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1. Stroke risk, combined hormonal contraception and triptan use
Due to concerns about stroke risk, patients with migraines with aura are advised against using combined hormonal contraceptives (CHCs) due to independent cardiovascular risk. However, CHC use may continue among patients with other headache types, including migraine without aura. Triptans, commonly used for migraine treatment, are vasoconstrictive agents contraindicated in patients with pre-existing cardiovascular risk factors. Therefore, there could be an increased risk of stroke in patients on combined hormonal contraception who also take triptans for migraine treatment. Using the Danish health registry, this cohort study evaluated stroke risk among nearly one million CHC users between 2004 and 2021 and found that CHC and triptan users had an increased risk of ischemic stroke when compared to individuals on CHC who were not taking triptans. However, the absolute stroke risk remained low. These results suggest that providers should consider the combination of CHC and triptans when making decisions about contraception and headache treatment with patients.
2. IUD self-removal: patient perspectives and simulation practice
- Assessing Motivating Factors for IUD Self-Removal Through Focus Groups and Simulation in Contraception
IUD removal is typically performed by a provider, but patients may face significant barriers to timely removal, including insurance gaps, appointment availability, and provider refusal. While self-removal of an IUD is feasible, safe, and patient-centered, studies assessing feasibility have previously found that only a minority of patients could actually accomplish removal. In this semi-structured focus group study of 25 IUD ever-users, participants viewed self-removal positively, describing it as a means of managing side effects, maintaining bodily autonomy, and avoiding negative healthcare encounters. Participation in a self-removal simulation significantly reduced fear and increased perceived control. The authors encourage providers to support IUD self-removal as an option for their patients, including anticipatory counseling and providing guidance and simulation practice.
3. Accuracy of LMP-based gestational age dating in adolescents
- Accuracy of Menstrual History for Determining Gestational Age Among Adolescents Who Underwent Abortion in England and Wales in Obstetrics & Gynecology
No-test abortion protocols, in which patients receive abortion care without in-person evaluation or ultrasound, have been validated as safe and effective. However, these protocols are subject to numerous restrictions, including gestational age limits and patient age restrictions. In the United Kingdom, patients ages 13–15 are required to undergo in-person clinical evaluation. In this retrospective analysis, the authors compared LMP-based gestational age dating to ultrasound dating among pregnant patients under age 16. The vast majority of patients, including those as young as 12, accurately dated their pregnancies using LMP; accuracy increased further when excluding patients with irregular periods or uncertainty about their LMP. These findings suggest that no-test abortion protocols should not be restricted based on patient age, and that adolescents face unnecessary barriers when age-based requirements are applied without supporting evidence.
4. Intravaginal vitamin C for bacterial vaginosis treatment and prevention
- Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Review and Meta-analysis in Obstetrics & Gynecology
Bacterial vaginosis (BV) is a common vaginal infection characterized by overgrowth of anaerobic bacteria, causing irritation, abnormal discharge, and an increased risk of STI acquisition, pregnancy complications, and surgical site infections. Although existing BV treatments are effective at first, the rate of recurrence is over 50%, and repeated infections can cause both physical and emotional distress. Because BV reduces vaginal acidity, acidifying agents such as intravaginal vitamin C have been proposed as potential adjunctive therapies. In this systematic review and meta-analysis of nine trials including more than 1,000 patients, intravaginal vitamin C demonstrated promising effects on BV cure rates and recurrence reduction. However, the authors raise concerns about study quality and call for additional research to validate these findings before routine clinical application.
5. Sex life concerns as a driver of contraceptive discontinuation
- The sex effect: the prevalence of sex life reasons for contraceptive discontinuation. A systematic review and meta-analysis in Sexual and Reproductive Health Matters
Reproductive autonomy includes the right to discontinue a chosen contraceptive method when desired. Sexual health effects of contraception are underacknowledged as a reason for method discontinuation, and little standardized research has examined this relationship. To better understand existing research on sexual health and contraception, the authors conducted this systematic review and meta-analysis of 64 studies published between 2004 and 2023, including more than 120,000 individuals ages 15–49. They found that “sex life concerns” accounted for approximately 5% of contraceptive discontinuations. Notably, this association did not appear to be specific to hormonal contraception or any particular method. The authors highlight significant measurement limitations, lack of standardization across studies and limited provider acknowledgment of sexual health as a discontinuation factor, and call for more research. More research is necessary in order to understand the fundamental role that sexual function plays in contraceptive discontinuation.
6. Ally chatbot captures regional variation in self-managed abortion information needs
- Ally, the pioneering abortion chatbot: Capturing regional variations in self-managed abortion needs in Contraception
Self-managed abortion (SMA) allows patients to terminate a pregnancy using medication partially or entirely outside a clinical setting. While SMA may help reduce some barriers to safe abortion care, navigating online information about SMA can be challenging due to misinformation and privacy concerns. Ally, a multilingual chatbot developed by HowToUseAbortionPill.org, was designed to integrate directly into social media and partner websites to reduce access barriers. In this analysis of more than 95,000 Ally conversations across 172 countries since 2022, the authors identified meaningful regional variation in how users engaged with the tool. Users in Latin America and Africa engaged in longer, more detailed interactions, often seeking specific medical abortion instructions, while users in North America and Asia tended toward narrower queries focused on pill access. While the authors stress that further research is necessary to understand how SMA users seek out and use information they find online, they conclude that a comprehensive, easy-to-use chatbot can respond usefully to a wide variety of user needs across different demographics.
7. Letrozole plus misoprostol as an alternative to mifepristone-based medication abortion
- Comparative effectiveness of misoprostol plus letrozole versus misoprostol alone for pharmacological abortion: a systematic review and meta-analysis of randomized controlled trials in The European Journal of Contraception & Reproductive Health Care
Medication abortion is a safe and effective form of abortion care, and typically uses either a combination of mifepristone and misoprostol or repeated doses of misoprostol alone. While the combination regimen is typically more effective, particularly for pregnancies later in the first trimester, mifepristone access may be limited in many regions. In settings where mifepristone access is limited, identifying effective alternatives is a clinical and public health priority. Previous studies have indicated that letrazole, an aromatase inhibitor, may increase the success and safety of medication abortion when combined with misoprostol. This systematic review and meta-analysis of 12 RCTs including more than 1,500 patients found that letrozole pretreatment before misoprostol significantly increased complete abortion rates, reduced time to abortion, and minimized hemoglobin decline compared to misoprostol alone, with comparable side effects. This data suggests that letrozole could be a viable alternative to maintain access to safe medication abortion, especially when mifepristone access is limited.
8. OB-GYN job satisfaction in the post-Dobbs landscape
- OB-GYN Job Satisfaction in a Changing Landscape of Legal Restrictions on Their Practice in Contraception
Since the 2022 Dobbs decision allowing restrictions on abortion care, research has shown that ObGyns faced with restrictive legislations are more likely to experience moral injury, burnout, and emotional exhaustion, all of which can impact job satisfaction. In this semi-structured interview study of 24 ObGyns across restrictive and non-restrictive states, providers in restrictive states described concrete clinical harms: difficulties providing full-scope reproductive care, unsafe clinical situations resulting from restrictions on evidence-based care, and difficulty meeting patient expectations. Importantly, ObGyns in all states, regardless of practice setting, expressed frustration about political interference in medicine, fear of legal consequences, and resentment about the chronic undervaluing and underfunding of reproductive health. The authors highlight that the current legal and political climate has exacerbated ObGyn workforce burnout and frustrations, and suggest that both legal clarification of the limits of abortion restrictions as well as changes in reimbursement structures are important to maintain job satisfaction in this specialty that is already facing significant shortages.