Substance use disorder: contraceptive options counseling
Contraceptive Technology Conference!
Excess breast cancer deaths after COVID-19
Contraception for patients with medical conditions
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
Challenges old and new during the pandemic
Reproductive health in the time of Covid-19
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
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
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
Menopause, mood, mental acuity, and hormone therapy
Emergency contraception for teens
Postpartum Contraception: Now, Not Later
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

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/ |