Research roundup: December 2021 edition

Pregnancy intentions and outcomes in transgender, non-binary, and gender-expansive populations, PMS and PMDD treatment with OCPs, HPV vaccination in boys and men, increasing PreP awareness through more culturally competent materials, and more.

by Colleen Denny, MD and Emma Gilmore, MD

published 12/30/21

1. Correlates of Sexual and Reproductive Health Discussions During Preventive Visits: Findings From a National Sample of U.S. Adolescents

Professional adolescent health guidelines consistently recommend that providers who take care of adolescent patients include age-appropriate counseling about sexual and reproductive health (SRH) during preventative care visits. However, even among adolescents with regular preventative care visits, many report that their provider did not engage them in discussions of puberty or other SRH topics. In this national survey, the authors reached out to both adolescent patients and their parents to determine what aspects of care were associated with a greater likelihood of adolescent patients receiving counseling about eight discreet SRH topics, including safe dating, gender identity, sexually transmitted infections, and pregnancy. Among more than 850 adolescents with a recent preventative care visit, the authors reported that face-to-face screening about sexual activity, time alone with the provider, and clear communication about patient confidentiality were all associated with a greater likelihood of counseling regarding SRH topics during a preventative health visit. For providers caring for adolescent patients, incorporating these features into adolescent visits may facilitate broader discussion of SRH topics with young patients and improve quality of care.

2. Efficacy of combined oral contraceptives for depressive symptoms and overall symptomatology in premenstrual syndrome: pairwise and network meta-analysis of randomized trials

Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are characterized by a range of both physical and affective symptoms late in the menstrual cycle and may affect up to 12% and 5% of all menstruating patients, respectively. While combined oral contraceptive pills (OCPs) are often prescribed to manage these symptoms, there is less high-quality evidence for this practice. In this meta-analysis, the authors identified nine studies including 1,200 patients studying whether OCPs were superior to placebo in managing PMS/PMDD symptoms. While OCPs were superior to placebo in managing general premenstrual symptoms, this effect was not seen specifically in premenstrual depressive symptoms. Further, while one OCP, ethinyl estradiol drospirenone (20 ug, 3mg) is specifically labeled for PMDD treatment, the authors found no particular benefit for any one formulation. These data indicate that modern OCPs may be an effective method of managing PMS symptoms for some patients, but that providers should consider close follow up and alternative management for patients suffering primarily from depressive symptomatology.

3. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial

Human papilloma virus (HPV) infection is the leading cause for cases of cervical cancer, anal cancer, and genital warts throughout the world. While HPV types 6 and 11 are most associated with genital warts, types 16 and 18 are most strongly associated with genital tract cancers. A quadrivalent HPV vaccine covering types 6, 11, 16, and 18, was initially approved for girls and women 9-26 years old and has since been shown to reduce lifelong cervical cancer and genitals warts risks after vaccination. In this double-blind randomized placebo-controlled study, the authors investigated the long-term benefit of HPV vaccination for adolescent and adult men ages 16-26. Among 1,800 heterosexual men and men who have sex with men (MSM), the researchers determined that HPV vaccination dramatically decreased the risk of genital warts related to HPV 6 or 11, with a zero incidence per 10,000 person-years in the vaccinated group compared to 137 in the placebo group. Further, among MSM, the incidence of anal dysplasia and cancer related to any of the four HPV types was 20.5 in the vaccinated group compared to 906.2 in the placebo group. The placebo group was offered HPV vaccination after the conclusion of the initial study, and similarly had decreased incidences of all HPV-related disease. This study confirms the high efficacy of HPV vaccination in boys and men as a primary benefit to avoid future disease.

4. Mi Familia Entera: Contraceptive Use Among Spanish-Speaking Mothers of Young Children

The pediatric primary care setting provides a unique opportunity to evaluate mothers’ contraceptive plans, as providers interface with parents on multiple occasions. As the field of pediatrics increases its involvement in family-centered maternal health initiatives, the authors of this study sought to focus on Latina mothers, who may experience difficulties with care access due to language or insurance barriers. They implemented an orally-administered, Spanish-language survey of 190 primarily uninsured mothers to assess demographics, health literacy, future pregnancy intent, and contraceptive use. They found that the majority of participants were satisfied with their current contraception use, though most were not using the most effective methods of contraception. However, almost 20% of participants were not using contraception, though they did not want to become pregnant. Overall, this information suggests that the pediatric setting is a useful place to assess the contraceptive needs of hard-to-reach communities. The results of this study provide important information to assist in more informed, culturally appropriate counseling for Latina mothers in an urban setting.

5. Racial, Ethnic, and Gender Disparities in Awareness of Preexposure Prophylaxis Among HIV-Negative Heterosexually Active Adults at Increased Risk for HIV Infection — 23 Urban Areas, United States, 2019

Pre-exposure prophylaxis, or PreP, is a highly effective method of HIV prevention for HIV-negative patients at high risk of infection. However, uptake and continued use of this treatment has not been evenly distributed among high-risk groups in the US, including among heterosexual groups, who account for 23% of the new HIV infections. In surveying more than 9,000 participants in 23 urban areas with high HIV incidence, the authors found that slightly less than a third (32.3%) of all patients were aware of PreP at all, and that these rates were even lower for sexually active heterosexual Hispanic women (17.6%), Hispanic men (19.5%), uninsured participants (26.4%), and participants residing in Puerto Rico (5.8%). In their discussion, the authors suggest that tailored campaigns to reach these groups, especially using Spanish-language and culturally competent materials, could increase PreP awareness.

6. Suppression of ovulation and pharmacokinetics following subcutaneous administration of various doses of Depo-Provera®: a randomized trial

The development of subcutaneous Depo-Provera 104mg has led to the acceptance and availability of this dosing, which is significantly lower than the 150mg intra-muscular formulation. Noting this difference in dosing continues to offer the same length of efficacy, three months plus one month of grace-period, the authors of this study sought to determine whether even lower doses of subcutaneous Depo-Provera, at 45, 75, and 105mg, would provide a similar efficacy profile. They conducted a four-arm randomized partially blinded parallel group study with 60 participants (15 per group), all of whom relied on permanent contraception or the copper intrauterine device for pregnancy prevention during the study. The authors found that 45 and 75mg doses of Depo-Provera did not sufficiently suppress ovulation. However, they did find that the 105mg formulation suppressed ovulation for the full time period evaluated (up to four months), allowing for a longer grace period for patients to receive or self-administer their next dose. While this finding necessitates further exploration, it may have important implications for the timeline and costs associated with subcutaneous Depo-Provera.

7. Contraceptive values and preferences of pregnant women, postpartum women, women seeking emergency contraceptives, and women seeking abortion services: A systematic review

Contraceptive values and preferences shift according to different times in patients’ lives and may be influenced by specific events. Information about individuals’ contraceptive preferences can inform and improve counseling. The authors of this study performed a systematic review in order to assess the contraceptive values and preferences of patients at the following time points: pregnancy, postpartum, or for those seeking emergency contraception or abortion. In the 23 studies that met inclusion criteria and were analyzed, the authors did not find that any specific method of birth control checked every box for patients, but that individuals’ preferences shifted depending on their prior experience, access to long-acting reversible contraception, and interactions with the health care system. Overall, these results suggest that individuals should have access to the full range of birth control methods, and counseling should take into account a patient’s prior experiences and life circumstances.

8. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: Results from a national, quantitative survey

Transgender, nonbinary, and gender-expansive people (TGE) experience pregnancy, but little is known about this population’s experience of pregnancy intent and outcomes. Most research on pregnancy has focused on cisgender women, whose gender identity is aligned with the one assigned at birth. The authors of this study designed a self-administered online survey for TGE individuals to better assess their reproductive histories, pregnancy intentions, and outcomes. Of the 1,694 individuals who responded to the survey, 12% had experienced pregnancy, and about half of these pregnancies were intended. Some pregnancies occurred while the participant was taking testosterone, necessitating specific counseling and management. Eleven percent of participants hoped for pregnancy in the future. Overall, these findings provide important information about a patient population that is largely invisible from pregnancy-focused literature and should be used by providers to augment care and counseling.

Colleen Denny, MD, is an attending ObGyn at Bellevue Hospital in New York City, where she is the Medical Director of the Women's Clinic, and a clinical assistant professor with the NYU School of Medicine. She enjoys providing care for patients in all phases of life and is especially interested in issues related to contraception access and public health. Outside of work, she’s a runner, a dancer, and a bit of a crossword puzzle nerd.
Emma Gilmore is a fellow in Complex Family Planning at the University of Pennsylvania. She completed her residency in Obstetrics and Gynecology at New York University. She's passionate about reproductive rights, medical education, and combating health care disparities, particularly in sexual and reproductive health. In her free time, she can be found taking her dog on walks around the beautiful parks in and around Philadelphia.
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