ADMs, CME, and You: Just What the Doctor Ordered

I have almost completed the “sweep” of our fall Annual District Meetings. Once again, I’m impressed with the dedication of my ob–gyn colleagues across the United States. These meetings are proving to be educational, collegial, and administrative. I say ”administrative” because we discuss the “goings on” of each region, including the political factors impacting each of our states, the public health dilemmas we face, and the effect of changing practice patterns. I look forward to these information exchanges and to sharing insights with my colleagues about the forces influencing our practices and our patients.

For me, the educational component of the ADMs has been most exciting. In a time when physicians are increasingly getting their CME online, the ADM courses provide more than just the course information. They provide perspective and insight from the experts in the field in real time. At the District I, III, and IV ADM in Puerto Rico, Jeffrey F. Peipert, MD, PhD, argued for a paradigm shift in our approach to contraception in his presentation about the St. Louis CHOICE Project. With wider use of LARC (long-acting reversible contraception), we can significantly reduce our nation’s high rate of unplanned pregnancies and abortions and start to see healthier pregnancies. Dr. Peipert provided abundant pearls about how easy LARC is to provide to our patients and how it can improve reproductive health outcomes. We can all use this valuable information in our practices.

At the same ADM, Louis J. Guillette, PhD, gave a rousing talk about the impact of the environment on reproductive health. As it turns out, we both did research at the University of Colorado at almost the same time and even shared members of our thesis teams. Who would guess that our paths would cross 35 years later around shared interests? Dr. Guillette’s message: Increase awareness among our patients—without alarming them—about the vast amount of research implicating environmental factors on our health. And, Deborah A. Driscoll, MD, helped to simplify for us the complex world of genetic testing and familial cancers. Thanks to her, genomic microarray-based technologies are now part of our vocabulary.

Increasingly, physicians are earning more of their CME online. The reality is we are all crunched for time and online CME opportunities are valuable options. But online courses don’t allow for that in-person learning that is so often accompanied by practice pearls. Nor do they provide an opportunity for us to have personal, individual conversations with our colleagues which are so important. I hope that you’ll make plans to attend your next ADM…it’s definitely worth your time.

Remember, registration for the 2014 Annual Clinical Meeting in Chicago opens November 5, just a few weeks away!

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Guest Blog: The Recipe for Preventing Unintended Pregnancy

Erika E. Levi, MD, MPH

Ob-gyns are on the front lines of the effort to decrease the rate of unintended pregnancy, which accounts for half of all pregnancies in the US. Now, we have more information about how we can best accomplish this goal.

Recent findings from the Contraceptive CHOICE Project made news headlines, and for good reason. The project—which included more than 9,000 contraception-seeking adolescents and women in the St. Louis region who were at risk for unintended pregnancy—found that the rate of unintended pregnancy dropped with just two simple interventions. Women were given:

  1. A short contraceptive counseling session that covered all methods of reversible contraception and emphasized the superior effectiveness of long-acting reversible contraception (LARC) methods: intrauterine devices (IUDs) and hormonal implants.
  2. The contraceptive method of their choice for free.

Seventy-five percent of the women selected a LARC method. Among all the women, there were lower rates of abortion, including repeat abortion, and lower rates of teen births. These findings support ACOG’s recommendations on the use of LARC methods as first-line contraceptive options to reduce unintended pregnancy and highlight the benefits of providing women with no-cost access to contraception.

ACOG advises ob-gyns to:

  • Provide counseling on all contraceptive options, including implants and IUDs, even if the patient initially states a preference for a specific contraceptive method
  • Encourage implants and IUDs for all appropriate women, including those who’ve never given birth
  • Adopt same-day insertion protocols. Screening for STIs may also occur on the day of insertion, if indicated
  • Avoid unnecessary delays to LARC initiation, such as waiting for a follow-up visit after an abortion or miscarriage or waiting to time insertion with the menstrual cycle
  • Advocate for coverage of all contraceptive methods by all insurance plans
  • Support local, state, federal, and private programs that provide contraception, including IUDs and implants

The problem of unintended pregnancy in the US is not going away. As ob-gyns, we are uniquely positioned to help women avoid unintended pregnancies. Let’s work with our patients and help them make the best choices for their reproductive health.

Erika E. Levi, MD, MPH, is a Family Planning Fellow at the University of North Carolina at Chapel Hill.

Guest Blog: Prevent Teen Pregnancy on a LARC

Elisabeth J. Woodhams, MD

In my Chicago clinic I see a lot of adolescents, and by extension, I prescribe a lot of contraception. Although, by “prescribe contraception” I actually mean “place IUDs and implants,” which, until recently, had been considered a fairly edgy clinical practice in some circles. Imagine my excitement, then, over ACOG’s latest recommendations from the Committee on Adolescent Health Care and the Long-Acting Contraception Work Group that encourage us to offer these two contraceptive methods as first-line options for sexually active teens.

Family planning specialists have long known that long-acting reversible contraception (LARC) devices are safe for adolescents and are significantly more effective at preventing pregnancy when compared with other forms of short-acting contraception, such as pills, patches, or vaginal rings. In fact, a recent study found that women using a LARC device were 20 times less likely to experience an unplanned pregnancy than women using short-acting methods. This is hugely important considering that:

  • 82% of adolescent pregnancies are unplanned
  • 20% of adolescent mothers will experience a second pregnancy within two years of their first pregnancy
  • Condoms are the most common method of contraception used by adolescents. While still important for preventing sexually transmitted infections (STIs), they are the least effective contraceptive method for preventing pregnancy.

LARC methods work better than short-acting ones because there’s no user error. As I tell my patients, a pack of pills only works if you’re actually taking them. Also, the continuation rates are better—in that same study, 86% of adolescents using a LARC device were still using it a year later, compared with 55% of those using a shorter-acting method.

And LARC methods are very safe for adolescents:

  •  IUD expulsion is uncommon in adolescents
  • There is no increased risk of infertility for IUD users
  • Any increased risk of pelvic inflammatory diseases (PID) is limited to the first 20 days after insertion of an IUD and is related to infection at the time of insertion rather than the IUD itself. This is another important reason ob-gyns should screen all their patients under 25 for chlamydia and gonorrhea annually.
  • IUDs and implants can be placed immediately post-delivery or post-abortion
  • IUDs and implants can decrease menstrual blood loss and decrease anemia, a plus for many teens

So make sure LARC methods are at the top of your list when you’re counseling adolescent patients. For many teens, LARC devices—combined with condoms for STI prevention—are the best way to ensure they get on the right reproductive track early.

Elisabeth J. Woodhams, MD, is a Family Planning Fellow at the University of Chicago in Illinois.