Estimated reading time: 7 minutes
1. Replacing vs. extending the Nexplanon implant at three years and bleeding patterns
- Bleeding Patterns after Replacing versus Extending the Use of the Contraceptive Implant at Three Years of Use in Contraception
The hormonal implant is a highly effective reversible form of long-acting contraception, and can be safely used by the grand majority of reproductive-aged patients. Irregular bleeding, however, is the most common side effect of the Nexplanon implant and the primary reason for discontinuation. The FDA recently extended the approved duration of use for pregnancy prevention from three to five years, but how extended use affects bleeding patterns has been unclear. In this prospective cohort study of 52 patients with approximately three years of implant use (32 to 40 months), the authors compared bleeding patterns in the month before and after patients chose to either replace their implant or continue with extended use. There was no significant difference in bleeding days between the two groups. The authors caution that this is a small sample size, but providers can use this data to counsel patients who are considering replacing their implant at three years specifically in hopes of changing their bleeding pattern.
2. Quality and completeness of freely available contraceptive decision aids
Contraceptive decision aids have been shown to support informed, autonomous decision-making, and numerous free options are available online. The International Patient Decision Aid Standards (IPDAS) checklist is one of a small number of checklists that can be used to certify decision aids. The United States, however, does not require the certification of decision aids, despite evidence suggesting that the structure and content of an aid has the power to influence users’ decisions. Using the PDAS checklist, the authors assessed 13 freely available contraceptive decision aids and found wide variation in quality scores. While most were written in accessible, unbiased language, many lacked a complete list of contraceptive options and did not clearly describe risks or contraindications. Given the potential influence these tools exert — particularly for patients with limited access to providers — greater standardization is needed to ensure the reliability of freely available contraceptive information.
3. TikTok as a source of information on tubal ligation: who’s creating content and how accurate is it?
- The use of TikTok as a source of medical information regarding tubal ligation: a cross-sectional study in Contraception and Reproductive Medicine
Permanent female contraception (PFC), or female sterilization, by tubal removal or ligation remains the most commonly utilized method of pregnancy prevention in the United States. An ever-increasing number of patients, especially young adults, get their medical information from social media platforms such as TikTok, and this information may influence their decisions about contraception, including PFC. In this cross-sectional analysis of the 101 most-viewed TikTok videos about permanent female contraception, negative and positive tones were equally common, and 16% of videos discussed tubal ligation failure, a relatively uncommon outcome. Videos created by people with medical backgrounds were more accurate and understandable, but 75% of the most popular videos were created by laypeople. The findings reinforce the importance of healthcare providers creating and sharing high-quality content on social media platforms, where engagement-driven algorithms don’t prioritize accuracy.
4. Contraception counseling training at high-volume abortion facilities serving cross-state patients
- Increasing Contraceptive Access at Sites Serving Cross-State Abortion Patients: Results From the Southwest Contraceptive Access Network (SCAN) Intervention in American Journal of Public Health
Since the Dobbs decision, changes in state-level abortion restrictions have forced many patients to travel across state lines for abortion care. Facilities that offer abortion care close to the borders of these states may see a high volume of abortion patients, but be less able to provide sufficient high-quality contraception-related counseling. In this article describing a quality improvement intervention, 53 non-physician staff at high-volume abortion clinics completed a training course in patient-centered contraception counseling. Post-training, staff more accurately reported contraindications and correct usage of contraceptive methods, and the average number of contraception options available at participating sites increased. The authors conclude that this kind of intervention improves patient access contraception and can be adopted and scaled to other abortion care settings.
5. Shifts in public perception of abortion safety, pre- and post-Dobbs
- Changes in beliefs about the safety of clinic-based abortion and self-managed abortion methods in the United States, pre- to post-Dobbs in Contraception
Procedural and medication abortion are generally extremely safe options for patients seeking abortion care. Medication abortion now makes up the majority of abortions in the US, and self-managed abortion (SMA), in which patients receive medications outside the formal healthcare system, is also supported by WHO guidance as safe and effective for patients early in pregnancy, especially in settings where healthcare access is limited. However, less is known about how the general public perceives the safety of abortion, and how this has changed since the Dobbs decision. In this cross-sectional survey comparing data from before and after Dobbs, a greater percentage of reproductive-aged AFAB respondents agreed that all types of abortion were safe post-Dobbs. The increase was much larger for clinic-based procedural abortion (64%) and clinic-based medication abortion (59%) than for SMA (9.6%). The authors call for increased efforts at education about the safety of abortion generally, and particularly about SMA with mifepristone and misoprostol.
6. Gender-affirming care protocols at reproductive health clinics
- Availability of Protocols Supporting Transgender and Gender-Expansive Patients: Results From a National Survey of Clinics Providing Contraceptive Services in Women’s Health Issues
Transgender and gender-expansive individuals face well-documented barriers to healthcare access, which may include difficulty seeking sexual and reproductive healthcare and contraceptive services. Some of these challenges include highly gendered language in some clinics (i.e. “Women’s Healthcare”) and a lack of training among providers and clinic staff. However, reproductive healthcare clinics have the opportunity to be a crucial resource for transgender and gender-expansive individuals, especially as certain states enact youth-focused care bans that increase both stigma and barriers for this population. The authors of this study sought to understand the availability and provision of gender-affirming care (GAC) at clinics providing contraceptive services around the United States, and any possible association with GAC bans in each state. In a survey of 446 clinics across 48 states, only 25% reported providing gender-affirming care, though a larger number had some supportive protocols in place to help support transgender and gender-expansive patients. Notably, fewer protocols were reported in states with gender-affirming care bans, even though those bans typically apply to minors, not adult patients. The results of this study highlight a need for improved GAC among reproductive healthcare clinics, regardless of state-based laws against GAC for youths. More work is needed in order to adequately support the sexual and reproductive health of this population.
7. Period tracking apps and gestational age self-assessment for abortion eligibility
- Accuracy of gestational dating by last menstrual period in period tracking application users in BMJ Sexual and Reproductive Health
Period tracking applications (apps) are widely used to log menstrual cycle data and estimate gestational age once a user becomes pregnant, information that may be particularly relevant when seeking abortion care. There is little regulation, however, regarding these apps and the health information that they provide. In this secondary analysis comparing self-reported gestational age estimates to early pregnancy ultrasound results, app users presented to care earlier and were more likely to correctly estimate gestational duration within five days compared to non-app users. These findings suggest that period tracking apps may be a useful component of gestational age self-assessment for abortion eligibility, particularly when ultrasound is unavailable.
8. Socioeconomic factors associated with chlamydia and gonorrhea positivity in the US
- Socioeconomic factors associated with chlamydia and gonorrhea positivity in the United States, 2022-2024 in BMC Public Health
Chlamydia and gonorrhea are the most common sexually transmitted infections (STIs) in the United States, and can lead to serious complications, including pelvic inflammatory disease and infertility. Prior geographic data has suggested higher STI rates in areas with greater housing instability and lower socioeconomic status, but patient-level data has been limited. In this analysis of the Truveta dataset, which links millions of healthcare records to individual demographic and socioeconomic variables, lower educational attainment and increased housing instability were independently associated with positive chlamydia and gonorrhea testing. These results highlight the connections between socioeconomic factors and STI infections, and can be used to inform public health initiatives and education.