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Contraception during perimenopause: oral contraception versus LARC
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Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Results: The 7 patients with PPVI had 11 pregnancies at a mean age of 29 ± 6 years (ranged 17–38 years). 6 pregnancies were complete (>20 week gestation (WG)) and led to deliveries. One of the deliveries was a late miscarriage at 22 WG. There were three other miscarriages (one late and two early) and two abortions. 3/6 pregnancies were delivered by cesarean section (50%), for obstetrical indications. Obstetric complications occurred in 3/6 complete pregnancies (50%): one severe preeclampsia leading to a premature birth at 26 WG + 6, one preterm birth at 22 WG with neonatal death and one threatening preterm labor at 34 WG who finally delivered at 38 WG + 2. There was no small for gestational age neonate. The mean gestational age at birth was 36 + 2 WG if we exclude the delivery at 22 WG. No congenital heart disease was diagnosed in the newborns and there was no neonatal or fetal death. During complete pregnancies no cardiac complication occurred. However one patient died from endocarditis in the aftermath of an abortion. All patients were treated by aspirin throughout pregnancy and received antibiotic prophylaxis at delivery, except the patient who died, who had antibiotics at the time of the abortion but no aspirin. At median follow-up of 14 months, there was no change in the trans-pulmonary valve maximal gradient (31 vs. 27 mmHg) and no pulmonary regurgitation. Conclusion: This small first series of pregnancies with PPVI seems reassuring for the maternal and neonatal outcomes, except for the risk of infection, which needs careful monitoring by experienced teams. http://dx.doi.org/10.1016/j.ejogrb.2016.07.125 Contraception Oral Presentation Contraception during perimenopause: oral contraception versus LARC Inês Gante 1,∗ , Fernanda Geraldes 2 , Teresa Bombas 3 , Fernanda Águas 4 1 Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal 2 President of Department of Menopause – Portuguese Society of Gynaecology; Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal 3 President of Portuguese Society of Contraception; Department of Obstetrics – Centro Hospitalar e Universitário de Coimbra, Portugal 4 President of Portuguese Society of Gynaecology; Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal E-mail address: [email protected] (I. Gante).
Introduction: Perimenopause marks the transition from normal ovulation to anovulation and ultimately to permanent loss of ovarian function. Although the absolute risk of pregnancy is lower, unintended pregnancy occurs. Therefore all perimenopausal women should receive counselling on contraception. A variety of contraceptive options may be offered to perimenopausal women, including oral contraception (OC) and long-acting reversible contraception (LARC), such as intrauterine devices and subcutaneous implants. Until the age of 50, no contraceptive method is specifically considered unsuitable due to age alone. Objective: To describe and compare the most used contraceptive methods in Portuguese perimenopausal women. Study design: Comparative study between OC and LARC in Portuguese women aged between 40 and 49 years. We used the data
from a cross-sectional study, with a representative subset of the female Portuguese population aged between 15 and 49, carried out by applying an anonymous survey between December 2014 and March 2015. Data were analyzed using STATA version 13.1. Results: A total of 1244 women aged between 40 and 49 years responded to the survey. 84.1% (n = 1045) of these women were using contraception. OC was the contraceptive option in 50.6% (n = 529) and LARC in 30.6% (n = 320) (26.3% intrauterine devices and 4.3% subcutaneous implants). 91.8% (n = 1140) of these women were sexually active [99.7% in OC group vs. 98.9% in LARC group (p > 0.05)] and 92.8% (n = 1154) were not nulliparous [95.5% in OC group vs. 98.1% in LARC group (p = 0.04)]. Only 23.0% (n = 286) had an high education level [21.4% in OC group vs. 25,0% in LARC group (p > 0.05)] and 5% (n = 62) had access to information on sexuality and/or sexual education [4.0% in OC group vs. 5.0% in LARC group (p > 0.05)]. Nevertheless, 74.8% (n = 931) had regular reproductive health care appointments [81.9% in OC group vs. 76.9% in LARC group (p > 0.05)]. In OC users, 8.9% (n = 47) admitted omission of at least one pill every cycle and 51.6% (n = 273) admitted that, in case of omission, they did not have any preventive action in order to avoid pregnancy; although 76.8% (n = 406) were aware of emergency contraception, only 6.7% (n = 27) of them had used it. An inferior age [aOR = 0.77 (0.73–0.81)], a not high education level [aOR = 0.59 (0.43–0.82)], regular reproductive health care appointments [aOR = 1.50 (1.08–2.09)] and an inferior parity [aOR = 0.71 (0.60–0.85)] were associated with the option for OC. Contrariwise a superior age [aOR 1.22 (1.16–1.28)] and parity [aOR = 2.87 (1.17–7.04)] were associated with the option for LARC. Conclusions: Despite the wide range of contraceptive options, OC remain the most frequent contraceptive option in Portuguese perimenopausal women. An inferior age, a lower education level, regular reproductive health care appointments and an inferior parity were associated with the option for OC. Contrariwise a superior age and parity were associated with the option for LARC. http://dx.doi.org/10.1016/j.ejogrb.2016.07.126 Infertility Poster Presentation Elastography assessment of the endometrial changes during the menstrual cycle of fertility treatment Raphael Boldes, Miriam Barlev, Irit Kafka, Yedidia Hovav, Ori Shen, Efraim Gdansky ∗ Department of Obstetrics and Gynecology, Bikur Holim Campus, Shaare Zedek Medical Center, Affiliated with the Faculty of Medicine, The Hebrew University of Jerusalem, Israel E-mail address: [email protected] (E. Gdansky). Objective: To explore the feasibility of using sonoelastography in evaluating the endometrium throughout the menstrual cycle during fertility treatments. Methods: Women treated in our fertility clinic underwent three elastographic examinations throughout the cycle: early follicular phase, midcycle, and midlutheal phase. Elastographic results were correlated to hormonal profile, fertility treatment and positive pregnancy test. All of the elastographic examinations were carried out by three ultrasound training technicians, who described the dominant color obtained in the endometrium during examination. We translated the dominant color to a numerical value, based on the degree of stiffness of the tissue from solid to soft, on a scale from 1 to 4 in the following way: purple–blue = 1; dark and light
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Results: The 7 patients with PPVI had 11 pregnancies at a mean age of 29 ± 6 years (ranged 17–38 years). 6 pregnancies were complete (>20 week gestation (WG)) and led to deliveries. One of the deliveries was a late miscarriage at 22 WG. There were three other miscarriages (one late and two early) and two abortions. 3/6 pregnancies were delivered by cesarean section (50%), for obstetrical indications. Obstetric complications occurred in 3/6 complete pregnancies (50%): one severe preeclampsia leading to a premature birth at 26 WG + 6, one preterm birth at 22 WG with neonatal death and one threatening preterm labor at 34 WG who finally delivered at 38 WG + 2. There was no small for gestational age neonate. The mean gestational age at birth was 36 + 2 WG if we exclude the delivery at 22 WG. No congenital heart disease was diagnosed in the newborns and there was no neonatal or fetal death. During complete pregnancies no cardiac complication occurred. However one patient died from endocarditis in the aftermath of an abortion. All patients were treated by aspirin throughout pregnancy and received antibiotic prophylaxis at delivery, except the patient who died, who had antibiotics at the time of the abortion but no aspirin. At median follow-up of 14 months, there was no change in the trans-pulmonary valve maximal gradient (31 vs. 27 mmHg) and no pulmonary regurgitation. Conclusion: This small first series of pregnancies with PPVI seems reassuring for the maternal and neonatal outcomes, except for the risk of infection, which needs careful monitoring by experienced teams. http://dx.doi.org/10.1016/j.ejogrb.2016.07.125 Contraception Oral Presentation Contraception during perimenopause: oral contraception versus LARC Inês Gante 1,∗ , Fernanda Geraldes 2 , Teresa Bombas 3 , Fernanda Águas 4 1 Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal 2 President of Department of Menopause – Portuguese Society of Gynaecology; Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal 3 President of Portuguese Society of Contraception; Department of Obstetrics – Centro Hospitalar e Universitário de Coimbra, Portugal 4 President of Portuguese Society of Gynaecology; Department of Gynaecology – Centro Hospitalar e Universitário de Coimbra, Portugal E-mail address: [email protected] (I. Gante).
Introduction: Perimenopause marks the transition from normal ovulation to anovulation and ultimately to permanent loss of ovarian function. Although the absolute risk of pregnancy is lower, unintended pregnancy occurs. Therefore all perimenopausal women should receive counselling on contraception. A variety of contraceptive options may be offered to perimenopausal women, including oral contraception (OC) and long-acting reversible contraception (LARC), such as intrauterine devices and subcutaneous implants. Until the age of 50, no contraceptive method is specifically considered unsuitable due to age alone. Objective: To describe and compare the most used contraceptive methods in Portuguese perimenopausal women. Study design: Comparative study between OC and LARC in Portuguese women aged between 40 and 49 years. We used the data
from a cross-sectional study, with a representative subset of the female Portuguese population aged between 15 and 49, carried out by applying an anonymous survey between December 2014 and March 2015. Data were analyzed using STATA version 13.1. Results: A total of 1244 women aged between 40 and 49 years responded to the survey. 84.1% (n = 1045) of these women were using contraception. OC was the contraceptive option in 50.6% (n = 529) and LARC in 30.6% (n = 320) (26.3% intrauterine devices and 4.3% subcutaneous implants). 91.8% (n = 1140) of these women were sexually active [99.7% in OC group vs. 98.9% in LARC group (p > 0.05)] and 92.8% (n = 1154) were not nulliparous [95.5% in OC group vs. 98.1% in LARC group (p = 0.04)]. Only 23.0% (n = 286) had an high education level [21.4% in OC group vs. 25,0% in LARC group (p > 0.05)] and 5% (n = 62) had access to information on sexuality and/or sexual education [4.0% in OC group vs. 5.0% in LARC group (p > 0.05)]. Nevertheless, 74.8% (n = 931) had regular reproductive health care appointments [81.9% in OC group vs. 76.9% in LARC group (p > 0.05)]. In OC users, 8.9% (n = 47) admitted omission of at least one pill every cycle and 51.6% (n = 273) admitted that, in case of omission, they did not have any preventive action in order to avoid pregnancy; although 76.8% (n = 406) were aware of emergency contraception, only 6.7% (n = 27) of them had used it. An inferior age [aOR = 0.77 (0.73–0.81)], a not high education level [aOR = 0.59 (0.43–0.82)], regular reproductive health care appointments [aOR = 1.50 (1.08–2.09)] and an inferior parity [aOR = 0.71 (0.60–0.85)] were associated with the option for OC. Contrariwise a superior age [aOR 1.22 (1.16–1.28)] and parity [aOR = 2.87 (1.17–7.04)] were associated with the option for LARC. Conclusions: Despite the wide range of contraceptive options, OC remain the most frequent contraceptive option in Portuguese perimenopausal women. An inferior age, a lower education level, regular reproductive health care appointments and an inferior parity were associated with the option for OC. Contrariwise a superior age and parity were associated with the option for LARC. http://dx.doi.org/10.1016/j.ejogrb.2016.07.126 Infertility Poster Presentation Elastography assessment of the endometrial changes during the menstrual cycle of fertility treatment Raphael Boldes, Miriam Barlev, Irit Kafka, Yedidia Hovav, Ori Shen, Efraim Gdansky ∗ Department of Obstetrics and Gynecology, Bikur Holim Campus, Shaare Zedek Medical Center, Affiliated with the Faculty of Medicine, The Hebrew University of Jerusalem, Israel E-mail address: [email protected] (E. Gdansky). Objective: To explore the feasibility of using sonoelastography in evaluating the endometrium throughout the menstrual cycle during fertility treatments. Methods: Women treated in our fertility clinic underwent three elastographic examinations throughout the cycle: early follicular phase, midcycle, and midlutheal phase. Elastographic results were correlated to hormonal profile, fertility treatment and positive pregnancy test. All of the elastographic examinations were carried out by three ultrasound training technicians, who described the dominant color obtained in the endometrium during examination. We translated the dominant color to a numerical value, based on the degree of stiffness of the tissue from solid to soft, on a scale from 1 to 4 in the following way: purple–blue = 1; dark and light