Estimated reading time: 7 minutes
1. Stroke risk, combined hormonal contraception and triptan use
Due to concerns about stroke risk, patients with migraines with aura are advised against using combined hormonal contraceptives (CHCs) due to independent cardiovascular risk. However, CHC use may continue among patients with other headache types, including migraine without aura. Triptans, commonly used for migraine treatment, are vasoconstrictive agents contraindicated in patients with pre-existing cardiovascular risk factors. Therefore, there could be an increased risk of stroke in patients on combined hormonal contraception who also take triptans for migraine treatment. Using the Danish health registry, this cohort study evaluated stroke risk among nearly one million CHC users between 2004 and 2021 and found that CHC and triptan users had an increased risk of ischemic stroke when compared to individuals on CHC who were not taking triptans. However, the absolute stroke risk remained low. These results suggest that providers should consider the combination of CHC and triptans when making decisions about contraception and headache treatment with patients.
2. IUD self-removal: patient perspectives and simulation practice
- Assessing Motivating Factors for IUD Self-Removal Through Focus Groups and Simulation in Contraception
IUD removal is typically performed by a provider, but patients may face significant barriers to timely removal, including insurance gaps, appointment availability, and provider refusal. While self-removal of an IUD is feasible, safe, and patient-centered, studies assessing feasibility have previously found that only a minority of patients could actually accomplish removal. In this semi-structured focus group study of 25 IUD ever-users, participants viewed self-removal positively, describing it as a means of managing side effects, maintaining bodily autonomy, and avoiding negative healthcare encounters. Participation in a self-removal simulation significantly reduced fear and increased perceived control. The authors encourage providers to support IUD self-removal as an option for their patients, including anticipatory counseling and providing guidance and simulation practice.
3. Accuracy of LMP-based gestational age dating in adolescents
- Accuracy of Menstrual History for Determining Gestational Age Among Adolescents Who Underwent Abortion in England and Wales in Obstetrics & Gynecology
No-test abortion protocols, in which patients receive abortion care without in-person evaluation or ultrasound, have been validated as safe and effective. However, these protocols are subject to numerous restrictions, including gestational age limits and patient age restrictions. In the United Kingdom, patients ages 13–15 are required to undergo in-person clinical evaluation. In this retrospective analysis, the authors compared LMP-based gestational age dating to ultrasound dating among pregnant patients under age 16. The vast majority of patients, including those as young as 12, accurately dated their pregnancies using LMP; accuracy increased further when excluding patients with irregular periods or uncertainty about their LMP. These findings suggest that no-test abortion protocols should not be restricted based on patient age, and that adolescents face unnecessary barriers when age-based requirements are applied without supporting evidence.
4. Intravaginal vitamin C for bacterial vaginosis treatment and prevention
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