Substance use disorder: contraceptive options counseling

What’s New in Contraception?

Contraceptive Technology Conference!

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


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


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 New and Improved

PMDD: Genetic clues may lead to improved treatment
April 2017


“This is a big moment for women’s health,” says researcher Dr. David Goldman, of the NIH’s National Institute on Alcohol Abuse and Alcoholism. Goldman and his colleagues discovered a gene complex in women with premenstrual dysphoric disorder (PMDD). In their research, this gene complex was associated with a genetically disordered cellular response after being exposed to estrogen and progestin. Goldman hopes that what they learn about the genetic response could one day lead to improved, targeted treatment for PMDD and related disorders.

Nearly every woman with menstrual cycles has experienced premenstrual symptoms of PMS (premenstrual syndrome), but some suffer more extreme symptoms of PMDD. Early  research investigating premenstrual symptoms in twins suggested that PMS has a heritability of 30% to 80%.[1],[2]  This research was performed prior to PMDD being designated as a separate DSM category. Between 2% to 5% endure the extreme anxiety or depression of PMDD.

In a 2007 preliminary study, researchers identified a variant in a gene that affects how estrogen and dopamine are metabolized in PMDD sufferers.[3] The gene variant was not present in controls. Building on that discovery, Goldman and colleagues more carefully examined how the genes expressed themselves differently in women with PMDD compared with women without PMDD. They began by conducting a case-control study of women: 34 reported having PMDD and 33 reported no similar symptoms. First the researchers administered hormone blockers to determine the effect on the women’s moods. This confirmed the diagnoses: women who said they suffered PMDD reported a marked improvement in their symptoms, while the controls reported no change.

In the next phase of the study, the researchers drew blood and tested the white blood cells to make sure the WBCs expressed sex receptor genes. Then they sequenced the mRNA from the white blood cells. Compared with the cells from women without PMDD,  the cells from women with PMDD had more genes switched on. Then the researchers exposed all the women to estrogen and progestin. With the women having been exposed to the hormones for 24 hours, the researchers drew more blood from the women and sequenced the mRNA from the white blood cells. What the researchers found were differences in the intrinsic cellular response to exposure to estrogen and progesterone, with the ‘on’ genes in women with PMDD turning ‘off, and vice versa in women without PMDD. These differences occurred in the ESC/E(Z) gene complex (an ovarian steroid-regulated gene silencing complex, explain Goldman, et al.).

According to Goldman, it is apparent that women with PMDD have an intrinsic difference in their response to sex hormones—not just emotional behaviors they should be able to voluntarily control. They are not simply having a “bad day.” With these findings, researchers now have information about what takes place on a cellular level when women are exposed to estrogen and progesterone. It appears that there is a clear physiologic trigger for PMDD, which may offer a target for treating the disorder more directly. Antidepressants and hormone treatments can help some women, but not all women can take these treatments. These treatments can have side effects, too. And they can be contraindicated for women with certain conditions or who are trying to get pregnant.

The next step will be to take a deeper look into the genes’ role in the brain, using cutting-edge methods called ‘disease-in-a-dish’ technology. In this new technology, neural stem cells and precursor cells are generated from cells sampled from a patient and grown in a petri dish. The researchers believe that ESC/E(Z) gene complex may be relevant to other reproductive endocrine-related disorders, including postpartum depression. Improved understanding can lead to improved treatment.

[1] Treloar, SA, Heath AC, and Martin NG. Genetic and environ- mental influences on premenstrual symptoms in an Australian twin sample. Psychological Medicine 2002;32:25–38.

[2] Kendler, KS, Karkowski LM, Corey,LA, and Neale MC. Longitudinal population-based twin study of retrospectively reported pre-menstrual symptoms and lifetime major depression. American Journal of Psychiatry 1998;155:1234–1240.

[3] Huo L, Straaub RE, Schmidt PJ, et al. Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene. Bio Psych 2007;62:935-33.