Contraceptive Pearls: Introducing the Drospirenone Progestin-Only Pill

Some people who prefer birth control pills can’t use estrogen. Drospirenone is a new progestin-only pill (POP) that differs from the other available POP in some key ways. Until recently in the United States, the only available POP was norethindrone. Due to its short half-life, the norethindrone POP should be taken at nearly the same…

Contraceptive Pearls: Progestin Contraceptives and Ulipristal to Treat Uterine Fibroids

Do progestin contraceptives help control the symptoms of fibroids? A recently updated Cochrane review addressed this question. The review examined four studies of 221 premenopausal patients with symptomatic fibroids. The results were inconclusive, with uncertainty about progestins’ effects on uterine bleeding and fibroid size. Ulipristal, on the other hand, showed more promise. A study of…

Contraceptive Pearl: Progestin IUD for Emergency Contraception

FDA-approved options for emergency or post-coital contraception include the copper IUD, oral levonorgestrel, and oral ulipristal. For ongoing contraception, more people in the United States choose progestin IUDs over copper IUDs, and previous studies show many patients would select a progestin IUD if it were available as emergency contraception. A new study suggests that progestin…

Contraceptive Pearls: Contraceptive Counseling For Transgender and Gender Diverse People

Creating a supportive, safe, and welcoming clinic environment can help reduce the barriers transgender and gender diverse individuals face when accessing reproductive health care. It is vital to understand the contraceptive needs, fertility, and reproductive goals of each individual when providing contraceptive counseling. Gender-affirming testosterone therapy alone does not prevent pregnancy. We do not know…

Contraceptive Pearl: IUD and Uterine Abnormalities

Providers may wonder whether or not uterine abnormalities, like fibroids, cervical stenosis, or congenital anomalies would preclude IUD use. For questions like this, the US Medical Eligibility Criteria (US MEC), published by the CDC, is a good resource to turn to. Uterine Fibroids: Category 2-A condition for which the advantages of using the method generally…

Contraceptive Pearl: Contraception and Dysmenorrhea

Dysmenorrhea causes distress and missed days of school/work for millions of people. What’s the best way to treat it? All hormonal contraceptives can help. The pill, patch, ring, implant, injection, and progestin IUD have evidence for benefit. Continuous use of the pill/patch/ring may provide extra help. The copper IUD, on the other hand, may worsen…

Contraceptive Pearl: Updating Our Contraceptive Materials

RHAP has embarked on an update of our contraceptive materials. We aim to ensure our materials reflect the latest, best clinical evidence and align our with our core values, in particular patient-centered care. We started with our most general and widely used contraceptive fact sheet, which includes all birth control methods. The old versions organized methods by their…

Contraceptive Pearl: Contraception During COVID-19: Acidifying Contraceptive Gel

In May, 2020, the FDA approved a new contraceptive gel containing lactic acid, citric acid, and potassium bitartrate. The brand name is Phexxi. The gel acidifies the vagina, creating an environment that’s hostile to sperm. The gel does not contain nonoxynol 9, the active ingredient in spermicides (which can irritate the vagina and raise the…

Contraceptive Pearl: Contraception During COVID-19: One Year Vaginal Ring

In 2018, the FDA approved a one-year contraceptive vaginal ring. It’s a flexible silicone ring that slowly releases segesterone acetate and ethinyl estradiol. The brand name is Annovera. The label instructs patients to insert the ring for three weeks and remove it for one week, repeating the cycle a total of thirteen times before starting…

Contraceptive Pearl: Contraception During COVID-19: Non-Coercive Contraceptive Counseling

Coercive contraceptive practices have a long history in the United States, beginning in the era of slavery and extending to forced sterilizations as recent as 2010. Forced contraception has targeted primarily low-income, incarcerated, disabled, Indigenous, Black, and Latinx people. Knowing this horrific history, how can we adjust our contraceptive counseling to avoid any semblance bias…