Estimated reading time: 8 minutes
1. Post-coital pregnancy prevention strategies among adolescents and young adults
- Use of Post-Coital Strategies to Prevent Pregnancy: Findings from a National Sample of Adolescents and Young Adults in the United States in Journal of Sex Research
“Post-coital” pregnancy prevention behaviors can include evidence-based options like emergency contraception (EC), along with a broader set of methods without scientific support, such as douching, jumping up and down, or home remedies inserted vaginally or rectally. U.S. contraceptive research has rarely looked at these other methods, so little is known about how often they are used. Adolescents and young adults (AYAs) face barriers to reproductive health care while also encountering a wide range of information on social media, which may leave them especially likely to rely on non-evidence-based strategies. Using a nationally representative survey of U.S. AYAs, the authors asked participants about post-coital pregnancy prevention behaviors they used within a week of penis-in-vagina sex. Among 633 respondents, 25% used a post-coital method. 8.9% used methods with established effectiveness, such as EC pills or a copper IUD, while 16.1% relied on non-medically-evidenced options, most commonly praying (9.4%). Greater contraceptive knowledge was associated with lower use of post-coital strategies. These results highlight a large gap in education and access for AYAs, and also suggest that providers should be aware of these strategies when caring for young people.
2. Breast tenderness with hormonal contraceptive methods
- Hormonal contraception and breast tenderness: A Danish cross-sectional study in European Journal of Obstetrics & Gynecology and Reproductive Biology
Breast tissue responds to estrogen and progesterone, so breast tenderness can show up at different points in the menstrual cycle and with hormonal contraception. Although it is a known potential side effect, there is limited data on which methods are most likely to cause it. Further, hormonal methods vary widely in hormone dose and in their effects on ovulation. To better understand this relationship, the authors analyzed data from a very large survey of reproductive-age females (ages 18 to 39) in Denmark. Among more than 110,000 respondents, about 15% reported having experienced breast tenderness. Compared with no hormonal contraception, combined oral contraceptive pills were associated with lower odds of breast tenderness, while low-dose progestin-only pills and hormonal IUDs were associated with higher odds. Because progestin-only methods do not reliably suppress ovulation, this may reflect the effects of each individual’s endogenous progesterone and estrogen. Further research is needed to explore the interactions between endogenous and exogenous hormones and breast tissue.
3. Multiple new studies on management options for IUD placement
- Multidose Ibuprofen Prior to Intrauterine device insertion (MIPI): a triple blinded randomized controlled trial in American Journal of Obstetrics & Gynecology
- Intrauterine Mepivacaine Instillation vs Placebo for Pain During IUD Placement: A Randomized Clinical Trial in JAMA
- Transcutaneous electrical nerve stimulation for pain management during intrauterine device insertion: a randomized controlled trial in American Journal of Obstetrics & Gynecology
- Characteristics of Patients Choosing Intravenous Moderate Sedation for IUD Placement in JAMA
IUDs are a safe, reversible, and highly effective form of contraception, but IUD placement is painful for many people, and fear of pain may deter patients who would otherwise be interested. Four studies this month look at different approaches to pain management for IUD placement.
In a triple-blinded randomized controlled trial by Ouyang et al, the authors examined whether a multidose ibuprofen regimen (as opposed to a single dose given immediately before insertion) could improve pain scores. Among 66 participants who underwent IUD placement, pain scores during insertion were significantly lower in the intervention group, who received three doses of 800mg ibuprofen in the 24 hours before placement. The authors noted that no participants received a paracervical block, which the CDC’s 2024 U.S. Selected Practice Recommendations identify as potentially useful for reducing pain during IUD placement, and call for more research combining the two approaches.
In a second randomized trial, Elgemark et al investigated whether intrauterine instillation of 10ml of mepivacaine reduced pain for nulliparous patients receiving IUDs with smaller-diameter placement tubes (Kyleena, Skyla, and a Nova-T 380 copper IUD), building on earlier research that reported benefit with the Mirena IUD. Mepivacaine was instilled using a hydrosonography catheter, and IUD placement began two minutes later. Among 366 patients who underwent placement, pain scores during IUD placement were significantly lower in the mepivacaine group, and a higher percentage of the intervention group rated their pain as tolerable (98.3% versus 91.4%).
A third randomized controlled trial by Kus et al compared high-frequency transcutaneous electrical nerve stimulation (TENS) with sham TENS during IUD placement. Among 99 participants, the authors found no difference in pain scores for either parous or nulliparous patients, though pain scores were higher among nulliparous patients and when the clinician rated the insertion as more difficult.
A fourth study by Storey et al looked at IV moderate sedation, which is becoming more widely available for patients concerned about pain. Over one year at an outpatient family planning clinic in Massachusetts, patients were routinely offered NSAIDs and a lidocaine cervical block and were also informed about the option of IV sedation. Among 1324 patients who underwent IUD placement, 20% chose IV sedation. This group was more likely to be nulliparous and to have diagnoses related to pelvic pain and anxiety. They also exhibited characteristics that suggested a higher level of privilege within the healthcare system, such as identifying as white and not needing to use an interpreter. However, these factors may actually reflect barriers to access, and not actual differences in preference.
Taken together, these studies identify two promising additions for the outpatient setting, multidose ibuprofen and intrauterine mepivacaine, while TENS showed no benefit. The sedation data show that a meaningful share of patients will choose IV sedation when it is offered, and more research is needed on what drives that choice and who faces barriers to it.
4. Mifepristone compared with other emergency contraception methods
- Mifepristone versus other interventions for the prevention of pregnancy in reproductive-age women using emergency contraception in Cochrane Database of Systematic Reviews
Emergency contraception (EC) can be used after unprotected or underprotected sex, before a pregnancy begins, to prevent pregnancy. Patients have both oral and IUD options, but mifepristone is not typically used for EC in the United States. In this Cochrane review, the authors identified 87 randomized controlled trials with approximately 36,000 participants comparing mifepristone with established EC options, including oral levonorgestrel, the oral Yuzpe regimen, and copper IUDs. In their analysis, the authors found that mifepristone at doses of 50mg or less was likely more effective than both oral levonorgestrel and the Yuzpe regimen at preventing pregnancy, and caused less nausea and vomiting than the Yuzpe regimen. There was insufficient high quality data to compare copper IUDs and mifepristone. The main trade-off the authors noted was delayed menses, which patients could interpret as a sign of pregnancy. These data suggest mifepristone may offer a superior alternative for oral EC.
5. Timing of syphilis screening in pregnancy
- Syphilis Screening Among Commercially-Insured Pregnant Women in the United States in Sexually Transmitted Diseases
Congenital syphilis diagnoses increased 81% in the United States between 2020 and 2024, with nearly 3900 cases reported in 2023. While national medical groups and many state laws recommend syphilis screening one or multiple times during pregnancy, it is unclear how well these recommendations are followed during prenatal care. In this study of more than 700,000 commercially insured pregnant patients, the authors examined whether and when syphilis testing occurred. While 79% of patients had at least one syphilis test during pregnancy and 53% had more than one, only 41.5% were screened in the first trimester, when treatment is most feasible. Screening rates increased 4.5% over the study period, but the authors describe current screening rates as reflecting significant systemic gaps, especially in the first trimester, when early detection allows early intervention. For clinicians providing prenatal care, the findings reinforce syphilis testing as a standard part of initial prenatal labs, with repeat screening later in pregnancy as recommended.
6. Reasons adolescents and young adults choose telehealth medication abortion
- Reasons for using telehealth medication abortion: adolescents and young adults compared with adults in Contraception
Adolescents and young adults (AYAs), ages 16 to 24, face well-established barriers to abortion care, including challenges with privacy, cost, and independence. Telehealth delivery of medication abortion can address many of these barriers and reach people who are unable to access in-person care, which has become increasingly important since the 2022 Dobbs v. Jackson decision significantly reduced abortion access across the United States. Less is known, however, about preferences and decision-making strategies of pregnant AYAs. For this study, the authors analyzed survey data collected before the Dobbs decision on why AYAs chose telehealth medication abortion, and compared their reasons with those of adults 25 and older. Cost was a significantly greater concern for AYAs than for adults. AYAs also reported more fear about going to in-person visits, and fewer concerns about childcare or COVID-19. Overall, these results highlight AYAs’ dependence on telehealth abortion care delivery to address numerous concerns, especially cost and fear of going to clinic in person. These services should be expanded, when possible, to care for this patient population.
7. Primary care clinic staff attitudes toward medication abortion
- U.S. Primary Care Clinic Staff Attitudes Toward Providing Medication Abortion in Women’s Health issues
Medication abortion (MAB) can be integrated into primary care, as it does not require additional training or procedural skills in order to be safely administered. Additionally, for patients who may feel more comfortable with (or have easier access to) their primary care providers, this option would offer expanded abortion access. Because abortion care is politicized and stigmatized, though, it is typically separated from other medical services. As part of an initiative to bring MAB services into primary care, the research team surveyed primary care clinic staff about their perspectives on MAB. More than 400 staff responded, including both patient-facing staff (such as nurses and medical assistants) and non-patient-facing employees (such as billers and administrators). Overall, staff viewed MAB integration positively, but also raised concerns about education, training, and stigma. Since successful integration depends on the whole clinic team, these results can help guide implementation efforts, including training and stigma-reduction work that reaches non-clinical staff as well as clinicians in primary care settings.
