1. Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial
IUDs are a highly effective and safe form of contraception, but pain with the initial placement of an IUD may be a deterrent for many patients who would otherwise choose this contraception option. Accordingly, outpatient interventions that reliably reduce pain during IUD insertion may reduce barriers for patients seeking this form of long-acting reversible contraception. In this randomized placebo-controlled trial, the authors tested whether intrauterine instillation of mepivacaine two minutes before IUD insertion improved patients’ pain during IUD placement; no other pain control modalities were used for either group. The authors found that pain scores were significantly lower in the mepivacaine group and that a higher percentage of the mepivacaine group reported insertion pain as tolerable (93% vs 80% in the control group). No serious adverse events were identified in the mepivacaine group. While it is unclear how these findings can be interpreted in comparison or in addition to other modalities frequently used to improve IUD insertion pain, such as NSAIDs or paracervical block, the authors argue that intrauterine mepivacaine potentially represents a safe option to increase patients’ comfort during IUD placement.
2. Permanent Contraception in the childfree population: an exploratory study
Permanent contraception through tubal ligation or bilateral salpingectomy is an important birth control option for patients who do not desire any future pregnancies. While no high-quality evidence has shown that parity is associated with increased regret after permanent contraception procedures, patients without children who are seeking permanent contraception may meet with hesitation or refusal on the part of providers. In this exploratory web-based research, the authors surveyed 400 child-free individuals with the capacity for pregnancy who were seeking or had previously sought permanent contraception. Approximately 99% of respondents were assigned female at birth,h and 83% identified as women, with 42% heterosexual and 41% bisexual. Only 38% had already undergone a permanent contraception procedure. Patients reported that cost was a barrier to undergoing the procedure, as well as difficulty finding a willing provider, with 46% of patients reporting having to ask more than one provider. Fully 97% of surveyed patients felt that permanent sterilization was the right choice for them. The authors discussed that this research shows that childless patients seeking permanent sterilization may face many unnecessary barriers and that the majority of childless patients seeking such care felt sure of their decision.
3. Effectiveness of the etonogestrel subdermal implant in users with overweight and obesity: a systematic literature review
The etonogestrel (ENG) birth control implant is a highly effective form of contraception that can be safely used among virtually all patient populations. However, pharmacokinetic studies have suggested that serum ENG levels in implant users who are overweight or obese may be lower, and ongoing research has attempted to determine whether these lower levels represent a clinical difference in effectiveness. In this systematic literature review, the authors identified twelve distinct research studies examining the use of the ENG implant in a total of more than 8,000 users who were determined to be overweight or obese. In their summary, the authors discuss that their results show a Pearl Index between 0.0–0.23/100 women years across the different studies, showing that contraceptive effectiveness in this population was well within the range of published Pearl Indices across all weight groups. While the authors also draw particular attention to the lack of research among ENG implant users undergoing bariatric surgery, they conclude that providers can confidently counsel patients with higher BMIs about implants as an effective contraception option.
4. Potential effect of immediate postpartum use of injectable contraception on lactogenesis
Depot medroxyprogesterone (DMPA) is an effective and low-maintenance option for contraception, which may be particularly appealing for postpartum patients. However, due to concerns about progestin’s effect on lactogenesis, some professional societies recommend waiting to administer DMPA until six weeks postpartum. This recommendation is based on theoretical risks, and large-scale human studies on this topic are lacking. The authors of this study performed a non-randomized trial to compare the timing of lactogenesis among postpartum individuals who received DMPA (vs no injection) within 48 hours of delivery. There was no difference in the timing of lactogenesis between groups, and DMPA did not appear to negatively impact human milk production. Although this study was initially planned as a randomized controlled trial, low enrollment (partly due to the COVID-19 pandemic) resulted in an adjustment in the study design. However, the study still provides encouraging data to support the administration of DMPA during the immediate postpartum period without concerns about lactogenesis.
5. How Dobbs May Influence the Geographic Distribution of Medical Trainees in the United States
Changes and restrictions in abortion access at the state level have immediate impacts on patients seeking abortion care but also may deter medical trainees as they make decisions about where to continue their training. As most medical trainees later practice in the regions where they train, changes in medical trainee decisions may have long-term effects on the availability and quality of providers in states with abortion restrictions. In this research, the authors surveyed nearly 500 third- and fourth-year medical students about how the abortion restrictions affected their decisions about where to apply for residency. Overall, 57.8% of respondents across all specialties replied that they were unlikely or very unlikely to apply to residency programs in a state with abortion restrictions, and students currently in abortion-protected states were less likely to apply in states with abortion restrictions. OB-GYN applicants were not more or less likely to be influenced by the Dobbs decision in choosing where to apply. The authors discuss that these trends may further worsen care capacity and reproductive rights in states with abortion bans, as physicians from all specialties who support reproductive rights progressively aggregate in states where those rights are already protected.
6. Randomized Trial of Very Early Medication Abortion
Medication abortion (MAB), performed using mifepristone and misoprostol, is a highly effective method of abortion. However, there is limited data regarding the use of MAB when a patient has a very early pregnancy or a pregnancy of unknown location (PUL), where a pregnancy test is positive, but no intrauterine or extrauterine pregnancy is visualized using transvaginal ultrasonography. While studies have shown that MAB for PUL does not increase the risk of ruptured ectopic, a small amount of data has suggested that it may have lower efficacy. This study was conducted to assess the efficacy of early MAB, defined as less than 42 days gestational age with either PUL or likely intrauterine pregnancy, across multiple sites around the world. hCG was trended on the day of mifepristone administration and seven days later, and patients were also followed up within four weeks. More than 1,500 patients participated in the study, with an efficacy rate of 95.2% in the early MAB group. Early MAB was found to be non-inferior to standard MAB, and this approach did not delay the diagnosis of ectopic pregnancy. This evidence reinforces the efficacy of using early MAB.
7. Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services
There are numerous side effects associated with hormonal birth control methods, but actual prevalence is sometimes hard to determine due to variations among differing studies. However, a small amount of existing data has shown that there may be differences in birth control side effects as experienced by different patient populations; for example, individuals seeking abortion care compared to individuals seeking contraception care. For this study, the authors compared these two populations’ experiences of birth control side effects by evaluating survey data in a cohort of patients in Helsinki, Finland. The authors found that patients seeking abortion care were more likely to report side effects from hormonal contraceptives, particularly mood side effects, and a much larger proportion of this group stated that they had stopped using birth control due to side effects. Since these patients had initially presented seeking abortion, the authors hypothesized that there may be a connection between discontinuation due to side effects and undesired pregnancy.
8. Medication and procedural abortions before 13 weeks gestation and risk of psychiatric disorders
Medication and procedural abortion are safe and effective and have no long-term negative effects. However, the specific relationship with mental health has not been fully studied, and some forms of anti-abortion rhetoric have suggested that abortion has unknown negative effects on mental health. To help in disputing this allegation, this study explored patients’ mental health after both medication and procedural abortions up to 13 weeks gestational duration. The authors also explored whether minor status (being under age 18) was related to mental health changes. More than 70,000 pregnancy-capable individuals in Denmark were included in the study, which used medical registry data to evaluate patients who had first-trimester abortions between 2000 and 2018. Subjects were followed for years to track the presence of psychiatric diagnoses in their health data. This study found that first-trimester abortion did not increase the risk of mental health diagnoses in either the short or long term and that the likelihood of a psychiatric diagnosis before abortion was equivalent to the likelihood afterward. Age did not have any significant relationship with mental health diagnoses. This information provides further reinforcement for the known safety of first-trimester abortion.
9. "That's not how abortions happen": a qualitative study exploring how young adults navigate abortion misinformation in the post-Roe era
Misinformation on abortion is widespread throughout the US and is used as a tool to disseminate anxiety and dissuade patients from obtaining wanted abortions. Much of this information is propagated through social media, which is known to be a resource for many individuals—especially young people—who are researching pregnancy options online. Because young adults already face numerous barriers to abortion access, including finances, delayed pregnancy recognition, and legal requirements involving guardians, this misinformation could have a devastating impact. This is particularly relevant post-Dobbs, as access is increasingly limited around the US. The authors of this study performed qualitative interviews with 25 young people to understand how they deal with misinformation on abortion. While many subjects were able to identify misinformation, knowledge gaps were still prevalent, and some subjects expressed worry about abortion’s links to infertility. The results of this study suggest that young people are able to correctly interpret much of the misinformation that they encounter online, but there is still a need for evidence-based support and guidance. More study is needed to create an improved public health framework to support young people’s research on abortion.
