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A Look At New Hormone-Free Contraceptive Option

SARAH MCCAMMON, HOST:

If you're someone who's recently explored your options for contraception, you may have heard about Phexxi, one of the newest products on the market. It's a prescription gel being advertised as a revolution in birth control. The product, which was approved by the Food and Drug Administration last year, is hormone-free and can be used on an as-needed basis. For some women with a limited range of non-hormonal options to choose from, a contraceptive like Phexxi is a much awaited and exciting development. But others, including some providers, aren't convinced the product is as revolutionary as the marketing claims.

We wanted to learn more about this contraceptive and how it compares to others, so we called Dr. Meera Shah. She's the chief medical officer at Planned Parenthood Hudson Peconic, outside of New York City. Dr. Shah is a board-certified family physician and author of the book, "You're The Only One I've Told: The Stories Behind Abortion." And we should mention that this conversation includes a discussion of sex and may not be appropriate for all listeners.

Dr. Shah, welcome.

MEERA SHAH: Hi, Sarah. Thanks for having me.

MCCAMMON: Well, let's start with the basics. How does this new contraceptive, Phexxi, actually work?

SHAH: What it does is it keeps the pH of the vagina low. So typically, semen enters the vaginal canal and raises the pH of the vagina, making it so that the sperm can be mobile and swim to meet the egg and cause a pregnancy. However, what Phexxi does, it's a combination of a few acids that keep the pH of the vagina low so that the sperm can - are no longer able to move and to swim.

MCCAMMON: So it essentially makes the woman's body inhospitable to pregnancy, right?

SHAH: Yep. No, that's exactly right.

MCCAMMON: Are there any notable side effects?

SHAH: So in the clinical trials, about less than 2% of participants experienced vaginal discomfort, itchiness, burning and urinary tract infections. So actually, what's recommended that - for folks who experience or have a history of getting frequent UTIs, we actually advise that they maybe, you know, not choose Phexxi as their method of contraception.

MCCAMMON: How much interest are you seeing from the patients that you work with in this kind of option?

SHAH: I have had patients express a strong interest in this product because many of them are - you know, are people who have tried everything that we have on our menu of options and really haven't found a method that works well for them. And, you know, there are some other folks who may have a medical contraindication, so someone who has a history of breast cancer and, you know, really needs to stay away from that hormonal method. And a lot of folks really liked the idea that it's a gel. It might help with lubrication.

So, you know, we are seeing a strong interest in this. Now, the one setback is that it's not - we've seen that it hasn't been covered by all insurance plans. And so there's been an unnecessary administrative burden with prior authorizations and just flat-out denials.

MCCAMMON: You mentioned that some people may have medical conditions that make hormonal birth control not an option or not the best option. What are some of the other reasons someone might be interested in hormone-free contraception?

SHAH: You know, there's - so there's many reasons. Some folks may come to their contraceptive method decision based on their own lived experience. And so some folks may say, you know, I have been told that hormones aren't safe or I - you know, or I personally just don't want hormones in my body. And, you know, as a physician, I dispel any myths. I, you know, reassure patients that hormones are safe if there's no medical contraindication. However, you know, if a patient truly just doesn't want a hormonal method, I'm not going to push it, right? I'm - what I'm going to do is I'm going to meet them where they are and make them feel comfortable by saying, you know what? Then let's explore the non-hormonal options. And I'm excited that there is another method that I can offer them.

MCCAMMON: You know, a few years ago, there was a lot of buzz around a clinical trial for a male birth control pill that was halted because of side effects like weight gain and mood swings. And as a lot of people pointed out, women have long complained of similar side effects from hormonal birth control in particular. Are we better off looking for more options for women? Or should more energy be focused on finding ways to make it possible for male patients to bear more of this burden?

SHAH: I love this question. And I think that there should be an interest in finding methods that are applicable to all gender identities. I think that the reproductive burden is, in theory, carried by everyone. However, unfortunately, that - you know, the work around sexual reproductive health and the burden of reproduction is carried by the individual with the uterus. And so that is where a lot of the research and sort of the advocacy lies, which I see in reality and in practice. But I do think that if we had more options for everyone, for men, that - I think that it would then seem like that reproductive burden has shifted.

MCCAMMON: That was Dr. Meera Shah, chief medical officer at Planned Parenthood Hudson Peconic outside of New York City. Thanks so much for joining us.

SHAH: Oh, thanks so much for having me.

MCCAMMON: And if you'd like more information about birth control options, NPR's Life Kit has an episode about just that. You can find it at npr.org/lifekit.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.