Contemporary OB/GYN week in review: Menstrual symptoms, cognitive decline, and more

Thank you for visiting the Contemporary OB/GYN® website. Take a look at some of our top stories from last week (Monday, April 14, 2025 - Friday, April 18, 2025), and click each link to read and watch anything you may have missed.

Mitchell Creinin, MD, reports estetrol pill eases menstrual symptoms

In a recent interview with Contemporary OB/GYN, Mitchell Creinin, MD, professor at University of California Davis Health, discussed a study evaluating the impact of estetrol combined with drospirenone, a novel oral contraceptive, on premenstrual and menstrual symptoms.

This was a planned secondary analysis of a phase 3 trial conducted in the United States and Canada, designed to assess not only contraceptive effectiveness but also the impact on menstrual complaints using the Menstrual Distress Questionnaire. A similar study had already been conducted and published in Europe and Russia. Due to demographic and clinical differences in the participant populations, the results were not pooled but analyzed separately.

The results showed that switchers generally reported low levels of menstrual distress at baseline, and those levels remained stable, indicating that switching to estetrol/drospirenone maintained their symptom relief. In contrast, starters showed a significant decrease in symptom intensity across key domains, particularly pain, water retention, and negative affect. Symptoms such as cramps, headaches, back pain, fatigue, swelling, tender breasts, anxiety, and irritability notably improved, with many showing at least a 40% reduction in severity.

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Early menopause linked to increased risk of cognitive decline

Women with early menopause are at an increased risk of 2-year follow-up cognitive decline, according to a recent study published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Women are disproportionately impacted by dementia compared to men, highlighting potential sex-specific risk factors. A link has also been established between early menopause and depression, which increases the risk of dementia. This led investigators to evaluate the association between early menopause and cognitive function.

“Since early menopause increases the risk of depression, which then increases the risk of dementia, we had to control for this factor to determine if early menopause in of itself was a direct risk factor,” said Miharu Nakanishi, PhD, lead author from the Tohoku University Graduate School of Medicine.

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Contraception for patients with mental health conditions

Mental health conditions affect about 1 in 7 people globally. Anxiety and depressive disorder account for most cases.

Reproductive-age females are more likely to be affected by depression and anxiety disorders than men, with an age-standardized prevalence of 24% among women vs 13.3% among men in the US. Those who are pregnant or who are recently in the postpartum period are increasingly at risk; depressive disorders diagnosed during US delivery hospitalizations increased 7-fold from 4.1 diagnoses per 1000 hospitalizations in 2000 to 28.7 diagnoses per 1000 hospitalizations in 2015.

Perinatal mental health conditions are associated with adverse outcomes for the pregnant or postpartum person as well as fetus, infant, partner, or family. Additionally, perinatal depression may signal a trajectory for chronic depression and its lasting implications.

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Outpatient cervical ripening with a Foley catheter

Labor induction is a common obstetric practice in the United States, occurring in 31.9% of deliveries in 2022. Elective induction rates have continued to rise since the publication of the results of the ARRIVE trial (NCT01990612) in 2018, which demonstrated a reduction in cesarean delivery and hypertensive disorders of pregnancy for low-risk nulliparous patients undergoing induction at 39 weeks.

The American College of Obstetricians and Gynecologists states that mechanical methods of outpatient labor induction may be an appropriate option in selected patient populations. Although a formal recommendation was not made, recent findings suggest this is a safe and effective alternative to inpatient practices.

Cervical ripening balloons apply direct pressure to the internal cervical os, causing endogenous prostaglandin release. A bladder catheter (Foley) or a commercial intracervical balloon (eg, Cook Cervical Ripening Balloon) can be used with similar efficacy, although the Foley catheter is often more readily available and considered more cost-effective.

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First baby born via fully automated ICSI system

The first baby was born using a fully automated, digitally controlled intracytoplasmic sperm injection (ICSI) system on April 10, 2025, as reported in Reproductive Biomedicine Online.

Jacques Cohen, PhD, embryologist at Conceivable Life Sciences, led a multidisciplinary team of specialists alongside others to develop the automated system. It was developed to automate all 23 steps of ICSI, with either artificial intelligence (AI) or a remote operator independently performing the steps.

“With AI, the system autonomously selects sperm and precisely immobilizes its midsection with a laser ready for injection - executing this rapid, precise process with a level of accuracy beyond human capability,” said Mendizabal-Ruiz, PhD, lead engineer professor and an additional study head.

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