CDC updates contraception guidelines for health-care providers

As new evidence comes to light, the CDC periodically updates its guidelines for contraceptive use and best practices for health-care professionals.

The latest round of updates was released this week.

The recommendations are meant to support health-care providers with creating what health scientist Kate Curtis with the CDC’s Division of Reproductive Health called “patient-centered contraceptive counseling and services and really to improve access and remove unnecessary medical barriers.”

But, she added, it’s still important for patients to be in the loop enough to have the right conversations with those providers.

“There's a recognition that while certain regimens of testosterone might suppress fertility, testosterone therapy has not been studied as contraception,” said Curtis. “And so it's important for both healthcare providers and patients who are using testosterone to recognize that they may be at risk for pregnancy.”

“They can talk to their health-care providers about the full range of contraception options that might be available to them, to help them figure out how they can best meet their needs and support their choices in contraception care.

Other key updates include recommendations for people with chronic kidney disease, management of bleeding irregularities with implants, and self-administration of the injectable contraception.

According to Curtis, the wide variety of recommendations open up a more patient-centered approach by increasing choices and making existing ones more accessible.

When it comes to the self-injectable contraceptive depot medroxyprogesterone acetate, or DMPA-SC for short, for example, “self-administered DMPA-SC can then be a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy.”

Patient comfort is another area Curtis indicated some newly included guidelines may come into play.

“In 2016, we did add a recommendation about medications for IUD placement and then this time around, we looked at that evidence again,” said Curtis. “Previously, we had talked about the use of lidocaine as a paracervical block for IUD placement, and we've added topical lidocaine based on evidence for that.”

Providers will also find some newly added information about how patients should be counseled on potential pain during placement, risks, benefits, and alternatives of different options for pain management.

“Really helping providers think about engaging patients and patient-centered discussions on pain management prior to IUD placement,” Curtis added.

Other key guidelines among the new batch include similar recommendations to manage irregular bleeding caused by contraceptive implants.

“A lot of people who use implants do have some irregular bleeding. It's generally not harmful, but it might be bothersome to the patient. And so, we've had recommendations about management of bleeding irregularities for many years,” explained Curtis.

But after looking at the evidence again: “We’ve added some new medications to that, as well as some more information about person-centered counseling, really helping providers think about exploring goals with patients. Do they want to continue implant use? Do they want to try and manage bleeding irregularities with the medication? Do they want to discontinue? And if so, do they want to think about switching to another method?”

Curtis said that, overall, the evidence-based recommendations are meant to serve as tools for providers to facilitate these conversations and reduce barriers to make contraceptive care more accessible.