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            "itemType": "journalArticle",
            "title": "Quadriphasic versus monophasic oral contraceptives for contraception",
            "creators": [
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                    "firstName": "Huib A. A. M.",
                    "lastName": "Van Vliet"
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                {
                    "creatorType": "author",
                    "firstName": "Marjolein",
                    "lastName": "Raps"
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                    "lastName": "Lopez"
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                    "firstName": "Frans M.",
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            "abstractNote": "BACKGROUND: Quadriphasic oral contraceptives have been developed to reduce the adverse effects of oral contraceptives and are presented as more physiological since they mimic the natural cycle. However, suggested disadvantages of quadriphasic oral contraceptives include a possible increased risk of pill-taking errors caused by the array of different color pills, complicated directions for catching up when a pill is missed, the higher price and potential inferiority in terms of side effects.\nOBJECTIVES: To compare the contraceptive effectiveness, bleeding pattern, minor side effects and acceptability of quadriphasic contraceptive pills versus monophasic contraceptive pills.\nSEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, POPLINE, ClinicalTrials.gov and ICTRP for trials comparing quadriphasic pills with monophasic pills. We contacted researchers and manufacturers of quadriphasic oral contraceptives to identify additional studies.\nSELECTION CRITERIA: Randomized controlled trials (RCTs) comparing quadriphasic with monophasic oral contraceptives . Trials had to report on contraceptive effectiveness, bleeding patterns, minor side effects, ease of use or trial discontinuation. We excluded studies where the intervention was primarily used as a treatment for disorders or was administered for fewer than three consecutive cycles.\nDATA COLLECTION AND ANALYSIS: T wo authors abstracted and entered data into RevMan. We critically appraised the methodological quality of the included trials. For continuous variables, we computed the mean difference with 95% confidence interval (CI) using the random-effects model. For dichotomous variables, we calculated the risk ratio with 95% CI using the random-effects model.\nMAIN RESULTS: We included one double-blind, double-dummy RCT comparing a quadriphasic oral contraceptive composed of dienogest and estradiol valerate with a monophasic oral contraceptive composed of levonorgestrel and ethinylestradiol. Contraceptive effectiveness, intracyclic bleeding and discontinuation due to side effects were similar for quadriphasic and monophasic pills. The number of women experiencing withdrawal bleeding was higher in the monophasic group compared to the quadriphasic group. Users of quadriphasic pills reported fewer bleeding/spotting days and fewer bleeding/spotting episodes than users of monophasic pills but the report did not specify whether the bleeding/spotting was scheduled or unscheduled. More women using quadriphasic oral contraceptives reported breast pain compared to women using monophasic oral contraceptives.\nAUTHORS' CONCLUSIONS: The available evidence is insufficient to determine whether quadriphasic differ from monophasic oral contraceptives in contraceptive effectiveness, bleeding pattern, minor side effects and acceptability. Studies that compare quadriphasic and monophasic oral contraceptives with an identical progestogen and estrogen type are needed to determine whether the quadriphasic approach differs from the monophasic approach. Studies that compare quadriphasic pills with monophasic pills containing 30 μg ethinylestradiol are indicated to determine whether quadriphasic oral contraceptives have an advantage over the current, first choice oral contraceptive . Until then, we recommend monophasic pills containing 30 μg estrogen as the first choice for women starting oral contraceptive use.",
            "publicationTitle": "The Cochrane Database of Systematic Reviews",
            "publisher": "",
            "place": "",
            "date": "2011",
            "volume": "",
            "issue": "11",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "CD009038",
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            "extra": "PMID: 22071862",
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                    "type": 1
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                    "type": 1
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                    "type": 1
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            "version": 5,
            "itemType": "journalArticle",
            "title": "Combined hormonal versus nonhormonal versus progestin-only contraception in lactation",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Laureen M.",
                    "lastName": "Lopez"
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                {
                    "creatorType": "author",
                    "firstName": "Thomas W.",
                    "lastName": "Grey"
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                {
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                    "firstName": "Alison M.",
                    "lastName": "Stuebe"
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                    "firstName": "Mario",
                    "lastName": "Chen"
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                {
                    "creatorType": "author",
                    "firstName": "Sarah T.",
                    "lastName": "Truitt"
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                    "creatorType": "author",
                    "firstName": "Maria F.",
                    "lastName": "Gallo"
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            ],
            "abstractNote": "BACKGROUND: Postpartum contraception improves the health of mothers and children by lengthening birth intervals. For lactating women, contraception choices are limited by concerns about hormonal effects on milk quality and quantity and passage of hormones to the infant. Ideally, the contraceptive chosen should not interfere with lactation or infant growth. Timing of contraception initiation is also important. Immediately postpartum, most women have contact with a health professional, but many do not return for follow-up contraceptive counseling. However, immediate initiation of hormonal methods may disrupt the onset of milk production.\nOBJECTIVES: To determine the effects of hormonal contraceptives on lactation and infant growth\nSEARCH METHODS: We searched for eligible trials until 2 March 2015. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, POPLINE, Web of Science, LILACS, ClinicalTrials.gov, and ICTRP. We also examined review articles and contacted investigators.\nSELECTION CRITERIA: We sought randomized controlled trials in any language that compared hormonal contraception versus another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception includes combined or progestin-only oral contraceptives, injectable contraceptives, implants, and intrauterine devices.Trials had to have one of our primary outcomes: breast milk quantity or biochemical composition; lactation initiation, maintenance, or duration; infant growth; or timing of contraception initiation and effect on lactation. Secondary outcomes included contraceptive efficacy while breastfeeding and birth interval.\nDATA COLLECTION AND ANALYSIS: For continuous variables, we calculated the mean difference (MD) with 95% confidence interval (CI). For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio (OR) with 95% CI. Due to differing interventions and outcome measures, we did not aggregate the data in a meta-analysis.\nMAIN RESULTS: In 2014, we added seven trials for a new total of 11. Five reports were published before 1985 and six from 2005 to 2014. They included 1482 women. Four trials examined combined oral contraceptives (COCs), and three studied a levonorgestrel-releasing intrauterine system (LNG-IUS). We found two trials of progestin-only pills (POPs) and two of the etonogestrel-releasing implant. Older studies often lacked quantified results. Most trials did not report significant differences between the study arms in breastfeeding duration, breast milk composition, or infant growth. Exceptions were seen mainly in older studies with limited information.For breastfeeding duration, two of eight trials indicated a negative effect on lactation. A COC study reported a negative effect on lactation duration compared to placebo but did not quantify results. Another trial showed a lower percentage of the LNG-IUS group breastfeeding at 75 days versus the nonhormonal IUD group (reported P < 0.05) but no significant difference at one year.For breast milk volume, two older studies indicated lower volume for the COC group versus the placebo group. One trial did not quantify results. The other showed lower means (mL) for the COC group, e.g. at 16 weeks (MD -24.00, 95% CI -34.53 to -13.47) and at 24 weeks (MD -24.90, 95% CI -36.01 to -13.79). Another four trials did not report any significant difference between the study groups in milk volume or composition with two POPs, a COC, or the etonogestrel implant.Seven trials studied infant growth; one showed greater weight gain (grams) for the etonogestrel implant versus no method for six weeks (MD 426.00, 95% CI 58.94 to 793.06) but less compared with depot medroxyprogesterone acetate (DMPA) from 6 to 12 weeks (MD -271.00, 95% CI -355.10 to -186.90). The others studied POPs, COCs versus POPs, or an LNG-IUS.\nAUTHORS' CONCLUSIONS: Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.",
            "publicationTitle": "The Cochrane Database of Systematic Reviews",
            "publisher": "",
            "place": "",
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            "pages": "CD003988",
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    {
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            "creatorSummary": "Black et al.",
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        "data": {
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            "version": 5,
            "itemType": "journalArticle",
            "title": "Contraceptive use among Canadian women of reproductive age: results of a national survey",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Amanda",
                    "lastName": "Black"
                },
                {
                    "creatorType": "author",
                    "firstName": "Qiuying",
                    "lastName": "Yang"
                },
                {
                    "creatorType": "author",
                    "firstName": "Shi",
                    "lastName": "Wu Wen"
                },
                {
                    "creatorType": "author",
                    "firstName": "André B.",
                    "lastName": "Lalonde"
                },
                {
                    "creatorType": "author",
                    "firstName": "Edith",
                    "lastName": "Guilbert"
                },
                {
                    "creatorType": "author",
                    "firstName": "William",
                    "lastName": "Fisher"
                }
            ],
            "abstractNote": "OBJECTIVE: Past studies indicate that despite a wide range of contraceptive options, Canadian women tend to use a narrow selection of contraceptive methods. New contraceptive methods have recently been introduced in Canada. The objective of this research is to characterize Canadian women's current contraceptive choices and adherence to contraceptive regimens.\nMETHODS: A national cross-sectional survey was conducted in November 2006. A standardized, confidential, Internet questionnaire was administered to female members of a previously recruited national market research panel. Percentages of current contraceptive use and consistency of use were calculated by age group, marital status, and province and were weighted according to age and region. Chi-square test was used to detect within-group differences for consistency of contraceptive use, oral contraceptive (OC) use, and condom use. Multivariate logistic regression analyses predicting consistent contraception use, OC use, and condom use were performed.\nRESULTS: Of 5597 survey respondents, 3253 were eligible for data analysis. Of these women, 2751 had had vaginal intercourse in the previous six months, were not trying to conceive, and reported whether they or their partner had used contraception. Of these 2751 women, 410 (14.9%) never used contraception. Among contraception users, the most frequently used methods of contraception were condoms (54.3%), OCs (43.7%), and withdrawal (11.6%). Newer contraceptive methods were used by less than 4%. Choice of contraceptive method varied by age. Only 65.2% of respondents who were sexually active and not trying to conceive \"always used\" contraception. Multivariate logistic regression analyses found significantly higher odds of no contraception use in women over 40 years of age, without higher education, living in PEI or Newfoundland, married or living common-law, or having annual household incomes under $100,000.\nCONCLUSION: Despite many contraceptive options, Canadian women continue to use a narrow range of contraceptive methods and to use contraception inconsistently. Consistent contraceptive use is influenced by a number of independent social variables. Future public health initiatives should focus on raising awareness of contraception options, increased access to a variety of contraceptive methods, and assisting with contraceptive adherence.",
            "publicationTitle": "Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstétrique et gynécologie du Canada: JOGC",
            "publisher": "",
            "place": "",
            "date": "Jul 2009",
            "volume": "31",
            "issue": "7",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "627-640",
            "series": "",
            "seriesTitle": "",
            "seriesText": "",
            "journalAbbreviation": "J Obstet Gynaecol Can",
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            "title": "The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives",
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                    "firstName": "A. L.",
                    "lastName": "Nightingale"
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                    "firstName": "R. A.",
                    "lastName": "Lawrenson"
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                    "firstName": "E. L.",
                    "lastName": "Simpson"
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                    "lastName": "Williams"
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                    "lastName": "MacRae"
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                    "lastName": "Farmer"
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            "abstractNote": "OBJECTIVES: To investigate the factors associated with idiopathic venous thromboembolism in combined oral contraceptive users and to estimate the crude and age-specific incidence rates ofidiopathic venous thromboembolism among this population.\nMETHODS: The UK MediPlus Database and the General Practice Research Database were searched to identify women with evidence of venous thromboembolism while exposed to combined oral contraceptives. Cohort and nested case-control studies were carried out using the same methodology on both databases. We conducted a meta-analysis using the individual data for the cases and controls from the two case-control studies to identify factors associated with idiopathic venous thromboembolism in women using combined oral contraceptives.\nRESULTS: The incidence rate of idiopathic venous thromboembolism among oral contraceptive users was 39.4 per 100,000 exposed woman-years. The age-specific incidence rates were found to rise sharply after the age of 39 years. Factors identified as being significantly associated with idiopathic venous thromboembolism in women using combined oral contraceptives were: body mass index of 25 kg/m2 and over, the association rising dramatically in women with a body mass index of 35 kg/m2 or more; smoking; general ill health; and asthma.\nCONCLUSION: We believe that, before prescribing combined oral contraceptives, the venous as well as the arterial factors need to be considered and, in addition, age, obesity and smoking are all relevant when assessing an individual patient's risk.",
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            "pages": "953-961",
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                    "lastName": "David"
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                    "lastName": "Fortin"
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                    "creatorType": "author",
                    "firstName": "Margaret",
                    "lastName": "Morris"
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                    "creatorType": "author",
                    "firstName": "Teresa",
                    "lastName": "O'Grady"
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                {
                    "creatorType": "author",
                    "firstName": "Helen",
                    "lastName": "Pymar"
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                    "creatorType": "author",
                    "firstName": "Thirza",
                    "lastName": "Smith"
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                    "firstName": "Elke",
                    "lastName": "Henneberg"
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                    "creatorType": "author",
                    "name": "Society of Obstetricians and Gynaecologists of Canada"
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            "abstractNote": "OBJECTIVE: To provide guidelines for health-care providers on the use of contraceptive methods to prevent pregnancy and sexually transmitted diseases.\nOUTCOMES: Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, risk of infection, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the cost and availability of cited contraceptive methods in Canada.\nEVIDENCE: Medline and the Cochrane Database were searched for articles in English on subjects related to contraception, sexuality, and sexual health from January 1988 to March 2003, in order to update the Report of the Consensus Committee on Contraception published in May-July 1998. Relevant Canadian Government publications and position papers from appropriate health and family planning organizations were also reviewed.\nVALUES: The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this Report.",
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