Differences in cortisol responding and post-stress affiliation among women who are naturally cycling, using oral contraceptives, and using IUDs.

Sex - and its associated gonadal hormones - matters for binge eating (BE). On average, females report higher BE than males. Estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action such that their combined presence represents a high-risk hormonal milieu for BE. Testosterone is thought to be associated with increased BE in females but appears protective in males. Hormonal contraceptives (HCs) provide a naturalistic means to study the relation between gonadal hormones and BE, as HCs vary in formulations and delivery. Oral contraceptive (OC) use has been linked to greater BE-related appetitive processes (e.g., food intake); however, the association with BE itself has not been studied, and research has overlooked hormonal variation across OCs. No study has systematically examined BE and hormonal intrauterine devices (IUDs), which differ in formulation and delivery from other HCs. We explored hormone-BE links in 401 human females (181 naturally cycling (NC); 152 OC users; 53 IUD users) and 159 males aged 18-44 years. ANCOVA tested differences in Binge Eating Scale (BES) summary scores across sex and HC groups (NC, OC, and IUD). Hierarchical linear regressions examined relations between OC hormone activities and BES summary scores. Analyses controlled for BMI and age. In this sample, females reported higher BE than males, but BE did not differ across HC groups or vary with OC hormonal activities. Null results may reflect true group-level similarities in BE or individual differences in vulnerability to hormonal exposures. Further research should replicate and extend these findings to other samples and using other methodologies.

Patterns of contraceptive side-effect variation: Assessing medical and lifestyle factors associated with side-effects among those using hormonal contraception in the United Kingdom.

Combined hormonal contraception (CHC) is habitually not prescribed to breastfeeding women due to concerns of decreased milk production. This habit is based on inconclusive studies that examined lactation suppression of CHC with high-dose Ethinylestradiol (EE ≥ 30 µg/day). Notably, the effect of oral CHC with current low-dose EE (20 µg/day EE), and of vaginal rings (15 µg/day EE), has not yet been studied. Here, we examine their effect on breastmilk production. This study included 172 breastfeeding women, and evaluated self-reported breastmilk production, with and without hormonal contraception. Breastfeeding women using CHC with low-dose EE, either orally (N = 20), or vaginally (N = 32), were asked to complete a questionnaire, at two time-points: (1) Before starting CHC, and (2) some 7-10 days after. The questionnaire recorded 12 variables linked with breastfeeding. As a control group, breastfeeding women using progestin-only pills (POP, N = 54) with Desogestrel 75 µg/day, were used. As another control group, breastfeeding women using no hormonal contraception (N = 66) were also asked to complete the same questionnaire. Vaginal rings, but not oral CHC pills, containing low-dose EE, are associated with a reduction of self-reported expressed breastmilk volume by 20%. Likewise, vaginal rings, but not oral pills, are correlated with impairment of 5 out of 12 breastfeeding variables, namely: (1) breastfeeding interval, (2) self-expressed milk volume, (3) use of milk substitutes, (4) number of night-feedings, and (5) full diapers. Vaginal rings with low-dose EE (15 µg/day) are associated with a modest, yet significant, decrease in self-expressed breastmilk volume. In contrast, oral CHC pills with low-dose EE (20 µg/day) are not associated with a significant impact on breastmilk production. These findings may have clinical implications for prescribers and patients.

Lifespan exposure to hormone therapies and structural brain morphometry in older women.

Family planning and contraception are central to disease management in people with rheumatic musculoskeletal diseases (RMD), particularly systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), in whom unplanned pregnancy can carry substantial maternal and fetal risk. This review summarizes current evidence and guideline-based recommendations regarding contraceptive choices in women with SLE and APS, with a focus on thrombotic risk, bone health, and cardiovascular considerations. Estrogen-containing hormonal contraception is well established as a pro-thrombotic risk and should be avoided in those with APS, antiphospholipid antibodies (aPL), lupus nephritis, or at least moderately active SLE. Emerging data also suggest an association of certain higher dose progestins such as norethindrone acetate, and injectable preparations such as depot medroxyprogesterone acetate (DMPA), with increased venous thromboembolism (VTE) risk. Regarding bone health, oral contraceptive pills (OCPs) and combined hormonal contraception (CHC) may slow the rate of bone mass acquisition in adolescents with uncertain long-term effects on fracture risk, whereas use in adult women is associated with modestly higher bone mineral density and lower osteoporotic risk. While awareness of the importance of contraception in the rheumatology community is improving, real-world practice reveals that implementation of reproductive health guidelines is lagging. For women with SLE and APS, contraception selection must account for thrombotic risk, bone health, and cardiovascular comorbidities. Long-acting reversible contraceptives, particularly progestin-only intrauterine devices (IUDs) and subdermal implants, remain highly effective and well tolerated for those with SLE and APS. Ongoing efforts to improve guideline implementation, shared decision-making, and patient and provider education are essential to reduce unplanned pregnancies and optimize reproductive outcomes in this population.

Expert consensus on the obstetric management of pregnant patients with endometriosis: A modified Delphi study.

Hormonal contraceptives (HCs) are commonly used by reproductive-age women. Long-term HC can transiently suppress ovarian reserve markers such as anti-Müllerian hormone (AMH) and antral follicle count (AFC) across routes and preparations. Suppression can occur within weeks and, in some women, may persist for several months after cessation, resulting in false positive diagnoses of diminished ovarian reserve (DOR) or primary ovarian insufficiency (POI). In this Brief Communications piece, we highlight the challenges of accurately assessing ovarian reserve in long-term HC users and provide strategies to avoid erroneous diagnoses of DOR and POI, thereby mitigating unnecessary patient anxiety and financial cost.

Background: Female athletes face unique health challenges related to the menstrual cycle and hormonal contraceptives. Despite increased research, knowledge gaps persist, leading to inadequate training adaptations, underreported menstrual irregularities and insufficient support. Societal pressures and critical comments exacerbate body dissatisfaction and stress. The aim was to explore experiences of management regarding female health issues related to the menstrual cycle and hormonal contraceptives in Swedish female elite athletes from various sports. Methods A descriptive design with a qualitative inductive approach was used. Semi-structured interviews were conducted with 16 female elite athletes. Purposeful sampling ensured diversity in sport type, years of involvement, training hours, age and onset of menstruation. Qualitative content analysis was used, and an overarching theme, categories and subcategories were constructed based on the participants’ experiences and perceptions. Results An overarching theme, ‘A self-contained path towards optimization and awareness’, and five categories described the participants’ management: ‘Ignoring the symptoms’, ‘Eliminating the symptoms’, ‘Adaptation to the menstrual cycle’, ‘Taboos, security and communication’, and ‘Gaining knowledge and seeking support’. Twelve subcategories further illuminated these categories. The overarching theme reflected the athletes’ way of dealing with female health issues on their own due to lack of support, and the categories described how they handled the circumstances. Conclusion Although not all athletes experienced symptoms related to the menstrual cycle or hormonal contraception, many managed their menstrual health independently, highlighting the need for better education and support from coaches, medical teams and sports organisations. Future research should integrate menstrual health management into athlete development programs.

Combined oestrogen-progestin oral contraceptives are classified as hepatic carcinogens based largely on older studies of outdated formulations, creating uncertainty about risks of contemporary hormonal contraceptives. We conducted a Danish nationwide registry-based cohort study including 1,957,490 women aged 15 to 49 years followed from 1995 to 2021 to examine current hormonal contraceptive use and liver cancer risk. Use was assessed as a time-dependent exposure using prescription data, and cancer diagnoses were identified through Danish Cancer Registry. Adjusted incidence rate ratios (IRRs) were estimated using Poisson regression. During 24.5 million person-years of follow-up, 130 women developed liver cancer. Ever use of hormonal contraception was not associated with liver cancer risk (IRR = 0.76, 95% CI = 0.50 to 1.15), nor were current use, product type, duration, or time since last use. Findings suggest that contemporary hormonal contraceptives are not associated with increased liver cancer risk and support reassessment of existing carcinogenic classifications.

E-cigarette use (vaping) is rapidly increasing among women of reproductive age, with an estimated one in five women aged 15-45 now using e-cigarettes in England. Despite being promoted as a safer alternative to cigarettes, the reproductive health consequences of e-cigarettes remain poorly understood, despite products being on the market for 2 decades. This study aimed to investigate the association between e-cigarette use, cigarette smoking, and two hormonal markers of ovarian reserve in women of reproductive age. A cross-sectional analysis was conducted using data from 16,087 women aged 18-45 who accessed a private reproductive hormone testing service between 11/2022 and 02/2025. Women with pre-existing reproductive health conditions (including PMOS, endometriosis, POI, and hypothalamic amenorrhoea) and those using hormonal contraception were excluded, ensuring a reproductively healthy population for analysis. Self-reported vaping and smoking were primary exposures, captured as never, former, occasional, or current use. Serum AMH and FSH were measured via standardised immunoassay from capillary blood samples. Multiple linear regression with log-transformed outcomes was performed, adjusting for age, BMI, and ethnicity. Vaping and smoking were modelled simultaneously to account for overlap between the two behaviours. Current vaping was associated with 5.6% lower serum AMH compared to never-vapers (p=0.023), with no significant association observed for FSH. Current cigarette smoking was associated with a 9.4% reduction in AMH (p=0.005) and a 7.7% increase in FSH (p<0.001). Neither occasional nor former vaping or smoking was significantly associated with either marker. Sensitivity analyses excluding dual users of tobacco and e-cigarettes (n=64, 0.4% of sample) and excluding all former users produced consistent results. No significant interaction between smoking and vaping status was detected (p=0.271 for AMH; p=0.244 for FSH). In this large study of reproductively healthy women, current vape use was independently associated with lower AMH, a commonly used marker of ovarian reserve, after adjustment for smoking status and relevant confounders. These findings warrant further investigation, particularly given the widespread and growing use of e-cigarettes among women of reproductive age.

The effect of acute angiotensin receptor blockade on subjective and biological markers of stress response.

Quantitative research examining hormonal contraception and its relationship with health, particularly mental health and wellbeing, has been inconclusive with mixed evidence regarding the magnitude and direction of associations. Qualitative approaches that focus on women's perspectives and lived experiences may offer valuable insights into the inconsistent results reported. In the present study we take a qualitative approach to exploring the lived experiences of mental health and wellbeing among young women when using hormonal contraception. Data were collected as part of the Twins Early Development Study (TEDS) when participants were aged 26. A total of 5594 women completed a questionnaire assessing mental and physical health. At the end of a section of a series of closed questions about menstruation and hormonal contraception, 626 respondents answered an open-ended question in which they were invited to share their thoughts on their related experiences. Of these responses, 272 specifically addressed links between mental health, wellbeing, and hormonal contraception and were included in the final analysis. Responses were analysed using thematic analysis. Our analysis generated five themes representing positive, neutral, uncertain, and negative experiences of health and wellbeing whilst using hormonal contraception. The importance of choice and autonomy was emphasised. Many respondents reported feeling a lack of adequate care and support from healthcare professionals. Women report a range of experiences whilst using hormonal contraception that have positive and negative consequences on health and wellbeing. Healthcare providers should offer clear, detailed information and tailored support to women regarding the range of options available for hormonal contraception, and possible outcomes.

Flowing Differently: Exploratory Characterization of Menstrual Effluent Compared to Peripheral Blood.

Previous studies have suggested that the intrauterine system increases the risk of depression, particularly in adolescents. However, these studies relied on national registry data collected at a time when medical guidelines discouraged adolescent use of this contraceptive method. As a result, the adolescents who appeared in these registries represented an atypical group who had this contraceptive prescribed against medical recommendations. Consequently, unknown or unmeasured participant characteristics may have introduced confounding variables and influenced conclusions. Although prescription guidelines for intrauterine systems now include adolescents, selective prescribing may persist. If so, it could affect future studies on hormonal contraceptives, even though the decision is clinically sound. We thus aimed to explore current contraceptive prescription practices, investigating user characteristics, policies, and contextual factors that might influence prescribing the intrauterine system rather than other hormonal contraceptive products, or vice versa. We conducted focus group interviews with 23 healthcare professionals employed at six health centers in Norway, prescribing hormonal contraceptive drugs to adolescent women. We used thematic analysis to identify factors that can influence which products are recommended and requested. Our analysis generated three themes: "Old conceptions die hard" describes skepticism among family doctors and mothers regarding adolescent use of the intrauterine system, "Particular promotion of the intrauterine system to "vulnerable" adolescents" outlines the practice of healthcare professionals recommending this contraceptive method to individuals identified as vulnerable, and "What tips the scale: Pros, peeves and other people" discusses influences on adolescents' contraceptive choice. This exploratory study suggests that both prescription practices and personal preferences influence choice of contraceptive product, and that it is not arbitrary who has the intrauterine device inserted. Future quantitative research should incorporate the factors identified in this exploration, to minimize their confounding effects when aiming to draw causal conclusions on the effects of the intrauterine system on mental health.

Hormonal contraception has revolutionized women's reproductive control, yet its effects on romantic relationships are underexplored. We tested the Congruency Hypothesis, which predicts that changes in hormonal contraceptive (HC) use after forming a romantic relationship can reduce relationship quality. Using semi-representative samples from 51 countries (n = 10,482), we analyzed partnered women aged 45 or younger (n = 2,224) who reported HC use both when they met their partner and at the time of the study, and who rated their relationship satisfaction and intensity of the three components of love: Intimacy, Passion, and Commitment toward their partner. We found no robust support for the Congruency Hypothesis. However, in a weighted model, participants who changed their HC use pattern reported slightly lower Passion than those who consistently used (or consistently did not use) HC. Our study contributes to the growing body of research on the role of HCs by offering some reassurance: for most women, choosing or changing HCs is unlikely to meaningfully alter their relationship quality, including their experience of love and relationship satisfaction. We acknowledge, however, that our study was underpowered to detect very small effect sizes (e.g., r = .04) reported in a recent meta-analysis, and should therefore not be read as a definitive contribution in the ongoing debate. Although such small effects are generally considered practically negligible at the population level, they may nonetheless carry personal relevance for individual women.

Sport-related concussion (SRC) is a significant public health concern, warranting exploration of neuroimaging and fluid-based biomarkers as objective measures for diagnosis and prognosis. Sex differences in concussion outcomes may be influenced by the menstrual cycle, hormones, and hormonal contraceptives. Equitable representation of female athletes in emerging biomarker research is critical, but existing literature may not meet this need. This scoping review assessed neuroimaging and fluid-based biomarker research in SRC for inclusion and analysis of female athletes and to summarize female-specific and sex-difference results. Searches in MEDLINE, Scopus, Cochrane, and PsycInfo from January 2001 to July 2025 identified original research published in English and focused on SRC with neuroimaging or fluid-based biomarker assessment within 6 months after injury. Studies were then classified based on study sample sex/gender, and studies with female-specific and sex-difference results were further summarized. Literature review revealed underrepresentation of concussed female athletes in biomarker research, with over three times more concussed male athletes studied than concussed female athletes and approximately 19 times more male-only than female-only studies. Most mixed-sex studies did not explicitly investigate female-specific results. The 29 summarized reports indicate potential sex differences and different results for female athletes than those in the broader existing literature, although small sample sizes make definitive conclusions difficult. Addressing the knowledge gap in SRC in female athletes requires future biomarker research to include sufficient numbers of female athletes, analyze data to identify potential sex differences, and collect relevant data, including hormone levels and detailed menstrual cycle and hormonal contraceptive use information.

We aimed to estimate contraceptive claims prevalence among reproductive-aged women with selected autoimmune diseases compared with those without these conditions in 2019. Using IBM MarketScan Commercial Claims and Encounters and Multistate Medicaid databases, we analyzed permanent and prescription contraception claims prevalence among women aged 15-49 years with inflammatory bowel disease (IBD), multiple sclerosis (MS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and among women with these autoimmune diseases using selected fetotoxic medications. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) using Poisson regression. In 2019, most (60-75%) insured women with selected autoimmune diseases did not have contraception claims. Among commercially insured women, those with SLE were less likely to have claims for any method assessed (aPR = 0.90, 95% CI: 0.86-0.95), less likely to have combined hormonal contraceptives (CHC) claims (aPR = 0.65, 95% CI: 0.60-0.70), and more likely to have long-acting reversible contraceptives (LARC) claims (aPR = 1.14, 95% CI: 1.05-1.23) than women without selected autoimmune diseases. Among Medicaid-insured women, those with IBD, MS, RA, and SLE were more likely to have claims for any method assessed (aPR = 1.23-1.31) and LARC (aPR = 1.23-1.47) than women without selected autoimmune diseases. Women with SLE with lupus nephritis were less likely to have CHC claims (aPR = 0.56, 95% CI: 0.35-0.89) than females without selected autoimmune diseases. Among those using selected fetotoxic medications, 70.4% of commercially insured women and 72.2% of Medicaid-insured women did not have contraceptive claims in 2019. Less than half of the insured women with selected autoimmune diseases had permanent or prescription contraception claims in 2019.

Relative energy deficiency in sport (REDs) is linked to low energy availability, menstrual disturbances (MD) and low bone mineral density (BMD; Z-score < -1.0). The prevalence of these symptoms across sports and their interrelationships requires further investigation. This study aimed to 1) investigate the prevalence of severe MD and low BMD among athletes from different sports, 2) compare BMD Z-scores at lumbar spine, total hip and whole-body between regularly menstruating (RM), severe MD and hormonal contraceptive (HC) users, and 3) examine factors related to BMD among endurance athletes, including menstrual status, athletic caliber and sport-specific loading characteristics. Retrospective analysis of cross-sectional data from seven projects included 411 women from 34 sports (endurance: n = 257; non-endurance: n = 154). BMD was assessed using dual-energy X-ray absorptiometry. Menstrual status was defined by the three-step method, cycle tracking or questionnaire, and categorized as RM, severe MD or HC. Endurance sports were further grouped by loading characteristics (very low, low and medium). Among non-HC users (51%), the prevalence of severe MD was 37% in endurance, 34% in ball sport and 36% in power- and technical- sports. BMD was not different between menstrual status groups at either lumbar spine (P = 0.334), total hip (P = 0.079) or whole-body (P = 0.164). Endurance athletes had lower lumbar spine BMD Z-scores than non-endurance athletes (-0.0 ± 1.0 vs 1.2 ± 1.2, P < 0.0001), with a higher prevalence of low BMD (17% vs 2%, P = 0.015). Total hip BMD Z-scores were lower in endurance than non-endurance athletes (0.6 ± 0.9 vs 1.4 ± 1.2, P < 0.05 for age < 27). Among endurance athletes, neither loading characteristics nor athletic caliber were associated with BMD. However, endurance athletes with severe MD had lower total hip BMD Z-scores compared to RM athletes (P = 0.008) and HC users (P = 0.021). The prevalence of severe MD did not differ between sport types. Overall, BMD Z-scores did not differ across menstrual status categories. However, endurance athletes had lower BMD, with total hip BMD being lower in those with severe MD. Heterogenous menstrual assessment methods across the projects included in this study may have impacted the results. Future research should integrate comprehensive REDs assessments including detailed data on menstrual status, training history, bone-loading impact and injuries in female athletes from different sports.

Androgen receptor activation is involved in maintaining goal-directed behavior in levonorgestrel-treated female rats.