1. Society of Family Planning Clinical Recommendation: Prevention of Infection after Abortion and Pregnancy Loss
This Clinical Recommendation updates and replaces the 2010 guideline on preventing infection after abortion and pregnancy loss. It is a clinically useful document that reviews the evidence supporting common practices in abortion and miscarriage management, including screening and treatment for pelvic infections, antibiotic timing, and antibiotic selection. Where evidence is limited—such as the use of antibiotics during osmotic dilator placement or vaginal preparation—the authors provide background information to guide clinical decision-making. Strong recommendations include testing and treating chlamydia and/or gonorrhea without delaying abortion care, using prophylactic antibiotics before uterine aspiration for abortion or early pregnancy loss, and prioritizing doxycycline and azithromycin as first-line antibiotic choices. This document is an essential resource for healthcare professionals providing early pregnancy and abortion care.
2. Effects of estetrol/drospirenone on self-reported physical and emotional premenstrual and menstrual symptoms: Data from the phase 3 clinical trial in the United States and Canada &
3. Estetrol/Drospirenone safety in a population with cardiovascular risk factors
Historically, all combined hormonal contraceptive medications have featured a single estrogenic component, ethinyl estradiol, which has well-known risks associated with venous thrombotic events along with widely recognized side effects. A new estrogenic steroid, estetrol, is currently under study as part of a combined oral contraceptive pill—estetrol 15mg - drosperinone 3mg (trade name Nextellis). Estetrol is a naturally occurring steroid hormone produced by the fetal liver during pregnancy, and when compared to ethinyl estradiol, it appears to have a much more neutral effect on multiple organ systems. These two recent publications review phase 3 trial data on the estetrol-drospirenone pill.
The first study examines the effect of estetrol-drosperinone on premenstrual and menstrual symptoms, assessed using the Menstrual Distress Questionnaire (MDQ). The MDQ is a validated instrument that allows patients to self-report 48 different symptoms that may be associated with the menstrual cycle. Patients self-reported reported MDQ results at both the beginning and end of the study. The authors recorded whether patients were “starters” (those starting a hormonal contraceptive) or “switchers” (those already taking another hormonal contraceptive when they switched over to estetrol-drosperinone). They found that starters noted a significant improvement in premenstrual and menstrual symptoms, particularly in the domains of pain, water retention and negative affect. Switchers did not notice a significant difference.
The second publication evaluates the effect of estetrol-drosperinone on cardiovascular risk factors. Given estetrol’s lower impact on metabolism and water retention compared to ethinyl estradiol, the authors hypothesized that it would have a diminished effect in this domain. Study personnel measured participants’ blood pressure and lipid profiles at regular intervals after starting the medication. They found that only 0.2% of participants experienced an increase in blood pressure after starting estetrol-drosperinone, and these individuals already had high-normal blood pressure and preexisting cardiovascular risk factors. These findings suggest that this estetrol may have a more neutral effect on cardiovascular health than contraceptives containing ethinyl estradiol.
Overall, future study is needed to better understand the effects of estetrol-drosperinone, but the initial data reported in these studies suggest that this new oral contraceptive may be a groundbreaking option for many patients.
4. Breastfeeding after immediate versus delayed postpartum contraceptive implant placement: a non-inferiority randomized controlled trial
Patients who have recently given birth are at risk for short-interval repeat pregnancies if they do not receive contraception, and the immediate postpartum period may offer convenient time for patients to initiate the birth control method of their choice. However, there has been theoretical concern that the etonogestrel contraceptive implant (Nexplanon) could interfere with lactogenesis in the immediate postpartum period and inhibit breastfeeding. In this randomized controlled trial, 126 postpartum patients who desired an implant for contraception received it either in the first 24 hours after birth or at least two weeks later. The authors found no significant difference in the number of patients reporting any breastfeeding at 8 weeks postpartum, nor any significant difference in continuation rates at 24 weeks postpartum. These results indicate that immediate postpartum contraceptive implant placement is safe for patients who plan to breastfeed and may represent a convenient window of placement for many patients seeking implants.
5. Efficacy of NSAIDs in reducing pain during intrauterine device insertion: A systematic review &
6. Differences in pain regimens among nulliparous patients undergoing IUD placement within a single health system
While IUDs are a highly effective form of long-acting reversible contraception and can be safely used by nearly all patient populations, IUD placement can be painful for many and may deter some patients from choosing these methods. Two studies this month investigated different aspects of pain management during IUD placement. In a systematic review by Martigano et al., the authors identified 20 studies evaluating the efficacy of NSAIDs, the most commonly recommended outpatient pain control option for IUD placements. Despite significant heterogeneity across NSAID types and dosing regimens, the authors noted that 70% of studies showed no significant benefit of NSAIDs for pain reduction. A second study, a retrospective analysis by Tsevat et al., examined pain management regimens among more than 1100 nulliparous patients having an IUD placement in a single large health care system. The authors noted significant variations in provider practices, with only 41% of patients receiving any pain medications before or during IUD placement. Premedication was more common for patients with lower BMIs, those receiving a Skyla IUD, or being treated by an APP, internist, or pediatrician. Medication during placement was more common among younger patients, those having same-day IUD placement, or being treated by an internist. Together, these studies highlight the wide variation in IUD pain management practices and underscore the need for further high quality studies to clarify which practices truly improve patient pain.
7. Prevalence of Chlamydia trachomatis genital infection among sexually experienced females aged 14-24 years by race/ethnicity, United States: 2011-March 2020
When examining rates of chlamydia infection in the United States over the past decade, non-Hispanic Black adolescent and young adult females have consistently shown much higher rates of infection compared to non-Hispanic white females in the same age groups. The relationship between known risk factors—such as access to healthcare and sexual behavior—has not been clearly explored. Furthermore, disparities in detection practices, such as Black individuals being offered testing more frequently than other ethnic or racial groups, may also contribute and warrant further study. The authors of this study analyzed data on almost 1,700 sexually experienced female adolescents and young adults, grouped in four racial/ethnic categories: non-Hispanic Black, Hispanic, non-Hispanic White, and non-Hispanic “other”. They found that chlamydia prevalence remained higher among non-Hispanic Black participants even after controlling for factors such as number of sexual partners, condom use and health insurance status. These findings underscore the need for healthcare providers to offer confidential, equitable STI screening and treatment for all adolescents and young adults, while recognizing that broader systemic factors influencing infection rates require continued attention and research.
8. SAHM Paper on Sexual and Reproductive Health Rights &
9. Guidelines on the Inclusion and Protection of Adolescent Minors and Young Adults in Health Research: A Position Statement of the Society for Adolescent Health and Medicine
Sexual and reproductive health encompasses mental and psychological well-being in relation to sexuality and reproduction, not merely the absence of disease. Young patients may be particularly vulnerable in their sexual and reproductive health and rights, facing disproportionately higher rates of sexually transmitted diseases, unintended pregnancy, sexual coercion, and sexual exploitation and violence. In this position statement from the Society of Adolescent Health and Medicine (SAHM), the authors highlight the challenges faced by adolescent and young adult (AYA) patients and affirm the human right for AYA patients to have access to comprehensive information and clinical sexual and reproductive care. They emphasize that all providers caring for this age group should have the knowledge and skills to provide this care for their patients and call for increased investment in education, services, research, and advocacy to support these goals.
This position statement complements another SAHM position statement this month on the inclusion of AYA patients in clinical research. In this second statement, the researchers address the ethical issues involved in research with this patient population, discussing the importance of their appropriate inclusion and the need to incorporate their developing understanding and capacity into the informed consent process. The authors also call actively involving AYA patients and community into the focus, design, and dissemination of research involving AYA participants.
10. Implications of Abortion Restrictions for Adolescents
A recent research letter in JAMA Pediatrics examines the impact of post-Dobbs abortion restrictions on adolescents across the United States. The authors highlight how abortion-related policy changes uniquely affect young people and emphasize the need for policies that prioritize adolescents' specific needs to ensure equitable access to care. This research underscores the urgency of protecting adolescent reproductive rights—especially for communities already disproportionately affected by health and social inequalities—in a rapidly shifting legal landscape.
