Research gaps identified during the 2014 update of the WHO medical eligibility criteria for contraceptive use and selected practice recommendations for contraceptive use
Open accessAbstract
Universal access to safe and effective contraception is an important public health goal. Family planning and prevention of unintended pregnancy are essential to securing the well-being and autonomy of individuals, while supporting the health and development of communities [1]. The World Health Organization (WHO) recently undertook a process to update its global guidance on “who” can use contraception safely and “how” to use contraception safely and effectively to generate the fifth edition of the WHO Medical Eligibility Criteria for Contraceptive Use (MEC) and the third edition of the WHO Selected Practice Recommendations for Contraceptive Use (SPR).
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The mechanism of GnRH antagonists differs from that of GnRH agonists, which after a first phase of stimulation desensitize GnRH receptors, leading to full suppression of LH and FSH production and complete suppression of E2 to levels similar to those after bilateral oophorectomy.
“The mechanism is different from that of the GnRH agonist which, after a first phase of stimulation, desensitizes GnRH receptors, leading to full suppression of LH and FSH production and subsequently to complete suppression of E2 to levels similar to those observed after bilateral oophorectomy [95,96,97,98].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
GnRH agonists cannot titrate E2 levels.
“GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
GnRH agonists have unpredictable reversibility of treatment when injectable depot forms are used.
“GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
GnRH agonists have a delayed therapeutic impact because of the flare-up effect.
“GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
GnRH agonists excessively suppress E2 to less than 20 pg/mL, with related unfavorable side effects.
“GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
GnRH agonists are effective at treating endometriosis symptoms.
“GnRH agonists are effective at treating endometriosis symptoms, but they have numerous limitations, including a delayed therapeutic impact because of the flare-up effect, excessive suppression of E2 to less than 20 pg/mL (with related unfavorable side effects), inability to titrate E2 levels, and unpredictable reversibility of treatment when injectable depot forms of GnRH agonists are used [95,96,”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
For elagolix, dyspareunia was only significantly alleviated at the highest daily dose (200 mg twice daily), but not at a lower dose (150 mg once daily), while other types of endometriosis-associated pain were significantly reduced with both the lower and higher dose.
“Indeed, dyspareunia was only significantly alleviated at the highest daily dose (200 mg twice daily), but not at a lower dose (150 mg once daily), while other types of endometriosis-associated pain were significantly reduced with both the lower and higher dose [96].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [96]
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- Authors
- Dragoman, M. V., Jatlaoui, T., Nanda, K., Curtis, K. M., & Gaffield, M. E.
- Affiliations
- World Health Organization (CH)
- Centers for Disease Control and Prevention (US)
- Family Health International 360 (US)
- Corresponding author
- Dragoman, Monica V.
- Venue
- Contraception
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 94
- Issue
- 3
- Pages
- 195-201
- ISSN
- 0010-7824 (ISSN-L)
- OpenAlex
- W2215984847
- Cited by
- 11
- References
- 39
- Citations by year
- 2024: 3 · 2021: 2 · 2017: 2 · 2016: 4
- FWCI
- 0.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Contraception (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- contraceptive use, research gaps, family planning, unintended pregnancy prevention, contraceptive safety, contraceptive effectiveness
- MeSH terms
- Contraception, Contraception Behavior, Eligibility Determination, Female, Humans, Male, Research, World Health Organization, Practice Guidelines as Topic
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