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By Lori Atkinson, MD and Maya Bass, MD MA FAAFP With the increased use of long-acting reversible contraception, clinicians are more likely to encounter difficult intrauterine device (IUD) insertions and removals in their practice. Below are a few strategies and techniques to help troubleshoot these procedures. Difficult IUD Insertions IUD insertions are most commonly…
Written by Maddie Fowler, Spark Dariy, Amy Stone Last month’s Pearl discussed key practices of consent. Here, we share unique considerations for those with physical disabilities, intellectual and developmental disabilities (IDD) or cognitive impairment, non-speaking patients, and deaf patients. Physical Disability People with physical disabilities may require additional assistance during the exam. Without making assumptions,…
Written by Maddie Fowler, Spark Dariy, Amy Stone Many disabled people have been systematically disempowered and taught to prioritize compliance over self-advocacy. People with disabilities experience sexual assault at over three times the rate of nondisabled people, rising to seven times the rate in people with intellectual and developmental disabilities (IDD).¹ Therefore, it is critical…
Written by Angeline Ti Two contraceptive patches are currently available in the United States: one containing norelgestromin (NGMN) 150 mcg/day with ethinyl estradiol (EE) 35 mcg/day (Xulane1 or the generic Zafemy2) and a newer one containing levonorgestrel (LNG) 120 mcg/day and EE 30 mcg/day (Twirla3). When prescribing the patch for patients with larger bodies, there…
Written by Samantha Hyacinth When we think of the pelvic exam, many of us picture a person lying on their back on an exam table with their heels in foot rests or leg rests, known as the lithotomy position. For some people, this position is not physically possible or comfortable.* There are many conditions that…
Written by Partners in Contraceptive Choice and Knowledge (PICCK) Prenatal care visits and the delivery stay are the optimal times to address postpartum contraception. Waiting until a postpartum visit to discuss a contraception plan is not sufficient, as 50% of people have sex before six weeks postpartum¹⁻² and 40% do not come to this visit.³…
This is an updated version of our September 2023 Contraceptive Pearl written by H. Reeve Bright, with updates written by Ruth Lesnewski. You can read September 2023’s Contraceptive Pearl on our website. Over-the-counter (OTC) oral contraceptive pills (OCPs) are available in over 100 countries. Requiring a prescription for OCPs creates access barriers, especially for the…
Written by Iffie Ikem Most combined oral contraceptives (COCs) are made from a combination of ethinyl estradiol and a progestin. However, in 2021 the FDA approved Nextstellis (Drospirenone-Estetrol), a new combined oral contraceptive containing Estetrol. Synthesized in a laboratory using a plant source, estetrol is chemically equivalent to the estrogen made by the human fetal liver.1-2…
Written by Sadia Contraception for patients with a current or prior history of eating disorders is similar to contraception for people without a history of eating disorders. Clinicians should first establish the extent of a patient’s eating disorder since there are several eating disorders with varying clinical manifestations. Commonly known eating disorders and their special…
Written by Liza Brecher Contraception for people with disabilities, including physical and cognitive disabilities, is similar to contraception for people without disabilities. Clinicians should discuss patient’s goals for pregnancy, parenting, and overall health to identify the contraceptive method that works best for each person. Most patients with disabilities are able to provide informed consent. Avoid…
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