Postabortion contraception

The European Society of Contraception Expert Group on Abor tion identified as one of its priorities to disseminate up-to-date evidence-based information on postabortion contraception to healthcare providers. A concise communication was produced which summarises the latest research in an easy-to-read format suitable for busy clinicians. Information about individual methods is presented in boxes for ease of reference

Emergency contraception: potential role of ulipristal acetate

Unintended pregnancy is a global reproductive health problem. Emergency contraception (EC) provides women with a safe means of preventing unwanted pregnancies after having unprotected intercourse. While 1.5 mg of levonorgestrel (LNG) as a single dose or in 2 doses with 12 hours apart is the currently gold standard EC regimen, a single dose of 30 mg ulipristal acetate (UPA) has recently been proposed for EC use up to 120 hours of unprotected intercourse with similar side effect profiles as LNG. The main mechanism of action of both LNG and UPA for EC is delaying or inhibiting ovulation. However, the ‘window of effect’ for LNG EC seems to be rather narrow, beginning after selection of the dominant follicular and ending when luteinizing hormone peak begins to rise, whereas UPA appears to have a direct inhibitory effect on follicular rupture which allows it to be also effective even when administered shortly before ovulation, a time period when use of LNG is no longer effective. These experimental findings are in line with results from a series of clinical trials conducted recently which demonstrate that UPA seems to have higher EC efficacy compared to LNG. This review summarizes some of the data available on UPA used after unprotected intercourse with the purpose to provide evidence that UPA, a new type of second-generation progesterone receptor modulator, represents a new evolutionary step in EC treatment

Self-assessment of success of early medical abortion using a self-performed urine pregnancy test.

Purpose: The European Society of Contraception Expert Group on Abortion identified as one of its priorities the need to disseminate up-to-date evidence-based information on the use of urine pregnancy tests by women for the self assessment of the success of early medical abortion (EMA). Methods and materials: A concise communication was produced which summarises the latest research in an easy-to-read format suitable for busy clinicians. Information about individual urinary pregnancy tests is presented in boxes for ease of reference. Results: Urinary pregnancy tests (low sensitivity, high sensitivity and multilevel) can be used in combination with signs and symptoms of pregnancy to exclude an ongoing pregnancy after EMA. Conclusion: Women are able to determine the success of early medical abortion (EMA) themselves using a combination of signs, symptoms and a urine pregnancy test. This simplifies EMA, expands the range of professionals able to provide EMA and most importantly gives women greater control over their bodies and treatment

Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion

Misoprostol (Cytotec) is recognised to be effective for many gynaecological indications including termination of pregnancy, management of miscarriage and postpartum haemorrhage. Although not licensed for such indications, it has been used for these purposes by millions of women throughout the world. Misoprostol tablets are most often packaged as multiple tablets within an aluminium strip, each within an individual alveolus. When an alveolus is opened, tablets will be exposed to atmospheric conditions

Le modèle de 'l'État-stratège':Genèse d'une forme organisationnelle dans l'administration française

Cet article retrace la genèse d'une nouvelle forme d'organisation du système administratif en France, désignée sous le nom d'« État-stratège », qui redessine, dans les années 1990, les relations entre administrations centrales et services territoriaux de l'État. La séparation entre les fonctions stratégiques de pilotage et de contrôle de l'État et les fonctions opérationnelles d'exécution et de mise en œuvre des politiques publiques est au cœur de ce changement. Cette transformation suit deux processus. D'un côté, l'adoption de mesures concrètes de « gouvernement à distance » fait l'objet de luttes de pouvoir entre trois acteurs ministériels majeurs (ministère de l'Intérieur, du Budget et de la Fonction publique). De l'autre, est produite une nouvelle « catégorisation » légitime de l'État, portée par des hauts fonctionnaires généralistes, dans le cadre de grandes commissions de réforme, et inspirée des idées du New Public Management. La fabrique d'une nouvelle forme d'organisation étatique renvoie ainsi à deux dynamiques et deux dimensions, politique et idéelle. — Numéro spécial : Les nouveaux formats de l'institution.Since the 1990s, a new organisational form of the administrative system in France has been steadily redefining relations between central administrations and local state units. Labelled “the steering state” or the “managerial state”, this new paradigm hinges on separating the strategic functions of steering and controlling the state from the operational functions of execution and policy implementation. The making of this new form of state organization involves two parallel processes: political and cognitive. For one thing, the adoption of concrete measures for “government at distance” results from power struggles between three major ministries (Home Office, Budget and Civil Service). For another, a new legitimate “categorization of the state” is being formed in the major committees involved in the reform process of the 1990s; it is borne by top civil servants and inspired by the ideas of New Public Management. — Special issue: New patterns of institutions

Thirty years of mirena : A story of innovation and change in women's healthcare

Since its introduction in 1990, the levonorgestrel-releasing intrauterine system (LNG-IUS) has played a key role in shaping the healthcare landscape of women. Here we explore the development of the first LNG-IUS (Mirena (R)) and the early clinical trials that demonstrated its potential. We highlight the contraceptive and therapeutic benefits of Mirena (R), and discuss how clinical practice has been changed since the introduction of LNG-IUS and other long-acting reversible contraceptive methods. The history of Mirena (R) is rich in innovation and has also paved the way to the development of smaller intrauterine systems with lower hormone doses. Along with Mirena (R), these newer LNG-IUS contribute to improving contraceptive choices for women, allowing them to select the option that is right for them and that meets their needs no matter their age, parity or circumstances.Non peer reviewe

More than just contraception : the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years

Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.Non peer reviewe

Emergency contraception -mechanisms of action

Abstract Concerns regarding the mechanisms of action of emergency contraception (EC) create major barriers to widespread use and could also lead to incorrect use of EC and overestimation of its effectiveness. While the copper intrauterine device (Cu-IUD) is the most effective method available for EC, the hormonal methods are frequently considered to be more convenient and acceptable. Today, the most commonly used method for hormonal EC is levonorgestrel (LNG). More recently, the progesterone receptor modulator ulipristal acetate (UPA) has been shown to be more effective than LNG to prevent an unwanted pregnancy. The main mechanism of action of both LNG and UPA for EC is delaying or inhibiting ovulation. However, UPA appears to have a direct inhibitory effect on follicular rupture which allows it to be effective even when administered shortly before ovulation, a time period when use of LNG is no longer effective. The main mechanism of action of the Cu-IUD is to prevent fertilization through the effect of Cu ions on sperm function. In addition, if fertilization has already occurred, Cu ions influence the female reproductive tract and prevent endometrial receptivity. Based on this review of the published literature, it can be concluded that existing methods used today for EC act mainly through inhibition of ovulation or prevention of fertilization. An additional effect on the endometrium as occurs for the Cu-IUD, but not for the hormonal alternatives, seems to increase the efficacy of the method