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Research roundup: December 2022 edition

#IUD on TikTok, factors associated with pain during medication abortion, continuation rates of IUDs placed as EC at one year, and racial differences in birth control method provision for adolescents.

by Colleen Denny, MD and Emma Gilmore, MD

published 12/30/22

1. How much will it hurt? Factors associated with pain experience in women undergoing medication abortion during the first trimester

Medication abortion using mifepristone and misoprostol is a safe and effective form of pregnancy termination outside of the health care setting. However, many patients may be concerned about pain levels during medication abortion, and providers may not feel comfortable giving individualized answers. In this observational study analyzing the experience of 242 patients undergoing medication abortion, the authors investigated how different patient characteristics correlated with pain scores. They found that a recent history of dysmenorrhea, a higher level of baseline anxiety, and no history of a vaginal birth were also associated with higher pain scores for patients during a medication abortion. While pain is a complex and individualized phenomenon, providers can incorporate these findings when counseling patients considering medication versus procedural abortion.

2. Comparing preference for and use of medication abortion in Texas after policy changes in 2014 and 2018

State-based abortion restrictions are often at odds with well-established guidelines. Medication abortion is FDA-approved through 70 days gestational age and is a safe and effective method of pregnancy termination. However, Texas has placed numerous restrictions on access to medication abortion, including House Bill 2 (HB 2), which was passed in 2013 and limited medication abortions to seven weeks gestational age or less. After the FDA label was updated in 2016, it supplanted HB 2 in regulating medication abortion access in Texas. The authors of this study assessed preferences for and use of medication abortion in Texas using surveys after HB 2 was passed in 2014 and after restrictions were lifted in 2018. Respondents were asked about their gestational age, demographics, pregnancy history, factors associated with finding and getting to care, their abortion preference, and what kind of abortion they ultimately obtained. The authors found that preference for medication abortion increased over time across both cohorts. However, participants were much less likely to access medication abortion after HB 2 was passed, compared to those who preferred medication abortion after 2018. These findings highlight the effect of state restrictions on patients’ ability to access their preferred abortion method, regardless of the safety and efficacy of that method.

3. TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media

Social media platforms are a common way for people to share and research their reproductive health care questions. Approximately half of the US digital population uses TikTok, a platform that supports user-created short-form videos. In this research project, the authors identified the top 100 TikTok videos using the #IUD tag to determine the videos' tone and evaluate their health content's accuracy. They found that 38% of IUD videos had a negative tone, compared to 19% with a positive tone, and that virtually all videos discussing placement or removal of an IUD discussed pain or negative side effects. Approximately 24% of videos featured medical content that was graded either moderately or highly inaccurate. The authors discuss that providers should be aware of this content reaching patients and address IUD concerns and misconceptions in their counseling. Additionally suggesting that health care providers can provide important voices and sources of accurate information on social media platforms.

4. One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: A randomized controlled trial

Recent research has demonstrated that both the copper IUD (Paragard) and 52mg levonorgestrel IUDs (Mirena and Liletta) are highly effective at preventing pregnancy when placed after sex as emergency contraception (EC). However, there is less information about the long-term continuation and pregnancy rates for patients who have an IUD placed for EC. In this randomized controlled trial, the researchers followed 655 patients from the initial study proving non-inferiority of the LNG IUD to determine whether they continued with their originally placed IUD and if they reported pregnancy (both intended and unintended). At 12 months after placement, 62.4% of LNG IUD users and 55.8% of copper IUD users were using the same IUD, and pregnancy rates overall were approximately 3% in both IUD groups at 12 months. These findings indicate that the majority of patients who had an IUD placed for EC continue to use their IUDs up to a year later.

5. Pooled analysis of two phase 3 trials evaluating the effects of a novel combined oral contraceptive containing estetrol/drospirenone on bleeding patterns in healthy women

Combined oral contraceptive (COC) pills are one of the most widely used birth control methods in the world. These pills are compounds of estrogen ethinyl, estradiol for most pills, plus a progestin. Estrogen stabilizes the uterine lining, decreasing episodes of unscheduled bleeding, but is not indicated for some patients, due to the associated risk of venous thromboembolism. However, lowering estrogen doses may lead to spotting and inconvenient bleeding patterns. The authors of this study describe a new COC formulation that includes estetrol, a type of estrogen with demonstrated efficacy at the low dose of 15mg. This study reports the results of two phase 3 trials evaluating the bleeding effects of a new COC pill comprised of 15mg estetrol and 3mg drospirenone in a 24-4 day regimen. Overall, the vast majority of patients using this pill experienced predictable, regular bleeding, and only 3% discontinued the pill for reasons related to unscheduled bleeding. These findings suggest that this COC formulation could be a useful alternative for patients who prefer a lower dose of estrogen and want to avoid unscheduled bleeding.

6. Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue

Racial differences exist in contraception prescription across multiple care domains, with Black and Latinx adolescent patients more often prescribed injectable contraception, IUDs, and the implant, and less often prescribed oral contraceptive pills in comparison with White adolescents. In this cross-sectional retrospective study, the authors analyzed data from a large academic Adolescent Medicine system to determine how contraception method delivery differed by race both before and after the COVID-19 pandemic. Among nearly 2,500 unique patients, the researchers determined that Black adolescents were approximately twice as likely as White adolescents to be prescribed LARC methods, including during the pandemic. Furthermore, patients who received new contraception prescriptions via telehealth during the pandemic were less likely to be Black or publicly insured. While the authors caution that the factors creating this difference are not fully understood, they discuss the potential impact of systemic bias and racism on contraceptive method provision, and caution that providers should consider the potential for reproductive coercion as they offer contraception to patients of color.

7. Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics

Adolescent patients deserve comprehensive counseling on sexual and reproductive health (SRH), which includes developmentally appropriate discussions of sexuality, sexually transmitted infections (STIs), and contraceptive options. Primary care providers (PCPs) are well-positioned to provide SRH care as part of routine preventative health care visits, but data shows that there are gaps in the primary care setting. To better understand the provider's experience and develop strategies for improvement, the authors of this study interviewed 25 PCPs across Minnesota. Participants were asked about barriers to the provision of SRH services and ideas for improvement. The study cohort included physicians and nurse practitioners in the fields of family medicine and pediatrics across a range of practice settings and years of experience. Participants identified numerous areas for improvement, including targeted training for providers and office staff, increased resources, and education for adolescents about their rights, particularly regarding confidentiality. These findings can be used as a resource for clinics and providers hoping to improve SRH counseling for adolescents.

8. Phase 3 study evaluating the safety and efficacy of oteseconazole in the treatment of recurrent vulvovaginal candidiasis and acute vulvovaginal candidiasis infections

Vulvovaginal candidiasis (VVC) is experienced by almost all people with a vagina during their lifetime. When an individual experiences recurrent VVC, defined as 3 or more infections over 12 months, they are usually given repeated doses of fluconazole. However, some concerns exist with this medication, including growing resistance and use during pregnancy. It is therefore important to develop other options for treating recurrent VVC. Oteseconazole demonstrated efficacy in a Phase 2 trial and this Phase 3 study aimed to study its efficacy and safety and compared to fluconazole. The study team enrolled female individuals with a history of recurrent VVC across the US and observed participants for 50 weeks. They found that oteseconazole was safe and efficacious for the treatment of recurrent VVC, and it was non-inferior to fluconazole; furthermore, it was able to treat candidal strains that were fluconazole-resistant. Overall, it shows potential as an effective treatment strategy for recurrent VVC.

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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