Contraceptive Pearls

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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…

Contraceptive Pearl: Reproductive Health Care for People with Physical Disabilities

Many people with mobility and physical disabilities lack basic reproductive health care. People with disabilities are less likely to receive cervical cancer screenings, prenatal care, and family planning services than those without disabilities. Estimates of contraceptive use vary across studies, but some studies indicate that those with disabilities use a narrower set of contraceptive methods…

Contraceptive Pearl: Oral Contraceptive Pills and Endometriosis

For decades, birth control pills have been used to treat the symptoms of endometriosis. Does evidence support this? The Cochrane Collaborative updated its review of this topic in May, 2018. Reviewers found 5 clinical trials that examined the use of oral contraceptives to control endometriosis pain. Of these 5 trials, three met criteria for analysis. Two…

Contraceptive Pearl: E-Cigarettes and Contraceptives

Cigarette smokers who use estrogen-containing contraceptives have a higher risk of cardiovascular disease. Are electronic cigarettes (e-cigarettes) a better choice? E-cigarettes deliver nicotine. Nicotine’s deleterious effects on the cardiovascular system are well established, but its toxicity is lower when not combined with smoke. There have been no published studies of electronic cigarette use among people…

Contraceptive Pearl: Opiate Use and Contraceptives

Opiate Use and Contraceptives Because there are no known interactions between opiates and contraceptive hormones, patients who take opiates are eligible for all birth control methods. Cornford, et al. collected data from 374 patients who were receiving treatment for opioid addictions. Overall contraceptive use was low (at 30%). These patients had high levels of ectopic…

Contraceptive Pearl: Misoprostol and IUD Insertion

Misoprostol and IUD Insertion Misoprostol, a synthetic prostaglandin, causes cervical dilation and has multiple uses in obstetrics and abortion. Can misoprostol help with IUD insertion, as well? Research has shown that misoprostol self-administered before IUD insertion in nulliparous women did not ease IUD insertion or reduce patient-perceived pain. In fact, several studies found that patients who…

Contraceptive Pearls

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