This month’s clinical fact

July 2020 Clinical Fact:

“You are your safest sex partner.” —New York City Department of Health and Mental Hygiene

May 2020 Clinical Fact:

“For many of us, the moral importance of our work is its most compelling appeal, and it helps sustain us in the face of political and economic challenges.”

—Felicia Stewart, 1943-2006, writing in Contraceptive Technology, 18th edition

April 2020 Clinical Fact:

“Although abstinence has become associated with saying “no,” viewed from another perspective, abstinence can mean saying “yes” to a number of other sexual activities and personal priorities.”—Contraceptive Technology, p. 418

March 2020 Clinical Fact:

“Penile-vaginal intercourse is much more strongly associated with satisfying orgasm for the person with the penis than for the person with the vagina.” – Contraceptive Technology, 21st edition, p. 669

February 2020 Clinical Fact:

“After having taken at least 7 COCs at the correct time, patients are at little risk for ovulation until they subsequently miss 7 consecutive pills.” – Contraceptive Technology, 21st edition, p. 296

January 2020 Clinical Fact:

“Health care providers can assist our patients … by starting with a clear understanding of our role, which we propose is to help our patients figure out what they want and then help them get it.” – Contraceptive Technology, 21st edition, p. 71

November 2019 Clinical Fact:

“Digital health resources have “transformed the provider-patient relationship such that HCPs are today not only responsible for providing information but also for guiding their patients’ search for and use of digital information.” – Contraceptive Technology, 21st edition, p. 929

October 2019 Clinical Fact:

“Family planning providers, who are often the sole source of healthcare for reproductive-aged women, are uniquely well-suited to address interrelated mental and reproductive health needs.” – Contraceptive Technology, 21st edition, p. 735

September 2019 Clinical Fact:

“While natural, sexuality is also cultural. Physiologic aspects of sexuality (for example, libido and arousal) are strongly linked with social and psychological factors.” – Contraceptive Technology, 21st edition, p. 66

August 2019 Clinical Fact:

“Nearly 90% of cycling women experience some discomfort with their menses.” – Contraceptive Technology, 21st edition, p. 45

July 2019 Clinical Fact:

“Technology fails people just as people fail technology…Contraceptive methods are imperfect and can fail even the most diligent user.” – Contraceptive Technology, 21st edition, p. 111

June 2019 Clinical Fact:

“In younger individuals, the most common cause [of postcoital bleeding] is chlamydia cervicitis. In older individuals, benign lesions such as cervical polyps and more serious problems, such as cervical carcinoma, classically present with this type of bleeding.” – Contraceptive Technology, 21st edition, p. 71

May 2019 Clinical Fact:

“Fluctuations in gonadotropins and estrogens seen during [perimenopause] are so dramatic that they have been described as “hormonal chaos.” – Contraceptive Technology, 21st edition, p. 583

April 2019 Clinical Fact:

“The fact that the hypothalamus is affected by an array of neurotransmitters and other factors described above can help explain why stress, obesity, and medications can disrupt ovulatory cycling.” – Contraceptive Technology, 21st edition, p. 46

March 2019 Clinical Fact:

“More than 80% of Fertility Awareness-Based methods (FABM) use in recent NSFG surveys is self-reported use of “rhythm.” So “lumped” estimates of effectiveness may not apply to individual FABMs.”  — Contraceptive Technology, 21st edition, p. 422

February 2019 Clinical Fact:

“The fact that the hypothalamus is affected by an array of neurotransmitters and other factors…can help explain why stress, obesity, and medications can disrupt ovulatory cycling.”  — Contraceptive Technology, 21st edition, p. 46

December 2018 Clinical Fact:

“Because implants and IUDs are highly effective, they are excellent choices for the short-term, too, and the fact that an implant or an IUD is good for “up to” 3 to 20 years is an added advantage but not always relevant.”  — Contraceptive Technology, 21st edition

November 2018 Clinical Fact:

“Given that the increase in maternal morbidity and mortality in the United States is due in part to chronic maternal conditions, providing appropriate contraceptive care is critical.”  — Contraceptive Technology, 21st edition, p.543

October 2018 Clinical Fact:

“Many of the resources listed in Contraceptive Technology represent sources that we believe will continue to be maintained by professional organizations and thus be updated to reflect the most current knowledge.”  — Contraceptive Technology, New 21st edition, p.947

September 2018 Clinical Fact:

“Ring use does not appear to have adverse effects on the cervico-vaginal epithelium or on cervical cytology”  — Contraceptive Technology, New 21st edition, p.237

August 2018 Clinical Fact:

“Once a pregnancy is visualized on ultrasound examination, then human chorionic gonadotropin hormone (hCG) testing is rarely useful.”  — Contraceptive Technology, upcoming 21st edition, in production

July 2018 Clinical Fact:

“The failure rate of every contraceptive method is lower in users over the age of 40 compared to younger individuals.”  — Contraceptive Technology, upcoming 21st edition, in production

June 2018 Clinical Fact:

“Placement of a copper IUD within 5 (or 7 or even 10) days after unprotected intercourse reduces the risk of pregnancy by more than 99%.”  — Contraceptive Technology, upcoming 21st edition, in production

May 2018 Clinical Fact:

“Overall, the full range of available contraceptive methods is appropriate for the majority of patients with depression and related conditions, including those taking SSRIs or SNRIs or using adjunct therapies.”  — Contraceptive Technology, upcoming 21st edition, in production

April 2018 Clinical Fact:

“COCs reduce the risk of ectopic pregnancy by 90%, a leading cause of maternal mortality in early pregnancy, because they substantially reduce the risk of pregnancy.” — Contraceptive Technology, upcoming 21st edition, in preparation

February 2018 Clinical Fact:

“There are three national guidelines; each one says something different. All three agree that there is no evidence that the [screening pelvic exam] is beneficial. There is evidence of harms, including false alarms.” — Contraceptive Technology, upcoming 21st edition, in preparation

January 2018 Clinical Fact:

“The Centers for Disease Control and Prevention’s Medical Eligibility Criteria and Selective Practice Recommendations website and mobile app … will have answers to most contraceptive questions healthcare providers might have when initiating contraceptives with their patients. These resources are also maintained regularly.” — Contraceptive Technology, upcoming 21st edition, in preparation

December 2017 Clinical Fact:

“No contraceptive method is contraindicated on the basis of age alone.” — Contraceptive Technology, upcoming 21st edition, in preparation

November  2017 Clinical Fact:

“Cumulatively, evidence supports the conclusion that once the implant is in place, it provides convenient, “forgettable,” ongoing pregnancy protection that is not affected by BMI.” — Contraceptive Technology, upcoming 21st edition, in preparation

October 2017 Clinical Fact:

” All patients should be offered counseling and voluntary HIV testing, and those at risk should be linked to services that provide HIV PrEP. A useful resource is the PrEP in Family Planning Tool Kit, available at” — Contraceptive Technology, upcoming 21st edition, in preparation

September 2017 Clinical Fact:

“Although abstinence has become associated with saying “no,” viewed from another perspective, abstinence can mean saying “yes” to a number of other sexual activities and personal priorities.”— Contraceptive Technology, upcoming 21st edition, in preparation

August 2017 Clinical Fact:

“As more than 75% of patients will begin their search for health information by using popular search engines such as Google, Bing, or Yahoo, they may face difficulty in parsing out the most appropriate sources for their queries.”— Contraceptive Technology, upcoming 21st edition, in preparation

July 2017 Clinical Fact:

“In a review of [the] literature, IUDs were placed up to 7 days after unprotected intercourse (UPI) in three studies, up to 10 days after UPI in one study, and up to 10+ days after UPI in one study; there were 0 pregnancies.”— Contraceptive Technology, upcoming 21st edition, in preparation

June 2017 Clinical Fact:

User instructions for progestin-only pills: “If you vomit within 4 hours after taking a pill, or if you have diarrhea…Keep taking the pills on schedule, but use a back-up method until 48 hours after vomiting or diarrhea are over.”— Contraceptive Technology, p. 244

May 2017 Clinical Fact:

“…approximately 15% of clinical recognized pregnancies end spontaneously in early pregnancy…a prospective observational trial of 30 women having spontaneous abortion found success rates for expectant management are 82.1% at 2 weeks and 100% by 30 days…as long as the woman is stable.”— Contraceptive Technology, p. 677

April 2017 Clinical Fact:

“When we counsel patients about birth control, help patients make decisions about an unintended pregnancy, help women plan for pregnancy and safely traverse its nine months…whether or not we are aware of it, we are engaged in a critically important and deeply moral undertaking.”—Contraceptive Technology, p. xxiii

March 2017 Clinical Fact:

“Women with osteopenia have twice the risk for hip fracture…and women with osteoporosis have a nearly 9-fold increased risk.”—Contraceptive Technology, p. 750

February 2017 Clinical Fact:

“Tubal infertility per PID episode: 8% after first episode; 20% after second episode; 40% after third episode.”—Contraceptive Technology, p. 573

January 2017 Clinical Fact:

“The difference between pregnancy rates during typical use and pregnancy rates during perfect use reveals the consequences of imperfect use; this difference depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly.”—Contraceptive Technology, p. 49

December 2016 Clinical Fact:

“Although abstinence has become associated with saying “no,” viewed from another perspective, abstinence can mean saying “yes” to a number of other sexual activities…an abstinent person does not lose his or her sexuality…” —Contraceptive Technology, p. 106-7

November 2016 Clinical Fact:

“The best approach to reducing the impact of [bleeding changes associated with using contraceptive implants] is to forewarn women about it emphasizing that it is generally not dangerous.” —Contraceptive Technology, p. 198

October 2016 Clinical Fact:

“Low levels of hCG (5 to 30 mIU) may be associated with tumors of the pancreas, ovaries, breast, and many other sites. some normal postmenopausal women also have low levels of circulating hCG-like substance of pituitary origin.”Contraceptive Technology, p.  667

September 2016 Clinical Fact:

“… double-blind placebo-controlled trials have shown no difference in the incidence of any of the major side effects in COC users compared to pill users; similar percentages…developed headaches, nausea, vomiting, mastalgia excessive weight gain, etc. However, some women may be more sensitive to exogenous hormones, so counsel all potential hormonal contraceptive users that side effects may be possible but not necessarily to be expected.”Contraceptive Technology, p.  311

August 2016 Clinical Fact:

“Milk expression, such as by hand or pump, is not a substitute for breastfeeding in terms of its fertility-inhibiting effect.”Contraceptive Technology, p.  487

July 2016 Clinical Fact:

“When a woman has had unprotected sex, we can offer her an intrauterine contraceptive rather than emergency contraceptive pills. Placement of the IUD within several days of unprotected sex reduces a woman’s risk of pregnancy to about 1 in 1,000 and providers her with 10 to 20 years of highly effective, fully reversible contraception…”Contraceptive Technology, p.  xxvi

June 2016 Clinical Fact:

“… severe diarrhea can decrease your body’s ability to absorb the pill’s hormone. If you have vomiting or diarrhea, treat it as if you had missed pills.”—Contraceptive Technology, p.  322

May 2016 Clinical Fact:

“Breastfeeding has a major protective effect against premenopausal cancers of the ovary, endometrium, and breast and protects against type 2 diabetes.”—Contraceptive Technology, p.  501

April 2016 Clinical Fact:

“For some areas of clinical medicine, the why seems hardly to need articulating…The value of work as a heart disease clinician [for example] is not likely to be attacked as immoral…Unfortunately, tis is not true for clinicians working in the field of family planning services and reproductive health.” —Felicia Stewart, MD, in Contraceptive Technology, p.  xxiii

March 2016 Clinical Fact:

“More frequently, women with [heavy menstrual bleeding] have functional problems with excessive endometrial fibrinolysis, a prostaglandin imbalance, vessel instability, or inhibition of matrix metalloproteinase activity. only about half of women with heavy menstrual bleeding have an anatomical pathology…”—Contraceptive Technology, p

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February 2016 Clinical Fact:

“The conditions that cause secondary amenorrhea…also commonly cause infrequent menses. Once pregnancy is ruled out, most cases are round to be associated with estrogen production but with a lack of progesterone.”—Contraceptive Technology, p.  541

December 2015 Clinical Fact:

“IUC use appears safe and effective for women who are immunosuppressed due to organ transplantation, autoimmune disease, or infection with HIV. IUC use has not been shown to increase viral shedding, and clinical HIV disease progression was slower among women using the TCU380A than among women using hormonal contraception.”—Contraceptive Technology, p. 159

November 2015 Clinical Fact:

“Ovulation can occur even though the breastfeeding mother has not yet resumed menstruation…33-45% during the first 3 months postpartum; 64-71% during months 4 through 12; 87-100% after 12 months.”—Contraceptive Technology, p. 486

October 2015 Clinical Fact:

“…the risk of infection and infertility among IUC users is very low. …the placement process, and not the device or its thread, poses a small transient risk of infection… However, antibiotic prophylaxis should not be routinely used before placement.”—Contraceptive Technology, p. 156

September 2015 Clinical Fact:

“…insulin resistance in women with polycystic ovarian syndrome does not predictably worsen with COC use.”—Contraceptive Technology, p. 287

August 2015 Clinical Fact:

Risk of death (per year)Using combined oral contraceptives (and presumably the path and ring) for nonsmokers aged 15-34: 1 in 1,667,000 / From an automobile accidents: 1 in 5,000 / From a fire: 1 in 20,000 / In an airplane crash: 1 in 250,00.”  —Contraceptive Technology, back inside cover

July 2015 Clinical Fact:

“Most studies show that during vaginal sex, condoms break approximately 2 percent of the time during intercourse or withdrawal and a similar proportion slip off completely…advise users to have several condoms available in case a condom is torn or put on incorrectly…”               —Contraceptive Technology, p. 380

June 2015 Clinical Fact:

“The risk of VTE [venous thromboembolism] with COCs [and other hormonal contraceptives] is greatest in the first 3 to 12 months of use and declines thereafter.”               —Contraceptive Technology, p. 277 

May 2015 Clinical Fact:

“COC use increases bone mineral density (BMD) in … anorexic teenagers. COC use by women with osteopenia due to anorexia nervosa is not sufficient to completely protect bone, but when added to anabolic agents such as insulin growth factor, COC use significantly improves that agent’s effectiveness. –Contraceptive Technology, p 270

April 2015 Clinical Fact:

“Preventing pregnancy is generally safer than pregnancy. Compare the risk of death associated with using combined hormonal contraceptives with the risk of death associated with pregnancy:

  • Pregnancy: 1 in 6,700
  • Nonsmokers: the risk for women aged 15-34 is 1 in 1,667,000 and for women aged 35-44 it is 1 in 33,000.
  • Smokers: the risk for women aged 15-34 is 1 in 57,800 and for women aged 35-44 it is 1 in 5,200.” –Contraceptive Technology, inside back cover

March 2015 Clinical Fact:

“Women using ACE inhibitors, angiotensin-II antagonists, potassium-sparing diuretics, heparin, aldosterone antagonists, and NSAIDS on a chronic daily basis to treat chronic conditions or diseases should have their serum potassium checked during the first cycle of drospirenone use (usually about 14 days after pill initiation). If those levels are normal, no future testing is necessary.” –Contraceptive Technology, p. 308

February 2015 Clinical Fact:

“In a study of high-school students who consider themselves virgins, 30% had engaged in heterosexual masturbation of or by a partner, 9% had engaged in fellatio (oral-penile contact) with ejaculation, and 10% had engaged in cunnilingus (oral-female genital contact).”–Contraceptive Technology, p. 102

January 2015 Clinical Fact:

“Women with continued spotting or bleeding following their scheduled bleeding may need more estrogen to proliferate the endometrium. Increase the estrogen to proliferate the endometrium. increase the estrogen in the first pills in the pack or decrease the progestin content of those first pills.”–Contraceptive Technology, p. 313

December 2014 Clinical Fact:

 “…probabilities of pregnancy cumulate over time. For example, suppose that each year the typical proportion of women becoming pregnant while taking the pill is 8%…Within 5 years [of pill use], 34%…will become pregnant.” —Contraceptive Technology, p. 55

November 2014 Clinical Fact:

“In terms of contraceptive service delivery, routine adherence to the 6-week convention does not seem appropriate…Although nearly all contraceptive methods can be used postpartum, the methods vary in terms of when in postpartum period they should be initiated. 6 weeks is too late to begin contraceptive for nonbreastfeeding mothers who wish to start using [hormonal methods]; 3 weeks is too soon for inserting an IUC…” —Contraceptive Technology, p. 490

October 2014 Clinical Fact:

“Unintended pregnancy/coital act: 17%-30% midcycle, <1% during menses.” —Contraceptive Technology, p. 573

September 2014 Clinical Fact:

“Among nonmarried women, 32% reported they had not had sex in the past year, 25% reported only a few times in the past year, 26% reported a few times in the past month, and 26% reported two or more times per week.”  —Contraceptive Technology, p. 5

August 2014 Clinical Fact:

“Most women wish to discuss sexual concerns but report that most providers neither inquire about nor follow up on sexual issues…” —Contraceptive Technology, p. 2

July 2014 Clinical Fact:

“While there is considerable variation in cycle length, less than 1% of women have a regular cycle length of less than 21 days or more than 35 days.” — Contraceptive Technology, p. 30

June 2014 Clinical Fact:

“Leiomyoma (uterine fibroids) contain both estrogen and progesterone receptors…However, clinical studies with low-dose COCs have found no impact on the risk of developing new fibroids or on increasing the size of pre-existing fibroids, except in women who used COCs early in life.” — Contraceptive Technology, p. 287

May 2014 Clinical Fact:

“While chronic daily use of some drugs may increase serum potassium in some women using drospirenone-containing contraceptive pills, note that intermittent use of NSAIDS does not pose any problems. If a woman is using other potassium-sparing drugs, test her potassium about 14 days after starting her first pack; if that value is normal, no further testing is needed for potassium.”                                                                                                 — Contraceptive Technology, p. 287-88

 April 2014 Clinical Fact:

“The typical woman who uses reversible methods of contraception continuously from age 15 to age 45 would experience 1.8 contraceptive failures.”                                                                         — Contraceptive Technology, p. 55

 March 2014 Clinical Fact:

“The protective effect of transabdominal tubal sterilization on ovarian cancer persists over many years…The risk remained low up to 25 years after surgery and was irrespective of sterilization technique.”
 Contraceptive Technology, p. 441

February 2014 Clinical Fact:

“What about new contraceptives for men? Except for gossypol, no method has been developed sufficiently for clinical studies.”
 Contraceptive Technology, p. 525

January 2014 Clinical Fact:

“…we need to convey not only the science of reproductive health, but also why it is of vital importance in people’s lives…If we fail to do so, we are abdicating the moral high ground to those who oppose efforts to provide reproductive health care.”

 Felicia Stewart, MD (1943-2006)

December 2013 Clinical Fact:

“IUCs [intrauterine contraceptives] protect women from ectopic pregnancy…However when a woman does conceive with an IUC in place she is at increased risk of having an ectopic pregnancy…6% to 50% of pregnancies are ectopic.”
 Contraceptive Technology, p. 157

November 2013 Clinical Fact:

“…antibiotic prophylaxis should not be routinely used before placement [of an intrauterine device].”
 Contraceptive Technology, p. 156

October 2013 Clinical Fact:
“Spermatozoa appear in the pre-ejaculatory fluid of some men and could cause pregnancy even if the man withdraws prior to ejaculation.”
Contraceptive Technology, p. 409

September 2013 Clinical Fact:
“…a women’s blood loss is excessive when she says it is excessive…the key factor in making a diagnosis of [heavy menstrual bleeding] is not the amount of blood a woman loses, which is difficult to ascertain, but how a woman’s HMB disrupts her life.
Contraceptive Technology, p. 547