Contraceptive Pearls

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Contraceptive Pearl: Irregular Bleeding with Hormonal Contraception

Many patients stop taking contraceptives due to an irregular bleeding pattern. Hormonal contraceptives often cause spotting, especially during the first 3-6 months. Anticipatory counseling about changes in bleeding patterns may help patients adjust to a new method. We can reassure patients that spotting is normal, and that they can stop the new method if bleeding…

Contraceptive Pearl: Pregnancy with an IUD in Place

The Intrauterine Device (IUD) is over 99% effective at preventing pregnancy. While pregnancy is rare with an IUD in place, it requires special management when it occurs. Pregnancies that occur with an IUD in place have a higher chance of being ectopic, so it is important to obtain imaging (e.g. pelvic ultrasound). (1) Studies show…

Contraceptive Pearl: Who Needs a Pregnancy Test When Starting Contraception?

Many clinicians or clinic protocols require a pregnancy test for patients who are starting contraception or receiving contraceptive care. However, a routine pregnancy test is not necessary for everyone starting contraception; it can act as a barrier to telehealth care and a negative test can provide false reassurance in some situations. The US Selected Practice…

Contraceptive Pearl: Starting Hormonal Contraception After Emergency Contraception

There are more and more options for emergency contraception (EC) available for patients. Not only do we have levonorgestrel (LNG) 1.5mg pills, ulipristal acetate 30mg pills, and the copper IUD (Cu-IUD), recent studies have shown that the 52mg progestin IUD can be used for EC up to 5 days after unprotected intercourse. While it’s great…

Contraceptive Pearl: Lactation and Hormonal Contraception

Effective contraception helps to optimize birth-spacing, thus improving the health of parents and babies. All patients receiving prenatal care should be counseled about available forms of postpartum contraception, their risks, and timing of initiation. For otherwise healthy birthing parents, most hormonal contraception can be safely initiated in the postpartum period. Theoretical concerns exist surrounding the…

Contraceptive Pearls: Post Abortion Contraception

Most people ovulate 9-14 days after an abortion. Patients presenting to end a pregnancy may be interested in starting or changing their contraceptive method. Depending on a patient’s medical eligibility, the following contraceptive methods are safe and effective post-abortion: Estrogen/progestin pill, patch, ring Progestin-only pill, injection, implant, IUD Copper IUD Barrier methods Sterilization Fertility Awareness…

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 Pearls

This monthly clinical e-newsletter highlights evidence-based best practices for contraceptive care

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