HER HEALTH FORUM WOMEN’S HEALTH UNVEILED: INSIGHTS INTO HORMONAL SHIFTS AND UNPLANNED PREGNANCY
05 Sep 2025
Across a woman’s life, she undergoes multiple stages and
challenges in her reproductive cycle. In a health forum organized by Organon on
March 28, 2025, Dr Eileen Manalo and Dr Bernabe Reyes Marinduque discussed important
aspects of unintended pregnancies (UIP), contraception and polycystic ovarian
syndrome (PCOS).
The burden of unintended pregnancies (UIP)
Dr Marinduque began his discussion by sharing three cases he encountered in his practice. The common denominator was the challenge of limited access to adequate information and resources in the Philippines in aiding and mitigating unintended pregnancies. His lecture discussed strategies in preventing UIP and emphasizing the integration of family planning (FP) into healthcare services.
UIP is classified as either mistimed, where pregnancy occurs earlier than planned and unwanted, where pregnancy is not desired at all. FP is a vital tool in helping women take control of their choices and plan pregnancies according to their readiness.1
In the Philippines, there is a total FP demand among 12 million women. However, there are around 5 million women of reproductive age who still rely on traditional FP or are not using modern birth control.1,2
From 2017 to 2019, maternal mortality increased (Figure 2). Yet, FP has contributed significantly to reducing its impact, helping to prevent over 3 million UIP and averting 810 maternal deaths during that period.2,3 Despite this, 51% of pregnancies in the country remain unintended. Notably, among women who visit healthcare providers for various concerns, only 3% of those who wish to delay or limit pregnancy receive family planning counseling. Additionally, 36 out of every 1,000 Filipino girls aged 15 to 19 have already given birth.1,4
Dr Marinduque stresses that UIP affects women and their child in multiple aspects - physical, emotional, social, and financial. Health risks include an increased likelihood of maternal complications, low birth weight, prematurity, and severe neonatal conditions. Socially and economically, it can disrupt a woman’s education, limit future opportunities, contribute to social stigma, and perpetuate cycles of poverty. These consequences can have lasting psychological effects on both the woman and her family.4
Addressing UIP involves expanding access to comprehensive sexual and reproductive services and addressing barriers to access. Key strategies include:4
- Integrating sexual reproductive health (SRH) packages in universal health care
- Improving systems to ensure coverage for the vulnerable populations
- Strengthening both preservice and in-service FP training
-Supporting women currently using FP methods
Additionally, promoting health literacy is crucial. This includes implementing comprehensive sexuality education (CSE) and integrating FP into routine care—such as antenatal, postpartum, post-abortion services, and well-woman visits.4
Finally, driving positive behavior change among women is essential. This involves educating them about their SRH rights, empowering them to make informed reproductive decisions, fostering autonomy, and building confidence through initiatives that support self-efficacy.4
Dr Marinduque concluded by urging healthcare providers to routinely discuss reproductive intentions during consultations and provide appropriate contraceptive counseling for women not seeking pregnancy.
Understanding hormonal transitions and PCOS
Dr Manalo shifted the discussion to hormonal health, beginning with the importance of family planning in enabling women to make informed reproductive decisions. She presented a case study of an 18-year-old student seeking contraceptive advice who was subsequently diagnosed with abnormal uterine bleeding (AUB) secondary to ovulatory dysfunction, PCOS, and obesity.
In the diagnosis of abnormal uterine bleeding the FIGO classification system has been a vital tool, which distinguishes structural from non-structural causes of AUB.5 The 2022 update introduced the HyPo-P framework, further categorizing ovulatory dysfunction into hypothalamic, pituitary, ovarian, and PCOS etiology (figure 3).6
PCOS, affecting 10-13% of reproductive-aged women, was discussed in detail. Diagnosis follows the Rotterdam criteria requiring at least two of three features (table 1).7,8 PCOS is associated with significant reproductive, metabolic, and psychological complications.9
Management of PCOS begins with lifestyle modifications including 5-10% weight loss and regular physical activity. For menstrual irregularities in women not seeking pregnancy, low-dose combined oral contraceptives (COCs) are recommended, with cyclic progestogens as alternatives.8
COCs contain both estrogen and progestin components. They are classified based on the type of progestin and are prescribed according to the desired therapeutic effects and the risk of adverse events associated with the specific progestin, as well as the estrogen dose. Progestins differ in their androgenic and progestogenic activity (table 2).9,10
The ethinyl estradiol (EE) dose in COCs varies (table 3). COCs may be, monophasic, with consistent doses of estrogen and progestin in all active pills or multiphasic, with varying doses of one or both hormones across the cycle.9
Depending on patient preference and clinical guidance, COCs can be taken in the various regimens (table 4).9 The cyclic regimen typically involves 21–24 days of active pills followed by 4–7 days of placebo.9,11
Multiple studies have demonstrated the efficacy of progestins combined with 20 mcg of EE. These studies showed efficacious contraception without serious side effects and minimal reports of minor side effects of a combination of 20mcg of EE with either desogestrel or gestodene.12-14
For non-contraceptive indications such as PCOS management, current guidelines recommend initiating therapy with the lowest effective estrogen dose, typically 20-30 mcg of EE. While no specific COC formulation demonstrates clear superiority for PCOS treatment, the addition of metformin should be considered for adolescents with BMI > 25 kg/m² who show inadequate response to COCs and lifestyle modifications, and in patients with high metabolic risk factors such as diabetes.8
Aside from its contraceptive use, desogestrel-containing COCs also reduces incidence and severity of dysmenorrhea and its impact on daily activities. Women requiring analgesics decreased from 100% to 41% and interference in daily activities reduced from 73% to only 10%.15
Lastly, regarding long-term use, current evidence supports COC continuation until menopause in healthy, non-smoking women without contraindications. COCs maintain bone mineral density in women with normal ovarian function, addressing previous concerns about potential skeletal effects.16
Dr Manalo concludes the discussion with several key practice points for managing reproductive-aged women:
1. Comprehensive assessment should address both contraceptive and non-contraceptive health concerns, with particular attention to menstrual cycle characteristics and reproductive plans.
2. Routine visits should include discussion of short- and long-term pregnancy intentions, as these may evolve over time and influence therapeutic choices.
3. Low-dose COCs represent a valuable option for many patients, requiring thorough counseling about proper use, potential side effects, and non-contraceptive benefits.
4. Shared decision-making should guide contraceptive selection, considering individual risk factors, preferences, and therapeutic goals.
Conclusion
The forum emphasized the vital connection between comprehensive reproductive healthcare and women’s overall well-being, stressing the need for accessible family planning services, informed contraceptive choices, and personalized PCOS management. Addressing the Philippines’ high UIP rate and hormonal health challenges requires integrating reproductive health discussions into routine care, expanding education on contraceptive options, and adopting evidence-based approaches like low-dose COCs for both contraception and PCOS treatment. By empowering women through patient-centered counseling and collaborative healthcare efforts, we can improve reproductive autonomy, reduce unintended pregnancies, and enhance long-term health outcomes, ensuring women receive the support they need at every stage of their reproductive lives.
The burden of unintended pregnancies (UIP)
Dr Marinduque began his discussion by sharing three cases he encountered in his practice. The common denominator was the challenge of limited access to adequate information and resources in the Philippines in aiding and mitigating unintended pregnancies. His lecture discussed strategies in preventing UIP and emphasizing the integration of family planning (FP) into healthcare services.
UIP is classified as either mistimed, where pregnancy occurs earlier than planned and unwanted, where pregnancy is not desired at all. FP is a vital tool in helping women take control of their choices and plan pregnancies according to their readiness.1
In the Philippines, there is a total FP demand among 12 million women. However, there are around 5 million women of reproductive age who still rely on traditional FP or are not using modern birth control.1,2
From 2017 to 2019, maternal mortality increased (Figure 2). Yet, FP has contributed significantly to reducing its impact, helping to prevent over 3 million UIP and averting 810 maternal deaths during that period.2,3 Despite this, 51% of pregnancies in the country remain unintended. Notably, among women who visit healthcare providers for various concerns, only 3% of those who wish to delay or limit pregnancy receive family planning counseling. Additionally, 36 out of every 1,000 Filipino girls aged 15 to 19 have already given birth.1,4
Dr Marinduque stresses that UIP affects women and their child in multiple aspects - physical, emotional, social, and financial. Health risks include an increased likelihood of maternal complications, low birth weight, prematurity, and severe neonatal conditions. Socially and economically, it can disrupt a woman’s education, limit future opportunities, contribute to social stigma, and perpetuate cycles of poverty. These consequences can have lasting psychological effects on both the woman and her family.4
Addressing UIP involves expanding access to comprehensive sexual and reproductive services and addressing barriers to access. Key strategies include:4
- Integrating sexual reproductive health (SRH) packages in universal health care
- Improving systems to ensure coverage for the vulnerable populations
- Strengthening both preservice and in-service FP training
-Supporting women currently using FP methods
Additionally, promoting health literacy is crucial. This includes implementing comprehensive sexuality education (CSE) and integrating FP into routine care—such as antenatal, postpartum, post-abortion services, and well-woman visits.4
Finally, driving positive behavior change among women is essential. This involves educating them about their SRH rights, empowering them to make informed reproductive decisions, fostering autonomy, and building confidence through initiatives that support self-efficacy.4
Dr Marinduque concluded by urging healthcare providers to routinely discuss reproductive intentions during consultations and provide appropriate contraceptive counseling for women not seeking pregnancy.
Understanding hormonal transitions and PCOS
Dr Manalo shifted the discussion to hormonal health, beginning with the importance of family planning in enabling women to make informed reproductive decisions. She presented a case study of an 18-year-old student seeking contraceptive advice who was subsequently diagnosed with abnormal uterine bleeding (AUB) secondary to ovulatory dysfunction, PCOS, and obesity.
In the diagnosis of abnormal uterine bleeding the FIGO classification system has been a vital tool, which distinguishes structural from non-structural causes of AUB.5 The 2022 update introduced the HyPo-P framework, further categorizing ovulatory dysfunction into hypothalamic, pituitary, ovarian, and PCOS etiology (figure 3).6
PCOS, affecting 10-13% of reproductive-aged women, was discussed in detail. Diagnosis follows the Rotterdam criteria requiring at least two of three features (table 1).7,8 PCOS is associated with significant reproductive, metabolic, and psychological complications.9
Management of PCOS begins with lifestyle modifications including 5-10% weight loss and regular physical activity. For menstrual irregularities in women not seeking pregnancy, low-dose combined oral contraceptives (COCs) are recommended, with cyclic progestogens as alternatives.8
COCs contain both estrogen and progestin components. They are classified based on the type of progestin and are prescribed according to the desired therapeutic effects and the risk of adverse events associated with the specific progestin, as well as the estrogen dose. Progestins differ in their androgenic and progestogenic activity (table 2).9,10
The ethinyl estradiol (EE) dose in COCs varies (table 3). COCs may be, monophasic, with consistent doses of estrogen and progestin in all active pills or multiphasic, with varying doses of one or both hormones across the cycle.9
Depending on patient preference and clinical guidance, COCs can be taken in the various regimens (table 4).9 The cyclic regimen typically involves 21–24 days of active pills followed by 4–7 days of placebo.9,11
Multiple studies have demonstrated the efficacy of progestins combined with 20 mcg of EE. These studies showed efficacious contraception without serious side effects and minimal reports of minor side effects of a combination of 20mcg of EE with either desogestrel or gestodene.12-14
For non-contraceptive indications such as PCOS management, current guidelines recommend initiating therapy with the lowest effective estrogen dose, typically 20-30 mcg of EE. While no specific COC formulation demonstrates clear superiority for PCOS treatment, the addition of metformin should be considered for adolescents with BMI > 25 kg/m² who show inadequate response to COCs and lifestyle modifications, and in patients with high metabolic risk factors such as diabetes.8
Aside from its contraceptive use, desogestrel-containing COCs also reduces incidence and severity of dysmenorrhea and its impact on daily activities. Women requiring analgesics decreased from 100% to 41% and interference in daily activities reduced from 73% to only 10%.15
Lastly, regarding long-term use, current evidence supports COC continuation until menopause in healthy, non-smoking women without contraindications. COCs maintain bone mineral density in women with normal ovarian function, addressing previous concerns about potential skeletal effects.16
Dr Manalo concludes the discussion with several key practice points for managing reproductive-aged women:
1. Comprehensive assessment should address both contraceptive and non-contraceptive health concerns, with particular attention to menstrual cycle characteristics and reproductive plans.
2. Routine visits should include discussion of short- and long-term pregnancy intentions, as these may evolve over time and influence therapeutic choices.
3. Low-dose COCs represent a valuable option for many patients, requiring thorough counseling about proper use, potential side effects, and non-contraceptive benefits.
4. Shared decision-making should guide contraceptive selection, considering individual risk factors, preferences, and therapeutic goals.
Conclusion
The forum emphasized the vital connection between comprehensive reproductive healthcare and women’s overall well-being, stressing the need for accessible family planning services, informed contraceptive choices, and personalized PCOS management. Addressing the Philippines’ high UIP rate and hormonal health challenges requires integrating reproductive health discussions into routine care, expanding education on contraceptive options, and adopting evidence-based approaches like low-dose COCs for both contraception and PCOS treatment. By empowering women through patient-centered counseling and collaborative healthcare efforts, we can improve reproductive autonomy, reduce unintended pregnancies, and enhance long-term health outcomes, ensuring women receive the support they need at every stage of their reproductive lives.