchi, Sun-Wei Guo, Marwan Habiba and Giuseppe Benagiano

J. Clin. Med. 2022, 11(19), 5836; https://doi.org/10.3390/jcm11195836 - 1 Oct 2022

Cited by 6 | Viewed by 5632

Abstract

Introduction: We undertook a literature review of the use of levonorgestrel-releasing intrauterine devices when utilized for heavy menstrual bleeding and/or dysmenorrhea. Methods: A narrative review of articles in the Scopus and Medline databases was conducted. Results: A number of options exist for the management of both abnormal uterine bleeding (AUB) and dysmenorrhea, and evidence is accumulating that the insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) represents a useful option for their long-term treatment. The idea of using a progestogen released in utero was initially conceived to achieve long-term contraception, but it was quickly found that these systems could be utilized for a number of therapeutic applications. The first device to be made commercially available, Progestasert, was withdrawn from the market because, in the event of contraceptive failure, it caused a disproportionate percentage of extrauterine pregnancies. On the other hand, the LNG-IUS continues to be successfully utilized in its various variants, releasing 20, 13, or 8 μg/day. These devices have a respective duration of action of 7 (possibly 8), 5, and 3 years, and there exist versions of frameless systems affixed to the myometrium of the uterine fundus. In the present review, following a brief description of the major causes of AUB and dysmenorrhea, the molecular bases for the use of the LNG-IUS are summarized. This is followed by a compendium of its use in AUB and dysmenorrhea, concluding that the insertion of the system improves the quality of life, reduces menstrual blood loss better than other medical therapies, and decreases the extent of dysmenorrhea and pelvic pain. In addition, there is no evidence of a significant difference in these outcomes when the use of the LNG-IUS was compared with improvements offered by endometrial ablation or hysterectomy. Possibly, the most important mechanism of action of the system consists of its ability to induce amenorrhea, which effectively eliminates heavy bleeding and dysmenorrhea. However, no method is ideal for every woman, and, in the case of the LNG-IUS, younger age and severe dysmenorrhea seem to be associated with a higher risk of discontinuation. Conclusion: The higher-dose LNG-IUS is a useful tool for HMB and dysmenorrhea in women of all ages. The low cost and ease of use make the LNG-IUS an attractive option, especially when contraception is also desired. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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9 pages, 445 KiB

Open AccessArticle

Women’s Access to Sexual and Reproductive Health Services during Confinement Due to the COVID-19 Pandemic in Spain

by Fatima Leon-Larios, Isabel Silva Reus, Isabel Lahoz Pascual, José Cruz Quílez Conde, María José Puente Martínez, José Gutiérrez Ales and Marta Correa Rancel

J. Clin. Med. 2022, 11(14), 4074; https://doi.org/10.3390/jcm11144074 - 14 Jul 2022

Cited by 6 | Viewed by 1590

Abstract

(1) Background: The COVID-19 pandemic has created a challenge for women’s sexual and reproductive health care. The objective of this research was to analyse access to sexual and reproductive health services during confinement in Spain. (2) Methods: A descriptive and cross-sectional study was conducted with a random sample that was stratified by age in July and August 2020. (3) Results: A total of 1800 women were invited to participate, obtaining a response rate of 98.72%. The frequency of sexual relationships reduced during confinement. Counselling was offered both in person (30.7%) and telematically (39%), although there were also women who experienced access problems (30%). Of those women who required some LARC, only half had access to it, mainly due to the contact difficulties as a result of the limited number of consultations with their prescribing physicians. The use of emergency oral contraception and the use of services for the voluntary interruption of pregnancy were considerably reduced. The women who stated having been victims of gender-based violence were those that lived with their aggressors during confinement and had children. (4) Conclusions: It is necessary to ensure sexual and reproductive rights in confinement times and, for such a purpose, telemedicine can be a good tool that helps to avoid unmet contraceptive needs and unplanned pregnancies. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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14 pages, 1174 KiB

Open AccessArticle

Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020)

by Fatima Leon-Larios, José Gutiérrez Ales, María José Puente Martínez, Marta Correa Rancel, Isabel Lahoz Pascual, Isabel Silva Reus and José Cruz Quílez Conde

J. Clin. Med. 2022, 11(13), 3777; https://doi.org/10.3390/jcm11133777 - 29 Jun 2022

Cited by 6 | Viewed by 1548

Abstract

Background: The National Contraception Survey conducted by Sociedad Española de Contracepción intends to know the sexual and contraceptive habits of Spanish women of reproductive age. Methods: A descriptive and cross-sectional study with random sample selection was conducted with women aged from 14 to 49 years old in July and August 2020. Results: A total of 1801 women participated in the study, of which 78.7% used some contraception method during their sexual relationships. The most frequently used methods were condoms (31.3%) and combined oral contraceptives (18.5%) at their last sexual encounter. A total of 25.7% used both condoms and pills, especially younger women and those who had no steady partners (p < 0.001). Use of Long-acting Reversible Contraceptives continues to be low, although a slight increase in their use is observed, and they are recommended for 50% of the users who need contraception. Counselling on contraception was provided to 64.3% of the women, mainly by their gynaecologists. Regarding the decision to use a contraceptive method, the one suggested by health professionals was more influential, although this was not the case for women aged less than 20 years old (p < 0.001). A total of 38.4% of the women have used emergency oral contraception at least once and 66.8% of those who do not make continuous use of contraception methods do so out of personal choice. Conclusions: It is necessary to deepen work on counselling and awareness among the population towards the use of efficient contraceptive methods that prevent unplanned pregnancies. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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9 pages, 246 KiB

Open AccessArticle

Norethisterone Reduces Vaginal Bleeding Caused by Progesterone-Only Birth Control Pills

by Naama Vilk Ayalon, Lior Segev, Abraham O. Samson, Simcha Yagel, Sarah M. Cohen, Tamar Green and Hila Hochler

J. Clin. Med. 2022, 11(12), 3389; https://doi.org/10.3390/jcm11123389 - 13 Jun 2022

Cited by 5 | Viewed by 3869

Abstract

(1) Background: Progesterone-only pills (POP) are widely used contraceptives. About 40% of women taking these pills report vaginal bleeding/spotting; 25% find this a reason for cessation. To date, no effective remedy has been described. We aimed to examine the therapeutic approaches offered by health providers. (2) Methods: A prospective questionnaire-based study of women experiencing vaginal bleeding due to POP, comparing the effectiveness of prescribed therapies. Women were recruited through social networks, and subsequently divided into groups according to the treatment offered: (1) POP with norethisterone (n = 36); (2) double dose POP (n = 19); (3) single dose POP (continuing initial treatment, n = 57); and (4) different POP formula (n = 8). Women rated bleeding quantity and frequency at four intervals, at weeks 0, 2, 4, and 6. (3) Results: Women who added 5 mg norethisterone acetate reported a significant decrease in bleeding frequency compared to the other groups, observed after 2, 4, and 6 weeks (p-values 0.019, 0.002, and 0.002, respectively). Women also reported an overall decrease in combined bleeding quantity and frequency (p-values 0.028, 0.003, and 0.005, respectively). There was no difference in the rate of side effects among groups. (4) Conclusions: Adding 5 mg norethisterone acetate (Primolut-nor) to progesterone-only pills significantly reduces bleeding and spotting associated with POP contraception. Full article

(This article belongs to the Special Issue New Insights into Contraception)

10 pages, 573 KiB

Open AccessArticle

Nursing Students’ Knowledge, Awareness, and Experiences of Emergency Contraception Pills’ Use

by Fatima Leon-Larios, Cecilia Ruiz-Ferron, Rocio-Marina Jalon-Neira and Juan-Manuel Praena-Fernández

J. Clin. Med. 2022, 11(2), 418; https://doi.org/10.3390/jcm11020418 - 14 Jan 2022

Cited by 6 | Viewed by 4242

Abstract

The emergency contraception pill (ECP) is a non-prescribed medication in Spain. However, there is not enough evidence of its use among young people to define sex education contents. The aims of this research were to describe the experiences of the use of the ECP in university students and analyze their knowledge, attitude, and awareness regarding the ECP. The cross-sectional, analytic study was conducted with nursing degree students at the University of Seville. A total of 478 students answered the questionnaire. All of the students (100%) had heard about the ECP and had a positive attitude towards this contraceptive. A total of 25.7% had used the ECP, mainly because a condom had failed or because they did not use any contraceptive at all. Deficiencies in knowledge are related with the ECPs’ mechanism of action, efficacy after repeated use, and the type of ECP available. Female students who used no method at all or withdrawal, and who were over 20 years old, used ECP to a greater extent (p < 0.005). Further education initiatives focused on the use of the ECP, its efficacy, and typology are needed, particularly among future health professionals who will later educate other young people. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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11 pages, 1146 KiB

Open AccessArticle

Characterization of the Use of Emergency Contraception from Sentinel Pharmacies in a Region of Southern Europe

by Anna M. Jambrina, Pilar Rius, Pilar Gascón, Mercè Armelles, Mariona Camps-Bossacoma, Àngels Franch and Manel Rabanal

J. Clin. Med. 2021, 10(13), 2793; https://doi.org/10.3390/jcm10132793 - 25 Jun 2021

Cited by 5 | Viewed by 2157

Abstract

Numerous studies have been published suggesting that emergency contraception (EC) is used repeatedly, but a lack of information regarding the profile of users makes it difficult to evaluate actual consumer habits. The aim of this study was to obtain information regarding the profile of users who obtain EC and other factors that might play a role, and to provide criteria to evaluate and improve the strategies of current contraceptive programs. This was an observational one-year study based on surveillance data on the provision of EC to women of reproductive age in 60 community pharmacies in Catalonia, Spain. In total, 941 notifications of dispensation of EC in Catalonia were received. A total of 44.2% of users said it was not the first time that they had taken the medication (repeat user). The percentage of users who used condoms was lower in repeat users compared to first-time users (56.7% vs. 64.4%, p < 0.05). A total of 25.7% of users stated that they did not use any barrier contraceptive method. The use of natural methods in repeat users was 53.8% in the subgroup who requested the medication after 48 h, significantly higher than in users who obtained the medication within the first 24 h (p < 0.05). A high percentage of repeat users with risky sexual behaviors were detected, suggesting that new measures must be implemented to provide information for this method, together with educational and preventive strategies. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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10 pages, 5937 KiB

Open AccessArticle

Long-Acting Reversible Contraception: Placement, Continuation, and Removal Rates at an Inner-City Academic Medical Center Clinic

by Aliye Runyan, Robert A. Welch, Katherine J. Kramer, Sarah Cortez, LeAnne J. Roberts, Clementina Asamoah, Sarah Ottum, Jessica Sanders, Adib Shafi and Maurice-Andre Recanati

J. Clin. Med. 2021, 10(9), 1918; https://doi.org/10.3390/jcm10091918 - 28 Apr 2021

Cited by 4 | Viewed by 2393

Abstract

Long-Acting Reversible Contraception (LARCs) has the potential to decrease unintended pregnancies but only if women can easily access a requested method. Retrospective electronic chart review identified women desiring LARC placement over a one-year period ending 31 December 2016. Most of the 311 insertions were for family planning, with 220 new insertions and 60 replacements. Delays occurred in 38% (n = 118) of patients, averaged 5 ± 5 weeks, and 47% received interval contraception. Reasons included absence of qualified provider (n = 44, 37%), pending cultures (n = 31, 26%), and Mirena availability. Teenage LARC use favored Nexplanon whereas older women preferred Mirena (p < 0.01). Of the 11% choosing early LARC removal, a significant number were African Americans (p = 0.040) or teenagers (p = 0.048). Retention time varied by device type; most patients switched to other contraceptives. No patients experienced IUD expulsion. Understanding barriers, attempting to remedy them, and addressing the side effects associated with LARC use is of importance in this inner-city patient population in the United States. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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Review

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15 pages, 2350 KiB

Open AccessReview

Bleeding Patterns of Oral Contraceptives with a Cyclic Dosing Regimen: An Overview

by David F. Archer, Diana Mansour and Jean-Michel Foidart

J. Clin. Med. 2022, 11(15), 4634; https://doi.org/10.3390/jcm11154634 - 8 Aug 2022

Cited by 12 | Viewed by 3593

Abstract

Bleeding irregularities are one of the major reasons for discontinuation of oral contraceptives (OCs), and therefore clinicians need to set expectations during consultations. In this review we provide an overview of bleeding data of recently marketed cyclic combined OCs (COCs) and one progestin-only pill (POP). We evaluated data from phase 3 trials (≥12 months) used to gain regulatory approval. Overall, each type of OC has its own specific bleeding pattern. These patterns however were assessed by using different bleeding definitions, which hampers comparisons between products. In COCs, the estrogen balances the effects of the progestin on the endometrium, resulting in a regular bleeding pattern. However, this balance seems lost if a too low dose of ethinylestradiol (EE) (e.g., 10 µg in EE/norethindrone acetate 1 mg) is used in an attempt to lower the risk of venous thromboembolism. Replacement of EE by 17β-estradiol (E2) or E2 valerate could lead to suboptimal bleeding profile due to destabilization of the endometrium. Replacement of EE with estetrol (E4) 15 mg in the combination with drospirenone (DRSP) 3 mg is associated with a predictable and regular scheduled bleeding profile, while the POP containing DRSP 4 mg in a 24/4 regimen is associated with a higher rate of unscheduled and absence of scheduled bleeding than combined products. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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8 pages, 1261 KiB

Open AccessReview

Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature

by Guglielmo Stabile, Carmelina Foti, Denise Mordeglia, Davide De Santo, Francesco Paolo Mangino, Antonio Simone Laganà and Giuseppe Ricci

J. Clin. Med. 2022, 11(11), 3226; https://doi.org/10.3390/jcm11113226 - 6 Jun 2022

Cited by 6 | Viewed by 4689

Abstract

The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon^® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon^® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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11 pages, 632 KiB

Open AccessEditor’s ChoiceReview

How Does Contraceptive Use Affect Women’s Sexuality? A Novel Look at Sexual Acceptability

by Salvatore Caruso, Gaia Palermo, Giuseppe Caruso and Agnese Maria Chiara Rapisarda

J. Clin. Med. 2022, 11(3), 810; https://doi.org/10.3390/jcm11030810 - 3 Feb 2022

Cited by 15 | Viewed by 5256

Abstract

Among the components of a healthy life, sexuality is essential, contributing to both the psychophysical and social well-being of women and, consequently, to their quality of life. A poorly investigated standpoint is the acceptability of contraceptive methods, both in terms of their tolerability and metabolic neutrality and in terms of their impact on sexual life. In this context, we will provide an overview of the different methods of contraception and their effects on female sexuality, from biological changes to organic, social, and psychological factors, which can all shape sexuality. A MEDLINE/PubMed review of the literature between 2010 and 2021 was conducted using the following key words and phrases: hormonal contraception, contraceptives, female sexual function, libido, sexual arousal and desire, and sexual pain. Recent studies have supported the effects of contraceptives on women’s sexuality, describing a variety of positive and negative events in several domains of sexual function (desire, arousal, orgasm, pain, enjoyment). However, satisfaction with sexual activity depends on factors that extend beyond sexual functioning alone. A more holistic approach is needed to better understand the multitude of factors linked to women’s sexuality and contraception. Contraceptive counseling must consider these important elements since they are closely related to good compliance and maximize non-contraceptive health benefits. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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12 pages, 1386 KiB

Open AccessReview

Estetrol: A New Choice for Contraception

by Franca Fruzzetti, Tiziana Fidecicchi, Maria Magdalena Montt Guevara and Tommaso Simoncini

J. Clin. Med. 2021, 10(23), 5625; https://doi.org/10.3390/jcm10235625 - 29 Nov 2021

Cited by 44 | Viewed by 6674

Abstract

Estetrol (E4) is a natural estrogenic steroid that is normally produced by human fetal liver. Recent research has demonstrated that it is a potent, orally bioavailable, natural selective estrogen receptor modulator; it has a moderate affinity for both human estrogen receptor alpha (ERα) and ERβ, with a preference for ERα. Clinical studies have demonstrated possible use as an estrogen in combined oral contraceptives (COC). COCs containing E4 and drospirenone (DRSP) showed a high acceptability, tolerability, and user satisfaction also when compared to COCs containing ethinylestradiol (EE). E4/DRSP effectively inhibits ovulation, with a similar effect on endometrium thickness than that of EE-containing COCs. Low doses (15 mg) of E4 with DRSP (3 mg) showed promising results in term of bleeding pattern and cycle control, also when compared to other COCs containing synthetic estrogens. Moreover, the association has limited effects on serum lipids, liver, SHBG levels, and carbohydrate metabolism. This combination also could drive a lower risk of venous thromboembolism than EE-containing COCs. In this review, we will summarize the actual knowledge about the new E4-containing contraceptive. Further large-scale studies in the full target population are needed to provide more insights into the cardiovascular safety profile and user satisfaction of E4/DRSP. Full article

(This article belongs to the Special Issue New Insights into Contraception)

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