Cervical carcinogenesis and contraception

Cervical changes associated with progestagen-only contraceptives: a team approach

OBJECTIVES

To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up.

DESIGN

A prospective cross-sectional comparative study.

SETTING

Family-planning clinic of a tertiary care university hospital.

SUBJECTS

A total of 325 current users of contraceptive methods for more than 3 years.

INTERVENTIONS

Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush.

MAIN OUTCOME MEASURES

Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer.

RESULTS

Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant.

CONCLUSIONS

Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.

Does contraceptive method change the Pap smear finding?

The aim of the present study was to investigate the effect of various types of contraceptives on morphological finding of Pap smear results. Pap smear results of 7,753 fertile women who presented to 15 different family planning services in Fars Province (south of Iran) were analyzed according to their methods of contraception. The population consisted of 2241 women who used intrauterine device (IUD) as a contraceptive method (Group 1), 2521 women who were oral contraceptive (OCP) users (Group 2), and the control group, which consisted of women who used other methods of contraceptive. Comparison between the Pap smear results showed a higher number of benign cellular changes among Group 1 (22.4%) than Group 2 (19.3%), and the differences were statistically significant (p = 0.009). In addition, 80.6% women who used oral contraceptive pill (OCP) as contraceptive showed cellular changes within normal limits, while it were 77.6% for intrauterine device (IUD) users. Compared with Group 2, Group 1 had a significantly higher percentage of metaplastic cells in their Pap smear results (G1 7.4%, G2 5.8%, p < 0.05). No epithelial abnormalities were reported in Pap smears. Trichomonas vaginalis was higher in G1 than the other groups (p < 0.005), but the difference was not statistically significant for candidiasis. It may be concluded that in this population, IUD and OCP had no effect on morphological pattern of the Pap smears, but there was a significant increased rate of trichomonas infection in IUD users.

Safety of implantable contraceptives for women: data from observational studies

Contraceptive implants are registered in over 60 countries and have been used by millions of women for three decades. This article reviews findings from observational studies on the safety of contraceptive implants and examines the risk of specific health outcomes. Fifty-five articles were reviewed, and the body of evidence for each health outcome was summarized. Available evidence suggests that contraceptive implants are safe and, overall, implant users do not experience adverse events at rates higher than women not using implants. With respect to specific outcomes, the evidence suggests no increased risks of pelvic inflammatory disease, decreased bone mineral density, anemia, thrombocytopenia, or death with implant use. The evidence was too limited to draw meaningful conclusions for neoplastic disease, cardiovascular events, and HIV/AIDS. Nonsignificantly elevated associations were reported for diabetes, serious mental disorders, and rheumatoid arthritis. Conditions for which risks were marginally, yet significantly, elevated were hypertension and gall bladder disease.

Formation of copper oxychloride and reactive oxygen species as causes of uterine injury during copper oxidation of Cu-IUD

The lining of the uterus and cervix might be injured by a variety of oxidation products of Cu in a Cu-IUD, including cuprous ions, dissolved and precipitated cupric ions, and reactive oxygen species such as superoxide radicals, hydrogen peroxide, and hydroxyl radicals. In this study, the human amnious WISH cell line was employed as a model of uterine cells in the presence of copper. The cell viability was decreased by elemental copper, which was alleviated up to 70% by the addition of catalase. The addition of copper oxychloride caused cell death in a dose-dependent manner. Hydroxyl radicals in the presence of copper were determined by the formation of malondialdehyde. Soluble cuprous chloride complexes are formed in the uterus by slowly entering oxygen. The complexes are partly oxidized to insoluble copper oxychloride. which damages the endometrium. Unoxidized cuprous ions migrate to the oxygen-rich cervix and are oxidized to copper oxychloride, causing cervix damage.