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Fertility regulation

This section includes RHL summaries of published systematic reviews evaluating male and female methods of contraception (including emergency contraception)

Contraception

Immediate postpartum insertion of intrauterine device for contraception

Immediate insertion (within 10 minutes of placenta delivery) may increase rates of intrauterine device (IUD) use compared to later placement, but may be associated with an increased rate of expulsion.

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Strategies for communicating contraceptive effectiveness

Effectively communicating contraceptive effectiveness is critical to making informed choices. There is currently no evidence to suggest that any one counselling strategy is superior to others. More well-designed and explicitly described studies are needed to further guide practitioners.

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Progestogens or progestogen-releasing intrauterine systems for uterine fibroids

Citation: Sangkomkamhang US, Lumbiganon P, Laopaiboon M, Mol BWJ. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids.Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008994. DOI:10.1002/14651858.CD008994.pub2.

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Hormonal and intrauterine methods for contraception for women aged 25 years and younger

Citation: Tang JH, Lopez LM, Mody S, Grimes DA. Hormonal and intrauterine methods for contraception for women aged 25 years.Cochrane Database of Systematic Reviews 2012, Issue11.Art.No.: CD009805.DOI:10.1002/14651858.CD009805.pub2.

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Vasectomy occlusion techniques for male sterilization

There is insufficient evidence to conclude on the effectiveness, safety, acceptability and costs of different vasectomy occlusion techniques for male sterilization.

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Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy

Subdermal implantable contraceptives are highly effective, easy to use and carry a low risk of side-effects. These features make them a good option for women in under-resourced settings. However, data are lacking on the performance of contraceptive implants compared with other contraceptive methods.

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Combination injectable contraceptives for contraception

Compared with progestogen-only injectables, combination injectable contraceptives are associated with more regular bleeding patterns, lower risk of amenorrhea, and less likelihood of infrequent bleeding.

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Minilaparotomy and endoscopic techniques for tubal sterilization

Major morbidity is a rare with minilaparotomy and laparoscopy, but culdoscopy is associated with serious complications. The choice between minilaparotomy and laparoscopy can be made based on the surgeon's preference, but culdoscopy is not recommended.

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Strategies for improving the acceptability and acceptance of the copper intrauterine device

This record should be cited as: Arrowsmith ME, Aicken CRH, Saxena S, Majeed A. Strategies for improving the acceptability and acceptance of the copper intrauterine device. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD008896. DOI:10.1002/14651858.CD008896.pub2.

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Strategies to improve adherence and acceptability of hormonal methods of contraception

Enhanced counselling and intensive reminder systems may improve adherence to, and continuation of, hormonal contraception. More high-quality trials are needed to identify more effective strategies among available options to support continued use of hormonal contraceptives.

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Behavioural interventions for improving condom use for dual protection

Available data on behavioural interventions to make condom use more effective for dual protection show little, if any, clinically beneficial effects for relevant outcomes. Better behavioural interventions studied through sound research are needed.

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Progestogens or progestogen-releasing intrauterine systems for uterine fibroids

Citation: Sangkomkamhang US, Lumbiganon P, Laopaiboon M, Mol BWJ. Progestogens or progestogen-releasing intrauterine systems for uterine fibroids.Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008994. DOI:10.1002/14651858.CD008994.pub2.

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Advance provision of emergency contraception for pregnancy prevention

Advance provision of emergency contraceptive pills may not reduce the rates of unintended pregnancy, but it leads to increased use of the method and is not associated with increased frequency of unprotected intercourse. It may be best to promote the use of emergency contraceptive pills among women who are at high baseline risk of pregnancy, (sex workers, adolescents, or women unable to use long-acting or daily contraception).

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Combined Oral Contraceptives and venous thrombosis

Combined Oral Contraceptives can increase the risk of venous thrombosis in healthy premenopausal women.

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Steroidal contraceptives and bone fractures in women: evidence from observational studies

Citation: Lopez LM, Chen M, Mullins S, Curtis KM, Helmerhorst FM. Steroidal contraceptives and bone fractures in women: evidence from observational studies. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD009849. DOI:10.1002/14651858.CD009849.pub2.

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Induced abortion

Surgical methods for first trimester termination of pregnancy

Dilatation and curettage, electric vacuum aspiration and manual vacuum aspiration are all safe and effective for first-trimester termination of pregnancy. Electric vacuum aspiration needs less time to perform than dilatation and curettage. Manual vacuum aspiration is associated with less pain than electric vacuum aspiration in cases of early terminations, but manual vacuum aspiration involves greater procedural difficulty compared with electric vacuum aspiration in cases of late terminations.

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Cervical preparation for first trimester surgical abortion

Mifepristone, osmotic dilators and misoprostol are effective methods for cervical ripening, although data in this review do not suggest a gestational age where benefits of cervical dilation outweigh side effects.

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Pain control in first trimester surgical abortion

Findings of this review are based on small studies that evaluated a variety of interventions. They suggest that conscious sedation, general anaesthesia and some non-pharmacological interventions are likely to be safe and helpful in decreasing procedural and postoperative pain, and patients rate these interventions as satisfactory. Available studies on paracervical block examined several aspects of the technique, but the data were inadequate to recommend its use.

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Anesthesia for evacuation of incomplete miscarriage

For pain management for evacuation of incomplete miscarriage, further research is required on the effectiveness of different forms of anesthesia.

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Perioperative antibiotics to prevent infection after first-trimester abortion

Perioperative use of antibiotics appears to prevent infection in first-trimester abortion, but adequate data are not available on the most appropriate regimen. Heterogeneity between trials suggests that the beneficial effect might not apply to all settings.

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Medical methods for first trimester abortion

Safe and effective methods of medical abortion are available for use. Combined methods, such as mifepristone with prostaglandins appear more effective then single methods.

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Antibiotics for incomplete abortion

There is a lack of research evidence on the effectiveness of routine antibiotic prophylaxis for women with incomplete abortion and more research is needed.

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Medical versus surgical methods for first trimester termination of pregnancy

Prostaglandins alone seem to be less effective and more painful than surgical abortion. Evidence is inadequate on the acceptability and side-effects of the two methods. The medical approach avoids the use of anaesthetics; this and the possibility of using it as an outpatient procedure may offer an advantage in under-resourced settings.

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Vacuum aspiration for induced abortion in the first trimester

The WHO recommendations for health worker roles in providing safe abortion care and post-abortion contraception (2015) provide a range of options of types of health workers who can perform specific abortion care and post-abortion contraception tasks safely and effectively.

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Doctors or mid-level providers for abortion

The review assessed safety and/or effectiveness for any type of first trimester abortion procedure by any type of mid-level provider, compared to doctors.

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Surgical versus medical methods for second-trimester induced abortion

For second-trimester induced abortion, dilation and evacuation is superior to medical methods of abortion. However, specialized training and consistent practice are needed to perform this method safely. Where practitioners with appropriate skills and experience are unavailable, medical methods may be more appropriate.

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