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Lindh I, Skjeldestad FE, Heikinheimo O, Hognert H, Lidegaard Ø, Bergh C, Gemzell-Danielsson K. Reproductive changes among women in their 40s: A cross-sectional study. Acta Obstet Gynecol Scand 2022; 101:248-255. [PMID: 34988971 DOI: 10.1111/aogs.14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim was to describe and compare changes in the reproductive pattern of women in their 40s observed over a decade in Scandinavia. MATERIAL AND METHODS Cross-sectional study using the total population of women aged 40-49 years between 2008-2018 in Denmark, Norway and Sweden (on average n = 1.5 million). Aggregated data concerning birth and induced abortion rate were collected and analyzed from national health registers. National data on redeemed prescriptions of hormonal contraceptives in the three countries were collected from prescription registers. Births after spontaneous and assisted conceptions were identified by using cross-linked data on deliveries from the Medical Birth Registers and National Registers of Assisted Reproduction in the three countries. RESULTS Use of hormonal contraception increased among women aged 40-44 years in Denmark from 24% to 31%, in Sweden from 27% to 30%, and in Norway from 22% to 24%. The levonorgestrel-releasing intrauterine device was the most frequently used method in all countries. Birth rates among women 40-44 years increased continuously from 9.5 to 12/1000 women in Denmark and from 11.7 to 14.3/1000 in Sweden, but remained stable in Norway at ~11/1000 women. There was a doubling of assisted conceptions in Denmark from 0.71 to 1.71/1000 women, Sweden from 0.43 to 0.81/1000 and Norway from 0.25 to 0.53/1000 women 40-49 years of age. Sweden had the highest induced abortion rate (7.7 to 8.1/1000 women) in women aged 40-49 years during the study period. CONCLUSIONS From 2008 to 2018, birth rates continuously increased among women aged 40-49 years in Denmark and Sweden and births resulting from assisted reproductive technology doubled in all three countries.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics and Gynecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Bergh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/ Karolinska University Hospital, Stockholm, Sweden
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Bond JC, Kachura JJ, Fox MP, Weuve J, Harlow BL. Potential for Selection Bias in Studies of the Association of Hormonal Contraception and Chronic Vulvar Pain. J Womens Health (Larchmt) 2022; 31:194-201. [PMID: 34190629 PMCID: PMC8864423 DOI: 10.1089/jwh.2020.8857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Hormonal contraceptive use is common among reproductive-aged women, but research evaluating its etiological relationship to vulvodynia remains mixed. We sought to evaluate this association and examine the potential for bias due to care-seeking behavior. Materials and Methods: We conducted a case-control study of women recruited from a large health care network database from 2008 to 2011. Of 26,455 eligible respondents, 1168 met the case definition for chronic vulvar pain (CVP). We matched each case to three controls by age and used conditional logistic regression to calculate odds ratios (ORs) for prior hormonal contraception (HC) use and CVP, stratifying cases by whether or not they sought care for their vulvar pain. We also simulated the influence of potential biases due to care seeking, using parameters based on this dataset. Results: HC users had higher odds of CVP (adjusted OR = 2.6, 95% confidence interval [CI]: 2.2-3.2). Effect estimates were stronger when cases were restricted to care seekers (adjusted OR = 2.9, 95% CI: 2.2-3.7). Effect estimates decreased slightly as time increased between HC initiation and pain onset. Our simulations suggested that effect estimates may be spuriously strengthened when cases are restricted to care-seeking women, but controls are recruited from the general population. Conclusions: Our results suggest an association between antecedent HC use and CVP that is potentially spuriously strengthened in case-control studies when cases are restricted to care seekers but controls are not.
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Affiliation(s)
- Julia C. Bond
- Department of Epidemiology and School of Public Health, Boston University, Boston, Massachusetts, USA.,Address correspondence to: Julia C. Bond, MPH, Department of Epidemiology, School of Public Health, Boston University, 715 Albany St, The Talbot Building, T3E & T4E, Boston, MA 02118, USA
| | - Jacob J. Kachura
- Department of Epidemiology and School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Matthew P. Fox
- Department of Epidemiology and School of Public Health, Boston University, Boston, Massachusetts, USA.,Department of Global Health, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Jennifer Weuve
- Department of Epidemiology and School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Bernard L. Harlow
- Department of Epidemiology and School of Public Health, Boston University, Boston, Massachusetts, USA
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Gilmore KL, Mansour D. A case vignette describing management of menopausal symptoms and migraine in the perimenopause. BMJ Sex Reprod Health 2022; 48:72-77. [PMID: 34732402 DOI: 10.1136/bmjsrh-2020-200977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Diana Mansour
- Newcastle Hospitals NHS Foundation Trust, Newcroft House, Newcroft Centre, Newcastle, UK
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Heller RL, Cameron S, Johnstone A, Cochrane R, Glasier A. Bone mineral density in progestogen-only implant and pill users with amenorrhoea: a pilot study. BMJ Sex Reprod Health 2022; 48:69-70. [PMID: 34429350 DOI: 10.1136/bmjsrh-2021-201184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Rebecca L Heller
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Sharon Cameron
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Anne Johnstone
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Rosemary Cochrane
- Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
| | - Anna Glasier
- University of Edinburgh Division of Health Sciences, Edinburgh, UK
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Delvaux T, Jespers V, Benova L, van de Wijgert J. Acceptability and Satisfaction of Contraceptive Vaginal Rings in Clinical Studies: A Systematic Review and Narrative Synthesis. Front Glob Womens Health 2022; 2:799963. [PMID: 34970653 PMCID: PMC8712726 DOI: 10.3389/fgwh.2021.799963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation. In the current context of multipurpose prevention of pregnancy and sexually transmitted diseases/HIV development, it is critical to have a better understanding of acceptability of and satisfaction with the contraceptive vaginal ring (CVR) including sexual satisfaction. The objective of this study was to review the evidence about acceptability of CVRs and general and sexual satisfaction of users. Methods: We searched PubMed, CINAHL, and Web of Science (until December 31, 2020) and selected original studies documenting actual use of hormonal CVR and explicitly addressing any of the 3 outcomes. Results: Of a total of 1,129 records screened, 46 studies were included. Most studies (n = 43, 93%) were prospective, conducted in high-income settings (n = 35), and reported on NuvaRing® use (n = 31). Overall, 27 (59%) studies included a comparison group, 38 (82%) studies used exclusively quantitative questionnaires, with qualitative only (n = 4, 9%), or mixed methods (n = 4, 9%) studies being less common. Ease of CVR insertion/removal/reinsertion was high in all the settings and improved with time of use, with qualitative studies supporting these findings. When mentioned, ring-related events were associated with discontinuation, and results on continuation of use were mixed. Among NuvaRing® studies, general satisfaction (being satisfied or very satisfied) was between 80 and 90% and tended to mirror continuation. Sexual satisfaction was less commonly reported and results were mixed. Overall, limited information was provided on actual CVR experiences of women (and men) and cultural norms that may affect sexuality and CVR use. Conclusion: Positive aspects of acceptability of and satisfaction with CVRs were reported, but ring-related events and factors, which may affect long-term CVR use, deserve further study. More information is needed on actual experiences of women using CVRs, relationship aspects, male partner opinions, and contextual norms to better understand the acceptability of and satisfaction with CVRs.
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Affiliation(s)
| | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Whitaker EM. Women should be able to obtain the progestogen-only pill from a pharmacist without a prescription. BMJ Sex Reprod Health 2022; 48:66-67. [PMID: 34127517 DOI: 10.1136/bmjsrh-2021-201206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
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Larsen SV, Ozenne B, Köhler-Forsberg K, Poulsen AS, Dam VH, Svarer C, Knudsen GM, Jørgensen MB, Frokjaer VG. The Impact of Hormonal Contraceptive Use on Serotonergic Neurotransmission and Antidepressant Treatment Response: Results From the NeuroPharm 1 Study. Front Endocrinol (Lausanne) 2022; 13:799675. [PMID: 35360055 PMCID: PMC8962375 DOI: 10.3389/fendo.2022.799675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hormonal contraceptive (HC) use has been associated with an increased risk of developing a depressive episode. This might be related to HC's effect on the serotonergic brain system as suggested by recent cross-sectional data from our group, which show that healthy oral contraceptive (OC) users relative to non-users have lower cerebral serotonin 4 receptor (5-HT4R) levels. Here, we determine if cerebral 5-HT4R binding differs between HC non-users, OC users, and hormonal intrauterine device (HIUD) users among women with an untreated depressive episode. Also, we test if antidepressant drug treatment response and its association with pre-treatment 5-HT4R binding depends on HC status. METHODS [11C]-SB207145 Positron Emission Tomography imaging data from the NeuroPharm-NP1 Study (NCT02869035) were available from 59 depressed premenopausal women, of which 26 used OCs and 10 used HIUDs. The participants were treated with escitalopram. Treatment response was measured as the relative change in the Hamilton Depression Rating Scale 6 items (rΔHAMD6) from baseline to week eight. Latent variable models were used to evaluate the association between global 5-HT4R binding and OC and HIUD use as well as rΔHAMD6. RESULTS We found no evidence of a difference in global 5-HT4R binding between depressed HC users and non-users (p≥0.51). A significant crossover interaction (p=0.02) was observed between non-users and OC users in the association between baseline global 5-HT4R binding and week eight rΔHAMD6; OC users had 3-4% lower binding compared to non-users for every 10% percent less improvement in HAMD6. Within the groups, we observed a trend towards a positive association in non-users (padj=0.10) and a negative association in OC users (padj=0.07). We found no strong evidence of a difference in treatment response between the groups (p=0.13). CONCLUSIONS We found no difference in 5-HT4R binding between HC users vs. non-users in depressed women, however, it seemed that 5-HT4R settings differed qualitatively in their relation to antidepressant drug treatment response between OC users and non-users. From this we speculate that depressed OC users constitutes a special serotonin subtype of depression, which might have implications for antidepressant drug treatment response.
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Affiliation(s)
- Søren Vinther Larsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Brice Ozenne
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Kristin Köhler-Forsberg
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | | | - Vibeke Høyrup Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Svarer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Vibe Gedso Frokjaer
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- *Correspondence: Vibe Gedso Frokjaer,
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Dabee S, Tanko RF, Brown BP, Bunjun R, Balle C, Feng C, Konstantinus IN, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Gill K, Baeten JM, Bekker LG, Passmore JAS, Heffron R, Jaspan HB, Happel AU. Comparison of Female Genital Tract Cytokine and Microbiota Signatures Induced by Initiation of Intramuscular DMPA and NET-EN Hormonal Contraceptives - a Prospective Cohort Analysis. Front Immunol 2021; 12:760504. [PMID: 34956191 PMCID: PMC8696178 DOI: 10.3389/fimmu.2021.760504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background Cervicovaginal inflammation, bacterial microbiota and hormonal contraceptives all influence sexual and reproductive health. To date, the effects of intramuscular depo-medroxyprogesterone acetate (DMPA-IM) versus injectable norethisterone enanthate (NET-EN) on vaginal microbiota or cytokines have not been compared back-to-back, although in-vitro data suggest that DMPA-IM and NET-EN have different pharmacokinetic and biologic activities. This study aimed at comparing the effects of DMPA-IM versus NET-EN initiation on cervicovaginal cytokines and microbiota in women at high risk for sexually transmitted infections (STIs) assigned to the respective contraceptives. Methods We collected socio-demographic characteristics and vaginal samples from women initiating DMPA-IM (ECHO Trial; n = 53) and NET-EN (UChoose Trial; n = 44) at baseline and after two consecutive injections to assess cytokine concentrations by Luminex, vaginal microbiota by 16S rRNA gene sequencing, STIs, bacterial vaginosis (BV) and candidiasis. Results Cytokine concentrations did not change significantly after initiating DMPA-IM or NET-EN, although NET-EN versus DMPA-IM-associated profiles were distinct. While the abundance of bacterial taxa associated with optimal and non-optimal microbiota fluctuated with DMPA-IM use, overall community composition did not significantly change with either contraceptive. HSV-2 serology, chlamydial infection, gonorrhoea and candidiasis did not influence the associations between contraceptive type and cervicovaginal cytokines or microbiota. Conclusions Both DMPA-IM and NET-EN use did not lead to broad inflammatory or microbiota changes in the female genital tract of sub-Saharan African women. This suggests that NET-EN is likely a viable option for contraception in African women at high risk of BV and STIs.
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Affiliation(s)
- Smritee Dabee
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Ramla F. Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Bryan P. Brown
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Christina Balle
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Colin Feng
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | | | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States,Gilead Sciences, Foster City, CA, United States
| | | | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,National Health Laboratory Service, Cape Town, South Africa
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Heather B. Jaspan
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States,Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Department of Global Health, University of Washington, Seattle, WA, United States,*Correspondence: Heather B. Jaspan,
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
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Rodriguez MI, Skye M, Edelman AB, Anderson L, Darney BG. Association of pharmacist prescription and 12-month contraceptive continuation rates. Am J Obstet Gynecol 2021; 225:647.e1-647.e9. [PMID: 34217725 DOI: 10.1016/j.ajog.2021.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND States have passed legislation to expand the scope of pharmacists to directly prescribe contraception. It is thought that pharmacist prescription of contraception may promote correct and consistent use of contraception by reducing barriers to access. However, it is not known how this may impact ongoing contraceptive use. OBJECTIVE This study aimed to determine whether 12-month rates of continuation of an effective form of contraception or perfect use of contraception differ by prescribing provider (pharmacist or clinician). STUDY DESIGN We conducted a 1-year prospective cohort study of 388 women seeking contraception in 139 pharmacies across 4 states (California, Colorado, Hawaii, and Oregon). Our study was powered to detect a 10% difference in 12-month continuation of an effective form of contraception. We clarified women's pregnancy intention at baseline and subsequent follow-ups. Women received a prescription directly from a pharmacist (n=149) or were filling a prescription from a clinician, our comparison group (n=239). We used multivariable logistic regression to measure the association between pharmacist prescriber and use of any effective contraceptive method or perfect use at 12 months. Model covariates included age, race, education, side effects experienced, payor, and contraceptive supply dispensed at baseline. RESULTS Of the study cohort, 88% (n=340) completed 12 months of follow-up. Among women not planning to become pregnant, 7 women in the clinic-prescribed group vs 1 woman in the pharmacy-prescribed group (3.4% vs 0.8%; P>.05) reported a positive pregnancy test during the study period. The majority of the cohort was continuing to use an effective method of contraception at 12 months (clinician 89.3% vs pharmacist 90.4%; P=.86). Among women receiving a prescription from a clinician, 53.9% reported perfect use (no missed days) at 12 months, compared with 47% of the pharmacist-prescribed group (P=.69). Pharmacist prescriber type was not associated with continuation of an effective contraceptive method at 12 months (adjusted odds ratio, 0.70; confidence interval, 0.28-1.71) or with perfect use of contraception (adjusted odds ratio, 0.87; confidence interval, 0.51-1.48), controlling for other woman-level characteristics. CONCLUSION We found no difference in use of any effective contraception, perfect use, or switching at 12 months among those who received their baseline prescription from a pharmacist vs a clinician. This study is limited by not examining information on safety outcomes.
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Vanpouille C, Günaydın G, Jangard M, Clerici M, Margolis L, Broliden K, Introini A. The Progestin Medroxyprogesterone Acetate Affects HIV-1 Production in Human Lymphoid Tissue Explants in a Dose-Dependent and Glucocorticoid-like Fashion. Viruses 2021; 13:v13112303. [PMID: 34835109 PMCID: PMC8621851 DOI: 10.3390/v13112303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/31/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
The association between the use of the injectable contraceptive depot medroxyprogesterone acetate and HIV-1 susceptibility has been addressed mainly in respect to the changes occurring in the female genital mucosa and blood. However, one of the main sites of HIV-1 pathogenesis is lymphoid organs. To investigate the immunoregulatory effect of medroxyprogesterone acetate (MPA) at this site, human tonsillar tissue explants were infected ex vivo with either a CCR5 (BaL) or CXCR4 (LAI) HIV-1 variant and the release of p24gag and cytokines was measured in culture supernatant. The response to MPA was compared with that elicited by treatment with progesterone (P4) and dexamethasone (DEX), which selectively binds the glucocorticoid receptor, in donor-matched explant cultures. MPA treatment reduced the replication of both tested HIV-1 strains as well as the production of the mediators of inflammation IL-1β, IL-17A and CCL5, but not CCL20, in a similar way to DEX, whereas P4 had no effect on HIV-1 replication. The magnitude of both MPA and DEX-mediated responses was proportional to the length of exposure and/or administered dose. Blockage of the progesterone and glucocorticoid receptors with mifepristone abolished all observed changes in HIV-1 and cytokine production, and was associated with increased IL-22 levels in HIV-infected explants. Our data indicate that elevated doses of MPA may affect the immune responses in lymphoid tissue in a glucocorticoid-like fashion with an immediate impact on local HIV-1 replication.
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Affiliation(s)
- Christophe Vanpouille
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA; (C.V.); (L.M.)
| | - Gökçe Günaydın
- Center for Molecular Medicine, Department of Medicine Solna, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, 171 77 Solna, Sweden; (G.G.); (K.B.)
| | - Mattias Jangard
- Ear, Nose and Throat Unit, Research Laboratory, Sophiahemmet University, 114 86 Stockholm, Sweden;
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Leonid Margolis
- Section on Intercellular Interactions, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA; (C.V.); (L.M.)
| | - Kristina Broliden
- Center for Molecular Medicine, Department of Medicine Solna, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, 171 77 Solna, Sweden; (G.G.); (K.B.)
| | - Andrea Introini
- Center for Molecular Medicine, Department of Medicine Solna, Division of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, 171 77 Solna, Sweden; (G.G.); (K.B.)
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, 20157 Milan, Italy
- Correspondence: or
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Bentivegna E, Luciani M, Scarso F, Bruscia C, Chiappino D, Amore E, Nalli G, Martelletti P. Hormonal therapies in migraine management: current perspectives on patient selection and risk management. Expert Rev Neurother 2021; 21:1347-1355. [PMID: 34739361 DOI: 10.1080/14737175.2021.2003706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The link between sex hormones and migraines has long been investigated but the mechanisms underlying this altered interaction are not yet fully understood. Herein, we retrace the knowledge on this association in relationship with risk of stroke. AREAS COVERED Estrogens fluctuations could trigger migraine attacks and exogenous estrogens intake could be a risk factor for venous thromboembolism (VTE) and stroke. At the same time, ischemic heart diseases and stroke share a common substrate with migraine and other mood disorders, depression, and anxiety. EXPERT OPINION The use of hormonal therapies in the context of contraception or replacement therapy must be closely evaluated in a careful risk assessment. We highlight the complex interaction of hormone/neuroinflammation pathways underlying the pathophysiology of migraine glimpsing in mood disorders a possible common denominator of link between hormonal and neuronal systems.
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Affiliation(s)
- Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Michelangelo Luciani
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Francesco Scarso
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Clara Bruscia
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Dario Chiappino
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Emanuele Amore
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Gabriele Nalli
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Regional Referral Headache Centre, Sant'Andrea Hospital, Rome, Italy
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62
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Al-Ghashri F, Al-Harthi H, Al Shukri M, Al Shidhani A. Discontinuation of hormonal contraception in Oman: prevalence and reasons. East Mediterr Health J 2021; 27:993-1000. [PMID: 34766325 DOI: 10.26719/emhj.21.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/04/2021] [Indexed: 11/09/2022]
Abstract
Background Discontinuation of hormonal contraceptives is an important contributor to unmet need of contraception. Aims To determine the discontinuation rate and the reasons for discontinuation of hormonal contraception among Omani women. Methods This was a 2-stage sampling, multicentre, retrospective cohort study conducted in 2018 at primary health care centres in Muscat Region, Oman. It included newly registered users of hormonal contraceptives in birth spacing clinics from January to December 2016 and the course of care over the following 12 months. A telephone interview was conducted to complement some of the missing data. The contraceptive methods available were combined oral contraceptives, progesterone only pills and injectable depot medroxyprogesterone acetate. Results We included 404 women and 87.8% were breast-feeding. By the end of the first year, (268; 66.3%) women discontinued their contraceptive method. More than half (55.2% 148/268) of the discontinuation was attributed to adverse effects and the most prevalent was menstrual abnormality (102/268; 38.1%). Only 5.6% (15/268) discontinued contraception because they desired pregnancy. Partners and logistics of availability and access played a minimal role in discontinuation. Age and number of children did not influence the discontinuation rate. Conclusion This study improves our knowledge about the rate of discontinuation of hormonal contraception and its related factors in Oman, which can be used for population-specific counselling. Future research should study the contraception behaviour of breast-feeding women to assess when and why they discontinue their contraceptive methods.
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Affiliation(s)
| | | | - Maryam Al Shukri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Asma Al Shidhani
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Muscat, Oman
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63
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Warren JG, Fallon VM, Goodwin L, Gage SH, Rose AK. Menstrual Cycle Phase, Hormonal Contraception, and Alcohol Consumption in Premenopausal Females: A Systematic Review. Front Glob Womens Health 2021; 2:745263. [PMID: 34816249 PMCID: PMC8594041 DOI: 10.3389/fgwh.2021.745263] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022] Open
Abstract
Women may be particularly vulnerable to alcohol harm, but many current theories fail to acknowledge the unique factors that influence female alcohol use. The biological mechanisms underlying female alcohol consumption have largely been unexplored, although recently the menstrual cycle has been highlighted as a potentially important factor. This systematic review, using a narrative synthesis, examined the association between the menstrual cycle phases on alcohol consumption and aimed to determine whether hormonal contraception influences this association. The review follows PRISMA and SWiM guidelines, registration number: CRD42018112744. Electronic searches were conducted in the relevant databases with keyword (e.g., "menstrua*"; "alcohol"). Thousand six hundred and sixty-two titles were identified, 16 of which were included in the review. Results were inconsistent regarding whether an association between menstrual cycle phase and alcohol consumption was found. Furthermore, there was inconsistency regarding which phase was associated with higher consumption, and different factors were reported to have moderated the direction, e.g., family history of alcohol use disorder (AUD), premenstrual syndrome (PMS). These conflicting results may be partly explained by variability in both study quality and design, and differences in measurement of cycle phase and alcohol consumption. More robust research is needed before conclusions can be drawn with regard to the role of the menstrual cycle and hormonal contraception on female drinking behavior. This review provides recommendations to strengthen research in this area.
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Affiliation(s)
- Jasmine G. Warren
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Victoria M. Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Laura Goodwin
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Suzanne H. Gage
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Abigail K. Rose
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
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64
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Byrne EH, Farcasanu M, Bloom SM, Xulu N, Xu J, Hykes BL, Mafunda NA, Hayward MR, Dong M, Dong KL, Gumbi T, Ceasar FX, Ismail N, Ndung'u T, Gosmann C, Ghebremichael MS, Handley SA, Mitchell CM, Villani AC, Kwon DS. Antigen Presenting Cells Link the Female Genital Tract Microbiome to Mucosal Inflammation, With Hormonal Contraception as an Additional Modulator of Inflammatory Signatures. Front Cell Infect Microbiol 2021; 11:733619. [PMID: 34604114 PMCID: PMC8482842 DOI: 10.3389/fcimb.2021.733619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
The microbiome of the female genital tract (FGT) is closely linked to reproductive health outcomes. Diverse, anaerobe-dominated communities with low Lactobacillus abundance are associated with a number of adverse reproductive outcomes, such as preterm birth, cervical dysplasia, and sexually transmitted infections (STIs), including HIV. Vaginal dysbiosis is associated with local mucosal inflammation, which likely serves as a biological mediator of poor reproductive outcomes. Yet the precise mechanisms of this FGT inflammation remain unclear. Studies in humans have been complicated by confounding demographic, behavioral, and clinical variables. Specifically, hormonal contraception is associated both with changes in the vaginal microbiome and with mucosal inflammation. In this study, we examined the transcriptional landscape of cervical cell populations in a cohort of South African women with differing vaginal microbial community types. We also investigate effects of reproductive hormones on the transcriptional profiles of cervical cells, focusing on the contraceptive depot medroxyprogesterone acetate (DMPA), the most common form of contraception in sub-Saharan Africa. We found that antigen presenting cells (APCs) are key mediators of microbiome associated FGT inflammation. We also found that DMPA is associated with significant transcriptional changes across multiple cell lineages, with some shared and some distinct pathways compared to the inflammatory signature seen with dysbiosis. These results highlight the importance of an integrated, systems-level approach to understanding host-microbe interactions, with an appreciation for important variables, such as reproductive hormones, in the complex system of the FGT mucosa.
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Affiliation(s)
- Elizabeth H Byrne
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Mara Farcasanu
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States
| | - Seth M Bloom
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Nondumiso Xulu
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jiawu Xu
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States
| | - Barry L Hykes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Nomfuneko A Mafunda
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States
| | - Matthew R Hayward
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Mary Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Females Rising Through Education, Support, and Health (FRESH), Durban, South Africa
| | - Krista L Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Females Rising Through Education, Support, and Health (FRESH), Durban, South Africa
| | - Thandeka Gumbi
- Females Rising Through Education, Support, and Health (FRESH), Durban, South Africa.,Health Systems Trust, Durban, South Africa
| | - Fransisca Xolisile Ceasar
- Females Rising Through Education, Support, and Health (FRESH), Durban, South Africa.,Health Systems Trust, Durban, South Africa
| | - Nasreen Ismail
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Thumbi Ndung'u
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute (AHRI), Durban, South Africa.,Max Planck Institute for Infection Biology, Berlin, Germany.,Division of Infection and Immunity, University College London, London, United Kingdom
| | - Christina Gosmann
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Musie S Ghebremichael
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Scott A Handley
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Caroline M Mitchell
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Alexandra-Chloé Villani
- Department of Medicine, Harvard Medical School, Boston, MA, United States.,Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Broad Institute of MIT and Harvard, Immunology Program, Cambridge, MA, United States
| | - Douglas S Kwon
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
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65
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Collado-Boira E, Baliño P, Boldo-Roda A, Martínez-Navarro I, Hernando B, Recacha-Ponce P, Hernando C, Muriach M. Influence of Female Sex Hormones on Ultra-Running Performance and Post-Race Recovery: Role of Testosterone. Int J Environ Res Public Health 2021; 18:10403. [PMID: 34639701 DOI: 10.3390/ijerph181910403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
In recent years, increasing numbers of women have participated in extremely long races. In adult males, there is a clear association between physiological levels of endogenous sex hormones and physical performance. However, the influence of plasmatic sex hormones and the effects of different types of hormonal contraception (HC) on the modulation of physical performance in adult females remain to be fully clarified. Eighteen female ultra-endurance athletes were recruited to participate in the study. Different variables were studied, including hematological parameters, body mass index, and body composition. Strength measurements were obtained using the squat-jump and hand-grip test. A repeated-measures analysis demonstrated significant differences in hematological values of CK and LDH pre-race as compared to immediately post-race and after 24/48 h. Furthermore, statistical differences were found in squat-jump and hand-grip test results after the ultramarathon. Testosterone, estradiol, and the testosterone/estrogen ratio were significantly correlated with muscle fatigue and were found to be indirect markers of muscle damage. A multivariate analysis demonstrated the protective role of testosterone against muscle damage and severe fatigue. Fluctuations in endogenous testosterone levels were correlated with greater fatigability and muscle damage after the competition. Adjusting the menstrual cycle with HC would not provide any further benefit to the athlete's competitive capacity.
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66
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Affiliation(s)
- Anita Mitra
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
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67
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Stovall DW, Aqua K, Römer T, Donders G, Sørdal T, Hauck B, Llata ESDL, Kallner HK, Salomon J, Zvolanek M, Frenz AK, Böhnke T, Bauerfeind A. Satisfaction and continuation with LNG-IUS 12: findings from the real-world kyleena ® satisfaction study. EUR J CONTRACEP REPR 2021; 26:462-472. [PMID: 34528857 DOI: 10.1080/13625187.2021.1975268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The Kyleena® Satisfaction Study (KYSS) aimed to assess satisfaction and continuation with levonorgestrel-releasing intrauterine system (LNG-IUS) 12 (Kyleena®) in routine clinical practice and to evaluate factors that influence satisfaction. MATERIALS AND METHODS This prospective, observational, multicentre, single-arm cohort study, with 1-year follow-up, was conducted in Belgium, Canada, Germany, Mexico, Norway, Sweden, Spain and the United States from 2017 to 2018. During routine counselling, women who independently selected to use LNG-IUS 12 were invited to participate in the study. KYSS assessed LNG-IUS 12 satisfaction, continuation and safety. RESULTS Overall, there were 1126 successful LNG-IUS 12 placements, with insertion attempted in 1129 women. Most participants (833/968, 86.1%, 95% CI 83.7-88.2%, with satisfaction outcome data available) reported satisfaction with LNG-IUS 12 at 12 months (or at the final visit if the device was discontinued prematurely). Satisfaction was not associated with age, parity or motivation for choosing LNG-IUS 12. The majority of women (919/1129, 81.4%) chose to continue after 12 months. Discontinuation was not correlated with age or parity. Overall, 191 women (16.9%) reported a treatment-emergent adverse event. CONCLUSIONS Results from KYSS provide the first real-world evidence assessing LNG-IUS 12, and demonstrate high satisfaction and continuation rates irrespective of age or parity. Clinical trial registration: NCT03182140.
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Affiliation(s)
- Dale W Stovall
- Department of Obstetrics and Gynecology, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Keith Aqua
- Virtus Research Consultants, Wellington, FL, USA
| | - Thomas Römer
- Obstetrics and Gynecology Department, Academic Hospital Weyertal, University of Cologne, Cologne, Germany
| | - Gilbert Donders
- Department of Clinical Research for Women, Femicare VZW, Tienen, Belgium.,Department of Obstetrics and Gynecology, University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Brian Hauck
- Department of Obstetrics and Gynecology, Foothills Hospital, University of Calgary, Calgary, Canada
| | | | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | | | | | | | - Tanja Böhnke
- ZEG - Berlin Center for Epidemiology and Health Research GmbH, Berlin, Germany
| | - Anja Bauerfeind
- ZEG - Berlin Center for Epidemiology and Health Research GmbH, Berlin, Germany
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68
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Schleifenbaum L, Driebe JC, Gerlach TM, Penke L, Arslan RC. Women feel more attractive before ovulation: evidence from a large-scale online diary study. Evol Hum Sci 2021; 3:e47. [PMID: 37588547 PMCID: PMC10427307 DOI: 10.1017/ehs.2021.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
How attractive we find ourselves decides who we target as potential partners and influences our reproductive fitness. Self-perceptions on women's fertile days could be particularly important. However, results on how self-perceived attractiveness changes across women's ovulatory cycles are inconsistent and research has seldomly assessed multiple attractiveness-related constructs simultaneously. Here, we give an overview of ovulatory cycle shifts in self-perceived attractiveness, sexual desirability, grooming, self-esteem and positive mood. We addressed previous methodological shortcomings by conducting a large, preregistered online diary study of 872 women (580 naturally cycling) across 70 consecutive days, applying several robustness analyses and comparing naturally cycling women with women using hormonal contraceptives. As expected, we found robust evidence for ovulatory increases in self-perceived attractiveness and sexual desirability in naturally cycling women. Unexpectedly, we found moderately robust evidence for smaller ovulatory increases in self-esteem and positive mood. Although grooming showed an ovulatory increase descriptively, the effect was small, failed to reach our strict significance level of .01 and was not robust to model variations. We discuss how these results could follow an ovulatory increase in sexual motivation while calling for more theoretical and causally informative research to uncover the nature of ovulatory cycle shifts in the future.
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Affiliation(s)
- Lara Schleifenbaum
- Georg August University, Goettingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | | | - Tanja M. Gerlach
- Georg August University, Goettingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | - Lars Penke
- Georg August University, Goettingen, Germany
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
| | - Ruben C. Arslan
- Leibniz ScienceCampus Primate Cognition, Goettingen, Germany
- University of Leipzig, Leipzig, Germany
- Max Planck Institute for Human Development, Berlin, Germany
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69
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Rikard R, Elliott J, Dalton E, Stone RH. Pharmacist-Prescribed Hormonal Contraception: Does Didactic Hormonal Contraception Education Affect Student Pharmacist Perceptions of This Professional Activity? Pharmacy (Basel) 2021; 9:145. [PMID: 34449736 DOI: 10.3390/pharmacy9030145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Since 2014, select states have allowed pharmacists to prescribe hormonal contraception (HC). This study describes student pharmacists’ perceptions of a pharmacist’s scope of practice, education, and interest, and identifies differences between students who have completed didactic HC content in their professional curriculum versus those who have not. A voluntary online survey was emailed to all students in three Georgia pharmacy schools. Descriptive statistics were reported. Likert square responses were dichotomized, and Chi square testing identified differences between groups. A total of 1256 students were invited, 35% completed the survey, of those 68% had received HC didactic content in their curriculum. Regardless of HC education, most students “agree” or “strongly agree” that pharmacists are adequately educated to prescribe HC (92% vs. 86%, p = 0.05) and prescribing HC is within the pharmacist’s scope of practice (89% vs. 84%, p = 0.12). Although not currently permitted in Georgia, most are interested in prescribing (97% vs. 96%, p = 0.5). Of the students who have received HC didactic content, 87% felt “moderately”, “well”, or “extremely well-educated” regarding HC prescribing clinical skills. Regardless of didactic training, pharmacy students believe pharmacists are prepared to prescribe HC and support pharmacist-prescribed HC as a part of their future professional scope of practice.
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70
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Turrini M, Bourgain C. Appraising screening, making risk in/visible. The medical debate over Non-Rare Thrombophilia (NRT) testing before prescribing the pill. Sociol Health Illn 2021; 43:1627-1642. [PMID: 34293180 DOI: 10.1111/1467-9566.13348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Non-rare thrombophilia (NRT) are hereditary predispositions to thromboembolism, the most severe side effect of combined hormonal contraception. In the mid-1990s, the identification of NRT stirred up a controversy over the possibility of investigating these genetic variants in women wishing to use contraception. Through a review of literature, this article reconstructs the debate over whether and how this genetic test should be prescribed as a way to reconfigure the risk visibility on pharmacological contraception. The main arguments identified concern the epidemiological, social, economic and clinical aspects of the test. In a context where the overall thrombotic risk for hormonal contraception is largely invisible, the genetic tests turn to embody the thrombotic risk itself. Those who opt for selective screening argue that a better estimation of risk implies a test prescription embed in a global medical assessment of women's individual risk. To advocates of universal or 'extended' screening, the tests are valuable tools to inform women on the thrombotic risk and, as such, appraised as a moral/legal obligation, whatever their predictive power. Risk visibility thus appears as an insightful concept to analyse a complex setting associating clinical, political, social and cultural considerations that touches upon medical power, women's responsibility and drug safety.
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71
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Lanfranchi A. Hormonal Contraception and Violent Death: The Physiological and Psychological Links. Front Behav Neurosci 2021; 15:667563. [PMID: 34393733 PMCID: PMC8363127 DOI: 10.3389/fnbeh.2021.667563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
In the past decade, two large prospective cohort studies of British and American women have been conducted which found a statistically significant increase in the risk of violent death in ever-users of hormonal contraceptives. Research on the effects of hormonal contraceptives upon the behaviors of intimate partners and on the physiology of women using hormonal contraceptives has provided insight into the possible basis for the resulting increase in violent death. This review examines the changes that are potential contributors to the reported increase.
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Affiliation(s)
- Angela Lanfranchi
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States.,Breast Cancer Prevention Institute, Whitehouse Station, NJ, United States
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72
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Shamseddin M, De Martino F, Constantin C, Scabia V, Lancelot AS, Laszlo C, Ayyannan A, Battista L, Raffoul W, Gailloud-Matthieu MC, Bucher P, Fiche M, Ambrosini G, Sflomos G, Brisken C. Contraceptive progestins with androgenic properties stimulate breast epithelial cell proliferation. EMBO Mol Med 2021; 13:e14314. [PMID: 34042278 PMCID: PMC8261488 DOI: 10.15252/emmm.202114314] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/15/2021] [Accepted: 04/23/2021] [Indexed: 12/25/2022] Open
Abstract
Hormonal contraception exposes women to synthetic progesterone receptor (PR) agonists, progestins, and transiently increases breast cancer risk. How progesterone and progestins affect the breast epithelium is poorly understood because we lack adequate models to study this. We hypothesized that individual progestins differentially affect breast epithelial cell proliferation and hence breast cancer risk. Using mouse mammary tissue ex vivo, we show that testosterone-related progestins induce the PR target and mediator of PR signaling-induced cell proliferation receptor activator of NF-κB ligand (Rankl), whereas progestins with anti-androgenic properties in reporter assays do not. We develop intraductal xenografts of human breast epithelial cells from 36 women, show they remain hormone-responsive and that progesterone and the androgenic progestins, desogestrel, gestodene, and levonorgestrel, promote proliferation but the anti-androgenic, chlormadinone, and cyproterone acetate, do not. Prolonged exposure to androgenic progestins elicits hyperproliferation with cytologic changes. Androgen receptor inhibition interferes with PR agonist- and levonorgestrel-induced RANKL expression and reduces levonorgestrel-driven cell proliferation. Thus, different progestins have distinct biological activities in the breast epithelium to be considered for more informed choices in hormonal contraception.
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Affiliation(s)
- Marie Shamseddin
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fabio De Martino
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Céline Constantin
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Valentina Scabia
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Anne-Sophie Lancelot
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Csaba Laszlo
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Ayyakkannu Ayyannan
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Laura Battista
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Wassim Raffoul
- Centre Hospitalier Universitaire Vaudois, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Philipp Bucher
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Maryse Fiche
- International Cancer Prevention Institute, Epalinges, Switzerland
| | - Giovanna Ambrosini
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - George Sflomos
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Cathrin Brisken
- Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- The Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
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73
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Wall KM, Karita E, Nyombayire J, Ingabire R, Mukamuyango J, Parker R, Brill I, Price M, Haddad LB, Tichacek A, Hunter E, Allen S. Genital Abnormalities, Hormonal Contraception, and Human Immunodeficiency Virus Transmission Risk in Rwandan Serodifferent Couples. J Infect Dis 2021; 224:81-91. [PMID: 33560366 PMCID: PMC8253127 DOI: 10.1093/infdis/jiab071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda. METHODS From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were followed up, and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; nonulcerative genital sexually transmitted infection (STIs), including gonorrhea, chlamydia, and trichomoniasis; and non-STI vaginal infections, including bacterial vaginosis and candida. Multivariable models evaluated associations between covariates and HIV transmission genetically linked to the index partner. RESULTS Among 877 couples in which the man was HIV positive, 37 linked transmissions occurred. Factors associated with women's HIV acquisition included genital ulceration in the female partner (adjusted hazard ratio, 14.1) and nonulcerative STI in the male partner (8.6). Among 955 couples in which the woman was HIV positive, 46 linked transmissions occurred. Factors associated with HIV acquisition in men included nonulcerative STI in the female partner (adjusted hazard ratio, 4.4), non-STI vaginal dysbiosis (7.1), and genital ulceration in the male partner (2.6). Hormonal contraception use was not associated with HIV transmission or acquisition. CONCLUSIONS Our findings underscore the need for integrating HIV services with care for genital abnormalities. Barriers (eg, cost of training, demand creation, advocacy, and client education; provider time; and clinic space) to joint HIV/STI testing need to be considered and addressed.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Etienne Karita
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Julien Nyombayire
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Rosine Ingabire
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Jeannine Mukamuyango
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Projet San Francisco, Kigali, Rwanda
| | - Rachel Parker
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ilene Brill
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Matt Price
- IAVI, New York, New York, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Amanda Tichacek
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Susan Allen
- Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Grindlay K, Wollum A, Karver J, Grossman D. Over-the-counter oral contraceptive use among women in Mexico: results from a national survey. BMJ Sex Reprod Health 2021; 47:205-210. [PMID: 33431615 DOI: 10.1136/bmjsrh-2020-200778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 06/12/2023]
Abstract
AIM In Mexico, many pharmacies sell oral contraceptives (OCs) over the counter (OTC); however, little is known about the background characteristics of OTC pill users. The primary objective of this study was to understand the characteristics of OTC OC users in Mexico, including whether there were differences by age, urbanicity, and insurance status. This information is instructive as other countries explore allowing OTC access to OCs. METHODS We analysed the nationally representative 2014 Mexican National Survey of Demographic Dynamics (ENADID) among a sample of OC users aged 15-54 years (n=1970). We performed multivariable logistic models to understand the characteristics associated with OTC access, with age, urbanicity, and insurance status as our primary predictors of interest. Additionally, we descriptively explored knowledge of how frequently to take OCs by pill source and age. RESULTS Some 54% of pill users, including 66% of those aged 15-17 years, obtained their OCs OTC. In multivariable regression we found no differences in OTC access by age. However, being uninsured (adjusted odds ratio (AOR) 1.86, 95% CI 1.23 to 2.82) (compared with employer-based public insurance) and living in an urban area (AOR 4.73, 95% CI 3.37 to 6.66) (compared with rural area) were associated with a higher odds of OTC access among pill users. Women's knowledge of how frequently to take OCs was similar between OTC and prescription users within age groups. CONCLUSIONS These findings point to the importance of OTC availability of OCs for pill users of all ages and uninsured and urban women in Mexico in particular.
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Affiliation(s)
- Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | | | - Jonathan Karver
- Poverty & Equity Global Practice, The World Bank, Washington, District of Columbia, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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75
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Lundin C, Wikman A, Bixo M, Gemzell-Danielsson K, Sundström Poromaa I. Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms. BMJ Sex Reprod Health 2021; 47:e8. [PMID: 33452056 DOI: 10.1136/bmjsrh-2020-200658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The study aim was to establish which demographic, clinical, reproductive and psychiatric factors are associated with self-reported hormonal contraceptive (HC)-induced adverse mood symptoms. STUDY DESIGN We compiled baseline data from two Swedish studies: one cross-sectional study on combined oral contraceptive (COC)-induced adverse mood symptoms (n=118) and one randomised controlled trial on adverse mood symptoms on COC (n=184). Both included women eligible for COC use, aged over 18 years. All women answered a questionnaire on HC use and associated mood problems. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to capture mood and anxiety disorders. Women who acknowledged HC-induced adverse mood symptoms, ongoing or previously (n=145), were compared with women without any such experience (n=157). RESULTS Compared with women without self-reported HC-induced adverse mood symptoms, women with these symptoms were younger at HC start (adjusted odds ratio (aOR) 0.83, 95% CI 0.72 to 0.95), had more often undergone induced abortion (OR 3.36, 95% CI 1.57 to 7.23), more often suffered from an ongoing minor depressive disorder (n=12 vs n=0) and had more often experienced any previous mental health problem (aOR 1.90, 95% CI 1.01 to 3.59). CONCLUSIONS In line with previous research, this study suggests that women with previous or ongoing mental health problems and women who are younger at HC start are more likely to experience HC-induced adverse mood symptoms. Former and current mental health should be addressed at contraceptive counselling, and ongoing mental health disorders should be adequately treated. IMPLICATIONS This study adds valuable knowledge for identification of women susceptible to HC-induced adverse mood symptoms. It should facilitate the assessment of whether or not a woman has an increased risk of such symptoms, and thus enable clinicians to adopt a more personalised approach to contraceptive counselling.
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Affiliation(s)
- Cecilia Lundin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Bixo
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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Gemzell-Danielsson K, Kubba A, Caetano C, Faustmann T, Lukkari-Lax E, Heikinheimo O. More than just contraception: the impact of the levonorgestrel-releasing intrauterine system on public health over 30 years. BMJ Sex Reprod Health 2021; 47:228-230. [PMID: 33514606 PMCID: PMC8292574 DOI: 10.1136/bmjsrh-2020-200962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Universal access to sexual and reproductive health services is essential to facilitate the empowerment of women and achievement of gender equality. Increasing access to modern methods of contraception can reduce the incidence of unplanned pregnancy and decrease maternal mortality. Long-acting reversible contraceptives (LARCs) offer high contraceptive efficacy as well as cost-efficacy, providing benefits for both women and healthcare systems. The levonorgestrel-releasing intrauterine system (LNG-IUS) first became available in 1990 with the introduction of Mirena (LNG-IUS 20), a highly effective contraceptive which can reduce menstrual blood loss and provide other therapeutic benefits. The impact of the LNG-IUS on society has been wide ranging, including decreasing the need for abortion, reducing the number of surgical sterilisation procedures performed, as well as reducing the number of hysterectomies carried out for issues such as heavy menstrual bleeding (HMB). In the context of the COVID-19 pandemic, Mirena can provide a treatment option for women with gynaecological issues such as HMB without organic pathology, minimising exposure to the hospital environment and reducing waiting times for surgical appointments. Looking to the future, research and development in the field of the LNG-IUS continues to expand our understanding of these contraceptives in clinical practice and offers the potential to further expand the choices available to women, allowing them to select the option that best meets their needs.
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Affiliation(s)
- Kristina Gemzell-Danielsson
- Department of Women's & Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Ali Kubba
- Department of Gynecology, Guys and St Thomas NHS Foundation Trust, London, UK
| | | | | | | | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Reynolds-Wright JJ, Fletcher J. Troublesome bleeding following early medical abortion. BMJ Sex Reprod Health 2021; 47:221-223. [PMID: 33055128 DOI: 10.1136/bmjsrh-2020-200672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- NHS Lothian, Chalmers Centre, Edinburgh, UK
| | - Joanne Fletcher
- Gynaecology, Room G25, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Abstract
Combined hormonal contraceptive methods are one of the most commonly used methods of planned parenthood. They show high contraceptive effectiveness, reasonable cycle control and bring several non-contraceptive benefits. A limitation of the widespread use of combined hormonal contraception is the risk of cardiovascular complications in individuals with specific risk factors. The risk of cardiovascular complications is related to the used estrogen component. Currently, the most common use of estrogen in combined hormonal contraception is ethinyl estradiol and estradiol valerate. The good estrogenic part of combined oral contraceptives is estetrol, a hormone produced exclusively by the fetal liver. Estetrol exhibits a tissue-selective receptor activity. Unlike previously used estrogens, it does not negatively affect the production of liver proteins and blood clotting parameters. Estetrol is not a perspective for combined hormonal contraception only. It is also promising for treating and preventing osteoporosis, hormonal therapy of menopausal syndrome, and vulvovaginal atrophy syndrome.
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79
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Castanier C, Bougault V, Teulier C, Jaffré C, Schiano-Lomoriello S, Vibarel-Rebot N, Villemain A, Rieth N, Le-Scanff C, Buisson C, Collomp K. The Specificities of Elite Female Athletes: A Multidisciplinary Approach. Life (Basel) 2021; 11:622. [PMID: 34206866 PMCID: PMC8303304 DOI: 10.3390/life11070622] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
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Affiliation(s)
- Carole Castanier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Caroline Teulier
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | | | - Sandrine Schiano-Lomoriello
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nancy Vibarel-Rebot
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Aude Villemain
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Nathalie Rieth
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Christine Le-Scanff
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
| | - Corinne Buisson
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
| | - Katia Collomp
- CIAMS, Université Paris-Saclay, 91405 Orsay, France; (C.C.); (C.T.); (S.S.-L.); (N.V.-R.); (A.V.); (N.R.); (C.L.-S.)
- CIAMS, Université d’Orléans, 45067 Orléans, France
- Département des Analyses, AFLD, 92290 Chatenay-Malabry, France;
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Whitney BM, Srinivasan S, Tapia K, Muriuki EM, Chohan BH, Wallis JM, Liu C, Guthrie BL, McClelland RS, Hoffman NG, Fredricks DN, Roxby AC. Influence of Intramuscular Depot Medroxyprogesterone Acetate Initiation on Vaginal Microbiota in the Postpartum Period. Clin Infect Dis 2021; 72:e1093-e1102. [PMID: 33354707 DOI: 10.1093/cid/ciaa1876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The vaginal microbiome plays a key role in women's reproductive health. Use of exogenous hormones, such as intramuscular depot medroxyprogesterone acetate (DMPA-IM), may alter the composition of vaginal bacterial community. METHODS Vaginal swab samples were collected from postpartum Kenyan women initiating DMPA-IM or nonhormonal contraception (non-HC). Bacterial vaginosis was assessed by Nugent score (Nugent-BV) and bacterial community composition was evaluated using broad-range 16S ribosomal RNA gene polymerase chain reaction with high-throughput sequencing. Changes in Nugent score, alpha diversity (Shannon diversity index), and total bacterial load between contraceptive groups from enrollment to 3 months after initiation were estimated using multivariable linear mixed effects regression. RESULTS Among 54 human immunodeficiency virus-negative women, 33 choosing DMPA-IM and 21 choosing non-HC, Nugent-BV was more common among DMPA-IM users at enrollment. At follow-up, Nugent score had decreased significantly among DMPA-IM users (change, -1.89; 95% confidence interval [CI], -3.53 to -.25; P = .02) while alpha diversity remained stable (0.03; -.24 to .30; P = .83). Conversely, Nugent score remained relatively stable among non-HC users (change, -0.73; 95% CI, -2.18 to .73; P = .33) while alpha diversity decreased (-0.34; -.67 to -.001; P = .05). The total bacterial load decreased slightly in DMPA-IM users and increased slightly among non-HC users, resulting in a significant difference in change between the contraceptive groups (difference, -0.64 log10 gene copies per swab sample; 95% CI, -1.19 to -.08; P = .02). While significant changes in Nugent score and alpha diversity were observed within contraceptive groups, changes between groups were not significantly different. CONCLUSIONS Postpartum vaginal bacterial diversity did not change in DMPA-IM users despite a reduction in Nugent-BV, but it decreased significantly among women using non-HC. Choice of contraception may influence Lactobacillus recovery in postpartum women.
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Affiliation(s)
- Bridget M Whitney
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Eric Munene Muriuki
- Institute of Infectious and Tropical Diseases (UNITID), University of Nairobi, Nairobi, Kenya
| | - Bhavna H Chohan
- Department of Global Health, University of Washington, and Kenya Medical Research Institute, Nairobi, Kenya
| | - Jacqueline M Wallis
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Congzhou Liu
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA
| | - R Scott McClelland
- Department of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Noah G Hoffman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, and Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alison C Roxby
- Department of Medicine and Global Health, University of Washington, Seattle, Washington, USA
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81
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Nelson AL. The new low-dose transdermal contraceptive system (Twirla ®): results from preclinical and Phase III trials. Ther Deliv 2021; 12:501-14. [PMID: 34098739 DOI: 10.4155/tde-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A new low-dose, once-a-week contraceptive transdermal delivery system (TDS) with 2.3-mg ethinyl estradiol (EE) and 2.6-mg levonorgestrel (LNG; Twirla®) has recently been approved by the US FDA for contraception of women with BMI <30 kg/m2. The rationale for developing this new patch, the preclinical study results and the results from two innovative Phase III clinical trials demonstrate that this patch has an acceptable Pearl index (4.3%) for its indicated users and has safety and tolerability comparable to other similar dose oral combined hormonal contraceptives. This new TDS provides an improvement over the existing TDS products, with significantly lower steady-state estrogen exposure, a level equal to that with 30-µg EE containing oral contraceptives.
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82
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Alvarez-Mon MA, Donat-Vargas C, Llavero-Valero M, Gea A, Alvarez-Mon M, Martinez-Gonzalez MA, Lopez-Del Burgo C. Analysis of Media Outlets on Women's Health: Thematic and Quantitative Analyses Using Twitter. Front Public Health 2021; 9:644284. [PMID: 34136450 PMCID: PMC8200480 DOI: 10.3389/fpubh.2021.644284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Media outlets influence social attitudes toward health habits. The analysis of tweets has become a tool for health researchers. Objective: The objective of this study was to investigate the distribution of tweets about women's health and the interest generated among Twitter users. Methods: We investigated tweets posted by 25 major U.S. media outlets about pre-menopausal and post-menopausal women's health between January 2009 and December 2019 as well as the retweets generated. In addition, we measured the sentiment analysis of these tweets as well as their potential dissemination. Results: A total of 376 tweets were analyzed. Pre-menopausal women's health accounted for most of the tweets (75.3%). Contraception was the main focus of the tweets, while a very limited number were related to infertility (1.4%). With regard to medical content, the effectiveness of contraceptive methods was the most frequent topic (46.2%). However, tweets related to side effects achieved the highest retweet-to-tweet ratio (70.3). The analysis of sentiments showed negative perceptions on tubal ligation. Conclusions: The U.S. media outlets analyzed are more interested in pre-menopausal than in post-menopausal women health and focused their content on contraception, while Twitter users showed greater interest in side effects.
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Affiliation(s)
- Miguel A Alvarez-Mon
- Department of Psychiatry and Medical Psychology, Hospital Universitario Infanta Leonor, Madrid, Spain.,Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain
| | - Carolina Donat-Vargas
- Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.,Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Maria Llavero-Valero
- Service of Endocrinology and Nutrition, Infanta Leonor Hospital, Madrid, Spain.,Department Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Alfredo Gea
- Department Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.,Center for Biomedical Research in the Liver and Digestive Diseases Network, Madrid, Spain.,Service of Internal Medicine and Rheumatology/Autoimmune Diseases, Príncipe de Asturias University Hospital, Alcalá de Henares, Spain.,Ramón y Cajal Institute for Health Research, Madrid, Spain
| | - Miguel A Martinez-Gonzalez
- Department Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Department of Nutrition, School of Public Health, Harvard University, Cambridge, MA, United States
| | - Cristina Lopez-Del Burgo
- Department Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,Institute for Culture and Society, University of Navarra, Pamplona, Spain
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83
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Smith JA, Beacroft L, Abdullah F, Buthelezi B, Makua M, Morroni C, Ramjee G, Velasquez C, Hallett TB. Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa. J Int AIDS Soc 2021; 23:e25620. [PMID: 33030312 PMCID: PMC7543057 DOI: 10.1002/jia2.25620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Some observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman's risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk. METHODS A mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in South Africa to estimate how changes in method mix could impact HIV- and reproductive health-related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use. RESULTS In South Africa, the HIV-related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infection of 1.1 or greater. A reduction in DMPA use among HIV-positive women would have no benefit in terms of HIV infections, but would incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health outcomes is the proportion of women who switch away from DMPA to no contraceptive method. CONCLUSIONS If there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.
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Affiliation(s)
- Jennifer A Smith
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Leo Beacroft
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Fareed Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | | | - Manala Makua
- National Department of Health, Pretoria, South Africa
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute, Gaborone, Botswana.,Liverpool School of Tropical Medicine, Liverpool, United Kingdom.,University of Cape Town, Cape Town, South Africa
| | | | | | - Timothy B Hallett
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
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84
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Iversen L, Fielding S, Lidegaard Ø, Hannaford PC. Contemporary hormonal contraception and cervical cancer in women of reproductive age. Int J Cancer 2021; 149:769-777. [PMID: 33818778 DOI: 10.1002/ijc.33585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/23/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
To determine cervical cancer risk associated with contemporary hormonal contraceptives, we conducted a cohort study of women aged 15 to 49 living in Denmark from 1995 to 2014, using routinely collected information about redeemed prescriptions, incident cancer and potential confounders. Poisson regression calculated adjusted cervical cancer risks among different contraceptive user groups by duration of use, time since last use, hormonal content and cancer histology. During >20 million person-years, 3643 incident cervical cancers occurred. Ever users of any hormonal contraceptives compared to never users had a relative risk (RR) of 1.19 (95% confidence interval [CI] 1.10-1.29). Increased risks were seen in current or recent users of any hormonal: RR 1.30 (95% CI 1.20-1.42) and combined: RR 1.40 (95% CI 1.28-1.53), but not progestin-only contraception: RR 0.91 (95% CI 0.78-1.07). Current or recent users of any hormonal contraception had an increased risk of both adenocarcinoma (RR 1.29, 95% CI 1.05-1.60) and squamous cancer (RR 1.31, 95% CI 1.19-1.44). The risk pattern among any hormonal and combined contraceptive users generally increased with longer duration of use and declined after stopping, possibly taking longer to disappear among prolonged users. Combined products containing different progestins had similar risks. Approximately one extra cervical cancer occurred for every 14 700 women using combined contraceptives for 1 year. Most women in our study were not vaccinated against human papillomavirus (HPV) infections. Our findings reinforce the urgent need for global interventions such as systematic screening, treatment of cervical intraepithelial neoplasia and HPV vaccination programmes to prevent cervical cancer, especially among users of combined contraceptives.
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Affiliation(s)
- Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Øjvind Lidegaard
- Department of Gynaecology, Rigshospitalet, The Juliane Marie Centre, University of Copenhagen, Copenhagen, Denmark
| | - Philip C Hannaford
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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85
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Gilmore KL, Hardman SM. New FSRH guideline on the progestogen-only implant. BMJ Sex Reprod Health 2021; 47:79-80. [PMID: 33850008 DOI: 10.1136/bmjsrh-2021-201095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Katherine Louise Gilmore
- Sexual and Reproductive Health, Newcroft Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Margaret Hardman
- Chalmers Centre, Edinburgh, UK
- Royal College of Obstetricians and Gynaecologists Faculty of Sexual and Reproductive Healthcare, London, UK
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86
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Cogswell C. Comments on FSRH National Audit on Combined Hormonal Contraception Service Provision: things our service has learned and possible learning points for others. BMJ Sex Reprod Health 2021; 47:155. [PMID: 33246933 DOI: 10.1136/bmjsrh-2020-200790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Charlotte Cogswell
- Department of Sexual and Reproductive Healthcare, Saint Cadoc's Hospital, Newport, UK
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87
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Huvinen E, Holopainen E, Heikinheimo O. Norethisterone and its acetate - what's so special about them? BMJ Sex Reprod Health 2021; 47:102-109. [PMID: 32398290 DOI: 10.1136/bmjsrh-2020-200619] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Progestogens (progestins) are widely used for contraception, in postmenopausal hormone therapy, and in treatment of abnormal uterine bleeding and endometriosis. Norethisterone (NET) and its acetate (NETA) differ from other progestogens by their partial conversion to ethinylestradiol (EE). We review their special characteristics and focus on the clinically relevant risk factors associated with estrogen action, such as migraine with aura and risk of thrombosis. METHODS Narrative review based on a medical literature (OvidMedline and PubMed) search. RESULTS NET converts to significant amounts of EE; 10-20 mg NET corresponds to 20-30 µg EE. The effects of NET on the endometrium are pronounced, making it a good choice for treating abnormal uterine bleeding, endometriosis, and endometrial hyperplasia. NET also has beneficial effects on bone mineral density and positive or neutral effects on cardiovascular health. Conversely, long-term use of NET is associated with a slightly increased breast cancer risk, and the risk of venous thromboembolism is moderately increased. This risk seems to be dose-dependent; contraceptive use carries no risk, but therapeutic doses might be associated with an increased risk. Studies suggest an association between combinations of EE and progestogens and ischaemic stroke, which in particular concerns women with migraine. No studies have, however, assessed this risk related to the therapeutic use of NET. CONCLUSIONS NET is a potent progestogen, especially when considering the endometrium. Its partial conversion to EE, however, is important to remember. Clinical consideration is required with women at high risk for either breast cancer or thromboembolism, or experiencing migraine with aura.
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Affiliation(s)
- Emilia Huvinen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Elina Holopainen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
| | - Oskari Heikinheimo
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki 00029, Finland
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88
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Rowlands IJ, Mishra GD, Lucke JC. Association between young women's physical and mental health and their method of contraception in a longitudinal, population-based study. BMJ Sex Reprod Health 2021; 47:129-136. [PMID: 32522842 DOI: 10.1136/bmjsrh-2019-200479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 05/06/2020] [Accepted: 05/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Women's physical and mental health are strongly inter-related and may influence patterns of contraceptive use. We examined the longitudinal associations between young women's physical and mental health and method of contraceptive use over a 5-year period. METHODS Data from 4952 young women (≤27 years) participating in the Australian Longitudinal Study on Women's Health who completed four self-reported surveys between 2013 and 2017 were analysed. Women's contraceptive use was categorised as: contraceptive pill/oral contraceptives, long-acting reversible contraception (LARC), condom, other methods and none. Multinomial logistic regression was used to determine the longitudinal associations between women's physical and mental health and method of contraception. RESULTS Over the 5-year period the percentage of pill users decreased from 60% (95% CI 58% to 61%) to 41% (95% CI 39% to 42%) and LARC users increased from 13% (95% CI 12% to 14%) to 21% (95% CI 20% to 22%) as did non-users from 9% (95% CI 8% to 9%) to 17% (95% CI 16% to 18%). Compared with women using the pill, women who used LARCs were more likely to be overweight (OR 1.34; 95% CI 1.17 to 1.53) and obese (OR 1.84; 95% CI 1.55 to 2.19), current smokers (OR 1.45; 95% CI 1.23 to 1.71) and reported fair or poor general health (OR 1.50; 95% CI 1.28 to 1.76) and very high levels of psychological distress (OR 1.47; 95% CI 1.24 to 1.76). Similar results were also found among women who used condoms or no contraception. CONCLUSIONS Findings suggest that obesity, smoking and poor physical and mental health play an important role in young women's contraceptive use.
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Affiliation(s)
- Ingrid J Rowlands
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Gita D Mishra
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jayne C Lucke
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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89
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Berlan ED. Implant and adolescents. BMJ Sex Reprod Health 2021; 47:150-151. [PMID: 32611545 DOI: 10.1136/bmjsrh-2020-200631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Elise D Berlan
- Pediatrics/Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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90
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Hughes SM, Pandey U, Johnston C, Marrazzo J, Hladik F, Micks E. Impact of the menstrual cycle and ethinyl estradiol/etonogestrel contraceptive vaginal ring on granulysin and other mucosal immune mediators. Am J Reprod Immunol 2021; 86:e13412. [PMID: 33641250 DOI: 10.1111/aji.13412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/13/2022] Open
Abstract
PROBLEM Changes in sex hormones during the menstrual cycle and contraceptive vaginal ring (CVR) use influence immunity within the female genital tract, but the magnitude of these effects and their anatomical location are unclear. METHOD OF STUDY In a prospective study, 29 women were assessed at three-time points: follicular phase, luteal phase, and one month after initiation of the ethinyl estradiol/etonogestrel CVR (NuvaRing®, Merck). We performed microarrays on endocervical cytobrushes and measured immune mediators in cervicovaginal fluid, adjusting for bacterial vaginosis and the presence of blood. We compared these results to public gene expression data from the fallopian tubes, endometrium, endo- and ectocervix, and vagina. RESULTS Immune-related gene expression in the endocervix and immune mediators in cervicovaginal fluid increased during CVR use versus both menstrual phases, and in the follicular versus luteal phase. The antimicrobial protein granulysin was high during CVR use, intermediate in the follicular phase, and nearly absent from the luteal phase. Re-analysis of public gene expression data confirmed increased immune-related gene expression in the endocervix during the follicular phase. However, in the fallopian tube, endometrium, and vagina, the follicular phase showed immunosuppression. CONCLUSIONS Immune-related genes in the cervicovaginal tract were highest during CVR use, intermediate in the follicular phase, and lowest in the luteal phase. Granulysin is a potential biomarker of menstrual phase: Frequently detected in follicular samples, but rare in luteal. Lastly, immunological differences between the follicular and luteal phases vary throughout the female genital tract.
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Affiliation(s)
- Sean M Hughes
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Urvashi Pandey
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
| | - Christine Johnston
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jeanne Marrazzo
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Hladik
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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91
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Cauci S, Xodo S, Buligan C, Colaninno C, Barbina M, Barbina G, Francescato MP. Oxidative Stress Is Increased in Combined Oral Contraceptives Users and Is Positively Associated with High-Sensitivity C-Reactive Protein. Molecules 2021; 26:1070. [PMID: 33670593 DOI: 10.3390/molecules26041070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Information concerning the mechanisms underlying oxidative stress and low-grade inflammation in young healthy women predisposing eventually to future diseases is scarce. We investigated the relationship of oxidative stress and high-sensitivity C-reactive protein (hsCRP) in fertile-age women by oral combined contraceptive (OC) use. Caucasian Italian healthy non-obese women (n = 290; 100 OC-users; 190 non-OC-users; mean age 23.2 ± 4.7 years) were analyzed. Blood hydroperoxides, as oxidative stress biomarkers, were assessed by Free Oxygen Radical Test (FORT). Serum hsCRP was determined by an ultra-sensitive method (hsCRP). Markedly elevated oxidative stress (≥400 FORT Units) was found in 77.0% of OC-users and 1.6% of non-OC-users, odds ratio (OR) = 209, 95% CI = 60.9–715.4, p < 0.001. Elevated hsCRP levels ≥ 2.0 mg/L, considered risky for cardiovascular diseases (CVDs), were found in 41.0% of OC-users and 9.5% of non-OC-users, OR = 6.6, 95%CI 3.5–12.4, p < 0.001. Hydroperoxides were strongly positively correlated to hsCRP in all women (rs = 0.622, p < 0.001), in OC-users (rs = 0.442, p < 0.001), and in non-OC-users (rs = 0.426, p < 0.001). Women with hydroperoxides ≥ 400 FORT Units were eight times as likely to have hsCRP ≥ 2 mg/L. In non-OC-users only, hydroperoxides values were positively correlated with weight and body mass index, but negatively correlated with red meat, fish and chocolate consumption. Our research is the first finding a strong positive correlation of serum hydroperoxides with hsCRP, a marker of low-grade chronic inflammation, in young healthy women. Further research is needed to elucidate the potential role of these two biomarkers in OC-use associated side-effects, like thromboembolism and other CVDs.
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92
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Nyirenda HT, Mukanga B, Choka N, Jegede AI, Mulenga D, Nyirenda HBC, Nyirenda T. Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia. EUR J CONTRACEP REPR 2021; 26:255-260. [PMID: 33554674 DOI: 10.1080/13625187.2021.1874335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception. METHODS The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants (N = 2151) were single, sexually active women aged 15-49 years, of whom 595 were using hormonal contraception. RESULTS Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse (p < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users (p = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15-19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20-24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77). CONCLUSION Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.
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Affiliation(s)
- Herbert Tato Nyirenda
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Bright Mukanga
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Nancy Choka
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Ayoola Isaac Jegede
- Department of Basic Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - David Mulenga
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Herbert B C Nyirenda
- Department of Adult Education and Extension Studies, School of Education, University of Zambia, Lusaka, Zambia
| | - Tambulani Nyirenda
- Department of Public Administration, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Franik S, Bauersachs R, Beyer-Westendorf J, Buchholz T, Bühling K, Diener HC, Erath A, Fischer R, Förderreuther S, Franz HBG, Hach-Wunderle V, Hadji P, Harlfinger W, Jaursch-Hancke C, König K, Krämer G, Naumann G, Neulen J, Oppelt PG, Pliefke J, Rimbach S, Rott H, Schroll E, Schumann C, Segerer S, Seyler H, Tempfer C, Thonke I, Toth B, Wildt L, Zotz R, Stute P, Kiesel L. Hormonal Contraception. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry Number 015/015, January 2020). Geburtshilfe Frauenheilkd 2021; 81:152-182. [PMID: 33623171 DOI: 10.1055/a-1259-1609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 10/22/2022] Open
Abstract
Aims This is an official interdisciplinary guideline published and coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking regions and is backed by numerous professional societies and organizations. The aim of this guideline is to provide an evidence- and consensus-based overview of the diagnostic approach and the management of hormonal contraception based on a systematic evaluation of the relevant literature. Methods To compile this S3-guideline, a systematic search for evidence was carried out in PubMed and the Cochrane Library to adapt existing guidelines and identify relevant reviews and meta-analyses. A structured evaluation of the evidence was subsequently carried out on behalf of the Guidelines Commission of the DGGG, and a structured consensus was achieved based on consensus conferences attended by representative members from the different specialist societies and professions. Recommendations Evidence-based recommendations about the advice given to women requesting contraception were compiled. The guideline particularly focuses on prescribing contraceptives which are appropriate to women's individual needs, take account of her personal circumstances, and have few or no side effects.
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Affiliation(s)
- Sebastian Franik
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Germany
| | | | - Jan Beyer-Westendorf
- Medizinische Klinik 1, Bereich Hämatologie und Hämostaseologie, Universitätsklinikum Dresden, Dresden, Germany
| | | | - Kai Bühling
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anke Erath
- Abteilung für Sexualaufklärung und Familienplanung, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Germany
| | - Ronald Fischer
- Innere Medizin, Hämostaseologie, Interdisziplinärer Schwerpunkt für Hämostaseologie, Universitätsklinikum Gießen, Gießen, Germany
| | - Stefanie Förderreuther
- Neurologische Klinik der Ludwig-Maximilians-Universität München, LMU Klinikum, München, Germany
| | - Heiko B G Franz
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Braunschweig, Braunschweig, Germany
| | - Viola Hach-Wunderle
- Gefäßzentrum - Sektion Angiologie, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Peymann Hadji
- Frankfurter Hormon- und Osteoporosezentrum, Frankfurt am Main & Philipps-Universität Marburg, Frankfurt am Main, Germany
| | | | | | - Klaus König
- Frauenärztliche Gemeinschaftspraxis Steinbach, Steinbach, Germany
| | | | - Gert Naumann
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinik Erfurt, Erfurt, Germany
| | - Joseph Neulen
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, RWTH Aachen, Aachen, Germany
| | - Patricia G Oppelt
- Frauenklinik der Universität Erlangen, Universität Erlangen, Erlangen, Germany
| | - Jutta Pliefke
- pro familia - Deutsche Gesellschaft für Familienplanung, Sexualpädagogik und Sexualberatung e. V., Berlin, Germany
| | - Stefan Rimbach
- Gynäkologie und Geburtshilfe, Krankenhaus Agatharied GmbH, Hausham, Germany
| | | | - Eckhard Schroll
- Abteilung für Sexualaufklärung und Familienplanung, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Köln, Germany
| | | | - Sabine Segerer
- Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologie, Hamburg, Germany
| | - Helga Seyler
- Familienplanungszentrum Hamburg, Hamburg, Germany
| | - Clemens Tempfer
- Universitäts-Frauenklinik der Ruhr-Universität Bochum, Marien Hospital Herne, Herne, Germany
| | - Ines Thonke
- pro familia - Deutsche Gesellschaft für Familienplanung, Sexualpädagogik und Sexualberatung e. V., Berlin, Germany
| | - Bettina Toth
- Universitätsklinik für Gynäkologische Endokrinologie u. Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Ludwig Wildt
- Klinik für Kardiologie und Angiologie, Marienhaus Klinikum Eifel, Klinikstandort Bitburg, Bitburg, Germany
| | - Rainer Zotz
- Institut für Laboratoriumsmedizin, Blutgerinnungsstörungen und Transfusionsmedizin (LBT), Düsseldorf, Germany
| | - Petra Stute
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | - Ludwig Kiesel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Germany
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94
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Hawkins KE, Montague-Johnstone E. Contraceptive usage in homeless women accessing a dedicated primary care service in Scotland, UK: a case note review. BMJ Sex Reprod Health 2021; 47:49-54. [PMID: 32414876 DOI: 10.1136/bmjsrh-2019-200541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Of the 70 000 people experiencing homelessness in Scotland, at least 40% are women. Little is known about their contraceptive usage. Most pregnancies in homelessness are unintended and children are usually looked after in the care system. METHODS A case note review of women's current contraceptive usage in a primary care service serving women experiencing homelessness in Edinburgh, Scotland. The service electronic database was searched for keywords relating to contraception to determine current usage, but also reproductive health, wider demographics and previous pregnancies. RESULTS Of 174 women (16-55 years), 75 (43%) were recorded as using a contraceptive method. 49 (28%) were using long-acting reversible contraception (LARC), most of which was the contraceptive implant. However, 6/41 (15%) of the most effective LARC (intrauterine contraception and implant) was being used beyond its' expiry date. 34 (20%) had no mention of contraceptive use in their medical record and 32 (19%) were not using contraception despite being sexually active. 6 (3%) had been hysterectomised/female sterilisation. 26 (15%) were not sexually active. 179 of the 233 (77%) children mentioned in women's electronic records were recorded as being looked after out with their care. 138/174 (79%) had current/previous drug or alcohol misuse. 100/174 (57%) had a history of domestic violence or abuse. 22/174 (13%) were involved/had been involved in sex work. CONCLUSIONS Primary care services need to give greater attention to the contraceptive needs of homeless women to empower them to become pregnant when the time is right for them and prevent the consequences of unintended pregnancy and homelessness.
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Affiliation(s)
- Katie Eirian Hawkins
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Edinburgh Access Practice primary care service, Edinburgh, UK
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95
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Laakkonen EK, Karppinen JE, Lehti S, Lee E, Pesonen E, Juppi HK, Kujala UM, Haapala EA, Aukee P, Laukkanen JA, Ihalainen JK. Associations of Sex Hormones and Hormonal Status With Arterial Stiffness in a Female Sample From Reproductive Years to Menopause. Front Endocrinol (Lausanne) 2021; 12:765916. [PMID: 34917027 PMCID: PMC8669797 DOI: 10.3389/fendo.2021.765916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Loss of sex hormones has been suggested to underlie menopause-associated increment in cardiovascular risk. We investigated associations of sex hormones with arterial stiffness in 19-58-years-old women. We also studied associations of specific hormonal stages, including natural menstrual cycle, cycle with combined oral contraceptives (COC) and menopausal status with or without hormone therapy (HT), with arterial stiffness. METHODS This study includes repeated measurements of 65 healthy women representing reproductive (n=16 natural, n=10 COC-users) and menopause (n=5 perimenopausal, n=26 postmenopausal, n=8 HT-users) stages. Arterial stiffness outcomes were aortic pulse wave velocity (PWVao) and augmentation index (AIx%) assessed using Arteriograph-device. Generalized estimating equation models were constructed to investigate associations of each hormone (wide age-range models) or hormonal stage (age-group focused models) with arterial stiffness. PWVao models with cross-sectional approach, were adjusted for age, relative fitness, fat mass and mean arterial pressure, while models with longitudinal approach were adjusted for mean arterial pressure. AIx% models used the same approach for adjustments and were also adjusted for heart rate. RESULTS Negative and positive associations with arterial stiffness variables were observed for estradiol and follicle-stimulating hormone, respectively, until adjustment for confounding effect of age. In naturally menstruating women, AIx% was higher at ovulation (B=3.63, p<0.001) compared to the early follicular phase. In COC-users, PWVao was lower during active (B=-0.33 - -0.57, p<0.05) than inactive pills. In menopausal women, HT-users had higher PWVao (B=1.43, p=0.03) than postmenopausal non-HT-users. CONCLUSIONS When using wide age-range assessments covering reproductive to menopausal lifespan it is difficult to differentiate age- and hormone-mediated associations, because age-mediated influence on arterial stiffness seemed to overrule potential hormone-mediated influences. However, hormonal status associated differentially with arterial stiffness in age-group focused analyses. Thus, the role of sex hormones cannot be excluded. Further research is warranted to resolve potential hormone-mediated mechanisms affecting arterial elasticity.
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Affiliation(s)
- Eija K. Laakkonen
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Eija K. Laakkonen,
| | - Jari E. Karppinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Satu Lehti
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Earric Lee
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Emilia Pesonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hanna-Kaarina Juppi
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M. Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eero A. Haapala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Pauliina Aukee
- Department Obstetrics and Gynecology and Pelvic Floor Research and Therapy Unit, Central Finland Health Care District, Jyväskylä, Finland
| | - Jari A. Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Johanna K. Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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96
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Seymour JW, Fix L, Grossman D, Grindlay K. Contraceptive use and access among deployed US servicewomen: findings from an online survey. BMJ Sex Reprod Health 2021; 47:61-66. [PMID: 32341070 DOI: 10.1136/bmjsrh-2019-200569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND/INTRODUCTION This study aimed to survey US servicewomen on their contraceptive access and use during deployment. METHODS Between June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample of current and former members of the US Military, National Guard and Reserves who had a deployment ending in 2010 or later. Participants were asked open-ended and closed-ended questions about their demographics and contraceptive use and access before and during their last deployment. Descriptive statistics were run on closed-ended questions and responses to open-ended questions were inductively coded. RESULTS A total of 353 participants were included. Sixty-five per cent reported using contraception during all or part of their last deployment. Nearly half (49.3%) did not have or remember having a discussion with a military care provider about contraception prior to deployment. Both prior to and during deployment, the free or low cost of birth control and ability to get a full supply for deployment facilitated contraceptive use. Difficulty obtaining an appointment and the inability to get a full supply of birth control were barriers to contraception access both before and during deployment. Half (49.1%) of respondents who had to start or refill contraception during deployment said it was somewhat or very difficult to do so. CONCLUSIONS For at least some servicewomen, there are barriers to contraceptive access and use prior to and during overseas deployment. Programmes to increase contraceptive access should be expanded and monitoring systems should be implemented to ensure all servicemembers receive predeployment contraceptive counselling.
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Affiliation(s)
| | - Laura Fix
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
| | - Kate Grindlay
- Ibis Reproductive Health, Cambridge, Massachusetts, USA
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97
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Gallimore A, Irshad T, Cooper M, Cameron S. Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study. BMJ Sex Reprod Health 2021; 47:43-48. [PMID: 32299825 DOI: 10.1136/bmjsrh-2019-200497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/28/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling. METHODS Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out. RESULTS Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception. CONCLUSIONS Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences.
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Affiliation(s)
| | - Tasneem Irshad
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | | | - Sharon Cameron
- Medical Research Council (MRC) Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
- Chalmers Sexual Health Clinic, NHS Lothian, Edinburgh, UK
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98
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Nobile B, Maimoun L, Jaussent ID, Seneque M, Dupuis-Maurin K, Lefebvre P, Courtet P, Renard E, Guillaume S. Effects of Hormonal Contraception Use on Cognitive Functions in Patients With Bulimia Nervosa. Front Psychiatry 2021; 12:658182. [PMID: 34079484 PMCID: PMC8165222 DOI: 10.3389/fpsyt.2021.658182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Growing evidences indicate that sex hormones have an effect on cognitive functions, and that Bulimia Nervosa (BN) is associated with cognitive impairment. The aim of this study was to determine the effect of hormonal contraception (HC) use on four cognitive functions that are impaired in patients with BN. Methods: This retrospective exploratory study included 103 women with a diagnosis of BN based on the DSM-5 criteria. Their age ranged from 15 to 45 years, and 46.6% were taking HC (oral, transdermal, or intrauterine). Cognition was assessed with the d2 test (attention), Iowa gambling task (IGT; decision making), Brixton spatial anticipation test (set shifting), and Rey-Osterrieth complex figure test (central coherence). Data were analyzed with logistic regression models to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) of HC effect on the neuropsychological test scores. Results: In the multivariate model, HC use was significantly associated with better scores for two d2 test indices: F-score [OR = 0.98, 95% CI = (0.95; 0.99)] and final total score ratio [OR = 0.87, 95% CI = (0.77; 0.99)]. HC was also associated with a better understanding of the IGT explicit rules. No difference between the two groups (HC and non-HC use) was detected for set shifting and central coherence. Conclusions: This exploratory study suggests that HC could have effects on the sustained attention and concentration in women with BN. More studies are needed to confirm these results.
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Affiliation(s)
- Benedicte Nobile
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Laurent Maimoun
- Department of Nuclear Medicine, CHRU Montpellier, Montpellier, France.,INSERM U1046, UMR9214 CNRS, Physiology and Experimental Medicine of the Heart and Muscles, University of Montpellier, CHRU Montpellier, Montpellier, France
| | | | - Maude Seneque
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France
| | - Kathlyne Dupuis-Maurin
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, and Nutrition, CHRU Montpellier, Montpellier, France
| | - Phillippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition, CHRU Montpellier, Montpellier, France.,UMR CNRS 5203, INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Sebastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France.,FondaMental Foundation, Créteil, France
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99
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Postma LGM, Donyai P. The cooccurrence of heightened media attention and adverse drug reaction reports for hormonal contraception in the United Kingdom between 2014 and 2017. Br J Clin Pharmacol 2020; 87:1768-1777. [PMID: 32978837 PMCID: PMC8056733 DOI: 10.1111/bcp.14563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022] Open
Abstract
Aim The aim of this study was to examine the cooccurrence of heightened media attention after the publication of a paper by Skovlund et al in September 2016 on the link between hormonal contraception and depression or mood on adverse drug reaction (ADR) reports in the UK. Methods A quantitative analysis of relevant newspaper articles published between January 2014 and December 2017 was performed, as well as a content analysis. ADR reports were collected from the Medicines and Healthcare Products Regulatory Agency website and via a Freedom of Information request. A quantitative analysis was performed on ADR reports of hormonal contraceptives for all ADRs and for depressed mood disorders and disturbances. Results The publication of the Skovlund et al paper did not lead to a peak in relevant newspaper articles, but there was a change in the content of the newspaper articles, which focussed more on the link between hormonal contraceptives and depression or mood. There was an overall increase in ADR reports by women relating to hormonal contraceptives between 2016 and 2017, and for combined contraceptives this was due to an increase in ADR reports of depressed mood disorders and disturbances. Conclusions The content of media attention appears to affect ADR reporting by women for combined contraceptives. In general, patients report the majority of depressed mood disorders and disturbances ADRs as opposed to health professionals, who report other ADRs. Care providers can anticipate the effect of heightened media attention and help patients when they experience these ADRs.
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100
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Grzeskowiak LE, Calabretto H, Amos N, Mazza D, Ilomaki J. Changes in use of hormonal long-acting reversible contraceptive methods in Australia between 2006 and 2018: A population-based study. Aust N Z J Obstet Gynaecol 2020; 61:128-134. [PMID: 33095452 DOI: 10.1111/ajo.13257] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-acting reversible contraceptives (LARCs) are promoted internationally as a key strategy for reducing unintended pregnancy and abortion rates. AIMS To examine trends in use of hormonal LARCs among reproductive-aged women in Australia between 2006 and 2018 and explore trends according to age groups and state/territory of dispensing. MATERIALS AND METHODS Retrospective population-based study using Pharmaceutical Benefits Scheme (PBS) dispensing claims of a 10% random sample of females aged 15-44. We investigated rates and annual trends in dispensing claims of etonorgestrel implant and levonorgestrel intrauterine systems (IUS). RESULTS Between 2006 and 2018, annual PBS claims for LARCs increased approximately two-fold from 21.7 to 41.5 per 1000 women, with a plateau observed from 2015 onward. Absolute rate increases were similar for the implant (9.0/1000) and IUS (10.8/1000), with increases observed across all age groups and states/territories. Overall dispensing rates varied by two-fold according to state/territory of dispensing and four-fold according to age groups. Rate increases for the implant were highest among the 15-19 and 20-24 age groups, while rate increases for the IUS were highest among the 35-39 and 40-44 age groups. It is estimated that in 2018, 10.8% of women aged 15-44 were using a LARC; 4.5% for the implant and 6.3% for the IUS. CONCLUSIONS Rates of hormonal LARC use have doubled over the past decade. Investigating underlying reasons for the large observed differences in rates of use according to age and state/territory could help further improve uptake for these most effective methods of contraception.
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Affiliation(s)
- Luke E Grzeskowiak
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Women's & Children's Hospital, Adelaide, South Australia, Australia
| | - Helen Calabretto
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,SHINE SA, Adelaide, South Australia, Australia.,Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Natalie Amos
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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