1. Use of Preferred Source of Contraception Among Users of the Pill, Patch, and Ring in the US
Patients who use prescription-based hormonal contraception such as the combined hormonal contraceptive pill, patch, and ring must interact frequently with the health care system to maintain consistent and correct use of these methods. In this cross-sectional survey, the authors interviewed approximately 600 patients who currently used the pill, patch, or ring for contraception about their preferred sources of contraception prescriptions. They found that 74% of patients reported that their last prescription had been procured during in-person, health center-based care, followed by online services with direct mailing (9%), asynchronous telehealth (8%), synchronous telehealth (5%), and pharmacist prescription (2%). However, only 44% of respondents listed in-person clinic-based care as their preferred source of contraception prescription, followed by over the counter (32%) and online direct mailing services (27%); 50% of patients were not receiving their prescriptions from a preferred source. In a sub-analysis, patients who reported past difficulties obtaining their method were more likely to prefer a non-traditional prescription source. The authors conclude that non-traditional sources of contraception prescriptions have the potential to improve contraception access and are often preferred by patients and call for policy changes to support and expand these non-traditional modalities.
2. Selection of long acting reversible contraception methods by emergency contraception clients: A prospective observationalstudy
Emergency contraception (EC), either through oral medications or IUDs, provides an important option for patients to avoid pregnancy after sex. While the copper IUD has been shown to be a very effective form of EC and the hormonal IUD has recent data showing it to likely be equally effective, less is known about whether the hormonal implant can be used in this way. In this prospective observational study of more than 2,100 patients seeking EC, the authors offered patients oral EC, the copper IUD, the hormonal IUD, or the contraceptive implant in addition to oral levonorgestrel (LNG) EC. They found that 14.5% of approached patients requested LARC methods, with 55% of these patients choosing the implant + oral LNG, 25% choosing the copper IUD, and 21% choosing the LNG IUD. Implant choosers were slightly younger and more likely to be Hispanic than IUD choosers. The authors discuss that this data shows that the implant plus oral LNG may be a more popular choice than other LARCs among patients seeking EC, stress the importance of offering all contraception options to patients, and call for additional research on the possible use of the contraceptive implant as stand-alone EC.
3. Contraceptive use among transgender men and gender diverse individuals in the United States: reasons for use, non-use, and methods used for pregnancy prevention
Transgender and gender diverse (TGD) individuals who are assigned female or intersex at birth (AFAB) can experience undesired pregnancy, and may use a variety of contraception methods for pregnancy prevention. Previous research has demonstrated that usage patterns in this population differ from those among cisgender women, and less is known about why and how TGD patients use contraception, including how past or current testosterone use may influence usage patterns. In this cross-sectional online survey of nearly 1,700 TGD individuals, the authors found that the majority of respondents (70%) had previously used contraception. While the most common previously used forms of contraception were external condoms (91%), combined hormonal birth control pills (63%) and withdrawal (46%), the most common currently used forms of contraception were external condoms (35%) and hormonal IUDs (25%). The most common reported reason for contraception use was pregnancy prevention (49%), followed by the desire to avoid period symptoms (39%). Among of the 27% of respondents who had never used contraception, the most common reported reasons for non-use were not engaging in penis-in-vagina sex or a partner who did not make sperm; other reported reasons included not wanting hormones to interfere with the gender affirmation process and concern about contraception side effects. Approximately 6.6% of respondents reported previously using testosterone for contraception, and 3.6% reported currently doing so. The authors discuss that contraception usage is common among TGD individuals, including contraception options that include estrogen and progestin, and that the wide range of contraception usage reported indicates the need for comprehensive counseling for all TGD patients without assumptions about patients’ preferences.
4. Beyond stigma: Clinician bias in contraceptive counseling to sexual and gender minority youth
Approximately a quarter of adolescents in the United States identify as sexual and gender minority (SGM). While the American Academy of Pediatrics recommends providing gender affirming care and nonjudgement care to SGM patients, less is known about how providers counsel these patients about contraception options. In 16 in-depth interviews, the authors discussed contraception counseling with pediatricians who provided care for SGM adolescents. They identified several important recurrent themes in these interviews, including 1) a range of provider reactions to patients’ reported gender identities from affirmation to suspicion, 2) assumptions about SGM patients’ priorities that could circumscribe patient-centered contraception counseling and neglect the importance of pregnancy prevention, as well as 3) a more universal approach to contraception that prioritizes LARCs and potentially ignores the particular interests of SGM adolescents. The authors stress the importance of continued training and awareness among physicians who provide adolescent reproductive health care to ensure high-quality, patient-centered care.
5. Association of levonorgestrel-releasing intrauterine device with gynecologic and breast cancers: a national cohort study in Sweden
This study, published this month, builds on prior research that has explored the link between progestin-containing birth control and breast cancer. This relationship continues to be a source of debate, and because most studies on this topic are observational, it remains difficult to understand the specific effects of hormonal birth control on cancer risk. For this study, the authors used Swedish medical record data to analyze cancer risk in more than 500,000 individuals with levonorgestrel intrauterine devices (LNG IUDs) and compared them to over 1.5 million control subjects. The authors found that use of the LNG IUD significantly decreased the risk of endometrial cancer and also reduced the risk of cervical and ovarian cancers. However, it did increase the risk of breast cancer, particularly in postmenopausal individuals, though the overall effect size was small, and the authors were not able to adjust for all confounders due to the observational nature of the study. It is therefore important to interpret these results with care and put this small increased cancer risk in perspective when counseling patients, as the risk of undesired pregnancy may be pronouncedly higher.
6. Society of Family Planning Committee statement: Contraception and body weight
Body weight and reproductive health care are tightly intertwined, as there is longstanding stigma around higher body weight, along with a lack of contraception research that encompasses the full spectrum of body weights and sizes. Furthermore, body mass index (BMI), which is traditionally used as a proxy for health, is based on measurements of white European men, rendering it an inadequate tool for assessing pregnancy-capable individuals. This Committee Statement updates a prior 2009 document, and provides up-to-date, inclusive recommendations to support the provision of contraception to patients of all body weights and sizes. More specifically, the statement explores existing data for efficacy of contraceptive methods at differing weights, and highlights evidence linking certain hormonal contraception methods to increased weight gain. Furthermore, it includes guidance on contraception counseling for patients undergoing weight management treatment such as gastric bypass or glucagon-like peptide 1 (GLP-1) agonists. This document is a useful reference for any health care professional who discusses contraception with patients.
7. Levonorgestrel 52mg Intrauterine Device placement without uterine sounding: A Feasibility study
While uterine sounding is a standard part of IUD placement, there is minimal evidence to support this step as a necessary component of the procedure. Theoretically, it is helpful to assess the cervix and ensure that the IUD inserter can pass and prevents wasting an IUD package if this is the case. However, patients report significant pain during uterine sounding, and the process may also add unnecessary time to the procedure. To better assess its necessity, the authors of this study performed a feasibility trial on sound-sparing placement of a levonorgestrel 52mg IUD. Ultrasounds were used to confirm placement, and the investigators measured the length of each procedure and assessed patient pain. They found that sound-sparing IUD placement is feasible when using concurrent transabdominal sonography, and this technique significantly decreases the length of the procedure. However, patient pain scores were not improved by eliminating uterine sounding. Overall, this study indicates that there is a need for larger-scale research on this topic, though it suggests that providers may opt to forego uterine sounding if they can use concurrent ultrasound during IUD placement.
8. Outcomes After Early Pregnancy Loss Management With Mifepristone Plus Misoprostol vs Misoprostol Alone
After being diagnosed with early pregnancy loss (EPL), stable patients can be offered three types of management: expectant, medication, and procedural. The most effective option for medication management of EPL involves administration of mifepristone and misoprostol, based on data that was published in 2018. However, because mifepristone is tightly regulated and not always accessible, it still is not routinely used for EPL management. The authors of this study used claims data to track outcomes for patients experiencing EPL between 2015 and 2022. Their cohort consisted of almost 32,000 patients with EPL who opted for medication management, and of this group, 97% received misoprostol alone while 3% were also given mifepristone. Over time, mifepristone utilization increased, suggesting improved education and access, though the proportion of patients receiving this evidence-based regimen remained low. Use of mifepristone was associated with fewer visits to the emergency department and a lower need for a procedure for definitive management. These results highlight the importance of using mifepristone for EPL management and the necessity for ongoing clinician education and expansion of access.
9. "Trust Women": Characteristics of and learnings from patients of a Shield Law medication abortion practice in the United States
In June 2022, the state of Massachusetts enacted legislation that protects clinicians who provide legally protected reproductive or gender affirming health care. Under the legislation, a patient who receives telemedicine services from a clinician licensed and practicing in Massachusetts is defined as a resident of Massachusetts, which protects providers providing telemedicine abortion for patients residing in other states. The Massachusetts Medication Abortion Access Project (MAP) is an asynchronous telemedicine service that offers mifepristone and misoprostol to patients in all 50 states who are in the first 11 weeks of pregnancy, using a pay-what-you-can model suggesting $250. In their research, the authors analyzed data from patients who received care between October 2023 and March 2024 through the MAP. Nearly 2,000 patients in 45 states receive care through the MAP, with 84% residing in ban or restricted states. Patients paid $134.50 on average, with 35% paying the full $250 and 29% paying $25 or less; many patients described financial hardship in their comments. These results show the demand for abortion services enabled by shield law legislation, and further demonstrates that patients seeking abortion care can and should be trusted to decide whether this care model is right for them and to pay what they are personally able to afford for this service.
