Casey, Petra M.

INTRODUCTION: Rates of long acting reversible contraception (LARC) use, including LNGIUS and LD-LNGIUS the United States are increasing. The aim of this study was to compare rates of and reasons for discontinuation of these two LARC. METHODS: Following IRB approval, premenopausal women 13-55 years old undergoing LD-LNGIUS (13.5 mg) insertion for contraception at Mayo Clinic Rochester from 1/1/2013 to 12/31/2015 were identified (n=82). A random sample of 328 women meeting the same criteria with LNGIUS insertion was identified. The cumulative incidence of discontinuation for symptom-related complaints was compared between groups after taking into account discontinuation for other reasons as a competing risk. RESULTS: Compared to those with LNGIUS, women with LD-LNGIUS were younger (mean age, 25.9 vs. 30.3 years), more likely to be nulliparous (86.6% vs. 28.0%), less likely to have previously used LARC (13.4% vs. 35.1%), and had lower BMI (mean, 25.2 vs. 27.0 kg/m 2 ). In women with subsequent follow-up, 57.3% (43/75) of the women with LD-LNGIUS expressed a symptom concern compared to 60.9% (171/281) of the women with LNGIUS. The cumulative incidence of discontinuation for symptom-related complaints by 2 years was higher in the LD-LNGIUS group, with rates of 20.0% vs. 13.8% based on patients with follow-up and 23.4% vs.12.8% based on a subset of 58+58 women matched on age, race, gravidity, and insertion year. CONCLUSION: Women with LD-LNGIUS are less likely to express symptom concerns than women with LNGIUS, but more likely to discontinue for symptom-related complaints. These findings may inform counseling of women with hormonal intrauterine contraception placement.

INTRODUCTION: Contraception is an important resource for Somali women as this population is at increased risk for adverse pregnancy outcomes. This study compares postpartum contraception use between Somali and non-Somali women. METHODS: A retrospective cohort study was performed utilizing the Rochester Epidemiology Project. All Somali women aged 18 and older who experienced liveborn, singleton births in Olmsted County, Minnesota, in 2009-2015 (n=317) and an age-matched non-Somali cohort (n=317) were identified. Postpartum contraception was defined as use of any method within 12 months after the first delivery in the time period of interest. Contraception use was compared using a chi-square test. Factors associated with contraception use were evaluated using multivariable logistic regression. RESULTS: Somali women were significantly less likely to use contraception than non-Somali women (62.1% versus 89.3%, p<0.001). Of those who used contraception, both Somali and non-Somali women reported comparable use of long-acting reversible contraception (LARC) (19.8% versus 23.7%, p=0.31) and non-LARC hormonal contraception (40.1% versus 45.2%, p=0.26). Somali women were more likely to use less reliable methods including natural family planning and barrier methods (57.3% versus 21.1%, p<0.001). Among Somali women, postpartum contraception use was less likely with older maternal age (OR 0.12 for oldest versus youngest quartile, 95% CI 0.04-0.37) and more likely with pre-pregnancy contraception use (OR 15.46, 95% CI 5.18-46.18). CONCLUSION: Our study represents the first assessment in the literature of contraception use in Somali women in the United States. Somali women are less likely to utilize postpartum contraception, highlighting an opportunity for improvement in counseling practices.

Background: Sexual dysfunction is common among US women of reproductive age, many of whom use contraception. Various contraceptive methods have been associated with changes in sexual function. Methods: In this narrative review, we selected key articles based on our collective clinical experience. We summarized findings and best practice recommendations for addressing a woman's contraception and its potential relationship to sexual function. Results: Although some hormonal contraception is associated with sexual dysfunction, studies show mixed results based on route of administration and progestin component. Interestingly, nonuse of contraception also appears to be associated with sexual dysfunction and dissatisfaction. Low-dose vaginal estrogen, lubricants, and moisturizers may be used for treating vaginal dryness in the setting of hypoestrogenic states in reproductive-age women. Conclusion: A review of current contraception is appropriate for women presenting with sexual health concerns. Sexual dysfunction chronologically associated with a contraceptive may be addressed by trial of an alternative method. A multidisciplinary approach to treatment is recommended, including sex therapy, pelvic floor physical therapy, and consultation with a women's health specialist as needed.

Abstract This article is part of the To the Point Series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. Principles and education in patient safety have been well integrated into academic obstetrics and gynecology practices, although progress in safety profiles has been frustratingly slow. Medical students have not been included in the majority of these ambulatory practice or hospital-based initiatives. Both the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education have recommended incorporating students into safe practices. The Accreditation Council for Graduate Medical Education milestone 1 for entering interns includes competencies in patient safety. We present data and initiatives in patient safety, which have been successfully used in undergraduate and graduate medical education. In addition, this article demonstrates how using student feedback to assess sentinel events can enhance safe practice and quality improvement programs. Resources and implementation tools will be discussed to provide a template for incorporation into educational programs and institutions. Medical student involvement in the culture of safety is necessary for the delivery of both high-quality education and high-quality patient care. It is essential to incorporate students into the ongoing development of patient safety curricula in obstetrics and gynecology.

Background: Many women have heavy menstrual bleeding during perimenopause that may interfere with overall quality of life and contribute to sexual dysfunction. We aimed to determine whether sexual function in women improves after endometrial ablation for heavy menstrual periods. Methods: Validated surveys (Female Sexual Function Index [FSFI], Female Sexual Distress Scale [FSDS], and Short-Form Health Survey [SF–12]) were administered to 136 women before and after endometrial ablation from August 2008 through June 2013. Scores at baseline and 6 months after surgery were compared using the paired t test. Results: A total of 97 women completed the FSFI and FSDS surveys at baseline and 6 months after ablation. Mean full-scale FSFI score increased from 26.5 to 28.8 ( p < .001), with improvement in 5 of 6 FSFI domains. Mean FSDS score decreased from 13.6 to 9.7 ( p < .001), showing decreased personal distress regarding sexual function. In assessing quality of life, SF–12 scores improved for global physical function ( p < .001) and mental function ( p = .002). Conclusions: Female sexual function improved and personal distress associated with sexual function decreased after endometrial ablation for heavy menstrual cycles.

Background: Care of the gynecologic cancer survivor extends beyond cancer treatment to encompass promotion of sexual, cardiovascular, bone, and brain health; management of fertility, contraception, and vasomotor symptoms; and genetic counseling. Methods: This is a narrative review of the data and guidelines regarding care and surveillance of the gynecologic cancer survivor. We searched databases including PubMed, Cochrane, and Scopus using the search terms gynecologic cancer, cancer surveillance, and cancer survivor and reached a consensus for articles chosen for inclusion in the review based on availability in the English language and publication since 2001, as well as key older articles, consensus statements, and practice guidelines from professional societies. However, we did not undertake an extensive systematic search of the literature to identify all potentially relevant studies, nor did we utilize statistical methods to summarize data. We offer clinical recommendations for the management of gynecologic cancer survivors based on review of evidence and our collective clinical experience. Results: Key messages include the limitations of laboratory studies, including CA-125, and imaging in the setting of gynecologic cancer surveillance, hormonal and non-hormonal management of treatment-related vasomotor symptoms and genitourinary syndrome of menopause, as well as recommendations for general health screening, fertility preservation, and contraception. Conclusions: A holistic approach to care extending beyond cancer treatment alone benefits gynecologic cancer survivors. In addition to surveillance for cancer recurrence and late treatment side effects, survivors benefit from guidance on hormonal, contraceptive, and fertility management and promotion of cardiovascular, bone, brain, and sexual health.