Alison Edelman

Acne vulgaris commonly presents in early adolescence with the onset of adrenarche. Treatments for acne in this age group typically mirror those in older adolescents. However, while combined oral contraceptives are an effective hormonal treatment for acne vulgaris in young women, the safety of using a systemic hormonal therapy in younger patients for the management of acne has not been established. Concerns include effects on pubertal development and weight, bone health, cancer risks, and psychiatric effects. This Pediatric Dermatology Research Alliance (PeDRA) consensus project convened a multidisciplinary work group to address these issues and, utilizing a modified Delphi process, to establish best practices regarding the use of combined oral contraceptives in patients under 16 years of age based on available evidence and expert opinion.

Background: 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. Objectives: To evaluate the effectiveness, safety and acceptability of mifepristone compared with other EC methods among reproductive-age women. Methods: 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). Results: 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. Conclusions: 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.

Objective: To address the need for improved measurement of the ways contraception impacts the baseline menstrual cycle (i.e., contraceptive-induced menstrual changes; CIMCs) by assembling an interdisciplinary, global research collective to rigorously develop a person-centered measure for CIMCs in multiple languages. As the first step, this paper reports on our conceptual model development, which is the foundation for ongoing measure development. Study design: We conducted 18 focus groups with 106 people experiencing CIMCs while using hormonal or intrauterine contraception in Durban, South Africa, Santo Domingo, Dominican Republic, and Portland Oregon, United States. We used a virtual affinity mapping approach to analyze qualitative data, which was the basis of our conceptual model along with relevant theory and related models in the literature. Results: The conceptual model of experiences with CIMCs depicts the baseline menstrual cycle, including CIMCs and conceptually-linked effects and the impacts and perceptions of those CIMCs. We found key domains of changes in pain, bleeding volume, bleeding patterns, and characteristics of blood. Conclusion: Our CIMC conceptual model will inform development of a measure with evidence of validation across three language and global contexts. Adoption of a person-centered, standardized CIMC measurement across trials will improve knowledge and decision-making between methods. Implications: Defining an evidenced-based conceptual model for CIMCs expands our understanding of how contraceptive users experience and understand menstruation and CIMCs. We can use this model to improve and standardize measurement of CIMCs.

Despite known hormonal influences on immune function, the impact of menstrual cycle phase on vaccine side effects and subsequent infection risk remains unexplored. We used prospectively tracked cycle data from the period tracking app, Clue, matched with an in-app vaccine survey conducted between November 2021 and February 2022. In a sample of 1,474 cycling women, we compared reported side effect and post-vaccination infection outcomes of women vaccinated in the estrogen-dominant follicular phase of their cycle, with those vaccinated in the progesterone-dominant luteal phase. Side effect presence, severity and number were analysed using binary, ordinal, and negative binomial regression models respectively. Post vaccination time to infection (over 67-372 days of follow-up) was compared between the two groups using Wilcoxon rank-sum test and a Cox proportional hazards model. Follicular-phase vaccination was associated with 35% higher odds of reporting any side effects (OR: 1.35, 95% CI: 1.05–1.66) compared to luteal-phase vaccination. The association remained significant after excluding individuals vaccinated during the bleed phase, and the perimenstrual phase, indicating that hormonal environment, rather than inflammation caused by menstruation or premenstrual symptoms, may drive the association. Median time to infection was 35 days longer for those vaccinated in the follicular phase (Follicular: 200 (140,237) Luteal 165 (107, 2107), p = 0.05), suggesting potential longer-lasting protection from the vaccine. These findings suggest that menstrual cycle phase should be considered when studying sex-based immune differences and may inform future research on vaccination timing and personalised health strategies.

Through the examination of scientific evidence related to human embryo development, the aim of this commentary is to support the right to science in sexual and reproductive health, to outline why science supports a legal approach to embryos as the biological material of human life but not as human persons, and to recognise that international human rights law adopts this approach in the protection of sexual and reproductive health and rights.

Background: 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. Methods: 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. Results: 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. Conclusions: 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.