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New combined oral contraceptive effective at suppressing ovarian activity
Newer combined hormonal contraceptives (CHCs) are in development which are hoped to have fewer side effects and better safety profiles. A Phase 2 clinical efficacy study has compared an experimental estetrol and drospirenone contraceptive pill with a commercially available ethinylestradiol-drospirenone pill and found similar suppression of ovarian activity. Estetrol, a naturally occurring estrogen, is thought to be less likely to increase thrombotic risk compared with ethinylestradiol; however, further research will be required to determine this, given that thromboembolic events remain rare in CHC users.
Contraception 2021; https://doi.org/10.1016/j.contraception.2021.03.003
Systemic hormonal contraception use immediately after abortion appears safe
Rapid initiation of effective contraception is recognised as a strategy to improve access to and continuation of contraception following abortion. There is limited high quality evidence to inform timing of initiating these methods particularly those that may require clinician involvement. A systematic review has identified a small number of variable quality randomised controlled trials (RCTs) initiating systemic hormonal contraception following medical and surgical abortion in the first trimester. Due to the size and quality of the studies included, definitive conclusions could not be drawn; however, it does not appear that any methods cause bleeding-related problems following abortion. There may be a slight decrease in efficacy of medical abortion when progestogen-only injectable contraception is co-administered with mifepristone; however, this reduction appears small and may be outweighed by the benefit of immediate initiation of a reliable method.
Contraception 2021; https://doi.org/10.1016/j.contraception.2021.01.017
Social media posts about LARCs are increasingly positive
Information shared via social media platforms is often highly valued by the reader and has the potential to influence a range of health behaviours, including contraception use. A study using natural language processing (a form of computer learning) to analyse more than 800 000 posts on Twitter over a 15-year period found that posts about contraception were generally negative overall in character. However, as time went on, the proportion of tweets about long-acting reversible contraceptive (LARC) methods increased and became increasingly positive. This may represent increasing access and promotion of these methods but may also be a way of sharing positive experiences, non-contraceptive benefits and good quality information with prospective contraceptive users.
Am J Obstet Gynecol 2020; https://doi.org/10.1016/j.ajog.2020.11.042
Short video reduces post-caesarean opioid use
Optimal pain management, without over-prescription of analgesia, following obstetric and gynaecological procedures can be difficult to achieve. An RCT demonstrated that a 5- minute video about self-management of postoperative pain, shown to women following caesarean section and prior to discharge from the ward, resulted in a significant reduction in postoperative oxycodone use at 7 and 14 days. There was no difference in pain scores and side effect rates between groups. The study is US-based and so analgesia regimens used may differ from other healthcare settings, but this simple intervention may help women to better manage their pain following childbirth. It is also possible that such interventions may be useful in other areas of sexual and reproductive healthcare (SRH), such as abortion care and hysteroscopy.
Obstet Gynecol 2021; doi: 10.1097/AOG.0000000000004468
Doxycycline is superior to azithromycin for the treatment of asymptomatic rectal chlamydia
In an era of worsening antimicrobial resistance, robust data are needed to guide clinicians on the treatment of common bacterial infections. Chlamydia remains susceptible to both doxycycline and azithromycin; however, there are benefits and drawbacks of each treatment, particularly with rectal infection. An RCT compared doxycycline 100 mg for 7 days with azithromycin 1 g single dose in the treatment of rectal chlamydia in men who have sex with men (MSM). Doxycycline was significantly more likely to lead to a confirmed cure and had a lower incidence of gastrointestinal side effects than azithromycin. Doxycycline use avoids the risk of macrolide resistance developing in other sexually transmimtted infections such as gonorrhoea and mycoplasma genitalium.
N Engl J Med 2021; https://www.nejm.org/doi/full/10.1056/NEJMoa2031631
Hepatitis B immunisation appears suboptimal among MSM
Hepatitis B immunisation is recommended for MSM in the UK; however, prevalence of susceptibility and immunisation is poorly documented. A study using over 2000 stored samples collected in 2016 found that among MSM, two-thirds had no evidence of immunity to hepatitis B infection. MSM were less likely to be immunised if they had never been previously tested for HIV, indicating lack of previous interaction with sexual health services. This study was conducted during a global shortage of hepatitis B vaccines and perhaps the low rate of immunity also reflects clinical protocols for vaccination at that time.
Sex Transm Infect 2021; https://sti.bmj.com/content/early/2021/06/29/sextrans-2021-055071
Valsalva movement may be an alternative to tenaculum during IUD insertion
Intrauterine device (IUD) insertion can be uncomfortable, and many women find application of a tenaculum to be particularly painful. An alternative method of stabilising the uterus during insertion may be to ask the woman to perform the Valsalva manoeuvre. An RCT compared tenaculum with Valsalva manoeuvre at the time of IUD insertion. There was no difference between groups regarding successful insertion rate; however, the pain score was lower in the Valsalva group. The trial was small but suggests that this could be a simple alternative or adjunct when inserting an IUD.
Eur J Contracept Reprod Health Care 2021; https://doi.org/10.1080/13625187.2021.1934442
Patient consent for publication
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.