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Biologic sexism of STIs

Excess breast cancer deaths after COVID-19

Contraception for patients with medical conditions

Pelvic Floor Dysfunction

Treating vulvodynia

Puzzling Over the Hurt Down-Under

Serious Mental Illness and Contraception

New 13-Cycle Vaginal Contraceptive System

The Future of Family Planning in Post-COVID America

New ASCCP Guidelines: Implications for FP

On the alert: mood disorders during 2020 stressors

Sex in the Time of COVID-19

Challenges old and new during the pandemic

Reproductive health in the time of Covid-19

Talking about toys

Missed Pills: The Problem That Hasn’t Gone Away

Find the “yes! . . . and” rather than “no” or “but”

Digital Family Planning: the Future is Now

Irregular Bleeding Due to Contraceptives

When she’s low on libido…

Ouch! Best approaches to menstrual pain

Contraceptive efficacy: understanding how user and method characteristics play their part

Strategizing treatment for chronic heavy menstrual bleeding

Perimenopause

Untangling the literature on obesity and contraception

High tech apps for no-tech FABM

Menstrual exacerbation of other medical conditions

From Princeton University: Thomas James Trussell (1949-2018)

The Short and Long of IUD Use Duration

Selecting a Method When Guidance Isn’t Clear-cut

Healthcare in the Time of Digital Expansion

The Scoop on Two New FDA-Approved Contraceptive Methods

Pregnancy of unknown location—meeting the challenge

Big “yes” (with caveats) to CHCs during perimenopause

The role of IUDs (LNG IUDs, too!) in emergency contraception

Combined pills’ effect on mood disorders

Abortion in the U.S.: safe, declining, and under threat

Hope for ovarian cancer screening test

Breast cancer still a small risk with some hormonal contraceptives

New treatment modality for BV

Record rate of HPV-related throat cancer

Viruses in semen potentially transmissible

Don’t Abstain from Your Role in Abstinence

Teens births declining but geographic ‘hotspots’ defy trend

Online Medical Abortion Service Effective and Safe

Do Women Really Need to Wait That Long?

Reassuring news on depression and OC use

PMDD: Genetic clues may lead to improved treatment

Breast cancer risk when there is a family history

Body weight link to breast and endometrial cancers (and 11 others)

Family Planning in 2017 and Beyond

Make Me Cry: Depression Link (Again)?

Managing implant users’ bleeding and spotting

Zika: Updated guidance for providers

Pharmacist-prescribed contraceptives

Hot off the press! 2016 MEC and SPR

Zika virus fears prompt increased request for abortion in nations outlawing abortions

Opioid use epidemic among reproductive-age women

Good news on the family planning home front!

War Against Planned Parenthood Hurts Women

Win-win for both treatment and prevention

Center of the Storm

Ambivalence

Menopause, mood, mental acuity, and hormone therapy

Emergency contraception for teens

Postpartum Contraception: Now, Not Later

Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”

Are we practicing what we preach?

Be alert to VTE in hormonal contraceptive users

LARC among teens increased 15-fold, but not enough

Brain cancer and hormonal contraception

Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use

Alcohol consumption when pregnancy is unwanted or unintended

Latest Data on Contraceptive Use in the United States

LateBreaker sampler from Contraceptive Technology conference

Emergency Contraceptive Pill Efficacy and BMI/Body Weight

Handout on Unintended Pregnancy and Contraceptive Choice

Ask About Withdrawal (Really!)

Rules to Practice By: Safety First and Cleanliness is Close to. . .

What’s Vanity Fair Got Against the NuvaRing?

Promising New Treatment for Hepatitis C

Numbers matter, so make them simple for patients

The Recession’s Effect on Unintended Pregnancies

Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative

Applying the “New” Cervical Cytology Guidelines in Your Practice

Acute Excessive Uterine Bleeding: New Management Strategies

Medical indications for IUD use in teens

Whatever happened to PID?

Update on Emergency Contraception

Contraceptivetechnology.com New and Improved

What’s New in Contraception?
January 1970

 

By: Robert A. Hatcher, MD, MPH
Professor Emeritus, Department of Gynecology and Obstetrics
Emory University School of Medicine

During the last week of September 2021, 500 participants in the Contraceptive Technology virtual conference learned about three new contraceptives that I want to tell you about.

  • The Progestin-only Pill providing 4mg of Drospirenone
    • As of early October 2021, the most important change in oral contraception is the progestin-only pill providing 4 mg of drospirenone (DRSP) and marketed as Slynd. It is packaged to provide 24 active pills (DRSP 4 mg) and 4 inert pills. There is only one absolute contraindication (“4” in US Medical Eligibility Criteria or MEC) for the use of this pill—current breast cancer. Someone who currently has or is being treated for breast cancer should not be prescribed Slynd.
    • This progestin-only pill may be used during breastfeeding and immediately postpartum. It is extremely effective, and it is NOT contraindicated for persons at an elevated risk for blood clots (in contrast to estrogen-containing birth control pill).
    • The drospirenone-only pill Slynd is being called the first of the 4th generation of birth control pills. It leads to a high likelihood of anovulation. Its suppression of ovulation and its pregnancy rates are equivalent to that associated with combined pills. It causes no increase in blood pressure and no increased risk of venous or arterial clots.
    • While users who take Slynd have more days of spotting in the first few cycles, only 3.3% discontinue use of this pill because of bleeding.
    • As with any new medication, its price will start out high, but most insurance plans do cover DRSP pills and persons covered by the Affordable Care Act will pay nothing for this new progestin-only pill.

 

  • Self-administered Subcutaneous Depo Provera
    • Depo SQ is the way some users are now being taught to self-inject Depo Provera.
    • For years now it has been apparent that Depo Provera provided by deep IM injections every three months has the highest rates of discontinuation of any reversible contraceptive. One of the effects of the Covid-19 pandemic is that healthcare that can be self-administered at home has been encouraged. Depo SQ is a self-administered Depo Provera shot. A meta-analysis (combined data from multiple studies) by Kennedy, et al., analyzed rates of continuation and pregnancy among 4,000 users, some of whom were provided Depo IM and others taught to inject for themselves Depo SQ. Users Instructed to self-administer Depo Provera subcutaneously had higher continuation rates and lower pregnancy rates.
    • The US MEC guidance for Depo SQ and Depo IM are exactly the same.

 

  • Levonorgestrel IUDs as Emergency Contraceptives
    • Clinicians have been reticent about providing a 52 mg levonorgestrel IUD (LNG IUD) for emergency contraception when a copper T 380A IUD, known to have an extremely low pregnancy rate, was available.
    • However, a recent study of IUDs for emergency contraception compared the 52 mg LNG IUD with the copper T 380A and found that the LNG IUD proved to be “noninferior” to the use of a copper IUD in pregnancy prevention. In the study, 706 women who had a negative pregnancy test and sought a morning-after contraceptive following unprotected intercourse were provided either the 52 mg LNG IUD or a copper T 380A IUD. After a month of IUD use, only 1 pregnancy was reported in users of an LNG IUD and 0 pregnancies among users of the copper IUD.
    • Users of the LNG IUD are likely to experience one of the non-contraceptive benefits attributed to the method, so it is likely that insertion of a 52 mg LNG IUD will become the preferred method of emergency contraception for many women in the future.
    • The non-contraceptive benefits associated with the LND IUD may include any of the following:
      • Decreased menstrual cramping, as much as a 95% reduction in menstrual blood loss
      • Protection against endometrial hyperplasia and endometrial cancer
      • Protection against the growth of uterine fibroids
      • Decreased endometriosis symptoms
      • Production of a thick mucus plug at the opening of the cervix preventing ascent into the uterus not only of sperm but also of a number of infectious agents.

BUT…innovation means nothing unless it leads to a change in practices. A continued focus is needed on the question “What is my (our) next right step?” The answer is in the hands of everyone providing contraceptives and of students of this field—offer your patients the option of any of these three exciting new methods: the drospirenone-containing progestin-only pill, the 52 mg LNG IUDs as emergency contraceptives, and Depo SQ for self-injection at home.

   Curious about online access to the Contraceptive Technology conference? You can earn CE by viewing the recorded sessions, beginning October 15, 2021. Visit http://contraceptivetechconf.com/