June 6, 2012Volume 7 - Issue 23  

DynaMed Weekly Update

For the week ending June 1, 2012

Last week 498 articles were evaluated via DynaMed's Systematic Literature Surveillance and 267 were added to DynaMed content.

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Contraception with IUDs, Subdermal Implants or DMPA Injections May Reduce Unintended Pregnancies Compared to Pills, Patches or Vaginal Rings


About half of the unintended pregnancies in the United States result from contraceptive failure, rather than from nonuse of contraception.  Some contraceptive methods may be more prone to failure than others, due to possibility of inconsistent or incorrect use, but little data have been available to directly compare the efficacy of different methods.   


The Contraceptive CHOICE Project evaluated the rates of unintended pregnancies associated with different forms of reversible contraception in 7,486 women aged 14-45 years desiring to postpone pregnancy for at least 1 year.  Women were given their choice of contraceptive at no cost and followed for up to 3 years.  Choices included intrauterine device (IUDs), subdermal implant, oral contraceptive pill, transdermal patch, vaginal ring, and depot medroxyprogesterone acetate (DMPA) injection.  Prior to selection, all women were read a standardized script describing the efficacy of IUDs and implants and were counseled about the risks and benefits of all reversible contraceptive methods.  IUD or implant was chosen by 77.2%, pill, patch, or ring by 20.4%, and DMPA injection by 2.4%.


There were 334 unintended pregnancies during follow-up.  The contraceptive failure rates per 100 person-years were 0.27 with IUD or implant, 0.22 for DMPA injections (not significant vs. IUD or implant), and 4.55 for pill, patch and ring combined (p < 0.001 vs. IUD or implant and vs. DMPA injection) (level 2 [mid-level] evidence).  Cumulative failure rates over 3 years were 0.95% with IUD or implant, 0.7% for DMPA injections (not significant vs. IUD or implant), and 9.4% with pill, patch or ring (p < 0.001 vs. IUD or implant and vs. DMPA injection).  In a subgroup analysis of pill, patch and ring users, women < 21 years old had a significantly higher risk of unintended pregnancy than older women (adjusted hazard ratio 1.9, 95% CI 1.2-2.8).  There were no significant differences in pregnancy rates associated with age in women using IUD or implant or in women using DMPA injections (N Engl J Med 2012 May 24;366(21):1998).


For more information, see the Contraception overview topic in DynaMed.



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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: June 6, 2012
Expiration Date: June 6, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
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AAFPThis Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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Program ID 1102072N.

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