Background State-level abortion bans, parental involvement laws and structural barriers to abortion care create a complicated landscape for adolescents under 18 years old seeking clinic-based abortion. Because of such obstacles, adolescents may seek medication abortion from online sources. We aimed to understand their individual motivations for obtaining medication abortion from one online telemedicine service instead of in-person clinic-based care.Methods We conducted a mixed-methods study among adolescents who requested medication abortion between 1 July and 30 November 2022 from a service providing asynchronous clinician consultation and medication dispensed by mail to people in all 50 United States (US) states. We examined demographic characteristics, reasons for request, and conducted a content analysis of a subsample of anonymised email communications.Results Over a 5-month period, 558 adolescents requested medication. The most frequently selected motivations were: I would rather keep my abortion private (66%); I would be more comfortable at home (64%); I need to keep my treatment a secret from my partner/family (64%); Pills at home are more affordable (47%); I prefer to take care of my own treatment (47%); and I want to have my partner/friend with me (45%). In email communications, adolescents expressed an urgent need for abortion and articulated additional barriers including the high cost of the service and lack of access to credit cards or digital payment methods.Conclusions Our results provide insights into why adolescents in the US pursue online medication abortion services and raise the need to address cost and payment barriers to telehealth abortion.
Background: Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years. Methods: We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years. Results: We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria. Conclusions: Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit.Abstract Background: Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years. Methods: We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years. Results: We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria. Conclusions: Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit. Abstract Background: Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years. Methods: We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years. Results: We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria. Conclusions: Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit.Abstract Background: Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years. Methods: We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years. Results: We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria. Conclusions: Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit.
Objective To evaluate the efficacy, safety and acceptability of quinestrol combined with quingestanol (Quin-QUIN), quinestrol combined with levonorgestrel (Quin-LNG) and quinestrol combined with norgestrel (Quin-NG) as contraceptives.Methods PubMed, Web of Science Core Collection, Embase, CENTRAL, CINAHL, CNKI, Wanfang, SinoMed and selected supplementary sources were systematically searched to identify randomised controlled trials (RCTs) and non-randomised studies of interventions related to Quin-QUIN, Quin-LNG and Quin-NG. Two investigators independently performed data extraction and risk-of-bias assessment. A random-effects model was used for the meta-analysis and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results Twelve studies (1 RCT and 11 case series) involving 5355 participants were included. Most studies were published in the 1970s. The only included RCT showed no significant difference in the risk of pregnancy (risk ratio (RR)=0.70, 95% confidence interval (CI) 0.31 to 1.55 for Quin-LNG compared with Quin-NG). Quin-LNG was associated with a lower risk of discontinuation and fewer side effects than Quin-NG. Proportion meta-analyses of the case series, all evaluating Quin-QUIN, found a pooled proportion of pregnancy of 3.6% (95% CI 2.5% to 5.0%) and a pooled discontinuation rate of 47.9% (95% CI 17.4% to 79.4%). Nausea, vomiting, dizziness and headache were the most common side effects. The certainty of evidence for most outcomes was low or very low.Conclusions Available evidence is limited; the risk-benefit profile of quinestrol-based once-monthly oral contraceptives remains uncertain. Their clinical use should be cautious, and high-quality studies are needed to clarify their safety and efficacy.
Objective To systematically review the contraceptive safety and effectiveness of ormeloxifene, a non-hormonal selective oestrogen receptor modulator, among reproductive-age women. Methods A comprehensive search was performed across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. No restrictions were applied regarding language, geography or publication year. Eligible studies included interventional and observational designs that evaluated the contraceptive effectiveness and/or safety of ormeloxifene. Two reviewers independently extracted data using a standardised form, assessed the risk of bias for individual studies, and graded the certainty of evidence using design-appropriate tools. Results The review included 14 studies on contraceptive use of ormeloxifene and 41 studies assessing its safety in non-contraceptive contexts. Twelve contraceptive studies reported Pearl Indices ranging from 0.48 to 4.2 per 100 woman-years, with failure rates between 0.8% and 10.1%. No serious adverse events such as thromboembolism or hepatotoxicity were reported. Two cases of benign endometrial hyperplasia were reported, and transient reductions in lactation were noted among 5.7% of women at 1 month, decreasing to 2% at 6 months among women using ormeloxifene as contraception. Infant exposure during breastfeeding remained below 10% of the maternal dose. The most common side effects were menstrual irregularities, leading to discontinuation in up to 31.5% of users. Continuation rates were high at 3-6 months (>85-100%), declining to 27-91% in larger cohorts involving longer follow-up extending beyond 12 months. Method satisfaction was consistently high (75-95%). All 14 studies on contraceptive use were conducted in India, had a high risk of bias, and only four were multicentre studies. Conclusions Ormeloxifene shows promise as a moderately effective, safe and user-acceptable contraceptive option. The current evidence is limited by methodological weaknesses and geographic concentration. High-quality, large-scale studies in diverse populations are essential to establish ormeloxifene's comparative effectiveness and safety with greater certainty and support its inclusion in global contraceptive guidelines.
Background To evaluate the contraceptive effectiveness, safety and acceptability of continuous or extended-cycle combined oral contraceptives (COCs) compared with conventional cyclic regimens (21/7 or 24/4).Methods A systematic search was conducted in Medline, Embase, Web of Science, trials registries and other databases from 1 January 1970 to 21 October 2024. Complementary searches were conducted in grey literature sources and reference lists.Results A total of 9531 records were identified, from which 18 randomised controlled trials and 10 studies of other designs were included. Overall, findings indicated that: (1) continuous or extended-cycle COCs had contraceptive effectiveness similar to cyclic COCs (unintended pregnancies over 1 year: OR 0.79, 95% CI 0.41 to 1.52; Pearl Index mean difference -0.20, 95% CI -1.31 to 0.92); (2) bleeding outcomes varied, with either no significant difference or fewer total bleeding and/or spotting days with continuous or extended-cycle COC use, but more unscheduled bleeding; (3) no significant difference was observed in the odds of experiencing at least one adverse event (OR 1.20, 95% CI 1.03 to 1.41); (4) the relative risk of deep vein thrombosis or venous thromboembolism was low (OR 1.05, 95% CI 0.16 to 6.79), with a small absolute increase (approximately 0.7 additional cases per 1000 users); and (5) satisfaction was generally high in both groups.Conclusions Continuous or extended-cycle COC use demonstrates comparable contraceptive effectiveness, safety and overall acceptability to conventional cyclic COC regimens. However, interpretation of acceptability and bleeding-related outcomes should consider higher discontinuation rates and missing outcome data.
