JWH eBook - 5

EXPERT PANEL DISCUSSION
I take care of a large transgender population, and many
of my patients have a history of trauma related to
sexual violence. They may have found the IUD insertion to be an uncomfortable, dysphoric, or even a
triggering experience. So although I cannot teach
them how to place their own IUDs, it is empowering
to tell them that when they are done with this method
of pregnancy prevention or bleeding control, that
they have the capacity to remove the device on their
own. I have talked to patients through IUD removals
during the pandemic, and I was on the other line
waiting and making sure that things were successful.
IUD self-removals can be part of that empowerment
of choice.
Dr. Lambing: What is interesting is you can build on
their knowledge. Women often have a lot of knowledge about their bodies. They use pads. They use
tampons. Many patients would be comfortable removing their own IUDs. Then again, there are always
some patients who are very comfortable with their own
bodies and maybe still just would not be able to do it.
''Absolutely. Just come on into the office, and we will
take care of it. Not a concern at all.'' So, yes, I think we
should do this.
Dr. Matthews: I think this just shows that we just need
to trust women to understand their body and teach
them how to understand their body. I am a big supporter of self-removal of IUDs, because it makes them
feel in control of one of the few things that they can be
in control of.
If I am here to encourage and motivate women, then
one of my things is to encourage that patients do not
need me unless there is something that they feel concerned about. We need to trust women to know that if
there is a concern about something, they will find us.
They will come into the doctor when it is appropriate
timing, and not just require them to come in for IUD
removal.
Dr. Levine: Excellent points, and I think very supportive recommendations that hopefully our readers will digest and may incorporate themselves.
Dr. Pickle, you mentioned the transgender population. These are special populations in whom
LARCs are being underutilized. How do you think
we can best improve acceptance and utilization by
our transgender community?
Dr. Pickle: I think there are two parts to this strategy.
The first part is equipping ourselves and colleagues
with the right knowledge and tools, and the second part
is sharing this education with our patients. One tool is
the act of degendering the language around reproductive choice and gender and sexual health in genª 2020 by Mary Ann Liebert, Inc.

eral. If you look at many of the advertisements and
patient education materials, you will see gendered
language. A patient who identifies as transgender,
gender diverse, or nonbinary could look at that and
think, ''That is not for me,'' and may be dissuaded
from choosing that method, even though it could be a
great option for pregnancy prevention or bleeding
control for that person.
Because so many of these devices put such a small
amount of systemic hormones into the bloodstream,
they are fantastic choices for many patients who
identify across the gender spectrum. I think that comes
back down to how we educate ourselves as colleagues,
and how we support each other as we are caring for
gender-diverse patients.
Dr. Levine: Any other populations for whom LARCs
are being underutilized that we can develop initiatives to best improve acceptance and utilization?
Dr. Remen: Definitely the adolescent population.
LARC is great for adolescents. Many adolescents do
not want their parents to know that they are sexually
active, and so they do not want to have to go to their
parents or take pills or have anything around the house
such that their parents will find out that they are being
sexually active and using birth control.
Another issue is just the issue of having to remember
to take a pill every day. Many adolescents find that to
be very difficult, and this is indeed true for people in
general.
For women who are postmenopausal and are on
estrogen therapy, LARC is a great way of preventing
endometrial cancer, and it is definitely underutilized in
them. I think many of them might think, ''Oh, I am
postmenopausal. What do I need an IUD for?'' So that
is another really great population that we can be addressing this with.
Dr. Matthews: I definitely think a population that
needs addressing is people who are getting ready for
gastric bypass surgery that needs an extended period of
time or recommended period of time before another
pregnancy.
I think that a way that that can be addressed is really
by informing the surgeons about the different available
concentrations that there are, that LARC is not a systemic estrogen-containing device that they really think
it is, because many of these surgeons are not aware of
what really the hormones are that are even in the
contraception. So they tell their patients they cannot
get hormones before surgery.
I think we really need to educate our peers on the
different LARCs and how they might be important for
their patient populations. That way they will be able to
educate their patients about pregnancy prevention also.
5



JWH eBook

Table of Contents for the Digital Edition of JWH eBook

JWH eBook - Cover1
JWH eBook - Cover2
JWH eBook - A
JWH eBook - B
JWH eBook - C
JWH eBook - D
JWH eBook - 1
JWH eBook - 2
JWH eBook - 3
JWH eBook - 4
JWH eBook - 5
JWH eBook - 6
JWH eBook - 7
JWH eBook - 8
JWH eBook - Cover3
JWH eBook - Cover4
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