Thank you for attending our Expanding Reproductive Autonomy and Contraceptive Access trainings on August 25th & 26th, 2023 at the Lentz Public Center in Nashville, TN. Many thanks to the Joe C. Davis Foundation for hosting our training.

Beyond the Pill is a program of the Bixby Center for Global Reproductive Health at UCSF and promotes access and equity in contraceptive health care through research and training.

Thanks to everyone who asked questions and participated during our sessions!

Parts: "Do you have preferred language that use use to refer to your body parts (i.e. genitals)?" "How would you like me to refer to your parts?"

Partners: "Tell me about the body parts of your partners."

Practices: "What parts of your body do you have sex with?" "What parts of your body touch what parts of your partner's body?"

Pregnancy: "Do you have a sense of if/when you might want to become pregnant/parent (again)?" "Would you like to talk about pregnancy planning or prevention today?"

Prevention: "What do you and your partner(s) do to prevent pregnancy?" "When you have sex, are there methods used for STI protection, like internal/external condoms?"

Pleasure: "Is there anything about your (or your partner's) sexual practices that you would like to change?"

Unfortunately, there is not a pregnancy wheel as part of the phone app, but one reliable option for EDD calculators or gestational age calculators is the ACOG app (if you are an ACOG member).

The "older age" designation in the MEC, found when clicking through the Personal Characteristics and Reproductive History section, is characterized as 40 and older, a 'hold-over' designation from the WHO. Some providers may use combined hormonal contraceptives for perimenopause treatment in people through 51 years of age, so it's important to recognize that being 40 or older is not a contraindication to using CHCs. The MEC states, "The risk for cardiovascular disease increases with age and might increase with CHC use. In the absence of other adverse clinical conditions, CHCs can be used until menopause."

Source: MEC

According to UptoDate, while there are not yet studies comparing norethindrone to the newer drospirenone POPs, there is reason to believe that drospirenone may be the more effective option, as there is a higher dose of hormone (4mg versus 3mg). However, this is purely hypothetical and needs to be confirmed through randomized control trials.

How POPs compare to COCs has also not been widely studied; however, it is more common that pill users are taking a combined estrogen-progestin pill. The typical failure rate for combined pills is about 7%, whereas the failure rate for those taking POPs is likely to be greater than 7 percent (Trussell, 2011). One consideration is that those who use POPs may be 'subfertile' due to factors such as breastfeeding, which may artificially lower the the typical-use failure rates for POPs.

Trussell, 2011. https://pubmed.ncbi.nlm.nih.gov/21477680/

If you have additional questions regarding STI treatment and follow-up, or even for issues like bacterial vaginosis (BV), and you don't have a local resource in your area, you can consult with the National Network of STD Clinical Prevention Training Centers to receive guidance as well.

According to the CDC STD treatment guidelines (there's a phone app as well!), there are several regimens listed. For our clinician trainer, the following options have had the most success in practice:

An additional guide is the University of Michigan's Resource for Vulvovaginal Conditions. This patient handout describes comfort care measures that may relieve symptoms (in addition to soaking in plain water baths regularly).

While there is no current consensus on whether all hormonal methods cause weight gain, there is reliable evidence that weight gain is a common side-effect of the DMPA birth control shot. One systematic review studying the question of whether appetite increase is the cause for weight gain when using DMPA found that there was insufficient evidence to draw this conclusion. Another systematic review (Dianat, et al. 2019) shows that DMPA-associated increases in weight have to do with an increase in fat mass and not lean mass (lean mass is defined as the total body weight excluding fat mass).

Behavioral mechanisms explaining weight gain with DMPA remain unclear; additional research is needed to inform a clearer understanding.

From the Office of Population Affairs: FABM resource for patients

The Reproductive Health Access Project is an amazing resource for individuals who work in reproductive health. RHAP offers several resources on contraception, emergency contraception, abortion, and miscarriage care.

The UCSF Person-Centered Reproductive Health Program (PCRHP) created the Person-Centered Contraceptive Counseling Measure, a tool to help clinics assess the person-centeredness of their contraceptive counseling. This measure was endorsed by the National Quality Forum in November 2020.