Contraception最新文献

Objectives: Intrauterine devices (IUDs) are highly effective, long-acting reversible contraceptives. The CDC updated their Selected Practice Recommendations for Contraceptive Use in August 2024, including guidance on pain management during IUD insertions. This study describes real-world trends in the use of lidocaine and opioids on the day of IUD insertion.

Study design: This study used a subset of Truveta Data, a daily updated electronic health record database from a collective of US health care systems. Lidocaine and opioid medications ordered or administered on the day of the IUD insertion were captured, and logistic interrupted time series models were used to evaluate predictors of receipt and quantify the impact of the 2024 recommendations.

Results: There were 286,144 IUD insertions meeting study criteria from 1/1/2018 - 6/30/2025. In 2018, 1.7% of patients received any pain medication, increasing to 5.0% in 2025. CDC guidelines were associated with an 18% immediate increase in the odds of lidocaine receipt (aOR 1.18, 95% CI: 1.05, 1.34) and a 22% increase in the odds of opioid receipt on the day of IUD insertion (aOR 1.22, 95% CI: 1.04, 1.44). The monthly trend of both lidocaine and opioid receipt did not change after the guidelines.

Conclusions: Despite a statistically significant increase in lidocaine and opioid use on the day of IUD placement after the CDC guidelines, in 2025, 95% of IUD recipients did not receive either pain control method. Our reliance on structured billing and medication fields may have missed lidocaine and opioid use documented only in clinical notes, which could lead us to underestimate utilization.

Implications: Intrauterine device (IUD) insertion is painful, and pain management is uncommon. Despite 2024 CDC guidelines encouraging pain management during IUD insertions, leading to a statistically significant increase in both lidocaine and opioid receipt on the day of the procedure, 95% of women did not receive either of these pain control methods with their IUD insertion in 2025.

Objective: To evaluate whether patients who attended a crisis pregnancy center (CPC) before initiating prenatal care hold more misinformation about contraception and abortion relative to CPC non-attendees.

Study design: We surveyed prenatal care patients who had attended a CPC during their current pregnancy before initiating prenatal care (n = 99) and a control group, matched on age and race, who had not attended a CPC during the index pregnancy (n = 99). We used bivariable linear regression to evaluate whether CPC attendees had lower knowledge scores for contraception and abortion (assessed separately) and to assess other potential correlates of poor knowledge.

Results: Mean knowledge score was 3.9 (standard deviation [SD]=1.8; range=0-7) for contraception and 2.1 (SD=1.3; range=0-5) for abortion. CPC attendance was not associated with either contraception (ß=-0.00; p = 1.00) or abortion scores (ß=-0.06; p = 0.37). A minority of CPC attendees (40.4%) correctly identified the intrauterine device (IUD) as more effective than the pill, male condom, and withdrawal. Few attendees (17.2%) recognized that the pill, the shot, and the implant do not cause infertility. About 57.6% of attendees accurately selected the IUD from a list, consisting also of tubal ligation and vasectomy, as the reversible method. Only 19.2% of CPC attendees correctly agreed that abortion in the U.S. is safer than childbirth and only 51.5% reported that abortion does not cause infertility.

Conclusions: Endorsement of inaccurate beliefs about contraception and abortion was common among prenatal care patients who had attended a CPC. Findings should be used to inform interventions to address inaccurate knowledge about reproductive health.

Implications: Endorsement of misinformation about contraception and abortion was common among prenatal care patients who attended a CPC but did not differ by crisis pregnancy center attendance.

Objectives: Contraceptive coercion during contraceptive counseling can limit pregnancy-capable individuals' contraceptive autonomy over decision-making and use. We examined the contraceptive counseling experiences of adolescent and young adult women for evidence of contraceptive coercion.

Methods: This study involved individual interviews with a racially diverse sample of 46 adolescents and young adults, ages 16-24, assigned female at birth, and residing in one of five southern states. All participants self-identified as women. The study team conducted interviews between October 2023 and March 2024. We used codebook thematic analysis to examine participants' accounts of healthcare interactions about contraception.

Results: Participants recalled how clinicians often presented the pill as their optimal contraceptive option and rarely discussed more than a few methods. Participants also recounted that clinicians discouraged them from using the copper intrauterine device (IUD) by emphasizing potential negative side effects, even when they expressed concerns about hormonal methods. Persistent self-advocacy was required among those who desired the copper IUD to obtain the method.

Conclusion: Our findings highlight how clinicians may circumscribe adolescent and young adult women's contraceptive access and autonomy by how they discuss patients' contraceptive options, especially when patients express interest in a non-hormonal prescription method. These interactions can inhibit patients' ability to use their preferred contraceptive method.

Implications: Clinicians' preference for certain methods and bias against others may lead them to disregard patients' contraceptive concerns and associated preferences, including a desire to switch methods or use the copper IUD. Such practices are inconsistent with a reproductive justice-informed, person-centered approach to contraceptive care.

Objective: To explore how people are experiencing abortion care in Aotearoa New Zealand (Aotearoa) following decriminalization in 2020 and to identify aspects of equitable and accessible abortion care.

Study design: An observational, mixed-methods study advertised at abortion services in Aotearoa (January-November 2023). All people aged ≥ 14 years attending abortion services were eligible for an anonymous survey. Wāhine Māori (Māori women) and Pacific women accessing abortion services since the law reform, and their families, also took part in qualitative interviews to privilege their voices. Māori and Pacific researchers undertook the interviews, underpinned by Kaupapa Māori and Pacific research methodologies. Main outcome measures were aspects of equitable and accessible abortion care identified by participants.

Results: 126 surveys and seven interviews were conducted. Among surveyed participants, 52/126 (41.3%) self-referred to an abortion service and this best suited 23/40 (57.5%). The abortion occurred within a week of the first appointment with the abortion service for 103/123 (83.7%) and no participant wanted more time. Interviewees not knowing about self-referral or encountering delays expressed frustration and distress. Almost all participants (124/126, 98.4%) had private and safe access to a mobile phone, but fewer to the internet (107/126, 84.9%) or space for telehealth appointments (77/126, 61.1%). Interviewees considered a private space for early medication abortion (EMA) essential.

Conclusions: People highly value self-referral, timeliness and choice between in-clinic abortion care or EMA at home, which reduce barriers to accessing abortion services. Protecting and further implementing these strategies are likely to contribute to achieving equitable and accessible abortion care.

Implications: We aimed to identify aspects of equitable, timely, safe, and accessible abortion services in Aotearoa. The findings suggest that many steps have been taken towards achieving accessible and equitable abortion care in Aotearoa. However, strategies and activities to protect and further implement high-quality abortion care are needed.

Objectives: To systematically review literature on management of bleeding irregularities during contraceptive implant use.

Study design: We searched multiple databases through November 2022 for randomized clinical trials assessing treatment of bleeding irregularities during implant use. Primary outcomes were changes in bleeding irregularities during and after treatment and patient satisfaction. We extracted data and assessed risk of bias for each included study, narratively summarized results, and determined certainty of evidence for primary outcomes.

Results: Twenty-one articles met inclusion criteria. Risk of bias ranged from high to low. Trials examining some non-steroidal anti-inflammatory drugs (celecoxib and mefenamic acid), tamoxifen, and ulipristal acetate (UPA) generally showed improved bleeding patterns during and after treatment compared with placebo, while ibuprofen trials showed no improvements during treatment and inconsistent results after treatment. Trials of tranexamic acid, some hormonal treatments [oral ethinyl estradiol (EE; 50 mcg), combined oral contraceptives], and mifepristone with EE or doxycycline showed improved bleeding patterns only during treatment. Mifepristone alone, doxycycline alone or with EE, oral EE (20 mcg), transdermal estradiol patch, oral levonorgestrel, aspirin, and vitamin E were not consistently effective during or after treatment. Six trials measured patient satisfaction and found improved satisfaction with bleeding patterns for tamoxifen and UPA, and improved satisfaction with treatment for celecoxib, tamoxifen, and mifepristone.

Conclusions: Across the different interventions assessed, certainty of evidence ranged from high to very low. The evidence summarized in this systematic review can help providers counsel patients about interventions to improve bleeding irregularities with contraceptive implant use, depending on patient preferences and goals.

Implications: Patients experiencing bothersome bleeding irregularities during contraceptive implant use may be offered different options to manage bleeding and improve their satisfaction. More data are needed on the effectiveness of specific interventions (drugs, regimens, and repeat dosing) and patient satisfaction outcomes.

Objective: To determine whether combined oral contraceptives (COCs) containing ethinyl estradiol and drospirenone are associated with higher chronic biological stress, indicated by hair cortisol and cortisone, among White South African women.

Methods: In this cross-sectional study, proximal hair segments (1 cm) from COC users (n = 24) and non-users (n = 24) were analyzed by LC-MS/MS.

Results: No significant group differences were observed for hair cortisol (median 2.22 vs 2.59 pg/mg), cortisone (6.58 vs 6.95 pg/mg), total glucocorticoids (8.66 vs 8.98 pg/mg), or cortisol/cortisone ratio (0.38 vs 0.38). In controls, cortisol and cortisone correlated negatively with age and sample storage time. Excluding women with hair treatments revealed modestly higher glucocorticoids in COC users (effect size ≈ 0.3) and stronger correlations with BMI and body fat, suggesting such treatments may mask glucocorticoid signals.

Conclusion: COC use was not associated with higher hair glucocorticoids, though hair treatments may influence detection.

Implications: These findings suggest that COC use does not increase hair glucocorticoid levels, while underscoring the need to consider hair treatments as a potential confounder in biomarker-based stress assessments.

Objectives: In this study, we assessed the association of modern systemic hormonal contraception (HC), including newly introduced estradiol-containing combined oral contraceptives, with major adverse cardiovascular events (MACE): myocardial infarction [MI] and ischemic stroke [IS], during 2018-2019.

Study design: A prospective registry-based cohort study including all 15-49-year-old women residing in Finland in 2017, using HC. We identified women from the national prescription register and incident cases of MACE from the national patient register, yielding 584,236 women and 1167,685 person-years. We analysed cases and their 1:4 age-matched controls in a nested case-control design assessing the association between use vs. non-use of different HC and risk of MACE. Altogether 19.1% of women used combined hormonal contraceptives (CHC), 8.0% ethinylestradiol (EE) and 3.7% estradiol (E2) containing pills while 7.5% used progestin-only-pills (POP).

Results: We recorded altogether 334 cases of MACE (84 MI and 250 IS), with an incidence rate of 28.6/100,000 person-years (7.2/100,000 for MI and 21.4/100,000 for IS). Compared to non-use of HC, the adjusted odds ratios (95% CI) of MACE were 1.24 (0.78 - 1.96) and 1.37 (0.73- 2.57) among users of EE and E2 containing HC, and 1.04 (0.64 -1.71) among users of POP.

Conclusion: We found no increased risk of MACE associated with use of CHCs containing either EE or E2, or with POP, compared to non-use. We speculate that the cardiovascular safety of modern use of HC is linked both to improved safety of modern contraceptives and their appropriate use.

Implications: The present findings are reassuring concerning the cardiovascular safety of modern HC, suggesting that use of modern hormonal contraceptives, when aligned with current guidelines, does not significantly increase the risk of MACE.

Objective: We aimed to assess the 6-month effectiveness of a salivary progesterone fertility awareness-based (FAB) method at preventing pregnancy, used with condoms when desired.

Study design: From May 2022 to April 2023, we performed a six-month prospective, observational study on sexually active, menstruating women in Germany desiring FAB methods for contraception. Study participants tracked their menstrual cycle by providing daily samples of saliva to a device which measures salivary progesterone levels and uses an algorithm to estimate the fertile window. The accompanying app informed users when the fertile window was beginning and reminded users to abstain or use a barrier method during that time. We identified pregnancy via user reports of positive pregnancy tests or clinical diagnosis. We used Kaplan-Meier life tables to estimate six-month typical-use effectiveness.

Results: Three hundred participants contributed 6 months of data for a total of 1492 valid cycles, equivalent to 115 person-years. Mean user age was 30.5 ± 5.2 years. We estimated six-month typical-use effectiveness of 96% (95% confidence interval [CI]: 93, 98) of the salivary progesterone FAB method (with barrier as back-up). No adverse events occurred. The majority of participants rated the usability of the device (74%) and strips (57%) as good or very good.

Conclusion: Our data suggest that salivary progesterone tracking method has an effectiveness consistent with other similar FAB methods and is easy to use.

Implications: These findings support salivary progesterone tracking as an effective digital contraceptive, expanding options for patients prioritizing non-hormonal, user-controlled methods.