1. SFP Cancer and Contraception Position Statements (3 publications)
Over the past decade, cancer diagnoses among people assigned female at birth aged 15–39 have increased, and advances in treatment have led to higher survival rates. As a result, there are more cancer survivors of reproductive age than ever before. To support health care professionals, the Society of Family Planning (SFP) and the Society of Gynecologic Oncology (SGO) released a three-part series on contraceptive considerations for patients with a history of cancer.
Part one, “Key considerations for clinical care,” addresses general issues for cancer survivors, including risks such as anemia and venous thromboembolism, as well as the potential for pregnancy after cancer treatment. It affirms that emergency contraception is safe for all patients.
Part two, “Breast, ovarian, uterine and cervical cancer,” offers detailed recommendations by cancer type, including gestational trophoblastic disease. It incorporates evidence and expert opinion on topics such as hormone receptor status and ongoing treatments like estrogen-blocking therapy (i.e., tamoxifen) to guide contraceptive counseling. This document also confirms that for patients without personal history, but at higher risk for hereditary or familial breast and ovarian cancers, providers may offer all contraceptive options using a shared-decision making approach.
Part three, “Skin, blood, gastrointestinal, liver, lung, central nervous system, and other cancers,” focuses on recommendations for cancers that may be less familiar to reproductive health care providers. While most patients can safely use all contraceptive methods, this section covers nuanced topics such as hormone-sensitive meningiomas and options for patients with impaired liver function after cancer. Because active cancer increases risk of venous thromboembolism, providers should keep this in mind when prescribing methods that increase this risk.
Together, these documents offer a comprehensive, practical resource for clinicians discussing contraception with cancer survivors. Providers can use them to inform counseling and guide evidence-based care.
2. The use of a menstrual cup as a risk factor for displacement of intrauterine devices: a case-control study
Intrauterine device (IUD) expulsion is a known risk—particularly in patients with uterine anomalies, prior expulsion or copper IUDs, among others. Emerging evidence suggests menstrual cup use may also increase the risk of IUD displacement. The authors of this paper performed a case-control study to evaluate the association between IUD displacement and menstrual cup use. Evaluating almost 800 patients with IUDs, they collected detailed histories, including menstrual cup use, and performed transvaginal ultrasounds to assess IUD position. IUD displacement was identified in 6.8% of participants, and those with displacement were significantly more likely to report menstrual cup use. This association remained significant after controlling for other risk factors, suggesting that menstrual cup use may be an independent risk factor for IUD displacement. The authors highlight the clinical relevance of this especially with copper IUDs, as correct fundal placement is needed for maximum contraceptive efficacy. Despite the recall bias inherent in case-control research, the findings support ongoing study and discussing menstrual cup use when counseling IUD patients.
3. Beyond pain medication: striving toward more patient-centered placement of intrauterine devices
While IUDs are a safe and highly effective form of reversible contraception, some patients experience significant pain during placement, which can affect satisfaction with care as well as reluctance to choose an IUD in the first place. While pharmaceutical interventions are gaining attention, non-medication aspects of the clinical encounter also play a key role. In this mixed methods study, the authors surveyed patients undergoing IUD placement about their providers’ behaviors, pain, and satisfaction.
Patients identified several supportive behaviors as important to their experience, including explaining the procedure steps in advance, discussing pain expectations, and being attentive to comfort during the procedure. Although higher pain scores were associated with lower satisfaction, provider behaviors continued to impact satisfaction even after adjusting for pain levels. The authors encourage providers to not only address pain, but to also engage in other supportive behaviors during the visit to improve patients’ experiences and satisfaction with care.
4. Effect of contraceptive methods on the vaginal microbiome and host immune factors
The vaginal microbiome, containing billions of diverse microbes, can help protect against sexually transmitted infections and other unwelcome pathogens by maintaining a population of beneficial microbes. The interaction between hormonal contraceptives and the vaginal microbiome is an area of active research. Limited data suggests that combined hormonal contraceptives may promote the growth of protective microbes like Lactobacillus, while the impact of other methods—such as IUDs—has been more variable. To better understand this relationship, the authors of this study analyzed the vaginal microbiome of more than 150 participants using a copper IUD, a levonorgestrel (LNG) IUD, or depot medroxyprogesterone acetate (DMPA). Samples were collected at enrollment, one month, and three months. Results showed that the copper IUD fostered growth of less favorable microbes, potentially leading to inflammation, while the LNG IUD had a more protective effect. DMPA showed no significant impact. These results suggest that different contraceptive methods may have varying effects on vaginal health. More study is needed in order to counsel patients about this issue.
5. Knowledge gaps and information needs and preferences regarding oral contraceptive pills and over-the-counter access: A focus group study with Black and Latinx young people assigned female at birth
The norgestrel-only pill (brand name Opill) is currently the only over-the-counter (OTC) oral birth control pill (OCP) available in the United States. Eliminating the prescription requirement for an OCP may reduce access barriers (time, money, or insurance coverage to seek a prescription from a provider), especially among young people of color. In this qualitative study, researchers held nine focus groups with pregnancy-capable Black and Latinx individuals aged 15-24 to explore knowledge gaps and information needs regarding the OTC OCP. Participants demonstrated many knowledge gaps and misunderstandings about OCPs, including the conflation of OCPs and emergency contraception and the beliefs that OCPs could cause sterility or death. Most were unaware that an OTC OCP existed or that minors could purchase it. Despite these gaps, participants reported wanting to learn about OCPs from health care providers, especially around effectiveness and side effects. These data highlight the importance of raising awareness of this contraceptive option to ensure OTC OCPs improve contraceptive access. They also emphasize the role of providers to address misconceptions and discuss the safety and efficacy OTC OCPs.
6. Change in hCG levels after very early medication abortion for pregnancy of unknown location or probable intrauterine pregnancy
Medication abortion is a safe, effective option through 11-12 weeks of gestation and now accounts for the majority of abortions in the United States. While previous research has shown the effectiveness of medication abortion even before a pregnancy is visualized on ultrasound, monitoring very early pregnancies to ensure safe resolution remains a clinical challenge. In this international prospective cohort trial, researchers followed more than 500 patients seeking medication abortion with a gestational duration ≤42 days without confirmed intrauterine pregnancy on ultrasound. Serum hCG levels were drawn at the time of mifepristone administration and again seven (±2) days later to evaluate HCG trends.
The study found a 91% success rate, with 2.9% ongoing pregnancies, 4.8% incomplete abortions, and 1.3% with ectopic pregnancies. A ≥80% decline in serum hCG by day 7 was strongly associated with successful abortion—none of the patients with ongoing or ectopic pregnancies met this threshold. While HCG changes could not reliably distinguish between an ectopic pregnancy, ongoing pregnancy, and incomplete abortion, a ≥80% HCG drop can reliably identify a successful medication abortion for a very early intrauterine pregnancy. Further surveillance is not indicated for these patients. These findings, along with SFP’s Clinical Guidelines, offer practical tools for early pregnancy follow-up. Providers can use this hCG benchmark to reduce unnecessary surveillance in appropriate patients, improving efficiency while maintaining safety in medication abortion care.
7. Hormonal Contraception after Use of Ulipristal Acetate as Emergency Contraception: A Systematic Review
Ulipristal acetate provides a safe and effective form of emergency contraception (EC), reducing the risk of pregnancy when used within 5 days of unprotected/underprotected intercourse. A selective progesterone receptor modulator, ulipristal delays ovulation to prevent fertilization. However, initiating hormonal contraception soon after ulipristal use has raised concern about potential interference with the efficacy of either or both medications. In this systematic review, the authors analyzed four studies examining the interactions between oral hormonal contraception and ulipristal.
The authors concluded that ulipristal did not appear to impact hormonal birth control’s ability to inhibit ovulation. Several studies, however, indicated that oral hormonal birth control could potentially decrease the effectiveness of ulipristal in delaying ovulation. Person-centered counseling on this topic should balance delaying initiating/resuming oral hormonal contraception to avoid decreasing the effectiveness of ulipristal EC with the risk of future pregnancy by delaying the initiation of hormonal contraception.
