For contraceptive methods, most women value three characteristics most: effectiveness, no side effects and affordable, but there may not be a truly perfect contraceptive method at present. At present, IUD is regarded as an ideal contraceptive method by women, which just shows the lack of progress in this field.
Insert the IUD as soon as possible.
This is the voice of American women after the Trump administration decided to abolish the medical insurance for reimbursement of contraceptive-related medical expenses in the US Affordable Care Act. 20 19 A study published in the Journal of Internal Medicine of the American Medical Association showed that within one month after Trump was elected president of the United States, the number of women adopting LARC increased by 2 1.6%. A reform, countless women in the United States will lose contraceptive protection. Therefore, they think we should seize the opportunity to use long-acting birth control methods as soon as possible.
The intrauterine device, an internal contraceptive device, is a small T-shaped plastic device. At present, there are two kinds of intrauterine devices in the United States, copper intrauterine devices and hormone intrauterine devices. They are placed in the uterus and play a long-term contraceptive role. This contraceptive method is called long-acting reversible contraceptive (LARC) in the field of reproductive health.
Although obviously affected by the new regulations, the resurgence of IUD actually began as early as a few years ago. The percentage of women who need contraception in the United States who use IUD as a contraceptive method has increased from 2% in 2002 to 1 1.8% in 2006, which is the highest point in American history and reaches the average level of other developed countries. In the nearly 60 years after the first marketing of oral contraceptives, most prescription contraceptive methods have been based on the same synthetic hormone. Therefore, IUD has become the contraceptive choice of thousands of women, but its popularity shows that this phenomenon masks the fact that there are few contraceptive methods and women lack choices. Why don't we have more innovative birth control options? On the issue of contraception, is this device that can achieve the effect by stimulating the uterus really the best answer that science can provide us?
Once and for all, but women are not satisfied.
We can easily understand why IUD is so attractive: only 1% users will get pregnant within one year, which means that this device is as effective as sterilization, and its contraceptive effect can last for 3~ 12 years. Compared with other contraceptive methods, the biggest advantage of IUD is that it will hardly be affected by human error. Once the IUD is put into the uterus, there is no need to do anything (such as wearing condoms during sexual activities or taking contraceptives every day) to ensure contraception. This feature of IUD has become a common word in the field of reproductive health: once and for all.
Looks like LARC is very popular. From 2007 to 20 1 1, a research project called "Choice" provided 9256 adult women and girls with their choice of contraceptive methods free of charge. Three-quarters of the participants chose LARC, and the probability of accidental pregnancy of these participants was only 1/20 of those who chose other prescription contraceptive methods (such as oral contraceptives). In addition to the amazing effect in reducing the probability of unintended pregnancy, the researchers are also excited to find that the rate of stopping using intrauterine devices is also very low. Compared with participants who use non-LARC contraceptive methods, the number of women who take out intrauterine devices or implants in advance is much smaller. It is particularly worth mentioning that 69% of women who choose oral contraceptives, injectable contraceptives, vaginal rings or transdermal patches give up using these contraceptive methods after three years, which is more than twice the rate of stopping using intrauterine devices. Because of this, IUD is considered to be the most popular contraceptive method for women.
Even though the outage rate is very low, the outage rate itself has not attracted enough attention. One year after placing IUD, nearly 20% users of copper IUD and about 14% users of hormonal IUD expressed dissatisfaction with IUD. 12.5% users of copper IUD and 16% users of hormonal IUD decided to take out IUD. About 5 years, 44. 1% users of copper IUD and 48.3% users of hormonal IUD have stopped using it. At the end of the study, about two-thirds of IUD users said that the reason for stopping using IUD was pain, changes in bleeding volume or other side effects, or because IUD fell off by itself.
From 2065438 to 2007, a retrospective study on the real stopping rate of IUD found that in 9 years, about 39% of women who implanted IUD took it out because of its side effects. Among these women who quit halfway, 6 1% quit because of bleeding or pain. The researchers didn't know how many women had these side effects, but they didn't quit the study.
In other words, although the rate of stopping using IUD related to side effects seems low, it is largely relative to other contraceptive methods. Women's relatively high acceptance of IUD may not mean how popular it is, but how dissatisfied women are with other birth control measures. Diana, director of the project to promote new standards of reproductive health at the University of California, San Francisco; Green; Many women are suffering from these adverse side effects because they think the risk of pregnancy is higher, or they estimate that the consequences of pregnancy are worse, DianaGreeneFoster said. About 40% of the women interviewed in guttmacher claimed that they were not satisfied with the contraceptive methods currently used. It also makes it impossible for them to stick to this contraceptive method. For example, 48% of women who are dissatisfied with oral contraceptives have missed taking them at least once in the past three months, while 35% are satisfied with users. When investigating what contraceptive methods women really want, for 9 1% women, there is actually no contraceptive method that can make them particularly satisfied.
Selection difficulty
Effective (84%), no side effects (78%) and affordable (76%) are the requirements of most women for satisfactory contraceptive methods. Supporters of LARC believe that effectiveness is the only factor to consider when choosing contraceptive methods. Anu, head of the sexual health and reproductive equality program at the University of California, Berkeley; Man Qi Kang; AnuManchikantiGomez said: People often say: I can't leave statins with an effective rate of 99% and only give you statins with an effective rate of 9 1%. Then why should I give you such an inefficient contraceptive method? ; However, in real life, when women choose some imperfect options, they can't just care about effectiveness. Side effects, health risks and whether you can control when to start and stop contraception are their key aspects.
Barrier contraception has no side effects, but hormone contraception is more effective. Choosing from these methods is actually weighing the pros and cons.
In a study in 20 15, Foster and her team asked 100 experts who had published research papers on LARC to make a questionnaire survey, and asked them to estimate how many women would choose LARC if all existing obstacles were removed. Their median estimate is 25%. The idea that LARC will solve all our problems is problematic in many ways, Foster said. But it is not realistic. She added that the key to improving contraceptive methods is to seek and respect women's wishes, and then use science to develop contraceptive methods that meet their needs.
Although some new contraceptive methods, such as transdermal patches, vaginal rings and hormonal intrauterine devices, were really harvested by R&D's investment in pharmaceutical industry in 1990s and early 20th century, this R&D craze has cooled down in the past 10 years. In the past few decades, the development of most contraceptives has only slightly adjusted the formula or administration mode, however, the synthetic hormones used have always been exactly the same. In other words, what they do is only superficial efforts, rather than fundamentally improving contraceptives.
The current research also focuses on improving the availability and safety of existing contraceptives. For example, a contraceptive recently approved in other countries that can be injected by users themselves may also enter the US market. Some people are still developing a contraceptive similar to the emergency contraceptive, which only needs to be taken during sex. Others are developing natural estradiol (which is biologically homogeneous with human estrogen) to replace the vaginal ring of synthetic estrogen. Many existing hormonal contraceptives will increase the risk of thrombosis in some women, and natural estradiol can provide a safer choice for these women. Experts claim that the focus of the research is to improve the existing hormonal contraceptive methods, mainly because researchers now know these methods better. It will take a long and expensive process to develop a new contraceptive method before the product goes on the market.
Contraceptive drugs
Because all contraceptive methods are aimed at women, no contraceptive method is satisfactory to women. So, is it feasible to put the object of contraception on men?
With the development of genomics, scientists have discovered many protein, enzymes and genes involved in the reproductive process. These protein, enzymes and genes may be the targets of male and female contraceptives, and may be more targeted. A research team is studying a molecule that can act on a specific protein, preventing sperm from maturing and making eggs unfertilized. Another research team is testing a compound in non-human primates, which can bind to another kind of protein to inactivate sperm.
However, none of these compounds can pass the preclinical toxicological study and enter the human trial stage. In the future, genomics may also introduce precision medical methods into prescription contraception. Genetic variation can explain why the side effects of contraceptive methods are so different among different individuals, and genetic testing can help predict the most suitable contraceptive methods for specific women. For example, although routine tests do not include this genetic test, doctors have been able to detect specific genetic mutations that increase the risk of thrombosis in some women when using estrogen contraceptives.
Of course, one way to reduce the burden of contraception for women is to let male partners share the responsibility of contraception. Compared with non-hormonal birth control measures of both sexes, the research and development of male hormonal birth control measures is much ahead. Bryce said: We have many small-scale studies that show that these birth control measures are similar to female birth control methods and are effective. At the end of 20 18, a male contraceptive jointly developed by the world population Council and NICHD*** entered the phase II clinical trial, and 420 couples participated in the safety and effectiveness test. However, in the past 30 years, there is a joke that has been repeatedly mentioned in this field, that is, there is still 10 years before the advent of male contraceptives. Bryce said: I won't promise that there will be male contraceptives in the next five years.
Researchers admit that male contraceptives need to meet higher standards than female contraceptives. For many women, the benefits of contraception are enough to make them willing to endure side effects such as nausea, mood swings or increased menstrual flow. But what about men? "It's not enough," said Sitchuk Weil, who co-founded the International Male Contraceptive Alliance. If they decide to take the responsibility of contraception, they will hope that contraceptive methods will have absolutely no side effects.
We hope that researchers and funders can develop more targeted contraceptive methods in the future and more accurately match the formula with individual's unique physiological conditions. At present, it is equally important to help women choose the existing contraceptive methods. The existing contraceptive methods force many of us to sacrifice our health for contraceptive effect.
Write an article |(MayaDusenbery)
Translation | Zhao Jin