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

Whatever happened to PID?
November 2013


Guidelines for treating PID continue to evolve, with questions about anaerobic infection and potential options for weekly dosing in select patients. Are you up to date, or are you lagging behind?

During the 1970s, the topic of PID was front and center. The family planning researchers were studying whether IUDs caused it, and whether hormonal contraception protected against it. Those in the infectious disease circles wondered what organisms caused it. Both groups evaluated the best ways to treat it, concerned that symptomatic PID led to tubal factor infertility.

By the 1980s, an all out war on PID was declared. Clinicians performed laparoscopies on all women with lower abdominal pain to determine whether acute PID was present (1). This usually required hospitalization, a costly and inconvenient experience. Meanwhile, the infectious disease specialists learned that only a minority of PID could be traced to traditional bacterial organisms—gonorrhea and chlamydia. Retrospective studies showed that women with documented tubal factor infertility frequently had chlamydia antibodies but no prior history of lower abdominal pain or PID. Something strange was going on.

Fast-forward 30 years. STD treatment guidelines flirted with recommending broader antibiotic coverage for symptomatic PID, including metronidazole. In parallel, recognition of the role of subclinical PID in producing tubal factor infertility led to recommending that clinicians adopt a low threshold for initiating antibiotics in women with lower abdominal pain (2). Screening for and treatment of lower genital tract infections—especially chlamydia—became a focus for infertility prevention. Finally, the well-designed PEACH cohort study discovered that outpatient therapy was as effective but less costly and more convenient than inpatient treatment (3). Not surprisingly the number of hospitalized PID cases declined. By 2013, PID management in family planning settings settled down to a relatively routine process.

A recent update to what we currently know about PID has just been published (4). It includes the potential role for anaerobes and bacterial vaginosis in PID and the development of chronic reproductive tract disease. Because multiple studies have found that BV-associated bacteria have been isolated from the fallopian tubes of women with symptomatic salpingitis, the CDC recommends that coverage of anaerobes in PID can be “considered.” As of now, this is a clinical judgment call. The experts agreed that the minimum requirement for any PID antibiotic treatment regimen is effectiveness against both gonorrhea and chlamydia. Thus, ceftriaxone 250 mg intramuscularly and oral doxycycline 100 mg twice daily for two weeks remains the standard. One study suggested that oral azithromycin 1 g per week for two weeks could be as effective as daily doxycycline., but this has not yet been confirmed. Prospective trials will be necessary to more definitively understand whether addition of metronidazole to this regimen can affect both subclinical endometritis, as well as its long-term sequelae of tubal infertility.

For women with mild or moderate clinical severity, hospitalization is not necessary.  We know now that our move to outpatient-based therapy has saved costs and enabled proactive treatment for women with mild and moderate PID. Future research on the next steps for managing PID and reducing its long-term consequences will require additional diagnostic tools such as endometrial biopsy, diagnostic imaging methods, and bacterial genomic studies may help further clarify this is elusive syndrome. Stay tuned.


  1. Westrom L, Joesoef R, Reynolds G, et al. Pelvic inflammatory disease and fertility. A cohort study of 1844 women with laparoscopically verified disease and 657 control women with normal laparoscopic results. Sex Transm Dis 1992; 19:185–192.
  2. Wiesenfeld HC, Hillier SL, Meyn LA, et al. Subclinical pelvic inflammatory disease and infertility. Obstet Gynecol 2012
  3. Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health peach randomized trial. Am J Obstet Gynecol 2002; 186:929–937.
  4. Darville T, The pelvic inflammatory disease workshop proceedings committee. Pelvic inflammatory disease: identifying research gaps – proceedings of a workshop sponsored by Department of Health and Human Services/National Institutes of Health/National Institute of Allergy and Infectious Diseases, November 3–4, 2011. Sex Trans Dis  2013;40:761–767.

Willard Cates, Jr., MD, MPH, Distinguished scientist and Emeritus President, FHI 360b.