Estimated reading time: 8 minutes
1. COCs vs. POPs for heavy menstrual bleeding: a systematic review
Heavy menstrual bleeding (HMB), defined as excessive or heavy menses that interferes daily life, is a common problem that affects millions of reproductive-aged individuals worldwide. Hormonal medications, either combined estrogen-progestins or progestin-only methods, are the primary treatment approach for HMB, but direct comparative data have been limited. In this systematic review, the authors reviewed 10 studies published between 2000 and 2025 that compared combined oral contraceptive pills (COCs) and progestin only pills (POPs) for HMB management. The synthesized evidence affirmed that both are effective for the treatment of HMB. However, COCs were associated with more side effects, including nausea, headaches and weight gain. POPs, specifically drosperinone, demonstrated an improved side effect profile alongside high effectiveness. These findings offer useful information for counseling patients on their options and underscores the need for additional comparative research on this topic.
2. Five-year efficacy and safety data for the Miudella copper IUD
The copper T380A intrauterine device (Paragard IUD) has been the only option for hormone-free long-acting reversible contraception (LARC) in the United States since its approval in 1984. In February 2025, the Food and Drug Administration (FDA) approved a new copper IUD, Miudella, which contains significantly less copper than Paragard and is smaller and more flexible. Initially approved for 3 years based on the manufacturer’s Phase 3 trial data, updated data now supports Miudella’s safety and efficacy for up to 5 years. Importantly, participants reported decreasing rates of bleeding and pain over time. This evidence is reassuring for both patients and providers. The availability of a second copper IUD option expands access to non-hormonal LARCs for the first time in over 40 years, further supporting autonomy and reproductive freedom.
3. VTE risk may be lower with “body-identical” estrogen COCs
Combined oral contraceptives (COCs) are an effective method of contraception and are also used to treat menstrual disorders, acne, endometriosis, and other conditions. While the benefits largely outweigh risks, COCs carry a small but clinically significant risk of venous thromboembolism (VTE) particularly for specific patient populations. Most COCs contain ethinyl estradiol (EE), a synthetic form of estrogen, but some newer formulations use “body-identical” estrogens, such as estetrol or 17β-estradiol valerate, designed to more closely mimic endogenous estrogen. Initial European data suggests that COCs using these compounds may have a different safety profile than EE-containing pills. To explore this theory, the authors of this study reviewed adverse event reports that had been submitted to the Food and Drug Administration (FDA) through October 2024. They found that COCs containing body-identical estrogens showed a substantially lower proportion of VTE reports than COCs containing EE, with rates more comparable to progestin-only pills. While this data is based on more recently released formulations, it is consistent with international data that suggests a similar improvement in safety with body-identical estrogens. These results should prompt further research, as the implications for COC users worldwide could be significant.
4. OTC Opill users demonstrate appropriate self-screening for contraindications
Norgestrel (Opill) is the only over-the-counter (OTC) contraceptive pill available in the United States. As a progestin-only pill (POP), it has few contraindications, and users are expected to self-screen at time of purchase. In this survey study comparing OTC POP users to individuals with a prescription for combined oral contraceptive pills (COCs), the authors found that OTC POP users had very few contraindications to progestin-only use. However, they do have significantly more contraindications to COCs than individuals with a prescription. COC contraindications were based on those considered by the Centers for Disease Control and Prevention (CDC), including migraines, tobacco use, and history of blood clot. These results suggest that OTC POP users are accurately reading and applying label guidance. The findings add to the growing body of evidence supporting the safety of over the counter contraception access.
5. Mood-related symptoms linked to early discontinuation of progestin-only methods
Mood-related side effects are among the most commonly reported concerns among hormonal contraceptive users, yet the evidence linking specific methods to mood changes remains mixed. Mood symptoms can have an enormous effect on user well-being and lead to method discontinuation. In this secondary analysis of the HER Salt Lake Initiative, which explored person-centered contraceptive counseling and patient preferences, more than 4,000 participants completed surveys on mood-related symptoms and contraception use and discontinuation. The investigators found that users of progestin-only methods, such as the implant, levonorgestrel intrauterine device, or progestin-only pills, were more likely to report mood symptoms as a reason for contraceptive method discontinuation within the first 6 months of use. Notably, individuals with pre-existing mood symptoms did not report worsening from contraception use. While observational in nature, these findings provide important context for anticipatory counseling about mood and contraceptive method choice, and highlight a priority area for future research.
6. Caring for incarcerated patients who request permanent contraception: provider perspectives
Permanent female contraception is a common choice for postpartum patients, requested after 8% of US births. But for patients who are incarcerated during pregnancy, requests for postpartum permanent contraception occur in the context of a coercive carceral system and limits on individual agency, raising complex ethical questions. Many institutions and professional organizations discourage or even prohibit such procedures during incarceration. At the same time, denying these procedures to incarcerated patients who genuinely desire them may further undermine individual autonomy and principles of reproductive justice. In this semi-structured interview study, the authors interviewed eight ObGyns who provided care to incarcerated pregnant patients to understand their experiences managing requests for permanent contraception. Interviewees discussed themes of physician support for patient autonomy, physicians’ desire for certainty, and the compounding challenges that incarceration creates around informed consent and postpartum care. The authors call for the development of clearer ethical guidance to support providers caring for patients navigating these complexities.
7. Residency applications to abortion-restrictive states declined after Dobbs
The 2022 Dobbs decision raised immediate concerns not only about patient access to full-scope reproductive care, but also about the long-term impact on the healthcare workforce in states with abortion restrictions. In this cross sectional study of medical residency applications in all specialties from 2019 to 2023, the authors found that residency applications in all specialties to programs in abortion-restrictive states decreased for both women and men after the Dobbs decision. Declines were more pronounced in abortion-related specialties such as ObGyn, Family Medicine, Internal Medicine, and Emergency Medicine. These findings represent early evidence of a widening healthcare training gap in restrictive states, with potential downstream effects on the availability of reproductive and primary care.
8. HPV self-sampling devices: high accuracy and global applicability
HPV self-sampling has emerged as a promising alternative to clinician-collected cervical cancer screening, particularly for patients who face barriers to pelvic exams or in-clinic visits. In this narrative review, the authors discuss 24 of the most widely studied self-sampling devices for cervical cancer screening worldwide. Overall, these devices demonstrated high accuracy and patient acceptability compared to clinician-collected testing. The authors discuss that some devices are already FDA-approved in the US and that others do not require FDA approval. This review reinforces the potential of self-sampling to expand cervical cancer screening to populations that are poorly served by traditional models of care—and provides a useful reference as adoption of these tools continues to grow.
9. Hospital-based abortion services: information and access barriers remain
While freestanding clinics have historically provided the majority of abortions in the United States, hospital-based services play an important role for medically complex patients. More hospitals started directly advertising abortion care in patient-facing resources and directories in the wake of the Dobbs decision. Yet little has been known about the patient-facing experience of accessing these hospital-based services. In this mystery-caller survey of 48 hospitals advertising abortion care, the authors systematically assess information barriers to abortion access, including number of calls needed, transfers, hold times, appointment availability, and costs. The authors found that 10 hospitals required callers to leave a message to await a return call. Of the 44 hospitals where contact was eventually made, the majority (75%) had at least one information barrier, including requiring multiple calls/transfers or hold times longer than 2 minutes. Only about half were able to offer an appointment within a week, compared to 72% of non-hospital facilities. Self-pay costs for hospital-based abortion were highly variable and higher than non-hospital facilities. These findings indicate the need for improved abortion scheduling workflows, and clearer patient-facing guidance about the potential differences between hospital-based and non-hospital-based abortion facilities.
10. Community-led contraceptive access in rural Appalachian Kentucky
Eastern Kentucky represents one of the most significant reproductive healthcare deserts in the United States, where geographic isolation, provider shortages, limited transportation, and stigma around reproductive health services compound one another. Nearly 60% of women in central Appalachia live in counties without a single healthcare provider offering the full range of contraception options. Since 2016, a program called All Access Eastern Kentucky has sought to address these barriers through community-based programs, including discreet direct no-cost mailing services. This paper describes the program’s development, data collection, outreach design, clinical training, and expansion goals. For organizations and providers working to expand contraceptive access in similarly underserved regions, this program offers a concrete, replicable model.
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