An evolutionary medicine perspective on the design of non-hormonal contraceptives for women.

Evolutionary mismatches between the reproductive life histories of women in industrialized societies and their Paleolithic ancestors are established risk factors for gynecological pathologies and breast cancer. In contemporary women, these include earlier menarche, delayed first full-term pregnancy, and reduced or absent lactation. Hormonal contraceptives lower the risks of ovarian and endometrial cancers by suppressing ovulation and modulating menstruation, and next-generation female contraceptives, including non-hormonal approaches, should aim to retain these non-contraceptive benefits. With careful design, non-hormonal contraceptives could further improve outcomes by reducing breast cancer risk, which may be variably elevated with oral contraceptive use. Importantly, these principles also have implications for male contraception, where preserving endocrine balance while achieving effective fertility control remains a central challenge. Evolutionary medicine provides a useful framework for developing contraceptives that optimize both reproductive and long-term health outcomes.