contraception

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.

Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

Saige Blanchard — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

Centers for Disease Control and Prevention

Publication Date:

May 21, 2021

Issue:

Volume:

Pages:

739-743

URL:

Update to U.S. Selected Practice Recommendations for Contraceptive Use: Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.15585/mmwr.mm7020a2

Keywords

PMID (1):

34014910

MeSH

Medroxyprogesterone Acetate

Contraceptive Agents

Surface Plasmon Resonance

Contraception Behavior

Patient Preference

decision making

Guidance from the CDC on self-administered depo-medroxyprogesterone acetate for contraception. James W. Mold, MD, MPH

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U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

Author/s:

Curtis, K. M., Nguyen, A., Reeves, J. A., Clark, E. A., Folger, S. G., Whiteman, M. K.