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Concept: Fertility awareness

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In recent years there has been an explosion in the development of medical apps, with more than 40,000 apps now available. Nearly 100 apps allow women to track their fertility and menstrual cycles and can be used to avoid or achieve pregnancy. Apps offer a convenient way to track fertility biomarkers. However, only some use evidence-based fertility awareness-based methods (FABMs), which with ideal use have rates of effectiveness similar to those of commonly used forms of hormonal birth control. Since having a baby or preventing a pregnancy are important responsibilities, it is critical that women and couples have access to reliable, evidence-based apps that allow them to accurately track their fertility.

Concepts: Pregnancy, Birth control, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Progesterone, Implanon, Fertility awareness

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The aim of the study was to retrospectively evaluate the effectiveness of a fertility awareness-based method supported by a mobile-based application to prevent unwanted pregnancies as a method of natural birth control.

Concepts: Pregnancy, Birth control, Sexual intercourse, Menstrual cycle, Abortion, Fertility awareness, Calendar-based methods, Natural family planning

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A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.

Concepts: Medicine, Pregnancy, Birth control, Sexual intercourse, Family planning, Combined oral contraceptive pill, Menstrual cycle, Fertility awareness

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BACKGROUND: Conventional methods of initiating combined hormonal contraceptives (CHCs), specifically combined oral contraceptives (COCs), the contraceptive patch and the contraceptive ring, require that women delay starting CHCs until menses begin, during which time a woman may be at risk of unintended pregnancy. The objective of this systematic review is to examine the evidence on the risk of becoming pregnant after starting the method (contraceptive effectiveness including surrogate measures such as ovarian follicular development and hormone levels), risk of already being pregnant, side effects and continuation when starting CHCs on different days of the menstrual cycle. STUDY DESIGN: We searched the MEDLINE database for all articles (in all languages) published in peer-reviewed journals from inception through March 2012 for evidence relevant to starting CHCs on different days of the menstrual cycle and the outcomes of contraceptive effectiveness (including ovarian follicular development and hormonal levels), side effects and continuation rates. RESULTS: From 1635 reviewed articles, 18 studies met our inclusion criteria. Evidence from four studies suggests that neither the risk of inadvertently starting COCs in a woman who is pregnant nor the risk of pregnancy after COC initiation are affected by the cycle day on which COCs are started. While follicular activity increased as the cycle day on which COCs were initiated increased, no women ovulated when starting on Day 5. When starting on Day 7, there was no increase in ovulation for a 30-mcg pill but a significant increase in ovulation with a 20-mcg pill compared with starting on Day 1. Evidence from two small studies suggests that 7 days of pills leads to inhibition of ovulation. One small study suggests that only 3 days of ring use is needed to inhibit ovulation, but this was following one complete treatment cycle of ring use. Evidence also suggests that starting CHCs on any day of the cycle does not affect bleeding problems or other side effects for both COCs and the patch. While starting CHCs via Quick Start (starting on the day of the health care visit) may initially increase continuation compared with more conventional starting strategies, evidence suggests that this difference disappears over time. CONCLUSION: The body of evidence suggested that (a) pregnancy rates did not differ by the timing of CHC initiation; (b) the more follicular activity that occurred prior to starting COCs, the more likely ovulation was to occur; however, no ovulations were seen when COCs were started at a follicle diameter of 10 mm (mean cycle day=7.6) or when the ring was started at follicle diameter of 13 mm (median cycle day=11); © bleeding patterns and other side effects did not vary with the timing of CHC initiation and (d) continuation rates of CHCs were initially improved by Quick Start, but differences between groups disappeared over time.

Concepts: Pregnancy, Birth control, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Progesterone, Ovulation, Fertility awareness

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Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates.

Concepts: Pregnancy, Birth control, Menstrual cycle, Ovulation, Pregnancy test, Fertility awareness

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Hormonal fluctuation across the menstrual cycle explains temporal variation in women’s judgment of the attractiveness of members of the opposite sex. Use of hormonal contraceptives could therefore influence both initial partner choice and, if contraceptive use subsequently changes, intrapair dynamics. Associations between hormonal contraceptive use and relationship satisfaction may thus be best understood by considering whether current use is congruent with use when relationships formed, rather than by considering current use alone. In the study reported here, we tested this congruency hypothesis in a survey of 365 couples. Controlling for potential confounds (including relationship duration, age, parenthood, and income), we found that congruency in current and previous hormonal contraceptive use, but not current use alone, predicted women’s sexual satisfaction with their partners. Congruency was not associated with women’s nonsexual satisfaction or with the satisfaction of their male partners. Our results provide empirical support for the congruency hypothesis and suggest that women’s sexual satisfaction is influenced by changes in partner preference associated with change in hormonal contraceptive use.

Concepts: Birth control, Emergency contraception, Hormonal contraception, Combined oral contraceptive pill, Menstrual cycle, Implanon, Fertility awareness, Norplant

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Objectives The aim of the study was to evaluate the ability of a novel web and mobile application to identify a woman’s ovulation day and fertile window, in order to use it as a method of natural birth control. Methods A retrospective study was performed on 1501 cycles of 317 women aged 18 to 39 years. Women entered their basal body temperatures, ovulation test results and date of menstruation into the application. Results The mean delay from the first positive ovulation test to the temperature-based estimation of the ovulation day was 1.9 days; the length of the luteal phase varied on average by 1.25 days per user. Only 0.05% of non-fertile days were falsely attributed and found within the fertile window. Conclusions The method is effective at identifying a user’s ovulation day and fertile window and can therefore be used as a natural method of birth control.

Concepts: Menstrual cycle, Arithmetic mean, Woman, Ovulation, Identification, Fertility awareness, Basal body temperature

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In 2006, WHO published international growth standards for children younger than 5 years, which are now accepted worldwide. In the INTERGROWTH-21(st) Project, our aim was to complement them by developing international standards for fetuses, newborn infants, and the postnatal growth period of preterm infants.

Concepts: Pregnancy, Childbirth, Infant, Embryo, Fetus, Gestational age, Newborn, Fertility awareness

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Eating disorders is a prevalent, serious condition that affects, mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia, however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed to young women with amenorrhea and concurrent eating disorders. This article is protected by copyright. All rights reserved.

Concepts: Birth control, Combined oral contraceptive pill, Menopause, Estrogen, Anorexia nervosa, Eating disorders, Menstrual cycle, Fertility awareness

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We explored the association between gestational age and cord blood DNA methylation at birth and whether DNA methylation could be effective in predicting gestational age due to limitations with the presently used methods. We used data from the Norwegian Mother and Child Birth Cohort study (MoBa) with Illumina HumanMethylation450 data measured for 1753 newborns in two batches: MoBa 1, n = 1068; and MoBa 2, n = 685. Gestational age was computed using both ultrasound and the last menstrual period. We evaluated associations between DNA methylation and gestational age and developed a statistical model for predicting gestational age using MoBa 1 for training and MoBa 2 for predictions. The prediction model was additionally used to compare ultrasound and last menstrual period-based gestational age predictions. Furthermore, both CpGs and associated genes detected in the training models were compared to those detected in a published prediction model for chronological age.

Concepts: DNA, Cohort study, Pregnancy, Childbirth, Embryo, Prediction, DNA methylation, Fertility awareness