- Email: [email protected]
Re: Intrauterine contraception as an alternative to interval tubal sterilization
Contraception 78 (2008) 84 – 85
Letters to the Editor
To the Editor: The cost-effectiveness figures in our article [1] relate to the United States; they show that both the copper T380A and levonorgestrel-releasing system compare favorably to interval tubal sterilization [2]. Although myths and misinformation about IUDs persist, the IUD is the most widely used reversible method of contraception in the world today [3]. We agree with Drs. Marasinghe and Wijeyaratne that a public-sector-price levonorgestrel device for developing countries is needed. In addition to effective, “forgettable” contraception, this device would reduce bleeding and increase hemoglobin levels [4], especially useful for women with iron-poor diets and heavy parasite burdens. We agree that the etonogestrel implant is another excellent contraceptive. We did not include it in our article only because its duration of use is substantially shorter than that of IUDs. Effectiveness with the hormonal and copper IUDs ranges from 7 [5] to 20 years [6], respectively. David A. Grimes Family Health International, P. O. Box 13950 Research Triangle Park, NC 27709, USA E-mail address: [email protected]
Daniel R. Mishell Jr. Department of Obstetrics and Gynecology Keck School of Medicine University of Southern California Women's and Children's Hospital Los Angeles, CA 90033, USA E-mail address: [email protected] doi:10.1016/j.contraception.2008.02.018 References [1] Grimes DA, Mishell Jr DR. Intrauterine contraception as an alternative to interval tubal sterilization. Contraception 2008;77:6–9. [2] Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception 2003;68:3–10. [3] d'Arcangues C. Worldwide use of intrauterine devices for contraception. Contraception 2007;75:S2–S7. 0010-7824/$ – see front matter © 2008 Elsevier Inc. All rights reserved.
[4] Faundes A, Alvarez F, Diaz J. A Latin American experience with levonorgestrel IUD. Ann Med 1993;25:149–53. [5] Sivin I, Stern J, Coutinho E, et al. Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Contraception 1991;44:473–80. [6] Sivin I. Utility and drawbacks of continuous use of a copper T IUD for 20 years. Contraception 2007;75:S70–5.
Re: Intrauterine contraception as an alternative to interval tubal sterilization To the Editor: We read with interest the article by Grimes and Mishell [1] on intrauterine contraceptive devices (IUD) and tubal sterilization. They elaborate on the usefulness of IUD compared to interval tubal sterilization. However, there are some issues that need further consideration. The cost of IUD, especially the cost of levenogestrel-releasing IUD (LNG-IUS), should gather the most speculation. It is important to analyze 5-year cost of contraceptives and their effectiveness and choose the least expensive methods. Nonetheless, the initial cost of LNG-IUS, which is approximately £100, is not comparable with cost of interval tubal sterilization, in low- and middle-income countries. Due to economic constraints, LNG-IUS is yet a novel method of contraception in developing countries. There are other hindrances for effective implementation of IUD. Myths perpetuated by women regarding dangers of IUD must not be ignored. Misconception regarding IUD needs eradication by education that gains client's trust and reports of user satisfaction with IUD. Most complaints are related to cultural difficulties in accepting changes in menstrual pattern [2]. Single-rod implantable contraceptive containing etonogestrel is another attractive method that can be offered to a variety of clients. It has high contraceptive efficacy and a satisfactory safety profile [3,4]. The insertion and removal of it is an officebased procedure, is fast and is uncomplicated. The action lasts for 3 years with prompt return of fertility. Contraceptive action is mainly by inhibition of ovulation. It can be offered to a wide range of age, body weight and cultural backgrounds. Although disturbed bleeding pattern and weight gain are some known side effects, the discontinuation rates can be lowered by counseling. This method can be offered to women after child
Letters to the Editor / Contraception 78 (2008) 84–85
birth with a variety of clinical problems such as maternal heart disease, diabetes, hypertension and autoimmune disease. It can also be offered to a breast-feeding mother. In our institution, in which we have specialized clinics to cater to high-risk pregnancies, nearly 30 women with medical disorders have accepted this method since its introduction in October 2007. At the time of reporting, none required removal for medical reasons (unpublished data). In conclusion, single-rod implantable contraceptive containing etonogestrel is another safe option for clients, with comparable efficacy with IUD. Jeevan P. Marasinghe Chandrika N. Wijeyaratne Professorial Obstetrics and Gynecology Unit De Soyza Hospital for Women, Sri Lanka E-mail address: [email protected]
85
To the Editor: In the article published earlier this year in Contraception [1], we provided estimates of contraceptive failure, both unadjusted and adjusted for underreporting of abortion, from the 2002 National Survey of Family Growth (NSFG) and revised estimates from the 1995 NSFG for the five most commonly used methods in the United States: injectable contraceptives, oral contraceptives (“the pill”), male condoms, fertility-awareness-based methods (“rhythm,” “calendar,” “mucus,” and “temperature” methods, “periodic abstinence” or “natural family planning”) and withdrawal. There were not enough uses of other methods in the 2002 NSFG data to allow separate estimates of contraceptive failure. However, there were enough uses of the diaphragm and spermicides in the 1995 NSFG to sustain separate analyses, and we present these results below, along with complete results for the other five methods in the 1995 NSFG (Table 1).
doi:10.1016/j.contraception.2008.03.001 James Trussell Office of Population Research Wallace Hall, Princeton University Princeton, NJ 08544, USA E-mail address: [email protected]
References [1] Grimes DA, Mishell Jr DR. Intrauterine contraception as an alternative to interval tubal sterilization. Contraception 2008;77:6–9. [2] Weisberg E, Fraser I. Australian women's experience with Implanon. Aust Fam Physician 2005;34:694–6. [3] Croxatto HB, Urbanscek J, Massai R, Coelingh Bennink H, van Beek AA. Multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod 1999;14: 976–81. [4] Funk S, Miller MM, Mishell Jr DR, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005;71:319–26.
doi:10.1016/j.contraception.2008.02.017 Reference [1] Kost K, Singh S, Vaughan B, Trussell J, Bankole A. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008;77:10–21.
Table 1 Probability of failure within the first 3, 6 and 12 months of typical contraceptive use in the United States: weighted data, both unadjusted and adjusted for underreporting of abortion in the 1995 NSFG Method
Injectable Pill Diaphragm Male condom Fertility-awareness Spermicides Withdrawal All methods a
Probability of failure, unadjusted
Probability of failure, adjusted
3 months
6 months
12 months
3 months
6 months
12 months
1.1 1.1 1.1 2.4 4.6 4.9 5.8 2.6
1.1 2.9 4.4 5.3 14.4 9.2 12.5 5.4
2.9 6.7 8.0 8.6 19.6 16.4 18.7 9.2
0.8 2.2 2.2 5.4 5.5 8.5 9.7 4.6
2.3 4.6 5.9 10.2 16.2 16.8 17.0 8.7
5.4 8.8 11.5 17.8 22.6 28.2 28.4 14.9
Number of contraceptive-use segments.
Unweighted na 209 2127 165 2909 249 272 438 6839
Letters to the Editor
To the Editor: The cost-effectiveness figures in our article [1] relate to the United States; they show that both the copper T380A and levonorgestrel-releasing system compare favorably to interval tubal sterilization [2]. Although myths and misinformation about IUDs persist, the IUD is the most widely used reversible method of contraception in the world today [3]. We agree with Drs. Marasinghe and Wijeyaratne that a public-sector-price levonorgestrel device for developing countries is needed. In addition to effective, “forgettable” contraception, this device would reduce bleeding and increase hemoglobin levels [4], especially useful for women with iron-poor diets and heavy parasite burdens. We agree that the etonogestrel implant is another excellent contraceptive. We did not include it in our article only because its duration of use is substantially shorter than that of IUDs. Effectiveness with the hormonal and copper IUDs ranges from 7 [5] to 20 years [6], respectively. David A. Grimes Family Health International, P. O. Box 13950 Research Triangle Park, NC 27709, USA E-mail address: [email protected]
Daniel R. Mishell Jr. Department of Obstetrics and Gynecology Keck School of Medicine University of Southern California Women's and Children's Hospital Los Angeles, CA 90033, USA E-mail address: [email protected] doi:10.1016/j.contraception.2008.02.018 References [1] Grimes DA, Mishell Jr DR. Intrauterine contraception as an alternative to interval tubal sterilization. Contraception 2008;77:6–9. [2] Chiou CF, Trussell J, Reyes E, et al. Economic analysis of contraceptives for women. Contraception 2003;68:3–10. [3] d'Arcangues C. Worldwide use of intrauterine devices for contraception. Contraception 2007;75:S2–S7. 0010-7824/$ – see front matter © 2008 Elsevier Inc. All rights reserved.
[4] Faundes A, Alvarez F, Diaz J. A Latin American experience with levonorgestrel IUD. Ann Med 1993;25:149–53. [5] Sivin I, Stern J, Coutinho E, et al. Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS. Contraception 1991;44:473–80. [6] Sivin I. Utility and drawbacks of continuous use of a copper T IUD for 20 years. Contraception 2007;75:S70–5.
Re: Intrauterine contraception as an alternative to interval tubal sterilization To the Editor: We read with interest the article by Grimes and Mishell [1] on intrauterine contraceptive devices (IUD) and tubal sterilization. They elaborate on the usefulness of IUD compared to interval tubal sterilization. However, there are some issues that need further consideration. The cost of IUD, especially the cost of levenogestrel-releasing IUD (LNG-IUS), should gather the most speculation. It is important to analyze 5-year cost of contraceptives and their effectiveness and choose the least expensive methods. Nonetheless, the initial cost of LNG-IUS, which is approximately £100, is not comparable with cost of interval tubal sterilization, in low- and middle-income countries. Due to economic constraints, LNG-IUS is yet a novel method of contraception in developing countries. There are other hindrances for effective implementation of IUD. Myths perpetuated by women regarding dangers of IUD must not be ignored. Misconception regarding IUD needs eradication by education that gains client's trust and reports of user satisfaction with IUD. Most complaints are related to cultural difficulties in accepting changes in menstrual pattern [2]. Single-rod implantable contraceptive containing etonogestrel is another attractive method that can be offered to a variety of clients. It has high contraceptive efficacy and a satisfactory safety profile [3,4]. The insertion and removal of it is an officebased procedure, is fast and is uncomplicated. The action lasts for 3 years with prompt return of fertility. Contraceptive action is mainly by inhibition of ovulation. It can be offered to a wide range of age, body weight and cultural backgrounds. Although disturbed bleeding pattern and weight gain are some known side effects, the discontinuation rates can be lowered by counseling. This method can be offered to women after child
Letters to the Editor / Contraception 78 (2008) 84–85
birth with a variety of clinical problems such as maternal heart disease, diabetes, hypertension and autoimmune disease. It can also be offered to a breast-feeding mother. In our institution, in which we have specialized clinics to cater to high-risk pregnancies, nearly 30 women with medical disorders have accepted this method since its introduction in October 2007. At the time of reporting, none required removal for medical reasons (unpublished data). In conclusion, single-rod implantable contraceptive containing etonogestrel is another safe option for clients, with comparable efficacy with IUD. Jeevan P. Marasinghe Chandrika N. Wijeyaratne Professorial Obstetrics and Gynecology Unit De Soyza Hospital for Women, Sri Lanka E-mail address: [email protected]
85
To the Editor: In the article published earlier this year in Contraception [1], we provided estimates of contraceptive failure, both unadjusted and adjusted for underreporting of abortion, from the 2002 National Survey of Family Growth (NSFG) and revised estimates from the 1995 NSFG for the five most commonly used methods in the United States: injectable contraceptives, oral contraceptives (“the pill”), male condoms, fertility-awareness-based methods (“rhythm,” “calendar,” “mucus,” and “temperature” methods, “periodic abstinence” or “natural family planning”) and withdrawal. There were not enough uses of other methods in the 2002 NSFG data to allow separate estimates of contraceptive failure. However, there were enough uses of the diaphragm and spermicides in the 1995 NSFG to sustain separate analyses, and we present these results below, along with complete results for the other five methods in the 1995 NSFG (Table 1).
doi:10.1016/j.contraception.2008.03.001 James Trussell Office of Population Research Wallace Hall, Princeton University Princeton, NJ 08544, USA E-mail address: [email protected]
References [1] Grimes DA, Mishell Jr DR. Intrauterine contraception as an alternative to interval tubal sterilization. Contraception 2008;77:6–9. [2] Weisberg E, Fraser I. Australian women's experience with Implanon. Aust Fam Physician 2005;34:694–6. [3] Croxatto HB, Urbanscek J, Massai R, Coelingh Bennink H, van Beek AA. Multicentre efficacy and safety study of the single contraceptive implant Implanon. Implanon Study Group. Hum Reprod 1999;14: 976–81. [4] Funk S, Miller MM, Mishell Jr DR, et al. Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception 2005;71:319–26.
doi:10.1016/j.contraception.2008.02.017 Reference [1] Kost K, Singh S, Vaughan B, Trussell J, Bankole A. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception 2008;77:10–21.
Table 1 Probability of failure within the first 3, 6 and 12 months of typical contraceptive use in the United States: weighted data, both unadjusted and adjusted for underreporting of abortion in the 1995 NSFG Method
Injectable Pill Diaphragm Male condom Fertility-awareness Spermicides Withdrawal All methods a
Probability of failure, unadjusted
Probability of failure, adjusted
3 months
6 months
12 months
3 months
6 months
12 months
1.1 1.1 1.1 2.4 4.6 4.9 5.8 2.6
1.1 2.9 4.4 5.3 14.4 9.2 12.5 5.4
2.9 6.7 8.0 8.6 19.6 16.4 18.7 9.2
0.8 2.2 2.2 5.4 5.5 8.5 9.7 4.6
2.3 4.6 5.9 10.2 16.2 16.8 17.0 8.7
5.4 8.8 11.5 17.8 22.6 28.2 28.4 14.9
Number of contraceptive-use segments.
Unweighted na 209 2127 165 2909 249 272 438 6839