BMJ Sexual & Reproductive Health最新文献

{"title":"The emerging role of progesterone receptor modulators in breast physiology, cancer prevention and treatment.","authors":"Abigail Liberty, Alison Edelman, Sarah Margaret Bernhardt","doi":"10.1136/bmjsrh-2024-202662","DOIUrl":"10.1136/bmjsrh-2024-202662","url":null,"abstract":"<p><strong>Background: </strong>Progesterone is critical for cyclic breast changes and breast cancer carcinogenesis. The commercially available progesterone receptor modulators (PRMs), ulipristal acetate (UPA) and mifepristone, have been utilised for their antiprogestogen effect in gynaecology. Administration of these medicines appears to induce favourable cellular and radiographic changes in the breast.</p><p><strong>Methods: </strong>This is a narrative review of the basic science, translational and clinical trials utilising UPA and mifepristone for breast health. It integrates historical and recent trials from around the world.</p><p><strong>Results: </strong>PRMs have shown promise in decreasing molecular markers of carcinogenesis in BRCA1 carriers. Outside of genetic cancer risk, PRMs decrease background parenchymal enhancement on breast magnetic resonance imaging and could be developed as a personalised protocol for breast cancer screening. Although there was limited efficacy of antiprogestogens in progression-free survival for people with breast cancer, there may be a role as neoadjuvant therapy prior to surgical resection.</p><p><strong>Conclusions: </strong>UPA and mifepristone have the potential to revolutionise breast cancer prevention, screening and treatment. As protocols emerge, gynaecologists will be on the front lines as regards both identifying patients who may benefit from these medications and serving as interdisciplinary support in accessing these medicines.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":"66-74"},"PeriodicalIF":2.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User-reported quality of self-managed medication abortion by care source in Nigeria.","authors":"Laura E Jacobson, Ruvani T Jayaweera, Ijeoma Egwuatu, Sarah Baum, Erin Pearson, Nirali M Chakraborty, Blair G Darney, Osasuyi Dirisu, Sybil Nmezi, Caitlin Gerdts","doi":"10.1136/bmjsrh-2025-202805","DOIUrl":"10.1136/bmjsrh-2025-202805","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate and compare self-managed abortion (SMA) user-reported quality of care between users accessing a safe abortion hotline versus proprietary patent medicine vendors (PPMVs) that provide medicines to rural communities in Nigeria, and identify factors associated with increases in total quality scores and key indicators of abortion access and information provision.</p><p><strong>Methods: </strong>We leveraged exit surveys and 30-day follow-up data collected from users of a safe abortion hotline and PPMVs in Nigeria used to develop the Abortion Care Quality Tool (ACQTool). We used bivariate statistics to compare 17 user-reported quality indicators across six domains and eight abortion outcomes, by care source (hotline vs PPMV). We used multivariable linear regression to identify factors associated with total quality scores and multivariable logistic regression to identify factors associated with abortion affordability and preparedness for a complication, controlling for user sociodemographic characteristics.</p><p><strong>Results: </strong>Hotline users (n=182; 40.8%) scored higher than PPMV users (n=264; 59.2%) on 9 of 17 quality indicators, particularly in the decision-making and information provision domains. Mean total quality score was significantly higher for hotline users (16.53 vs 14.53; p<0.001). Hotline users were associated with an increase of 1.87 points in the total quality and higher odds (aOR=3.23; 95% CI 1.07 to 12.02) of feeling prepared if a complication occurred, but had lower odds (aOR=0.10; 95% CI 0.05 to 0.21) of indicating the abortion was affordable, adjusting for sociodemographic factors.</p><p><strong>Conclusions: </strong>This study highlights the high overall quality of abortion care from both hotlines and PPMVs but identifies key areas for improvement, such as affordability for hotline users and decision and information support for PPMV users.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the literature.","authors":"","doi":"10.1136/bmjsrh-2025-203053","DOIUrl":"https://doi.org/10.1136/bmjsrh-2025-203053","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progestogen-only contraception use during breastfeeding: an updated systematic review.","authors":"Angeline Ti, Sylvia Ayieko, Mercedes Bonet","doi":"10.1136/bmjsrh-2025-202837","DOIUrl":"10.1136/bmjsrh-2025-202837","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aimed to update a 2016 review and answer two questions: (1) Among breastfeeding women, does the use of progestogen-only contraception (POC) (ie, pills, injectables, implants, hormonal intrauterine devices) increase the risk of poor breastfeeding or infant outcomes compared with those not using POC? (2) Among breastfeeding women, does the initiation of POC before 6 weeks postpartum increase the risk of poor breastfeeding or infant outcomes compared with the initiation of POC at 6 weeks or later?</p><p><strong>Methods: </strong>We searched multiple databases (MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and CINAHL) from inception to 6 September 2023. We extracted data and assessed risk of bias (RoB) for each study and certainty of evidence for each outcome.</p><p><strong>Results: </strong>Sixty-one articles met the inclusion criteria; 11 were newly identified since the previous review, most with high RoB. Nine new randomised and non-randomised studies assessing breastfeeding and/or infant outcomes met the inclusion criteria for Question 1. Two new randomised studies assessing breastfeeding and/or infant outcomes met the inclusion criteria for Question 2, examining early versus late initiation of the implant. One new article for each objective included preterm infants. For both questions, studies continue to find no significant adverse effects on breastfeeding (eg, continuation, supplementation, duration) or infant (eg, growth, illness) outcomes. The certainty of evidence ranged from very low to moderate across outcomes.</p><p><strong>Conclusions: </strong>This updated systematic review provides additional evidence for the safety of POC use during breastfeeding. Newly identified studies are consistent with the prior review in suggesting no consistent findings of adverse effects, while adding evidence for preterm infants.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s4-s17"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The WHO Medical Eligibility Criteria for Contraceptive Use 6th edition and the WHO Selected Practice Recommendations 4th edition: update and future direction.","authors":"Nancy Kidula, James N Kiarie","doi":"10.1136/bmjsrh-2025-202836","DOIUrl":"10.1136/bmjsrh-2025-202836","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s1-s3"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-pharmacologic techniques for interval intrauterine device placement: a systematic review.","authors":"Tesfaye Tufa, Emily Snyder, Sophia Garbarino, Mekdes Wolderufael, Petrus Schonken Steyn","doi":"10.1136/bmjsrh-2025-202840","DOIUrl":"10.1136/bmjsrh-2025-202840","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review the evidence on the effectiveness of non-pharmacologic techniques for interval intrauterine device (IUD) placement.</p><p><strong>Methods: </strong>We searched various databases from database inception to 15 December 2023 for randomised controlled trials (RCTs) examining non-pharmacologic techniques for IUD placement compared with placebo or pharmacologic techniques. Outcomes of interest were pain experienced with IUD placement, provider ease of placement, need for adjunctive placement measures, placement success, patient satisfaction, side effects and adverse events. We extracted data from included articles, assessed risk of bias, and determined certainty of evidence for all outcomes.</p><p><strong>Results: </strong>Eleven RCTs met the inclusion criteria, examining 10 different non-pharmacologic techniques. The risk of bias was high in 10 trials and low in 1 trial. Of 11 RCTs that examined patient pain, two found reduced pain with the Valsalva breathing technique (where women inhaled deeply and held their breath during IUD placement), without tenaculum placement compared with routine care (i.e., use of a tenaculum) (OR 0.04; 95% CI 0.01 to 0.15) or acupuncture compared with routine care (mean difference -1.88; 95% CI -2.72 to -1.04). None of the four trials that assessed ease of IUD placement found differences between study groups. Across nine RCTs, most had high rates of placement success. One study each examined need for cervical dilation and patient satisfaction; the findings were similar between study groups. Overall, few side effects and no adverse events were reported across the studies.</p><p><strong>Conclusions: </strong>Non-pharmacologic techniques like the Valsalva manoeuvre and acupuncture may reduce patient pain with IUD placement (certainty of evidence ranging from moderate to low). However, evidence is limited, and more high-quality trials with larger sample sizes are needed.</p><p><strong>Prospero registration number: </strong>CRD42024507788.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s38-s51"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual and reproductive health clinical consultations: breastfeeding and progestogen-only contraception.","authors":"Abigail Liberty, Alison Edelman, Lisa Bayer","doi":"10.1136/bmjsrh-2025-202854","DOIUrl":"10.1136/bmjsrh-2025-202854","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s60-s63"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of repeated use of emergency contraceptive pills in the same menstrual cycle: a systematic review.","authors":"Petrus Schonken Steyn, Erin Fleurant, Emma Marie Smith, James N Kiarie","doi":"10.1136/bmjsrh-2025-202841","DOIUrl":"10.1136/bmjsrh-2025-202841","url":null,"abstract":"<p><strong>Background: </strong>Emergency contraception refers to contraceptive methods used following unprotected sexual intercourse.</p><p><strong>Objective: </strong>To review the literature on safety of repeated use of emergency contraceptive pills (ECPs) in the same menstrual cycle.</p><p><strong>Methods: </strong>We searched multiple databases from inception through February 2024 for articles on repeated ECP use. We assessed the risk of bias for each study and certainty of evidence for all outcomes.</p><p><strong>Results: </strong>From 4565 articles identified, six met the inclusion criteria. Four studies of repeated levonorgestrel (LNG)-ECP use provided very low certainty evidence. Among women who became pregnant after at least one use of LNG-ECP in the conception cycle, women with ectopic pregnancy had increased odds of repeated LNG-ECP use in the conception cycle compared with women with intrauterine pregnancy (adjusted OR (aOR) 2.5, 95% CI 1.0 to 6.2). One non-comparative study reported few serious adverse events with repeated pericoital use of LNG-ECP, and two cohort studies of LNG-ECP failure found no differences in pregnancy, fetal/neonatal, infant or child outcomes comparing higher (2.25-9 mg LNG) and lower (0.75-1.5 mg LNG) doses in the conception cycle. Two studies of repeated ulipristal acetate (UPA) use provided very low certainty evidence. One non-comparative study observed no serious adverse events, no abnormal laboratory results and normal endometrial biopsies with UPA (30 mg, 4-6 doses/month). One randomised controlled trial in a clinical setting observed no serious adverse events with UPA (10 mg, 20 mg or 50 mg for 10 days) compared with placebo.</p><p><strong>Conclusion: </strong>Evidence on the safety of repeated ECP use is limited and of very low certainty, but overall does not suggest safety concerns.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s30-s37"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to fertility after subcutaneous depot medroxyprogesterone acetate: a narrative review.","authors":"Alfred Osoti, Nancy Kidula, Lauryn Busolo Mengesa, James N Kiarie","doi":"10.1136/bmjsrh-2025-202839","DOIUrl":"10.1136/bmjsrh-2025-202839","url":null,"abstract":"<p><strong>Background: </strong>This narrative review examines the time to return to fertility after discontinuation of subcutaneous depot medroxyprogesterone acetate (DMPA SC) 104 mg among women of reproductive age.</p><p><strong>Methods: </strong>The review was conducted using multiple data sources including PubMed, CINAHL, Web of Science, The Cochrane Library, Google Scholar, Ovid Medline, EMBASE, POPLINE, Global Health/EBSCO, Scopus, WHO Global Index Medicus, International Clinical Trials Registry Platform (ICTRP), Global Index Medicus - WHO, African Index Medicus (AIM), ScienceDirect, Public Library of Science (PLOS), BioMed Central, Dryad and JSTOR. Search terms included DMPA, SC-DMPA, depot medroxyprogesterone acetate, ovulation, pregnancy, Depo Provera, return to ovulation, fertility, return to fertility, subcutaneous and SubQ. We included studies that used the standard and not experimental dosing of DMPA SC.</p><p><strong>Results: </strong>Four of the 31 articles met the inclusion criteria. The trials compared DMPA SC 104 mg with intramuscular DMPA (DMPA IM) at various dosages and routes. Follow-up varied from 7.5 to 18 months after the last injection. Median time to ovulation for DMPA SC was 212 days and was not statistically significantly different from DMPA IM 150 mg (183 days). There were no differences in time to ovulation by region, body mass index or age. No studies reported on time to pregnancy, effect of duration or frequency of dosing.</p><p><strong>Conclusions: </strong>Median time to ovulation for DMPA SC 104 mg of 212 days was similar to that of DMPA IM 150 mg of 183 days, suggesting that choice of formulation (SC vs IM) does not impact the timeline for return to fertility.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s52-s59"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety of intrauterine devices during breastfeeding: an updated systematic review.","authors":"Angeline Ti, Sylvia Ayieko, Mary E Gaffield, Moazzam Ali","doi":"10.1136/bmjsrh-2025-202838","DOIUrl":"10.1136/bmjsrh-2025-202838","url":null,"abstract":"<p><strong>Objectives: </strong>To update a 2016 review and answer three questions: (1) Among women using an intrauterine device (IUD), does breastfeeding increase the risk of adverse events? (2) Among breastfeeding women, does IUD use increase the risk of adverse events? (3) Among breastfeeding women, does copper (Cu)-IUD use increase risk of adverse breastfeeding or infant outcomes?</p><p><strong>Methods: </strong>We searched multiple databases from inception to August 2023. We extracted prespecified data and assessed risk of bias (RoB) for each article and certainty of evidence for each outcome.</p><p><strong>Results: </strong>Thirty-eight articles met the inclusion criteria; 16 were newly identified since the previous review, most with high RoB. Evidence suggested no effect of breastfeeding on IUD-related adverse events (ie, expulsion, bleeding, pain and infection) compared with not breastfeeding; however, an increased relative risk of perforation was observed with breastfeeding at the time of IUD insertion compared with not breastfeeding. For perforation, relative measures of association ranged from 1.4 to 10.1, and absolute rates varied (eg, 0.6-7% or 6.8 per 1000). Evidence suggested no effect of IUD use on risk of adverse events (ie, bleeding, pain and infection) among breastfeeding women compared with no IUD use. Evidence suggested no effect of Cu-IUD use on breastfeeding or infant outcomes among breastfeeding women compared with no Cu-IUD use.</p><p><strong>Conclusions: </strong>We continued to find an increased relative risk of IUD perforation among breastfeeding women compared with no breastfeeding; however, the absolute risk is low. No other adverse effects with IUD use and breastfeeding were observed. The certainty of evidence for all outcomes was very low.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"51 Suppl 1","pages":"s18-s29"},"PeriodicalIF":2.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145437437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}