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Written by Mayra A Hernandez Schulte, M.D. 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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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