The relative risks of thrombotic stroke and myocardial infarction (MI) are higher among users of hormonal contraception, although absolute risks remain low, a Danish study conducted at Copenhagen University  showed.

Use of oral contraceptives combining low-to-moderate doses of ethinyl estradiol and various progestins was associated with up to 2.3 times the risks of thrombotic stroke or MI compared with non-use.The type of progestin in the pill had little effect on the risks, the researchers reported in the June 14 issue of the New England Journal of Medicine.

To put the risk in perspective, they estimated that among 10,000 women taking a pill combining desogestrel with ethinyl estradiol at a dose of 20 μg for 1 year, two will have arterial thrombosis and seven will have venous thrombosis.

"Although venous thrombosis is three to four times as frequent as arterial thrombosis among young women, the latter is associated with higher mortality and more serious consequences for the survivors," they wrote. "Therefore, these figures should be taken into account when prescribing hormonal contraception."

Several previous studies have examined the relationship between hormonal contraceptive use and the risk of venous thromboembolism. But fewer have looked at arterial complications like thrombotic stroke and MI, and the results have been mixed.

In an accompanying editorial, Diana Petitti, MD, MPH, of Arizona State University in Tempe, said that the absolute increases in the risks of thrombotic stroke and MI observed in the study were small."None of the hormonal contraceptives studied ... were associated with an excess risk of stroke that was unacceptable, considering their contraceptive and noncontraceptive benefits," she wrote.

And, she added, evidence from previous studies "shows that the small risk could be minimized and perhaps eliminated by abstinence from smoking and by checking blood pressure, with avoidance of hormonal contraceptive use if blood pressure is raised."

The researchers acknowledged the study was limited by possible diagnostic misclassification, the potential for a time lag between the date of prescription and when the contraceptives were started, the lack of information on body mass index, and the incomplete information on smoking status.

Source reference:
Lidegaard Ø, et al "Thrombotic stroke and myocardial infarction with hormonal contraception" N Engl J Med 2012; 366: 2257-2566.

The Patient Protection and Affordable Care Act has cleared two major hurdles in the recent past: the Supreme Court ruling on constitutionality and the reelection of President Obama. However, there is a very good chance that the Supreme Court has not seen the last of the health care reform law. Despite the bill's legal successes in the past, there are (at publication) more than 35 different cases on file against the contraception mandate in the bill filed by individual companies and religious organizations.

Thanks to the health care law, insurance plans are required to cover birth control and other women's preventive health services with no co-payments or deductibles at the start of their next plan year. For proponents of the bill, this means more health plans come under the law's reach, and that more women will be able to keep their wallets closed when they pick up their birth control.

Proponents further assert that gender equality means women having complete control over their reproductive lives. However, some organizations do not believe funding such services align with their organizational missions. Most filing amicus briefs are using the Religious Freedom Restoration Act, and it’s unanimous support by the Supreme Court, to say that the mandate violates religious organizations right to not pay for contraception.

The Religious Freedom Restoration Act requires that the federal “government may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person 1. Is in furtherance of a compelling governmental interest and 2. Is the least restrictive means of furthering that compelling governmental interest.”

Those in support of the mandate, like the American Civil Liberties Union (ACLU), believe that the mandate will be upheld. The ACLU specifically states in their amicus brief that the plaintiffs are trying to “discriminate against women and deny them benefits because of [the employer’s] religious beliefs.”

No matter where a woman falls in her beliefs about what the health reform bill should and should not require, it is clear that the Affordable Care Act still has many hurdles before full implementation. For more information about the impact of these state-level decisions on your contraception and access to reproductive health care, contact your local Congressional leaders and employer mission statements.

A growing number of U.S. women may be opting for intrauterine devices (IUDs) as their birth control method, a national survey finds.  That's good news, researchers say, since IUDs and contraceptive implants are the most effective forms of reversible birth control.

In the U.S., though, they are still far from the most popular, with use lagging well behind birth control pills and condoms.   In the new study, researchers found that in 2009, 8.5 percent of U.S. women using birth control chose an IUD or implant - with the large majority going with the IUD.

That was up from just under four percent in 2007, according to findings published in the journal Fertility and Sterility.

"We saw some pretty notable growth," said lead researcher Lawrence B. Finer of the Guttmacher Institute in New York, a sexual and reproductive health organization.  Some of the possible reasons given:    medical societies, like the American College of Obstetricians and Gynecologists (ACOG), have endorsed IUDs and implants; and an increase in advertisements for IUDs.

ACOG says the devices should be offered as "first-line" options for most women, because of their effectiveness and safety.

IUDs are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy.   It is estimated that with IUDs, between 0.2 - 0.8 % of women will have an unplanned pregnancy.  It is effective for 5-10 years depending on the device.   The contraceptive implant, about the size of a matchstick, is inserted under the skin of the arm, where it releases controlled amounts of progestin.  The rate for unplanned pregnancy with implants is 0.05% and it works for 3 years.

"They are basically ‘set and forget' methods," Finer said.

In contrast, the Pill and condoms must be used perfectly to be most effective. And with the way people typically use them, the unintended pregnancy rate is about 9.0%  per year.    With condoms alone, it's between 18 and 21 percent.

More could be done to encourage U.S. women to opt for IUDs and implants, according to Finer.    In some other countries, the devices are much more popular: in France and Norway, for example, about one-quarter of women on birth control use IUDs or implants. And in China, a full 41 percent do, Finer's team says in its report.

SAFETY MISCONCEPTIONS

When IUDs first came out, there were concerns that they might raise the risk of pelvic infection and jeopardize women's future fertility. So the original IUD labeling said the devices were contraindicated for women who'd never had children.   But it's now known that IUDs do not carry those risks.     "Many doctors continue to have outdated ideas about who can and cannot use an IUD," Finer said.

Cost may be another issue keeping women from using IUDs and implants.   The devices have a big upfront cost: the price of an IUD is $500-900 which does not include the doctor's charges for putting them in.    The Implanon implant costs between $400 and $800, with all charges considered.

Since the devices last for years, they are cost-effective in the long run, Finer said.

Birth control pills, for instance, cost anywhere from about $10 to $50 per month, depending on whether a woman uses generic or brand-name pills.   Finer said that may change, though, with healthcare reform. The new law considers birth control part of preventive healthcare, and most health plans must cover it without co-pays and deductibles.

IUDs and implants can have unwanted side effects, however. With the implant, irregular menstrual bleeding is most common; some women stop having their periods altogether.

"There's no one best birth control method for all couples," Finer said.    But he added that now that many couples are putting off having children until their 30s, more women may want to consider long-acting birth control options.

SOURCE: http://bit.ly/MRSbZO Fertility and Sterility, online July 13, 2012.

With women’s reproductive health reemerging as a heated issue this year in policy debates and news reports, this month’s Kaiser Health Tracking Poll assesses women’s perceptions and reactions to that attention and its potential impact on the upcoming presidential election.

Three in ten women (31 percent) overall believe that there is currently a “wide-scale effort to limit women’s reproductive health choices and services, such as abortion, family planning, and contraception” in the U.S.  A larger share (45 percent) say there are some groups that would like to limit women’s reproductive health choices and services but it is not a wide-scale effort, while others volunteer that no such effort exists (7 percent) or decline to offer an opinion (17 percent).  Women who say they are liberals (49%) are far more likely than women who say they are conservatives (18%) to perceive a wide-scale effort to limit services.

For many women, women’s reproductive health issues resonate on a personal level, with 42 percent reporting that they took some action in the past six months in reaction to something they’ve seen, heard or read.  This includes attempting to influence a friend or family member’s opinion (23 percent), donating money to a non-profit working on reproductive health issues (15 percent), and contacting an elected official (14 percent).  Fewer say they’ve changed their mind about who to vote for, donated to a political candidate or group, or contacted a media outlet.

For now, female voters (like male voters) continue to focus on the economy above all else as an election issue, with several other issues (including health care generally) rising above women’s reproductive health.  Six in ten women voters name the economy and/or jobs as the issue they’d most like to hear about from candidates, compared to just 5 percent who name women’s health or other women’s issues (including abortion).  To the extent this becomes a voting issue, female registered voters give President Barack Obama a clear advantage over presumptive Republican nominee Mitt Romney: more than half say they trust the president more to “look out for the best interests of women” and to make decisions about women’s reproductive health in particular, while closer to a quarter pick Governor Romney.

Other findings from the poll include:

• The share of the public with a favorable view of the Affordable Care Act (ACA) dropped 5 percentage points this month, with unfavorable views now outnumbering favorable ones by a small margin (44 percent versus 37 percent).

• The idea of defunding the law, as discussed by some members of Congress, is as unpopular now as it was a year ago, with roughly six in ten (58 percent) saying they disapprove of cutting off funding as a way to stop some or all of the law from being put into place, and about a third (32 percent) saying they approve of this strategy.

The poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and  was conducted May 8-14, 2012, among a nationally representative random digit dial telephone sample of 1,218 adults living in the United States.

The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people.