Estimated reading time: 9 minutes
1. Patient decision-making around LARC replacement and extended use
Long-acting reversible contraception (LARCs) are a category of contraception options including IUDs and the contraceptive implant that provide highly effective contraception for years at a time. While the 52mg levonorgestrel (LNG) IUD was initially approved for 5 years of use when it was first FDA-approved, later research resulted in an extension to up to 8 years of use; similarly, while the etonorgestrel implant was initially FDA-approved for 3 years, it has since been expanded to 5 years. This change can be confusing to patients who had their LARC placed prior to the updated FDA approvals, and there is little research available on how they may incorporate this into their decision-making. In this semi-structured interview study, the authors recruited 30 patients who were scheduled to remove their LARCs at the previous maximum duration of use (5 years for the LNG IUD and 3 years for the implant) to determine how they decided whether to replace or continue with their existing LARC method. Several themes emerged during the interviews, including participants’ desire for centralized, consistent information; the importance of physical or experiential factors that influenced the decision (such as increased recent bleeding with their LARC, or wishing to avoid the pain of IUD replacement); and the desire for more information to clarify the new recommendations. The authors conclude that providers counseling their patients about updated LARC usage duration should be prepared to provide sources of up-to-date information to their patients, ideally before their replacement appointments, and to address patients’ priorities about non-contraceptive benefits from LARCs.
2. Contraceptive Progestogens and Incident Meningioma
Meningiomas are the most common intracranial tumor in adults, and while most are benign, can cause mass effect symptoms requiring surgery or radiotherapy treatment. 87% of meningiomas carry progesterone receptors, and previous research has suggested that exogenous progesterone use may increase the risk of meningioma. In this case-control study, the authors used data from a 25-year population-based register study of reproductive aged females in Denmark to compare 1473 cases of meningioma with nearly 15,000 matched case controls and to determine their exposure to various types of progesterones. Recent use of cyproterone, desogestrel, drospirenone, levonorgestrel, injectable medroxyprogesterone acetate, and the 52mg levonorgestrel IUD was associated with increased meningioma risk, with the highest associated risk seen with exposure within the prior year. While the authors note that the absolute increased risk was slight overall, this information could potentially influence patients’ contraception decisions when included in counseling.
3. Adolescents and birth control side effects
- Adolescent experiences navigating contraceptive side effects and method satisfaction in Contraception
Adolescents use contraception for numerous reasons, including birth control, menstrual regulation, and acne management. Contraception uptake is increasing in the United States for this age group, but research is limited on adolescents’ motivations and experiences with birth control. While it has been well-established that side effects are a component of adolescents’ decision-making around contraception use, less is known about the details of this relationship. Furthermore, care for adolescents is often influenced by stereotypes about their ability to comprehend and act upon complex information. The authors of this study conducted in-depth interviews with 27 adolescents aged 13-18 to better understand their experiences with contraception. Questions covered topics that included contraception preferences, navigating side effects, method switching, and method satisfaction. Interview subjects described nuanced approaches to their contraceptive choices, understanding that all methods have pros and cons, and that it may be necessary to tolerate minor side effects to attain their primary goals. Rather than passive recipients of provider recommendations, these adolescents demonstrated sophisticated, individualized approaches to method selection. These findings can inform how providers structure contraceptive counseling with adolescent patients and reinforce the value of centering their priorities and preferences from the outset.
4. Residual levonorgestrel in the 52mg IUD after 8 years of extended use
- Quantification of residual levonorgestrel following extended use of the levonorgestrel 52 mg intrauterine device beyond 8 years in Contraception
The 52mg levonorgestrel (LNG) IUD IUD was initially FDA-approved for up to 5 years of pregnancy prevention; subsequent research showed that the device maintained contraceptive efficacy for up to 8 years. Given this finding, there is interest in determining whether such IUDs might be effective even longer. In this prospective study, the authors analyzed 42 LNG IUDs used for 8 to 10 years and found that approximately 21.5% of levonorgestrel remains on the device after 10 years, with residual content at 10 years (11.2mg) exceeding the reported residual content of the 19.5mg LNG IUD at the end of its approved 5-year duration (5.8mg). While this suggests the possibility of contraceptive efficacy beyond 8 years, the authors caution that the clinical implications are not yet clear and that additional research is needed before any changes to current counseling or practice.
5. PrEP modality preferences and contraceptive use among reproductive-aged women
- Current Contraceptive Practices and Pre-exposure Prophylaxis Modality Preferences among Black and Non-Black Women in the United States: Implications for Bundled Messaging in Archives of sexual behavior
Pre-exposure prophylaxis (PrEP), available as a pill or injection, is highly effective at preventing HIV acquisition in HIV-negative individuals. The American College of Obstetricians and Gynecologists (ACOG) is one of many professional societies that advise healthcare providers to ask about PrEP during discussions of reproductive health. However, previous studies have shown that providers discuss PrEP less frequently than other common reproductive healthcare-related topics such as contraception. For this study, the authors investigated the relationship between race, current contraception use, and PrEP modality (pill vs injection) preferences among individuals identifying as women in the United States. Because Black women in the US have higher rates of both HIV acquisition and unintended pregnancy, this study intentionally over-sampling Black women in order to learn more about their preferences. Out of 779 participants, 64% were Black women. The majority of participants had limited awareness of PrEP, and modality preferences did not differ by race. Most participants were unaware of the full range of PrEP options available. These findings point to a persistent knowledge gap and reinforce the need for proactive PrEP counseling integrated into reproductive health visits.
6. Updated WPSI cervical cancer screening guidelines
- Screening for Cervical Cancer: An Announcement in Obstetrics and gynecology
Regular screening for cervical dysplasia/pre-cancer significantly reduces morbidity from cervical cancer, and new guidelines have emphasized the role of high risk HPV (hrHPV) testing either in co-testing with cytology or as a primary modality.The Women’s Preventive Services Initiative (WPSI) has published updated cervical cancer screening guidelines for average-risk patients. For patients ages 21 to 29, cytology alone every 3 years remains the recommendation, without high-risk HPV (hrHPV) testing. For patients ages 30 and older, primary hrHPV testing is the preferred approach, with co-testing with cytology and hrHPV every 5 years as an acceptable alternative. The authors highlight that this updated guideline supports patient-collected hrHPV testing as equivalent to clinician-collected hrHPV testing. This new recommendation was recently approved by the US Department of HHS for coverage without co-pay or deductible charges for most eligible patients beginning in 2027. Clinicians who perform cervical cancer screening should be prepared to offer primary hrHPV testing for patients and to consider patient-collected testing as a patient-centered approach.
7. GLP-1 receptor agonists and adverse maternal pregnancy outcomes
- Glucagon-Like Peptide-1 Receptor Agonists and Risk of Adverse Maternal Pregnancy Outcomes in Obstetrics & Gynecology
GLP-1 receptor agonist (GLP-1 RA) use for weight loss increased 40-fold between 2017 and 2021, raising questions about outcomes in patients with inadvertent pregnancy exposure. As there is insufficient data about the effects of these medications on pregnancy or the resultant offspring, guidelines typically recommend stopping GLP-1 RA medications prior to conception; however, as use has risen dramatically, there is an increasing number of pregnancies with unintentional exposure. In this systematic review and meta-analysis of more than 47,000 pregnancies with GLP-1 RA exposure before or during pregnancy, GLP-1 RA use was not significantly associated with adverse maternal outcomes including gestational diabetes, preterm birth, preeclampsia, or other hypertensive disorders. In fact, some data suggested that GLP-1 RA use may actually have a protective effect against gestational diabetes, though the authors caution that more research is needed. Providers can use these findings to reassure patients who report inadvertent GLP-1 RA use before or during pregnancy about the current lack of evidence suggesting increased maternal risk.
8. Transmasculine pregnancy: occurrence and outcomes
- Transmasculine pregnancy-Occurrence, associations, and outcomes: A quantitative systematic review in AOGS
“Transmasculine” is typically used to describe individuals assigned female at birth (AFAB) who identify themselves as non-binary, trans, or other gender identities. Transmasculine individuals have a wide range of reproductive preferences and outcomes, shaped by hormonal and surgical treatments as well as well-documented barriers to reproductive healthcare. This systematic review explores the current state of data on transmasculine pregnancy, including pregnancy rates, adverse outcomes, and testosterone uptake. The research team reviewed thousands of studies and ultimately included 44 articles with very heterogeneous populations and study topics. They found that up to 8.5% of transmasculine individuals have experienced pregnancy, with significant rates of postpartum depression. Data also suggested a higher incidence of miscarriage among individuals taking testosterone, though very little information was available on outcomes of any kind. This review underscores the significant gaps in research on transmasculine pregnancy and the need for studies designed to address the specific reproductive health needs of this population.
9. Opt-in vs Opt-out Rh immunoglobulin policy in early abortion care
- Rh Immunoglobulin Uptake With Opt-Out Versus Opt-In Policy in Patients Obtaining Abortion Care at Less Than 12 Weeks Gestation in Women’s Health Issues
Due to concerns about sensitization, Rh-negative pregnant individuals historically received Rh immune globulin (RhIG) for any episode of first-trimester vaginal bleeding, including abortion care. However, emerging evidence has shown that the risk of sensitization is extremely low during the first trimester. Although we do not know exactly when in pregnancy Rh sensitization begins, numerous professional society guidelines now recommend RhIG only after 12 weeks using a shared decision-making model. These recommendations have affected clinical practices around the United States and the world. For this study, the authors sought to understand if RhIG uptake changed after their clinic began to offer it as an “opt-in” medication in 2022. They performed a retrospective chart review on 1497 Rh-negative patients undergoing abortion before 12 weeks, comparing RhIG uptake before and after their clinic transitioned to an opt-in protocol in 2022. The authors noted a dramatic decrease in RhIG uptake between the two groups: before the change, 76.1% of eligible patients received RhIG; after the transition to opt-in, only 10.4% chose to receive it. This study offers a concrete example of what practice change looks like after adopting updated RhIG guidance, and can help inform protocol updates at other facilities.
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