Progestin-only Pills Research Articles

Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States

In July 2023, the US Food and Drug Administration approved the first nonprescription oral contraceptive, a progestin-only pill, in the United States. Transgender, nonbinary, and gender-expansive people assigned female or intersex at birth face substantial contraceptive access barriers and may benefit from over-the-counter oral contraceptive access. However, no previous research has explored their perspectives on this topic. This study aimed to measure interest in over-the-counter progestin-only pill use among transgender, nonbinary, and gender-expansive individuals assigned female or intersex at birth. We conducted an online, cross-sectional survey from May to September 2019 (before the US Food and Drug Administration approval of a progestin-only pill) among a convenience sample of transgender, nonbinary, and gender-expansive people assigned female or intersex at birth who were aged 18 to 49 years from across the United States. Using descriptive statistics and logistic regression analyses, we estimated interest in over-the-counter progestin-only pill use (our outcome) overall and by sociodemographic and reproductive health characteristics (our exposures). We evaluated separate logistic regression models for each exposure. In each model, we included the minimally sufficient adjustment set to control for confounding pathways between the exposure and outcome. For the model for age, we ran a univariable logistic regression model; for all other exposures, we ran multivariable logistic regression models. Among 1415 participants in our sample (median age, 26 years), 45.0% (636/1415; 95% confidence interval, 42.3-47.6) were interested in over-the-counter progestin-only pill use. In separate logistic regression models for each exposure, there were higher odds of interest among participants who were aged 18 to 24 years (odds ratio, 1.67; 95% confidence interval, 1.33-2.10; vs those aged 25-34 years), those who were uninsured (adjusted odds ratio, 1.91; 95% confidence interval, 1.24-2.93; vs insured), those who currently used oral contraceptives (adjusted odds ratio, 1.69; 95% confidence interval, 1.17-2.44; vs non-users), had ≤high school degree (adjusted odds ratio, 3.02; 95% confidence interval, 1.94-4.71; vs college degree), had ever used progestin-only pills (adjusted odds ratio, 2.32; 95% confidence interval, 1.70-3.17; vs never users), and who wanted to avoid estrogen generally (adjusted odds ratio, 1.32; 95% confidence interval, 1.04-1.67; vs those who did not want to avoid estrogen generally) or specifically because they viewed it as a feminizing hormone (adjusted odds ratio, 1.72; 95% confidence interval, 1.36-2.19; vs those who did not want to avoid estrogen because they viewed it as a feminizing hormone). There were lower odds of interest among participants with a graduate or professional degree (adjusted odds ratio, 0.70; 95% confidence interval, 0.51-0.96; vs college degree), those who were sterilized (adjusted odds ratio, 0.31; 95% confidence interval, 0.12-0.79; vs not sterilized), and those who had ever used testosterone for gender affirmation (adjusted odds ratio, 0.72; 95% confidence interval, 0.57-0.90; vs never users). Transgender, nonbinary, and gender-expansive individuals were interested in over-the-counter progestin-only pill use, and its availability has the potential to improve contraceptive access for this population.

Prevalence of anxiety and depression among Lebanese women using oral contraceptives: a cross-sectional study

BackgroundOral contraceptives (OCs) are used worldwide, including Lebanese women. However, the association between OCs use and anxiety or depression remains unclear. This study aims to assess the prevalence of anxiety and depression among Lebanese women using oral contraceptive pills and investigate the differential impact of combined oral contraceptives (COCs) versus progestogen-only pills (POPs) on mental health outcomes.MethodsA cross-sectional study was conducted among a sample of Lebanese women using OCs between January and March 2023. Nine hundred nighty seven out of the 2051 women who took part in the survey met our criteria and were included in this study. Data on anxiety and depression were collected using validated and reliable scales, the Arabic versions of the Generalized Anxiety Disorder-7 Questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses, including multivariate analysis, were performed to assess the association between OCs type (COC vs. POP) and anxiety/depression.ResultsThe prevalence of anxiety and depression among Lebanese women taking OCs was found to be 39.9% and 64.3%, respectively. Furthermore, the study revealed that POP users had 2.8 times higher odds of developing anxiety (adjusted odds ratio ORadj = 2.8 with 95% confidence interval CI of 1.770 to 4.435) p-value < 0.001 and 9.2 times higher odds of developing depression (adjusted odds ratio ORadj = 9.2 with 95% confidence interval CI of 5.790 to 14.506) p-value < 0.001 compared to COC users.ConclusionThe results of this study shed light on the elevated prevalence of anxiety and depression among Lebanese women using OCs and emphasized the varying effects of COCs and POPs on their mental health outcomes. Further research is needed to comprehensively understand this association, considering both the dosage and specific type of oral contraceptive to improve the overall well-being of women using these contraceptives.

Thrombotic and Vascular Complications of Oral Contraceptives.

The oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2-9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors.

Physiologically-based pharmacokinetic modeling of prominent oral contraceptive agents and applications in drug-drug interactions.

Considerable interest remains across the pharmaceutical industry and regulatory landscape in capabilities to model oral contraceptives (OCs), whether combined (COCs) with ethinyl estradiol (EE) or progestin-only pill. Acceptance of COC drug-drug interaction (DDI) assessment using physiologically-based pharmacokinetic (PBPK) is often limited to the estrogen component (EE), requiring further verification, with extrapolation from EE to progestins discouraged. There is a paucity of published progestin component PBPK models to support the regulatory DDI guidance for industry to evaluate a new chemical entity's (NCE's) DDI potential with COCs. Guidance recommends a clinical interaction study to be considered if an investigational drug is a weak or moderate inducer, or a moderate/strong inhibitor, of CYP3A4. Therefore, availability of validated OC PBPK models within one software platform, will be useful in predicting the DDI potential with NCEs earlier in the clinical development. Thus, this work was focused on developing and validating PBPK models for progestins, DNG, DRSP, LNG, and NET, within Simcyp, and assessing the DDI potential with known CYP3A4 inhibitors (e.g., ketoconazole) and inducers (e.g., rifampicin) with published clinical data. In addition, this work demonstrated confidence in the Simcyp EE model for regulatory and clinical applications by extensive verification in 70+ clinical PK and CYP3A4 interaction studies. The results provide greater capability to prospectively model clinical CYP3A4 DDI with COCs using Simcyp PBPK to interrogate the regulatory decision-tree to contextualize the potential interaction by known perpetrators and NCEs, enabling model-informed decision making, clinical study designs, and delivering potential alternative COC options for women of childbearing potential.

Opill: The Over-the-Counter Contraceptive Pill.

The U.S. Food and Drug Administration has approved the first oral contraceptive pill (OCP) for over-the-counter status. This progestin-only pill contains norgestrel 0.075 mg taken daily, with a Pearl Index estimated at 4.4 (95% CI, 1.9-8.8). This formulation has an excellent safety profile, with current breast cancer as the only absolute contraindication and few relative contraindications. Ultimately, this approval has great potential to improve the accessibility of effective contraception for many pregnancy-capable Americans, especially those who have poor access to the health care system for prescription-required contraception, most notably people who hold marginalized identities. The pill's overall success in reducing rates of unintended pregnancy will rely on its availability, particularly in rural communities that may rely on one pharmacy, and affordability, especially for uninsured or underinsured individuals. However, given the need for improved contraceptive provision, particularly in abortion-restrictive settings, the over-the-counter approval of this daily OCP is a major advancement in the nation's contraceptive ecosystem.

A new progestin-only pill (POP): the impact of drospirenone-only pill 4 mg 24 + 4 on coagulation markers and bleeding patterns

Purpose Progestin-only pills (POPs), compared to combined, are not associated with an increased risk of venous thromboembolism, but are associated with a poor cycle control. The aim of this study was to evaluate the impact of a new POP [4 mg drospirenone (DRSP) for 24 days with a 4-day hormone-free interval] on some coagulation markers (both procoagulant and fibrinolytic) and to describe its impact on bleeding patterns. Materials and methods This is a prospective trial, based on serum evaluation of following coagulation markers and tests: Factor (F) X, F VIII, F V, INR, aPTT, Protein S and antithrombin III. A ‘bleeding diary’ was used to categorise women as having (1) unscheduled bleeding, (2) scheduled bleeding and (3) amenorrhoea. Thirty patients were followed for six 28-day intake cycles, with a follow-up at the end of the 3rd and 6th cycles. Results There was a significant decrease of F X (p = 0.03) (-5.7% at cycle 6). No significant changes have been observed for F VII, F V and INR. A significant increase in aPTT (p = 0.01 at 3 cycles), Protein S (p = 0.0006 at 3 cycles) and antithrombin III (p < 0.0001 at 3 cycles) was recorded. This non-deteriorating coagulation impact was associated with a significant and progressive reduction of days of scheduled and unscheduled bleeding in users between cycles 4 and 6 (from 1.3 ± 0.2 days at cycle 4 to 0.8 ± 0.1 days at cycle 6 and from 2.6 ± 0.4 days at cycle 4 to 0.6 ± 0.2 days at cycle 6, respectively, p < 0.0001). Conclusions DRSP 24 + 4 use was associated with a non-deteriorating effect on coagulation markers and a significant progressive reduction of days of scheduled and unscheduled bleeding.

Contraception prescribing in England during the COVID-19 pandemic

BackgroundNational lockdowns in England due to COVID-19 resulted in rapid shifts in healthcare provision, including in primary care where most contraceptive prescriptions are issued. This study aimed to investigate contraception...

SAT379 Potassium Levels in Women with PCOS Using Spironolactone for Long-term

Abstract Disclosure: T.A. Oliveira: None. L.B. Marchesan: None. P.M. Spritzer: None. Introduction. Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. Spironolactone (SPL) has been used off-label to manage hyperandrogenic manifestations in women with PCOS but the incidence of hyperkalemia in these population is scarce. Materials and Methods. In this retrospective study, we assessed data collected from electronic medical records of women with PCOS that received spironolactone, in addition to other drugs, to manage hyperandrogenic manifestations. Women with PCOS, defined by the Rotterdam criteria, without heart or kidney disease, who were treated with SPL for a minimum of 12 months and had records of serial potassium concentrations, were included for the analyses. Mild hyperkalemia was defined as potassium concentration between 5.1 to 5.5mEq/L, moderate 5.6 to 6,0mEq/L or severe ≥ 6,0mEq/L. Results. Data from 78 women with PCOS with potassium dosages totaling 98 measurements, were analyzed. Mean age was 29.1 ± 9.6 years, BMI 32.2 ± 8.1 kg/m², 9 had Diabetes (9.2%) and 22 (22.4%) pre-diabetes. SPL was used in association with combined oral contraceptives (COCP) in 55 participants (56.1%), progestin only pill (POP) in 21 (21.4%), metformin (MTF) in 35 (35.7%) and ACEi/angiotensin receptor blockers (ARBs) in 15 (15.3%). The median SPL dose was 100mg (50 to 150mg). Ten(12,8%) women had hyperkalemia, 4 of them more than once during follow-up, all classified as mild. The most common minor adverse effects included menstrual irregular bleeding in 8 (8.2%) in 5 using POP irregularly and 3 using COCP, followed by dizziness in 6 (6.1%) and postural hypotension in 3 (3.1%). Only in two cases (2.1%) SPL was discontinued due to poor tolerance, one due to breast pain and the other due to cramps. Conclusion: The present study suggests that women with PCOS, without kidney or heart diseasee, using SPL associated with hormone contraception for managing clinical hyperandrogenism, have a low incidence of hyperkalemia, no life-threatening episodes, well-tolerated minor adverse effects and a low rate of drug discontinuation. Sources of research support: INCT/CNPq and FAPERGS. Presentation Date: Saturday, June 17, 2023

The benefits of estetrol addition to drospirenone for contraception

Ethinylestradiol and drospirenone combined oral contraceptive formulations have been marketed for >20 years. Drospirenone has antimineralocorticoid and anti-androgenic effects that may offer several health benefits. Recently, 2 new drospirenone-containing oral contraceptives entered the market, 1 as a progestin-only pill containing 4 mg drospirenone and the other as a combined oral contraceptive containing 15 mg estetrol and 3 mg drospirenone. Estetrol has a unique differential effect on nuclear and membrane estrogen α-receptors when compared with other estrogens, leading to low impact on the liver, breast, and hemostasis parameters and a beneficial effect on the endometrium, vagina, cardiovascular system, bone, and brain. Phase 3 clinical studies demonstrated that the Pearl Index (pregnancies per 100-woman-years) for drospirenone alone is 4.0 in the United States and 0.93 in the European Union and for the estetrol-drospirenone combination it is 2.65 and 0.44, respectively. Drospirenone alone demonstrates high rates of unscheduled bleeding and low rates of scheduled bleeding, whereas the estetrol-drospirenone combination demonstrates a predictable and regular bleeding profile for most users with a high stable rate of scheduled bleeding and a low rate of unscheduled bleeding, reported primarily as spotting only. The adverse event profiles and discontinuation rates owing to adverse events are comparable, and no clinically significant effects were observed on metabolic parameters with either product. Hemostatic assays for drospirenone do not fully evaluate all parameters although the testing that is available suggests negligible effects, whereas validated hemostatic assays demonstrate that the estetrol-drospirenone combination has limited impact on hemostasis. The introduction of 4 mg drospirenone and 15 mg estetrol with 3 mg drospirenone are valuable additions to the contraceptive market. Adding estetrol to 3 mg drospirenone provides advantages of contraceptive efficacy and a regular, predictable bleeding profile with minimal impact on hemostasis parameters.

Modeling one-stop-shop integration of family planning and HIV services in Zimbabwe, 2021

Objectives: In October 2020, the Ministry of Health and Child-care Zimbabwe commenced integrating reproductive health with human immunodeficiency virus (HIV) services. Family planning (FP), sexually transmitted infection (STI) screening and treatment, HIV testing services (HTS), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART) services were offered through an integrated one-stop-shop model. The project aimed to address unacceptably high incidences of HIV and STIs among FP clients and demonstrate improved access and uptake of integrated services at dedicated FP centers. Materials and Methods: We conducted an intervention study. A service package of STI symptom screening and HTS (including HIV self-test [HIVST] primary and secondary distribution) was offered to all FP clients by multi-skilled nurses. Service uptake was measured pre and post-introduction of the intervention, before which services were provided by different nurses, in different rooms. HIV-diagnosed clients were linked to ART and eligible negative testers were offered PrEP. Service uptake was measured at 1 year of implementation against the same period before. Results: A total of 20,947 clients were recruited between October 2019 and September 2021, 9386 pre-intervention and 11,561 post-intervention. We observed a 5.2% total increase in clients seen and a 27.1% increase in the average uptake of all integrated services (FP, STI, HTS, PrEP, and ART). Most (93.5%) clients received oral contraception (Progestogen-only pills and combined-oral-contraceptives), while fewer (4.8%) received injectables and implants (1.1%). Following the intervention, STI screening increased by 30.2% (2730 vs. 11,028). HTS delivery increased by 38.9% and PrEP by 44.1%. HIV positivity yield increased significantly (10.1%, 62/615 vs. 16.6%, 813/4910) and linkage to ART improved by 44.4%. HIVST distribution contributed to improved access to HIV testing with 3754 FP clients accepting distribution compared with 4910 receiving HTS by nurses, provider-delivered testing was accessed by reactive self-testers. The project increased (?) improved linkage to preventive and treatment services and reduced missed opportunities associated with fragmented services. Conclusion: The integrated one-stop-shop model demonstrated improved service uptake during the intervention period. This project shows the benefits of integrated FP/STI/HTS/PrEP in Zimbabwe’s high HIV burden settings.

Preconception contraceptive use and miscarriage: prospective cohort study

ObjectivesTo evaluate the association between preconception contraceptive use and miscarriage.DesignProspective cohort study.SettingResidents of the United States of America or Canada, recruited from 2013 until the end of 2022.Participants13 460 female...

Over-the-Counter Oral Contraception as an Opportunity to Reduce Contraceptive Access Inequity

This Viewpoint argues that making a progestin-only contraceptive pill available for sale as an over-the-counter product will help reduce logistic barriers to safe and effective birth control.

A Focus on Contraception in the Wake of Dobbs.

A Focus on Contraception in the Wake of Dobbs.

Postpartum contraception: A matter of guidelines.

The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin-only pill postpartum in non-breastfeeding women (category 1). Differences are found in women who breastfeed. In non-breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high-income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing.

Every ED Visit is an Opportunity to Talk about Contraception

Every ED Visit is an Opportunity to Talk about Contraception

Use of progestogen‐only pills for oral contraception

The progestogen‐only pill (POP) is often a safe and effective option for women who prefer oral contraception but in whom combined hormonal contraception is unsuitable. This article outlines the choice of POPs available, their administration, efficacy and adverse effects.

Treatment of Adolescent Endometriosis Before, During, and After Use of Gonadotropin-Releasing Hormone Agonists: A Retrospective Cohort Study

To explore the use duration of a gonadotropin-releasing hormone agonists (GnRHa) plus add-back in adolescents with laparoscopically confirmed endometriosis and the treatment course before and after GnRHa therapy. Retrospective cohort study. We identified 51 subjects with laparoscopically confirmed endometriosis who had participated in a randomized trial of a GnRHa plus add-back as adolescents between 2008 and 2012. Electronic medical records were reviewed to obtain demographic data, clinical characteristics, and treatment outcomes after trial completion. The study was deemed IRB exempt. The average age of participants during trial enrollment was 17.9±1.7 years. Thirty-three participants had stage I endometriosis (65%). The most common treatments trialed before GnRHa therapy were combined oral contraceptives (n=47, 92%) and progestin-only pills (n=23, 45%). The average duration of GnRHa use during the trial was 9.5±3.5 months; 34 subjects (67%) completed the 1-year trial. After trial completion, 23 subjects (45%) continued to use a GnRHa with add-back therapy. The mean duration of additional GnRHa use was 31.7±28.6 months, and the longest identified duration was an additional 96 months. Twenty-four subjects switched to other hormonal treatments after trial participation, most commonly oral progestins (n=15) or combined oral contraceptives (n=6). Thirteen participants (25%) returned to a therapy that had been trialed before GnRHa use. Almost half the participants in this cohort continued to use a GnRHa with add-back for treatment of endometriosis beyond the 12-month recommended duration. Treatment varied widely after discontinuation of GnRHa, with many participants returning to previously trialed medical therapies.

Attitudes of women and pharmacists on the opportunity to obtain a progestogen-only pill over the counter – Italian outcomes

Purpose Scrutinizing, among potential providers and users, the perceived claim and interest for over the counter (OTC) accessibility of a progestogen-only pill (POP). Methods Cross-sectional, descriptive study based on an online survey of 1000 women and 100 pharmacists in Italy, part of a larger sample including Germany and Spain. Results Hormonal contraceptive methods are used by 35%; 5% of women reported currently not using contraception, 40% using a barrier method, and 20% a method considered less effective than male condoms (including 16% withdrawal and 4% natural methods and fertility/contraceptive applications). Almost 80% of women felt knowledgeable about the different contraceptive method, but about 1/3 had experienced difficulty accessing their oral contraceptive (OC) in the past two years. Women reacted positively to the proposition of an OTC-POP and 85% agreed that they would discuss the decision to buy it with their doctor; 75% reported they would continue to see their doctor for other reproductive health issues, including screening. The most frequent barrier is cost (reported by 25–33% of women) followed by long waiting times for doctor appointments and lack of personal time to schedule an appointment. Pharmacists (66%) would be likely/fairly likely to recommend the POP after appropriate training, agreeing that the benefits of an OTC-POP included improved access for women, saving them time and giving them more independence. Conclusions Potential users of contraception in Italy have a positive attitude toward OTC-POP, with doctors continuing to have a relevant role. Following training, pharmacists are also positive.

Modeling the Potential Benefit of an Over-the-Counter Progestin-Only Pill in Preventing Unintended Pregnancies in the U.S.

ABSTRACT Almost half of the 6.1 million annual pregnancies are unintended. Barriers to accessing contraception including prescription requirements contribute to inconsistent use or nonuse. This has led to a call from major medical organizations for effective over-the-counter (OTC) contraceptives such as progestin-only pills (POPs). Studies have modeled the potential impact on an OTC POPs; however, they are based on women expressing interest versus actual use. The objective of this model was to utilize data from an actual-use clinical trial to calculate the potential impact of a POP, when they are available over the counter, on the number of unintended pregnancies in the United States. Data were obtained from a recent actual-use clinical trial that simulated OTC use of a norgestrel POP over a 6-month period. In this study, 883 women chose to pay out of pocket and use the norgestrel POP. This model compared the number of expected pregnancies among 2 cohorts of 100,000 women, one of which was based on the contraceptive mix of volunteers entering the actual-use trial, and the second was women exclusively using an OTC POP. The primary analysis set the failure rate of the OTC POP to 7%, the reported failure rate for oral contraceptive pills, and that of “no method” as 85%. The failure rate of the non-OTC POP cohort was that from the actual-use trial. A “tipping point” analysis was conducted to determine the failure rate of the OTC POP beyond which no unintended pregnancies would be prevented by OTC POP compared with the mixed-method cohort. At the 6-month time point in the actual-use trial, only 51.1% of subjects were continuing OTC POP use. A continuation-in-use analysis was conducted to determine what effect discontinuation might have on unintended pregnancy rate. According to the model, a total of 37,624 unintended pregnancies would occur if 100,000 women continued their current contraceptive method over the course of 1 year. If those 100,000 women had used the OTC POP exclusively for 1 year, 7000 unintended pregnancies would be expected. Thus, an estimated 30,624 fewer unintended pregnancies, a reduction of 80%, would be expected over 1 year by use of an OTC POP. The results of a sensitivity analysis that decreased the OTC POP failure rate from 7% to 3.5% resulted in an estimated 34,124 fewer unintended pregnancies and an increase in OTC POP failure rate to 10.5%, and reduction of “no method” failure rate to 46% resulted in an estimated 1461 fewer unintended pregnancies. The tipping point analysis identified an OTC POP typical use failure rate of 38% at the point which using the OTC actual-use trial method mix profile and a “no method” failure rate of 85% would result in equivalent unintended pregnancy rate to the OTC POP cohort. When revising estimates according to the continuation-in-use analysis, a reduction in unintended pregnancies of 59% over 6 months compared with the actual-use trial method mix profile (11,009 pregnancies prevented) was calculated. The results of this study suggest that the use of a POP when available over the counter will result in a significant reduction of unintended pregnancies in the United States.

Response to Eglash re: "The Risk of Breakthrough Bleeding Justifies the Use of Combined Hormonal Contraception Over Progesterone-Only Pills While Breastfeeding": Combined Hormonal Contraception Is Not Without Disadvantages, But Is Acceptable During Lactation.

Breastfeeding MedicineVol. 18, No. 5 CorrespondenceResponse to Eglash re: “The Risk of Breakthrough Bleeding Justifies the Use of Combined Hormonal Contraception Over Progesterone-Only Pills While Breastfeeding”: Combined Hormonal Contraception Is Not Without Disadvantages, But Is Acceptable During LactationLior Segev, Abraham O. Samson, Goldie Katz-Samson, and Naama SrebnikLior SegevAzrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.PUAH Institute: Fertility. Medicine. Halacha, Jerusalem, Israel.Search for more papers by this author, Abraham O. SamsonAddress correspondence to: Abraham O. Samson, PhD, Azrieli Faculty of Medicine, Bar Ilan University, Henrietta Szold Street 8, Safed 1311502, Israel E-mail Address: avraham.samson@biu.ac.ilhttps://orcid.org/0000-0001-7436-3515Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.Search for more papers by this author, Goldie Katz-SamsonNishmat: The Jeanie Schottenstein Center for Advanced Torah Study for Women, Jerusalem, Israel.Search for more papers by this author, and Naama SrebnikDepartment of Obstetrics and Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel.Search for more papers by this authorPublished Online:17 May 2023https://doi.org/10.1089/bfm.2023.0064AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Response to Eglash re: “The Risk of Breakthrough Bleeding Justifies the Use of Combined Hormonal Contraception Over Progesterone-Only Pills While Breastfeeding”: Combined Hormonal Contraception Is Not Without Disadvantages, But Is Acceptable During Lactation." Breastfeeding Medicine, 18(5), pp. 402–403FiguresReferencesRelatedDetails Volume 18Issue 5May 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Lior Segev, Abraham O. Samson, Goldie Katz-Samson, and Naama Srebnik.Response to Eglash re: “The Risk of Breakthrough Bleeding Justifies the Use of Combined Hormonal Contraception Over Progesterone-Only Pills While Breastfeeding”: Combined Hormonal Contraception Is Not Without Disadvantages, But Is Acceptable During Lactation.Breastfeeding Medicine.May 2023.402-403.http://doi.org/10.1089/bfm.2023.0064Published in Volume: 18 Issue 5: May 17, 2023Online Ahead of Print:May 2, 2023PDF download