Endometriosis is a benign gynecological condition that is estimated to affect 10% of women in the general population and appears to be increasing in incidence. It is an estrogen-dependent inflammatory disease, and is primarily characterized by dysmenorrhea, deep dyspareunia, chronic pelvic pain, and variable effects on fertility. The symptoms may greatly affect quality of life, and symptom control may be the primary aim of initial management, while contraceptive effect is often secondary. It is estimated that 30%–50% of women with endometriosis have an infertility problem, so a considerable number of endometriosis sufferers will require effective, planned contraception to maximize “protection of fertility” and prevent progression of the endometriotic condition. Ideally, this contraception should also provide symptom relief and improvement of physical, mental, and social well-being. At the present time, long-term progestogens appear to be the most effective choice for meeting all of these requirements, but other options need to be considered. It is becoming increasingly recognized that hormonal contraceptive systems are necessary for prevention of disease recurrence following surgical treatment of endometriosis. The personal preferences of the woman are an integral part of the final contraceptive choice. This article discusses the advantages and disadvantages of the contraceptive options available to women with endometriosis.

Consistent condom use among sexually active hiV-positive women in Amhara region, Ethiopia Kefyalew Addis Alene Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: Consistent condom use has been described as the most effective way to prevent both sexually transmitted infections and HIV transmission among people living with HIV. Therefore, this study assessed the prevalence and factors associated with condom use among sexually active HIV-positive women in Amhara region referral hospitals, Ethiopia. Methods: An institution-based cross-sectional study design was conducted from April to June, 2013 in Amhara region referral hospitals. A standardized questionnaire was used to collect the data. The data were entered into EPI INFO version 3.5.1 statistical software and analyzed by SPSS version 20.0. Binary logistic regression model was used to identify the associated factors. Odds ratios with 95% confidence intervals (CIs) were calculated to assess the strength of association. Results: A total of 351 sexually active HIV-positive women were interviewed. Consistent condom use among sexually active HIV-positive women was found to be 56.7% (51.7%–61.9%). Being in the age groups 30–34 years (adjusted odds ratio [AOR]: 2.82, 95% CI 1.31, 6.08) and 35–39 years (AOR: 2.64, 95% CI 1.15, 6.08), having a relatively large family (three to five family members) (AOR: 2.54 95% CI 1.57, 4.12) and more than five family members (AOR: 1.69 95% CI 0.79, 3.63), and being Muslim or Protestant (AOR: 0.52 95% CI 0.33, 0.84) were variables associated with consistent condom use. Conclusion: Consistent condom use among sexually active HIV-positive women in Amhara region referral hospital was low, suggesting an urgent need for intervention through the involvement of a religious leader. Keywords: condom use, HIV-positive women, Amhara region, Ethiopia

Use of IUDs for emergency contraception: current perspectives Rebecca McKay,1 Lynne Gilbert2 1Department of Obstetrics and Gynaecology, Peterborough City Hospital, Peterborough, Cambridgeshire, United Kingdom; 2Department of Contraception and Sexual Health, Cambridgeshire Community Services NHS Trust, Cambridge, Cambridgeshire, United Kingdom Abstract: Emergency contraception is an essential intervention for the prevention of unplanned pregnancy worldwide. The copper intrauterine device (IUD) is highly effective at preventing pregnancy after unprotected sex or contraceptive failure. Unfortunately, its usage in this context is low and far exceeded by hormonal forms of emergency contraception. These have higher failure rates and, unlike the IUD, are not effective post-fertilization. This review aims to summarize the literature surrounding IUD use as emergency contraception, contrast it with the hormonal options, and provide suggestions for increased usage. Keywords: levonorgestrel, ulipristal acetate, copper intrauterine device

Abstract: Hormonal contraceptive use is an identified co-factor that modifies cervical cancer risk. The mechanisms by which sex steroid hormones affect the multi-stage natural history of human papillomavirus (HPV) infection and cervical carcinogenesis are still unclear, with no consistent evidence in support of a single biological hypothesis. Understanding the means by which hormonal contraception affects HPV infection and cervical cancer risk may provide critical information to guide future secondary interventions for cancer prevention. Keywords: hormones, human papillomavirus, cervical cancer

Emergency contraception: current options, challenges, and future directions Serena Dovey, Joseph Sanfilippo Magee Women’s Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Abstract: The term emergency contraception (EC) refers to utilizing a medication or placing a copper intrauterine device within a short time interval after unprotected intercourse in order to prevent pregnancy. Established methods of EC include the Yuzpe regimen, levonorgestrel, and placement of a copper intrauterine device. Recently, ulipristal acetate, a selective progesterone receptor modulator, has been examined in several large-scale clinical trials and been shown to have comparable if not improved efficacy over the levonorgestrel regimen, which is the most commonly used form of EC today. EC has increased in efficacy since its advent with the Yuzpe regimen several decades ago, and many have expressed hope that widespread utilization of EC will lead to a decreased abortion rate worldwide. However, despite increased access to EC over the past several years, many barriers still exist in regards to allowing EC to be widely available to women wishing to prevent unplanned pregnancies. Future research must focus on addressing such barriers in order to realize the potential of EC to decrease abortion rates worldwide. This review article will address the current options for EC, describe current challenges in the field, and highlight future avenues of research. Keywords: emergency contraception, levonorgestrel, ulipristal acetate, Yuzpe regimen

Oral contraception and risk of endometrial cancer Alfred O Mueck1, Harald Seeger1, Xiangyan Ruan2 1Department of Endocrinology and Menopause, University Women's Hospital of Tuebingen, Tuebingen, Germany; 2Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China Abstract: No placebo-controlled studies concerning hormonal contraception in general have been published, and only investigations on biological mechanisms and observational clinical studies are available. Thus, associations can be described but not their causality. Experimental studies strongly suggest protective effects of the progestagen component of hormonal contraception against development of estrogen-related (type 1) endometrial cancer. In light of this research, it seems biologically plausible that, in more than 20 published studies, a reduction in endometrial cancer risk was achieved in up to 50% of users of combined oral contraceptives (COC), compared with nonusers. Few data exist for progestin-only oral preparations. However, in view of the mechanisms involved, a reduction in cancer risk should also be expected. Whereas hormonal dose-dependency has been investigated in only a few studies, which showed a stronger risk reduction with increasing progestagenic potency, a decreased risk dependent on duration of use has been clearly demonstrated, and after stopping COC this effect has persisted for up to 20 years. Possible confounders, including family history, parity, and smoking, have been investigated in a few studies, with only a minor impact on hormonal effect of endometrial cancer risk, with the exception of obesity, which was a strong risk factor in most but not all studies. There are obvious differences in the incidence of endometrial cancer in women using COC when evaluated in absolute numbers for Western and Asian countries, being about 3–5-fold higher in the US than in Asia. Further research should include the noncontraceptive benefit of COC, especially in patients with a high risk of cancer, as in polycystic ovary disease, and should also include new contraceptive drugs using natural estradiol instead of ethinyl estradiol. Of importance is the question of the potency of hormonal intrauterine devices to protect against endometrial cancer. It can be concluded on the basis of biological plausibility and observational data that COC can strongly decrease the risk of estrogen-related endometrial cancer, with an effect persisting after withdrawal of the hormones, and a causal relationship for this protection against cancer seems reasonable. Keywords: hormonal contraceptives, endometrial cancer

Background: The primary objective of this study was to evaluate Malaysian women’s perception acceptance and views on Implanon® as a contraceptive method. We also aimed to identify women who favor Implanon their vaginal bleeding patterns nonmenstrual adverse events reasons for discontinuation and effect of Implanon on breastfeeding. Study design: This study followed up 140 women after insertion of Implanon at the University of Malaya Medical Centre by examination of their medical records and telephone interviews. User profile discontinuation rate reasons for choice of Implanon discontinuation menstrual and nonmenstrual side effects and satisfaction rate were assessed. Results: The average age of users was 34.7 years and 94.2% were para 2 and above. The ethnic distribution of the women reflected that of the general Malaysian population. The majority had at least secondary education (94.2%) with 41.2% having a higher degree. All of the users reported that they chose Implanon because it does not need compliance and 72.1% felt that Implanon was cost-effective in the long term. Most users (70%) reported irregular menses and this was the main reason given for discontinuation. The vast majority reported an overall decrease in menstrual blood loss. Almost half (46%) suffered prolonged bleeding/spotting and infrequent bleeding was experienced by 71 users (50.7%). Half of the women did not experience any nonmenstrual adverse events. The commonest complaint was weight gain with the next most common complaints being hair loss acne headache nausea mood swings and reduced libido. Most of the nursing mothers denied a reduction in breast milk. There was a high mean satisfaction score with Implanon. Conclusion: Implanon is well accepted by Malaysian women despite a high incidence of irregular bleeding which was found to be a major concern among women who discontinued the implant.

Child spacing and contraception among the poor in Zambia Vijayan K Pillai1, Rashmi Gupta21School of Social Work, University of Texas at Arlington, Arlington, TX, USA; 2Department of Social Work, San Francisco State University, San Francisco, CA, USAAbstract: For decades, family planning programs have targeted women in developing countries. These programs bestow a great deal of autonomy on women with respect to fertility decision making. It is well known that a number of close relatives in multigenerational and extended family systems influence women’s fertility decisions with respect to child spacing and contraceptive use. One approach toward a systematic study of fertility decision making is to explicitly consider the husband’s influences on fertility decision making. This study examines the effects of a selected number of factors on the desired birth interval lengths. We interviewed husbands and wives separately from 165 randomly selected households from two poor neighborhoods in the city of Kitwe, Zambia. Three ordinal birth interval groups were obtained for both husbands and wives separately. The effect of selected factors on the likelihood of influencing the three groups was examined using ordinal logistic regression methods. Data from husbands and wives were analyzed separately. Qualitative methods such as semistructured interviews were used to gather extensive information on the various factors that husbands and wives perceive to influence their child spacing decisions. We found differences in accounts with respect to child spacing between husbands and wives, likely due to a lack of communication. A gender-sensitive approach is necessary to promote spacing methods among poor couples in Zambia.Keywords: child spacing, contraceptive use, correspondence analysis, couple decision making