Clinician perspectives on adolescent contraceptive counseling following Dobbs v. Jackson: Implications for young people's contraceptive autonomy.

OBJECTIVE: The objective of this study is to understand whether clinicians who provide contraceptive counseling to adolescent patients perceive that the Dobbs decision has influenced their counseling. STUDY DESIGN: We conducted in-depth interviews with a convenience sample of 16 clinicians who provide contraceptive counseling to adolescents at the American Academy of Pediatrics annual conference in October 2022. We used thematic content analysis and an iterative process of constant comparison to identify themes inductively. This analysis focused on participants' perception of if and how the Dobbs decision has or will influence their contraceptive counseling with adolescents. RESULTS: Most clinicians in our study reported that the Dobbs decision influenced their contraceptive counseling. This included promoting long-acting, reversible methods more so than pre-Dobbs, and explicitly considering changing state-level abortion laws and restrictions. Many clinicians openly noted that their personal preferences influence their counseling, such as prioritizing pregnancy prevention and encouraging patients to use particular methods. CONCLUSION: We found that most clinicians in our sample acknowledged that the Dobbs decision has influenced their contraceptive counseling practices with adolescents. Clinicians' responses demonstrate that, in many instances, the Dobbs decision motivated them to focus on method effectiveness, leading to tiered and directive contraceptive counseling. We recommend practice changes to support comprehensive contraceptive care provision, provider trainings in unbiased counseling, and developmentally tailored decision aids are needed to ensure that adolescent patients' autonomy is prioritized over a singular focus on pregnancy prevention.

Effects of multiple-dose administration of zavegepant nasal spray on the single-dose pharmacokinetics of ethinyl estradiol-levonorgestrel.

OBJECTIVE: The potential for drug-drug interaction of multiple-dose intranasal zavegepant on the single-dose oral contraceptive ethinyl estradiol and levonorgestrel (EE-LNG) was evaluated. BACKGROUND: Zavegepant (as a nasal spray) is a calcitonin gene-related peptide receptor antagonist approved in the United States for treatment of acute migraine in adults. METHODS: This single-center, Phase 1, open-label, fixed-sequence study included healthy, nonsmoking females (18-45 years old). In treatment Period 1, a single oral dose of EE-LNG 0.02-0.10 mg was administered on Day 1. In treatment Period 2, intranasal zavegepant (20 mg daily; 10 mg per nostril separated by 1 h) was administered on Days 1-5; 1 oral dose of EE-LNG 0.02-0.10 mg was administered immediately after first 10 mg intranasal zavegepant dose on Day 2. Blood samples for EE-LNG concentrations were collected on Day 1, treatment Period 1, and Day 2, treatment Period 2, and zavegepant concentrations on Day 2, treatment Period 2. Noncompartmental pharmacokinetic parameters included maximum observed concentration (Cmax), area under the concentration-time curve (AUC) from Time 0 to last non-zero concentration (AUC0-t), and AUC from Time 0 to infinity (AUC0-inf). The safety and pharmacokinetic sample sizes were 26 and 23, respectively. RESULTS: Statistical comparisons of pharmacokinetic exposure parameters after co-administration of zavegepant and EE-LNG versus EE-LNG alone showed small, but statistically insignificant, changes in either EE or LNG exposure. EE comparison ratios (90% confidence intervals [CIs]) were 109.9% (105.3%, 114.8%) for AUC0-inf and 110.2% (104.6%, 116.1%) for Cmax. LNG comparison ratios (90% CIs) were 107.0% (100.2%, 114.3%) for AUC0-inf and 108.8% (99.9%, 118.4%) for Cmax. Frequently reported treatment-emergent adverse events included dysgeusia (n = 25, 96%), throat irritation (n = 11, 42%), headache (n = 10, 39%), nasal discomfort (n = 7, 27%), pharyngeal paresthesia (n = 5, 19%), and nausea (n = 4, 15%). CONCLUSION: Co-administration of zavegepant nasal spray with a single dose of an oral contraceptive resulted in no clinically meaningful changes (<12% increase) in EE-LNG exposure.

Prolonged use of chlormadinone acetate and risk of intracranial meningioma: A population-based cohort study.

BACKGROUND AND PURPOSE: Chlormadinone acetate (CMA) is a synthetic progestin for which cases of intracranial meningioma have been reported following prolonged exposure. METHOD: An observational cohort study was conducted based on the French national health data system. Women aged 10-70 years and who started CMA between 2007 and 2017 were included. Participants were considered to be exposed if they had received a cumulative dose >360 mg of CMA during the first 6 months and very slightly exposed (control group) when they had received a cumulative dose ≤360 mg. The outcome was surgery or radiotherapy for one or more intracranial meningioma(s). Poisson models assessed the relative risk (RR) of meningioma. RESULTS: In total, 828,499 women were included: 469,976 in the exposed group (mean age 39.1 years, SD 10.1) and 358,523 in the control group (38.3 years, SD 11.0). Surgery or radiotherapy for intracranial meningioma between 2007 and 2017 was recorded for 164 and 104 women in the exposed and control groups, respectively. The incidence of meningioma was 18.5 and 6.8 per 100,000 person-years for the exposed and control groups respectively (crude RR = 2.7, 95% confidence interval [CI] 2.1-3.5; age-adjusted RR = 3.1, 95% CI 2.4-4.0). Meningioma incidence reached almost 47 cases/100,000 person-years in the most exposed group (>8.64 g), giving an age-adjusted RR of 6.9, 95% CI 5.1-9.2, relative to the control group. CONCLUSIONS: A strong dose-effect relationship was observed between prolonged use of CMA and risk of meningiomas. As with other progestogens, meningiomas associated with CMA are more likely to be found at the base of the skull.

Current oral contraceptive use affects explicit and implicit measures of depression in women.

Some data suggest that increased depressive symptoms may occur in women using combined oral contraceptives (OCs). However, this idea is controversial and the existing evidence is conflicting. The present study compared negative affect in 53 healthy women (M age = 19.9 years) during intervals of active daily OC hormone intake and during the washout week of the contraceptive cycle when no exogenous estrogens or progestins are used. A prospective counterbalanced repeated-measures study design was employed. Depressive affect was evaluated using standard psychometric tests of explicit (self-perceived) and implicit negative affect. Implicit measures are considered less subject to bias related to social expectations, self-awareness, or willingness to disclose. Other than their usual OCs, participants were medication-free and had been using OCs for a median of 12 mo. We found that measures of implicit affect (e.g., Affect Misattribution Procedure, Emotional Stroop Test) displayed a more depressive-like pattern of performance during active hormone intake, particularly among a subgroup of OC users who reported experiencing high levels of depressive affect more generally. In contrast, participants' self-perceptions suggested that they perceived their negative symptoms to be greater during the 'off' phase of the OC cycle, when OC steroids are withdrawn and menses occurs. The present findings reinforce the possibility of depressive mood effects associated with OC usage, and highlight the utility of including implicit measures, but also illustrate the complexity of mood assessment in OC users.

Male Contraception - part of gender medicine and reproductive right of men.

A pregnancy is in general the result of the sexual interaction of two individuals, with either different or same genders (male, female, non-binary etc) Preventing an unwanted pregnancy is therefore basically a "joint preventive behavior", which can be achieved by gender specific behaviors with gender specific methods in a specific sociocultural environment. This sociocultural environment (circumstances) determines the frame of gender specific behaviors (reproductive rights) and the available gender specific contraceptive methods (contraceptive technology). In the sociocultural history of contraception different models of contraceptive practice evolved from the patriarchal to the female emancipation model, with different balances and imbalances regarding these two basic components. Based on the concept of the "joint preventive behavior" not only reproductive rights including reproductive responsibilities, but also contraceptive choices should be as equally balanced as possible, to allow collaboration between two individuals involved in reproduction. The development and the broad availability of different male contraceptive methods allowing individualization and best fit between the method and the individual profile, will be an important way forward to achieve this goal.

The association of reproductive health factors with periodontitis in 45-80 years old US women from NHANES 2009-2014.

OBJECTIVES: We investigated the association of female reproductive factors with periodontitis. MATERIALS AND METHODS: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2014 on 2321 women aged 45-80 years who had full-mouth periodontal examination and reproductive questionnaire. The 2018 World Workshop Classification of Periodontal and Peri-implant Diseases was used to classify periodontitis stages. RESULTS: After adjustment, > 3 pregnancies or live births were associated with increased stage III/IV periodontitis but age at first birth (AFB) > 23 years and female hormone use were associated with decreased stage III/IV periodontitis, while there were no associations of oral contraceptive use or menopause status with stage III/IV periodontitis. Stage III/IV periodontitis was more common in women with > 3 pregnancies or live births and AFB ≤ 23 years or never using female hormones but less common in women with ≥ 3 pregnancies or > 3 live births and AFB > 23 years or using female hormones. >3 pregnancies or live births were related with increased stage III/IV periodontitis and increased AFB was related with lowered stage III/IV periodontitis in overweight and smoking subgroups but using female hormone was related with reduced stage III/IV periodontitis in nonsmoking, non-overweight and black subgroups. CONCLUSIONS: >3 pregnancies/live births were related with severe periodontitis but AFB > 23 years and female hormone use were related with ameliorating periodontitis. CLINICAL RELEVANCE: Women with > 3 pregnancies/live births should receive intensive periodontal interventions. Female hormone therapy or AFB > 23 years may be beneficial for periodontal health of > 3 pregnancies/live births women.

Contraceptive Choice and Sexual Behaviors in Both-Sex Attracted Adolescents: A Retrospective Cohort Study.

STUDY OBJECTIVE: Bisexual adolescents have higher rates of unintended pregnancy than their heterosexual peers and increased rates of high-risk sexual behaviors. They may be less likely to use effective contraception, though limited data is available. This study sought to compare contraceptive choice and sexual risk behaviors of both-sex attracted and opposite-sex attracted adolescents and young adults (AYA) presenting to a contraception clinic. METHODS: A retrospective chart review of AYA aged 14-24 years who presented for an initial visit to a contraception clinic from 2014 to 2020. The primary outcome was contraceptive choice (long-acting reversible contraception (LARC), non-LARC, or nothing). Secondary outcomes included sexual behaviors. Results were analyzed using Pearson's chi-square and Wilcoxon tests. RESULTS: 2369 AYA were included in this study. Both-sex attracted and opposite-sex attracted patients were similar in age, race, and ethnicity. There was no difference between groups in percent selecting LARC (71% vs 66.1%, p=0.11). Both-sex attracted patients reported a younger age at first sex (14.6 years vs 15.5 years, p < .001), more lifetime sexual partners (4.1 vs 2.8, p < .001), and a higher prevalence of forced intercourse (21.9% vs 8.8%, p < .001). CONCLUSIONS: Both-sex attracted and opposite-sex attracted AYA patients chose LARCs at similar rates in a setting with standardized contraceptive counseling. Both-sex attracted patients had more sexual risk behaviors. Healthcare providers should be inclusive in their approach to obtaining sexual health histories and providing contraceptive counseling and be cognizant that adolescents with both-sex attraction may be at higher risk of forced intercourse.

Primary Care Clinicians' Interest In, and Barriers To, Medication Abortion.

PURPOSE: Providing medication abortion in the primary care setting is a promising way to increase access to abortion, a threatened service in many States. This study aimed to characterize primary care clinicians' interest in prescribing medication abortion, what barriers they face in adding this service, and what support they need. METHODS: Data were collected from 162 practicing primary care clinicians in Minnesota using an online survey with closed- and open-ended response options. Data were analyzed using descriptive statistics, group comparison analyses, and content analysis for the open-ended questions. RESULTS: Participants represented a diverse range of ages, years in practice, credentials, genders, and urban/rural practice settings, and held mixed knowledge and attitudes around medication abortion. All demographic groups surveyed expressed interest in prescribing medication abortion, with the strongest interest represented among younger respondents, women, and those practicing in urban settings. Clinicians who provide prenatal care or who already work with these medications in other contexts were more likely to want to add medication abortion to their practices. The most common barrier to providing medication abortion was a lack of knowledge about organizational policies and about the medications themselves. To empower clinicians to provide medication abortion, respondents voiced needing their health systems to build clear processes and wanting supportive networks of other clinicians for collaboration. CONCLUSIONS: Given the interest of primary care clinicians in providing medication abortion, health systems have a valuable opportunity to increase access.

A Novel Intravaginal Contraceptive Plug for Cats: A Preliminary Biocompatibility Assessment on Haematology and Vaginal Swab.

This preliminary study evaluated the biocompatibility of a novel degradable intravaginal plug contraceptive composed of PEG 4000 and chitosan in cats using haematological profiling and vaginal cytology. Five healthy, non-pregnant female cats were fully anaesthetised and fitted with an intravaginal plug (10 × 0.3 mm) using an applicator, following oestrogen administration 3 h prior. Blood samples were collected from the cephalic vein on days 0 (pre-insertion) and 3 and 7 (post-insertion). Vaginal cytology examinations were conducted on day 0 (pre- and post-oestrogen injection) and days 1, 3 and 7 post-insertion. Haematological parameters, including red blood cell count, haemoglobin levels, haematocrit values, total white blood cell count and differentiation, showed no significant changes after contraceptive insertion (p > 0.05). Vaginal cytology indicated an acute inflammatory response in one out of five subjects on day three post-insertion. The distribution of vaginal epithelial cells (parabasal, intermediate and superficial) remained unaffected by contraception. Oestrogen injection resulted in the dominance of superficial cells up to day 7 of observation (p < 0.05). Overall, PEG 4000 and chitosan-based intravaginal plug contraceptives demonstrated sufficient biocompatibility, indicating their potential as viable contraceptive options for feline use.

Factors associated with modern contraceptive utilization among reproductive age women in Cambodia; evidenced by the recent Cambodia demographic and health survey.

INTRODUCTION: Cambodia is a low-income country with limited access to family planning (FP) in terms of modern contraceptive utilization. Despite several FP programs designed to make contraceptives accessible, adoption of contraceptives has been difficult in Cambodia, which has high rates of fertility and maternal mortality. This gap in essential care can put women and adolescent girls at greater risk of adverse outcomes such as stillbirth, spontaneous abortion, unwanted pregnancy, or even maternal death. One of the goals set by the government to decrease both maternal and child mortality and morbidity was increasing the modern contraceptives utilization. So, the main objective of this study was to evaluate spatial variations in modern contraceptives utilization and its contributing factors among women. METHODS: Data from the Cambodia 2021-22 Demographic and Health Survey datasets were used for secondary data analysis. A total of 19,496 women of reproductive age participated in the study. A spatial and multilevel mixed effects analysis was done on the factors affecting modern contraceptives utilization among Cambodian women. Finally, the percentage, odd ratio, together with their 95% confidence intervals and the results of the spatial analysis were provided. RESULT: The prevalence of modern contraceptive use was 31.2% in Cambodia. Living in an urban area [AOR = 1.224; 95% CI = (1.126.1.330); P = 0.0001]; being married [AOR = 34.131; 95% CI= (12.673, 91.921); P = 0.0001]; and having a history of terminated pregnancy [AOR = 1.137; 95% CI= (1.055, 1.225); P = 0.0001] were found to be positively associated with modern contraceptive utilization. In contrast to this, being between the age range of 46-49 [AOR = 0.421; 95% CI = (0.364, 0.487); P = 0.0001]; being a female-headed household [AOR = 0.784; 95% CI = (0.723, 0.850); P = 0.0001]; and current breast feeding [AOR = 0.84; 95% CI = (0.75, 0.93); P = 0.010] were found to be negatively associated with modern contraceptive utilization. Additionally, the spatial analysis of modern contraceptive utilization showed that a higher proportion was utilized in the southern and southwest regions of Cambodia. CONCLUSION: In this study, living in urban area, being married and having history of terminated pregnancy were found positively associated with modern contraceptive utilization. In contrast to this, being old age, being female headed household and being currently breast-feeding women were found negatively associated with modern contraceptive utilization. In addition to this, there were geographic (spatial) variations in modern contraceptive utilization among Cambodian's women across the country.

Suspected Hepatotoxicity from Etonogestrel Contraceptive Implant: A Rare Case Report.

We present a case of suspected hepatotoxicity secondary to an etonogestrel contraceptive implant in which the patient presented with vomiting, jaundice, pruritis, elevated transaminases, and hyperbilirubinemia. An extensive work-up, including liver biopsy, was unremarkable. The implant was removed and the patient's symptoms and transaminitis resolved, suggestive of drug-induced liver injury.

Pandemic changes in U.S. contraceptive use: National survey estimates reveal significant differences by demographic subgroups.

OBJECTIVES: The COVID-19 pandemic brought multiple simultaneous consequences, with high potential to change fertility-related behaviors. We use nationally representative sex and contraceptive use event history calendar measures to demonstrate person-specific changes in contraceptive use after the pandemic, showing differences across demographic subgroups. STUDY DESIGN: We use data from the first nationally representative web survey of U.S. fertility, fielded in 2020-2022: the American Family Health Study (AFHS). Using responses from 1357 female-identifying respondents ages 18-49, we analyze 26,274 person-months of sex and contraceptive use data spanning directly before and after the beginning of the pandemic to detect change. RESULTS: Individual-level hazard models of starting and stopping contraception revealed no pandemic-related changes in starting contraception, but significant reductions in the rate of stopping contraception for specific subgroups. Hispanic females reduced their rates of stopping contraceptive use during the pandemic (lowering their odds of stopping use by 71%), ultimately behaving more similarly to individuals from other racial or ethnic subgroups. Additionally, those aged 41 and older significantly reduced their rates of stopping contraceptive use (lowering their odds of stopping use by 78%) relative to other age groups. CONCLUSIONS: Sudden large-scale health policy changes can produce significant changes in contraceptive use behaviors. The COVID-19 changes interacted with race, ethnicity, and age to produce different changes in contraceptive behaviors among different subgroups of the U.S.

Influences on ethnic minority women's experiences and access to contraception in the UK: a systematic qualitative evidence synthesis.

BACKGROUND: Accessible contraception is critical for promoting the health and well-being of women and their families. In the UK, contraception is free at the point of access, but only 55% of pregnancies are planned, with negative implications for maternal and infant outcomes. In general, women from ethnic minorities use contraceptives less than white women. Barriers to the uptake of contraceptives have been identified, including perceived poor information from healthcare professionals and concerns about side effects. However, most studies do not include representative proportions of women from ethnic minorities. Evidence suggests that ethnic minority (EM) women feel targeted and coerced by healthcare professionals regarding contraception. METHODS: A systematic search of Medline, Embase, and PsycINFO via Ovid, CINAHL, and Web of Science was conducted to identify primary qualitative and mixed-methods studies exploring ethnic minority women's experience of contraception in the UK. The data were charted using thematic analysis, using both summary and synthesis. RESULTS AND CONCLUSIONS: 16 studies met the inclusion criteria, including the perspectives of 717 participants from an ethnic minority. Four overarching themes were developed: contraceptive knowledge, beliefs, family, and services. Similar to women in general, ethnic minority women have concerns about side effects, especially infertility, value the perspectives of their peers and male partners, and express a preference for female healthcare professionals. Novel perspectives included conflicting ideas about the influence of religion and stereotyping of ethnic minority women. Culturally competent consultations and a better understanding of hormonal hesitancy are essential.

A Family Physician's Experience in the Removal of Migrating Subdermal Contraceptive Implants.

Subdermal contraceptive implants are among the most effective and reversible contraceptive methods available today. Implanon®ï¸, approved by the US FDA, is widely used for long-term family planning due to its extended contraceptive effects. Although generally safe, these implants can occasionally lead to rare but serious complications, such as migration into deeper axillary structures. In this case report, we describe the experience of a family physician with a 30-year-old Saudi woman whose Implanon implant migrated approximately 11 cm from the original insertion site over three years. The patient presented for removal of the implant, which had reached the end of its contraceptive duration and was to be removed in preparation for future conception. Initial attempts by the family physician to localize and remove the implant were unsuccessful due to its continued migration toward the axilla. Consequently, the case was referred to the obstetrics and gynecology clinic and subsequently to the orthopedic department. The foreign body was successfully removed using an intraoperative, fluoroscopy-guided procedure, with no complications observed post-surgery. This case underscores the importance of physician awareness and a multidisciplinary approach to managing such complications. It also highlights that implant migration is not necessarily related to the physician's skill or patient characteristics, underscoring the unpredictable nature of this complication. This report aims to provide insights and recommendations for handling similar cases, advocating for early intervention, and the use of imaging techniques when managing non-palpable implants.

From data to decisions: Exploring family planning services utilization in Karnataka and India through the prism of NFHS-4 and NFHS-5.

Background: Family planning (FP) services are pivotal in assessing a country's healthcare efficacy. Despite India's strides in FP promotion, disparities persist in its utilization rates. This study analyzes Karnataka's FP trends by using National Family Health Survey (NFHS) rounds 4 and 5, comparing its indicators with national averages. Methods: A retrospective record review-based descriptive study design was employed. Data from NFHS-4 (2015-16) and NFHS-5 (2019-21) were analyzed using MS Excel 365. Key variables included age at marriage, total fertility rate (TFR), and various contraceptive methods. Results: Karnataka exhibited a stable rate of early marriages for women and a decline among men aged 25-29 years. TFR in Karnataka slightly decreased, with increased contraceptive usage and significant growth in modern contraceptive methods. However, male sterilization rates remained low. There was an improvement in health workers' engagement with female non-users and in providing information on contraceptive side effects. Conclusion: While Karnataka has progressed in FP, challenges such as early marriages persist. Enhancing integration, leveraging technology, and empowering women are essential for comprehensive FP services in India.

Effectiveness of the etonogestrel subdermal implant in users with overweight and obesity: a systematic literature review.

BACKGROUND: The etonogestrel (ENG) subdermal implant is considered a well-tolerated and effective contraception option to avoid unintended pregnancies. However, it is unclear whether being affected by overweight or obesity diminishes the effectiveness of the implant. OBJECTIVES: To systematically assess the published evidence on implant contraceptive effectiveness in women with overweight or obesity, and in women who underwent bariatric surgery. SEARCH STRATEGY: A systematic search of MEDLINE and Embase for publications reporting implant effectiveness since 2011. SELECTION CRITERIA: Primary publications of randomised and non-randomised trials, observational studies and case reports were included. DATA COLLECTION AND ANALYSIS: Two independent reviewers identified the Pearl Index, qualitative descriptions of contraceptive failure, implant exposure and potential bias, and assessed overall quality of evidence. MAIN RESULTS: We found 12 publications meeting our criteria, consisting of nine observational studies and three case reports. Excluding case reports, the publications reported Pearl Indices from 0.0/100 women-years (WY) to 0.23/100WY for women with overweight and obesity, respectively. No studies met the eligibility criteria for the post-bariatric surgery population. CONCLUSIONS: Observed implant effectiveness in women with overweight and obesity falls within the range of published data across all weight groups (0.0-1.4/100 WY) and does not suggest a reduced effectiveness associated with higher body mass index. Large, well-controlled studies designed to specifically assess the effectiveness of the ENG implant with respect to user weight, particularly in women following bariatric surgery, are warranted.

The Effect of the Oral Contraceptive Pill on Acute Glycaemic Response to an Oral Glucose Bolus in Healthy Young Women: A Randomised Crossover Study.

Background/Objective: The oral contraceptive pill (OCP) is widely used by women worldwide, yet the influence of the OCP on carbohydrate metabolism remains under-investigated, with existing studies being few and largely cross-sectional. The study objective was to assess, for the first time, the effect of the combined OCP on postprandial glycaemic response to an oral glucose bolus, using a randomised crossover design. Methods: The effect of a combined monophasic OCP phase on glucose homeostasis and metabolic profile was investigated in 21 healthy young women, who were regular users of either androgenic or anti-androgenic OCP formulations. Plasma glycaemic markers (glucose, insulin and C-peptide) were assessed prior to a 60 g glucose drink (fasting) and for a further 4 h postprandially; once during the "active" (hormone-containing) pill phase and once during the "inactive" (hormone-free) pill phase of the OCP usage cycle. Results: Despite no change in fasting values, in androgenic pill users, postprandial glucose and insulin responses to an oral glucose bolus were ~100% and ~50% greater, respectively, during the active versus inactive phase. In contrast, in anti-androgenic pill users there was no significant change in response between the two OCP usage cycle phases. Conclusions: These findings highlight an acute, but potentially detrimental, influence of the combined OCP on glucose homeostasis, particularly in users of formulations containing androgenic progestogens. Given the high global prevalence of OCP use and increasingly common prolonged active pill regimens, which may continue for months, years or even decades, potential cumulative effects of such changes on metabolic risk demand further investigation.

Tennessee Medicaid patient immediate postpartum long-acting reversible contraception utilization.

OBJECTIVES: To understand immediate postpartum long-acting reversible contraception (IPP LARC) desire and utilization trends among publicly insured patients delivering at one academic hospital in a state with health care barriers and high short-interval birth rates. STUDY DESIGN: We conducted a retrospective cohort study of electronic delivery records between March 2018 and June 2023 for publicly insured patients. Patient demographics, IPP LARC desire and utilization trends were compared using χ2 or Fisher exact tests. Binary logistic regression explored the relationship between IPP LARC utilization and demographics. Multivariable logistic regression was performed on all statistically significant variables. RESULTS: Analysis included 10,472 delivery encounters; 2459 (23.5%) requested IPP LARC on admission and 464 (4.4%) changed contraception to IPP LARC after admission. Among those obtaining IPP LARC (n = 2523, 24.1%), 1224 (48.5%) selected arm implants and 1299 selected intrauterine devices (IUDs). Patients who self-reported as non-Hispanic Black and non-Hispanic Other or multiple races utilized IPP LARC less (adjusted Odds Ratio (aOR)=0.84, 95% CI: 0.72-0.98, aOR=0.68, CI 95%: 0.48-0.97, respectively). Patients with cesarean delivery (aOR=1.45, 95% CI: 1.31-1.61) or inadequate prenatal care (aOR=1.54, CI 95%: 1.35-1.75) were more likely to utilize IPP LARC. Maternal age and years of education were inversely associated with utilization. Primiparous patients were less likely to utilize IPP LARC. CONCLUSIONS: Long-acting reversible contraception (LARC) utilization was 24.1% during the immediate postpartum period; higher than the 11% nationally reported interval LARC use among publicly insured patients. Understanding the demographics of those desiring IPP LARC could highlight accessibility gaps. The impact of IPP LARC utilization on rates of short-interval birth is being evaluated. IMPLICATIONS: Understanding the demographics of IPP LARC utilizers may contribute to understanding accessibility gaps and facilitate discernment of factors impacting patient initiation. Evidence suggests that comprehensive contraception access during delivery admission is feasible, patient-desired, and essential.

Simultaneous removal of impalpable implants in both the left and the right arm - a case report and implications for their use in low-resource settings.

Implanon NXT® is a single rod contraceptive implant that is a long-acting reversible contraceptive method. Placement and removal is usually simple if the instructions of use are followed. Deviation from these instructions may lead to the implant becoming impalpable and consequently difficult to remove. We report on a case of a 46- year- old woman who had an impalpable implant in both the left and the right upper arms simultaneously. They had been placed approximately ten and seven years previously and were probably not releasing etonogestrel and were no longer relied on for contraceptive efficacy. The implants were removed relatively easily after ultrasound mapping. This case highlights some of the problems with the provision of implants in low-resource settings. The problems of implant management and some practical suggestions regarding its use in these settings is discussed.

The Association between Medroxyprogesterone Acetate Exposure and Meningioma.

BACKGROUND/OBJECTIVES: Medroxyprogesterone acetate (MPA) is a synthetic progesterone that is most commonly used as a contraceptive. MPA acts by binding to the progesterone receptor of the hypothalamus, and this receptor has been found to be important in the pathophysiology of meningiomas. Recent research has reported an increased association between the use of MPA and intracranial meningioma, though the literature is mostly limited by low numbers of meningioma cases and low exposure to MPA. The objective of the current study is to build upon the previously published literature utilizing a large database from the United States. METHODS: Utilizing a large commercial insurance database, the current matched case-control study identified meningioma cases using ICD-10 codes from hospital data and MPA exposure, as established from pharmaceutical claims data. Controls were matched 10:1 to cases based on age, year of enrollment, and duration of enrollment. A conditional logistic regression estimated odds ratios (ORs) for the association between MPA exposure and the odds of developing a meningioma. RESULTS: Among 117,503 meningioma cases and 1,072,907 matched controls, oral MPA exposure was not associated with odds of meningioma; however, injection MPA exposure was associated with a 53% increased odds of being a case (OR 1.53, 95% CI 1.40-1.67). This association was specific to cerebral meningiomas (OR 1.68, 95% CI 1.50-1.87), an association that became stronger with a longer duration of use of injection MPA. CONCLUSIONS: The current results are consistent with the prior literature, which reports an association between injection exposures to MPA and a stronger association with increasing use of MPA. Women should be cautioned about the prolonged use of MPA, and future research should examine whether the extended use of MPA is associated with the meningioma grade.