BMJ Sexual & Reproductive Health最新文献

{"title":"WHO guidelines to support expansion of contraceptive methods and alternative contraceptive usage practices into the contraceptive method mix of national family planning programmes.","authors":"Nancy Kidula, Asantesana Kamuyango, James N Kiarie","doi":"10.1136/bmjsrh-2026-203333","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203333","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"52 Suppl 2","pages":"s1-s2"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029723","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":"Effectiveness, safety and acceptability of mifepristone compared with other interventions in reproductive-age women using emergency contraception for the prevention of pregnancy: a systematic review and meta-analysis.","authors":"Shaalini Ramanadhan, Alison Edelman, Yan Che, Robin Paynter, Alyssa Hersh, Jillian T Henderson","doi":"10.1136/bmjsrh-2026-203328","DOIUrl":"10.1136/bmjsrh-2026-203328","url":null,"abstract":"<p><strong>Background: </strong>Emergency contraception (EC) prevents pregnancy after unprotected sexual intercourse using oral medications or intrauterine devices. Comparative evidence on effectiveness and safety is essential to inform emergency contraceptive counselling.</p><p><strong>Objectives: </strong>To evaluate the effectiveness, safety and acceptability of mifepristone compared with other EC methods among reproductive-age women.</p><p><strong>Methods: </strong>We searched CENTRAL, MEDLINE, Embase, Global Index Medicus, Scopus conference abstracts, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform through 28 February 2025. Randomised controlled trials enrolling women within 5 days of unprotected sexual intercourse and comparing mifepristone with oral EC methods (levonorgestrel (LNG), Yuzpe regimen, ulipristal acetate) or intrauterine devices (IUDs) (copper or LNG) were included. Pregnancy was the primary outcome. Risk of bias was assessed using the Risk of Bias 1 (RoB 1) tool. Meta-analyses used fixed or random-effects models and certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).</p><p><strong>Results: </strong>Eighty-seven trials including approximately 36 000 participants were analysed. Mifepristone reduced pregnancy risk compared with the Yuzpe regimen (risk ratio (RR) 0.14, 95% CI 0.05 to 0.41; moderate-certainty evidence). It was more effective compared with LNG with either low-dose (<25 mg; RR 0.73, 95% CI 0.59 to 0.90; high-certainty) or mid-dose (25-50 mg; RR 0.67, 95% CI 0.49 to 0.91; moderate-certainty) levels. Evidence was inconclusive regarding comparisons with the copper IUD. Mifepristone causes less nausea and vomiting than Yuzpe. Mifepristone increases the risk of delayed menses relative to both Yuzpe and LNG.</p><p><strong>Conclusions: </strong>Mifepristone is an effective emergency contraceptive, potentially more effective than commonly used oral EC methods, with a favourable side effect profile aside from delayed menstruation.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"52 Suppl 2","pages":"s3-s12"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029572","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":"Efficacy, safety and acceptability of once-monthly oral contraceptives containing quinestrol and quingestanol, quinestrol and levonorgestrel or quinestrol and norgestrel: a systematic review.","authors":"Yuanyuan Yao, Hui Liu, Bingyi Wang, Meihua Wu, Huayu Zhang, Haodong Li, Qi Wang, Liu Yang, Nancy Santesso, Asantesana Kamuyango, Nancy Kidula, James N Kiarie, Yaolong Chen","doi":"10.1136/bmjsrh-2026-203330","DOIUrl":"10.1136/bmjsrh-2026-203330","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy, safety and acceptability of quinestrol combined with quingestanol (Quin-QUIN), quinestrol combined with levonorgestrel (Quin-LNG) and quinestrol combined with norgestrel (Quin-NG) as contraceptives.</p><p><strong>Methods: </strong>PubMed, Web of Science Core Collection, Embase, CENTRAL, CINAHL, CNKI, Wanfang, SinoMed and selected supplementary sources were systematically searched to identify randomised controlled trials (RCTs) and non-randomised studies of interventions related to Quin-QUIN, Quin-LNG and Quin-NG. Two investigators independently performed data extraction and risk-of-bias assessment. A random-effects model was used for the meta-analysis and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Twelve studies (1 RCT and 11 case series) involving 5355 participants were included. Most studies were published in the 1970s. The only included RCT showed no significant difference in the risk of pregnancy (risk ratio (RR)=0.70, 95% confidence interval (CI) 0.31 to 1.55 for Quin-LNG compared with Quin-NG). Quin-LNG was associated with a lower risk of discontinuation and fewer side effects than Quin-NG. Proportion meta-analyses of the case series, all evaluating Quin-QUIN, found a pooled proportion of pregnancy of 3.6% (95% CI 2.5% to 5.0%) and a pooled discontinuation rate of 47.9% (95% CI 17.4% to 79.4%). Nausea, vomiting, dizziness and headache were the most common side effects. The certainty of evidence for most outcomes was low or very low.</p><p><strong>Conclusions: </strong>Available evidence is limited; the risk-benefit profile of quinestrol-based once-monthly oral contraceptives remains uncertain. Their clinical use should be cautious, and high-quality studies are needed to clarify their safety and efficacy.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"52 Suppl 2","pages":"s23-s32"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029746","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":"Contraceptive effectiveness and safety of ormeloxifene: a systematic review.","authors":"Tesfaye Tufa, Muhammad Idrees, Goodness Ogeyi Odey, Asantesana Kamuyango, Nancy Kidula, Mojisola Alere, Komal Preet Allagh, Rita Kabra, Julie Thorne, James Kiarie","doi":"10.1136/bmjsrh-2026-203329","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203329","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review the contraceptive safety and effectiveness of ormeloxifene, a non-hormonal selective oestrogen receptor modulator, among reproductive-age women.</p><p><strong>Methods: </strong>A comprehensive search was performed across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. No restrictions were applied regarding language, geography or publication year. Eligible studies included interventional and observational designs that evaluated the contraceptive effectiveness and/or safety of ormeloxifene. Two reviewers independently extracted data using a standardised form, assessed the risk of bias for individual studies, and graded the certainty of evidence using design-appropriate tools.</p><p><strong>Results: </strong>The review included 14 studies on contraceptive use of ormeloxifene and 41 studies assessing its safety in non-contraceptive contexts. Twelve contraceptive studies reported Pearl Indices ranging from 0.48 to 4.2 per 100 woman-years, with failure rates between 0.8% and 10.1%. No serious adverse events such as thromboembolism or hepatotoxicity were reported. Two cases of benign endometrial hyperplasia were reported, and transient reductions in lactation were noted among 5.7% of women at 1 month, decreasing to 2% at 6 months among women using ormeloxifene as contraception. Infant exposure during breastfeeding remained below 10% of the maternal dose. The most common side effects were menstrual irregularities, leading to discontinuation in up to 31.5% of users. Continuation rates were high at 3-6 months (>85-100%), declining to 27-91% in larger cohorts involving longer follow-up extending beyond 12 months. Method satisfaction was consistently high (75-95%). All 14 studies on contraceptive use were conducted in India, had a high risk of bias, and only four were multicentre studies.</p><p><strong>Conclusions: </strong>Ormeloxifene shows promise as a moderately effective, safe and user-acceptable contraceptive option. The current evidence is limited by methodological weaknesses and geographic concentration. High-quality, large-scale studies in diverse populations are essential to establish ormeloxifene's comparative effectiveness and safety with greater certainty and support its inclusion in global contraceptive guidelines.</p><p><strong>Prospero registration number: </strong>CRD42024622516.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"52 Suppl 2","pages":"s13-s22"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029573","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":"Efficacy, safety and acceptability of the use of 68 mg etonogestrel contraceptive subdermal implant for up to 5 years compared with up to 3 years: a systematic review.","authors":"Jessica Chen, Jen Sothornwit, Asantesana Kamuyango, Nancy Kidula, James Kiarie, Melanie Cedrone, Nancy Santesso, Sarita Sonalkar","doi":"10.1136/bmjsrh-2026-203332","DOIUrl":"10.1136/bmjsrh-2026-203332","url":null,"abstract":"<p><strong>Background: </strong>Prolonging the use of the etonogestrel (ENG) implant beyond the currently approved duration of 3 years could offer substantial benefits including improved accessibility, reduced need for replacements and overall lower healthcare costs. The purpose of this systematic review is to examine the current evidence regarding the effectiveness, safety and acceptability of the use of the ENG implant for up to 5 years.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Scopus, Global Health, CINAHL, ClinicalTrials.gov, Global Index Medicus, Cochrane Central Register of Controlled Trials and International Clinical Trials Registry Platform from 1996 to 2024. Our study population included reproductive-aged women using the 68 mg single-rod ENG contraceptive implant. We included randomised controlled trials, retrospective and prospective cohort studies, case-control studies and conference presentations. Outcomes included those related to efficacy, safety and acceptability. The primary contraceptive efficacy outcome was Pearl Index between the third and fifth years of placement compared to that within 3 years.</p><p><strong>Results: </strong>We identified seven relevant studies. No pregnancies were noted among 860 participants within years 3-4 or among 306 participants within years 4-5. No important safety events were identified. Discontinuation of the implant due to bleeding was higher in the first 3 years of use (20.6%), compared with years 3-5 (5.4%). Due to the non-comparative nature of the studies and the overall low sample sizes of the studies, evidence certainty was deemed to be low or very low using the GRADE criteria.</p><p><strong>Conclusions: </strong>Current evidence, despite its low certainty, does not carry signals of potential concerns with regard to extended use, with potential for benefit.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":"52 Suppl 2","pages":"s49-s56"},"PeriodicalIF":3.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029675","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":"Retirement: what's in a word?","authors":"Paul D Blumenthal","doi":"10.1136/bmjsrh-2026-203474","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203474","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928919","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":"Postpartum contraception information and resources: what do migrant and refugee women in Australia want?","authors":"Jessica R Botfield, Jenna Perkins, Ana Romero, Sharon Cameron, Danielle Mazza, Kirsten I Black, Delaram Ansari","doi":"10.1136/bmjsrh-2026-203265","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203265","url":null,"abstract":"<p><strong>Background: </strong>Although closely spaced and unintended pregnancies can occur among all women, women from migrant and refugee backgrounds may experience these at higher rates. Access to high-quality, culturally responsive information regarding fertility return and postpartum contraception is essential for supporting informed decision-making. However, limited research has examined the related information needs of migrant and refugee women.</p><p><strong>Methods: </strong>We undertook an exploratory qualitative study with 17 English-speaking postpartum migrant and refugee women to better understand their experiences of and preferences for receiving postpartum contraception information. As part of their interview, participants were shown two educational contraception videos. Reflexive thematic analysis was used to construct themes.</p><p><strong>Results: </strong>No participant currently wanted to be pregnant; however, most were using condoms or no contraception. Knowledge of postpartum fertility return and contraception options was limited. Although desired, antenatal and postpartum education on fertility return and contraception had been provided to few of the women. Participants found the videos to be informative, culturally appropriate and visually engaging. Content considered important related to cost, effectiveness, side effects, where and how to access, and what is involved. Viewing short videos, along with provision of additional fertility and contraception information, was seen as especially valuable during pregnancy to support postpartum planning.</p><p><strong>Conclusions: </strong>Limited resources and inconsistent postpartum contraception discussions with maternity providers can hinder contraceptive choice and decision making for migrant and refugee women. Our study underscores the need for accessible, culturally responsive, plain English and in-language resources on fertility return and postpartum contraception, supported by routine discussions and timely access to contraception methods.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928909","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":"Sexual and reproductive health clinical consultations: sexual assault.","authors":"Hayley Webb, Jayne Kavanagh","doi":"10.1136/bmjsrh-2026-203317","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203317","url":null,"abstract":"","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928917","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":"Predictors and prediction models for complications of early medical abortion: a scoping review.","authors":"Angela Dawson, Fantu Mamo Aragaw, Deborah Bateson","doi":"10.1136/bmjsrh-2026-203390","DOIUrl":"https://doi.org/10.1136/bmjsrh-2026-203390","url":null,"abstract":"<p><strong>Background: </strong>Despite its overall safety and efficacy, early medical abortion (EMA) may result in complications. Understanding factors predicting these complications is essential for improving clinical risk assessment by healthcare providers and guiding effective management of complications associated with EMA. The purpose of this scoping review is to systematically map the existing evidence of predictors and prediction models of complications associated with EMA.</p><p><strong>Methods: </strong>We conducted a comprehensive literature search using databases with Embase (OVID), Medline (OVID), Scopus and Web of Science. Studies were included if they presented evidence on the predictors and prediction models of complications associated with EMA. Retrieved articles were screened using Covidence. A descriptive and narrative synthesis of the included studies was conducted to summarise findings across studies.</p><p><strong>Results: </strong>Thirteen studies were included in the final synthesis. Pain, incomplete abortion and retained products of conception, continuing pregnancy, heavy bleeding requiring transfusion and infection were the most frequently addressed complications associated with EMA. Gestational age was identified as a key determinant across major complications of EMA. Two studies included the development of a model to predict surgical intervention following EMA demonstrating moderate discriminatory performance (AUC 63%).</p><p><strong>Conclusions: </strong>This review highlights an evidence gap in the identification of predictors and the development of clinical prediction models for complications associated with EMA. Future research using larger prospective studies is needed to identify the predictors and develop individualised prediction models for assessing the risk of complications in patients undergoing EMA to support evidence-based clinical decision-making in post-abortion care.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891003","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":"Early medical abortion in Irish general practice: the Activity Data on Abortion in General Practice (ADAPT) data collection project and telemedicine as routine care.","authors":"Katelin Bratt, Danielle Young, Mary Favier, Patricia Horgan, Catherine Conlon, Mark Murphy","doi":"10.1136/bmjsrh-2026-203296","DOIUrl":"10.1136/bmjsrh-2026-203296","url":null,"abstract":"<p><strong>Background: </strong>Early medical abortion (EMA) in Ireland is delivered through general practitioners (GPs) operating within a nationally standardised, three-visit care protocol. Since 2020, a blended model has emerged in which the initial consultation and follow-up may be conducted by telemedicine, with in-person attendance required for medication administration. We describe the development and implementation of the Activity Data on Abortion in General Practice (ADAPT) data collection tool and present the first GP-level evidence on the integration of telemedicine into Irish GP-delivered EMA.</p><p><strong>Methods: </strong>ADAPT was developed in 2025 by a subcommittee of the Southern Taskforce on Abortion and Reproductive Topics (START) and researchers at Trinity College Dublin to fill a critical void in abortion data collection in Ireland. The tool collects 49 prospective anonymous patient- and practice-level measures. Descriptive, provider-level statistics were reviewed.</p><p><strong>Results: </strong>Between August 2025 and April 2026, 124 GPs expressed interest in ADAPT, 112 signed consent and data-sharing agreements and 64 submitted at least one complete patient record. Of these 64 GPs, 48.4% provided mixed (both remote and in-person) consultation modalities, 32.8% delivered fully in-person care and 18.8% provided fully remote care at Visit 1, with no significant differences by provider characteristics.</p><p><strong>Conclusions: </strong>ADAPT provides the first structured GP-level evidence base for EMA in Ireland. Our early data show that telemedicine is not a marginal or exceptional feature of Irish GP-delivered EMA: the majority of participating GPs offer it in some form.</p>","PeriodicalId":9219,"journal":{"name":"BMJ Sexual & Reproductive Health","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599318","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}