Contraception

Premenstrual disorders encompass a spectrum of cyclic affective and physical symptoms that interfere with daily functioning, occurring during the luteal phase and resolving with or immediately following menstruation. Premenstrual disorders may be caused by fluctuations of estrogen in the luteal phase, leading to dysregulation of serotonin, increased sensitivity to changes in the progesterone metabolite allopregnanolone, or both. Diagnosis can be made based on symptom assessment with daily ratings for at least 2 consecutive menstrual cycles, such as the Daily Record of Severity of Problems.1,2 Affective symptoms include lability (mood swings, sudden sadness or tearfulness, sensitivity to rejection), irritability or anger, depressed mood, and anxiety or tension. Physical symptoms include difficulty concentrating, lethargy or fatigue, appetite changes, sleep disturbances, breast tenderness, joint pain, and abdominal bloating.

Premenstrual syndrome (PMS) is characterized by the cyclic occurrence of any of these affective or physical findings during the premenstrual period and affects approximately one-quarter of menstruating individuals. Premenstrual dysphoric disorder (PMDD) is more severe than PMS and less common (affecting 2%-5% of females). Based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), the diagnosis of PMDD requires at least 5 symptoms, including at least 1 affective symptom and 1 physical symptom, the week before menses. Symptoms of PMDD substantially decrease or resolve the week after menses.1,2 Treatment choices are based on the timing and severity of symptoms and patient goals such as desire for contraception.

Author/s:

Rebeca Ortiz Worthington, Lindsey M Eastman, Jason T Alexander

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Erin Blanchette — Mon, 24 Mar 2025 16:11:24 +0000

Date Added:

March 24, 2025

Journal/Publication:

Journal of the American Board of Family Medicine

Publisher:

American Board of Family Medicine

Publication Date:

November 1, 2024

Issue:

Volume:

Pages:

1150-1155

URL:

Practical Recommendations for Minimizing Pain and Anxiety with IUD Insertion

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3122/jabfm.2024.240079R1

Keywords

PMID (1):

40118554

MeSH

Intrauterine Devices* / adverse effects

Intrauterine Devices

female

Contraceptive Agents, Female

Pain / prevention & control

pain management

Lidocaine

Prilocaine Drug Combination

An evidence-based review of methods for reducing pain during IUD insertion. Many of these would probably work as well for other painful procedures. James W. Mold, MD, MPH

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Background: Intrauterine devices (IUDs) are one of the most effective, long-lasting, and convenient contraceptive methods available in the United States. Unfortunately, the anticipated pain and anxiety associated with an IUD insertion procedure deter many people from using this contraceptive method.

Methods: A literature review was conducted on PubMed by searching the terms “IUD insertion”, “pain management”, “anxiety”, “gynecologic procedures”. The Cochrane database was also searched for reviews about pain management methods during IUD insertions. Findings were summarized using the American Academy of Family Physicians’ Strength of Recommendation Taxonomy (SORT) scale.

Results: Pharmacologic methods that can be used to reduce pain with IUD insertion include naproxen, tramadol, lidocaine paracervical blocks, 10% lidocaine spray, lidocaine-prilocaine cream, and EMLA cream. Non-pharmacologic methods for reducing pain or anxiety during gynecologic procedures include pre-insertion counseling, “verbal analgesia”, lavender aromatherapy, distraction with music or television, using Valsalva maneuver instead of tenaculum during IUD insertion, and use of heating pad during procedure.

Conclusion: Moderately effective pharmacologic and non-pharmacologic methods exist for reducing pain and anxiety with IUD insertion. These treatment methods should be offered to create a more comfortable experience for patients. Additional research is needed to determine the comparative efficacy of these methods.

Author/s:

Viktoriya Ovsepyan, Petra Kelsey, Ann E Evensen

Adolescent-Centered Sexual and Reproductive Health Communication

Alex Haga — Thu, 23 Jan 2025 19:37:47 +0000

Date Added:

January 23, 2025

Journal/Publication:

JAMA

Publication Date:

January 21, 2025

URL:

Adolescent-Centered Sexual and Reproductive Health Communication

Type:

Best Local Practices

Format:

Article

DOI (1):

10.1001/jama.2024.24246

Keywords

contraception

adolescent

sexual behavior

PMID (1):

39693089

MeSH

adolescent

Reproductive Health

Sexual Behavior

sexually transmitted diseases

Contraception

Tips for talking with teens about sex and pregnancy. James W. Mold, MD, MPH

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This JAMA Insights explores how clinicians can effectively communicate person-centered health care information to adolescents regarding sexual and reproductive health, contraception, and sexually transmitted infection testing and treatment.

Author/s:

Bianca A Allison, Tracey A Wilkinson, Julie Maslowsky

What Teens Should Know About Choosing Contraception

Alex Haga — Sat, 10 Aug 2024 18:09:38 +0000

Date Added:

August 10, 2024

Journal/Publication:

JAMA

Publication Date:

July 29, 2024

URL:

What Teens Should Know About Choosing Contraception

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.1530

Keywords

PMID (1):

39073806

MeSH

Reproductive Health Services

Information for teens and their parents regarding contraceptive options. James W. Mold, MD, MPH

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This JAMA Pediatrics Patient Page describes what teens should consider when choosing contraception methods.

Author/s:

Shaketha A Gray, Lindsay A Thompson

Long-Acting Reversible Contraception With Contraceptive Implants and Intrauterine Devices

Saige Blanchard — Tue, 14 Jun 2022 05:00:00 +0000

Date Added:

June 14, 2022

Journal/Publication:

JAMA

Publisher:

JAMA Network

Publication Date:

May 6, 2022

Issue:

Volume:

327

Pages:

2013-2014

URL:

Long-Acting Reversible Contraception With Contraceptive Implants and Intrauterine Devices

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.5448

Keywords

contraception

Contraceptive Implants

Intrauterine Devices

PMID (1):

35522320

MeSH

Contraception

Contraceptive Agents, Female

Humans

Intrauterine Devices

Long-Acting Reversible Contraception

A concise summary of long-acting, reversible contraceptive options for women. James W. Mold, MD, MPH

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Long-acting reversible contraception (LARC), including contraceptive implants and intrauterine devices (IUDs), is highly effective, with typical-use failure rates of less than 1 pregnancy per 100 person-years of use.1 Fertility returns rapidly after discontinuation of LARC.

Author/s:

Averbach, S., Hofler, L.

Contraceptive Challenges in Women With Common Medical Conditions

Brian Desmarais — Sat, 07 Nov 2020 21:17:24 +0000

Date Added:

November 7, 2020

Journal/Publication:

Mayo Clinic proceedings

Publisher:

Mayo Clinic

Publication Date:

November 1, 2020

Issue:

Volume:

Pages:

2525-2534

URL:

Contraceptive Challenges in Women With Common Medical Conditions

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.08.045

MeSH

health personnel

reproduction

Contraceptive Devices

Recommendations for contraception in patients with a variety of medical conditions. James W. Mold, MD, MPH

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Women have the opportunity to meet personal contraceptive goals with convenient, highly reliable, and easily reversible methods. Long-acting reversible contraception represents an increasingly popular option for most women throughout the reproductive lifespan. Nonetheless, many women and their health care providers are challenged by coexisting medical issues. We aim to help clinicians individualize contraception and use shared decision-making to enhance patient satisfaction and continuation with their method.

Author/s:

Gave, C.J., Marnach, M.L., Casey, P.M.