Network: Hormonal Contraceptive Methods

Ongoing efforts to make hormonal contraceptive methods safer, more acceptable, easier to use, and more diverse is the focus of this issue of Network. How researchers have altered formulations and delivery systems for hormonal contraceptives, creating new products that are beginning to enter the market, is discussed. The issue also explores ways to help oral contraceptive users adhere to pill-taking regimens and identifies efforts to have community-based workers provide injectable contraceptives. Another highlight is provider guidance, derived from evidence-based medicine, for several challenging clinical cases involving hormonal contraceptive use. The issue includes a review of issues related to hormonal contraceptive use by women either infected with sexually transmitted infections, including HIV, or at risk of infection. Finally, an article describes the growing role of pharmacies as outlets for information about, and provision of, emergency contraceptive pills for youth.

In this issue Advances in Hormonal Contraception Researchers have been altering formulations and delivery systems for hormonal contraceptives -- used by more than 100 million women worldwide -- to develop new versions that are safer, more acceptable, and easier to use. This article discusses the evolution of oral contraceptive pills, then describes the new contraceptive patch and vaginal ring. A sidebar, Norplant Alternative to Join Method Mix Soon, describes characteristics of the new Jadelle implant that contains only two levonorgestrel-releasing rods. Why Women Miss Pills When used correctly and consistently, oral contraceptives (OCs) are among the most effective reversible methods of contraception. Too often, however, women miss taking pills. So that family planning programs can help women take OCs more consistently, researchers in China and Bangladesh have tried to determine how women's daily routines, interpretations of pill taking, or knowledge about OCs affects their pill use. Daily Pill-Taking Routine Important provides suggestions, based on U.S. research, for ways to improve OC adherence. On a related subject, 'Quick Start' of Pills Promising discusses starting OC use under the supervision of a health care provider during the first clinic visit, regardless of the time in a woman's menstrual cycle. This new OC initiation method may improve OC continuation rates. CBD of Injectables While community-based distribution (CBD) of injectables has been limited, in part because of concerns about safety, experience suggests that well-trained CBD workers can administer injectables safely. The impact of CBD of injectables has been investigated in a few studies in Asia and sub-Saharan Africa and is increasingly being tested in various settings in Latin America. Providing CBD injectable services is important because it is the only way some women will have access to this increasingly popular method. Single-Use Injectable Devices Address Barriers, Concerns discusses how the ongoing development of various single-use injection devices may make injectable contraceptive provision safer in both clinic and CBD settings. Perceived 'Wetness' Can Affect Injectable Acceptability describes a perception by some users that progestin-only injectables increase vaginal wetness. Although not supported by scientific evidence, this perception could reduce the acceptability of progestin-only injectables, leading to their discontinuation. Clinical Challenges Is the use of combined oral contraceptives (COCs) advisable for a women who suffers from headaches? Is the use of the progestin-only injectable depot-medroxyprogesterone acetate (DMPA) appropriate for an adolescent? What are a provider's management options when a client misses taking COCs? Can a woman with highly elevated blood pressure use hormonal contraceptives? Can COCs be helpful not only for contraception but also for controlling a client's acne? Guidance derived from evidence-based medicine is given to help providers handle these clinical challenges. Hormonal Contraception and STIs The possible impact of hormonal contraceptive use on the acquisition or transmission of sexually transmitted infections (STIs), including HIV, remains an important research question. Current knowledge of a potential relationship is insufficient to change family planning practices. However, since hormonal contraceptives do not appear to protect against HIV or other STIs, providers should counsel hormonal contraceptive users who are also at high risk of HIV/STIs to use a condom during each act of intercourse. Ongoing research about this topic is described. YouthLens: Enhancing Pharmacy ECP Provision to Youth The word is spreading among youth that emergency contraceptive pills (ECPs) are available to help prevent pregnancy after unprotected intercourse. But youth's detailed knowledge of ECPs is limited, and their rates of ECP use are still low. One of several ways to increase youths' knowledge and use of ECPS is to focus on pharmacies -- a growing outlet for ECP information and provision.

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