With high rates of unintended pregnancy in the United States, it is crucial for clinicians to be well-informed about the full spectrum of contraceptive options to improve reproductive autonomy. We review new contraceptive options including a nonhormonal intravaginal gel, hormonal contraceptives in the form of new pills, patches, and vaginal rings, and combined hormonal contraceptives that contain new estrogens as alternatives to ethinyl estradiol. We review updated prescribing methods for several established hormonal contraceptives such as depot medroxyprogesterone acetate, which is now available for subcutaneous self-injection. Additional choices of available contraceptive methods have important clinical implications that may remove unnecessary barriers to contraceptive use.
KEY POINTSCertain long-acting reversible contraceptive methods can prevent pregnancy beyond the approved duration of use. However, this does not allow for extending the duration of use for lowest-dose progestin intrauterine devices.Intravaginal contraceptive gel offers a nonhormonal contraceptive alternative.Contraceptives with longer approved durations of use or that do not require frequent access to healthcare professionals can improve adherence and outcomes.
■ NONHORMONAL CONTRACEPTIVE INTRAVAGINAL GELA 47-year-old with latex allergy presents to the offi ce. She is interested in contraception, but does not want anything that contains hormones.
Primary hyperparathyroidism (PHPT) typically occurs in persons above 45 years, with a female predominance. PHPT induces a state of hypercalcemia, but acute pancreatitis is a rare sequelae of this hypercalcemia. We report a case of a 31-year-old man with no known medical history who presented in diabetic ketoacidosis with electrolyte abnormalities. His clinical course progressed to multi-organ dysfunction despite correction of metabolic derangements. Further workup led to the discovery of the uncommon triad by which previously undiagnosed PHPT precipitated severe diabetic ketoacidosis.
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