1. Managing bleeding irregularities with contraceptive implants
- Management of Bleeding Irregularities during Contraceptive Implant Use: A Systematic Review in Contraception
Contraceptive implants are highly effective and safe for most patients, but unscheduled bleeding remains a leading reason for early discontinuation. This systematic review synthesized 21 studies evaluating treatments for bothersome bleeding, including NSAIDs, tranexamic acid, doxycycline, hormonal regimens, progesterone receptor modulators, and vitamin E. Certainty of evidence ranged from high to very low. Overall, celecoxib, mefenamic acid, tamoxifen, and ulipristal acetate showed the most consistent improvement in bleeding patterns during,and sometimes after, treatment; hormonal treatments, TXA, and mifepristone with ethinyl estradiol or doxycycline appeared to improve bleeding during treatment but not after. The authors recommend that providers who provide contraceptive implants provide anticipatory counseling to patients about likely irregular bleeding patterns and consider offering a trial of treatment for patients bothered by such bleeding.
2. Interest in 12-month supply of contraceptives
- Patient interest in and availability of a 12-month supply of contraception: A cross-sectional analysis in Contraception
Extended dispensing of oral contraceptives (e.g., a 12-month supply of pill packs) is associated with fewer gaps in use and improved continuation, but access often breaks down between prescribing, coverage, and pharmacy fulfillment. While many states (23) require insurers to cover pharmacies dispensing an extended or 12-month supply of oral contraception, patients may not receive this amount due to insurance restrictions, provider prescriptions issues, or pharmacy stocking. In this cross-sectional study of ~500 oral contraceptive users living in a state with an extended-supply coverage requirement, nearly three-quarters (72.9%) wanted a 12-month supply, citing convenience and avoiding pharmacy trips and lapses in contraception. Despite that interest, only 17% reported being offered a 12-month supply by a clinician, and even among those prescribed a 12 month supply, only 64.9% of these patients were actually able to fill the 12-month prescription at the pharmacy. Patients with public insurance were less likely to have been offered a 12-month supply. The authors advocate for an increase in state-level policies to cover dispensing extended supplies, and for efforts to increase both provider and patient awareness in states with existing policies mandating such coverage.
3. Misoprostol routes for cervical priming
- Sublingual or Oral Versus Vaginal Misoprostol for Cervical Priming Prior to First-Trimester Surgical Abortion: A Systematic Review and Meta-Analysis in American Journal of Obstetrics and Gynecology
Procedural (surgical) abortion is an extremely safe method of pregnancy termination, and is typically completed in a single clinical visit for patients in the first trimester or early second trimester of pregnancy. For certain gestational durations or clinical histories, misoprostol may be used for cervical priming to reduce procedure time, blood loss, and risk of cervical or uterine injury. Misoprostol can be administered through several routes, including oral, sublingual, and vaginal, and it has not been clear which of these routes is superior. In this systematic review and meta-analysis of 21 randomized controlled trials (4,000+ patients undergoing first-trimester procedural abortion with premedication with misoprostol), the authors found comparable outcomes across oral, sublingual, and vaginal routes. There were no significant clinical differences in preoperative cervical dilation, duration of procedure, or blood loss; while there was a statistically significant difference in procedural duration between sublingual and vaginal misoprostol, this was not clinically significant (less than a minute shorter duration with sublingual misoprostol). Given these findings, the authors suggest that oral or sublingual administration of misoprostol may be simpler to administer and more acceptable for patients, without compromising clinical outcomes.
4. Clinician beliefs about self-managed abortion reporting
To continue reading, become a member today.
Stay on top of policy updates, social media trends shaping your patients’ beliefs, and the latest clinical information and research – all in one place. Your membership helps sustain tools millions of young people rely on, including Bedsider.