Contraception

Key clinical point: Overall, oral contraceptives were more effective than placebo for treating symptoms of PMS and PMDD, but none of the combined oral contraceptives stood out as more effective than the others, and oral contraceptives had no apparent impact on premenstrual depressive symptoms.

Major finding:  In a pairwise meta-analysis, combined oral contraceptives showed no effectiveness compared to placebo for reducing premenstrual depressive symptoms, with a standardized mean difference of 0.22. However, combined oral contraceptive use overall was moderately effective compared to placebo for improving premenstrual symptomatology overall (standardized mean difference 0.41).

Study details: The data come from a meta-analysis of nine randomized clinical trials including 1,205 women aged approximately 24-37 years who reported premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).  

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: De Wit AE et al. Am J Obstet Gynecol. 2021 Jul 2. doi: 10.1016/j.ajog.2021.06.090. 

Key clinical point: Overall, oral contraceptives were more effective than placebo for treating symptoms of PMS and PMDD, but none of the combined oral contraceptives stood out as more effective than the others, and oral contraceptives had no apparent impact on premenstrual depressive symptoms.

Major finding:  In a pairwise meta-analysis, combined oral contraceptives showed no effectiveness compared to placebo for reducing premenstrual depressive symptoms, with a standardized mean difference of 0.22. However, combined oral contraceptive use overall was moderately effective compared to placebo for improving premenstrual symptomatology overall (standardized mean difference 0.41).

Study details: The data come from a meta-analysis of nine randomized clinical trials including 1,205 women aged approximately 24-37 years who reported premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).  

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: De Wit AE et al. Am J Obstet Gynecol. 2021 Jul 2. doi: 10.1016/j.ajog.2021.06.090. 

Key clinical point: Overall, oral contraceptives were more effective than placebo for treating symptoms of PMS and PMDD, but none of the combined oral contraceptives stood out as more effective than the others, and oral contraceptives had no apparent impact on premenstrual depressive symptoms.

Major finding:  In a pairwise meta-analysis, combined oral contraceptives showed no effectiveness compared to placebo for reducing premenstrual depressive symptoms, with a standardized mean difference of 0.22. However, combined oral contraceptive use overall was moderately effective compared to placebo for improving premenstrual symptomatology overall (standardized mean difference 0.41).

Study details: The data come from a meta-analysis of nine randomized clinical trials including 1,205 women aged approximately 24-37 years who reported premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).  

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: De Wit AE et al. Am J Obstet Gynecol. 2021 Jul 2. doi: 10.1016/j.ajog.2021.06.090. 

Key clinical point: Adolescent oral contraceptive use was associated with a significant increase in risk of major depressive disorder in young adulthood; the results may help inform choices for contraceptive methods.

Major finding:  Use of oral contraceptives at age 16-19 years was significantly associated with an episode of major depressive disorder at age 20-25 years (odds ratio 1.41, P < .001). The association was slightly higher among young women with no previous history of major depressive disorder.

Study details: The data come from a prospective cohort study of 725 women who participated in the Tracking Adolescents’ Individual Lives (TRAILS) study in Denmark. Use of OCs at ages 16-19 years was assessed as a predictor of major depressive disorder at ages 20-25 years based on the Diagnostic and Statistical Manual of Mental Disorders-IV oriented Lifetime Depression Assessment Self-Report and the Composite International Diagnostic Interview.

Disclosures: The larger TRAILS study was supported by Netherlands Organization for Scientific Research NWO, the Dutch Ministry of Justice, the European Science Foundation, the European Research Council, Biobanking and Biomolecular Resources Research Infrastructure, the Gratama Foundation, the Jan Dekker Foundation, the participating universities, and Accare Centre for Child and Adolescent Psychiatry. This specific study was also supported by the Feodor Lynen Research Fellowship from the Alexander von Humboldt-Foundation and a Canadian Institutes of Health Research Project Grant awarded to study authors. The researchers had no financial conflicts to disclose.

Source: Anderl C et al. J Child Psychol Psychiatry. 2021 Jul 12. doi: 10.1111/jcpp.13476. 

Key clinical point: Adolescent oral contraceptive use was associated with a significant increase in risk of major depressive disorder in young adulthood; the results may help inform choices for contraceptive methods.

Major finding:  Use of oral contraceptives at age 16-19 years was significantly associated with an episode of major depressive disorder at age 20-25 years (odds ratio 1.41, P < .001). The association was slightly higher among young women with no previous history of major depressive disorder.

Study details: The data come from a prospective cohort study of 725 women who participated in the Tracking Adolescents’ Individual Lives (TRAILS) study in Denmark. Use of OCs at ages 16-19 years was assessed as a predictor of major depressive disorder at ages 20-25 years based on the Diagnostic and Statistical Manual of Mental Disorders-IV oriented Lifetime Depression Assessment Self-Report and the Composite International Diagnostic Interview.

Disclosures: The larger TRAILS study was supported by Netherlands Organization for Scientific Research NWO, the Dutch Ministry of Justice, the European Science Foundation, the European Research Council, Biobanking and Biomolecular Resources Research Infrastructure, the Gratama Foundation, the Jan Dekker Foundation, the participating universities, and Accare Centre for Child and Adolescent Psychiatry. This specific study was also supported by the Feodor Lynen Research Fellowship from the Alexander von Humboldt-Foundation and a Canadian Institutes of Health Research Project Grant awarded to study authors. The researchers had no financial conflicts to disclose.

Source: Anderl C et al. J Child Psychol Psychiatry. 2021 Jul 12. doi: 10.1111/jcpp.13476. 

Key clinical point: Adolescent oral contraceptive use was associated with a significant increase in risk of major depressive disorder in young adulthood; the results may help inform choices for contraceptive methods.

Major finding:  Use of oral contraceptives at age 16-19 years was significantly associated with an episode of major depressive disorder at age 20-25 years (odds ratio 1.41, P < .001). The association was slightly higher among young women with no previous history of major depressive disorder.

Study details: The data come from a prospective cohort study of 725 women who participated in the Tracking Adolescents’ Individual Lives (TRAILS) study in Denmark. Use of OCs at ages 16-19 years was assessed as a predictor of major depressive disorder at ages 20-25 years based on the Diagnostic and Statistical Manual of Mental Disorders-IV oriented Lifetime Depression Assessment Self-Report and the Composite International Diagnostic Interview.

Disclosures: The larger TRAILS study was supported by Netherlands Organization for Scientific Research NWO, the Dutch Ministry of Justice, the European Science Foundation, the European Research Council, Biobanking and Biomolecular Resources Research Infrastructure, the Gratama Foundation, the Jan Dekker Foundation, the participating universities, and Accare Centre for Child and Adolescent Psychiatry. This specific study was also supported by the Feodor Lynen Research Fellowship from the Alexander von Humboldt-Foundation and a Canadian Institutes of Health Research Project Grant awarded to study authors. The researchers had no financial conflicts to disclose.

Source: Anderl C et al. J Child Psychol Psychiatry. 2021 Jul 12. doi: 10.1111/jcpp.13476. 

Key clinical point: A uterine sound-sparing approach significantly increased patient satisfaction with IUD insertion compared to a trans-abdominal ultrasound guided approach.

Major finding:  The VAS scores for patient satisfaction were significantly higher in women who underwent IUD placement with the USSA approach compared to the TVS approach (7.80 vs 5.45, P = .0001). Significantly lower VAS pain scores and significantly shorter duration of insertion also were reported in the USSA group compared to the TVS group (P = .001 and P = .0001, respectively).

Study details: The data come from a randomized, open-label study of multiparous women who requested copper IUD insertion for birth control; 44 women underwent placement with the trans-abdominal ultrasound (TAS) guided approach and 44 with the uterine sound-sparing approach (USSA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ali MK et al. Eur J Contracept Reprod Health Care. 2021 Apr 15. doi: 10.1080/13625187.2021.1900565.

Key clinical point: A uterine sound-sparing approach significantly increased patient satisfaction with IUD insertion compared to a trans-abdominal ultrasound guided approach.

Major finding:  The VAS scores for patient satisfaction were significantly higher in women who underwent IUD placement with the USSA approach compared to the TVS approach (7.80 vs 5.45, P = .0001). Significantly lower VAS pain scores and significantly shorter duration of insertion also were reported in the USSA group compared to the TVS group (P = .001 and P = .0001, respectively).

Study details: The data come from a randomized, open-label study of multiparous women who requested copper IUD insertion for birth control; 44 women underwent placement with the trans-abdominal ultrasound (TAS) guided approach and 44 with the uterine sound-sparing approach (USSA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ali MK et al. Eur J Contracept Reprod Health Care. 2021 Apr 15. doi: 10.1080/13625187.2021.1900565.

Key clinical point: A uterine sound-sparing approach significantly increased patient satisfaction with IUD insertion compared to a trans-abdominal ultrasound guided approach.

Major finding:  The VAS scores for patient satisfaction were significantly higher in women who underwent IUD placement with the USSA approach compared to the TVS approach (7.80 vs 5.45, P = .0001). Significantly lower VAS pain scores and significantly shorter duration of insertion also were reported in the USSA group compared to the TVS group (P = .001 and P = .0001, respectively).

Study details: The data come from a randomized, open-label study of multiparous women who requested copper IUD insertion for birth control; 44 women underwent placement with the trans-abdominal ultrasound (TAS) guided approach and 44 with the uterine sound-sparing approach (USSA).

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Ali MK et al. Eur J Contracept Reprod Health Care. 2021 Apr 15. doi: 10.1080/13625187.2021.1900565.

Key clinical point: Users of hormone-containing intrauterine  (HIUD) devices had no significant increase in risk of developing precancerous cervical lesions than women who used other contraceptives.

Major finding: Women who used hormone-containing IUDs had the same risk as users of copper IUDs (CIUD) of developing cervical intraepithelial neoplasia 3+ (CIN3+) with adjusted relative risk of 1.08 over 5 years. The risk of CIN3+ was lower for the HIUD group and CIUD group compared to users of oral contraceptives (aRR 0.63 and aRR 0.58, respectively).

Study details: The data come from a population-based cohort study of women aged 26-50 years in Denmark, using registry data from 2008 to 2011; the study population included 60,551 users of HIUDs, 30,303 users of CIUDs, and 165,627 users of oral contraceptives.

Disclosures: The study was supported by the A.P. Møller Foundation for the Advancement of Medical Science, the Else and Mogens Wedell-Wedellborgs Fund, the Direktør Emil C. Hertz og Hustru Inger Hertz Fund, and the Fund for Development of Evidence Based Medicine in Private Specialized Practices. Lead author Dr. Skortengaard had no financial conflicts to disclose.

Source: Skortengaard M et al. Hum Reprod. 2021 Jun 18. doi: 10.1093/humrep/deab066.

Key clinical point: Users of hormone-containing intrauterine  (HIUD) devices had no significant increase in risk of developing precancerous cervical lesions than women who used other contraceptives.

Major finding: Women who used hormone-containing IUDs had the same risk as users of copper IUDs (CIUD) of developing cervical intraepithelial neoplasia 3+ (CIN3+) with adjusted relative risk of 1.08 over 5 years. The risk of CIN3+ was lower for the HIUD group and CIUD group compared to users of oral contraceptives (aRR 0.63 and aRR 0.58, respectively).

Study details: The data come from a population-based cohort study of women aged 26-50 years in Denmark, using registry data from 2008 to 2011; the study population included 60,551 users of HIUDs, 30,303 users of CIUDs, and 165,627 users of oral contraceptives.

Disclosures: The study was supported by the A.P. Møller Foundation for the Advancement of Medical Science, the Else and Mogens Wedell-Wedellborgs Fund, the Direktør Emil C. Hertz og Hustru Inger Hertz Fund, and the Fund for Development of Evidence Based Medicine in Private Specialized Practices. Lead author Dr. Skortengaard had no financial conflicts to disclose.

Source: Skortengaard M et al. Hum Reprod. 2021 Jun 18. doi: 10.1093/humrep/deab066.

Key clinical point: Users of hormone-containing intrauterine  (HIUD) devices had no significant increase in risk of developing precancerous cervical lesions than women who used other contraceptives.

Major finding: Women who used hormone-containing IUDs had the same risk as users of copper IUDs (CIUD) of developing cervical intraepithelial neoplasia 3+ (CIN3+) with adjusted relative risk of 1.08 over 5 years. The risk of CIN3+ was lower for the HIUD group and CIUD group compared to users of oral contraceptives (aRR 0.63 and aRR 0.58, respectively).

Study details: The data come from a population-based cohort study of women aged 26-50 years in Denmark, using registry data from 2008 to 2011; the study population included 60,551 users of HIUDs, 30,303 users of CIUDs, and 165,627 users of oral contraceptives.

Disclosures: The study was supported by the A.P. Møller Foundation for the Advancement of Medical Science, the Else and Mogens Wedell-Wedellborgs Fund, the Direktør Emil C. Hertz og Hustru Inger Hertz Fund, and the Fund for Development of Evidence Based Medicine in Private Specialized Practices. Lead author Dr. Skortengaard had no financial conflicts to disclose.

Source: Skortengaard M et al. Hum Reprod. 2021 Jun 18. doi: 10.1093/humrep/deab066.

Key clinical point: Current use of hormonal contraceptives was associated with lower mean levels of anti-Müllerian hormone compared to levels in women not on contraceptives; the data may guide clinicians in counseling women to continue their contraceptives during evaluation of ovarian reserve.

Major finding: Compared to women not using any contraceptives, mean anti-Müllerian hormone levels were significantly lower in women using a combined oral contraceptive pill (23.68%), vaginal ring (22.07%), hormonal intrauterine device (6.73%), implant (23.44%), or progestin-only pill (14.80%).

Study details: The data come from a cross-sectional study of 27,125 women aged 20-46 years in the United States. The researchers used dried blood spot cards or venipuncture to assess anti-Müllerian hormone levels.

Disclosures: Modern Fertility, manufacturer of the tests used in the study, paid salaries and consulting fees to the study authors. Lead author Dr. Hariton is a paid consultant for Modern Fertility, has stock options in the company, and his spouse is a Modern Fertility employee.

Source: Hariton E et al. Am J Obstet Gynecol. 2021 Jun 12. doi: 10.1016/j.ajog.2021.06.052.

Key clinical point: Current use of hormonal contraceptives was associated with lower mean levels of anti-Müllerian hormone compared to levels in women not on contraceptives; the data may guide clinicians in counseling women to continue their contraceptives during evaluation of ovarian reserve.

Major finding: Compared to women not using any contraceptives, mean anti-Müllerian hormone levels were significantly lower in women using a combined oral contraceptive pill (23.68%), vaginal ring (22.07%), hormonal intrauterine device (6.73%), implant (23.44%), or progestin-only pill (14.80%).

Study details: The data come from a cross-sectional study of 27,125 women aged 20-46 years in the United States. The researchers used dried blood spot cards or venipuncture to assess anti-Müllerian hormone levels.

Disclosures: Modern Fertility, manufacturer of the tests used in the study, paid salaries and consulting fees to the study authors. Lead author Dr. Hariton is a paid consultant for Modern Fertility, has stock options in the company, and his spouse is a Modern Fertility employee.

Source: Hariton E et al. Am J Obstet Gynecol. 2021 Jun 12. doi: 10.1016/j.ajog.2021.06.052.

Key clinical point: Current use of hormonal contraceptives was associated with lower mean levels of anti-Müllerian hormone compared to levels in women not on contraceptives; the data may guide clinicians in counseling women to continue their contraceptives during evaluation of ovarian reserve.

Major finding: Compared to women not using any contraceptives, mean anti-Müllerian hormone levels were significantly lower in women using a combined oral contraceptive pill (23.68%), vaginal ring (22.07%), hormonal intrauterine device (6.73%), implant (23.44%), or progestin-only pill (14.80%).

Study details: The data come from a cross-sectional study of 27,125 women aged 20-46 years in the United States. The researchers used dried blood spot cards or venipuncture to assess anti-Müllerian hormone levels.

Disclosures: Modern Fertility, manufacturer of the tests used in the study, paid salaries and consulting fees to the study authors. Lead author Dr. Hariton is a paid consultant for Modern Fertility, has stock options in the company, and his spouse is a Modern Fertility employee.

Source: Hariton E et al. Am J Obstet Gynecol. 2021 Jun 12. doi: 10.1016/j.ajog.2021.06.052.

Key clinical point: Pregnancy rates were low following placement of an IUD for emergency contraception, including among women who resumed intercourse within days of IUD placement without backup contraception.

Major finding:  No pregnancies were reported among 138 women who received levonorgestrel IUS or among 148 who received copper IUDs who reported intercourse within 7 days of placement, regardless of use of backup contraception.

Study details: The data come from a secondary analysis of 518 participants in a randomized controlled trial of IUDs for emergency contraception; participants received a 52 mg levonorgestrel intrauterine system (IUS) or 380 mm2 copper IUD.

Disclosures: The study was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Development, the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health. The Division of Family Planning in the University of Utah's Department of Obstetrics and Gynecology receives research funding from Bayer Women's Health Care, Merck & Co. Inc., Cooper Surgical, Sebela Pharmaceuticals, Femasys, and Medicines 360. Lead author Dr. Fay had no financial conflicts to disclose.

Source: Fay KE et al. Contraception. 2021 Jun 21. doi: 10.1016/j.contraception.2021.06.011.

Key clinical point: Pregnancy rates were low following placement of an IUD for emergency contraception, including among women who resumed intercourse within days of IUD placement without backup contraception.

Major finding:  No pregnancies were reported among 138 women who received levonorgestrel IUS or among 148 who received copper IUDs who reported intercourse within 7 days of placement, regardless of use of backup contraception.

Study details: The data come from a secondary analysis of 518 participants in a randomized controlled trial of IUDs for emergency contraception; participants received a 52 mg levonorgestrel intrauterine system (IUS) or 380 mm2 copper IUD.

Disclosures: The study was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Development, the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health. The Division of Family Planning in the University of Utah's Department of Obstetrics and Gynecology receives research funding from Bayer Women's Health Care, Merck & Co. Inc., Cooper Surgical, Sebela Pharmaceuticals, Femasys, and Medicines 360. Lead author Dr. Fay had no financial conflicts to disclose.

Source: Fay KE et al. Contraception. 2021 Jun 21. doi: 10.1016/j.contraception.2021.06.011.

Key clinical point: Pregnancy rates were low following placement of an IUD for emergency contraception, including among women who resumed intercourse within days of IUD placement without backup contraception.

Major finding:  No pregnancies were reported among 138 women who received levonorgestrel IUS or among 148 who received copper IUDs who reported intercourse within 7 days of placement, regardless of use of backup contraception.

Study details: The data come from a secondary analysis of 518 participants in a randomized controlled trial of IUDs for emergency contraception; participants received a 52 mg levonorgestrel intrauterine system (IUS) or 380 mm2 copper IUD.

Disclosures: The study was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Development, the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences of the National Institutes of Health. The Division of Family Planning in the University of Utah's Department of Obstetrics and Gynecology receives research funding from Bayer Women's Health Care, Merck & Co. Inc., Cooper Surgical, Sebela Pharmaceuticals, Femasys, and Medicines 360. Lead author Dr. Fay had no financial conflicts to disclose.

Source: Fay KE et al. Contraception. 2021 Jun 21. doi: 10.1016/j.contraception.2021.06.011.

Key clinical point: Rates of continuation and satisfaction were high among women who underwent placement of IUDs during cesarean deliveries, with two cases of infection and no cases of perforation or pregnancy reported.

Major finding:  Rates of IUD continuation were 92% at 6 weeks and 71.5% at 6 months; and approximately 85% and 76% of the women reported satisfaction with the devices at 6 weeks and 6 months, respectively.

Study details: The data come from a prospective, observational study of 158 women in Brazil who received copper IUDs during cesarean deliveries, with follow-up at 6 weeks and 6 months after IUD placement.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Uchoa de Albuquerque C et al. Eur J Contracept Reprod Health Care. 2021 Jun 29. doi: 10.1080/13625187.2021.1943739.

Key clinical point: Rates of continuation and satisfaction were high among women who underwent placement of IUDs during cesarean deliveries, with two cases of infection and no cases of perforation or pregnancy reported.

Major finding:  Rates of IUD continuation were 92% at 6 weeks and 71.5% at 6 months; and approximately 85% and 76% of the women reported satisfaction with the devices at 6 weeks and 6 months, respectively.

Study details: The data come from a prospective, observational study of 158 women in Brazil who received copper IUDs during cesarean deliveries, with follow-up at 6 weeks and 6 months after IUD placement.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Uchoa de Albuquerque C et al. Eur J Contracept Reprod Health Care. 2021 Jun 29. doi: 10.1080/13625187.2021.1943739.

Key clinical point: Rates of continuation and satisfaction were high among women who underwent placement of IUDs during cesarean deliveries, with two cases of infection and no cases of perforation or pregnancy reported.

Major finding:  Rates of IUD continuation were 92% at 6 weeks and 71.5% at 6 months; and approximately 85% and 76% of the women reported satisfaction with the devices at 6 weeks and 6 months, respectively.

Study details: The data come from a prospective, observational study of 158 women in Brazil who received copper IUDs during cesarean deliveries, with follow-up at 6 weeks and 6 months after IUD placement.

Disclosures: The study received no outside funding. The researchers had no financial conflicts to disclose.

Source: Uchoa de Albuquerque C et al. Eur J Contracept Reprod Health Care. 2021 Jun 29. doi: 10.1080/13625187.2021.1943739.

Levonorgestrel intrauterine devices (LNG IUD) are a hot topic in contraceptive research. A recent study on LNG IUDs published by Fay KE et al evaluated pregnancy rates in US women who received LNG or copper IUDs for emergency contraception and reported intercourse within 7 days of insertion. Zero pregnancies were reported in women who resumed intercourse within 7 days of IUD insertion for both the LNG IUD and copper IUD, even in women who had multiple unprotected sexual encounters.  LNG IUDs are more readily accessible and better tolerated than their copper IUD counterparts, and expanding their use will only continue to improve access to reliable contraception. Women often resume penetrative intercourse shortly after initiating new contraceptive method despite counseling. Patients can be reassured that placement of a LNG IUD appears to provide immediate contraceptive benefit.

 A new estrogen is on the market for use in combined oral contraceptive pills (COC). Estetrol is a natural estrogen produced by the human fetal liver only found in circulation during pregnancy.  Estetrol was previously studied for use in menopausal hormone therapy as it acts as a mixed agonist and antagonist, offering a potential improved side effect profile with less activity in the breast and liver.  Estetrol (15 mg) was combined with 3 mg of drospirinone for a novel combined oral contraceptive option in a study by Gemzell-Danielsson K et al.  The pregnancy rate was similar to traditional COCs, demonstrating good contraceptive efficacy. Bleeding patterns and side effects were similar to traditional COCs, and one case of venous thromboembolism was reported in the large study population. A phase III trial with similar results has been completed and this new oral contraceptive formulation recently received FDA approval and is now marketed as Nextstellis. This new oral contraceptive pill hopefully represents a novel option for women who desire COCs with a low androgenic profile and VTE risk or have failed other COC formulations.  

Women are increasingly delaying childbearing, utilizing a variety of contraceptive options to avoid pregnancy. Many proactively seek to determine their fertility potential and clinicians often utilize anti-Müllerian hormone (AMH) as the standard biomarker for assessing ovarian reserve, as it is cycle independent and can be drawn at any time during a woman’s clinical assessment.  Hormonal contraception suppresses ovulation by gonadotropin suppression as a means of contraceptive action, and thus could impact an AMH value. A fascinating study by Hariton E et al looked at all contraceptive options and their impact on AMH values. AMH levels were significantly lower in women using COCs, implants, progestin-only pills, and vaginal rings compared to patients not using contraceptives, and AMH levels were slightly lower in women using hormonal IUDs. These results help clinicians counsel patients on expectations for AMH levels while on contraceptives and can guide future research to generate contraceptive-specific ranges. Women using contraceptives should be counseled to retest after stopping if AMH levels are low.

Levonorgestrel intrauterine devices (LNG IUD) are a hot topic in contraceptive research. A recent study on LNG IUDs published by Fay KE et al evaluated pregnancy rates in US women who received LNG or copper IUDs for emergency contraception and reported intercourse within 7 days of insertion. Zero pregnancies were reported in women who resumed intercourse within 7 days of IUD insertion for both the LNG IUD and copper IUD, even in women who had multiple unprotected sexual encounters.  LNG IUDs are more readily accessible and better tolerated than their copper IUD counterparts, and expanding their use will only continue to improve access to reliable contraception. Women often resume penetrative intercourse shortly after initiating new contraceptive method despite counseling. Patients can be reassured that placement of a LNG IUD appears to provide immediate contraceptive benefit.

 A new estrogen is on the market for use in combined oral contraceptive pills (COC). Estetrol is a natural estrogen produced by the human fetal liver only found in circulation during pregnancy.  Estetrol was previously studied for use in menopausal hormone therapy as it acts as a mixed agonist and antagonist, offering a potential improved side effect profile with less activity in the breast and liver.  Estetrol (15 mg) was combined with 3 mg of drospirinone for a novel combined oral contraceptive option in a study by Gemzell-Danielsson K et al.  The pregnancy rate was similar to traditional COCs, demonstrating good contraceptive efficacy. Bleeding patterns and side effects were similar to traditional COCs, and one case of venous thromboembolism was reported in the large study population. A phase III trial with similar results has been completed and this new oral contraceptive formulation recently received FDA approval and is now marketed as Nextstellis. This new oral contraceptive pill hopefully represents a novel option for women who desire COCs with a low androgenic profile and VTE risk or have failed other COC formulations.  

Women are increasingly delaying childbearing, utilizing a variety of contraceptive options to avoid pregnancy. Many proactively seek to determine their fertility potential and clinicians often utilize anti-Müllerian hormone (AMH) as the standard biomarker for assessing ovarian reserve, as it is cycle independent and can be drawn at any time during a woman’s clinical assessment.  Hormonal contraception suppresses ovulation by gonadotropin suppression as a means of contraceptive action, and thus could impact an AMH value. A fascinating study by Hariton E et al looked at all contraceptive options and their impact on AMH values. AMH levels were significantly lower in women using COCs, implants, progestin-only pills, and vaginal rings compared to patients not using contraceptives, and AMH levels were slightly lower in women using hormonal IUDs. These results help clinicians counsel patients on expectations for AMH levels while on contraceptives and can guide future research to generate contraceptive-specific ranges. Women using contraceptives should be counseled to retest after stopping if AMH levels are low.

Levonorgestrel intrauterine devices (LNG IUD) are a hot topic in contraceptive research. A recent study on LNG IUDs published by Fay KE et al evaluated pregnancy rates in US women who received LNG or copper IUDs for emergency contraception and reported intercourse within 7 days of insertion. Zero pregnancies were reported in women who resumed intercourse within 7 days of IUD insertion for both the LNG IUD and copper IUD, even in women who had multiple unprotected sexual encounters.  LNG IUDs are more readily accessible and better tolerated than their copper IUD counterparts, and expanding their use will only continue to improve access to reliable contraception. Women often resume penetrative intercourse shortly after initiating new contraceptive method despite counseling. Patients can be reassured that placement of a LNG IUD appears to provide immediate contraceptive benefit.

 A new estrogen is on the market for use in combined oral contraceptive pills (COC). Estetrol is a natural estrogen produced by the human fetal liver only found in circulation during pregnancy.  Estetrol was previously studied for use in menopausal hormone therapy as it acts as a mixed agonist and antagonist, offering a potential improved side effect profile with less activity in the breast and liver.  Estetrol (15 mg) was combined with 3 mg of drospirinone for a novel combined oral contraceptive option in a study by Gemzell-Danielsson K et al.  The pregnancy rate was similar to traditional COCs, demonstrating good contraceptive efficacy. Bleeding patterns and side effects were similar to traditional COCs, and one case of venous thromboembolism was reported in the large study population. A phase III trial with similar results has been completed and this new oral contraceptive formulation recently received FDA approval and is now marketed as Nextstellis. This new oral contraceptive pill hopefully represents a novel option for women who desire COCs with a low androgenic profile and VTE risk or have failed other COC formulations.  

Women are increasingly delaying childbearing, utilizing a variety of contraceptive options to avoid pregnancy. Many proactively seek to determine their fertility potential and clinicians often utilize anti-Müllerian hormone (AMH) as the standard biomarker for assessing ovarian reserve, as it is cycle independent and can be drawn at any time during a woman’s clinical assessment.  Hormonal contraception suppresses ovulation by gonadotropin suppression as a means of contraceptive action, and thus could impact an AMH value. A fascinating study by Hariton E et al looked at all contraceptive options and their impact on AMH values. AMH levels were significantly lower in women using COCs, implants, progestin-only pills, and vaginal rings compared to patients not using contraceptives, and AMH levels were slightly lower in women using hormonal IUDs. These results help clinicians counsel patients on expectations for AMH levels while on contraceptives and can guide future research to generate contraceptive-specific ranges. Women using contraceptives should be counseled to retest after stopping if AMH levels are low.

One of the most common reasons patients seek care from an ob.gyn. is for contraceptive counseling and family planning. While prescribing contraceptives for cisgender patients is often part of the daily routine for ob.gyns., many are unfamiliar with counseling and options for patients who identify as transgender. In a survey of practicing ob.gyns. in nine academic centers, 80% did not receive training on caring for transgender patients.¹ Other studies have found that 5.5%-9% of transgender men have reported that a clinician informed them that testosterone was a contraceptive.^2,3

Testosterone is not a reliable form of contraception and, in fact, testosterone is considered category X, as it can induce labial fusion, produce abnormal vaginal development, cause a persistent urogenital sinus, and cause clitoromegaly in the developing fetus. Given the teratogenic effects of testosterone, it is imperative that patients who do not desire pregnancy receive appropriate contraceptive options. Counseling of patients should be individualized and start by taking a comprehensive sexual history. Such strategies include using gender-inclusive language, avoiding assumptions about sexual orientation, and obtaining an anatomic inventory of both the patient and their partner(s).⁴ While a majority of patients achieve amenorrhea while taking testosterone, it is important to discuss the need for contraception if patients are engaging in penile-vaginal intercourse. According to a study of 41 transmasculine patients who achieved pregnancy, one-third of pregnancies were unplanned. Another study reported that 20% of transmasculine patients were taking testosterone and amenorrheic at the time of conception.²

Contraindications to certain types of contraception, such as a history of a thromboembolic event precluding a patient from using combined oral contraceptives, still apply. Transmasculine patients have additional concerns that providers should be aware of and sensitive to when prescribing contraceptives. Gender dysphoria may be exacerbated by contraceptive options that require a pelvic exam or procedure, such as an intrauterine device. For patients that desire an IUD but experience heightened distress in anticipation of the procedure, premedication with anxiolytics or topical anesthetics are reasonable options.⁴ Using an adequate amount of lubricant and a small speculum may also make the exam more comfortable for patients, especially if patients do not engage in receptive frontal intercourse. Of note, certain types of IUDs, such as the Paragard, may cause pelvic cramping or abnormal bleeding, which could be a trigger for dysphoria. Patients may also experience worsening dysphoria by repeatedly taking a medication that is often associated with cisgender women, such as combined oral contraceptives (COCs). Furthermore, patients may want to avoid COCs secondary to concerns about potential feminizing effects of these hormones and their counteraction of masculinizing effects of testosterone. While COCs act to lower androgen levels by increasing sex hormone–binding globulin, which subsequently binds to testosterone, the amount of estrogen in the pill does not contribute significantly to inhibiting masculinization, and patients should be counseled accordingly.^4,5 Side effects such as breast tenderness, which is common among COCs and other estrogen-containing contraceptives, can increase dysphoria and make chest binding more painful. In patients who undergo gender-affirming mastectomies, these effects are less pronounced, however, there may be residual breast tissue left behind which can still produce tenderness and pain.

Sterilization is also a reasonable option in transmasculine patients desiring permanent contraception. Similar to sterilization counseling in cisgender women, a discussion about the irreversibility of the procedure and rates of regret should occur. Transmasculine patients may seek hysterectomy for contraception and to avoid further pelvic exams, cervical cancer screening, pelvic cramping, and/or uterine bleeding. Providers should be knowledgeable about the World Professional Association for Transgender Health standards of care for gender-affirming hysterectomies and counsel patients appropriately.

In summary, transmasculine and all gender-diverse patients deserve the same comprehensive care that their cisgender counterparts receive. Even if the ob.gyn. is not the prescribing physician for testosterone, we all must have a basic understanding of the effects of testosterone and provide appropriate contraceptive services and family planning options to patients when indicated.

Dr. Brandt is an ob.gyn. and fellowship-trained gender-affirming surgeon in West Reading, Pa.

References

1. Unger CA. J Women’s Health. 2015;24(2):114-8.

2. Abern L and Maguire K. Obstet Gynecol. 2018;131:65S.

3. Light A et al. Contraception. 2018;98:266-9.

4. Krempasky C et al. Am J Obstet Gynecol. 2020;222(2):134-43.

5. Goodman NF et al. Endocrin Pract. 2015:21(11):1291-300.
 

One of the most common reasons patients seek care from an ob.gyn. is for contraceptive counseling and family planning. While prescribing contraceptives for cisgender patients is often part of the daily routine for ob.gyns., many are unfamiliar with counseling and options for patients who identify as transgender. In a survey of practicing ob.gyns. in nine academic centers, 80% did not receive training on caring for transgender patients.¹ Other studies have found that 5.5%-9% of transgender men have reported that a clinician informed them that testosterone was a contraceptive.^2,3

Testosterone is not a reliable form of contraception and, in fact, testosterone is considered category X, as it can induce labial fusion, produce abnormal vaginal development, cause a persistent urogenital sinus, and cause clitoromegaly in the developing fetus. Given the teratogenic effects of testosterone, it is imperative that patients who do not desire pregnancy receive appropriate contraceptive options. Counseling of patients should be individualized and start by taking a comprehensive sexual history. Such strategies include using gender-inclusive language, avoiding assumptions about sexual orientation, and obtaining an anatomic inventory of both the patient and their partner(s).⁴ While a majority of patients achieve amenorrhea while taking testosterone, it is important to discuss the need for contraception if patients are engaging in penile-vaginal intercourse. According to a study of 41 transmasculine patients who achieved pregnancy, one-third of pregnancies were unplanned. Another study reported that 20% of transmasculine patients were taking testosterone and amenorrheic at the time of conception.²

Contraindications to certain types of contraception, such as a history of a thromboembolic event precluding a patient from using combined oral contraceptives, still apply. Transmasculine patients have additional concerns that providers should be aware of and sensitive to when prescribing contraceptives. Gender dysphoria may be exacerbated by contraceptive options that require a pelvic exam or procedure, such as an intrauterine device. For patients that desire an IUD but experience heightened distress in anticipation of the procedure, premedication with anxiolytics or topical anesthetics are reasonable options.⁴ Using an adequate amount of lubricant and a small speculum may also make the exam more comfortable for patients, especially if patients do not engage in receptive frontal intercourse. Of note, certain types of IUDs, such as the Paragard, may cause pelvic cramping or abnormal bleeding, which could be a trigger for dysphoria. Patients may also experience worsening dysphoria by repeatedly taking a medication that is often associated with cisgender women, such as combined oral contraceptives (COCs). Furthermore, patients may want to avoid COCs secondary to concerns about potential feminizing effects of these hormones and their counteraction of masculinizing effects of testosterone. While COCs act to lower androgen levels by increasing sex hormone–binding globulin, which subsequently binds to testosterone, the amount of estrogen in the pill does not contribute significantly to inhibiting masculinization, and patients should be counseled accordingly.^4,5 Side effects such as breast tenderness, which is common among COCs and other estrogen-containing contraceptives, can increase dysphoria and make chest binding more painful. In patients who undergo gender-affirming mastectomies, these effects are less pronounced, however, there may be residual breast tissue left behind which can still produce tenderness and pain.

Sterilization is also a reasonable option in transmasculine patients desiring permanent contraception. Similar to sterilization counseling in cisgender women, a discussion about the irreversibility of the procedure and rates of regret should occur. Transmasculine patients may seek hysterectomy for contraception and to avoid further pelvic exams, cervical cancer screening, pelvic cramping, and/or uterine bleeding. Providers should be knowledgeable about the World Professional Association for Transgender Health standards of care for gender-affirming hysterectomies and counsel patients appropriately.

In summary, transmasculine and all gender-diverse patients deserve the same comprehensive care that their cisgender counterparts receive. Even if the ob.gyn. is not the prescribing physician for testosterone, we all must have a basic understanding of the effects of testosterone and provide appropriate contraceptive services and family planning options to patients when indicated.

Dr. Brandt is an ob.gyn. and fellowship-trained gender-affirming surgeon in West Reading, Pa.

References

1. Unger CA. J Women’s Health. 2015;24(2):114-8.

2. Abern L and Maguire K. Obstet Gynecol. 2018;131:65S.

3. Light A et al. Contraception. 2018;98:266-9.

4. Krempasky C et al. Am J Obstet Gynecol. 2020;222(2):134-43.

5. Goodman NF et al. Endocrin Pract. 2015:21(11):1291-300.
 

One of the most common reasons patients seek care from an ob.gyn. is for contraceptive counseling and family planning. While prescribing contraceptives for cisgender patients is often part of the daily routine for ob.gyns., many are unfamiliar with counseling and options for patients who identify as transgender. In a survey of practicing ob.gyns. in nine academic centers, 80% did not receive training on caring for transgender patients.¹ Other studies have found that 5.5%-9% of transgender men have reported that a clinician informed them that testosterone was a contraceptive.^2,3

Testosterone is not a reliable form of contraception and, in fact, testosterone is considered category X, as it can induce labial fusion, produce abnormal vaginal development, cause a persistent urogenital sinus, and cause clitoromegaly in the developing fetus. Given the teratogenic effects of testosterone, it is imperative that patients who do not desire pregnancy receive appropriate contraceptive options. Counseling of patients should be individualized and start by taking a comprehensive sexual history. Such strategies include using gender-inclusive language, avoiding assumptions about sexual orientation, and obtaining an anatomic inventory of both the patient and their partner(s).⁴ While a majority of patients achieve amenorrhea while taking testosterone, it is important to discuss the need for contraception if patients are engaging in penile-vaginal intercourse. According to a study of 41 transmasculine patients who achieved pregnancy, one-third of pregnancies were unplanned. Another study reported that 20% of transmasculine patients were taking testosterone and amenorrheic at the time of conception.²

Contraindications to certain types of contraception, such as a history of a thromboembolic event precluding a patient from using combined oral contraceptives, still apply. Transmasculine patients have additional concerns that providers should be aware of and sensitive to when prescribing contraceptives. Gender dysphoria may be exacerbated by contraceptive options that require a pelvic exam or procedure, such as an intrauterine device. For patients that desire an IUD but experience heightened distress in anticipation of the procedure, premedication with anxiolytics or topical anesthetics are reasonable options.⁴ Using an adequate amount of lubricant and a small speculum may also make the exam more comfortable for patients, especially if patients do not engage in receptive frontal intercourse. Of note, certain types of IUDs, such as the Paragard, may cause pelvic cramping or abnormal bleeding, which could be a trigger for dysphoria. Patients may also experience worsening dysphoria by repeatedly taking a medication that is often associated with cisgender women, such as combined oral contraceptives (COCs). Furthermore, patients may want to avoid COCs secondary to concerns about potential feminizing effects of these hormones and their counteraction of masculinizing effects of testosterone. While COCs act to lower androgen levels by increasing sex hormone–binding globulin, which subsequently binds to testosterone, the amount of estrogen in the pill does not contribute significantly to inhibiting masculinization, and patients should be counseled accordingly.^4,5 Side effects such as breast tenderness, which is common among COCs and other estrogen-containing contraceptives, can increase dysphoria and make chest binding more painful. In patients who undergo gender-affirming mastectomies, these effects are less pronounced, however, there may be residual breast tissue left behind which can still produce tenderness and pain.

Sterilization is also a reasonable option in transmasculine patients desiring permanent contraception. Similar to sterilization counseling in cisgender women, a discussion about the irreversibility of the procedure and rates of regret should occur. Transmasculine patients may seek hysterectomy for contraception and to avoid further pelvic exams, cervical cancer screening, pelvic cramping, and/or uterine bleeding. Providers should be knowledgeable about the World Professional Association for Transgender Health standards of care for gender-affirming hysterectomies and counsel patients appropriately.

In summary, transmasculine and all gender-diverse patients deserve the same comprehensive care that their cisgender counterparts receive. Even if the ob.gyn. is not the prescribing physician for testosterone, we all must have a basic understanding of the effects of testosterone and provide appropriate contraceptive services and family planning options to patients when indicated.

Dr. Brandt is an ob.gyn. and fellowship-trained gender-affirming surgeon in West Reading, Pa.

References

1. Unger CA. J Women’s Health. 2015;24(2):114-8.

2. Abern L and Maguire K. Obstet Gynecol. 2018;131:65S.

3. Light A et al. Contraception. 2018;98:266-9.

4. Krempasky C et al. Am J Obstet Gynecol. 2020;222(2):134-43.

5. Goodman NF et al. Endocrin Pract. 2015:21(11):1291-300.
 

SACRAMENTO (AP) – California is poised to approve reparations of up to $25,000 to some of the thousands of people – some as young as 13 – who were sterilized decades ago because the government deemed them unfit to have children.

The payments will make California at least the third state – following Virginia and North Carolina – to compensate victims of the so-called eugenics movement that peaked in the 1930s. Supporters of the movement believed sterilizing people with mental illnesses, physical disabilities, and other traits they deemed undesirable would improve the human race.

While California sterilized more than 20,000 people before its law was repealed in 1979, only a few hundred are still alive. The state has set aside $7.5 million for the reparations program, part of its $262.6 billion operating budget that is awaiting Gov. Gavin Newsom’s signature.

California’s proposal is unique because it also would pay women the state coerced to get sterilized while they were in prison, some as recently as 2010. First exposed by the Center for Investigative Reporting in 2013, a subsequent audit found California sterilized 144 women between 2005 and 2013 with little or no evidence that officials counseled them or offered alternative treatment.

While all of the women signed consent forms, officials in 39 cases did not do everything that was legally required to obtain their permission.

“We must address and face our horrific history,” said Lorena Garcia Zermeño, policy and communications coordinator for the advocacy group California Latinas for Reproductive Justice. “This isn’t something that just happened in the past.”

California’s forced sterilization program started in 1909, following similar laws in Indiana and Washington. It was by far the largest program, accounting for about a third of everyone sterilized in the United States under those laws.

California’s law was so prominent that it inspired similar practices in Nazi Germany, according to Paul Lombardo, a law professor at Georgia State University, Atlanta, and an expert on the eugenics movement.

“The promise of eugenics at the very earliest is: ‘We could do away with all the state institutions – prisons, hospitals, asylums, orphanages,’” Mr. Lombardo said. “People who were in them just wouldn’t be born after awhile if you sterilized all of their parents.”

In California, victims include Mary Franco, who was sterilized in 1934 when she was just 13. Paperwork described her as “feeble minded” because of “sexual deviance,” according to her niece, Stacy Cordova, who has researched her case.

Ms. Cordova said Franco actually was molested by a neighbor. She said her family put Ms. Franco in an institution to protect the family’s reputation.

Ms. Cordova said her late aunt loved children and wanted to have a family. She married briefly when she was about 17, but Ms. Cordova said the marriage was annulled when the man discovered Ms. Franco couldn’t have children. She lived a lonely life in a Mexican culture that revered big families, Ms. Cordova said.

“I don’t know if it is justice. Money doesn’t pay for what happened to them. But it’s great to know that this is being recognized,” said Ms. Cordova, who has advocated for the state to pay survivors. “For me, this is not about the money. This is about the memory.”

Relatives like Ms. Cordova aren’t eligible for the payments, only direct victims are.

Sterilizations in California prisons appear to date to 1999, when the state changed its policy for unknown reasons to include a sterilization procedure known as “tubal ligation” as part of inmates’ medical care. Over the next decade, women reported they were coerced into this procedure, with some not fully understanding the ramifications.

A state law passed in 2014 bans sterilizations for the purpose of birth control at state prisons and local jails. The law permits sterilizations that are “medically necessary,” such as removing cancer, and requires facilities to report each year how many people were sterilized and for what reason.

Questionable sterilizations also occurred in facilities run by local governments. In 2018, the Los Angeles County Board of Supervisors apologized after more than 200 women were sterilized at the Los Angeles–University of Southern California Medical Center between 1968 and 1974.

Those people are not eligible for reparations under California’s program. But advocates say they hope to include them in the future.

“It’s only the beginning,” said state Assemblywoman Wendy Carrillo, a Democrat from Los Angeles who has been advocating for reparations. “I can’t imagine the trauma, the depression, the stress of being incarcerated, being rehabilitated and trying to start your life again in society, wanting to start a family, only to find out that that choice was taken away from you.”

Of the people California sterilized under its old eugenics law, just a few hundred are still alive, according to research conducted by the Sterilization and Social Justice Lab. Including the inmates who were sterilized most recently, advocates estimate more than 600 people would be eligible for reparations.

But finding them will be difficult, with advocates predicting only about 25% of eligible people will ultimately apply for reparations and be paid.

California’s Victim Compensation Board will run the program, with $2 million used to find victims by advertising and poring through state records. The state also set aside $1 million for plaques to honor the victims, leaving $4.5 million for reparations.

A version of this article appeared on Medscape.com.

Associated Press © 2021 

SACRAMENTO (AP) – California is poised to approve reparations of up to $25,000 to some of the thousands of people – some as young as 13 – who were sterilized decades ago because the government deemed them unfit to have children.

The payments will make California at least the third state – following Virginia and North Carolina – to compensate victims of the so-called eugenics movement that peaked in the 1930s. Supporters of the movement believed sterilizing people with mental illnesses, physical disabilities, and other traits they deemed undesirable would improve the human race.

While California sterilized more than 20,000 people before its law was repealed in 1979, only a few hundred are still alive. The state has set aside $7.5 million for the reparations program, part of its $262.6 billion operating budget that is awaiting Gov. Gavin Newsom’s signature.

California’s proposal is unique because it also would pay women the state coerced to get sterilized while they were in prison, some as recently as 2010. First exposed by the Center for Investigative Reporting in 2013, a subsequent audit found California sterilized 144 women between 2005 and 2013 with little or no evidence that officials counseled them or offered alternative treatment.

While all of the women signed consent forms, officials in 39 cases did not do everything that was legally required to obtain their permission.

“We must address and face our horrific history,” said Lorena Garcia Zermeño, policy and communications coordinator for the advocacy group California Latinas for Reproductive Justice. “This isn’t something that just happened in the past.”

California’s forced sterilization program started in 1909, following similar laws in Indiana and Washington. It was by far the largest program, accounting for about a third of everyone sterilized in the United States under those laws.

California’s law was so prominent that it inspired similar practices in Nazi Germany, according to Paul Lombardo, a law professor at Georgia State University, Atlanta, and an expert on the eugenics movement.

“The promise of eugenics at the very earliest is: ‘We could do away with all the state institutions – prisons, hospitals, asylums, orphanages,’” Mr. Lombardo said. “People who were in them just wouldn’t be born after awhile if you sterilized all of their parents.”

In California, victims include Mary Franco, who was sterilized in 1934 when she was just 13. Paperwork described her as “feeble minded” because of “sexual deviance,” according to her niece, Stacy Cordova, who has researched her case.

Ms. Cordova said Franco actually was molested by a neighbor. She said her family put Ms. Franco in an institution to protect the family’s reputation.

Ms. Cordova said her late aunt loved children and wanted to have a family. She married briefly when she was about 17, but Ms. Cordova said the marriage was annulled when the man discovered Ms. Franco couldn’t have children. She lived a lonely life in a Mexican culture that revered big families, Ms. Cordova said.

“I don’t know if it is justice. Money doesn’t pay for what happened to them. But it’s great to know that this is being recognized,” said Ms. Cordova, who has advocated for the state to pay survivors. “For me, this is not about the money. This is about the memory.”

Relatives like Ms. Cordova aren’t eligible for the payments, only direct victims are.

Sterilizations in California prisons appear to date to 1999, when the state changed its policy for unknown reasons to include a sterilization procedure known as “tubal ligation” as part of inmates’ medical care. Over the next decade, women reported they were coerced into this procedure, with some not fully understanding the ramifications.

A state law passed in 2014 bans sterilizations for the purpose of birth control at state prisons and local jails. The law permits sterilizations that are “medically necessary,” such as removing cancer, and requires facilities to report each year how many people were sterilized and for what reason.

Questionable sterilizations also occurred in facilities run by local governments. In 2018, the Los Angeles County Board of Supervisors apologized after more than 200 women were sterilized at the Los Angeles–University of Southern California Medical Center between 1968 and 1974.

Those people are not eligible for reparations under California’s program. But advocates say they hope to include them in the future.

“It’s only the beginning,” said state Assemblywoman Wendy Carrillo, a Democrat from Los Angeles who has been advocating for reparations. “I can’t imagine the trauma, the depression, the stress of being incarcerated, being rehabilitated and trying to start your life again in society, wanting to start a family, only to find out that that choice was taken away from you.”

Of the people California sterilized under its old eugenics law, just a few hundred are still alive, according to research conducted by the Sterilization and Social Justice Lab. Including the inmates who were sterilized most recently, advocates estimate more than 600 people would be eligible for reparations.

But finding them will be difficult, with advocates predicting only about 25% of eligible people will ultimately apply for reparations and be paid.

California’s Victim Compensation Board will run the program, with $2 million used to find victims by advertising and poring through state records. The state also set aside $1 million for plaques to honor the victims, leaving $4.5 million for reparations.

A version of this article appeared on Medscape.com.

Associated Press © 2021 

SACRAMENTO (AP) – California is poised to approve reparations of up to $25,000 to some of the thousands of people – some as young as 13 – who were sterilized decades ago because the government deemed them unfit to have children.

The payments will make California at least the third state – following Virginia and North Carolina – to compensate victims of the so-called eugenics movement that peaked in the 1930s. Supporters of the movement believed sterilizing people with mental illnesses, physical disabilities, and other traits they deemed undesirable would improve the human race.

While California sterilized more than 20,000 people before its law was repealed in 1979, only a few hundred are still alive. The state has set aside $7.5 million for the reparations program, part of its $262.6 billion operating budget that is awaiting Gov. Gavin Newsom’s signature.

California’s proposal is unique because it also would pay women the state coerced to get sterilized while they were in prison, some as recently as 2010. First exposed by the Center for Investigative Reporting in 2013, a subsequent audit found California sterilized 144 women between 2005 and 2013 with little or no evidence that officials counseled them or offered alternative treatment.

While all of the women signed consent forms, officials in 39 cases did not do everything that was legally required to obtain their permission.

“We must address and face our horrific history,” said Lorena Garcia Zermeño, policy and communications coordinator for the advocacy group California Latinas for Reproductive Justice. “This isn’t something that just happened in the past.”

California’s forced sterilization program started in 1909, following similar laws in Indiana and Washington. It was by far the largest program, accounting for about a third of everyone sterilized in the United States under those laws.

California’s law was so prominent that it inspired similar practices in Nazi Germany, according to Paul Lombardo, a law professor at Georgia State University, Atlanta, and an expert on the eugenics movement.

“The promise of eugenics at the very earliest is: ‘We could do away with all the state institutions – prisons, hospitals, asylums, orphanages,’” Mr. Lombardo said. “People who were in them just wouldn’t be born after awhile if you sterilized all of their parents.”

In California, victims include Mary Franco, who was sterilized in 1934 when she was just 13. Paperwork described her as “feeble minded” because of “sexual deviance,” according to her niece, Stacy Cordova, who has researched her case.

Ms. Cordova said Franco actually was molested by a neighbor. She said her family put Ms. Franco in an institution to protect the family’s reputation.

Ms. Cordova said her late aunt loved children and wanted to have a family. She married briefly when she was about 17, but Ms. Cordova said the marriage was annulled when the man discovered Ms. Franco couldn’t have children. She lived a lonely life in a Mexican culture that revered big families, Ms. Cordova said.

“I don’t know if it is justice. Money doesn’t pay for what happened to them. But it’s great to know that this is being recognized,” said Ms. Cordova, who has advocated for the state to pay survivors. “For me, this is not about the money. This is about the memory.”

Relatives like Ms. Cordova aren’t eligible for the payments, only direct victims are.

Sterilizations in California prisons appear to date to 1999, when the state changed its policy for unknown reasons to include a sterilization procedure known as “tubal ligation” as part of inmates’ medical care. Over the next decade, women reported they were coerced into this procedure, with some not fully understanding the ramifications.

A state law passed in 2014 bans sterilizations for the purpose of birth control at state prisons and local jails. The law permits sterilizations that are “medically necessary,” such as removing cancer, and requires facilities to report each year how many people were sterilized and for what reason.

Questionable sterilizations also occurred in facilities run by local governments. In 2018, the Los Angeles County Board of Supervisors apologized after more than 200 women were sterilized at the Los Angeles–University of Southern California Medical Center between 1968 and 1974.

Those people are not eligible for reparations under California’s program. But advocates say they hope to include them in the future.

“It’s only the beginning,” said state Assemblywoman Wendy Carrillo, a Democrat from Los Angeles who has been advocating for reparations. “I can’t imagine the trauma, the depression, the stress of being incarcerated, being rehabilitated and trying to start your life again in society, wanting to start a family, only to find out that that choice was taken away from you.”

Of the people California sterilized under its old eugenics law, just a few hundred are still alive, according to research conducted by the Sterilization and Social Justice Lab. Including the inmates who were sterilized most recently, advocates estimate more than 600 people would be eligible for reparations.

But finding them will be difficult, with advocates predicting only about 25% of eligible people will ultimately apply for reparations and be paid.

California’s Victim Compensation Board will run the program, with $2 million used to find victims by advertising and poring through state records. The state also set aside $1 million for plaques to honor the victims, leaving $4.5 million for reparations.

A version of this article appeared on Medscape.com.

Associated Press © 2021