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While multiple reversible contraceptives are available, long-acting reversible contraception (LARC) offers multi-year protection with minimal user burden. The etonogestrel implant is the most effective LARC but carries higher upfront acquisition costs. This analysis evaluated whether the acquisition costs for the etonogestrel implant are offset via pregnancy prevention and pregnancy-related expenditures. A discrete Markov chain model with 5-year time horizon simulated pregnancy outcomes among 1,000 women 18-49 years initiating 1 of 8 hormonal contraceptive methods: branded or generic oral contraception (OC; progestin only and combined), medroxyprogesterone acetate injection, etonogestrel/ethinyl estradiol vaginal ring, norelgestromin/ethinyl estradiol transdermal patch, 3- or ≥5-year levonorgestrel IUD, and the etonogestrel implant. The model specified 28-day cycles. Contraceptive acquisition costs, typical-use failure rates, discontinuation rates, pregnancy outcomes and costs, and healthcare resource use were examined from a United States managed care perspective. Sensitivity analyses were also conducted. The etonogestrel implant followed by IUDs were associated with the fewest pregnancies (60 [etonogestrel implant], 105 [3-year IUD], and 104 [≥5-year IUD], respectively) and the lowest per-woman costs ($3,428 [etonogestrel implant], $5,275 [3-year IUD], and $4,728 [≥5-year IUD], respectively). Cost offsets occurred in Year 1 and increased incrementally through Year 5. In comparison, branded and generic OC resulted in 299 and 323 pregnancies, respectively, and $8,477 and $8,678 per-woman costs; the vaginal ring, injection, and patch resulted in 328, 265, and 327 pregnancies, respectively, with per-woman costs ranging from $8,781 to $13,963. Discontinuation rates, not acquisition costs, were the primary driver impacting overall costs. The etonogestrel implant was the most cost-effective contraceptive option when modeled over a 5-year period, offering the fewest pregnancies and lowest associated healthcare costs. Policies and practices that support initiation and continuation of the etonogestrel implant can enhance both clinical outcomes and overall cost-effectiveness. Researchers used a health economic model to estimate the pregnancy outcomes and healthcare costs incurred by 1,000 women over a 5-year period while using one of eight common hormonal birth control methods, including pills (progestin-only, combined hormonal), the injection, patch, vaginal ring, IUDs, and the etonogestrel implant. The model considered typical use, real-world discontinuation rates, and costs of contraception and childbirth/termination. Results found that the etonogestrel implant led to the fewest pregnancies and the lowest overall costs per woman compared with other methods. Its cost savings began within the first year and continued to grow over time. In contrast, methods like pills, the patch, and the vaginal ring resulted in more pregnancies and higher overall healthcare costs. Supporting women in their choice of birth control could help prevent unintended pregnancies and reduce overall costs to the healthcare system.

Young women with albinism in Rwanda face a triple burden of intersecting stigma related to gender, disability, and albinism-specific myths, yet their sexual and reproductive health (SRH) needs remain largely invisible in research, policy, and practice. Despite Rwanda´s progress toward universal health coverage and disability inclusion, no published studies specifically examine SRH access, outcomes, or barriers among this population. Drawing on intersectionality theory and evidence from separate bodies of literature on gender, disability, and albinism in East Africa, this perspective article argues that overlapping discrimination likely creates unique and compounded obstacles to contraception, antenatal care, sexually transmitted infection (STI) services, and freedom from sexual violence. Cultural beliefs portraying albinism as a curse or conferring supernatural properties perpetuate social exclusion, internalized shame, and heightened vulnerability to gender-based violence. Visual impairment associated with albinism compounds accessibility challenges, while the absence of low-vision materials, genetic counselling, sun-protection guidance, and provider training on albinism further limits equitable care. National SRH and disability frameworks mention persons with disabilities broadly but lack tailored provisions for albinism. To achieve true health equity, Rwanda must make young women with albinism visible through disaggregated data collection, explicit integration into SRH policies, accessible materials and facilities, mandatory provider training, and community-led myth-busting initiatives. Primary research co-designed with women with albinism is urgently needed to document their lived experiences and evaluate interventions. Addressing these intersecting barriers will strengthen inclusive SRH services for all marginalized groups.

High-quality contraceptive counseling has been associated with increased contraceptive method satisfaction. We aimed to assess this relationship in the postpartum period and to investigate practical aspects of counseling underlying this association. We used data from 219 pregnant individuals aged 21-44 years contemplating tubal sterilization who were recruited to a randomized trial assessing the efficacy of the MyDecision/MiDecisión decision aid. Three months postpartum, participants rated their satisfaction with their chosen contraceptive method and their perception of contraceptive counseling encounter quality on Likert scales. Counseling quality domains included provider demonstration of respect, explanation of methods, pressure toward a method, and response to questions, as well as subjective counseling satisfaction. We used logistic regression analyses to assess the relationship between optimal counseling (both overall and in each domain) and optimal contraceptive method satisfaction, adjusting for randomization arm and demographic covariates significant in bivariate analysis. Participants had a mean (SD) age of 30 (5) years; 42% identified as non-Hispanic White, 25% as non-Hispanic Black, and 26% as Hispanic. Approximately one-third of participants (37%) had a tubal sterilization by study follow-up; 11% reported using no method of contraception. Many participants reported optimal contraceptive counseling (61%) and optimal method satisfaction (65%). Optimal counseling was associated with higher odds of optimal method satisfaction (aOR 1.88, 95% CI 1.03-3.46, p = 0.04). This relationship was sustained across all individual counseling quality domains. Patient-perceived provider demonstration of respect, discussion of contraceptive pros and cons, avoidance of pressure, and answering questions were associated with postpartum contraceptive method satisfaction.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder manifested by hyperandrogenism, ovulatory dysfunction, and systemic metabolic dysregulation. While the 'gut-diet' axis offers potential therapeutic avenues, the synergistic molecular mechanisms integrating dietary flavonoids and gut microbiota remain elusive. This study employed a comprehensive network pharmacology approach, coupled with molecular docking validation, to decode the tripartite interaction network of 'Dietary Flavonoids-Gut Microbiota-Host Targets.' Our analysis identified Luteolin and Quercetin as critical bioactive mediators that interact with specific gut microbial taxa. Topological network analysis revealed that these compounds exert the effects by targeting pivotal nodes-AKT Serine/Threonine Kinase 1 (AKT1), Epidermal Growth Factor Receptor (EGFR), and Insulin Receptor (INSR). Functional enrichment analysis further demonstrated that these targets converge on the Mitogen-Activated Protein Kinase (MAPK) signalling pathway. Conclusively, this study establishes a systematic theoretical framework for the integrated management of PCOS. Future research should prioritize experimental validation and clinical translation of the findings to develop personalized precision medicines targeting the gut-metabolic axis.

Elevated serum uric acid (SUA) has been linked to adverse outcomes in polycystic ovary syndrome, yet its broader role in female fertility is unclear. This retrospective cohort study of 16,223 women undergoing a first in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycle investigated associations between pre-treatment SUA and reproductive parameters. Higher SUA levels were independently associated with elevated luteinizing hormone (LH), testosterone, and anti-Müllerian hormone (AMH), and with lower estradiol and follicle-stimulating hormone. Each 50 µmol/L SUA increase correlated with a 16-gram reduction in neonatal birth weight and a 0.06-week decrease in gestational age, with a threshold effect near 350 µmol/L. Bidirectional Mendelian randomisation analyses supported a causal effect of elevated SUA on increased LH and testosterone, while reverse analysis suggested lower AMH may elevate SUA. These findings identify SUA as a biomarker influencing ovarian reserve and neonatal outcomes through bidirectional mechanisms, including a potential SUA-AMH feedback loop. Routine SUA monitoring in fertility treatment is supported, and interventions for individuals with SUA ≥350 µmol/L warrant clinical investigation.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by ovulation disorders. Zishen Qingre Lishi Huayu Recipe (ZQLHR), a traditional Chinese medicine (TCM) formula, has shown clinical efficacy by effectively increasing the ovulation rate and menstrual cycle regularity in patients with PCOS and is widely used in practice; however, its underlying pharmacological mechanism has not been fully elucidated. Aim of the study: This study aimed to elucidate how ZQLHR modulates the proliferation-apoptosis balance of ovarian granulosa cells (GCs) in PCOS via the C/EBPβ/STAT3 signaling axis. Human granulosa cells (hGCs) from PCOS and non-PCOS patients were analyzed for proliferation, apoptosis, and C/EBPβ/STAT3 expression. In vivo, letrozole-induced PCOS mice were subjected to scAAV-mediated C/EBPβ knockdown, followed by administration of ZQLHR to evaluate treatment outcomes. In vitro, C/EBPβ or STAT3 was silenced in Human granulosa-like tumor cell line (KGN) cells to explore their regulatory relationship and roles in proliferation and apoptosis. Additionally, ZQLHR effects were evaluated in a dose- and time-dependent manner. Notably, CETSA was employed to confirm for the first time direct binding of ZQLHR to C/EBPβ, and C/EBPβ-silenced cells were subsequently treated with ZQLHR to examine whether its effects involve C/EBPβ-dependent STAT3. The pharmacological mechanism of ZQLHR was further evaluated through histological and molecular biology experiments. PCOS patient-derived GCs exhibited reduced proliferation, elevated apoptosis, and decreased C/EBPβ/STAT3 expression. In LET-induced PCOS mice, ZQLHR treatment significantly improved estrous cycle regularity, hormonal balance, follicular development, and GC apoptosis, accompanied by modulation of the C/EBPβ/STAT3 pathway. C/EBPβ knockdown exacerbated ovarian dysfunction and KGN apoptosis, whereas ZQLHR attenuated these effects and partially restored pathway activity. In vitro, C/EBPβ and STAT3 influenced each other and CFTR expression, associated with changes in proliferation and apoptosis. ZQLHR increased proliferation markers (PCNA, cyclin D1) and decreased apoptosis markers (Caspase-3, PARP) in a dose- and time-dependent manner, with CETSA confirming direct binding to C/EBPβ. Notably, despite C/EBPβ knockdown, ZQLHR partially restored KGN cell proliferation and modestly modulated the C/EBPβ/STAT3 signaling pathway. ZQLHR improves GC homeostasis and promotes follicular development in PCOS by modulating the C/EBPβ/STAT3 pathway.

Female infertility is a major reproductive health concern. Hepatic steatosis index (HSI), a non-invasive marker of liver-related metabolic burden, has not been well studied in relation to infertility across its distribution. We analyzed women aged 20-49 years from three NHANES cycles (2013-2018). HSI was examined as both a continuous variable and in quartiles, and restricted cubic spline models were used to assess potential nonlinearity. Sensitivity analyses using alternative infertility definitions and exploratory interaction analyses were also performed. Among 3,007 women, 416 (13.8%) were classified as having infertility. In the fully adjusted model, women in the highest HSI quartile had higher odds of infertility than those in the lowest quartile (OR 1.66, 95% CI 1.08-2.57; P = 0.031), with a significant trend across quartiles ( P for trend = 0.010). Restricted cubic spline analysis showed a nonlinear association between HSI and infertility ( P for overall association = 0.005), which was more evident at higher HSI levels. Higher HSI was associated with greater odds of infertility among reproductive-aged women.

Polycystic ovary syndrome (PCOS), also known as polyendocrine metabolic ovarian syndrome (PMOS), impairs health-related quality of life (QoL) and daily functioning. While estimates of medical-related costs have been made, this study aimed to estimate indirect (work productivity-related) and intangible (QoL-related) economic costs. In a cross-sectional US registry (PCOS/PMOS = 433, controls = 252), we measured willingness to pay, health utility using the EuroQol five-dimension five-level (EQ-5D-5L) and the Short Form 6-Dimensions (SF-6D) tools, and work productivity with Work Productivity and Activity Impairment: General Health. Adjusted regression estimated utility differences were converted to quality-adjusted life year (QALY) loss. XGBoost classification with Shapley Additive exPlanations feature importance identified key discriminating domains. PCOS/PMOS had lower health utility compared to controls (EQ-5D-5L, 0.72 vs 0.88; SF-6D, 0.67 vs 0.72; P < .001), corresponding to QALY losses of 0.12 and 0.04, respectively. Annual intangible costs per woman were then estimated to be $12 000 (per EQ-5D-5L) or $4000 (per SF-6D). Median work productivity loss for PCOS/PMOS was 39.5% vs 6.0% for controls (using $37/hour and 2080 hours/year). Considering the number of women with PCOS/PMOS in the United States, the total yearly indirect cost was estimated to be $97.9 billion, and yearly intangible cost was estimated to range from $17.8 billion (by SF-6D) to $53.4 billion (by EQ-5D-5L), in 2026 USD. Machine learning identified pain, anxiety/depression, and physical functioning limitations as key discriminators. PCOS/PMOS is associated with lower utility, significant QALY losses, and work productivity impairment. Considering prior estimates of medical-related costs, the total annual US Societal burden ranges from $133 to $169 billion, predominantly from indirect and intangible costs, underscoring the profound functional and economic impact of the disorder.

To evaluate metabolic outcomes in women with and without Polyendocrine Metabolic Ovarian Syndrome (PMOS, formerly Polycystic Ovary Syndrome (PCOS))) receiving multidisciplinary care through a women's health telehealth platform that combines physician and registered dietitian support. Retrospective cohort analysis of 919 women with BMI ≥ 25 initiating care in 2024, with ≥ 6 months follow-up (mean 9.6 months). Participants included 557 with PMOS and 362 without. Outcomes extracted from the electronic health record (EHR) included change in weight, HbA1c, HOMA-IR, fasting insulin, fasting glucose, ALT, AST and total cholesterol between baseline and last measured value. Linear regression models adjusted for baseline values of each outcome, age, BMI, race/ethnicity and follow-up time. Significant improvements were observed across all metabolic markers for the group overall: HOMA-IR (-14.0%), fasting insulin (-15.6%), fasting glucose (-13.0%), HbA1c (-6.2%), ALT (-21.2%), AST (-25.5%), total cholesterol (-8.0%) and weight (-4.9%). PCOS status was not associated with differential improvement in any outcome after adjustment. GLP-1 receptor agonist use was associated with greater weight loss; however, improvements were also observed in the no-medication group. Women with PCOS achieved metabolic improvements equivalent to those without PMOS through a multidisciplinary telehealth model despite presenting with a more adverse metabolic profile at baseline.

Obesity substantially influences clinical and metabolic manifestations of polycystic ovary syndrome (PCOS). However, differences in clinical, metabolic, and hormonal profiles between obese and lean women with PCOS have not been explored in large-scale meta-analyses. Databases were searched from inception through 31 December 2025 for studies reporting clinical, metabolic, and hormonal profiles in obese and lean PCOS phenotypes. Random-effects meta-analyses in R yielded mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals. Forty-two studies (N = 5363; 3078 obese, 2285 lean PCOS) met inclusion criteria. Menstrual irregularity (84.7% vs. 70.9%; RR 1.19), hirsutism (65.9% vs. 58.8%; RR 1.10), acne (44.9% vs. 36.8%; RR 1.25), acanthosis nigricans (52.7% vs. 22.6%; RR 1.94), and biochemical hyperandrogenism (45.6% vs. 31.8%; RR 1.49) were more prevalent in obese than in lean PCOS. Obese PCOS was associated with a less favourable cardiometabolic profile, with higher HOMA-IR (MD 2.03), fasting (MD 5.12 mg/dL), and 2-h (MD 9.91 mg/dL) plasma glucose, and greater risks of prediabetes (25.3% vs. 12.1%; RR 1.84), diabetes (8.6% vs. 2.7%; RR 2.58), and metabolic syndrome (51.2% vs. 11.9%; RR 3.59). Mean lipid levels were worse in obese PCOS, with higher total cholesterol, triglycerides, and LDL cholesterol, and lower HDL cholesterol. Nonetheless, lean PCOS exhibited substantial burdens of menstrual dysfunction, hyperandrogenism, insulin resistance, dysglycemia, and dyslipidemia. Obesity in PCOS is associated with more severe reproductive, metabolic, and hormonal abnormalities, but lean PCOS still carries substantial reproductive and metabolic burdens. However, the observational design of the included studies and substantial heterogeneity across several outcomes warrant cautious interpretation. The meta-analysis was registered with PROSPERO under registration number CRD420251240521. The review protocol summary is available on the PROSPERO website.

Surgical reproductive control remains the most widely used method for reproductive control in dogs and cats, but it requires anesthesia, trained personnel, surgical facilities, and post-operative care, which may limit its application in large-scale free-roaming animal populations. In males, orchidectomy also eliminates Leydig cell testosterone production, removes negative feedback on the hypothalamic-pituitary-gonadal axis, and may contribute to persistent elevation of luteinizing hormone. These endocrine changes have increased interest in hormone-sparing contraceptive strategies that suppress fertility without fully reproducing the hormonal consequences of castration. This review summarizes current non-surgical male contraceptive approaches in dogs and cats, including GnRH agonists, progestogens, androgens, systemic chemical contraceptive agents, intratesticular and intraepididymal chemical contraceptive agents, therapeutic ultrasonography, gene-editing strategies, and immunological approaches. Many existing methods suppress the hypothalamic-pituitary-gonadal axis, damage testicular tissue, require repeated administration, or have inconsistent effects on testosterone preservation. In contrast, follicle-stimulating hormone receptor (FSHr)-targeted antibody fragments offer a more selective approach by targeting Sertoli cell support of spermatogenesis while avoiding direct interference with LH-mediated Leydig cell testosterone production. Recent studies in dogs and cats have demonstrated species-specific anti-FSHr antibody fragments that suppress Sertoli cell functional markers in vitro, while in vivo evidence from long-tailed macaques suggests that anti-FSHr scFv can impair sperm output and semen quality without significantly altering serum testosterone concentrations. Although further in vivo studies are required in dogs and cats, anti-FSHr antibody fragments represent a promising emerging direction for hormone-sparing male contraception in companion animals.

Women's autonomy in fertility decision-making is essential for improved health and social outcomes. Guided by the social-ecological model, this investigation explores multilevel influences on the fertility autonomy of women with an unmet need for family planning in rural Uganda. We conducted four focus groups with men and women ( n = 26), and 15 key informant interviews with community leaders and individuals involved in the provision of family planning. The data were analyzed thematically. The results highlight how community-level norms reinforce gender inequalities in decision-making and underpin beliefs to not limit men's number of children. Religious norms and polygamy practices were shown to influence attitudes towards family size and family planning, as well as shape relationship dynamics related to fertility. Concerns about poverty were identified as a driver of shifting preferences and increasing acceptance of family planning. Results showcase how health system weaknesses limit women's access to family planning services, contribute to mistrust of health systems and drive misinformation about contraceptives, especially among men. This study underscores the need for multifaceted gender transformative interventions to increase women's fertility autonomy. This study also highlights health system strengthening, religious leader endorsement and male engagement as approaches to increase women's autonomous use of family planning.

This study examined transitions between contraceptive states within women's contraceptive trajectories and identified the factors associated with contraceptive continuation, method switching, and discontinuation. The study used contraceptive calendar data from the 2018 DHS Guinea. A woman-month event dataset was constructed to reconstruct contraceptive and reproductive histories over the five years preceding the survey. Transitions between contraceptive states - non-use of contraception, use of traditional methods, use of modern methods, pregnancy, and pregnancy outcomes - were modelled as recurrent events. To account for multiple transitions experienced by the same woman over time, the Prentice-Williams-Peterson gap-time survival model was applied. The probability of transitioning to another contraceptive state was estimated at 1.0% among women not using contraception, 1.6% among users of traditional methods, and 2.7% among users of modern methods. The probability increased to 7.5% during pregnancy and reached 61.1% following pregnancy outcomes. Transition probabilities varied only marginally by age, ranging from 23.6% among women aged 15-24 years to 23.0% among those aged 25-34 years and 22.3% among women aged 35-49 years. Similar patterns were observed across educational attainment and household wealth categories. By contrast, exposure to family planning messages and place of residence were not significantly associated with contraceptive transitions. Contraceptive transitions are primarily driven by reproductive events rather than by socioeconomic characteristics. These findings emphasise the importance of strengthening family planning interventions at key stages of the reproductive life course. However, the findings should be interpreted with caution, as the analysis did not account for sociocultural norms, the availability of family planning services, and the characteristics of local health systems. In addition, the retrospective contraceptive calendar data are subject to recall bias.

Progestin-only pills (POPs) represent an underutilized contraceptive option despite expanding evidence for their safety, efficacy, and noncontraceptive applications. This article updates the 2022 review of progestin-only contraception by Liu et al ., describing currently available POP formulations and their characteristics. Contraceptive POPs vary substantially by formulation in mechanism of action, efficacy, and tolerability. The three available in the US contain norethindrone, norgestrel, and drospirenone. While current recommendations are largely based on outdated information, more recent research considers the more nuanced characteristics and noncontraceptive applications of different POPs. Typical-use failure rates are likely lower than historically reported, and the 3-h window (the recommended cutoff for a 'late' dose) has limited evidentiary support and does not apply uniformly across formulations. Drospirenone's unique antiandrogenic and antimineralocorticoid properties, improved bleeding profile, and ovulation suppression distinguish it from other POPs; recent data may support continuous dosing and expand off-label applications. Importantly, this review discusses specific safety considerations and highlights the availability of norgestrel over-the-counter as a major milestone in contraceptive accessibility. Understanding the distinct contraceptive and noncontraceptive characteristics of each POP formulation allows clinicians to offer individualized counseling that aligns with each patient's reproductive and healthcare goals.

Pain during intrauterine device (IUD) insertion is currently a major focus of contraceptive care, driven by patient advocacy, social media discourse, and growing recognition that procedural pain may deter patients from seeking an IUD. Concurrently, professional organizations have released updated guidance on pain management during IUD placement. This review summarizes contemporary evidence regarding patient risk factors, procedural techniques, and pharmacologic and non-pharmacologic interventions for IUD insertion pain. Recent literature demonstrates that pain during IUD placement is multifactorial and influenced by patient characteristics, including nulliparity, dysmenorrhea, anxiety, and anticipated pain. Among available interventions, the strongest evidence supports local anesthetic approaches. Ultrasound-guided placement may reduce pain and procedural difficulty. In contrast, routine use of misoprostol is not supported by current evidence. Data regarding non-pharmacologic environmental interventions, oral anxiolytics/opiates, nitrous oxide, intravenous sedation, and operating room-based anesthesia care remain limited or conflicting. Effective pain management for IUD placement likely requires a multimodal, patient-centered approach that addresses both physiologic and psychological contributors to pain. Future research should prioritize standardized outcome measures, comparative effectiveness studies, and implementation and cost-effectiveness analyses to inform equitable integration of evidence-based pain management strategies for IUD insertions.

Armed conflict profoundly affects women's sexual and reproductive health and rights, yet the pathways through which conflict shapes family planning and abortion uptake and decision-making remain insufficiently understood. This scoping review aimed to identify and map the available evidence on how armed conflict influences women's use of, access to, and decisions about family planning and abortion in conflict-affected settings. Following JBI guidance and -ScR reporting standards, searches were conducted in Web of Science, Scopus, PubMed and Embase for peer-reviewed articles published in English between 2014 and 2024. Studies were eligible if they included primary data on women living in conflict-affected settings or internally displaced populations, treated conflict as an exposure or shaping condition, and addressed family planning, contraception, sterilisation, abortion or post-abortion care. Thirty studies were included, and the data were synthesised using a thematic synthesis approach. Relevant findings from each article were organised into subcategories based on their commonalities under two main themes: a) Factors shaping the uptake of and decision-making about family planning, including contraception and sterilisation, and b) Factors shaping the uptake of and decision-making about abortion. The results highlight that armed conflict does not automatically affect reproductive health in a single direction; rather, its effects depend on how violence, service availability, gendered power relations, social norms and social conditions interact. This study calls for further research to better understand the effects of conflict on women's reproductive health and autonomy, and inform tailored humanitarian interventions to address these needs. Main findings: Armed conflict shapes women’s uptake of and decision-making about family planning and abortion in complex and context-specific ways. Its effects depend on how health services, violence, poverty, social norms, gender relations and humanitarian responses interact in particular settings. Added knowledge: This scoping review maps evidence on family planning and abortion in conflict-affected settings and shows that conflict does not influence reproductive health in one uniform direction. The review highlights how conflict can both restrict access to care and reshape the conditions under which women make reproductive decisions. Global health impact for policy and action: Policies and programmes in conflict-affected settings should address not only service availability, but also insecurity, poverty, gender-based violence, social norms and women’s reproductive autonomy. Responses should be adapted to local conditions and ensure accessible, acceptable and rights-based family planning and abortion-related care.

Unmet need for contraception among women is high in Tanzania. Hormonal intrauterine device was not among the contraceptives offered in public health facilities in Tanzania until a Ministry of Health pilot in 2023-2024. Explore the feasibility of providing hormonal intrauterine devices in public health facilities in Tanzania. An observational exploratory mixed-methods study design was conducted, using cross-sectional and longitudinal components, in 20 peri-urban facilities in two districts in Tanzania between January 2023 and February 2024. Facility assessments were collected to understand equipment/infrastructure gaps, while clinical assessments, surveys and in-depth interviews were conducted with trained providers to explore the feasibility of introducing hormonal intrauterine devices. Quantitative data was analyzed descriptively for trends. Qualitative data was analyzed thematically, then triangulated with quantitative data in line with a convergent mixed-methods approach. 1,198 women chose to take up hormonal intrauterine devices during the eight-month pilot. There was an average of 1.8 hormonal intrauterine device clients per facility per week, and overall ratios of 2.5 removals per 100 insertions and 0.3 expulsions per 100 insertions. Clinical average assessment scores in contraceptive counselling and intrauterine device insertion improved over the pilot, from 62% and 79% to 99% and 90% for counselling and insertions, respectively. This tallied with providers' expressions of increased confidence in provision of hormonal intrauterine device through interviews. It is feasible to introduce hormonal intrauterine device into the public sector in Tanzania, with sufficient training and mentorship to providers on contraceptive counselling, insertion skills, and side effects management. Main findings: It is feasible to introduce hormonal intrauterine devices into the public health sector in Tanzania with sufficient training and mentorship. Added knowledge: Capacitating health care providers in family planning counselling, intrauterine device insertion and side-effects management skills through comprehensive training and repeated mentorship can help ensure sustainable retention of knowledge and skills over time in a new product introduction. Global health impact for policy and action: Before and during introduction, strengthening training for health care providers with a focus on counselling skills plays a major role in successful provision of hormonal intrauterine device.

Unwanted or mistimed pregnancies are pregnancies that occur in women who do not intend to become pregnant or did not desire another child at the time of conception. Ensuring access to contraception is important for both preventing unwanted pregnancy among active duty service women (ADSW) and preserving their right to reproductive autonomy. Women's Health Clinics (WHCs), available on some installations, bases, or duty stations owned and operated by the United States military, are intended to improve contraceptive access. This study aims to determine the association between availability of WHCs and unwanted pregnancy among ADSW. Using data from the 2020 Women's Reproductive Health Survey of ADSW we examined unwanted pregnancy in 2,939 ADSW who reported pregnancy in the last 12 months. Bivariate analyses and weighted binary and multivariable logistic regressions were used to assess the relationship between women reporting an unwanted pregnancy and having a WHC at their installation. We identified 354 unwanted pregnancies. Having a WHC at their current installation was significantly associated with a 39% decreased odds of unwanted pregnancy (aOR = 0.61; 95% CI: 0.42-0.88). Having a WHC at an ADSW's installation is associated with significantly decreased odds of unwanted pregnancy. This suggests that access to specialty women's health care at duty stations may promote reproductive autonomy among ADSW, contributing to the prevention of unwanted or mistimed pregnancies, ultimately enhancing mission readiness.

Various obesity metrics are used to assess female infertility risk, but their relative prognostic value remains unclear. This cross-sectional study systematically evaluated 16 anthropometric indices to identify the most effective predictors. Using National Health and Nutrition Examination Survey (NHANES) 2017-2020 data ( n = 1154 reproductive-aged women), we applied a three-phase framework: (1) weighted restricted cubic spline (RCS) models were applied to examine potential non-linear associations between 16 anthropometric obesity indicators and female infertility risk, with univariate analyses used to assess their statistical associations, (2) two model states ('real-world settings' and 'ideal-world settings') were constructed based on the union and intersection of indicator datasets, and weighted logistic regression models were developed for each state and (3) predictive performance and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA), with key diagnostic metrics compared to identify optimal predictors. Thirteen obesity indicators showed predictive value for infertility; Anthropometric Body Shape Index (ABSI) exhibited a U-shaped association, whereas the others demonstrated positive linear relationships. Body mass index (BMI), Weight-Adjusted Waist Index (WWI) and Conicity Index (CI) demonstrated relatively better predictive performance (AUC > 0.65), with WWI showing slightly stronger association with infertility than the other indicators in both model states (adjusted OR = 1.40, 95% CI: 1.10-1.77; AUC = 0.656; results were consistent across the two model states). Thirteen obesity indicators predicted infertility; ABSI was U-shaped, others were linear. WWI was slightly superior, though differences were modest. This study examined the association between multiple anthropometric obesity indicators and female infertility risk using data from the U.S. NHANES 2017–2020. Infertility was defined as failure to conceive after at least one year of regular unprotected intercourse.The analysis included 1154 women aged 18–45 years, of whom 142 were classified as infertile. Thirteen out of 16 tested obesity indicators were associated with increased infertility risk. Most showed a positive linear relationship, while Anthropometric Body Shape Index displayed a U-shaped association. The Weight-Adjusted Waist Index performed slightly better than other indicators in predicting infertility risk.These findings indicate that routine anthropometric obesity indicators can help identify women at higher risk of infertility, supporting early risk assessment and targeted weight management to improve fertility outcomes.

People with epilepsy of child-bearing potential (PWECP) require access to highly effective contraception, yet many antiseizure medications (ASMs) can reduce the effectiveness of some hormonal methods by inducing hepatic enzymes. In this retrospective cohort study, we aimed to identify the proportion of PWECP prescribed a susceptible hormonal contraceptive method who were concurrently prescribed an interacting ASM and patient characteristics associated with coprescription. We obtained Medicaid claims data from 2016 to 2021 for female beneficiaries and defined a cohort of people with epilepsy on ASMs prescribed at least 1 method of hormonal contraception susceptible to hepatic enzyme induction. Using prescription fill dates and contraceptive procedure dates, we identified periods of inducing ASM and susceptible contraceptive overlap lasting at least 14 days. We used descriptive statistics to calculate the proportion experiencing overlap and median days of overlap. We used logistic regression to identify associated patient characteristics with any 14-day period of overlap and binominal regression to identify characteristics associated with greater proportion of overlap days. Our cohort included 110,976 PWECP (median age 24 [interquartile range 18-30] years, 54.8% White non-Hispanic). Of those, 21,923 were prescribed a susceptible contraceptive method from 2018 to 2021. In that group, 7,154 (32.6%) had at least a 14-day period of overlap with an enzyme-inducing ASM. The median days of overlap for this group were 218 days (interquartile range 74-511). Patient characteristics associated with both any period of overlap and longer periods of overlap included intellectual disability (any overlap: adjusted odds ratio [aOR] 2.33, 95% CI 2.19-2.48; longer overlap: 2.27, 95% CI 2.05-2.53), drug-resistant epilepsy (any overlap: aOR 1.73, 95% CI 1.62-1.84; longer overlap: 1.27, 95% CI 1.14-1.41), and age older than 35 years compared with 19-34 years (any overlap: 1.45, 95% CI 1.32-1.59; longer overlap: 1.51, 95% CI 1.29-1.75). Drug interactions with ASMs leading to reduced contraceptive effectiveness are common among PWECP prescribed susceptible hormonal contraception. Certain populations, including those with intellectual disability, drug-resistant epilepsy, or age older than 35 years, were more likely to experience these drug interactions. Limitations include that our data set lacks information on adherence, counseling, pregnancy intentions, sexual orientation and activity, and barrier use.

In western countries women are much more likely to suffer from depression than men are. Some reports have suggested that there is an increased risk of depression diagnoses in young women who start using hormonal contraception. Using an established approach to quantifying levels effective dosages of estradiol, progestins, and androgens in specific brands and types of hormonal contraception, we address a) whether hormonal contraception use in general is associated with depressive symptoms, and b) which contraceptive hormonal effects are associated with depressive symptoms as measured with the Beck Depression Inventory, brooding and negative metacognitions about rumination in a community sample of 757 young women (age 16-19). We also consider associations with age and relationship status. We detected no overall effect of hormonal contraception on depressive symptoms. We furthermore detected no effects of specific hormonal dosages on any of the three outcome measures depressive symptoms, brooding or negative metacognitions. The results are discussed in light of previous robust but limited findings of an association and the possibility that health care system contact increases likelihood of more health care services, rather than robust causal effects of hormones.

Women of childbearing age represent a significant proportion of solid organ transplant (SOT) patients and often regain fertility within 1-year post-transplant. Societal guidelines exist for best contraceptive/family planning practices post-SOT but are often not well implemented. This study aimed to summarize current SOT providers' knowledge of contraception guidelines and counseling practices at a single institution. This was a cross-sectional consented survey of current knowledge and practice of contraception guidelines and counseling. SOT providers included nurses, advanced practice providers (APP), coordinators, pharmacists and physicians. The primary outcome, consistency with societal guidelines, was defined as counseling patients and recommending at least 1 contraception type as per guidelines. The survey was sent to 235 participants, of which 38 (16%) consented and completed it. Respondents included 42% physicians, 39% coordinators, and 18% APPs. Almost all respondents (97%) indicated that they believe transplant providers hold responsibility to provide reproductive health counseling to SOT patients. Twenty-nine respondents (76%) indicated that they provide some level of contraception counseling, but only 2 (7%) indicate they make specific recommendations. Due to this small number, we were unable to further analyze the primary outcome. Reported barriers to providing contraception counseling included time (58%), lack of knowledge (44%), and the belief that it did not fall within one's role (34%). Although almost all respondents believe that transplant providers share responsibility of contraception counseling for SOT patients, they are not actively providing it. Solutions include creating a unique SOT provider role for contraception counseling and collaboration with obstetrics/gynecology.

Emergency contraception remains an essential component of comprehensive contraceptive care and reproductive autonomy. Despite being safe, highly effective, and associated with almost no absolute medical contraindications or age limits, emergency contraception is often underutilized due to systemic barriers, limited access, persistent misconceptions, and inconsistent clinical guidance, provider knowledge gaps, or stigma. This FIGO Committee statement provides an evidence-based overview of the current landscape of emergency contraception, including available methods such as the copper-bearing intrauterine device, levonorgestrel, and ulipristal acetate pills and combined oral contraceptives as well as their mechanisms of action, safety, repeated use, and key implementation challenges. The statement also presents practical recommendations to improve equitable access and uptake, including integrating emergency contraception into routine family planning, sexual violence, and sexually transmitted infection care as well as promoting advance provision, strengthening provider education, and supporting advocacy and policy efforts to reduce barriers to access. FIGO calls upon governments, donors, and health professionals to uphold every individual's right to timely access to emergency contraception, affirming this is not only a clinical issue but a matter of reproductive justice.

Long-acting reversible contraceptive (LARC) methods are often grouped in contraception studies, although they differ in ways that may influence patient preferences and access. This study examines trends in intrauterine device (IUD) and implant use in Mexico, and identifies factors associated with implant use compared with IUD use. We used the 2009, 2014, 2018, and 2023 waves of the Mexican National Survey of Demographic Dynamics (ENADID). The sample included women aged 15-45 currently using LARC. We described the characteristics of LARC users in 2023 and estimated percentage point changes in prevalence for implant and IUD use as a proportion of all modern method use across survey periods. Multivariable logistic regression identified factors associated with implant use versus IUD (reference) among LARC users in 2023. The sample included 10,411 women (weighted N = 4,012,772). Between 2009 and 2023, implant use increased while IUD use declined, with the largest shifts between 2018 and 2023. During this period, implant use increased by 3.48 percentage points while IUD use declined by 3 percentage points, indicating a method mix shift of implants for IUDs rather than an overall expansion of LARC use. Younger age was associated with higher odds of implant use, with odds declining with increasing age. Women with one or two children had lower odds of implant use compared with nulliparous women. Use of LARC methods in Mexico has shifted towards increased implant use and decreased IUD use, suggesting a shift between methods rather than expansion of overall LARC use. Increasing implant use alongside declining IUD use may reflect improved access but could also indicate constrained contraceptive choice. Ensuring availability of both methods is essential to support informed, patient-centered, and contraceptive decision-making.

To characterize difficult long-acting reversible contraception (LARC) removal experiences among reproductive-aged U.S. women. Using U.S. National Survey of Family Growth (2017-2019) data to identify individuals reporting LARC removal difficulty in the previous 10 years, we examined common reasons and variations by socio-demographics or LARC type. Of 1036 respondents using LARC within the past 10 years, 61.2% desired removal. 12.2% reported removal difficulty. Reasons included complications (72.3%) and provider discouragement (10.6%). Difficult removal prevalence did not significantly vary by socio-demographics or LARC type. Challenges removing LARC upon request may be more common than providers realize and should inform contraceptive counseling.

We studied the risk of ischemic (IS) and hemorrhagic stroke (ICH) in users of progestogen-only contraceptives (POCs): levonorgestrel-releasing intrauterine device (LNG-IUD), progestogen-only pill (POP), implant and injection. In this nationwide cohort study using Danish registry data for all women aged 18-49 years, 2004-2021, we estimated incidence rate ratios (IRRs) for IS and ICH associated with POC use. Comparisons were made with non-use of hormonal contraception and with combined hormonal contraceptives (CHC) with ethinylestradiol containing equivalent progestogens. Poisson regression models were adjusted for age, ethnicity, education, calendar year, and risk factors. A total of 1,734,905 non-pregnant women contributed 16,854,953 person-years of follow-up. The most frequently used POCs were LNG-IUD (1,720,931 person-years), followed by desogestrel-only pills (255,404), norethisterone-only pills (104,261), etonogestrel implants (61,756), and medroxyprogesterone injections (27,469). CHCs with ethinylestradiol accounted for 4,431,841 person-years. Compared with non-use of hormonal contraception, no POC type was associated with increased adjusted IRRs for IS or ICH. Compared with CHCs containing desogestrel or levonorgestrel in addition to ethinylestradiol, adjusted IRRs for IS were significantly lower for desogestrel-only pills (IRR 0.56, 95% CI 0.38, 0.82) and LNG-IUD (IRR 0.44, 95% CI 0.36, 0.53). IRRs for ICH were not significantly changed: LNG-IUD 0.85 (95% CI 0.37, 1,92); desogestrel-only pills 0.98 (95% CI 0.44, 2,20). POCs were not associated with increased stroke risk. Relative to CHCs with ethinylestradiol, POCs were linked to approximately half the risk of IS. However, the absolute number of strokes avoided by choosing POCs over CHCs with ethinylestradiol is small and, for most women-particularly those under 40 years-unlikely to be clinically detectable. POCs-including POPs, implants, injections, and LNG-IUDs-were not associated with an increased risk of either IS or ICH and support their use as appropriate alternatives to CHCs with ethinylestradiol for women in whom stroke risk is an important clinical consideration.

While intrauterine devices (IUDs) are highly effective for contraception and menstrual-related concerns, a significant barrier to usage in adolescents is fear of pain during placement. We sought to identify patient characteristics associated with receiving sedation for IUD placement among adolescents. A retrospective cohort study was performed at a single institution from January 2022 to December 2023. Patients (N = 284) assigned female at birth, aged ≤18, who underwent IUD placement for any indication with or without sedation were included. Demographic and clinical characteristics were analyzed using multivariable logistic regression. Two hundred thirty-three patients (82.0%) underwent IUD placement in clinic without sedation and 51 (18.0%) underwent placement with sedation. There were no significant differences in age, race, ethnicity, or insurance type between cohorts. Sedation patients had a higher BMI (26.2 vs 24.3 kg/m 2 , p = 0.04), were more likely to identify as non-binary (13.7% vs 4.3%, p = 0.01), and were less likely to be sexually active (25.4% vs 62.7%, p < 0.001). In multivariable analysis, a bleeding disorder was associated with a 19.6 percentage-point higher predicted probability of undergoing sedation (95% CI 4.7-34.5 percentage points), whereas being sexually active was associated with an 11.8 percentage-point lower predicted probability (95% CI -23.3 to -0.3 percentage points). We identified several patient characteristics that increase the likelihood of adolescents undergoing IUD placement with sedation, including higher BMI, having a bleeding disorder, identifying as non-binary, and not being sexually active. These findings may help clinicians identify adolescents who could benefit from expanded pain management options. This study identifies specific adolescent patient characteristics associated with use of sedation for IUD placement, including obesity, having a bleeding disorder, identifying as non-binary, and not being sexually active. Expanding equitable pain management access may reduce deterrents to IUD use and strengthen patient-centered contraceptive care.

Abortion bans have been associated with decreased reproductive health care access. We examined the association between Idaho's abortion ban and postpartum contraceptive use among Medicaid beneficiaries. This retrospective cohort study used Medicaid claims data from Idaho and Oregon with a difference-in-differences approach. We included Medicaid-enrolled women aged 15-44 who delivered a live birth between July 1, 2021, and September 30, 2023. Idaho's abortion ban, implemented August 25, 2022, criminalized abortion from fertilization with narrow exceptions; Oregon served as the comparison state. The primary outcome was receipt of most effective contraception (implant, intrauterine device, or tubal ligation) within 90 days of delivery. Secondary outcomes included most effective contraception within 3 days of delivery, most or moderately effective contraception within 3 days and within 90 days of delivery, and postpartum visit attendance within 60 days. Analyzing 56,508 live births to 53,966 Medicaid beneficiaries in Idaho and Oregon, we found that Idaho's abortion ban was associated with a 1.52-percentage point decrease in receipt of the most effective contraception within 90 days postpartum (95% CI, -2.94 to -0.10; p = 0.04) and a 1.41-percentage point decrease within 3 days (95% CI, -2.29 to -0.52; p = 0.002). Postpartum visit attendance declined by 3.13 %age points (95% CI, -5.59 to -0.67; p = 0.01). Immediate postpartum declines coincided with decreased permanent contraception in Idaho (5.0% vs. 4.2%), while Oregon saw an increase (5.9% vs. 6.6%). Idaho's abortion ban was associated with significant declines in most effective postpartum contraceptive use and visit attendance among Medicaid beneficiaries, suggesting abortion restrictions may have unintended consequences for postpartum care access. Idaho's abortion ban was associated with reduced postpartum contraceptive use and visit attendance among Medicaid beneficiaries. Clinicians practicing in states with abortion restrictions should be aware of potential declines in postpartum care engagement and prioritize counseling and access to contraception throughout care.

The objective of the current study was to assess whether prenatal incarceration exposure is associated with postpartum contraceptive use. Using pooled cross-sectional data from Phase 8 (2016-2021) of the Pregnancy Risk Assessment Monitoring System (n = 111,616) from 26 sites (25 states and New York City), we examined associations between incarceration exposure (i.e., direct or vicarious through husband/partner) in the 12 months before birth and postpartum contraceptive use. We estimated survey-weighted bivariate and multivariable logistic regression analyses to examine associations between prior incarceration and type of contraceptive use. Overall, 2.7% of respondents reported personal or vicarious incarceration exposure via a spouse or partner, and 82.9% of respondents reported postpartum contraceptive use. Respondents exposed to incarceration had lower odds of using any postpartum contraception compared to those without exposure (aOR = 0.69, 95% CI = 0.60-0.78). Incarceration exposure was associated with a lower odds of condom use among those using contraception (aOR = 0.84, 95% CI = 0.72-0.98) and a higher odds of abstinence (aOR = 1.61, 95% CI = 1.36-1.91). These findings demonstrate the need for coordinated efforts across medical, public health, and criminal justice systems to improve postpartum contraceptive support for individuals affected by incarceration. Incarceration history is an important consideration for post partum contraception use. Future research is needed to assess best practices, such as contraception counseling and access within correctional health care and reentry services for postpartum individuals and their partners.