1. Using updated clinical recommendations to support contraceptive decision-making: U.S. Medical Eligibility Criteria for Contraceptive Use, 2024
The US Medical Eligibility Criteria for Contraceptive Use (US-MEC) is a rigorously-maintained guideline from the Center for Disease Control and Prevention (CDC). The US-MEC can help guide healthcare professionals on safety considerations for different contraceptive methods based on individual medical conditions. A companion reference, the US Selected Practice Recommendations (US-SPR), provides detailed guidance regarding specific scenarios, such as how to start a contraceptive method, how to determine if a patient is not pregnant, and what to do in the setting of missed pills. In 2024, the CDC updated the guidelines and published new versions for the first time since 2016. This detailed document provides summaries of changes, the evidence and background for each, and suggestions on how to use the updated information. The comprehensive reference list is also available for readers who would like to review the CDC’s primary sources. This publication is a valuable reference tool for anyone who considers the US-MEC and US-SPR to be a standard component of their reproductive healthcare practice.
2. Vaginal Contraception with NuvaRing© Decreases Symptoms and Uterine Features of Adenomyosis. A Prospective Evaluation
Adenomyosis occurs when endometrial tissue invades the uterine muscle, often causing pelvic pain, heavy menses, dyspareunia and other complications. Few evidence-based treatment options exist, especially for young patients who wish to preserve their fertility. This prospective, observational study from Italy evaluated the effect of continuous NuvaRing© use over six months on 42 patients with ultrasound-confirmed adenomyosis. Researchers theorized that the NuvaRing©, a combined estrogen/progestin contraceptive ring placed in the vagina, would lead to higher pelvic concentrations of and thus greater symptom relief. Most participants reported decreased pelvic pain, along with a correlated decrease in uterine volume. While the study population was small and homogeneous, findings suggest that a vaginal contraceptive ring may be a promising non-surgical treatment for adenomyosis, warranting further investigation.
3. Co-administration of combined oral contraceptives and psychotropic drugs – risk of contraceptive failure and adverse events
The category of psychotropic drugs (PDs), which affect neurotransmitters in the brain, includes numerous medications that are used to treat conditions such as depression, psychosis, anxiety, and mood disorders. Many pregnancy-capable patients take combined oral contraceptives (COCs) alongside PDs, but data on potential drug interactions are limited. This pooled analysis of four large prospective studies examined over 8,000 COC + PD users and more than 70,000 COC-only users, comparing adverse events and efficacy between the two groups. The authors found no increased risk of contraceptive failure with concurrent PD use, even after adjusting for BMI and age. However, user of both COC and PD reported more adverse events, such as gastrointestinal or genitourinary symptoms. These findings highlight the efficacy of COCs for individuals taking PDs, and suggest a need for additional research into the interactions between these two medications.
4. Perception of Having Enough Information to Make Contraceptive Decisions: A Novel Metric of Person-Centered Contraceptive Access
Patients choose to use different types of birth control, or to not use birth control at all, based on diverse factors. One essential aspect of patient-centered reproductive health care is ensuring that patients have access to information about contraception they themselves deem adequate to make informed choices. This nationally representative online survey of more than 3000 participants assigned female and birth and aged 15-44 years old investigated whether participants felt they had enough information to choose a birth control method that was right for them. It also explored what missing information they would need to make this decision, as well as whether they perceived that they would be easily able to access or switch to their preferred birth control method. While 75% reported they had sufficient information, the rest said no or were unsure—especially those who were younger, non-heterosexual, or had less formal education. Commonly identified gaps included information about side effects, safety, and complications. Those who felt well-informed were also more confident in accessing their preferred method. The authors highlight the importance of patient-centered counseling that prioritizes what individuals themselves consider essential to decision-making.
5. Evaluating the Quality and Communicative Aspects of Contraceptive Decision Aids
Contraception decision aids are interactive educational tools designed to support patients in a decision-making process that centers the individual’s preferences and values regarding birth control methods. While criteria have been established to evaluate these decision aids on their completeness, lack of bias, and communicative aspects, there has been limited research on how different publicly available decision aids adhere to these guidelines. This review assessed 13 free, interactive contraceptive decision aids for quality and clarity. Most offered unbiased, visually engaging content, but few included comprehensive data like both perfect- and typical-use effectiveness or common contraindications. Many aids did not indicate their funding sources or cite data sources. While helpful for initial guidance, most tools lacked the detail needed for fully informed decision-making. The findings point to opportunities for improving the accuracy and transparency of patient-facing resources.
6. Interest in period pills in the United States: A nationally representative survey, 2021–2022
“Period pills” refers to the use of medications, typically misoprostol, with or without mifepristone, to induce bleeding when a period is late and a pregnancy is suspected but not yet confirmed. Although not currently marketed for this use in the U.S., period pills are used internationally and could potentially provide an important option for patients to control their fertility. They are safe to take in the absence of pregnancy and will usually end a very early pregnancy if one exists.
In this cross-sectional national panel survey, the authors assessed interest in period pills among patients ages 15 to 49 years old who were assigned female at birth. One in four respondents expressed interest in using the pills themselves if available, and half supported making period pills available even if they would not use them personally. Interest and support was higher among particular groups, including respondents who were younger, had had a previous abortion, had a non-straight sexual orientation, or had faced barriers accessing reproductive healthcare. Even some who personally opposed abortion supported access. This study indicates a potentially broad appeal and market for period pills in the US; the authors advocate for further research on the safety and feasibility of this option.
7. How Will Abortion Bans Affect Maternal Health? Forecasting the Maternal Mortality and Morbidity Consequences of Banning Abortion in 14 U.S. States
Following the Dobbs v Jackson decision in June 2022, which overturned the right to abortion in the US, expanding abortion restrictions have exacerbated the U.S. maternal health crisis. The US has the highest maternal mortality rate among high-income nations, a crisis exacerbated by institutionalized racism, socioeconomic inequities, and inequitable insurance access. Using abortion and demographic data from the CDC and Guttmacher, the authors created a statistical forecast to estimate the increase in both death and morbidity associated with abortion bans. The model estimated 42 additional maternal deaths due to abortion bans over 4 years, and nearly 3,000 instances of severe maternal morbidity which may be due to delayed care, being turned away from emergency services, or forced continuation of high-risk pregnancies. The burden falls disproportionately on Black birthing people, reinforcing existing racial health inequities. Due to underreporting, actual impacts may be even greater. This forecast serves as a dire prediction of worsening outcomes for birthing people around the US.
8. Exploring Adolescent Abortion Information Sources and Preferences post-Dobbs in the Midwestern United States
In the post-Dobbs landscape, adolescents and minors face increasing challenges to accessing abortion services and information. Because adolescents interact with the healthcare system and acquire health information in different ways than older patients, understanding how adolescents seek out abortion information is essential to addressing these barriers. In this survey research, the authors conducted in-depth interviews with patients aged 16-19 years old living in Midwestern US states to determine which sources of abortion information they trust and prefer. While social media platforms like TikTok, YouTube, and Reddit were widely used, participants expressed skepticism and a preference for trusted sources—like healthcare providers, Planned Parenthood, and school-based health education. Providers who care for adolescent patients should be aware of the onslaught of social media (mis)information regarding abortion and reproductive health care, but should also embrace their own role as a preferred source of accurate information.
9. Accuracy of survey-based assessment of eligibility for medication abortion compared with clinician assessment
Medication abortion with mifepristone and misoprostol is a safe and effective form of abortion care and now represents the majority of abortions in the US. With the rise of abortion restrictions and bans in the US, more patients are relying on self-assessment to determine whether they are eligible candidates for medication abortion, rather than relying on provider assessment. In this diagnostic accuracy study of approximately 1400 15+ year old patients seeking abortion care, participants completed a survey on medication abortion eligibility prior to assessment by a clinician. The authors found that clinicians deemed 22% of patients ineligible for medication abortion, most commonly for reasons of gestational duration over 77 days (74%) or anemia (11%). However, approximately 69% of patients reported themselves ineligible for medication abortion for at least one reason, most commonly for reasons of unexplained pain (55%), gestational duration over 77 days (36%), or anemia (29%). Removing unexplained pain as an exclusion criteria decreased overall self-reported ineligibility to 54%. Self-assessment had high sensitivity (92%) but low specificity (38%). These findings suggest self-screening is unlikely to lead to unsafe abortions but may result in eligible patients unnecessarily excluding themselves. Given the importance of ensuring abortion access, further research is needed to determine how to focus self-assessment criteria for medication abortion, especially regarding assessing pelvic/back pain, to increase abortion access without compromising patient safety.
