Contraceptive Pearl: Contraceptive Counseling Through the Lens of Reproductive Justice

Contraceptive counseling is an art. We adapt and improve as we learn from our patients and our colleagues. The SisterSong Women of Color Reproductive Justice Collective defines reproductive justice as the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” The United States…

Contraceptive Pearls: IUD Self-Removal

IUDs are typically removed by clinicians during a pelvic exam in the office. There can be numerous barriers to this arrangement, such as difficulty scheduling an appointment, concern about appointment cost, and clinician refusal of patient’s request for removal. Unsurprisingly, these barriers can raise patients’ concerns about ability to retain control over their own reproductive…

Contraceptive Pearl: Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that begin after ovulation and resolve within the first 4 days of menstruation. Over 90% of women experience PMS at some point during their reproductive years, and approximately 5% of women experience the more severe premenstrual dysphoric disorder (PMDD). PMS symptoms include irritability, fatigue,…

Contraceptive Pearl: Natural Family Planning

Natural Family Planning (NFP) methods, also known as Fertility Awareness, help women track their fertile and non-fertile days. This Contraceptive Pearl discusses Natural Planning Methods, their efficacy and important considerations.

Contraceptive Pearl: Birth Control for Less: Low-Cost Oral Contraceptives

The Affordable Care Act mandates free birth control pills for most patients with health insurance. However, uninsured people and many people with a religious employer don’t benefit from this policy. For uninsured and underinsured people, access to affordable contraception is difficult. Fortunately, there are several ways for clinicians to help patients get birth control pills…

Contraceptive Pearl: A Review of Emergency Contraception

There are 3 mainstays of treatment for emergency contraception: copper IUD, ulipristal acetate, and levonorgesterel. Emergency contraception prevents pregnancy after unprotected sex; it does NOT end a pregnancy and will not work if the patient is already pregnant. *May be cheaper with 340B pricing or the Paragard Patient Assistance Program. The copper IUD is the…

Contraceptive Pearl: Lidocaine for Pain Reduction with IUD Insertion

Though IUDs are among the most effective forms of contraception, some patients and providers are often deterred from this option due to fear of painful insertion. Lidocaine spray, gel, and 1% lidocaine paracervical block have been utilized as methods of pain reduction with IUD insertion; research shows that some methods may be more effective than…

Contraceptive Pearl: The Mirage of “Perfect Use”

Many contraceptive patient information materials report two types of efficacy: that with “perfect use” and that with “typical use.” Perfect use assumes that a contraceptive method is used exactly as directed. For example, this means taking a pill daily or using a barrier method correctly with every episode of vaginal intercourse over the span of…

Contraceptive Pearl: Progestin IUDs

We’re fortunate to have various options to offer patients desiring progestin intrauterine devices (IUDs) for contraception. Which IUD is best for each patient? Mirena, Liletta, Skyla, and Kyleena have a few differentiating characteristics, including dose, size, duration, and cost. Apart from the inserter device, Mirena and Liletta IUDs are nearly identical. Liletta’s federal 340b pricing…

Contraceptive Pearl: Progestin Implant Update

In 2006 the FDA approved the progestin implant. At the time, the device was approved for 3-year duration. Studies since then provide evidence that the progestin implant is effective for up to 5 years, although the labeling remains at 3 years. The progestin implant is a soft, flexible polymer about the size of a match…