1. Estimating emergency contraception efficacy with levonorgestrel and copper intrauterine devices
Copper IUDs have been shown for decades to be effective options for emergency contraception (EC). Recent research suggests that 52mg levonorgestrel (LNG) IUDs may offer comparable efficacy to copper IUDs for EC. In this secondary analysis of an RCT comparing copper and LNG IUDs for EC, researchers sought to calculate standard EC effectiveness assessment for both types of IUDs by assessing the percentage of expected pregnancies that are prevented based on the day of the menstrual cycle unprotected intercourse (UPI) occurred. The analysis included both the most recent UPI and any UPI within five days prior to IUD placement. LNG IUDs prevented 93.2% to 95.7% of expected pregnancies, and copper IUDs prevented 100% of expected pregnancies. This research further supports the benefit of LNG and copper IUDs as EC options, especially in comparison to oral options, and may help providers counsel patients who are seeking highly effective EC.
2. Pain Management for In-Office Uterine and Cervical Procedures: ACOG Clinical Consensus
Outpatient gynecological (GYN) procedures are often performed in clinic settings and can cause varying levels of patient pain. This ACOG clinical consensus emphasizes that pain is influenced by both physical and psychological factors, as well as individual patient risk factors and the broader historical background of racism and misogyny in medicine. While the authors note that evidence is limited for many commonly used pain management strategies, and no single approach is effective across all procedures, they recommend that providers always discuss and offer pain management options. The clinical consensus includes procedure-specific evidence for common GYN procedures including IUD placement, endometrial biopsy, hysteroscopy, ablation, intrauterine imaging, uterine aspiration, and cervical biopsy and excisional procedures. It also highlights populations at greater risk for pain, including adolescents, individuals with disabilities, patients with chronic pain, and those with histories of abuse or trauma—underscoring the importance of personalized care planning for pain management.
3. Progestin-only contraception and thrombosis: an updated systematic review &
4. Thrombosis risk with the use of hormonal contraception among women with thrombophilia: An updated systematic review
While hormonal contraception is safe for most reproductive-aged patients, thrombosis risk with hormonal contraception may be elevated among individuals with underlying thrombophilias or other risk factors.Two updated systematic reviews by Tepper et al examine the potential of thrombosis with progestin-only and combined hormonal contraception for higher-risk patients.
The first review, focusing on estrogen containing contraception, analyzed 18 studies on combined hormonal contraception (CHC) in patients with known genetic conditions increasing their clot risk (e.g., Factor V Leiden, prothrombin gene mutation, protein C/S or antithrombin deficiency). Though evidence quality was low, the authors reported that CHC use appeared to increase the risk of both venous thromboembolism and arterial thromboembolism among all groups, with the possible exception of Protein S deficiency.
The second updated review, focusing on progestin-only methods, evaluated 31 studies (seven new since the prior review). Most progestin-only methods—including pills, implants, and IUDs—were not associated with increased thrombotic risk, even in patients with elevated baseline risk of thrombosis. Depot medroxyprogesterone acetate (DMPA) was, however, associated with elevated venous thromboembolism (VTE) risk. While the authors reiterate that more high-quality research is needed, these reviews suggest that patients with preexisting thrombogenic conditions may be at higher risk of thrombosis with both estrogen-containing contraception as well as DMPA.
5. Comparative performance of ultra-thin and standard latex condoms: a randomized multi-centre trial
Condoms are used worldwide as a dual protection contraceptive option that provides both pregnancy and sexually transmitted (STI) protection. However, a common concern is that the barrier itself (typically made out of latex) decreases sensitivity and reduces sexual enjoyment. Recently researchers have developed thinner latex condoms (42µm, as compared to more established latex condoms at 55µm and 70µm), typically called ultrathin condoms. These newer condoms, however, have less available evidence to support their safety and effectiveness.
This multi-site RCT evaluated a 42µm ultra-thin latex condom against standard 55µm and 70µm condoms for breakage and slippage. Among 225 cisgender couples using the condoms during vaginal intercourse (over 1100 uses per arm), the ultra-thin condom demonstrated non-inferiority with no increased failure rates. Overall, these findings suggest that condom thinness does not result in an increased failure rate.
6. Prevalence of crisis pregnancy center attendance among women in four U.S. states
Crisis pregnancy centers (CPCs), which often mimic medical clinics while promoting anti-abortion and anti-contraception agendas, are widespread with more than 2500 CPCs in the U.S. CPCs are not usually licensed, but may offer services that give the appearance of medical care including limited ultrasonography. These centers are a source of medical misinformation as well as delays for patients trying to find actual abortion care.
This cross-sectional study examined CPC attendance among reproductive-aged women in four states. Attendance rates ranged from 11.6% (New Jersey) to 20.2% (Arizona), with little demographic variation.The authors discuss that CPC attendance is not a rare phenomenon across geographically distinct areas. These findings highlight the pervasiveness of CPCs and the potential for misinformation, particularly in areas with limited access to comprehensive reproductive health care.
7. The use of telemedicine services for medical abortion
Remote and telemedicine services have taken on increasingly important roles in abortion care–both as a person-centered approach as well as a response to abortion restrictions. Medication abortion is specifically well-suited to telemedicine care, and a growing body of evidence supports the safety and acceptability of telemedicine services. This systematic literature review assessed the safety, efficacy, and acceptability of comprehensive telemedicine services for medication abortion compared to in-person care. Across 22 studies (over 130,000 patients, up to 12 weeks’ gestation duration), outcomes for telemedicine were comparable to in-person provision. Overall, they found that telemedicine services was not associated with higher rates of failed medication abortion or other adverse events, and may actually increase adherence to follow up plans. This review adds further support to existing knowledge around the safety and utility of telehealth and medication abortion care.
8. Effectiveness and safety of medication abortion with vs. without screening ultrasonography or pelvic exam
Due to both the COVID-19 pandemic and the United States political landscape, abortion providers have increasingly focused on “no-test” abortion provision, which allows patients to obtain medication abortions without an in-person visit. In this retrospective cohort study of over 2,000 patients receiving medication abortion under 11 weeks gestation, outcomes were compared between those who had pre-abortion pelvic exams or ultrasounds and those who did not. Safety and efficacy were similar across both groups, with a 1% rate of major complications. No-test patients had slightly higher odds of receiving additional misoprostol, but it was not clear if this was a result of concern for retained products of conception, or if the medication was recommended as a conservative measure because the patient would not have in-person follow up. These results suggest that no-test medication abortion can be safely offered based on patient history, gestational age calculations, and ectopic pregnancy risk factors.
9. Contraception for Adolescents: Policy Statement &
10. Contraceptive Counseling and Methods for Adolescents: Clinical Report
The American Academy of Pediatrics (AAP) published these paired documents to summarize existing evidence and support the provision of contraception to adolescent patients. The first document updates a previous APP policy from 2014, and reviews foundational principles around contraception counseling for adolescents, including the use of a reproductive justice framework. Key points include an emphasis on person-centered counseling and shared-decision making, along with a review of long-acting reversible contraception methods. Noting the barriers to contraception access for many adolescents, the policy statement encourages pediatricians to offer same-day provision of contraception and also discusses the evidence supporting no-touch and remote care for adolescents. This policy statement provides the foundation for the next document, the Clinical Report, which features in-depth clinical information.
The Clinical Report offers specific, evidence-based suggestions for conversations about reproductive health and contraceptive goals. Recognizing that it can be difficult to discuss sexual health with the adolescent population, the document lists specific conversation prompts and counseling techniques. It also features high-yield, in-depth descriptions of available contraceptive methods, including side effects, efficacy and appropriate initiation, as well as the use of hormonal contraception for menstrual regulation.
In combination, these two documents provide both a theoretical framework and an evidence-based reference for the provision of contraception to adolescent patients. Although they were created with pediatric providers in mind, they include information that is digestible and relevant for anyone who cares for adolescent patients.
