OBJECTIVE:To determine whether medical students' intent to use long-acting reversible contraception (LARC) increased after exposure to the obstetrics and gynaecology (OB-GYN) clerkship. METHODS:This is a prospective cohort study conducted at a US medical school. We administered a survey to students before and after the OB-GYN clerkship, asking about intent to personally use an intrauterine device (IUD) or implant in the future or recommend to a sexual partner, a family member, friend, or patient. We also asked about familiarity with method benefits and side effects. To compare pre and post responses, we used McNemar's and the marginal homogeneity test. We used Stata SE Version 16.1 for all analyses (α = 0.05). RESULTS:Of 254 medical students who completed the clerkship between August 2022 and November 2023, 237 (93.3%) completed the pre-clerkship survey; of these, 123 (51.9%) also completed the post-clerkship survey. Of those who could be matched, 58 students (47.2%) said they would very likely use a LARC themselves or recommend to a partner pre-clerkship; this number increased to 85 (69.1%) post-clerkship (p < 0.001). Students' likelihood of recommending LARC to family, friends, and patients all increased, as did their familiarity with method benefits and side effects. Students were most likely to recommend the hormonal IUD to patients (73.8%), compared to 43.1% for the implant and 31.7% for the copper IUD. CONCLUSIONS:Medical students' stated intent to use LARC or recommend to a sexual partner increased after exposure to the OB-GYN clerkship. There appears to be a preference for the hormonal IUD over the copper IUD and implant.
PURPOSE:To assess contraceptive dissatisfaction and examine its correlation with contraceptive methods and demographic factors in a Swedish population. Intention to switch methods was also assessed as a secondary measure of dissatisfaction. MATERIALS AND METHODS:Women in Sweden aged 15-45 who attended midwifery and gynaecology clinics across 14 regions of Sweden answered an online questionnaire on contraception and reproductive health. Dissatisfaction and switching intention were assessed using Chi-square test, Fisher's exact test and univariate logistic regression. RESULTS:Of the 874 women included in the analysis, 12.9% were dissatisfied with their contraceptive method. Dissatisfaction was 7.9% for short-acting reversible contraception (SARC), 10.4% for intrauterine devices, 13.3% for barrier methods, 31.6% for implant and 29.7% for other methods. Highest levels of dissatisfaction were found for emergency contraception pill (46.2% dissatisfied) and implant (31.6%). Unadjusted odds ratio for dissatisfaction with implant was 5.78 (CI 3.18-10.49) compared to SARC as reference. No demographic factor was correlated with dissatisfaction. Three out of ten reported an intention to switch methods. For most contraceptives, switching intention rate aligned with dissatisfaction level. CONCLUSIONS:Most women are satisfied with their contraceptive method, but dissatisfaction differs significantly between methods. Efforts should be made to strengthen individualised contraceptive counselling in order to further decrease dissatisfaction levels.
This position paper, issued by the European Society of Contraception and Reproductive Health (ESCRH) following its 18th Congress in Belgrade (2026), articulates a comprehensive, evidence-based and rights-centred stance on Sexual and Reproductive Health and Rights (SRHR). Drawing on landmark international frameworks - including the Guttmacher-Lancet Commission, the WHO Action Plan for Sexual and Reproductive Health, the FIGO Cartagena Declaration, and the Porto Proclamation - the Society affirms ten core positions covering contraception, safe abortion, sexuality education, STI/HIV prevention, prevention of reproductive tract cancers, gender-based violence and female genital mutilation, and the needs of marginalised populations including adolescents, LGBTQIA+ individuals, migrants, people with disabilities, sex workers and older adults. The paper documents persistent inequities in contraceptive and abortion access across Europe, calls for evidence-based policy free from ideological interference, and outlines concrete recommendations for governments, health systems, the scientific community, and civil society. Endorsed by recognized international scientific societies, this position paper calls for urgent, coordinated action to guarantee universal SRHR.
PURPOSE:The United States Food and Drug Administration recently expanded approval of the 68 mg radiopaque etonogestrel (ENG) contraceptive implant (Nexplanon, Organon, Oss, The Netherlands) from three years to five years, based on clinical trial data showing no pregnancies in years four or five of use. We present two cases of pregnancy in year four of implant use. MATERIALS AND METHODS:Two patients presented to our medical center's emergency department with ENG implants in situ and were found to have positive pregnancy tests. The first patient had her implant placed three years and one month prior to presentation, and had an intrauterine pregnancy. The second patient had her implant placed three years and five months prior to presentation, and had a tubal ectopic pregnancy. RESULTS:The first patient underwent a medical termination of pregnancy and implant removal and replacement three days after initial presentation. Her original implant was removed intact. The second patient underwent a laparoscopic right salpingectomy and implant removal and replacement one day after initial presentation. Her original implant was removed intact. CONCLUSIONS:These cases suggest that both intrauterine and ectopic pregnancies can occur in year four of ENG implant use. Further work should be conducted to determine risk factors for implant failure, especially in years four and five of use.
OBJECTIVE:This was a single-centre, randomised, single-ring insertion, 2-period, 2-sequence, crossover study designed to assess comparative bioavailability and thereby establish bioequivalence of two ethinylestradiol/etonogestrel vaginal rings (delivering 0.015/0.12 mg per day) after a single vaginal ring was inserted and worn for 28 days in healthy female subjects. PATIENTS AND MATERIALS:Forty subjects were randomised for this bioequivalence study. The test product contains etonogestrel/ethinylestradiol 8.25/2.6 mg, compared with etonogestrel/ethinylestradiol 11.00/3.474 mg in the existing Ornibel® formulation, and was compared with NuvaRing (etonogestrel/ethinylestradiol 11.7/2.7 mg) as the reference product. RESULTS:The criteria for bioequivalence between the test and reference products were met. The test-to-reference ratio of geometric LSmeans and corresponding 90% CI for Cmax after Day 1, C504, AUC0-504, C672 and AUC0-672 were all within the acceptance range of 80.00 to 125.00% for ethinylestradiol and etonogestrel. The percentage reduction in residual hormone content remaining in the device after 21 days use, in comparison with NuvaRing®, is as follows: ETO residue after 21 days was reduced by 30%, and EE residue after 21 days was reduced by 4%. CONCLUSIONS:The test formulation (ethinylestradiol/etonogestrel vaginal ring delivering 0.015/0.12 mg per day; manufactured by Laboratorios Leon Farma, S.A.) is bioequivalent to the reference formulation (NuvaRing®; manufactured by N.V. Organon) following a single vaginal ring insertion worn for 28 days in healthy adult female subjects. Overall, the products tested were generally safe and well tolerated.
OBJECTIVES:The aim of this study is to examine the relationship between genital self-image and body perception during sexual intercourse by determining women's intentions to undergo genital cosmetic surgery and their preferences for genital cosmetic surgery. METHODS:This cross-sectional study included 410 women between January and December 2025. Women were evaluated based on their intentions to undergo genital cosmetic surgery and were divided into two groups accordingly. Data were collected using the Descriptive Characteristics Assessment Form, Female Genital Self-Image Scale (FGSIS), and Body Exposure During Sexual Activity Questionnaire (BESAQ). RESULTS:Among all women, 46.3% of women stated that they had considered undergoing genital cosmetic surgery. The most frequently preferred procedures were genital whitening (31.1%), laser vaginal rejuvenation (20.0%), and vaginoplasty combined with genital whitening (15.8%). The most important motivation for requesting surgery was sexual pleasure (32.6%), followed by social media (21.1%) and partner request (21.1%). BESAQ scores were found to be significantly higher among women considering genital cosmetic surgery (p = 0.015), but no significant difference was found in terms of FGSIS scores (p = 0.177). A moderate negative correlation was found between BESAQ and FGSIS in the group considering surgery (r= -0.387; p < 0.001). CONCLUSION:The intention for genital cosmetic surgery appears to be more closely related to increased body-focused cognitive processes during sexual intercourse than to genital self-image. This highlights the importance of psychosexual evaluation and comprehensive counselling processes in genital cosmetic surgery requests. SHORT CONDENSATION:Approximately half of women consider genital cosmetic surgery. Women who consider genital cosmetic surgery have a higher body focus during sexual intercourse. Social media and partner influence are important motivators.
OBJECTIVES:FDA approval of the over-the-counter Opill® presents a significant opportunity to expand access to contraception in the United States. We aimed to assess the Opill's® availability, affordability, and accuracy of pharmacist provided information nationwide, hypothesising that pharmacies located in states with higher abortion restrictions and smaller populations would have less availability and more inaccurate counselling. STUDY DESIGN:Utilising secret shopper methodology, we called pharmacies representing 530 randomly selected cities based on a modified version of the Guttmacher abortion restriction metric which classified states into three categories. Pharmacies were equally distributed between cities with populations above and below 50,000. Pharmacists were asked about availability, cost, and differentiation from abortive medications. Data was analysed by restriction category and population size using Chi-square (or Fischer's exact) tests. RESULTS:The cohort included 513 pharmacies, with the distribution proportionate to the number of states in each abortion restriction category and evenly distributed by population size. Overall, the Opill® was available in 65% of pharmacies and 47% reported a cost of under $20 per month. There were no significant differences in availability or cost by abortion restriction category, however, pharmacies in areas with <50,000 people were less likely to have the Opill® available (56% vs 73%) and reported higher costs than pharmacies with ≥50,000 population size (both p < 0.01). CONCLUSIONS:This study found that two thirds of pharmacies had the Opill® available but access was significantly reduced in less populated areas; however, this did not seem to be affected by state level abortion restrictions.
BACKGROUND:Paired hormonal data spanning a full androgen panel before and during etonogestrel (ENG) implant use are scarce. We quantified within-subject hormonal change about one year after ENG implant insertion and tested whether it differed by menstrual bleeding phenotype. METHODS:In this paired cohort study, 200 women with an ENG 68 mg implant in situ for 10-14 months attended a single index visit. Pre-insertion hormone values, obtained routinely before insertion, were retrieved from records; current values were measured at the index visit in the same laboratory. Paired comparisons used the Wilcoxon signed-rank test, reporting Cohen's dz and absolute change with 95% CIs; post-implant values were compared between bleeding phenotypes by ANCOVA adjusted for age, BMI, and parity, with multiple-testing correction. RESULTS:LH showed the largest decrease (-47.1%; dz = 1.84), followed by SHBG (-49.8%; dz = 1.42), total testosterone (-45.3%; dz = 1.24), and free testosterone (-46.0%; dz = 1.08). Oestradiol, AMH, and DHEA-S changed by ≤3% and, though significant, were clinically negligible (dz ≤ 0.60). Regular monthly bleeding fell from 95.5% to 45.0% (p < 0.001), with no frequent, prolonged, or heavy bleeding. After adjustment, no hormonal value differed by bleeding phenotype (all p ≥ 0.38). CONCLUSION:One year after ENG implant insertion, deep LH suppression was accompanied by parallel reduction of gonadal androgens (total and free testosterone) and SHBG, whereas oestradiol, AMH, and adrenal DHEA-S were essentially unchanged, indicating a dissociation between suppressed gonadal and preserved adrenal androgens. The reduced-bleeding phenotype was not accompanied by differential hormonal change.
PURPOSE:To compare two starting doses (50 µg vs. 100 µg) of a titrated low-dose misoprostol regimen after mifepristone for second-trimester abortion in women with one prior cesarean and premature rupture of membranes (PROM). MATERIALS AND METHODS:We retrospectively analyzed 271 eligible women at 13-26 weeks from 6,636 undergoing second-trimester abortion. All received 200 mg mifepristone, followed at 36 h by titrated misoprostol (initial 50 or 100 µg every 3 h, maximum 4 doses per day, escalated to 400 µg based on uterine response). Induction-to-abortion time, total dose, success rates and complications were compared between gestational age groups (13-16 and 16+1-26 weeks) and initial doses using t-tests, chi-square tests, and multivariable regression. RESULTS:Induction-to-abortion time was similar across groups (15.4-18.6 h). Total misoprostol dose was significantly lower with 50 µg (372-518 µg) than 100 µg (778-878 µg). No uterine rupture or severe hemorrhage occurred. Success rates within 48 h were high (95.7%-97%) and comparable. CONCLUSIONS:The 50 µg starting dose significantly reduced total drug exposure, with similarly high success rates and no observed uterine ruptures. These findings suggest a potentially safe, individualized approach, but require confirmation in prospective randomized trials against standard higher-dose regimens.
OBJECTIVE:To identify associated factors, to unplanned pregnancies (UP) among pregnant adolescents in the Southeast region of Brazil. METHODS:A cross-sectional survey was conducted among 12-20 years old pregnant adolescents at the antenatal care services of the Women's Hospital, State University of Campinas, Brazil. RESULTS:We included 101 female adolescents with a median age of 17 years, a median age of 14 years at sexual debut, and a median age of 16 years at first pregnancy. Most participants were self-reported as Pardas (Bi-racial) (49/101), students (59/101), and reported between 10 and 12 years of schooling (79/101). Eighty-five of them (84.0%) reported that the present pregnancy was unplanned. Living with a partner [OR 0.12; 95% CI 0.01; 0.53] and delaying age at first pregnancy [OR 0.65; 95% CI 0.40;0.98] were associated with protective factors to UP. CONCLUSION:We believe both the public and private sectors should implement actions to strengthen the capacity of the health system to foster adequate contraceptive methods counselling and methos availability, particular long-acting reversible contraceptives, to adolescents throughout Brazil. Also, educational interventions should focus on encouraging the postponement of sexual debut and first pregnancy. These interventions should be recommended, among those adolescents involved in a romantic relationship, foster relationships based on respect, communication and stability. We believe these efforts may result in better sexual and reproductive health through life for this population. SHORT CONDENSATION:We found that 8 out of 10 adolescents reported having an unplanned pregnancy at the time of the survey.
PURPOSE:To inform contraceptive decisions, we aimed to compare the pregnancy and continuation rates of a digital contraceptive, when paired with temperature data from wearable devices versus from oral thermometers. MATERIALS AND METHODS:We employed prospectively collected data from women who registered to Natural Cycles for contraception between the 1st of August 2022 and the 1st of September 2024. Using Kaplan-Meier curves, we calculated 13-cycle pregnancy rates in typical and perfect use as well as one-year continuation rates. We estimated the association of known demographic characteristics with pregnancy rates using a multivariate Cox proportional hazards model. RESULTS:Among the 195 027 presumed fertile women whom we analysed, the unadjusted 13-cycle pregnancy rate for wearable device users was significantly lower than for oral thermometer users both in typical use (4.7% vs 7.3%; p < 0.001) and in perfect use (2.0% vs 2.9%; p < 0.001). However, when adjusting for demographics, measuring with a wearable device rather than a thermometer was not independently associated with pregnancy. We observed one-year continuation rates of 75.8% for wearable device users and 56.4% for thermometer users. CONCLUSIONS:Findings from this study suggest that combining a contraceptive app with a wearable device rather than an oral thermometer does not affect pregnancy rates when adjusting for socio-demographic variables. However, the substantial increase in continuation implies greater user convenience.
INTRODUCTION:Pain is a recognised side effect of medical abortion, however there is limited information on the experience and treatment of this pain. Qualitative data are needed to understand pain during medical abortion and how this pain might relate to measurement scales for clinical practice and research studies. MATERIALS AND METHODS:We conducted a single-centre exploratory qualitative study in Edinburgh UK, interviewing 32 patients who had undergone medical abortion at home at less than 12 weeks pregnant. We interviewed them two to six weeks after their abortion. We analysed data thematically using a framework approach and asked participants to share pain ratings on a series of different pains scales. RESULTS:For most participants, the pain they experienced was more intense or prolonged than they felt the abortion service indicated it would be and would have preferred more detailed information in advance of the procedure. Use of analgesia was variable, as was response to analgesia when it was used correctly. Existing pain-rating scales, including numerical rating scales and descriptive Likert scales, did not clearly reflect the intensity of pain described in participants' accounts. An 11-point numerical rating scale with incorporation of verbal descriptors of intensity and temporality, was endorsed as a potential future approach. CONCLUSIONS:Patients require more detailed descriptions of pain during medical abortion. Existing pain-rating scales inadequately capture divergent abortion-pain experiences and development of a new tool is needed.
PURPOSE:Persistent high-risk human papillomavirus (HR-HPV) infection is a major cause of cervical cancer, yet the association between ultra-processed food (UPF) intake and HPV infection remains unclear. METHODS:We analysed 7,555 women aged 18-59 years from NHANES 2003-2016. UPF intake was estimated from 24-hour dietary recalls and expressed as a percentage of total energy using the NOVA classification. HPV status was determined by genotyping self-collected vaginal swabs. Weighted logistic regression, restricted cubic spline models, and subgroup analyses were applied. RESULTS:3,154 women (39%) were HPV-positive. Higher UPF intake was associated with greater odds of overall HPV infection per interquartile range increase (OR = 1.18; 95% CI: 1.07-1.32) and across quartiles (Q4 vs. Q1: OR = 1.26; 95% CI: 1.04-1.53; P for trend = 0.004). Spline analyses showed a positive linear association. UPF intake was not associated with a clear dose-response relationship with HR-HPV, although subgroup differences were noted. CONCLUSION:Higher UPF intake was positively associated with HPV infections among U.S. women, suggesting a potential role of diet quality in HPV-related outcomes.
PURPOSE:We report the first use of linzagolix (Yselty®), an oral GnRH antagonist, to manage progesterone hypersensitivity, an ultra-rare disorder with fewer than 200 cases reported worldwide. METHODS:A 23-year-old woman presented with severe cyclic luteal-phase symptoms from menarche: vulvar edoema, recurrent cystitis, fever (38-42 °C), urticaria, angioedema, and systemic inflammation. Diagnosis was confirmed by positive intradermal progesterone testing (1:10 dilution) and elevated IgE (1,010 IU/mL). Combined oral contraceptives were ineffective. Linzagolix 200 mg daily was started in May 2025 under exceptional approval granted by a government pharmaceutical inspector (off-label use), achieving partial symptom control. Progesterone desensitisation in July 2025 triggered an anaphylactic reaction (hypotension 80/40 mmHg, tachycardia 120 bpm). Anakinra (an IL-1 receptor antagonist) was subsequently added. RESULTS:Linzagolix induced ovarian suppression and clinical improvement. Following anaphylaxis, combination therapy with linzagolix and anakinra achieved complete symptom resolution. Multidisciplinary collaboration enabled monitoring. CONCLUSIONS:To our knowledge, this is the first use of linzagolix for progesterone hypersensitivity, suggesting GnRH antagonists may serve as bridge therapy. Multi-disciplinary care proved essential.
PURPOSE:Some perimenopausal women treated for fibroid-related bleeding may already experience hot flashes. MATERIALS AND METHODS:In this pilot case series, we evaluated the effect of relugolix combination therapy (relugolix 40 mg + oestradiol 1 mg + norethisterone acetate 0.5 mg) on hot flashes and endocrine parameters in seven perimenopausal women. RESULTS:All women reported a marked improvement (visual analogue scale: 8.6 ± 1.0) of hot flashes, while treatment significantly suppressed FSH (p = 0.004), LH (p = 0.002) and oestradiol (p = 0.002) serum levels. CONCLUSIONS:These preliminary findings indicate that hot flashes improvement may not depend on crude circulating oestradiol levels in perimenopausal women, but probably on their stabilisation with the oral GnRH antagonist addition.
OBJECTIVE:Endometriosis is a chronic, oestrogen-dependent inflammatory disorder affecting up to 10% of reproductive-age women, associated with pelvic pain, infertility, and reduced quality of life. Emerging evidence implicates the vaginal microbiome and oestrogen metabolism in its pathogenesis. This study aimed to evaluate the potential therapeutic role of the oral administration of Ligilactobacillus salivarius CECT 30632, a probiotic with demonstrated ability to metabolise oestrogens in vitro, to improve the quality of life in women with endometriosis. MATERIAL AND METHODS:We conducted a pilot, randomised, double-blind, placebo-controlled clinical trial assessing its effects, alongside standard dienogest treatment, in 37 women with endometriosis. Outcomes included changes in the vaginal microbiota composition (16S rRNA sequencing), in the immunological markers, in serum oestradiol levels, and in the quality-of-life of participants assessed with the EHP-30 questionnaire. RESULTS:Vaginal microbial diversity remained unchanged between groups; however, ∼20% of participants exhibited individualised microbiota shifts, including transitions to Lactobacillus-dominated profiles. In the immunological markers, the IL-10 levels decreased in 65% of probiotic supplemented participants (p = 0.042). Serum oestradiol levels were significantly reduced (∼50%) in the probiotic group (p = 0.013). The probiotic supplementation was associated with significant improvements in pain, emotional well-being, and perceived self-control (p < 0.05). CONCLUSIONS:Daily oral intake of L. salivarius CECT 30632 was associated with changes in circulating oestradiol levels and improvements in the quality of life in women with endometriosis. These preliminary findings support further powered trials to confirm efficacy and clarify underlying mechanisms.
OBJECTIVE:This debate paper aims to examine the effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), whose use in obesity and diabetes management has rapidly expanded, on fertility, contraceptive efficacy, and pregnancy outcomes in reproductive-aged individuals, and to provide evidence-based clinical guidance. MAIN ARGUMENTS/EVIDENCE:GLP-1 RAs improve fertility in obese women with polycystic ovary syndrome (PCOS) through weight reduction and enhanced insulin sensitivity, meta-analyses demonstrated significantly higher spontaneous pregnancy rates. However, gastrointestinal side effects may theoretically compromise the absorption of oral contraceptives. Animal studies indicate potential foetal risks, and limited human data support discontinuation before conception with appropriate washout periods (2-4 weeks for short-acting agents, 8 weeks for semaglutide and tirzepatide). In men, metabolic improvements may indirectly enhance reproductive parameters. From a contraceptive perspective, non-oral hormonal methods and long-acting reversible contraception may represent more reliable options during treatment, particularly in the presence of gastrointestinal side effects that could compromise oral drug absorption. CONCLUSIONS:GLP-1 RAs are valuable adjuncts in managing obesity-related infertility, particularly in patients with PCOS. Clinicians must counsel patients regarding contraceptive reliability during treatment, ensure adequate washout before attempting conception, and recognise that while fertility benefits are well documented, pregnancy safety data remain limited.
PURPOSE:To compare the effectiveness of vaginal or oral misoprostol combined with letrozole versus misoprostol alone for medical abortion and medical management of miscarriage, assessing complete abortion rate, time-to-abortion, haemoglobin decline, and side effects. MATERIALS AND METHODS:This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251165732). PubMed, EMBASE, Cochrane Library, and Clinical Trials were searched for randomised controlled trials (RCTs) comparing letrozole plus misoprostol versus misoprostol alone. Analyses were conducted in Review Manager, dichotomous outcomes (complete abortion, side effects) were expressed as risk ratios (RR) and continuous outcomes (time-to-abortion, haemoglobin decline) as mean differences (MD), with 95% confidence intervals (CI) in a random-effect model. Risk of bias was assessed with RoB2, and certainty with GRADE. RESULTS:Twelve RCTs (1,524 women) were included. Letrozole pre-treatment increased complete abortion rates (RR = 1.45; 95% CI 1.25-1.68; p < 0.00001; I2=73%), reduced time-to-abortion (MD = -5.47h; 95% CI -8.68 to -2.26; p = 0.0008; I2=99%), and minimised haemoglobin decline (MD = +0.26 g/dL;95% CI 0.13-0.39;p < 0.001;I2=0%). Side effects were comparable (RR = 1.04; 95% CI 0.88-1.23;p = 0.67;I2=57%). CONCLUSION:Letrozole pre-treatment improves medical abortion efficacy, without raising side effects.
