Podcasts about larcs

Today, I am thrilled to reconnect with my friend and colleague, Jackie Piasta. Jackie is a Vanderbilt-trained nurse practitioner. She is board-certified in women's and gender health, and has been practicing since 2010. She serves on medical advisory committees for several foundations and co-hosts the justASK Podcast.  In our discussion today, we dive into the challenges menopausal women face with hormone replacement therapy due to the lack of provider education on the effects of oral estrogen, the importance of bio-individuality, and how nuanced messaging can make all the difference for women. Jackie unpacks the latest guidelines from the American Urological Society, which address vulvovaginal, urinary, and sexual health symptoms, and explains the importance of addressing those issues proactively. We also explore fertility tracking in perimenopause, especially for women using long-acting reversible contraception (LARCs), and the latest trends in hormone testing. You will not want to miss this insightful conversation where Jackie sheds light and offers practical guidance on the often-missed details of women's health. IN THIS EPISODE, YOU WILL LEARN: Why bio-individuality is essential in menopause treatments The challenges OB-GYNs and other clinicians face in staying updated on menopause treatments. Why healthcare providers must become more educated about hormone therapy Jackie explains the historical context surrounding the vilification of oral estrogen. How the new American Urological Society guidelines are now addressing symptoms of perimenopause and menopause Why vaginal laser therapy might be harmful for some individuals Why diagnosing menopause in women using long-acting reversible contraceptives (LARCs) is so challenging Why hormone level labs are needed to guide clinical decision-making on menopause treatments Jackie highlights the need for more research to understand the hormone levels that protect bone health. Connect with Cynthia Thurlow   Follow on Twitter Instagram LinkedIn Check out Cynthia's website Submit your questions to support@cynthiathurlow.com Connect with Jaclyn Piasta Monarch Health  Jackie on all social media: Jackiep_gynnp The justASK Podcast

The adolescent population is experiencing increasing pressure to take part in sexual activity. It is part of our role as pediatricians to counsel our patients appropriately & thoroughly through their sexual & reproductive health. Dr. Shreeti Kapoor, a general pediatrician, joins Pediatric Resident Dani Watson & MS3 Irielle Duncan to discuss contraception options & how to have those conversations with adolescent patients. Specifically, they will: Review the efficacy, mechanism of action, potential adverse effects, and benefits of various contraceptive options, including abstinence, barrier methods, combination hormonal contraceptives, Depo Provera, and LARCs.  Discuss how to obtain relevant medical and sexual history to help in choosing an appropriate contraceptive for an adolescent patient.  Identify potential barriers or considerations that are specific for adolescent patients when discussing contraceptives.  Discuss options for emergency contraception & their mechanisms of action.  Special thanks to Drs. Rebecca Yang & Danielle Rosema for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  https://www.aafp.org/pubs/afp/issues/2003/0401/p1571.html https://www.cdc.gov/nchs/products/databriefs/db366.htm#:~:text=By%20age%2015%2C%2021%25%20of,had%20ever%20had%20sexual%20intercourse. https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method/how-effective-is-withdrawal-method-pulling-out#:~:text=What%20we%20do%20know%20is,or%20not%20you%27re%20ovulating. https://www.acog.org/womens-health/faqs/barrier-methods-of-birth-control-spermicide-condom-sponge-diaphragm-and-cervical-cap https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices https://www.acog.org/womens-health/faqs/combined-hormonal-birth-control-pill-patch-ring https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection https://www.aafp.org/pubs/afp/issues/1998/0801/p522.html https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods      

Today, we're discussing a subject that plays a crucial role in many people's lives: birth control. I had the pleasure of chatting with our guest, Dr. Bana Kashani, about this topic in great detail. Dr. Kashani provided tremendous medical insights and discussed the various forms of contraception, what to expect with each, and debunked some common myths. Birth control isn't just about preventing pregnancy—it's about empowerment, choice, and taking control of your health. Whether you're thinking about changing the current birth control you're on, needing to consider your options after you have baby (if you're pregnant), curious about how different methods work, or just looking to understand more about this important aspect of reproductive health, this episode is for you. We navigated through the maze of pills, patches, IUDs, and more so that you can make an informed decision that best suits your lifestyle and needs. Now, let's meet our guest! Who is Dr. Bana Kashani? Dr. Bana Kashani is double board-certified in Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. She has been treating infertility patients since 2014 and has been practicing in Orange County, where she grew up, since 2017. Dr. Kashani received her medical degree from the University of South Alabama, College of Medicine, where she graduated at the top of her class, and she completed her residency at the University of Southern California. There, she received tremendous experience in all facets of Obstetrics and Gynecology but specifically had an interest in Reproductive Endocrinology and Infertility. She continued her medical training and pursued a subspecialty in Reproductive Endocrinology and Infertility at Rutgers, New Jersey Medical School. Since Dr. Kashani is focused on providing her patients with the most personalized approach to fertility services and treatments, she opened up her own practice in 2020. Her practice's mission is to ensure patients feel comfortable and cared for since infertility treatments can be overwhelming. What Did We Discuss? In this episode, we chat with Dr. Bana Kashani about navigating birth control. In a rapidly evolving landscape of reproductive health, navigating the variety of birth control options can be overwhelming. Here are several of the questions that we covered in our conversation: How do you help patients determine which birth control method is best suited for them? What factors should individuals take into consideration when selecting birth control to meet their needs? What are the most common forms of birth control available? Can you talk about the efficacy of these methods?  What are the main differences between barrier methods and hormonal methods? When talking specifically about hormonal birth control, how effective is it in preventing pregnancy, and is there any negative impact on fertility when used for an extended period of time?  Can you explain what Long-Acting Reversible Contraceptives (LARCs) are and how they differ from other forms of birth control? What are the benefits and drawbacks of LARCs compared to other methods? What are some common side effects associated with different types of birth control? We know that it can be overwhelming when navigating the world of birth control, but we hope this episode leaves you feeling more knowledgeable about the different forms of contraception as well as empowered to choose the right form for you. Dr. Kashani's Resources Website: www.banakashanimd.com Instagram: @dr.banakashani Thank you for listening to this episode! Be sure to follow us on our podcast Instagram page @thebabychickchat. Let us know what you think and if there are any other topics you'd like us to cover. Cheers to being empowered to make your own choices! Learn more about your ad choices. Visit megaphone.fm/adchoices

The standardized assessment known as IREAD-3, or the Indiana Reading Evaluation and Determination, will be given to all third graders and most second graders during a testing window open March 4–15.  A Senate committee approved a bill Thursday that would increase access to postpartum, long-acting reversible contraceptives, also known as LARCs, for people on Medicaid. Language to disqualify candidates for Indiana attorney general if they face certain sanctions to their law license was removed from a bill on the Senate floor this week. A bill that provides tax breaks for developers and homeowners that preserve wetlands is awaiting Governor Eric Holcomb's signature. It passed the state House on Tuesday. The Indiana University Board of Trustees is keeping the Kinsey Institute at IU.  Want to go deeper on the stories you hear on WFYI News Now? Visit wfyi.org/news and follow us on social media to get comprehensive analysis and local news daily. Subscribe to WFYI News Now wherever you get your podcasts. Today's episode of WFYI News Now was produced by Darian Benson, Abriana Herron, Drew Daudelin and Kendall Antron with support from Sarah Neal-Estes.

Indiana Catholic Action Network (ICAN) Podcast The ICC staff do a quick roundup of where bills are this session, offer a deeper analysis of HB1426 on LARCs, and discuss the implication of HB1284 on deposit account agreeements.

Tech increases access to contraceptives in Cameroon A counselling app for family planning, used by nurses at a women and children's hospital in Yaoundé, Cameroon, has increased the use of long-term reversable contraceptives (LARCs) threefold. The study, published in the journal Science Advances, shows that the impact of the app was similar to giving large discounts on these contraceptives. Nurses used a tablet computer to conduct counselling sessions with clients, which recorded their fertility plans, needs, and preferences regarding contraceptive methods. The digital app uses an internal algorithm to rank methods according to their suitability for the client's lifestyle and health needs. Professor Susan Athey, from Stanford University and Berk Özler, from the World Bank's research department – both authors of the study – are on the show. Web Summit 2023 – was there any good tech for good? Angelica Mari, one of our regular studio experts, has just left Lisbon after chairing four sessions at the conference. More than 70,000 delegates showed up to one of the biggest tech meet ups in the world – but how much tech for good was discussed?  Angelica gives us an insider look.  The programme is presented by Gareth Mitchell and the studio expert is Angelica Mari.  Find a Story + Make it News = Change the World.  For new episodes, subscribe wherever you get your audio. If you like Somewhere on Earth, please rate and review it      More on this week's stories:  Can personalized digital counselling improve consumer search for modern contraceptive methods? https://www.science.org/doi/10.1126/sciadv.adg4420  Professor Susan Athey: Director, Golub Social Impact Lab https://www.gsb.stanford.edu/faculty-research/faculty/susan-athey  Berk Ozler: Lead Economist, Poverty and Inequality, Development Economics https://www.worldbank.org/en/about/people/b/berk-ozler  WebSummit  https://websummit.com/ Sound editor is Keziah Wenham-Kenyon  Head of Broadcast is Jon Cronin Production Manager is Liz Tuohy  Editor: Ania LichtarowiczRecorded and sound editing by: Lansons | Team Farner For new episodes, subscribe wherever you get your podcasts. If you like Somewhere on Earth, please rate and review it.

In this episode, KJK Student Defense attorneys Susan Stone and Kristina Supler talk with Dr. Michelle Fourcier, a Professor of Pediatrics, Assistant Dean of Medicine at The Warren Alpert Medical School of Brown University.  Dr. Forcier specializes in gender, sexual and reproductive health.  In this episode, they talk about what all the terms of LGBTQ+ mean, how pediatricians work with both parents and children about gender identity, and resources for parents to learn more about this complicated issue. Links: PubMed Website Show Notes: (04:12) Understanding the Gender Terminology within LGBTQ+ (06:59)  How Does Type of Care Different from Heteronormative (09:27)  Assigned Gender versus Gender Identity: What is the Difference? (12:16)  Is the Child Just Playing With Identities?  Or Do We Need to Act? (15:02)  When Does a Physician Decide if Hormones are Required? (16:44)  Do We Want Puberty in Children to Happen Later? (18:11)  How Pediatricians Work With Children to Keep Them Safe (19:15)  What are the Side Effects of Hormones? (20:52)  Blockers: What Do They Do? (22:43)  Conversations with Parents Who Are Not on Board with Hormones or Blockers (24:45)  When Do Children Go Through Surgery? (25:32)  When Surgery for Minors may be Necessary (27:46)  What are LARCs?  How Do They Prevent STIs? (30:36)  Dual Method for Birth Control and STI prevention (31:46)  Consider This Thought If Your 14 Year Old Child is Sexually Active (34:19)  Resources for Parents to Learn More Transcript: Susan Stone: So everybody out there listening to this podcast know that my, this is Susan and my daughter got married this weekend, and I'm a little tired.  But  Kristina Supler: though you think everyone knows that. Everyone doesn't actually know that.  Susan Stone: I know, but I felt the need. This is Real Talk guys out there on listening land. I am exhausted. But I had to come into work today cuz they knew that we had, the books, the recording of this podcast. And we're gonna talk about pediatric health for the L G P. Lg, I told you I'm tired. BTQ Plus community and I, Kristina, I just wanna have a conversation about the health needs and not a political conversation.  Kristina Supler: Yeah. I'm really looking forward to today's episode because I think there's so muchto talk about and learn to have more real conversations about the issues versus some of the politicized language that has pushed people into corners and people have in many ways shut down and are not open to learning new information. Susan Stone: and I think we're just forgetting that we're still talking about kids. So why don't you kick off the guest so we can just launch in and talk about whatever the health needs are of the kids and guys, let's leave the politics out. Okay? For once.  Kristina Supler: Today we are really happy to be joined by Dr. Michelle Fourier, who is an associate professor of pediatrics and an assistant dean at the medical school at Brown University. And with extensive training and experience in adolescent health and sexual healthcare, she's dedicated her career to addressing the unique needs of the LGBTQ plus youth.  Susan Stone: That is the guest we needed for today's podcast, a Doctor.  Perfect.  Dr. Michelle Forcier: So let's jump in.  Susan Stone: Let's just jump in. Dr. Fourier, can you explain exactly what you do for that population? Dr. Michelle Forcier: I have been a pediatrician for about 25 plus years. And I've been providing gender, sex and reproductive justice care, basically across the lifespanfor this period of time. And it's been a pretty exciting, community, pretty wonderful and satisfying community to work for and to work with. And the way I look at providing care for the L G B T Q community is that it really is primary care. Basically gender and sexuality are part of human identity. And they're there before we leave the womb. There's a neat study about in utero masturbation, which is kind of cool. So we get started early and we are gendered and sexual persons, until we die. So if we look at gender and sexuality as being a ubiquitous part of the human experience, and we look at biology as absolutely diversity is a part of biology. It's one of the basic tenets of biology. Then we understand that both sex and gender are gonna be diverse experiences for a range of different people and folks. And my role has been to provide care for some of our most marginalized community members, which is the L B G T Q I A plus. Sometimes it's easier just to say rainbow population. I like that.  Kristina Supler: Before we dive in further, just to get some terminology nailed down for our listeners who maybe aren't as familiar. you've spoken about gender and sex and we're referencing the plus, but can you just define those terms for our listeners, particularly the plus as well? Dr. Michelle Forcier: Sure. For many gender has been considered in this very binary, traditional way of male, female. Or heterosexual and homosexual. Sexuality is about who we love and who we're attracted to and who we have different sexual behaviors with. Gender is who we are. It's a part of our identity in terms of being masculine, feminine, non-binary and all the other ways that we could express, a gendered self. And the world for many years has been pretty limited in terms of only discussing these binary identities. I think with time, with improved social discourse, with the advent of the internet and increasing knowledge spread in, in diverse ways and diverse communities, we understand that there are many, many ways to be sexual and many ways to be gendered. So the L stands for lesbian, which are persons, we might say women who are attracted to or have sex with women. Gay usually is referenced to either, males or females who are attracted to the same gender partner, bisexual, historically has been the term for people who identify as being attracted to both males and females. But now we have even more inclusive terms, which are things like pansexual, which means gender doesn't factor into who I'm attracted to. Transgender or gender diverse are persons whose gender identity doesn't exactly match the gender they were assigned by their parts, chromosomes or hormones and birth. I is another. Initial for intersex or persons who have differences, in sexual development in the parts and organs they were born with. And A can mean asexual or persons who really don't have a sexual affinity or an interest in, sexual activity.  allied, And the plus means there are probably a million different ways, and we know there are a million different ways people may identify in terms of how they see themselves as a gendered person and their gender expression and gender role and gender self in the world, as well as their sexual, um, attraction, their sexual behaviors and their sexual identity in the world. Susan Stone: That's a lot. That's a lot. But here's messy. Something that comes into my mind, because you are a pediatrician. How do those differences make a difference in terms of just treatment for well visits? What is, what type of care is specific and unique to that population as opposed to what I would call a heteronormative child. Dr. Michelle Forcier: Sure. to be honest, in any visit, and again whether it's children or whether it's adults, we should be talking about these aspects of selfhood and behavior and health needs across the lifespan. Of course, we should do it in a developmentally appropriate way. So if we're gonna talk to a six year old about their gender identity, we might ask them, they're like, what is it like to be a boy or a girl? How does that feel to you? How do you express boyness? How do you express girlness, For a 16 year old, that may have very different words in terms of, how do you view your gender identity? What parts of it are comfortable for you, what parts are not comfortable? Do you have any questions? Again, the same with sexuality. Who might you have a crush on versus, a full sexual history forlater teen or young adult who's sexually active with one or more partners. So it's all about, again, using the language of the patient and understanding where they are developmentally to continue to talk about these aspects of both selfhood and wellness during health visits. Susan Stone: Well, I guess I wanna press you on that because I'm a mother of three. And I would say for the first 14 years of, checkups. It's, you know, height, weight, weight, vaccinations,  Kristina Supler: poking and prodding,  Susan Stone: poking and prodding, talking about school and milestones. We really,  Kristina Supler: or at least that was your experience with your child's children's pediatrician. Susan Stone: Yeah, but I just don't rem I don't think conversations regarding sex came into play until when the making a decision about the H P V vaccine or maybe when does menstruation start for that being the end of growth? I guess that's what I'm confused. Or birth control when that comes in. But other than that, I think of, how big is the baby? Dr. Michelle Forcier: And I'm thrilled that you ask about this. Because what I'm proposing is a slightly more advanced model of care in the sense that, again, if we know that there is gender diversity in the world and some youth present as gender diverse, gender exploratory as early as four, five, and six. Shouldn't we be talking to parents about, say again, educating people? Your child who is assigned male or female at birth. But we don't know what their gender identity may be later down the line. And that's the one or two sentences that a pediatrician can have with a parent to, again, describe and educate the difference between an assigned gender at birth and the fact that potentially two or three of probably more percent of the population of young people are going to be, or exploring gender, or at least talking about it over time. Then when we know that many youth undergo puberty and it's considered normal. As early as seven or eight year old, you can start having breast buds. By age seven or eight, it's considered within the normal range. You can be having a period by the age of 10. So if you're waiting for the magic number of teen years, 13, you've missed a whole bunch of folks that have already started many and of the stages of puberty and actually maybe completely, adult in their hormones and progressing toward adulthood very quickly in terms of their bodies.  So by waiting till kids are teens until quote unquote, they're ready to be sexual or ready to go through the process of puberty, we've missed the boat in preparing both parents and kids for helping their children approach adolescence, approach the changes of puberty. Approach the concepts of being a gendered or a sexual person in a healthy and supportive way.  Think about it. Wouldn't it be easy as a parent or easier as a parent to talk about sexuality when it's theoretical? Versus you're coming in because your daughter's pregnant and you didn't even know she was having sex? I would prefer to talk with kids in a developmentally appropriate way over time. So that kids are prepared to make decisions and that we're not going back and saying, okay, now we need to deal with an issue. Now we need to deal with a problem. Now we need to deal with some sort of health need versus let's talk about anticipatory guidance. Let's have our kids be healthy.  Susan Stone: I know that you are involved in giving T blockers or hormones.  Kristina Supler: Oh, I was gonna ask about that.  Susan Stone: Yeah. I'm really curious, when do you decide that's appropriate? What are the side effects? Are they safe and are they safe? And also, how do you know, and this is a lot, that a child's just not playing with identities and trying on what suit fits because there is discussion versus this is real and we need to act.  Dr. Michelle Forcier: Sure. So we know that gender play trying on identities is common among kids. It's how again, we explore and figure ourselves out. But every kid that plays with their gender identity and gender rules and gender expression doesn't get hormones and doesn't go to a clinician to go get hormones. So if a child is really thinking hard and long about their gender identity, and oftentimes they'll think about it quite a bit before they even talk to their parents, they'll have that conversation with their parents about maybe the gender they were B with were born with doesn't quite fit them. Or maybe it absolutely doesn't fit them. And we have kids really at young ages, just like they know their cisgender identity. We have some kids at very young ages know their transgender identity. Regardless as a parent, in some ways, it really shouldn't matter what their gender identity is. What you want is to create a home situation and ideally again, or early clinical situation where kids and parents have lots of information so they can explore gender in whatever ways make sense for that child in a safe and healthy way. If you look at the studies by Kay Olson, the Trans Youth, project, she shows that kids that grow up in supportive environments, kids who present early as gender diverse and exploring gender identity, she demonstrates that they look just like their cisgender peers in terms of anxiety and depression growing up in supportive households. Now a supportive household doesn't care. The endpoint is a happy and safe child. It doesn't matter which directions the child goes in terms of gender identity, because as an accepting and loving parent, I don't care what their gender identity is. I want my child to be authentic. I want my child to feel safe. I want my child to feel loved. I want my child to feel heard and respected. And it doesn't matter what their gender identity is. They're my child.  Kristina Supler: Is there an average age when the research shows children start to explore gender identity and conversations are starting to be had within households or is it different for everyone? Dr. Michelle Forcier: It's different for everyone. I've had 80 year old patients come to me and say, now is the time that they're ready to start their gender affirmation process.  Susan Stone: But I do wanna press back on the question. Yeah. Because there are parents who do want to help their child. Yep. Good hormones are a health option. And I think Kristina's question was a good one. When does a physician make, how does a physician, and when does a physician make a choice that this is appropriate and are they safe?  Dr. Michelle Forcier: It's not based on age. It's based on need. And so a patient will go through a very thorough evaluation. People don't just walk in clinic and get a shot of puberty blockers, people. Kristina Supler: What do those evaluations entail?  Dr. Michelle Forcier: Oh, long history. About home, about activities, about the family medical history, their medical history, their social history, substances, self harm and mental health issues, exposures at home, in school,  Kristina Supler: it's like I assume questionnaires are given to children and parents as well. Dr. Michelle Forcier: It depends. And I mean, I find that most kids would rather talk to me than fill out a piece of paper.  Susan Stone: Yeah. So we talk. So if you make the decision that it's appropriate, what are the, the benefits and what are the risks?  Dr. Michelle Forcier: So the benefits, again, just remember we're not having the same conversation about, say, kids that are using the same medication for precocious puberty. Again, just to remind yourself in the context of avoiding political chatter, same medicine, kids not talking about it at all. So these are very safe medicines that have been around for many, many years. And we've used them in first, studied them with precocious puberty. Again, completely reversible.  Susan Stone: because Provo, is it true doctor, that precocious puberty, which just for our listeners who mm-hmm. don't know what that is, that's the onset of pub. Pub of puberty, very, very early at life. And we wanna delay that as much as possible because they're now finding that, especially for females, you want a puberty go in later and menopause to be later.  Dr. Michelle Forcier: Well, you want puberty to be later for a couple reasons. Number one, it would be really, really weird to have a fully feminized body at age six. Horrible. Yes. So they're social as well as biological consequences. And these kids use puberty blockers far longer than many of our trans kids. Again without all the bruja about safety and effectiveness. So puberty blockers basically are an hormone analog, and they fool glands in the brain to shut down and stop secreting the hormones that trigger ovaries and testes to secrete testosterone and estrogen, the sort of puberty hormones that start to create adult body and adult sort of physiology. And by putting this temporary pause on those brain gland signals, the ovaries and testes just sort of rust. They stop secreting. And when we take away that hormone, the ovaries and testes start secreting again. So it's sort of like putting a pause button on your Spotify or your, your music player. Pause, lift it back up. The music starts right back where it was. It just has a delay in time.  Susan Stone: Have children ever gone back but forth and said to you, you were, they were on the medication and then said they changed their mind? Or do you see that when kids are evaluated, you make that choice, they're happier, more fulfilled, and they'll stay on it long-term? Or is it across the board?  Dr. Michelle Forcier: It's across the board. as a pediatrician, we wanna keep asking kids, is this the right path for you? Should we be doing this? Does this still help you figure out who you need to be, where you need to go? Or are, have you figured some of these things out and don't need puberty blockers anymore? Or have you figured these things out and now need gender hormones? It all depends on the child. So our job is not to push someone forward through gender hormones or puberty blockers. It's to keep asking kids, what do you need? And that's medicine 1 0 1 patient. Sure. What do you need? Where are we now? Things change in our body. Things change in our heart and mind. We have to keep talking and listening to kids to find out what they need. So if they need to stop, they should. And if they need to, start again because stopping actually demonstrated that they are really uncomfortable with the changes of puberty. Then, yeah, we can honor that request and honor their experience.  Kristina Supler: So what are the, what are some of the risks though, that can be attendant to taking these hormones?  Dr. Michelle Forcier: Well, the way I tell kids and parents having to come to the doctor to get a shot kind of stinks. So that's a risk and that's a bummer. Let's see if kids start these medicines very early in puberty, there's very little change in their internal hormone environment. So they don't have side effects like say, menopause, some hot flashes and some little bit of irritability as hormones are shifting.  Is growth impacted?  Growth usually, is, that's a great question. Impacted in the sense that, trans boys may have the potential to grow a little bit taller because we're gonna block estrogen's effect on growth plates. And for trans girls, again, we can work with them to look at again, their potential height or their, high trajectory to figure out how tall they are gonna be. And will that factor into, again, starting estrogen or gender hormones so we can use it again to inform our patients what their options are. So that they can be in a body that's comfortable and safe for them. Susan Stone: Well, is, are those blockers different than hor gender hormones to help, let's say in a trans. Would it be a child who identifies as trans male wanting to be female? I hope, again, I'm terms right and forgive me if I'm getting 'em wrong. So if you want to help someone develop the other way, or maybe a female by birth sex, who wants to be a male, is that a different type of hormone or medication protocol? Dr. Michelle Forcier: So blockers are used basically just to stop the current gonads, ovaries and testes from secreting, estrogen and testosterone. If a patient is either way past the beginning of puberty or a patient is on gender blockers, you know, puberty blockers, they can start the other hormones in the past referred to as cross-gender hormones to basically start the puberty that makes sense for them. So if I am identifying as female, and I have been on puberty blockers, At age, say 13 or 14 or 15 or 16, whenever again that child, that patient says it's appropriate for them, they have parent support and we all have a plan. They may start estrogen so that they can develop just like their peers. Which we think, again, has a positive health benefit in terms of, again, that congruence.  Socially with my body is developing just like my friends. I feel normal, I feel accepted, I feel like,I'm a part of my community. So for boys puberty usually happens a little bit later, so sometimes they might start their male testosterone hormones a little bit later, say, than females. But again, It's all dependent on when we first see a patient, how far they've gone through puberty, what they understand of their gender identity and where they are in terms of making a plan to affirm their gender identity or not, or just learn more and explore. Kristina Supler: What do you say to parents who are in your office with the child and the parent you can tell, just isn't on board with the child's desire to start hormone therapy or whatever the circumstance may be. What sort of conversations do you have?  Dr. Michelle Forcier: Would that ever happen? Never. So yes, that happens quite frequently. We have parents that want us to say, this is just a phase or a fad. Let me tell you, being transgender or gender diverse is hard in our culture. It's hard. And when we see kids in our clinic, the vast majority of the time, they're there for real issues, real goals, and real pain. And we need again to start with taking our patients at their word and carefully explore what they mean by their experience, their dysphoria or their goals. So I tell parents, listen, you and I are coming from the same place. I want a safe kid, a kid who's around alive participating in the world, the kid who's healthy. Who's mentally and physically healthy. We may come at it from slightly different approaches. You're coming at it as I expected my child to be cisgender and to I wanna walk them down the aisle, at their wedding and they're gonna have a baby and provide me with grandchildren. And my job as that child's pediatrician is to say, your child is telling me that their body, if it's to continue to develop, say, into a female body, is gonna create such harm, such discomfort with their physical self, such anxiety and depression because in their heart and head they identify as male. And so we have to really listen to your, your child and hear what they say in terms of how do we explore the identity you were assigned at birth with the identity that you are telling me you experience now.  Susan Stone: When do you talk about surgery? When does that enter into the conversation? Because it's, I think, One, I think it's a very different conversation. When do you start maybe blockers or hormones versus when do you actually put a child through radical surgery that you can't reverse?  Dr. Michelle Forcier: Most children don't go through quote unquote radical surgeries. In fact, children have far more radical surgeries for lots of other issues or problems, and they ascent to the process of surgery for whatever their healthcare needs, along with the consent of their parents. So I think that's the first thing to take that. would some children  Susan Stone: wa, I would say would wanna com complete the process right?  Dr. Michelle Forcier: But many children don't have necessarily the support or the resources to necessarily go through some of the more major and intensive surgeries. Vaginoplasty and phalloplasty creating a vagina and a penis are very intensive. People don't usually do that until after age 18.  Susan Stone: Okay. So it's not really a pediatric issue then?  Dr. Michelle Forcier: No. Now say there are some youth, and this is the more quote unquote common surgery, although again, with blockers, we don't have to do this quite as often now is say a child's developed breast at age seven or eight and say they identify longstanding as a trans male. Why? When they come see me at age 16, or they come see me at age 14 and by age 16 they're gender dysphoria regarding their adult size breasts, which they've had now for eight years is killing them. They're not showering. They're wearing a binder 24 7. They have suicidality and again, nothing's changed in their gender identity. Why would I say you need to wait two more years until the magic number of 18 to have a male chest construction knowing that nothing has changed from age six to now 16, and you have had eight years of female breast tissue That's harmful. The harm in that is far greater than the harm of saying you're 16, you've been through years of care with us. You're gonna be as assessed by a surgeon. The surgeon may require other information before they do your surgery. And then through this long standing process, not I come in the clinic and tomorrow I have my chest removed, oftentimes months to years I get my chest surgery and I no longer have to wear a binder 24 7 and I can take a shower. And look in the mirror.  Susan Stone: So it can be a pediatric issue. Yeah. Something that a pediatrician. Okay. That's all I wanted to understand. Yeah. Is this something that pediatricians deal with versus not? Dr. Michelle Forcier: Not too often. And most of the time when we get to the point of surgery, again, there may be a number of people involved including gender specialists as well as including mental health people as well as the team that works with the surgeon. So we're talking about a whole lot of people.  Kristina Supler: Dr. Forcier can you tell our listeners a little bit. I, in preparing for today, we came across the term or pneumonic I had never seen before. Lark. Susan Stone: I looked it up too.  Kristina Supler: How do you work with this population in terms of contraception and tell our listeners what a lark is and yeah,  Susan Stone: Because a lark is not a bird, guys. It's an acronym.  Dr. Michelle Forcier: No, and it's wonderful. It's a long acting, completely reversible contraception. They are a little device we can put in the arm or an intrauterine device we put in the uterus. So the I U D, right? Yeah, exactly. They're so effective in terms of preventing pregnancy.  Now we know that young people may not identify, they may identify as straight, but they have either same sex relationships. We also know that young women who have sex with women are actually at increased risk for STIs in pregnancy because they're not prepared.  Susan Stone: Wait, wait. So I was gonna say, if you have a child who tells you that they're interested in only sex with their own matching sex, not gender. Mm-hmm. Because that can be an identity issue. Yeah. You know what? I have to be honest with you, Dr. I would think, why do I need to go down the contraception path?  Dr. Michelle Forcier: Because the data says that young women who have sex with women get STIs and get pregnant because they're exploring well, but wait.  Susan Stone: But long act larks won't prevent an sti I only condom use. Correct. Or dances. They're not  Dr. Michelle Forcier: having sex barriers prevent  Susan Stone: STIs. yes. But given we all know, we can all say that. But we are in the world. World and teens engage in sexual activity. I like the idea of a lark in terms of, you don't have to depend on taking that pill and memory. You got, I gotta be honest with you though, it's not as good though in terms of St I. Infection prevention, is it?  Dr. Michelle Forcier: No, it's purpose is not to prevent STIs. To be like asking your microwave to show you a TV show. Your microwave isn't gonna play Netflix. It's a D, it's a d it's a device for a different purpose. So we need, so I feel like I'm missing about this. Talk about them as separate  Susan Stone: pieces. Help me out. help me out. I'm getting confused.  Dr. Michelle Forcier: I dunno.  Kristina Supler: I'll ask the dumb question. so I mean it's essentially an i u d . Dr. Michelle Forcier: What's essentially an i u D? A lark. Well, no, there's one that goes in the arm or and there's one that goes in the uterus. There, there are different kinds of long, I was confused. Thank you. Yeah. Got it. Cause it's just about the location of the implant. Some young people don't want people putting things in their uteruses. They don't want a pelvic exam. They're freaked out. And so that little rod in the arm that suppresses ovulation, wonderful. Very effective, very easy to put in and take out. Nice.  Kristina Supler: So it's really about patient comfort and what the patient is more,open to.  Dr. Michelle Forcier: Shouldn't that be patient care 1 0 1 anyway?  Susan Stone: Yes. Yeah. But, but, but we still need to insist that students are mindful of using condoms or other ways of preventing disease. So what do you recommend a LARC plus what Dr. Michelle Forcier: I mean the lit well number when the literature shows that, dual methods are wonderful and especially dual methods of STI protection with some sort of barrier method or condom, internal external condom. Or again, a lark in terms of a long-acting reversible contraceptive.  So again,think about the story. You have a parent coming in and she's worried about her teen being sexually active, right? And she says, I don't wanna, I don't wanna allow her to have birth control, even though she tells me this is what she wants, cuz that's gonna give her permission to have sex. Do you really think the parent allowing birth control gives that child permission to have sex? Or do you think that child's gonna make that decision to have sex on their own?  Susan Stone: You're talking to two lawyers whose whole practice is dealing with students and issue sex issue. So and and I have to gather that people who listen to our podcast are well on the way of understand. I guess our questions are focused differently because really our parents all are very supportive of their students and their choices. We're very lucky that by large, by and large, not all of 'em, but. By and large. Yeah.  Dr. Michelle Forcier: but I think the main thing is your kid's telling you they need something and you may not agree with the fact that you want them to be sexually active. Most of us aren't super excited to think about like our 14 year old being sexually active, but I'm not a 14 year old. But if my 14 year old is sexually active, I would really wanna make sure they had good birth control and I would really wanna make sure they understood things like consent. Saying no, saying you need to use a condom. And walking away from that encounter feeling empowered and safe. We don't how Advocacy, yeah. Yeah. If we don't talk about sex and how to manage it, how are young people gonna make thoughtful decisions? And safe decisions.  Kristina Supler: What are some of the most promising or not promising, pressing health issues facing the lgbtq plus community today?  Dr. Michelle Forcier: I thought we weren't gonna talk about politics and legislation. so I'm gonna say health issue. Health issue. Health. Health issue. Yeah. Those are health issues though. Because those are about geographic and political access to care and a state by state basis.  Kristina Supler: So Access's huge. Yeah, funda fundamentally just, it's not even access so much access, the medicine or the science, it's access. Dr. Michelle Forcier: Sure. The science is actually a lot less exciting because the science is pretty consistent. In terms of avail, like different types of availability and access to care for larks is really important. The safety of abortion, the benefits, short term and long term of gender affirmative care.  The science, again, we're not seeing there's like a huge variance in terms of different outcomes in different studies. The outcomes are pretty consistent in terms of access to care improves outcomes. And a whole host of these sexual gender health issues.  Susan Stone: I have to tell you something. I learned something today because, I learned a lot. I did not know what a lot of these acronyms meant, and they're missing, I have to be honest with you. I like taking worries off the table and I did not think you had to worry about pregnancy when you have a child. I thought that, that's, a huge benefit is that's one issue off the table. Or I didn't think about the s t I issue. So I thank you for educating me.  Kristina Supler: Absolutely. I think that this has been a really good discussion with a lot of information for our listeners. And if, parents out there listeners want to learn more about you or any of your research or any good literature, where would you direct them?  Dr. Michelle Forcier: PubMed has lots of good information in terms of all the research. Not just me, but all the research that supports sort of making these types of decisions. Up to date is a nice summary of different information about gender, sexuality, and reproductive healthcare. I'm happy to come on with you guys if you ever wanna have a question and answer session. This is really important stuff and I'm really excited to talk science and to talk evidence and to talk about listening to kids. So I'm, I so appreciate what you're doing and happy to be helpful in any way.  Susan Stone: Thank you, and I'm concerned. I can't imagine, doctor, how many doctors in your area are across the country?  Dr. Michelle Forcier: I wish, that's what, that's why we keep talking about this healthcare being primary care. Primary care, pediatricians, family, medicine doc, nurse practitioners, we all should be comfortable talking about gender and sexuality because they're a part of our lives and they're a part of primary care. Yeah. So we're,  Susan Stone: I can, we're doing more and more training. Yes. Yeah. We do need more discussion about this. Because like I said, when I think of a well visit with the child, I do think of weight, health, and, pumping meningitis, getting,yeah. Yeah. So thank you.  Dr. Michelle Forcier: My 14 year old did not wanna talk about pooping and peeing. There were more pressing and more pertinent issues relevant to her life. Oh, than age 14.  Susan Stone: You need to spend a day at my house because, Pooping is an everyday conversation.  Dr. Michelle Forcier: Okay. And not that, I think it's time to wrap it up.  Kristina Supler: Time to wrap it up. Dr. Forcier thanks so much for joining us and we, hope our listeners enjoyed this episode. Dr. Michelle Forcier: Thank you. Bye-bye. Bye-bye. 

LARCS provide remarkable contraception. The IUD and the IUS are both HIGHLY effective, although they do not have the same typical-use failure rates. While it is common knowledge that active mucopurulent cervicitis is a contraindication for IUD/IUS placement, what about the presence of bacterial vaginosis (BV)? BV has been identified for years as an independent risk factor for Pelvic Inflammatory Disease. Is placement of an IUD/IUS in a patient with current BV contraindicated? What do the guidelines say? Listen in and find out.

After weeks of putting it off, Dr. Jen is finally tackling a topic that she's sad and enraged that she even has to address: the need to consider hysterectomies as birth control due to the current abortion restrictions in the U.S. A heavy topic, yes, but at the end of the day, this podcast is a safe space where we can mention it all and have the hard and necessary conversations. So today, Dr. Jen is doing just that and giving the lowdown on hysterectomies, from what they are to the different forms, risks to be aware of, if they really are worth it as a contraceptive after all, and other options to consider before going down that road. So buckle up and brace yourselves for a wild and informative ride!       What's going down:     Breaking down hysterectomies and the different types of procedures available    Why tubal ligation, or "tying your tubes," is a solid form of birth control to consider  Examples of LARCs and their overarching benefits    A walkthrough of how hysterectomies are done and the risks associated with each kind   Hysterectomy aftercare: how you'll feel and what really happens to your organs when your uterus is removed    Why Dr. Jen LOVES the way people are keeping it real about hysterectomy recovery on social media. Watch the TikTok here!      Thank you for continuing the conversation and calling into the Viva la Vulva Voicemail at (503) 893-2016! Please be sure to rate, follow, review, and remember that nothing is considered TMI around here.      Social & Website   TikTok: @drjenniferlincoln   Instagram: @drjenniferlincoln   YouTube: @drjenniferlincoln   Website: www.drjenniferlincoln.com      Resources    Grab a copy of my book HERE!   Obstetricians For Reproductive Justice      References    https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html  https://www.acog.org/womens-health/faqs/hysterectomy  https://www.theguardian.com/media/mind-your-language/2012/mar/08/mind-your-language-feminisation-madness  American College of OBGYN FAQ: Sterilization by laparoscopy. https://www.acog.org/womens-health/faqs/sterilization-by-laparoscopy  American College of Obstetricians and Gynecologists. Practice Bulletin 208: Benefits and risks of sterilization. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2019/03/benefits-and-risks-of-sterilization     Thank you to our sponsors for making this episode possible. Check out these deals just for you:   Green Chef - Get 60% off plus free shipping when you go to GreenChef.com/drjen   Learn more about your ad choices. Visit megaphone.fm/adchoices

Guest: Edmund Kim, MD The COVID-19 pandemic impacted the way contraceptive care was offered to patients, with many offices turning to telemedicine.1 Telemedicine can be used while still offering long-acting reversible contraception (LARC) options by implementing a hybrid model for care.2,3 This type of approach consists first of a telemedicine appointment to counsel patients on all appropriate contraceptive options and, if necessary, an in-person appointment to initiate any contraceptive method that requires placement by a healthcare provider.2,3 To learn more about how you can incorporate this model into your practice, tune in to hear Dr. Edmund Kim share his approach and how the use of a hybrid model has enabled him to continue to offer all contraceptive options, including LARCs.2-4 References:1. Comfort AB, Rao L, Goodman S, et al. Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States. Reprod Health. 2022;19(1):99.2. Stifani BM, Madden T, Micks E, et al. Society of Family Planning clinical recommendations: contraceptive care in the context of pandemic response. Contraception. 2022;113:1–12.3. Prioritization of in-person and virtual visits during COVID-19: a decision-making guide for staff. Family Planning National Training Center. Accessed December 15, 2022.

Guest: Edmund Kim, MD The COVID-19 pandemic impacted the way contraceptive care was offered to patients, with many offices turning to telemedicine.1 Telemedicine can be used while still offering long-acting reversible contraception (LARC) options by implementing a hybrid model for care.2,3 This type of approach consists first of a telemedicine appointment to counsel patients on all appropriate contraceptive options and, if necessary, an in-person appointment to initiate any contraceptive method that requires placement by a healthcare provider.2,3 To learn more about how you can incorporate this model into your practice, tune in to hear Dr. Edmund Kim share his approach and how the use of a hybrid model has enabled him to continue to offer all contraceptive options, including LARCs.2-4 References:1. Comfort AB, Rao L, Goodman S, et al. Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States. Reprod Health. 2022;19(1):99.2. Stifani BM, Madden T, Micks E, et al. Society of Family Planning clinical recommendations: contraceptive care in the context of pandemic response. Contraception. 2022;113:1–12.3. Prioritization of in-person and virtual visits during COVID-19: a decision-making guide for staff. Family Planning National Training Center. Accessed December 15, 2022.

Episode 132: Harm Reduction and Reproductive HealthMeghana explains how to implement harm reduction strategies in at-risk populations such as unhoused patients and injected drug users. Dr. Arreaza adds comments about PrEP for HIV and Expedited Partner Therapy (EPT)  Written by Meghana Munnangi, MPH, third-year osteopathic medical student, College of Osteopathic Medicine of the Pacific Western University of Health Sciences. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Arreaza: It can be frustrating for physicians trying to change “risky” behaviors in their patients and turn those behaviors into “healthy” behaviors. Doctors deal with this issue every day, but after reading more about the principle of harm reduction, I'm feeling more prepared to help our patients reduce their risks.What is harm reduction?Meghana: Harm reduction is a set of evidence-based interventions that arose within the public health community to reduce the harms associated with risky health behaviors. Most commonly, harm reduction refers to the policies and programs that aim to minimize the negative impacts associated with substance use disorder. The goal is to “meet people where they are” and to provide compassionate, judgment-free interventions and resources to at-risk populations.Examples of people who are part of the “at-risk population.”Some examples are injection-drug users and sex workers. With America experiencing the largest substance use and overdose epidemic we have ever faced, it is exceedingly important we provide services such as clean needle exchange, overdose reversal training, safer sex kits, and more to prevent unnecessary injury, disease, and death. Arreaza: In some countries where prostitution is legal, women are required to have regular check-ups to continue work. I see that as a harm-reduction strategy. I disagree with having sexual workers, but if we are unable to eliminate them, then harm reduction may be the way to go. Why is harm reduction important in medicine?Meghana: Healthcare providers have a unique opportunity to improve the quality of life and limit the negative outcomes associated with risky health behaviors by incorporating harm reduction strategies into their practice. Harm reduction interventions not only decrease health risks in an individual but also in the community. Examples of harm reduction strategies. Meghana: Studies have shown that areas that have introduced clean needle exchange interventions have lower HIV seroprevalence compared to areas that do not have similar interventions [1]. It is critical  as health care providers to respect our patient's choices and provide supportive care that will not deter patients from accessing care in the future. Patients who engage in risky activities often face stigma and are treated poorly by the medical system making behavioral changes even more difficult [2]. Understanding that many patients may not be willing to change their behaviors and using a practical approach to medical counseling can strengthen physician-patient relationships. Arreaza: I can think of another example. Pre-exposure prophylaxis for HIV in patients who have multiple sex partners. You wish those patients would have more insight into the risks associated with having multiple sexual partners, but if you cannot change them, you can still reduce the risk.What is harm reduction in the context of the reproductive health field?Meghana: Within Harm Reduction programs, there are many important strategies targeted toward improving sexual and reproductive health. Individuals who inject drugs and sex workers have limited access to family planning services and HIV testing. Studies have shown that individuals with substance use disorder have higher rates of unintended pregnancies, pregnancy-related mortality and morbidity, and lower rates of contraceptive use compared to the general population [3,4]. Harm reduction within the reproductive health field must include expanding access to condoms, contraceptive methods, STI and HIV testing, and prenatal care. Reproductive health harm reduction strategies can reduce rates of STIs, HIV, and unintended pregnancies. In addition to expanding access to condoms, STI screening, treatment, and partner therapy must be offered and encouraged to all patients. Arreaza: As a reminder to our listeners, Expedited Partner Therapy (EPT) consists in treating the partner(s) of a patient with chlamydia or gonorrhea. You, as a physician, treat a patient with STI, but you also give a prescription or medication to that patient, and he/she takes the prescription or medication to his/her partner(s) without me (the doctor) seeing the partner in the clinic or hospital. This is a harm-reduction strategy. It is permissible in 46 states in the US and potentially allowable in Alabama, Kansas, Oklahoma, and South Dakota. It is prohibited in 0 states. Meghana: Regarding birth control, a recent study by Dr. Frank and Dr. Morrison from the University of Michigan suggests that long-acting reversible contraceptives (LARCs) such as the Intrauterine Device (IUD) or the “Implant” should be offered and easily accessible to women with substance use disorder [5].  In America, around 45% of all pregnancies are unintended, and among women with substance use disorders, this number is doubled [6,7]. More so, women with substance use disorders are 25% less likely to use any form of contraception and are more likely to use less effective methods [5]. Patient autonomy is important.Meghana: Autonomy is one of the fundamental principles of ethics in medicine, so it is important that all contraceptive decisions are made without any form of coercion. Also, all discussions must take into consideration previous trauma, such as intimate partner violence. Contraceptive counseling should be comprehensive, and patients should be educated on all methods, including emergency contraception and barrier methods.  Patients should not be coerced into choosing a LARC simply because they engage in risky health behaviors and should be offered the same methods as the general population [8]. Arreaza: Let's remember to offer Nexplanon to unhoused patients. On the topic of emergency contraception, you can listen to episode 129. Now, please give us a conclusion.“If you can't fly then run, if you can't run then walk, if you can't walk then crawl, but whatever you do you have to keep moving forward.”― Martin Luther King Jr.Meghana: Overall, family physicians are in a unique position to incorporate harm reduction strategies into their practice to improve the quality of life of their patients and to improve health outcomes in their community. Reproductive health harm reduction strategies should be considered and offered to all patients who engage in risky health behaviors. Individuals with substance use disorder and sex workers should be routinely tested for STIs, including HIV and Hepatitis C, as well as offered pregnancy testing and prenatal care if needed. Comprehensive contraceptive counseling, including condom use and emergency contraception, should be discussed with all patients, and conversations should be stigma-free and collaborative. Incorporating reproductive health interventions into already existing harm reduction programs is key to improving the overall health and well-being of our most vulnerable communities. _____________________Conclusion: Now we conclude episode number 132, “Harm Reduction and Reproductive Health.” Meghana gave us an excellent introduction to the principles of harm reduction in medicine. Applied to reproductive health, we can reduce risk by improving access to condoms, HIV and STI tests, and birth control methods, especially IUD and subdermal implants. Dr. Arreaza also reminded us of strategies such as pre-exposure prophylaxis for HIV (PrEP) and Expedited Partner Therapy for STIs. This week we thank Hector Arreaza and Meghana Munnangi. Audio editing by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you. Send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Amundsen EJ. Measuring effectiveness of needle and syringe exchange programmes for prevention of HIV among injecting drug users. Addiction. 2006;101:911–2. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1360-0443.2006.01519.x?sid=nlm%3ApubmedNyblade L, Stockton MA, Giger K, et al.; Stigma in health facilities: why it matters and how we can change it. BMC Med. 2019;17(1):25. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376713/.Woodhams E. Partners in contraceptive choice and knowledge. November 18, 2021. Available at https://picck.org/enduring-sud/.Patel P. Forced sterilization of women as discrimination. Public Health Rev. 2017;38:15. Available at https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-017-0060-9Frank CJ, Morrison L. Harm reduction for patients with substance use disorders. Am Fam Physician. 2022;105(1):90-92. Preview available at https://www.aafp.org/pubs/afp/issues/2022/0100/p90.html.Heil SH, Jones HE, Arria A, et al.; Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat. 2011;40(2):199-202. Preview available at https://pubmed.ncbi.nlm.nih.gov/21036512/.Terplan M, Hand DJ, Hutchinson M, et al.; Contraceptive use and method choice among women with opioid and other substance use disorders: a systematic review. Prev Med. 2015;80:23-31. Preview available at https://www.sciencedirect.com/science/article/abs/pii/S0091743515001140?via%3DihubBaca-Atlas MH, Nimalendran R, Baca-Atlas SN. Applying Harm Reduction Principles to Reproductive Health. Am Fam Physician. 2023 Jan;107(1):Online. PMID: 36689956. Available at https://www.aafp.org/pubs/afp/issues/2023/0100/letter-reproductive-health.html.Royalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

CME credits: 0.50 Valid until: 12-12-2023 Claim your CME credit at https://reachmd.com/programs/cme/long-acting-reversible-contraceptives-their-critical-role-in-addressing-todays-reproductive-health-landscape/14661/ Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARCs), are the most effective reversible contraceptive methods. The major advantage of LARCs compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term, effective use. In addition, after the device is removed, the return of fertility is rapid. Join Dr. David Eisenberg has he discusses when LARCs should be recommended as a first-line contraceptive choice and when they should not. He further details how to approach a shared decision-making discussion with patients about their contraceptive options.

How much do you know about your contraceptive options? From barrier methods, oral contraceptives, long acting reversible contraceptives (LARCs) and permanent methods, there is a veritable smorgasbord of options! In today's episode women's health GP Dr Dominique Baume and gynaecologist Dr Preetam Ganu discuss the pros and cons of each option and answer some FAQs.

Without doubt, the most common reason for requested progestin-intrauterine system (IUS) removal is abnormal bleeding patterns. But do you know what the second most common reason is? It's acne! In this episode, we will summarize a soon to be released article accepted for print in Obstetrics and Gynecology (the Green Journal). This episode will provide practical clinical pearls to truly obtain informed consent from our patients seeking long acting reversible contraceptives (LARCS).

Traditionally, physicians have informed patients that long acting reversible contraceptives are “just as effective“ as female sterilization. While as a Class that statement is correct, not all individual LARCS have the same efficacy; one in particular beats all other birth control methods, hands-down. Do you know which one? In this session we will review key facts regarding female sterilization and review the individual efficacies of long acting reversible contraceptives. We will also review the historic “math model” for female sterilization.

Today we talk about your options if you are really sure you don't want to have a child for like, years (or more!). Long-term birth control options exist, and they're great! Long-acting reversible contraception (LARCs) and permanent options (surgeries) are here. Learn more about your ad choices. Visit megaphone.fm/adchoices

Women in the military are suffering serious long term physical and mental health problems because of widespread bullying and sexual harassment. Research by the University of Oxford, King's College London and the charity Combat Stress found over 20% were sexually harassed, over 5% were sexually assaulted and over 20% were emotionally bullied. Laura Hendrikx, is the author of the study which was published in the BMJ Military Health Journal. She and Chloe Tilley are joined by veteran Colonel Ali Brown. Have you been watching Maid on Netflix? The 10-part series is a word-of-mouth hit, about a single mother in the US who flees her abusive partner and takes up cleaning for wealthy clients to support her and her daughter. Inspired by the 2019 memoir 'Maid: Hard Work, Low Pay, and a Mother's Will to Survive', it tackles poverty, domestic abuse, motherhood and homelessness. Rachael Sigee, a freelance journalist and TV critic and Caron Kipping, a divorce and separation coach and Independent Domestic Violence Advocate, herself a survivor of domestic abuse, discuss why it's so popular. The Lowdown, the world's first review platform for contraception, has found that women prefer the coil to any other contraceptive method. Long-acting reversible contraceptives (LARCS), such as the implant, injection, the hormonal and copper coil tend to be those chosen most frequently. However, during the pandemic, the Faculty of Sexual and Reproductive Healthcare (FSRH) has found a steep fall in access to these LARCS. Alice Pelton Founder of the Lowdown and Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Health Care, discuss. Blogger Toni Tone has thousands of followers across social media - many of whom call her “the big sister I never had”. Her work on relationships and female empowerment have been shared by the likes of Demi Lovato, Khloe Kardashian and Oprah Magazine. Toni's new book of ‘I Wish I Knew This Earlier' is a Sunday Times bestseller, and details her advice on the complicated, and sometimes painful, world of dating. Toni joins Chloe to discuss. Presenter: Chloe Tilley Producer: Kirsty Starkey Interviewed Guest: Laura Hendrikx Interviewed Guest: Colonel Ali Brown Interviewed Guest: Rachael Sigee Interviewed Guest: Caron Kipping Photographer: Ricardo Hubbs Interviewed Guest: Alice Pelton Interviewed Guest: Dr Asha Kasliwal Interviewed Guest: Toni Tone

Um episódio para esmiuçar melhor as características e o manejo de um dos métodos contraceptivos de longa duração (LARC) que possuímos no Brasil, o Implanon®. No episódio 06 falamos sobre os LARCs de forma geral, agora aprofundamos em um deles. Espero que gostem.

In this, the last episode of season 2,  Cara and Missi start with an overview of the hypothalmic-pituitary-adrenal axis as a basis for a comprehensive conversation around contraception.  Progesterone only, LARCS, combined methods, and everything in between. Come one, come all.  If you need a refresher on contraception, then this is your episode.  

In this, the last episode of season 2,  Cara and Missi start with an overview of the hypothalmic-pituitary-adrenal axis as a basis for a comprehensive conversation around contraception.  Progesterone only, LARCS, combined methods, and everything in between. Come one, come all.  If you need a refresher on contraception, then this is your episode.  

Many options exist nowadays for teenagers choosing to be on hormonal contraceptives. They are generally categorized into SARCs (short-acting reversible contraceptives) and LARCs (long-acting reversible contraceptives). LARC methods are recommended as first-line contraceptives. These include intrauterine devices and a new option that gets implanted into the arm and lasts up to three years. In this episode, Dr. Margot Rosenthal, a fifth-year obstetrics and gynaecology resident, explains the different contraception options, which choice is best, and what side effects to watch out for. She co-authored a practice article with Dr. Sarah McQuillan. The article is published in CMAJ: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.202413 Podcast transcript: https://www.cmaj.ca/transcript-202413 Calling all aspiring podcasters! Are you our next podcast host? CMAJ seeks a curious, astute and dynamic Canadian physician as the new voice of CMAJ Podcasts. For details and to apply: https://www.cmaj.ca/content/cmaj-podcast-host ----------------------------------- This podcast episode is brought to you by Dr. Bill. Dr. Bill makes billing on the go easy and pain free. Start your 45-day free trial today: https://www.drbill.app/cmaj ----------------------------------- This podcast episode is brought to you by Shingrix. Learn more at: https://www.shingrix.ca/en-ca/index.html ----------------------------------- Listen to Cold Steel, the official podcast of the Canadian Journal of Surgery: https://canjsurg.ca/podcasts ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts or your favourite podcast app. You can also follow us directly on our SoundCloud page or you can visit https://www.cmaj.ca/page/multimedia/podcasts.

In this week's episode, the Good GP welcomes back Dr Karin Sekhon to discuss long-acting reversible contraceptives (LARCs). This episode covers LARCs and Intrauterine devices (IUDs). Karin explains how they work, the procedures, contraindications and side effects. We also cover contraceptive injections. Dr Sekhon is a practicing GP with a special interest in women's health. Helpful resources: LARCs RACGP journal article: https://www.racgp.org.au/afp/2017/october/larcs-as-first-line-contraception/ Marie Stopes Australia: https://www.mariestopes.org.au/contraception/larc/ SHQ contraception choices: https://shq.org.au/wp-content/uploads/2021/03/Contraception-choices-2021_final.pdf SHQ LARC flyer: https://shq.org.au/wp-content/uploads/2020/06/SHQ-contraceptive-implant_web2019.pdf SHQ copper IUD: https://shq.org.au/wp-content/uploads/2020/06/SHQ-copper-IUD_web2019.pdf SHQ hormonal IUD: https://shq.org.au/wp-content/uploads/2020/06/SHQ-Hormonal-IUD_web2019.pdf SHQ contraceptive injection: https://shq.org.au/wp-content/uploads/2020/06/SHQ-contraceptive-injection_web2019.pdf

Dr Terri Foran, Sexual Health Physician, will dispel some of the major myths and misperceptions that seem to impact LARC uptake, and provide practical advice on how to effectively communicate those with your patients. LARCs are an important set of effective contraceptive options that Australian women should be more aware of. The ease of use and reliability should make them the first option for many women, yet they are not as widely used as they should be.  See omnystudio.com/listener for privacy information.

The desire to have and love children is one of the strongest, most basic human urges. But studies show that having less kids or no kids is by far the single most impactful action you can take to create a more sustainable tomorrow. So is there any wiggle room in these studies? Or could we justify having a baby on other grounds? Perhaps countries with low birth rates and high consumption rates, (i.e us here in Aotearoa and other wealthy nations), should actually focus the way we consume? We love babies here at How to Save the World and see this episode as a chance to personally reflect on what feels right for you, not as a chance to forward to your prodigiously reproducing friends. It's a hard topic - so hard in fact that it is usually completely omitted from civic debate or sustainability forums. Thanks to those who have gone there, notably: North & South Magazine, Feb 2020, ‘Saving Planet Earth One (Less) Child at a Time' by Sharon StephensonPopulation Matters (website & Facebook page)8 Billion Angels movieUN Sustainable Development Goals - less population video:University of Lund and University of British Columbia, 2017 Study (cited in N&S article)BIoScience journal, 2019 Report, ‘World scientists' warning of a climate emergency, (cited in N&S article)Project Drawdown, health & education of women If you'd like to take more control of your fertility: Hooray, in Aotearoa all LARCS (long lasting reversible contraceptives) (i.e. implant and IUDs) are now completely funded. Have a contraception plan: visit any Family Planning Clinic for professional, non judgemental advice and support See acast.com/privacy for privacy and opt-out information.

Listen to Alan Weil interview Dr. Nora Becker from the University of Michigan on the affordability of long-acting reversible contraceptives, how the Affordable Care Act impacted the costs associated with such devices, and the role of behavioral economics in choosing a health plan.

This week is the second of a three part series on contraception. We discuss LARCs and the short acting hormonal contraceptives, including side effects, mechanism of action, benefits, and what to consider when deciding between these options. If you have any requests, questions, or are interested in speaking on our podcast, please email obwannabes@gmail.com. You can find us on Instagram at @obwannabes. Join us next week as we learn about the rest of the contraceptives!

Podcast: Common Diagnosis and Treatments in Women's Health  Evaluation and Credit:  https://www.surveymonkey.com/r/MedChat22   Target Audience             This activity is targeted toward primary care specialists.   Statement of Need Often times, when female patients seek medical attention it is either for a specific complaint or their annual wellness exam. It is recognized that there are key issues affecting women's health that can be overlooked if practitioners do not evaluate or address at this time; including heart disease, mental/emotional distress, etc. Objectives At the conclusion of this offering, the participant will be able to: Discuss the role of the Women's Wellchart in the annual exam. Describe common causes of pelvic pain, evaluation and management of pelvic pain; e.g. endometriosis, PCOS, fibroids. Discuss the latest recommendations for the treatment of menopausal symptoms.   Moderator Carmel Person, M.D. Geriatric Medicine Norton Healthcare   Speaker Tamara Callahan, M.D. Gynecologist Norton Medical Group   Moderator, Speaker and Planner Disclosures  The moderator, speaker and planners for this activity have no potential or actual conflicts of interest to disclose.   Commercial Support  There was no commercial support for this activity.   Physician Credits American Medical Association Accreditation Norton Healthcare is accredited by the Kentucky Medical Association to provide continuing medical education for physicians.   Designation Norton Healthcare designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.   Date of Original Release |December 2020 Course Termination Date | December 2021 Contact Information | Center for Continuing Medical Education; (502) 446-5955 or cme@nortonhealthcare.org     Resources for Additional Study   Is urinary incontinence associated with sedentary behaviour in older women? Analysis of data from the National Health and Nutrition Examination Survey https://pubmed.ncbi.nlm.nih.gov/32017767/   Long-acting reversible contraceptive (LARCs) methods https://pubmed.ncbi.nlm.nih.gov/32014434/   Effect of hormone replacement therapy on atherogenic lipid profile in postmenopausal women https://pubmed.ncbi.nlm.nih.gov/31677448/ 

CME credits: 0.25 Valid until: 15-10-2021 Claim your CME credit at https://reachmd.com/programs/cme/expanding-choices-combined-hormonal-contraceptivesseeing-beyond-larcs/11929/ Approximately 70% of all reproductive-age females in the United States are at risk for an unplanned pregnancy every year. Patient-centered counseling is extremely important so physicians can offer the most appropriate contraceptive option to each individual patient based on her preferences and lifestyle. With so many options for women to choose from, this discussion takes a closer look at the advantages and disadvantages of non-LARC options.

CME credits: 0.25 Valid until: 15-10-2021 Claim your CME credit at https://reachmd.com/programs/cme/expanding-choices-combined-hormonal-contraceptivesseeing-beyond-larcs/11929/ Approximately 70% of all reproductive-age females in the United States are at risk for an unplanned pregnancy every year. Patient-centered counseling is extremely important so physicians can offer the most appropriate contraceptive option to each individual patient based on her preferences and lifestyle. With so many options for women to choose from, this discussion takes a closer look at the advantages and disadvantages of non-LARC options.

A Larcs talk talks about new music and more.....

Join host Dr. Natalie Crawford as she talks about contraception. In this episode, she’ll review the basics about all types of contraception, including daily methods, long-acting reversible contraception (LARCs), permanent options, and emergency contraception. Empower yourself with education.   This segment of ‘As a Woman’ is sponsored by Plan B One-Step® emergency contraception. To learn more about Plan B, visit www.PlanBOneStep.com for more information on the product and where to access it.

CME credits: 0.25 Valid until: 30-09-2021 Claim your CME credit at https://reachmd.com/programs/cme/expanding-contraceptive-choices-beyond-long-acting-reversible-methods/11886/ Every year, approximately 70% of all reproductive-aged females in the United States are at risk for unplanned pregnancy. All of these women are candidates for contraceptive counseling and services and the availability of a broad range of contraceptive options is integral to the health and wellbeing of these women. New methods are emerging that are not long-acting reversible contraceptives (LARCs). Detailed knowledge of these contraceptive methods and their appropriateness for each patient is needed by all medical professionals who provide contraceptive services to women of reproductive age.

CME credits: 0.25 Valid until: 30-09-2021 Claim your CME credit at https://reachmd.com/programs/cme/expanding-contraceptive-choices-beyond-long-acting-reversible-methods/11886/ Every year, approximately 70% of all reproductive-aged females in the United States are at risk for unplanned pregnancy. All of these women are candidates for contraceptive counseling and services and the availability of a broad range of contraceptive options is integral to the health and wellbeing of these women. New methods are emerging that are not long-acting reversible contraceptives (LARCs). Detailed knowledge of these contraceptive methods and their appropriateness for each patient is needed by all medical professionals who provide contraceptive services to women of reproductive age.

According to the 2017 Youth Risk Behavior Survey, nearly 40% of US teens reported ever having sex; however, only 54% reported using a condom at last intercourse, 37% reported using a hormonal method, and 14% reported not using anything to prevent pregnancy. On the flip side, we know that long-acting reversible contraceptives are recommended as first-line for adolescents for contraception. So why aren’t teens using them? Join Megen Vo, MD, and Lisa Patel, MD for this important conversation.  To view the references for this segment CLICK HERE

This Week:  (01:23) Marie O’Byrne Director at Hawkswell Theatre (06:45) Seamie O’Dowd singer/songwriter extraordinaire (09:15) Lyn Brookes reads from LARCS & other Lovely Things by Leitrim For Choice (16:28) Emer McGarry Director of The Model Sligo For more visit www.oceanfm.ie/arts All podcasts can be found on Spotify, Apple Podcast, Soundcloud or wherever you find your podcasts. Just search OceanFmIreland. Arts North West is a weekly, magazine arts show that covers everything creative in the region. Featuring the best of music, theatre, storytelling, with the best of talent from Sligo, North Leitrim & South Donegal. Produced and Recorded in The Glens Arts Centre, Manorhamilton. It is supported by Pobal, The Arts Council & Leitrim County Council. Presented by Glens Artistic Director, Brendan Murray, it aims to afford artists of all disciplines the opportunity to engage with the community during this lockdown season. See Connect With Us on the Arts North West Page to contact The Glens Arts Centre. www.oceanfm.ie/arts

Vamos falar sobre os métodos contraceptivos mais eficazes que existes, os LARCs (contraceptivos de longa duração reversíveis). Métodos ideais para quem esquece as pílulas ou se incomodam em tomar medicamento todos os dias, também indicado para quem não quer ou não pode usar estrogênio e principalmente para quem não quer filho tão cedo, visto que os métodos duram anos e anos. Abraço a todos.

LARCS are endorsed by the ACOG due to the high efficacy. However, unpredictable bleeding can affect continuation rates. A new RCT has evaluated the use of tamoxifen to control and prevent future abnormal bleeding with etonogestrel implant use. Does this work? What is the MOA? In this session, we will summarize this new publication (published ahead of print) in Obstetrics and Gynecology.

IT GETS CONFUSING TODAY GUYS. Hannah's guest on the show is Hannah. They're chatting about the implanon – it is a type of hormonal contraception where a matchstick-sized implant is inserted into the arm. It secretes a type of progesterone, and can stay in for up to 3 years. Implanon is one of the MOST reliable forms of contraception, and falls into the category of ‘long-acting reversible contraceptives' or LARCs.Host Hannah asks guest Hannah about:

This podcast is for entertainment and general info/discussion only. Your host Hannah is a doctor (specifically a GP registrar) working full time in sexual health and sexual assault services. Nothing that is discussed on this show should be taken as personal medical advice. Please see your GP, sexual health clinic, family planning practice or other trusted healthcare professional for information and advice specific to your situation.Hannah chats with Dr Greta, a GP based in Christchurch NZ who has a background in reproductive anatomy/biology and family planning. You can find more information about Greta at her website, Woman Be Kind: https://www.womanbekind.com/Please note that this episode is a general overview, and we have some juicy detailed episodes coming soon that will answer more of your burning questions about specific types of contraception.In this episode, Hannah and Greta chat about:

The Judgment by Franz KafkaSend us feedback at MetagnosisPodcast@gmail.com TranscriptYuta    00:14    Okay. So this week we readYuta    00:17    the judgment by Kafka and for me, I had read this work before and I like Kafka so it was a fun chance to go back to it again. And I tried to upload a reading of it as well, but I would recommend you read it if at all possible. So this time I actually got an interpretation of the story as I was reading it and listening to the reading of it. And I hadn't really, like I've read this many times, like over many years, like maybe over six years. And yeah. I, I never really understood the story, but I really enjoyed the story from the first time that I read it and it's, I got like a very mysterious feeling from it, I guess.   I don't know. It gave me a, some kind of experience that I really enjoyed.Yuta    01:25    And then the ending of course also kind of was shocking to me  but I couldn't really explain it. But this time, so I'll just say what I thought this time, which was, it seems to me like the narrator is basically, or the story is basically conveying what it's like to have a father who's very domineering and, kind of abusive although not physically, and then kind of the dynamics that are involved in a very kind of close and intimate but, but like totally domineering kind of like gaslighting relationship. So I think that's what it,  conveyed. That's what it portrayed. And that kind of explains to me a lot of the mysterious characteristics of the story. Because a lot of things just kind of don't make sense. Like at the end, the father, you know, I sentence you to death by drowning and then, you know, the character goes to drown himself. But I think, you know, those things can be explained because they're kind of the first person perspective of the character. And I think there's an element to those kinds of relationships where it kind of messes with your sense of reality. I mean, that's what gaslighting is, right? So, yeah, that's my theory. But how did you react to this story?Henry    03:10     well first I guess I'll just say why I also enjoyed it. Yeah, I think I enjoyed it for similar reasons. This is the most recently, this is the first time that I've read the story. I've read some other things by Kafka but not this one. Apparently it's one of his more famous works. Well, that's interesting. But yeah, it's a very closed story. It's very focused on a certain circumstance and there's not a lot going on. It's just this interaction between these two people and it's mysterious because you get a sense of the two people. Like you feel like, you know them in some way? You can predict what they're going to do, how they're going to feel about certain things, but especially at the end. But,  little parts throughout the story as well, there are twists that while they are unexpected in the sense that they go against the grain of how you feel, you've learned the characters, they also feel natural.Henry    04:18    They also make sense in retrospect. I think that would be the way that I would explain it. It doesn't feel like the story broke, but it seemed like the story broke at the time. And  so I thought it was an interesting story and it definitely is, it feels like there's some deep meaning to it or some deep expression that it's trying to expose. So that's why it's interesting to talk about it.   I definitely didn't come away with a cohesive theory. I definitely just found it interesting to think about in lots of different ways,  but I'm sure there is a cohesive theory to come away with. And what strikes me about your theory is that it seems very specific. It seems almost like you're taking the story literally. It is in particular about a relationship between, I guess, a child who's an adult and their aging parent and maybe even more specifically a father and his son.Yuta    05:26    Yeah, I guess it is very literal and maybe it's kind of the conclusion most people would come away with the first time they read it.Henry    05:35    Well, it's almost just a description of what happened, right. It's the friction between a father and his son, in this aging stage of the father's life, that he's dependent on his child.Yuta    05:46    Well, so the first times I read it and I heard this on my own, then I also read it in a class and then afterwards as well. Right? Yeah. And every time that I read it, to me, it didn't really make sense. Like I couldn't explain all of the kind of mysterious, you know, stylistic aspects of the story. Basically. Like, you know, in the beginning there was also like a huge chunk of the book is about his friend in some country and then it shifts to the, you know, the father and it's like the first part didn't even matter to the story. And then, yeah, just the conversation with the father is so weird. I don't, it's, I don't think it's like a straight forward yeah. A straight forward conversation between a father and a son. That would happen normally.  maybe I'm wrong, but it, yeah. So for me, I didn't, yeah, I didn't have this interpretation until now. I maybe,  yeah, I don't know. I guess it's maybe a little bit different because I think it is trying to depict something that's Mmm. I guess, yeah. Stranger. Mmm. Because it's kind of trying to tell the story from the perspective of the person who is being kind of dominated. And in that way it's different from just telling a story about an abusive relationship from, you know, a third person perspective. Mm. Well it has like a warped sense of reality, you know, it's nightmarish and the kind of shifts between the topics from the friend rod, it just kind of doesn't make sense. But I think that kind of could be a depiction of a altered state of mind.Henry    08:05    That's a good word for it. Yeah. It's nightmarish. It almost like the story just feels like a nightmare. It's the exact sort of timeframe as well. Yeah. It's something that you would, you know, he jumps into the river and then he wakes up. Right. You could totally see that being a game.   maybe, yeah.Yuta    08:24    The logic to it is nightmarish. It's, yeah, there isn't really, it's, yeah, it's very weird.Henry    08:33    Going along with what you were saying about,  describing this from the perspective of someone who is the underling and this abusive or domineering relationship.  the first part of the story is about him describing his relationship, this sort of strange relationship to his friend who's abroad,  who he wants to move back home but knows won't. Right. And they have a sort of not super close relationship, but they're still friends after a long time. So they're somewhat familiar with each other.   what do you think the significance of all of that is? I guess one way to take it would be that there is some metaphorical significance to the specifics of that story or perhaps the point of bringing it up was just to show how it all gets dismissed away when the father comes into the picture.Yuta    09:31    Yeah.   yeah, I couldn't totally, yeah, I don't totally understand or have a theory about that part of the story.   but yeah, I think my theory would imply that, yeah, it is basically in consequential. Yeah. So in the second option when you went out.Henry    09:54    Okay. I guess. So here's the way that I would, or that I am inclined to say it is that what I thought was really interesting about that turn when the father is introduced is that when we're describing or when we're hearing the story about the friend and he, he tells us about how he writes to his friend and he is getting married and he seems to be doing pretty well for himself. Like he's moving out in life and he seems very modest and he also seems weirdly focused on this friend. Like what, why does he even keep in touch with them? That doesn't seem like they have any sort of special relationship other than they happen to know each other. And  it also doesn't seem like the friend is very communicative. Mmm. And my sense of this was that when he was describing his life at that point, he was describing sort of a fantasy of how he wanted his life to be. And he kept trying to put down his friend's situation, although not explicitly, he was trying to put it down and make it seem like, yeah, that's not actually what I would want to do. I, I'm fine staying here and doing things here. But then we, we get another picture on his reality living at home, which is, is the relationship with his father. So then it comes crashing down the sort of fantasy view of his successful life at home to the point where he's driven to suicide by his father, by the end.Yuta    11:29    Uh huh.Henry    11:30    So I think that there's an implicate or perhaps there's an implication that he's actually envious of his friend. He just can't say it explicitly. You'd rather get out of his house, out of his home, away from his father.Yuta    11:46    Yeah. But that seems right. And yeah, you get the sense that he's, you know, he complains about his friend a lot and he's kind of obsessed with his friend in the beginning of the story and they're barely even friends. Like, yes, I think it says they were just acquaintances before he moved abroad and then they kind of started writing to each other more. So it's, yeah, kind of this weird interests that the, the Gregor develops.   and this person. Yeah. So it seems like just kind of this, his straightforward, Mmm. Ex explanations or comments about his friend. Don't fully explain why he has those thoughts.Henry    12:39    It's a really well crafted,  section as well cause it seems almost like an uninteresting story, but the way that it's written and so,  ambiguous and, you know, questioning, it's really fun to read.Yuta    12:54    Did you, do you think the friend exists?Henry    12:57    Oh yeah. So that's, that's one of the twists is that the father says, Oh, your friend doesn't even exist. But also that I've been telling him to not read your letters. So obviously there's a little bit of a conflict there, but Mmm. I honestly don't think it's important whether or not he really exists. I don't think that he's of significance in that way.   but my guess would be that he probably does exist. Yeah.Yuta    13:33    Yeah. I think, yeah. So reading the story, I also, like many times it kind of, it makes me think back, especially at the very, at the start of,   the conversation with the father and, and Gregor where the father kind of implies that the friend doesn't exist. It's like, Oh, maybe he doesn't exist. I'm reading it. It feels like, and then I have to kind of think back to the story and,   you know, consider the possibility that the friend didn't exist. And I think that's maybe also another reason that this story makes me think it is about, or it is trying to depict, you know, the psychological state of being I, gasoline is such a cool word now, but something like that that kind of state on because, and it's also really interesting because it kind of induces the same state and not us as the readers because we're also like, you know, it's not, it could tell a straight forward, you know, obese story where the facts are clear, but, and that's, that's how most narratives would go.   even most first person narratives. Mmm. Yeah. There's an aspect to it where the reader can kind of tell what's going on.   but this were put almost in the same position that Gregory's and, and, yeah. So I think it's kind of a little bit left up to the air, whether the friend exists, it seems like he probably does and the father is messing within. But,   yeah, I, I enjoyed the kind of the conflict that that created.Henry    15:33    Yeah. It makes you want to go back and read the first part. You're like, wait a second, I need to go see if there was a hint that I miss.Yuta    15:41    Yeah. And this is like the kind of the crazy thing about,  what he's depicting, right. Just the fact that one person could be so domineering that he can, I guess, mess with someone's sense of reality. And I should say, by the way, disclaimer that I have read Kafka wrote a letter to his father, which is, you know, actually super famous.   and so that kind of, I definitely recommend reading that as well. And, but probably sports,  this theory.   so yeah, that might've influenced it.   but yeah, that's basically Kafka is,  writing to his father. Kafka is all grown up already about and he's kind of complaining about his childhood basically and how domineering his father was. And then he gave it to his mom. He gave the letter to his mom for his mom to give to his father, but then his mom never gave it to his father.Henry    16:56    Well huh.Yuta    16:58    That's weird. Yeah. And it's, it's a very long, very classically Kafka a very well written. Very interesting. Well,Henry    17:10    well, so very whiny. Do you think that the mother also read it and that's why they didn't give it to the father?Yuta    17:18    Yeah, I imagine so. You know, I'm sure she would've given it to him if it was nothing. Oh, that is an interesting thing. Yeah. It makes you think to Kafka like actually want it to get to his father because why wouldn't you give it to his mom?Henry    17:39    Yeah. I don't know. Did he write? So did he write this story before or after he wrote that letter?Yuta    17:49    I think before and yeah, so some other contexts is that this is his first work that he's, he wrote a fiction ever I think. And the story is that he kind of got into like a few state one night and just madly wrote down the entire story in one sitting. Yeah.Henry    18:11    That's really interesting.Yuta    18:13    Yeah, that's, that's the context that I know of.Henry    18:19    Well that's lots of mystery surrounding the story, so.Yuta    18:25    Hmm.Henry    18:26    Yeah. I wonder if he is trying to express something that he experienced himself, at least, you know, the mental state of it, not the particular happenstancesYuta    18:40    yeah. Or maybe, yeah. Maybe even the particulars.Henry    18:45    Yeah. I wonder. I have a feeling, probably not.Yuta    18:54    Yeah, that's the extent of my,  reading I guess the metamorphosis also.   as a very similar theme about the father and the son.Henry    19:10    Hmm. That's true. Yeah. Except I guess it's a bit of a reverse relationship in that one.Yuta    19:21    What, how, how so?Henry    19:23    Well, this one, the father. Oh yeah.Yuta    19:28      well in the metamorphosis, the sun is like the bug and the father's the,  I'm in the father, the one that's trying to get rid of him. Right?Henry    19:39    Yeah. But I mean in, and the metaphor Morphosis he is, the bug is dependent on his father and that's the way that he's controlling. But in this story,  the father is dependent on the son. I guess that's what I meant by reversed.Yuta    19:58    Oh, I thought I didn't think that's the case at all because isn't, I mean just everything we talked about, about,  the mental state of the, of Gregory being, you know, kind of deteriorated obviously. And then like the last scene is his father commanding him to drown himself. And he does that almost seems to suggest that Gregory has no agency on all that. He doesn't even, he doesn't even have control over his own mind that his father is completely dominating him.Henry    20:36    I agree with that. I mean, dependent for like,  your lifestyle, like your health. That's what I meant.Yuta    20:48    But I agree that in both stories, the father's controlling the son. So that is an interesting parallel. I bet there is significance to that too. Kafka zone life it sounds like. Yeah. Yeah. I mean, yeah. I don't know. I think, I don't think the economic relationship is the core to the story. Yeah. Hmm. Which would make them similar. Well, it seemed like,  when the father was introduced, th this might not be super interesting. When the father was introduced though,  he was basically revealed to be pretty sickly and the son was taking care of him. Right. Trying to keep them healthy. Yeah. So that's what I got the impression from. But, but I, I don't, that doesn't seem like to be a very interesting difference. The, the focus is on the domineering relationship and that's the same.Yuta    21:54    Yeah. Well, the fact that it's Mmm. But the father is kind of financially and practically dependent I think kind of adds to the, you know, how impressive his power over his son is. Right? Yeah. Because the son definitely feels responsible for his father. Yeah. But you know, it's easy to dominate someone if you have all the financial and, and practical power. But in this case, the father is almost even more dominating because yes, there's like, there's nothing behind,  his total domination of, of Gergor.   not nothing like economic growth or anything like that. It's just he's this legal Nan who's totally dependent, but Gregory, he's kind of, yeah, everything. Okay. Yeah. Yeah. It's a, it's definitely a strange mental position to be in because you could imagine another,  person could be in that position and think, okay, I'm just done with my father. I'm moving out. Sorry. That could be another position you take. But it's clear that in this case I saw that even an option for Gregor, he's completely mentally being controlled or he, he feels as if he doesn't have any willpower,  to change the situation at all. Yeah. I guess kind of as readers, there is basically what you were saying. Yeah. We have kind of, it's in perspective.Yuta    23:45Henry    23:46    you're cutting out. Oh, sorry. I think you're cutting out.Yuta    23:51    I can't, Oh, you cut out also from my side, huh? Oh, okay.Henry    24:00    It seems like it's back though.Yuta    24:02    Yeah. So I think, repeat what you were saying.  Oh. So from our perspective, we can tell that the   but the father is this week a sickly, you know, dependent old man. And that is kind of a neutral perspective that we get that we're able to tell that whereas Greg or seems to be like a godly power to this person.Henry    24:42    Yeah. And that's what's kind of unsettling is that it's not really explained why that is. It just is made clear through the circumstances.Yuta    24:54    Yeah. The explanation is, I guess the story of his childhood, right? Something, something along. Yeah. That's not an explanation, but it's in there somewhere I think.Henry    25:12    Yeah. I don't remember that part super clearly, but I remember what you're talking about.Yuta    25:16    Well, it's not, it's not part of the story, but it's just speculation. Like how would this kind of relationship arise?Henry    25:23    Oh, that's what you mean. Yeah. I thought you were having to sing a part of the story. Yeah. I mean there must be some history behind this. Of course. Yeah. Or this is just an abstract scenario and there isn't a particular history to this relationship, butYuta    25:40    warm history doesn't necessarily mean childhood. That's true.Henry    25:49    Huh. But as I stand now, it seems like I have a pretty interesting viewpoint on what the story is talking about without knowing that detail.Yuta    26:01    Mmm. Well all in all I'll say it first of all, like I have no, I just tried it out a theory, but I have, I don't think I figured it out. Mmm. But yeah. Yeah. I, I don't know. Well that's a good place to end, I think.Henry    26:27    Well, in this episode of something a little unique, which is a reading of a story that I wrote in middle school called consequence, the story has a similarities to judgement in terms of theme and Tanner. So I think it'll be interestingSpeaker 3    26:44    to see in comparison to the other story. I actually hadn't heard of judgement before Yuta told me about it, but when he read the story, he saw the parallels immediately. John handed the lengthy contract to his client, mr Joffrey. As for read the document, making sure not skip the suspiciously small print. John reflected on the earlier events of the day. Soon after his breakfast around 10 o'clock John's boss had called him, asking him to rush over to the house. Mr Joffrey was trying to buy. John was dismayed for he planned to pull off his devious plan. That morning through the middle part of the day, John had argued half-heartedly with mr Joffrey about the price of the house. It's foundries and insurance contracts. Now, after receiving the final scripted paper from mr Joffrey's stubborn, bulky hands, John filed it in a slick suitcase. He walked out the door waving a tired goodbye to draw free, who was wearing a black suit and a red tie and flopped into the leather seat of his car.Speaker 3    27:51    With the sunsetting of the scene, John pulled his blue sports car in the parking lot outside of the local Shasta view bank. Shasta view was a small suburban town, knew that Lake Shasta resort. John had lived in this town for many years after he moved from Sacramento for the better real estate job, you figured fingered the USB and wires in the zipper pocket of his black jacket. As he stepped out of the car. You walked past the glass entrance doors without going through them and made his way to the two ATM machines that were on the wall at the bank outside. John turned his head back and forth. Wehrly searching for witnesses in the dark of the night and when seeing none, he took out the flash drive. He carefully unraveled the wires around it. When John was done, he realized how exhausted and nervous he was.Speaker 3    28:41    Never done anything like this before, anything against the law and now he was, the benefit was too good and the chances of him getting copper slim if he was careful. But then again, Mr. Williams, a deep voice. Bellowed John old buddy. Where are you been? Greg Davis pushing the heavy glass doors open and heading for John. Had been one of John's friends ever since he moved to Shasta view John Golden Gill and hit his tools at the side of his friend. Hi Greg. How are the stocks today? John asked Greg, knowing his interest, answering my bidding. Greg joked then changed attitude. He asked you look like you've run a marathon, John. No. Why don't you come over to my place tonight. We'll have a few drinks and watch the game. Okay, I'll be there. That's also awfully nice of you, John consented, but with the tone in his voice that bid, Greg gone.Speaker 3    29:37    Sure. Just finish your deposit. Greg looked at before leaving noting the implied message, but before Greg got home, John had already committed the crime by inserting the wires under one of the keys of the ATM. He ran the program from the USB into it, making it feed him $500,000 John stuffed it in his second empty suitcase and laughed as he drove it away around the corner of where the ATM was. He saw a man that Don black and had white hair and his guiltiness. John denied himself that the man had seen the offense. The man's name was Lark. Lark was always looking for opportunities like this, whether they were morally straight or not. Use this opportunity to blackmail John for yet another illegal purpose. Murder. John opened the front door of his house. This house was blue, but the paint was fading and it was darkened by the elements.Speaker 3    30:33    The front door was Brown and it was still Brown when he walked in his house because he had just given it a coat of paint. The other day, John lifted off his coat and hot and set them on the bench inside the foyer of the house. He was tired. He wanted to sleep, so he headed for his bedroom. The home team and also the team he and Greg were rooting for. I lost in the baseball game as they had watched. John was slightly disappointed, but shrugged it off. It was only a game. John walked into his bedroom and looked out at the view over the pond and an open space. Sometimes he would walk to the pond and look at his reflection when things weren't going well or he disappointed something crucial. He sat on his bed, still gazing of the dark outside or it was close to midnight.Speaker 3    31:16    When he heard the door creak open slowly behind him. John swung himself around to see a tall elderly middle aged man standing in the doorway to his bedroom. Who had his eyes wide open. He had white hair and was wearing all black and John remembered this man. This man was the man. John had seen her on the corner of the bank. He'd robbed. John gasped, horrified, and the man greeted him with a wide smile. Greetings, John. He paused. I don't think you know who I am. I am Lark and I might soon become your greatest nightmare. I know this because I've met and dealt with people in the way. I'm going to deal with you, but don't worry. I'm sure you won't turn out like them if you just comply and do everything correctly, you'll be able to forget about all this. In a while, John replied, feeling frightened and caught.Speaker 3    32:06    You're going to blackmail me, sir. I know that I've committed a sin and now I'm going to pay. Take it all, all 500,000 of it. It is curse to me now, but it's kind of you, but I have a deal. Continued Lark. Give me only 100 grand and kill this man and said Larken and John, a curious picture. It was banned with blonde hair and wearing a sport shirt and gray shorts under the detailed picture was the name Hank Adams and also information about him. When John looked up from the document, the infiltrator was gone. What should I do? Thought John, you couldn't call the police or LARC would reveal his crime. Instead of only losing a hundred thousand, he would lose all of it plus fines and it would probably have to go to jail and that meant his boss would fire him. John thought, well, I'll see what happens in the side.Speaker 3    32:54    Later he laid down on his bed before even getting undressed and fell asleep for the next few days. John was absentminded about everything. He didn't answer questions while looking at people. He sometimes send in conversations without a reason. His friend Greg was getting slightly annoyed, but he was also sympathetic. John, what's the matter? Greg asked his friend while they tracked to Greg's office building. I,  I'm just tired. John mumbled not even looking at Greg as the cross, the busy urban street of Shasta Lake city, a bustling city. And you're like, that's what you've been saying for the whole week, John, you act like a blank page. Just tell me what's on your mind. I'm your friend. You make me feel tuned up. John just kept walking though almost as if he hadn't been listening to Greg. John had been thinking about the night. That was a few nights from then, that hoard night lurk had come to his room.Speaker 3    33:52    John didn't know what to feel a powerful, unique and unnerving situation such as this one had never entered his life before you wanted to give up, but he was afraid of the consequences of being the villain. But if he didn't do a sarcastic, he would certainly reveal his undertaking and get him into a distressful trouble with the law he knew was completely guilty. And John, watch out. Greg, lunch at John as he stepped into the street of the corner of the road across the office building stood. John felt a sort of selflessness as he claps in a Greg's arms behind him. It was holed away from the curb. What are you thinking Greg on the ground? You're a man who saw me, John and an ignorant fool and you're going to be collecting me also. This is that. Goodbye. Great stress the ladder. Two words as if to force them in John's confused consciousness as he marched away, John lay on the ground and then he sat on his all those and shook his head.Speaker 3    34:48    He straightened his blue striped tie and walk to work from there, feeling sad and helpless as he stated at the sidewalk. He bumped into some people as he walked past them because he couldn't see properly, but it didn't care. There was nothing he could do. The spirit took too much of a blow from all that had happened to him and John knew that he would kill Hank no matter who he was thinking in a way that made it seem as if strangling him to the floor and fleeing away from the morbid scene would repair his own fractured existence.Speaker 0    35:18    Okay.Speaker 3    35:20    It was late, dark, and cold. The night that John pulled into his driveway, the meeting he had with the associates in Boston, the city that day had gone on past the scheduled time. The real estate company who worked for her decided to buy a big chunk of land near the Lake Shasta resort. The resorts owner was planning to buy the estate from them and expand their premises. They would use the land for more accommodating buildings. And another thing that happened at the meeting, John learned who Hank was and gardens was the owner of the Lake Shasta resort and can be planning to buy the land the John's company had bought. At first they promised that they would build the buildings there for Hank for an extra sum of money. Of course, and Hank couldn't refuse the offer for it was the only imperfect spot to expand and he had not gotten it before John's business, but John wasn't thinking about that. Now he was tired, tired, and he was starting to get anxious to see what might resolve from the back layers. Dealer.Speaker 3    36:17    You thought though, maybe he's been caught. I don't have to think about the same way, but John was wrong. John said a suitcase down on the counter before his kitchen. It wasn't married. He had just huddled away, wrapped up in his own life and never thought about it. John took the different papers and notes that had been accumulating at his office and filed them in folders that were in a jar near the wall of the kitchen. That's where the screen door open behind him. John knew it was dark before he even turned around. Who else could it have been? Then he spoke to lurk, grieved, hello, what is it? But before he had finished, Lark was already starting to talk. Talk to John. John, I want to talk about our arrangement and Hank, I suppose you found out about him by now. He's going to be in his office tomorrow night alone.Speaker 3    37:10    I want you to meet me at the Plaza at 9:00 PM tomorrow with no police friends, nothing. You be there and I won't tell the world you're a little secret. Do you understand? John looped Lark up and down. He was wearing high black boots, dark coat, and a knitted black beanie. His eyes glared at him permanently through the conversation and John answered him. Yes, good Lord. Grint is unnaturally large smile. I will see you there. And then afterward, all of you, all for you and for me. Stop lurked out. Lurk stepped out of the screen doorway and ran through the woods behind John's house until he was well site. John went to sleep that night with many unexplainable thoughts, dreams, nightmares and emotions, but he remembered Matt o'clock in the town Plaza the next day, rushed by for John and he dreaded every accelerated moment of it. John had no work to do well he did, but he didn't move from his bed. The shelter, John, like the world would end for him that night if he complied with Lark, but if he didn't, he would have to live with everything that he had done for the rest of his nightmarish life. It was the end of a nightmare for life for John.Speaker 3    38:28    You thought of suicide, but that didn't seem to reflect his character. John wanted to go to the situation and embrace everything that was projected about him. John would not be a coward. He would be a homicidal criminal.Speaker 3    38:44    It was eight 40 before John could put all of his thoughts together. Why does Mark want me to kill Hank? What is, yeah, that's so valuable. Why does this have to happen to me? He trudged to his Dole topless car and drove the 10 minute journey to the nearly empty Plaza. As he arrived, he saw lurk leaning against the shadowy tree. Lurk didn't know it was John's car, but there were crowds of people around and lights to Luminate the scene. It would not just be killing lurk, but running into him by running into him, but also who'd be convicted of it and he would damage his car. John decided not to. John walked from his car to Lark and the light of the streetlights and was greeted stuff into my car. John, let's go. Lurk motion. John. In the back of his car. There was a metal separator between the backseat were drawn, sat in the driver's seat where LARC was so we couldn't get to work during the drive.Speaker 3    39:37    LARC steps in the car and pulled a pistol from his pocket. Even in the dark. John can see the menacing sentence are screwed on the end. John's face turned white at the side of a weapon like propped it up on something in dashboard. He just said a few times I spoke to John. See this strong Lark ass as he pointed at the gun. This is pointed straight at you and I can fire it while I'm driving with a switch. Don't try anything very. You'll have a hole through your head before you can think twice. Got it. But before John could respond, like push the gas and sent them through the night wasn't long before they arrived at the tall office building.Speaker 3    40:11    John and Mark stood together at the bottom of the building. John having LARCs weapon in his back. Lurk then handed John an oversized gun shaped object. Shoot this at the top story and then faceted to it with this harness. Learn quartered. As John's caught the dangling harness, he had tossed him following instructions. John fired the device and saw a black line soar through the air and hot shot at something at the top of the coast building. You'd attach the line to his harness after putting it on and push the button on the side of the gun. I pulled them up faster than John preferred. Along the edge of the wall of the building. They became colder and gentlemen, Donald Lark. As he walked up the wall, Mark wasn't too small from John's perspective. When he reached the top, you could see that Lark was looking away for other people that might come by.Speaker 3    40:57    You took off the roof that was fastened to his harness and dropped it into the balcony under him. This was the room that Lark had indicated there was no one on the balcony, but there was a light on the inside in chairs and glass table. Thank you. Must be inside. John looked down at his harness and saw a bundle of red wire. John thought this must be what Lark wanted him to strangle Hank with. Then he thought again of the things that lurk had done to assemble this, a sudden hatred flew through his body and he could only think of one thing to appease it. Violence, specifically LARC stuff without really thinking like stepped over to the glass table that was resting on the balcony. He keeps it up and it and sent it hurling. Donald Lark, John can believe what he was doing. All the chances that it could fail. The wind could blow it. He could so easily mess, but now it hit with a satisfactory crack on Lark. Sorry, head John couldn't really remember what happened after that, but he felt a heavy hand on his back. It must've been Hanks and he fell unconscious after that. He was questioned by the police and he confessed to everything. His trial sent him to prison for a sentence that isn't remembered. He died in prison. It isn't known why, but it is proposed that he died of a violent and unstable set of emotions and a loss of will to live. 

Fei and Nick are tackling the world of LARCs! We focus on those methods available in the United States. Here's the scoop on implants vs. IUDs!  Twitter: @creogsovercoff1  Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Approximately 45% of pregnancies in the United States are unintended. Similarly, 70% of pregnancies that occur within 1 year of delivery are also unplanned. Interpregnancy interval shorter than 6 months are associated with increased risk of perinatal complications. In this session, we will review the stance from the ACOG and the SMFM regarding immediate postpartum LARC initiation. What is the difference between “immediate” placement and “early postpartum“ placement? Are there any risks? We will cover these topics and more in this episode.

This week we're talking about sex... ed! Kelsey explores the special places in Hell for Jeffrey Epstein and his many accomplices (it's a criminal cake with many layers). Then Mike Amico brings you the complete  sex education triangle: The doctor, the porn star, and the holy sex educator). Show References: - BROKEN: Jeffrey Epstein “S1 E1: Their Day in Court” (Three Uncanny Four) - The Sex Ed “Gwen McClendon”, “Lexington Steele”, “Dr. Carrie Wambach” (Liz Goldwyn) - Armchair Expert with Dan Shepard “Charlie Day” (Armchair Umbrella) - Every Little Thing “How to Get Rid of an Earworm” (Gimlet) For more info or to send Mike and Kelsey your thoughts on new pods you've heard, visit www.strawhutmedia.com or @sihtipandlisten on Instagram Learn more about your ad choices. Visit megaphone.fm/adchoices

This week we're talking about sex... ed! Kelsey explores the special places in Hell for Jeffrey Epstein and his many accomplices (it's a criminal cake with many layers). Then Mike Amico brings you the complete  sex education triangle: The doctor, the porn star, and the holy sex educator). Show References: - BROKEN: Jeffrey Epstein “S1 E1: Their Day in Court” (Three Uncanny Four) - The Sex Ed “Gwen McClendon”, “Lexington Steele”, “Dr. Carrie Wambach” (Liz Goldwyn) - Armchair Expert with Dan Shepard “Charlie Day” (Armchair Umbrella) - Every Little Thing “How to Get Rid of an Earworm” (Gimlet) For more info or to send Mike and Kelsey your thoughts on new pods you've heard, visit www.strawhutmedia.com or @sihtipandlisten on Instagram Learn more about your ad choices. Visit megaphone.fm/adchoices

We're heading back into the world of adolescent medicine to talk about contraception. We'll cover OCPs, IUDs, LARCs and more to have you ready for your next exam and to keep your patients from having babies of their own until they're good and ready

Nearly half of the pregnancies in the United States each year are unplanned, and such unwanted or mistimed pregnancies can create negative outcomes for women, children, and families. Greater access to birth control, especially long-acting reversible contraceptives (LARCS) empower women to only have children if, and when, and with whom they want. As restrictions on abortion become more widespread, how can states and organizations increase the availability of family planning information and access to contraceptive methods like LARCS? In this episode, Brookings Senior Fellow leads a conversation with former Delaware Governor and , the co-founder and co-CEO of Upstream USA, a non-profit working to expand opportunity by reducing unplanned pregnancy in the US. Also on the program, in a new Metro Lens segment, Senior Fellow , director of the Anne T. and Robert M. Bass Center for Transformative Placemaking, describes how the digital revolution is shifting where jobs are concentrating and why this job density matters to cities and regions. Subscribe to Brookings podcasts  or on , send feedback email to , and follow us and tweet us at  on Twitter. The Brookings Cafeteria is part of the .

Dr. Lisa Hofler demystifies the business of postpartum LARCs.Have feedback or suggestions for future topics? Email us at:healtheconomics@acog.org Additional links:ACOG Webinar on Immediate Postpartum LARC Implementation: Systems and Sustainability led by Dr. Lisa Hofler: https://live.blueskybroadcast.com/bsb/client/CL_DEFAULT.asp?Client=490885&PCAT=2791&CAT=10780 ACOG Postpartum Contraceptive Access Initiative Website: https://pcainitiative.acog.org/Implementation resources: https://pcainitiative.acog.org/implementation/Request a training here! https://pcainitiative.acog.org/contact-us/ACOG LARC Program Website: Immediate Postpartum LARC: https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARCMedicaid State Map: https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid-ReimbursementACOG LARC Program Help Desk: https://acoglarc.freshdesk.com/support/home ACOG Legal Disclaimer: Information contained in this podcast should not be construed as legal advice. As always, practitioners should consult their personal attorney about legal requirements in their jurisdiction and for legal advice on a particular matter. The information presented in this podcast is for guidance purposes only. ACOG makes no representations and/or warranties, express or implied, regarding the accuracy of the information contained in this podcast. ACOG assumes no liability for any consequences resulting from or otherwise related to any use of, or reliance on, this podcast. Inclusion of any product, procedure, or method of practice in this presentation does not constitute endorsement by the College. Music Attribution: Our intro and outro music is a derivative of “Golden Sunrise (Instrumental Version)” from the album The Wake by Josh Woodward, used under a Creative Commons Attribution 4.0 International LicenseFree Download: https://www.joshwoodward.com/ Album: The Wake Creative Commons Attribution 4.0 International License Support the show (https://www.acog.org/Practice-Management)

In this podcast we talk with Dr. Deb (Dr. Deborah Bateson) and Christy (Dr. Christy Newman) about reproductive justice and awareness. We delve deeply into the diversity in women's health care, access to care, education, reproductive care and choices, male contraception, LARCs, and reproductive coercion. This is an extremely important episode as many of us take for granted our access to healthcare and more specifically birth control.Links we talk about in the podcast are:Queer Generations Study - https://queergenerations.org/Check Out Clinic (Acon) - https://www.theinnercircle.org.au/check-out-clinicFamily Planning NSW - https://www.fpnsw.org.au/Centre for Social Research in Health UNSW - https://csrh.arts.unsw.edu.au Proudly part of the Swingset.fm team!Find us on social media!!!On Twitter @BytheBiPodcastOn Facebook @BytheBiPodcastOn Instagram @BytheBiPodcastOr email us hereWant to help us out? Sure you do!!!Help us out on Patreon hereCheck out our OnlyFans page hereWanna get your own prize from Geeky Sex Toys? Head over here!Please help out, and donate to Bi+ Visibility by clicking the link here!Leave some feedback for us on whatever medium you listen to your podcasts on. See acast.com/privacy for privacy and opt-out information.

In the April 2019 episode of the JAAPA Podcast, hosts Adrian Banning and Kris Maday discuss articles on long-acting reversible contraceptives (LARCs), management of acute wounds, cubital tunnel syndrome, and "the 150 rule" to prevent acetaminophen hepatotoxicity. Plus, our hosts discuss ways in which legislation has affected PA practice and we learn yet another amazing fact about Kris, "The Chuck Norris of PA Education."

Progestin only contraceptive options include the subdermal implant, Injection, IUS, and pills. Progestin based LARCs provide HIGHLY effective contraception. A common perception in the public community is that these options may result in depression! Do they? Let’s take a look at a systematic review from 2018 on the subject.

Immediate postpartum LARCs are endorsed by the ACOG. This podcast will summarize the ACOG committee opinion 670, and review the new data (October 2018) regarding IUD expulsion rates based on timing of insertion, route of delivery, and IUD types.

More than 60 percent of reproductive-aged women use some kind of birth control. But there's a lot to consider when picking out the right method for you!  Eliza Bennett is an ob-gyn and expert in family planning in the UW Department of Ob-Gyn. In part one of this two-episode series, Dr. Bennett discussed why people decide to use birth control, the basics of how hormonal and non-hormonal contraceptives work, how she helps patients choose the right methods for them, and answered *so many* detailed questions about The Pill. Special thanks to the friends and listeners who shared their birth control questions for this episode! Stay tuned for Part 2, in which we discuss LARCs, permanent birth control, and how pregnancy and birth control mix.

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz! Written by: Molly Heublein, MD, Beth Garbitelli and Sarah Roberts, MPH. Edited by Matt Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Disclaimer 00:35 Intro 01:32 Guest bios 03:45 One liners, app recommendations, picks of the week 09:32 Picks of the week 12:45 Intro to contraception and a clinical case 13:33 Starting a conversation about contraception 16:55 Is having a period needed? And, which agents cause amenorrhea? 19:28 The menstrual cycle reviewed 23:29 Pros and Cons of long acting progesterone only agents 26:55 Choosing between IUDs 30:00 Who should get a copper IUD 30:53 Mechanism of hormonal IUDs 31:37 Risk with IUDs 34:05 Why are there so many OCPs? 36:05 Counseling patients on risks of OCPs 38:00 Risk of breast cancer with hormonal contraception 42:10 Benefits of hormonal contraception 43:38 Migraines and hormonal contraception 44:53 Mono- vs bi- vs triphasic pills. Does it matter? 46:15 Starting dose for OCPs 48:31 Is the mini pill effective? 49:37 Patches and rings 51:15 Take home points 52:40 Whoops, almost forgot emergency contraception! 56:32 How do copper IUDs work? 58:10 The Curbsiders recap the episode, plus some clinical pearls from Molly about birth 65:00 Outro Tags: contraception, birth control, IUDs, LARCs, mirena, skyla, lilletta, Paragard, OCPs, minipill, birth, control, pills, menstruation, follicular, phase, luteal, side, effects, emergency, contraceptives, ulipristal, ella, plan B, levonorgestrel, women’s, health, internal, medicine, internist, primary, care, family, practice, nexplanon, depo-provera, breast, cancer, family, planning, CDC, MEC, eligibility, criteria, bedsiders, pregnancy, ovulation, meded, foamed, nurse, student, physician, assistant, doctor

On the last edition of Radiotherapy for 2017 it's a jam packed show. Expert neurologist Prof Mark Cook is in the studio to explain innovative new technology to help predict seizures in epilepsy. Plus a look at the controversial survey about surgical costs published this week by Choice Magazine, and the latest in long acting reversible contraceptives (curiously called LARCs).Thank you to all the listeners for a great year!

If there is a hot button issue in politics these days, it's abortion. But abortion is the result of a long line of issues that are being inadequately addressed in this country. Today we take a look at contraception - what it is, how it works, its history and its future.  We also offer a look at an innovative program that has the potential to help both pro-choice and pro-life groups happy.    Resources: Details on various types of birth control The Choice Project Use of LARCs in Colorado Slang for using a condom (adult humor - you've been warned)   Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

Long-acting reversible contraceptives (LARCs) like intrauterine devices (IUDs) and implants are becoming increasingly popular as birth control methods. Between 2011 and 2013, the number of women using an IUD increased 83 percent from the previous four years, according to a 2015 report from the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics. Though today LARCs are recommended by the American College of Obstetricians and Gynecologists as very safe and effective methods of birth control, they have a troubled history that have made many people slow to accept them. In the second episode of our miniseries CHOICE/LESS: The Backstory, Loretta Ross, one of the founding mothers of the reproductive justice movement, talks about how her experience with the infamous Dalkon Shield IUD inspired her career as a human rights activist. Note: This updated episode features a correction of a minor audio issue from the previous version.

If there is a hot button issue in politics these days, it's abortion. But abortion is the result of a long line of issues that are being inadequately addressed in this country. Today we take a look at contraception - what it is, how it works, its history and its future.  We also offer a look at an innovative program that has the potential to help both pro-choice and pro-life groups happy.    Resources: Details on various types of birth control The Choice Project Use of LARCs in Colorado Slang for using a condom (adult humor - you've been warned)   Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!