Purpose of ReviewWe completed this review to update readers on the current literature and controversies surrounding different approaches to permanent female contraception. Recent FindingsPermanent contraception continues to be a popular method of pregnancy prevention. The withdrawal of the Essure® hysteroscopic approach to permanent contraception from the US market and the increased use of salpingectomy to decrease risk of ovarian cancer have changed options available to women. Current studies support allowing adult women who desire no future pregnancies to access permanent contraception regardless of age, parity, or marital status. Permanent contraception may offer particular benefit to women with complex medical issues, and those who decline hormonal contraception or intrauterine devices. We also discuss the development of new methods of permanent contraception, including the FemBloc® system and polidocanol foam.

Objective: Expanded legal access to cannabis in the United States has led to its increased use for treating medical conditions. We assessed the use of and attitudes toward cannabis for treating gynecological conditions. Materials and Methods: We utilized Amazon.com Inc.'s Mechanic Turk platform to administer a survey to U.S. women 18 years and older about cannabis use for recreational and medicinal purposes and willingness to use cannabis to treat 17 gynecological conditions. We collected sociodemographic data and views about the legal status of cannabis. We used logistic regression to identify factors associated with willingness to use cannabis for gynecological conditions. Results: In our analytical sample (N = 995), women who reported ever using cannabis were more willing to use cannabis to treat a gynecological condition compared with never users (91.6% vs. 64.6%, p < 0.01). Women willing to use cannabis for gynecological conditions were most interested in using cannabis for treating gynecological pain (61.2% of never users vs. 90.0% of ever users; p < 0.001) compared with procedural pain (38.2% vs. 79.0%, respectively; p < 0.001) or other conditions (38.0% vs. 79.8%, respectively; p < 0.001). In multivariate analysis, willingness to use cannabis for a gynecological condition was associated only with a history of ever using cannabis and views that cannabis should be legal in some capacity and not by age, race, or education. Conclusions: The majority of women would consider using cannabis to treat gynecological conditions. Overall, respondents who had a history of cannabis use were more likely to report willingness to use cannabis for all gynecological conditions, but a large proportion of those who reported never using cannabis were also willing to use it.

OBJECTIVE: To evaluate whether prophylactic dronabinol, a synthetic tetrahydrocannabinol, reduces pain during medical abortion. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of women undergoing medical abortion with mifepristone and misoprostol up through 70 days of gestation. All participants received 800 mg of ibuprofen and were randomized to either 5 mg of oral dronabinol or a placebo 30 minutes before misoprostol administration. Participants used a text messaging service to report pain on a numeric rating scale from 0 to 10 (0=no pain, 10=worst pain). The primary outcome was maximum pain experienced during the 24 hours after misoprostol administration. Secondary outcomes were pain scores at 0, 6, and 24 hours after misoprostol administration; maximum anxiety and nausea scores; use of additional pain medication; reported side effects; and satisfaction (yes or no). We needed 68 participants (34 per group) to have 80% power to detect a 2-point difference in maximum pain on a numeric rating scale. RESULTS: From November 2018 to May 2019, we randomized 70 women (dronabinol=35, placebo=35). Participants in the study arms had comparable baseline characteristics. We found no difference between groups in the median maximum pain score reported (dronabinol 7 [interquartile range 6–8], placebo 7 [interquartile range 5–8], P=.82) or median pain scores at any timepoint. Groups were also no different in mean maximum anxiety (dronabinol 3.33 [SD 3.06], placebo 3.23 [SD 2.53], P=.88) or nausea scores (dronabinol 2.21 [SD 2.32], placebo 2.72 [SD 2.64], P=.41). Most women were satisfied with their pain management (76% dronabinol, 82% placebo, P=.51). CONCLUSION: Dronabinol does not reduce the maximum level of pain experienced by women undergoing medical abortion. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03604341.