Contraception lessons for 2020

October 29, 2020
Bob Kronemyer

Freelance writer for Contemporary OB/GYN

“Telehealth visits serve to ensure patient-centered, shared decision-making counseling, as well as allowing the provider to confirm that the patients are good candidates with no contraindications for their method of choice,” Eve Espey, MD, MPH, said.

The American College of Obstetricians and Gynecologists’ (ACOG) 2020 Virtual Conference starts this Friday, Oct. 30, with presentations by preeminent experts in ob/gyn. Presentations will be given through Saturday, Oct. 31. Check out the full schedule here and register to attend. It will stream live and on-demand.

Now is the time for all clinicians to embrace telehealth when prescribing contraceptives, incorporate reproductive justice into their practice, and include the United States Medical Eligibility Criteria for Contraceptive Use (US MEC) as a contraceptive resource, according to Eve Espey, MD, MPH, Chair of ob/gyn at the University of New Mexico in Albuquerque.

In her presentation at the American College of Obstetricians and Gynecologists (ACOG) 2020 Virtual Conference, Dr. Espey notes that especially in the era of the COVID epidemic, telehealth sessions are a viable alternative to in-person clinical visits for contraception in patients seeking short-acting methods like oral contraceptive pills, the contraceptive patch, and the contraceptive ring.

“Telehealth visits serve to ensure patient-centered, shared decision-making counseling, as well as allowing the provider to confirm that the patients are good candidates with no contraindications for their method of choice,” Dr. Espey told Contemporary OB/GYN.

In the case of estrogen-containing contraceptives, a history ruling out contraindications and a prior normal blood pressure (BP) reading in the chart or a self-reported normal BP is sufficient for prescribing the method.

“Similarly, a 12-month prescription of a contraception to be filled at a single pharmacy visit in states that permit this, and considering refills beyond a year, can improve care for patients during COVID,” Dr. Espey said.

SisterSong, a Women of Color Reproductive Justice Collective, defines reproductive justice as the human right to maintain personal bodily autonomy, have children or not have children, and parent children in safe and sustainable communities. “For clinicians, that means actively opposing reproductive oppression and adopting an entirely patient-centered framework, where we work to leave our biases at the door, respect the values and preferences of our patients, value the reproductive desires of all our diverse patients equally, and ensure affordable access to all contraceptives,” Dr. Espey said.

Reproductive justice also entails not pushing one’s own beliefs about who needs contraception and/or what kinds of contraceptives are most appropriate for any given patient. “Allow patients to drive conversations and decision-making about contraception, including honoring their decisions about whether and when to start and stop contraceptive methods,” Dr. Espey said.

The US Medical Eligibility Criteria (US MEC) provides user-friendly, data-driven guidance on appropriate candidates for contraception.

“The resource uses data from ongoing systematic literature reviews and integrates the best up-to-date evidence on safety of contraceptives for patients, with a number of different characteristics and conditions,” Dr. Espey said.

One of the new developments in contraception is the extended use of long-acting reversible contraception (LARC), particularly during the pandemic, “to ensure excellent contraception and minimize unnecessary patient-provider contact,” Dr. Espey said.

Passage of proactive policy measures to improve contraception adherence is also needed in many states; examples include passing legislation to require insurance coverage for 12 months of contraceptives dispensed at a time or passing contraceptive equity laws to ensure that contraceptives are covered to the same degree as other pharmaceuticals.

Two new contraceptives on the market are a 1-year combined estrogen-progestin vaginal ring and a new lower-dose contraceptive patch.

“Continuing contraceptive technology development ensures a wide array of methods to fulfill patients’ needs over their reproductive lifespans,” Dr. Espey said.

In addition, oral emergency contraception, including levonorgestrel (Plan B, Next Step) and ulipristal acetate (Ella) are not abortifacients, according to Dr. Espey. “The public and some providers remain confused about oral emergency contraception, which acts by delaying ovulation in contrast to mifepristone, which is one of two medications used for early medication abortion and for early pregnancy loss management,” she said.

Likewise, intrauterine devices (IUDs) do not cause pelvic inflammatory disease or tubal infertility. “These two conditions are caused by sexually transmitted infections and not independently by IUDs,” Dr. Espey said.

The ACOG 2020 Virtual Conference will be held on October 30 and 31 from noon to 4 pm ET. Register here.

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Dr. Espey reports no relevant financial disclosures.