Clinical Instructor, Obstetrics & Gynecology
PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception.RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data.SUMMARY: Repeat pericoital dosing of 1.5-mg LNG is approximately as effective as other on-demand contraceptive methods and is overall very safe. The most common side effect is irregular bleeding. Repeat on-demand ulipristal acetate or meloxicam/other cyclo-oxygenase-2 inhibitors have potential as an on-demand option either alone or in combination but have not been evaluated for contraceptive efficacy in a large-scale study. Given the high unmet need for contraception, even among women with access to available options, there is a distinct need for options that address needs of women who are interested in an on-demand option. On-demand oral contraception has the potential to expand the convenience of contraceptive options and overall contraceptive use.
View details for PubMedID 30399016
The immediate postpartum period is a critical moment for contraceptive access and an opportunity to initiate long acting reversible contraception, including insertion of an intrauterine device (IUD). The use of the IUD in the postpartum period is a safe practice with few contraindications and many benefits. While an IUD placed during the postpartum period is more likely to expel compared to one placed at the postpartum visit, women initiating IUDs at the time of delivery are also more likely to continue to use an IUD compared to women planning to follow up for an interval IUD insertion. This review will focus on the most recent clinical and programmatic updates on postpartum IUD practice. We discuss postpartum IUD expulsion and continuation, eligibility criteria and contraindications, safety in regards to breastfeeding, and barriers to access. Our aim is to summarize evidence related to postpartum IUDs and encourage those involved in the health care system to remove barriers to this worthwhile practice.
View details for PubMedID 30031750