Long-acting Reversible Contraception in Women with Medical ComorbiditiesBy Lucy FuObjectiveTo evaluate how medical comorbidities, which are considered contraindications to combined hormonal (estrogen-progestin) contraception, effect continuation of long acting reversible contraception (LARC).
Methods: We described the patient population who received a LARC method at Grady Memorial Hospital. We then randomly selected a subset of patients for a retrospective chart review. Our exposure of interest was any medical comorbidity listed as category 3 or 4 in the CDC MEC. Our outcome was LARC continuation. Discontinuation included removal, expulsion, or pregnancy. We compared the proportions of patients continuing LARC at one year between exposure and non-exposure groups. We plotted Kaplan Meier Survival plots and performed Cox Proportional Hazards modelling to compare rates of continuation between exposure and non-exposure groups.
Results: From 11/01/2010 to 03/31/2014, LARC methods were inserted in 2338 patients at Grady Memorial Hospital: 1350 Implants (57.8%), 747 Mirenas (32.0%), and 239 Paragards (10.2%). In our selected cohort, there were 347 patients (45.8%) with the exposure of interest and 410 patients (54.2%) without. Continuation of LARC at one year in the exposure group was 55.0%; in the non-exposure group, 61.5%. The hazard ratio for discontinuation in one-year of LARC method comparing exposure and non-exposure groups was 1.17 (95% CI 0.99 - 1.37; p-value 0.06). The Kaplan Meier survival plots for our non-exposure and exposure groups differ significantly (Log-rank test p-value = 0.002, Wilcoxon test p-value 0.005), with the difference occurring in the first two months.
Conclusion: Our study suggests that presence of medical comorbidities does not decrease continuation of LARC at one year but that there is a decrease in the first 2 months. By contributing to the literature of contraceptive use among women with medical comorbidities, we hope our results will increase access to safe, effective contraception for this vulnerable population.
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About this Master's Thesis
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|Long-acting Reversible Contraception in Women with Medical Comorbidities ()||2018-08-28 12:58:57 -0400||
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