Melanie Cole, MS (Host): Welcome to the podcast series from the specialists at Penn Medicine. I'm Melanie Cole. And today, we're highlighting the Penn Pregnancy Early Access Center, or the PEACE Program and the contraceptive services offered through the PEACE program.

Joining me is Dr. Sarita Sonalkar. She's an Associate Professor of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania. Dr. Sonalkar, thank you so much for joining us today. What is the PEACE Program at Penn Medicine? Give us a little overview of what this program is.

Sarita Sonalkar, MD: Hi, Melanie. It's so nice to be here today with you. And I'm very excited to talk to you about the PEACE Program. So, PEACE is the Penn Pregnancy Early Access Center, and it's an integrated family planning and urgent pregnancy care center that bridges a major gap for people who can become pregnant or who are pregnant.

 for those looking to prevent pregnancy, PEACE offers timely efficient appointments for patient-centered contraception counseling and contraception service provision. And for those who are early in pregnancy, PEACE provides a range of services including counseling and early ultrasound for people that are experiencing concerning symptoms like bleeding and also pregnancy options, counseling and abortion care, as well as miscarriage management.

Melanie Cole, MS: That's so important. Tell us a little bit about the contraceptive options that you offer, because I mean, there's so many today. Tell us a little bit about the ones that you prefer or how you work with the patient in shared decision-making to decide on one of the options.

Sarita Sonalkar, MD: it's true there are a lot of different options, and it can be kind of confusing for patients to know even where to start when they come to the doctor, asking for these methods. So, we offer counseling and provision of all forms of female contraception, including IUDs, implants, pills, patches, rings, and injectables.

We also do preoperative consultations and surgical permanent contraception using laparoscopic bilateral salpingectomy, which is removal of the fallopian tubes. And then, we'll discuss with patients how to optimize the use of other non-prescription methods like condoms or fertility awareness, if that's what they want to use, and even withdrawal, depending on what works best for them.

Melanie Cole, MS: Well, then, how do you decide with patients what method is best for them? How do you help them decide? And I imagine the age and reproductive years and reproductive future are in discussion there.

Sarita Sonalkar, MD: that's exactly right. Those are two really important aspects of contraception counseling. The approach is generally a very careful balance of person-centered and evidence-based counseling. we know that each patient has personal and unique values around their reproductive lives, and there's no one overall gold standard method for contraception.

So, we use, like you said, a shared decision-making approach. first, we will have a conversation with the patient about what's most important to them. So, it might be making sure that their method is safe in the context of other medical conditions, or maybe they want to reduce or stop heavy bleeding with their periods. Maybe they want to carefully time their pregnancy around optimization of their medical conditions or maybe they just want the most effective or permanent method.

So once we have that conversation and understand what they value most, we can then tailor our recommendations to them, basically saying that this is the method or these are the methods that could potentially meet the needs that you have. And we use the highest quality and most up-to-date evidence around contraception in order to help them make those decisions.

Melanie Cole, MS: Now, people are not always aware that contraception is not only to prevent pregnancy, but also used in some cases for other health concerns that a woman might have, including pain management. So, how does your approach to pain management for IUD insertion and removal differ from a routine obstetrician-gynecologist? Tell us a little bit about that.

Sarita Sonalkar, MD: I think there are two parts to your question. One, I think contraception can be used not specifically for pregnancy prevention, but also for underlying conditions like painful periods or really heavy periods or maybe pain with endometriosis. And so, we will help people choose a contraceptive method that might help them manage their pain related to other conditions related to the reproductive system.

when it comes to pain management for IUD insertion, many people know that insertion of an IUD is a relatively invasive procedure that can be painful. And will talk to patients about their pain management options when placing an IUD. And we'll use a trauma-informed approach to all our pelvic exams and procedures, meaning that we basically address their psychological, their emotional, and their physical needs.

And then, for the procedure itself, we have a variety of different techniques to reduce pain. I would say the cornerstone of that is a local anesthetic that we inject into the cervix prior to placing the IUD, which has been shown in multiple randomized control trials to reduce pain levels and the proportion of people who experience severe pain. And this is particularly for people who haven't delivered a baby before, but we offer numbing medication into the cervix, basically for all of our patients, and also offer other oral medications, heating pads, and just a calming approach to care. And in addition, we will offer IUD insertions under sedation if that is really what's necessary for the patient to achieve the pain management goals that they have.

Melanie Cole, MS: Such a comprehensive approach for women. Now, what are they saying about the PEACE Program? What is the patient experience like with your program at Penn Medicine?

Sarita Sonalkar, MD: , the number one thing that patients will say to me is that that was way better than I thought it was going to be. And I'm always very happy when I hear that. I also am a little bit saddened by the fact that so many people come in so afraid of the pain that they're going to experience. But I'm glad that we're able to help them through the process and make them feel comfortable.

They also really enjoy the fact that we are very kind. We don't rush them through their procedures. We often have somebody who can hold their hand during the procedures if they need that. And many patients when they're done with their IUD insertion are able to leave and go home in a really comfortable state.

Melanie Cole, MS: Doctor, thank you so much. Now, I'd like you to speak to referring physicians. about patient selection for the program. What patients should providers consider referring to your program? And I'd like you to summarize the key takeaways, about the important work that you're doing and communication with those referring physicians.

Sarita Sonalkar, MD: I think it's really important to know that any patient in their reproductive years who has a uterus has the potential to become pregnant. And even with medical conditions, patients with disabilities, all of those patients, deserve a comprehensive approach to reproductive life planning, which includes pregnancy planning and contraception care, if that's something that they want.

And so for our program, we're really happy to see Any patient who is in their reproductive years and would like information or services related to family planning, whether that's contraception care, early pregnancy evaluation, abortion, miscarriage. We really welcome patients with medical complexity. Patients with disabilities and we take all types of insurance, including public and private insurance. So, I think patients whether they're at risk for pregnancy want to be pregnant or want help with pregnancy prevention and they are a person that they can refer to our program, we were happy to see them.

 I'd also like to add that patients can find us directly by calling 610-902-4989. Option five is PEACE, and that is the number that providers can give to patients if they want to reach the PEACE Program directly.

Melanie Cole, MS: Thank you so much, Doctor, for joining us today and telling us about the PEACE Program at Penn Medicine. To refer your patient to Dr. Sonalkar at Penn Medicine, please call our 24/7 provider-only line at 877-937-PENN or you can submit your referral via our secure online referral form by visiting our website at pennmedicine.org/referyourpatient. That concludes this episode from the specialists at Penn Medicine. I'm Melanie Cole.