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xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIn her inaugural speech at her swearing in as the 64th president of the American Congress of Obstetrics and Gynecology (ACOG) at the 2013 annual meeting, Jeanne A. Conry, MD, PhD, used the mantra \u201cEvery Woman, Every Time\u201d to highlight the importance of addressing reproductive health in women at every opportunity. This article discusses the advantages of long-acting reversible contraceptives, best emergency contraception, transcervical sterilization, as well as evidence-based guidelines for contraceptive use.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn her inaugural speech at her swearing in as the 64th president of the American Congress of Obstetrics and Gynecology (ACOG) at the 2013 annual meeting, Jeanne A. Conry MD, PhD, used the mantra \u201cEvery Woman, Every Time\u201d to highlight the importance of addressing reproductive health in women at every opportunity.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDuring a session at the 2014 ACOG annual meeting that updated participants on issues they need to know about contraceptives in 2014, Eve Espey MD, MPH, and Tony Ogburn, MD, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA, echoed this message emphasizing the need for gynecologists to consider every visit by a woman of reproductive age an opportunity to discuss contraception.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf. Espey urged participants to treat any woman who is interested in a contraceptive as an emergency and to schedule her in for a visit as soon as possible. She also emphasized the need to remove barriers such as the 2-visit requirements for insertion of intrauterine devices (IUDs) and implants.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EShe also highlighted the need to help women decide on using more effective methods of contraception, saying that women using contraceptives in the United States make up 89% of the women at risk of unintended pregnancies and 53% of women with unintended pregnancies. \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E shows the types of contraceptives used in the United States.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022US Contraceptive Use (2006 to 2008; percentage)\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1795386654\u0022 data-figure-caption=\u0022US Contraceptive Use (2006 to 2008; percentage)\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15964\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EUS Contraceptive Use (2006 to 2008; percentage)\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EIUD=intrauterine devices; OC=oral contraceptive.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003ESource: \u003Cem\u003EVital Health Stat.\u003C\/em\u003E Aug 2010;23(29):1\u201344.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EAmong the topics discussed during the session were the advantages of long-acting reversible contraceptives (LARCs), current guidelines on contraceptives, and the advantages and limitations of transcervical sterilization.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EADVANTAGES OF LONG-ACTING REVERSIBLE CONTRACEPTIVES\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EProf. Espey walked participants through the current evidence showing the advantages of (LARCs) over short-acting contraceptives to prevent pregnancies, both in adolescents and in nulliparous women. Three types of LARCs are currently available, all of which show a 99% efficacy (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Types of Long-Acting Reversible Contraceptives\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1795386654\u0022 data-figure-caption=\u0022Types of Long-Acting Reversible Contraceptives\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/7\/30\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15965\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ETypes of Long-Acting Reversible Contraceptives\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced with permission from Eve Espey, MD, MPH.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ECiting the Contraceptive Choice Project study [CHOICE; Peipert JF et al. \u003Cem\u003EObstet Gynecol\u003C\/em\u003E 2012], in which almost 10,000 women desiring contraception were given their choice of all methods at no cost along with counseling, she said the study showed that most women (76%) chose an LARC and that 80% were satisfied with an IUD compared with 54% who were satisfied with the pill, patch, or ring.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe superior efficacy of a LARC was shown by the study finding that the risk of failure was 20 times higher in women who chose pills, the patch, or the ring compared to those who chose a LARC. The study also showed that women in the CHOICE study had a significant reduction in abortion rates compared to the general population (6 per 1000 vs 20 per 1000, respectively; p\u0026lt;0.001), representing a prevention of 1 abortion for every 108 women given free contraception. In addition, the CHOICE study found a reduction in teenage births compared with the general population (6 per 1000 vs. 34 per 1000, respectively).\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EProf. Espey said that data coming from the CHOICE study will continue to provide a treasure trove for years to come.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBEST EMERGENCY CONTRACEPTION\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EBy far the most effective method for emergency contraception is the copper IUD, said Prof. Espey, which can be placed up to 7 days after unprotected intercourse. Also recommended is 30 mg ulipristal acetate, which she believes is a well-kept secret that gynecologists need to know about. The first selective progesterone receptor modulator approved by the Food and Drug Administration, the sole mechanism of action is to delay ovulation and is effective in preventing pregnancy up to 5 days after having unprotected sex. She cited data showing the superior efficacy of 30 mg ulipristal acetate compared with 1.5 mg levonorgestrel (odds ratio of 0.55 if used within 120 hours and 0.35 if used within 24 hours) [Glasier AF et al. \u003Cem\u003ELancet\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EShe emphasized that ulipristal acetate is available only by prescription and said that it is the only emergency contraception that she writes a prescription for. She encouraged gynecologists to do the same if they are involved in prescribing an emergency contraception, saying that ulipristal acetate also has very few side effects.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ETRANSCERVICAL STERILIZATION\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EProf. Ogburn discussed the advantages and limitations of transcervical sterilization, emphasizing that it is a good procedure and, particularly for specific women such those who are obese, is a recommended procedure. Advantages include no anesthesia or incisions needed, ability to perform as an outpatient procedure, less pain and shorter recovery, and potentially being less expensive. Limitations, he said, include the lack of immediate efficacy and the need to use an alternative contraceptive until hysterosalpinography is performed 3 months after the procedure to ensure blockage of tubes, the need for specialized equipment and training, and the lack of data on long-term effects.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EHe cautioned, however, that patients should be told of the varying success rates reported on first attempt at the bilateral placement of the coils. He cited real-life clinical data from the experience at his institution between 2005 and 2012 that showed a success rate of only 89.5%, which translates into about 1 out of 10 occurrence of not successfully placing the coils at first attempt. Based on these data, he said that he and his colleagues have changed their practice and now include this information when counseling patients about this option. They also inform patients that about 3% will not have complete occlusion on hysterosalpinography at 3 months among those in whom bilateral placement is achieved.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EEVIDENCE-BASED GUIDELINES FOR CONTRACEPTIVE USE: UNITED STATES MEDICAL ELIGIBILITY CRITERIA\u003C\/h2\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EProf. Espey recommended that participants refer to the 2013 \u201cUnited States Medical Eligibility Criteria (USMEC) for Contraceptive Use\u201d to help counsel individual patients on contraceptive use based on different patient and disease characteristics [CDC 2014]. Developed by the Centers for Disease Control and Prevention, the evidence-based guidelines are free, downloadable charts that can be displayed in the office and be downloaded as an app for easy referral, as she does. The charts provide easy-to-read recommendations based on 4 categories and are color coded either as green (use recommended) or red (use not recommended).\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/7\/30.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp9n1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp9n1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}