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Gassen J, Mengelkoch S, Shanmugam D, Pearson JT, van Lamsweerde A, Benhar E, Hill SE. Longitudinal changes in sexual desire and attraction among women who started using the Natural Cycles app. Horm Behav 2024; 162:105546. [PMID: 38640590 DOI: 10.1016/j.yhbeh.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.
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Affiliation(s)
- Jeffrey Gassen
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America.
| | - Summer Mengelkoch
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America
| | - Divya Shanmugam
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, Cambridge, MA 02139, United States of America
| | - Jack T Pearson
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | | | - Eleonora Benhar
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | - Sarah E Hill
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America
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Saadedine M, Faubion SS. Hormonal Contraception and Sexual Function: A Review, Clinical Insights, and Management Considerations. Obstet Gynecol Clin North Am 2024; 51:381-395. [PMID: 38777490 DOI: 10.1016/j.ogc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Most sexually active women of reproductive age have used contraception, with hormonal methods constituting approximately 40% of contraceptive choices. Among these hormonal options, combined oral contraceptives stand out as the most selected. Within this same demographic, sexual issues are prevalent. Although specific hormonal contraceptives have been implicated in sexual dysfunction among these women, the correlation lacks consistency across studies and varies between different types of hormonal contraception. This article assesses the available literature on the associations between various hormonal contraceptive methods and sexual function and provides practical management insights.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA.
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Hill SE, Mengelkoch S. Moving beyond the mean: Promising research pathways to support a precision medicine approach to hormonal contraception. Front Neuroendocrinol 2023; 68:101042. [PMID: 36332783 DOI: 10.1016/j.yfrne.2022.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Women's psychological and behavioral responses to hormonal contraceptive (HC) treatment can be highly variable. One of the great challenges to researchers seeking to improve the experiences of women who use HCs is to identify the sources of this variability to minimize unpleasant psychobehavioral side-effects. In the following, we provide recommendations for programs of research aimed at identifying sources of heterogeneity in women's experiences with HC. First, we review research demonstrating person- and prescription- based heterogeneity in women's psychobehavioral responses to HCs. Next, we identify several promising person- and prescription- based sources of this heterogeneity that warrant future research. We close with a discussion of research approaches that are particularly well-suited to address the research questions raised in article. Together, this review provides researchers with several promising research pathways to help support the development of a precision medicine approach to HC treatment.
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Schmidt NM, Hennig J, Munk AJL. Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users. Front Neurosci 2022; 15:798823. [PMID: 35058744 PMCID: PMC8764149 DOI: 10.3389/fnins.2021.798823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aims: Exposure toward positive emotional cues with - and without - reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women. Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment. Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen. Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.
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Affiliation(s)
- Norina M. Schmidt
- Department of Differential and Biological Psychology, University of Giessen, Giessen, Germany
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Weigard A, Loviska AM, Beltz AM. Little evidence for sex or ovarian hormone influences on affective variability. Sci Rep 2021; 11:20925. [PMID: 34686695 PMCID: PMC8536752 DOI: 10.1038/s41598-021-00143-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Women were historically excluded from research participation partly due to the assumption that ovarian hormone fluctuations lead to variation, especially in emotion, that could not be experimentally controlled. Although challenged in principle and practice, relevant empirical data are limited by single measurement occasions. The current paper fills this knowledge gap using data from a 75-day intensive longitudinal study. Three indices of daily affective variability-volatility, emotional inertia, and cyclicity-were evaluated using Bayesian inferential methods in 142 men, naturally cycling women, and women using three different oral contraceptive formulations (that "stabilize" hormone fluctuations). Results provided more evidence for similarities between men and women-and between naturally cycling women and oral contraceptive users-than for differences. Even if differences exist, effects are likely small. Thus, there is little indication that ovarian hormones influence affective variability in women to a greater extent than the biopsychosocial factors that influence daily emotion in men.
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Affiliation(s)
- Alexander Weigard
- grid.214458.e0000000086837370Department of Psychology, The University of Michigan, 2227 East Hall 530 Church Street, Ann Arbor, MI 48109 USA
| | - Amy M. Loviska
- grid.214458.e0000000086837370Department of Psychology, The University of Michigan, 2227 East Hall 530 Church Street, Ann Arbor, MI 48109 USA
| | - Adriene M. Beltz
- grid.214458.e0000000086837370Department of Psychology, The University of Michigan, 2227 East Hall 530 Church Street, Ann Arbor, MI 48109 USA
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Deumic Shultz E, Mills JA, Ellingrod VL, Bishop JR, Calarge CA. Sexual Functioning in Adolescents With Major Depressive Disorder: A Prospective Study. J Clin Psychiatry 2021; 82:21m13892. [PMID: 34610228 PMCID: PMC10552909 DOI: 10.4088/jcp.21m13892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To examine the association between sexual functioning, depression and anxiety severity, and selective serotonin reuptake inhibitor (SSRI) use in adolescents. Methods: From September 2010 to December 2014, 15- to 20-year-old participants, either unmedicated or within a month of beginning SSRI treatment, completed the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Changes in Sexual Functioning Questionnaire (CSFQ) at baseline and every 4 months for up to 2 years. The DSM-IV-TR was used to determine presence of psychiatric disorders. Data regarding use of medications and hormonal contraception were collected. Polymorphisms of the HTR2A and ABCB1 genes were genotyped. Linear mixed-effects regression models examined the association between depression and anxiety symptom severity, SSRI use, and sexual functioning, accounting for relevant covariates. Results: A total of 263 participants (59% female, mean ± SD age = 18.9 ± 1.6 years, 70% with major depressive disorder) contributed to this analysis. After adjusting for age, sex, and duration in the study, depression severity, but not anxiety severity, was associated with lower CSFQ total scores (β = -0.13, P < .0001) and lower arousal, orgasm, and pleasure subscale scores (all β = -0.03, P < .003). Higher SSRI doses were associated with lower orgasm subscale scores (β = -0.30, P < .03). Hormonal contraceptive use was associated with higher CSFQ total scores (β = 0.97, P < .003) and higher arousal (β = 0.25, P < .009), desire (β = 0.24, P < .001), orgasm (β = 0.27, P < .02), and pleasure (β = 0.15, P < .004) subscale scores. No significant genetic moderating effect was found. Conclusions: In adolescents, depression is associated with lower sexual functioning while SSRI use impairs orgasm.
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Affiliation(s)
- Emira Deumic Shultz
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - James A Mills
- Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Vicki L Ellingrod
- Clinical and Translational Pharmacy, College of Pharmacy; Departments of Psychiatry and Psychology; Michigan Institute for Clinical and Health Research (MICHR); and Education and Mentoring Group, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey R Bishop
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota eMenninger Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Baylor College of Medicine-Texas Children's Hospital, Houston, Texas *Corresponding author: Chadi A. Calarge, MD, 1102 Bates Ave, Ste 790, Houston, TX 77030
| | - Chadi A Calarge
- Menninger Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Baylor College of Medicine-Texas Children's Hospital, Houston, Texas
- Corresponding author: Chadi A. Calarge, MD, 1102 Bates Ave, Ste 790, Houston, TX 77030
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de Wit AE, Booij SH, Giltay EJ, Joffe H, Schoevers RA, Oldehinkel AJ. Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women. JAMA Psychiatry 2020; 77:52-59. [PMID: 31577333 PMCID: PMC6777223 DOI: 10.1001/jamapsychiatry.2019.2838] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Oral contraceptives have been associated with an increased risk of subsequent clinical depression in adolescents. However, the association of oral contraceptive use with concurrent depressive symptoms remains unclear. OBJECTIVES To investigate the association between oral contraceptive use and depressive symptoms and to examine whether this association is affected by age and which specific symptoms are associated with oral contraceptive use. DESIGN, SETTING, AND PARTICIPANTS Data from the third to sixth wave of the prospective cohort study Tracking Adolescents' Individual Lives Survey (TRAILS), conducted from September 1, 2005, to December 31, 2016, among females aged 16 to 25 years who had filled out at least 1 and up to 4 assessments of oral contraceptive use, were used. Data analysis was performed from March 1, 2017, to May 31, 2019. EXPOSURE Oral contraceptive use at 16, 19, 22, and 25 years of age. MAIN OUTCOMES AND MEASURES Depressive symptoms were assessed by the DSM-IV-oriented affective problems scale of the Youth (aged 16 years) and Adult Self-Report (aged 19, 22, and 25 years). RESULTS Data from a total of 1010 girls (743-903 girls, depending on the wave) were analyzed (mean [SD] age at the first assessment of oral contraceptive use, 16.3 [0.7]; (mean [SD] age at the final assessment of oral contraceptive use, 25.6 [0.6] years). Oral contraceptive users particularly differed from nonusers at age 16 years, with nonusers having a higher mean (SD) socioeconomic status (0.17 [0.78] vs -0.15 [0.71]) and more often being virgins (424 of 533 [79.5%] vs 74 of 303 [24.4%]). Although all users combined (mean [SD] ages, 16.3 [0.7] to 25.6 [0.6] years) did not show higher depressive symptom scores compared with nonusers, adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (β coefficient for interaction with age, -0.021; 95% CI, -0.038 to -0.005; P = .0096). Adolescent contraceptive users particularly reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers. CONCLUSIONS AND RELEVANCE Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence.
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Affiliation(s)
- Anouk E. de Wit
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands,Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sanne H. Booij
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts,Connors Center for Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A. Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Albertine J. Oldehinkel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM). J Sex Med 2019; 16:1681-1695. [DOI: 10.1016/j.jsxm.2019.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
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Women using hormonal contraceptives show increased valence ratings and memory performance for emotional information. Neuropsychopharmacology 2019; 44:1258-1264. [PMID: 30836380 PMCID: PMC6784990 DOI: 10.1038/s41386-019-0362-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/08/2019] [Accepted: 02/25/2019] [Indexed: 01/04/2023]
Abstract
Perception of emotional valence and emotional memory performance vary across the menstrual cycle. However, the consequences of altered ovarian hormone levels due to the intake of hormonal contraceptives on these emotional and cognitive processes remain to be established. In the present study, which included 2169 healthy young females, we show that hormonal contraceptives (HC) users rated emotional pictures as more emotional than HC-non-users and outperformed non-users in terms of better memory recall of emotional pictures. The observed association between HC-status and memory performance was partially mediated by the perception of emotional picture valence, indicating that increased valence ratings of emotional pictures in HC-users led to their better emotional memory performance. These findings extend the knowledge about the relation of HC-intake with emotional valence perception and emotional memory performance. Further, the findings might stimulate further research investigating the interrelation of enhanced memory for emotional events and the increased risk for anxiety-related psychiatric disorders in women.
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de Castro Coelho F, Barros C. The Potential of Hormonal Contraception to Influence Female Sexuality. Int J Reprod Med 2019; 2019:9701384. [PMID: 30941356 PMCID: PMC6421036 DOI: 10.1155/2019/9701384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/30/2019] [Indexed: 02/02/2023] Open
Abstract
The association between female sexual function and hormonal contraception is controversial. Recognition and management of sexual side effects in women using hormonal contraceptives are challenging. An unsatisfactory number of studies report the influence of the available contraceptives on female sexuality. This article provides an updated narrative review regarding the effect and the magnitude of the impact that hormonal contraceptives play in female sexual function.
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Affiliation(s)
- Filipa de Castro Coelho
- Department of Gynecology and Obstetrics, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira, E.P.E., Funchal, Portugal
| | - Cremilda Barros
- Department of Gynecology and Obstetrics, Hospital Dr. Nélio Mendonça, Serviço de Saúde da Região Autónoma da Madeira, E.P.E., Funchal, Portugal
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Farnam F. Assisting IUD and DMPA Users with Overcoming their Sexual and Mood Problems. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.29252/pcnm.8.4.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Zettermark S, Perez Vicente R, Merlo J. Hormonal contraception increases the risk of psychotropic drug use in adolescent girls but not in adults: A pharmacoepidemiological study on 800 000 Swedish women. PLoS One 2018; 13:e0194773. [PMID: 29566064 PMCID: PMC5864056 DOI: 10.1371/journal.pone.0194773] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/11/2018] [Indexed: 12/18/2022] Open
Abstract
The burden of depression and anxiety disorders is greater in women, and female sex hormones have been shown to affect mood. Psychological side effects of hormonal contraception (HC) are also a common complaint in the clinic, but few previous studies have investigated this subject. We therefore wanted to investigate whether use of HC was associated with adverse psychological health outcomes, and whether this association was modified by age. All women aged 12–30 years on 31 December 2010, residing in Sweden for at least four years and with no previous psychiatric morbidity (n = 815 662), were included. We followed the women from their first HC use (or 31 December 2010, if they were non-users) at baseline, until a prescription fill of psychotropic drugs or the end of the one-year follow-up. We performed age-stratified logistic regression models and estimated odds ratios (OR) to measure the association between different HC methods and psychotropic drug use, as well as the area under the receiver operating curve to estimate discriminatory accuracy of HC in relation to psychotropic drugs. Overall, we found an association between HC and psychotropic drugs (adjusted OR 1.34, 95% confidence interval [CI] 1.30–1.37). In the age-stratified analysis, the strongest association was found in adolescent girls (adjusted OR 3.46, 95% CI 3.04–4.94 for age 12 to 14 years), while it was non-existent for adult women. We conclude that hormonal contraception is associated with psychotropic drug use among adolescent girls, suggesting an adverse effect of HC on psychological health in this population.
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Affiliation(s)
- Sofia Zettermark
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
- * E-mail:
| | - Raquel Perez Vicente
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
| | - Juan Merlo
- Unit of Social Epidemiology, Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden
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Hamstra DA, de Kloet ER, de Rover M, Van der Does W. Oral contraceptives positively affect mood in healthy PMS-free women: A longitudinal study. J Psychosom Res 2017; 103:119-126. [PMID: 29167038 DOI: 10.1016/j.jpsychores.2017.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/01/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Menstrual cycle phase and oral contraceptives (OC) use influence mood and cognition and these effects may be moderated by the mineralocorticoid receptor (MR) genotype. The effect of menstrual cycle phase on mood may be increased if participants know that this is the focus of study. We assessed aspects associated with reproductive depression such as mood, interpersonal sensitivity, affect lability and depressive cognitions in MR-genotyped OC-users and naturally cycling (NC) women in a carefully masked design. METHODS A homogenous sample of healthy, PMS-free, pre-menopausal MR-genotyped women (n=92) completed online questionnaires eight times during two consecutive cycles. RESULTS The masking of the research question was successful. OC-users did not differ significantly from NC women in positive and negative affect at the time of assessment, personality characteristics (e.g. neuroticism) or mental and physical health. Both groups reported more shifts in anger in the first cycle week (p<0.001; ηp2=0.08). Compared to NC women, OC-users reported fewer mood-shifts between depression and elation in the mid-luteal phase of the menstrual cycle (p=0.002; ηp2=0.10) and had fewer ruminating thoughts at all phases (p=0.003; ηp2=0.11). Effects of MR-genotype were not significant after correction for multiple comparisons. CONCLUSION OC users scored more favorably on measures associated with reproductive depression. OC users also showed a decreased affect variability possibly indicating an emotional blunting effect, which is in line with previous reports on affect-stabilizing effects of OC. Limitations were loss of cases due to irregularities in the menstrual cycle length and possible confounding by the 'survivor effect', since almost all OC-users took OC for more than a year.
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Affiliation(s)
- Danielle A Hamstra
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University.
| | | | - Mischa de Rover
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University
| | - Willem Van der Does
- Institute of Psychology, Leiden University; Leiden Institute of Brain and Cognition, Leiden University; Department of Psychiatry, Leiden University Medical Center
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Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M, Hirschberg AL. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril 2017; 107:1238-1245. [PMID: 28433366 DOI: 10.1016/j.fertnstert.2017.02.120] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/28/2017] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether there is a causal effect of oral contraceptive (OC) treatment on general well-being and depressed mood in healthy women. DESIGN Double-blind, randomized, and placebo-controlled trial. SETTING University hospital. PATIENT(S) Three hundred and forty healthy women aged 18-35 years randomized to treatment, of whom 332 completed the data collection at follow-up evaluation. INTERVENTION(S) A combined OC (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment. MAIN OUTCOME MEASURE(S) Primary outcome measures: global score of Psychological General Well-Being Index (PGWBI) and the Beck Depression Inventory (BDI); secondary outcome measures: six separate dimensions of the PGWBI. RESULT(S) The OC treatment statistically significantly decreased general well-being compared with placebo -4.12 (95% CI, -7.18 to -1.06). Furthermore, OC decreased the following PGWBI dimensions compared with placebo: positive well-being -3.90 (95% CI, -7.78 to -0.01), self-control -6.63 (95% CI, -11.20 to -2.06), and vitality -6.84 (95% CI, -10.80 to -2.88). The effect of OC on depressive symptoms and on the PGWBI dimension depressed mood were not statistically significant. CONCLUSION(S) This study demonstrates a statistically significant reduction in general well-being by a first-choice OC in comparison with placebo in healthy women. We found no statistically significant effects on depressive symptoms. A reduction in general well-being should be of clinical importance.
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Affiliation(s)
- Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Dreber
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Eva Ranehill
- Center for Economic Research, ETH, Zurich, Switzerland; Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Liselott Blomberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Bo von Schoultz
- Department of Economics, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Casey PM, MacLaughlin KL, Faubion SS. Impact of Contraception on Female Sexual Function. J Womens Health (Larchmt) 2017; 26:207-213. [DOI: 10.1089/jwh.2015.5703] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Petra M. Casey
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie S. Faubion
- Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Schaffir J, Worly BL, Gur TL. Combined hormonal contraception and its effects on mood: a critical review. EUR J CONTRACEP REPR 2016; 21:347-55. [DOI: 10.1080/13625187.2016.1217327] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Jonathan Schaffir
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
| | - Brett L. Worly
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Tamar L. Gur
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
- Institute for Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH, USA
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Abstract
The onset of menses for adolescents with physical or intellectual disabilities can affect their independence and add additional concerns for families at home, in schools, and in other settings. The pediatrician is the primary health care provider to explore and assist with the pubertal transition and menstrual management. Menstrual management of both normal and abnormal cycles may be requested to minimize hygiene issues, premenstrual symptoms, dysmenorrhea, heavy or irregular bleeding, contraception, and conditions exacerbated by the menstrual cycle. Several options are available for menstrual management, depending on the outcome that is desired, ranging from cycle regulation to complete amenorrhea. The use of medications or the request for surgeries to help with the menstrual cycles in teenagers with disabilities has medical, social, legal, and ethical implications. This clinical report is designed to help guide pediatricians in assisting adolescent females with intellectual and/or physical disabilities and their families in making decisions related to successfully navigating menarche and subsequent menstrual cycles.
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Lisofsky N, Riediger M, Gallinat J, Lindenberger U, Kühn S. Hormonal contraceptive use is associated with neural and affective changes in healthy young women. Neuroimage 2016; 134:597-606. [DOI: 10.1016/j.neuroimage.2016.04.042] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022] Open
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Higgins JA, Smith NK. The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept. JOURNAL OF SEX RESEARCH 2016; 53:417-56. [PMID: 26954608 PMCID: PMC4868075 DOI: 10.1080/00224499.2015.1134425] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.
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Singata-Madliki M, Hofmeyr GJ, Lawrie TA. The effect of depot medroxyprogesterone acetate on postnatal depression: a randomised controlled trial. ACTA ACUST UNITED AC 2016; 42:171-6. [PMID: 27030698 DOI: 10.1136/jfprhc-2015-101334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/14/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Depot medroxyprogesterone acetate (DMPA) is the most commonly used hormonal contraceptive method in South Africa. It is frequently administered in the immediate postnatal period, yet it is unclear whether it affects the risk of postnatal depression (PND). AIM To determine whether DMPA increases the risk of PND compared with the copper-containing intrauterine device (IUD) when administered after delivery. DESIGN AND SETTING A single-blind randomised controlled trial conducted at two teaching hospitals in East London, South Africa. METHODS Eligible, consenting women (N=242) requiring postnatal contraception were randomised to receive DMPA or an IUD within 48 hours of childbirth and interviewed at 1 and 3 months postpartum. Depression was measured using the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Resumption of sexual intercourse, menstrual symptoms and breastfeeding rates were also assessed. RESULTS One-month EPDS depression scores were statistically significantly higher in the DMPA arm compared with IUD arm (p=0.04). Three-month BDI-II scores were significantly higher in the DMPA arm than in the IUD arm (p=0.002) and, according to the BDI-II but not the EPDS, more women in the DMPA arm had major depression at this time-point (8 vs 2; p=0.05). There were no statistically significant differences in other outcome measures except that fewer women had resumed sexual activity by 1 month postpartum in the DMPA arm (13% vs 26%; p=0.02). CONCLUSIONS The possibility that immediate postnatal DMPA use is associated with depression cannot be excluded. These findings justify further research with longer follow-up. CLINICAL TRIAL NUMBER PACTR201209000419241.
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Affiliation(s)
- Mandisa Singata-Madliki
- Deputy Director, Effective Care Research Unit (ECRU), Eastern Cape Department of Health, East London Hospital Complex, Universities of the Witwatersrand and Fort Hare, East London, South Africa
| | - G Justus Hofmeyr
- Director, Effective Care Research Unit (ECRU), Eastern Cape Department of Health, East London Hospital Complex, Universities of the Witwatersrand and Fort Hare, East London, South Africa and Professor, Department of Health, Walter Sisulu University and Eastern Cape, East London, South Africa
| | - Theresa A Lawrie
- Research Consultant, Effective Care Research Unit (ECRU), Eastern Cape Department of Health, East London Hospital Complex, Universities of the Witwatersrand and Fort Hare, East London, South Africa Honorary Research Consultant, Cochrane Office, Education Centre, Royal United Hospital, Bath, UK
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22
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Abstract
OBJECTIVE To examine the effect of hormonal contraception on sexual desire. MATERIALS AND METHODS We performed a cross-sectional analysis of 1,938 of the 9,256 participants enrolled in the Contraceptive CHOICE Project. This subset included participants enrolled between April and September 2011 who completed a baseline and 6-month telephone survey. Multivariable logistic regression was used to assess the association between contraceptive method and report of lacking interest in sex controlling for potential confounding variables. RESULTS More than 1 in 5 participants (23.9%) reported lacking interest in sex at 6 months after initiating a new contraceptive method. Of 262 copper intrauterine device (IUD) users (referent group), 18.3% reported lacking interest in sex. Our primary outcome was more prevalent in women who were young (younger than 18 years: adjusted odds ratio [OR] 2.04), black (adjusted OR 1.78), and married or living with a partner (adjusted OR 1.82). Compared with copper IUD users, participants using depot medroxyprogesterone (adjusted OR 2.61, 95% confidence interval [CI] 1.47-4.61), the vaginal ring (adjusted OR 2.53, 95% CI 1.37-4.69), and the implant (adjusted OR 1.60, 95% CI 1.03-2.49) more commonly reported lack of interest in sex. We found no association between use of the hormonal IUD, oral contraceptive pill, and patch and lack of interest in sex. CONCLUSION CHOICE participants using depot medroxyprogesterone acetate, the contraceptive ring, and implant were more likely to report a lack of interest in sex compared with copper IUD users. Future research should confirm these findings and their possible physiologic basis. Clinicians should be reassured that most women do not experience a reduced sex drive with the use of most contraceptive methods.
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Affiliation(s)
- Amanda Boozalis
- Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
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Albrecht K, Callhoff J, Buttgereit F, Straub RH, Westhoff G, Zink A. Association Between the Use of Oral Contraceptives and Patient-Reported Outcomes in an Early Arthritis Cohort. Arthritis Care Res (Hoboken) 2015; 68:400-5. [PMID: 26275790 DOI: 10.1002/acr.22667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/06/2015] [Accepted: 07/14/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the association between exposure to oral contraceptives (OCs) and clinical outcomes in an early arthritis cohort. METHODS Female patients with early inflammatory arthritis, ages 18-60 years, who were enrolled in an early arthritis cohort and had no exposure to hormone replacement were studied (n = 273). Associations between OC exposure (current/past/never) and disease activity, treatment, and patient-reported outcomes, including the Rheumatoid Arthritis Impact of Disease Score (RAID), the Rheumatoid Arthritis Disease Activity Index (RADAI), the Profile of Mood and Discomfort (PROFAD), and the Hannover Functional Assessment (FFbH), were studied over 2 years. Linear mixed models adjusted for age, body mass index, parity, smoking, and education were used. RESULTS Eighteen percent of patients had never used OCs, 63% had used OCs in the past, and 19% currently used OCs. After adjustment, the current/past OC use was associated with better RAID, PROFAD, RADAI, and FFbH scores at 12 months (P < 0.05 for all) compared to never use. Longitudinally over 2 years, the mean RAID scores were significantly better in women with current/past OC use (P < 0.001). Actual inflammatory markers were not associated with OC use. Glucocorticoids were used by a higher percentage of OC never users than by current/past users (P = 0.08), especially in patients with impaired function (FFbH <70: odds ratio 4.2 [95% confidence interval 1.6-11]). CONCLUSION For past as well as current use, OCs seem to moderate patient-reported outcomes in inflammatory arthritis. Protective effects may be induced via central nervous pathways rather than through the suppression of peripheral inflammation.
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Affiliation(s)
| | | | | | | | | | - Angela Zink
- German Rheumatism Research Centre and Charité University Hospital, Berlin, Germany
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25
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Shahnazi M, Bayatipayan S, Khalili AF, Kochaksaraei FR, Jafarabadi MA, Banoi KG, Nahaee J. Comparing the effects of the second-and third-generation oral contraceptives on sexual functioning. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2015; 20:47-55. [PMID: 25709690 PMCID: PMC4325413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 11/11/2013] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to compare the effects of the second- and third-generation oral contraceptives on women's reproductive sexual function. MATERIALS AND METHODS This randomized, double-blind, placebo-controlled clinical trial was conducted on 82 married women of reproductive age in Tehran. Samples were randomized into the groups receiving second- and third-generation oral contraceptive pills. Female Sexual Function Index (FSFI) tool was used before the intervention and 2 and 4 months after the intervention. Data analysis was carried out using analysis of variance (ANOVA) within repeated measures and P < 0.05 were considered significant. RESULTS There was a statistically significant difference in the positive and negative moods between the experimental and control groups before the intervention in the second and fourth months. The second-generation pills caused a decrease in sexual function in the second month and an increase in sexual function in the fourth month, but the third-generation pills led to an increase in sexual function in the second and fourth months. The increase in sexual function that resulted from using the third-generation pills was significantly higher than that resulted on using the second-generation pills. CONCLUSIONS According to the results of this study, sexual functioning decreased in the second month of using the second-generation pills and sexual performance was significantly more on using the third-generation pills compared to second-generation pills. The most common type of oral contraceptive used in Iran is the second-generation oral contraceptive LD™ (low-dose estrogen), which is freely distributed in health centers. Therefore, it is necessary for women who wish to use these contraceptive methods to be educated and consulted before they start using them. The third-generation contraceptive pills can be recommended to women who wish to use oral contraceptives.
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Affiliation(s)
- Mahnaz Shahnazi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somaye Bayatipayan
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran,Address for correspondence: Ms. Somaye Bayati payan, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail:
| | - Azizeh Farshbaf Khalili
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | | | - Jila Nahaee
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Menstrual and reproductive issues in adolescents with physical and developmental disabilities. Obstet Gynecol 2014; 124:367-375. [PMID: 25004333 DOI: 10.1097/aog.0000000000000387] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most obstetrician-gynecologists will encounter adolescents with disabilities in their practice, because developmental and physical disabilities are common in young patients (8.4%). Reproductive health issues such as puberty, sexuality, and menstruation can be more complicated for teenagers with disabilities and their families as a result of concerns surrounding menstrual hygiene, abuse risk, vulnerability, changes in seizure pattern, and altered mood. Teenagers with disabilities have gynecologic health care needs similar to those of their peers as well as unique needs related to their physical and cognitive issues. The gynecologic health visit for a teenager with disabilities should include an evaluation of the teenager's reproductive knowledge as well as an assessment of her abuse and coercion risk and her ability to consent to sexual activity. The menstrual history is focused on the effects of menstrual cycles on her daily life. Diagnostic testing is not different from other adolescents. Hormonal treatment is often requested by the patient and her family to alleviate abnormal bleeding, cyclic mood changes, dysmenorrhea, or a combination of these, to assist with menstrual hygiene, and to provide contraception. Menstrual manipulation can be used to induce complete amenorrhea, regulate cycles, or decrease regular menstrual flow. However, treatment risks and side effects may have a different effect on the lives of these adolescents. The comfort level of health care providers to respond to the special concerns of adolescents with disabilities is low, and several barriers exist. This review addresses the complex issues of puberty, menstruation, sexuality, abuse, and safety highlighting the distinctive needs of this population. The options and decisions around menstrual manipulation are highlighted in detail.
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27
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Seven A, Yüksel B, Kılıç S, Esen H, Keskin U, Ulubay M, Ozekinci M. Effect of injectable medroxyprogesterone acetate and etonogestrel implants on GABA-A and serotonin receptors in white and gray matter of the brain: experimental study in rats. Gynecol Endocrinol 2014; 30:320-4. [PMID: 24460500 DOI: 10.3109/09513590.2014.880417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate the time-dependent effect of progesterone-only contraceptives on the brain and to obtain an improved understanding of mood disorders experienced under this medication. A total of 66 Wistar albino rats were divided into three groups: etonogestrel (ENG) implant (group 1, n = 30); depot medroxyprogesterone acetate (MPA)-injectable (group 2, n = 30); and control (group 3, n = 6) groups. Groups 1 and 2 were each divided into five subgroups, which were examined every 10 d for up to 50 d after medication administration, to evaluate its time-dependent effect. There was no difference in terms of gamma-aminobutyric acid (GABA) and serotonin immunohistochemical staining in white and gray matter among the subgroups of group 1. In group 2, there was a significant decrease in serotonin receptor staining intensity in white and gray matter on day 50, when compared to the control group (p = 0.041). When the subgroups of group 2 were compared, there was a significant decrease in serotonin receptor staining intensity in white and gray matter on days 40 and 50 when compared to day 10. In conclusion, we showed that ENG and MPA have no effect on apoptosis and GABA-A receptors in the brain. We also showed that MPA has time-dependent effects on serotonin receptors, which may be a possible mechanism involved in mood disorders during long-term usage of injectable progesterone-only contraceptives.
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Affiliation(s)
- Ali Seven
- Department of Obstetrics and Gynaecology, Dumlupinar University, Faculty of Medicine , Kutahya , Turkey
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Gahr M, Freudenmann RW, Connemann BJ, Kölle MA, Schönfeldt-Lecuona C. Rapid relapse in depression following initialization of oral contraception with ethinyl estradiol and chlormadinone acetate. Gen Hosp Psychiatry 2014; 36:230.e1-2. [PMID: 24287129 DOI: 10.1016/j.genhosppsych.2013.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Female sexual hormones (estrogens and gestagens) may affect neurocognitive functioning and mood. Thus, the use of oral hormonal contraceptives (OHC) bears the risk of psychiatric adverse drug reactions such as depression and psychosis. However, the available empiric evidence regarding this connection is conflicting, and, moreover, female sex hormones seem to feature also mood-stabilizing and antidepressive effects. Hence, individual susceptibility factors and preparation-specific pharmacologic properties might play a pivotal role in the development of mood disturbances related to OHC. Single case reports provide empiric data for further systematic approaches. METHODS A clinical case is presented and discussed. RESULTS A 36-year-old female patient with recurrent major depressive disorder developed rapid relapse in depression after initialization of OHC with ethinyl estradiol 30 μg/chlormadinone acetate 2 mg. This OHC combination was described to particularly feature positive effects on depressive mood. CONCLUSIONS OHC may induce serious mood disturbances and should be administered with care, particularly in patients with affective disorders.
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Affiliation(s)
- Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany.
| | - Roland W Freudenmann
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany
| | - Bernhard J Connemann
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany
| | - Markus A Kölle
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany
| | - Carlos Schönfeldt-Lecuona
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany
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Klapilová K, Cobey KD, Wells T, Roberts SC, Weiss P, Havlíček J. Current hormonal contraceptive use predicts female extra-pair and dyadic sexual behavior: evidence based on Czech National Survey data. EVOLUTIONARY PSYCHOLOGY 2014; 12:36-52. [PMID: 24412772 PMCID: PMC10426934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/19/2013] [Indexed: 06/03/2023] Open
Abstract
Data from 1155 Czech women (493 using oral contraception, 662 non-users), obtained from the Czech National Survey of Sexual Behavior, were used to investigate evolutionary-based hypotheses concerning the predictive value of current oral contraceptive (OC) use on extra-pair and dyadic (in-pair) sexual behavior of coupled women. Specifically, the aim was to determine whether current OC use was associated with lower extra-pair and higher in-pair sexual interest and behavior, because OC use suppresses cyclical shifts in mating psychology that occur in normally cycling women. Zero-inflated Poisson (ZIP) regression and negative binomial models were used to test associations between OC use and these sexual measures, controlling for other relevant predictors (e.g., age, parity, in-pair sexual satisfaction, relationship length). The overall incidence of having had an extra-pair partner or one-night stand in the previous year was not related to current OC use (the majority of the sample had not). However, among the women who had engaged in extra-pair sexual behavior, OC users had fewer one-night stands than non-users, and tended to have fewer partners, than non-users. OC users also had more frequent dyadic intercourse than non-users, potentially indicating higher commitment to their current relationship. These results suggest that suppression of fertility through OC use may alter important aspects of female sexual behavior, with potential implications for relationship functioning and stability.
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Affiliation(s)
| | - Kelly D. Cobey
- School of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Timothy Wells
- Institute of Human Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - S. Craig Roberts
- School of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Petr Weiss
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Havlíček
- Faculty of Science, Charles University, Prague, Czech Republic
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Di Carlo C, Sansone A, De Rosa N, Gargano V, Tommaselli GA, Nappi C, Bifulco G. Impact of an implantable steroid contraceptive (etonogestrel-releasing implant) on quality of life and sexual function: a preliminary study. Gynecol Endocrinol 2014; 30:53-6. [PMID: 24131079 DOI: 10.3109/09513590.2013.848851] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of the study was to determine the impact of etonogestrel (ENG)-implant used for contraceptive purpose on Quality of life (QoL) and on sexual function (FSF) of healthy Italian women. The Female Sexual Function Index (FSFI) questionnaire and the Short Form-36 (SF-36) validated questionnaire were administered at baseline, 3 and 6 months after insertion of Nexplanon. The implant seems to have a positive impact on QoL after the first three months of therapy. Users showed an improved general health status and physical role status. The implant did not show negative effects on libido and on sexual function. In the first three months of treatment, users experienced a temporary reduction of vitality, mental health, social functioning and emotional role functioning, which seem to disappear after six months of therapy.
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Affiliation(s)
- Costantino Di Carlo
- Department of Obstetrics and Gynecology, University of Naples "Federico II" , Naples , Italy
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32
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Klapilová K, Cobey KD, Wells T, Roberts SC, Weiss P, Havlíček J. Current Hormonal Contraceptive Use Predicts Female Extra-Pair and Dyadic Sexual Behavior: Evidence Based on Czech National Survey Data. EVOLUTIONARY PSYCHOLOGY 2014. [DOI: 10.1177/147470491401200103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Data from 1155 Czech women (493 using oral contraception, 662 non-users), obtained from the Czech National Survey of Sexual Behavior, were used to investigate evolutionary-based hypotheses concerning the predictive value of current oral contraceptive (OC) use on extra-pair and dyadic (in-pair) sexual behavior of coupled women. Specifically, the aim was to determine whether current OC use was associated with lower extra-pair and higher in-pair sexual interest and behavior, because OC use suppresses cyclical shifts in mating psychology that occur in normally cycling women. Zero-inflated Poisson (ZIP) regression and negative binomial models were used to test associations between OC use and these sexual measures, controlling for other relevant predictors (e.g., age, parity, in-pair sexual satisfaction, relationship length). The overall incidence of having had an extra-pair partner or one-night stand in the previous year was not related to current OC use (the majority of the sample had not). However, among the women who had engaged in extra-pair sexual behavior, OC users had fewer one-night stands than non-users, and tended to have fewer partners, than non-users. OC users also had more frequent dyadic intercourse than non-users, potentially indicating higher commitment to their current relationship. These results suggest that suppression of fertility through OC use may alter important aspects of female sexual behavior, with potential implications for relationship functioning and stability.
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Affiliation(s)
| | - Kelly D. Cobey
- School of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Timothy Wells
- Institute of Human Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - S. Craig Roberts
- School of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Petr Weiss
- 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Havlíček
- Faculty of Science, Charles University, Prague, Czech Republic
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Di Carlo C, Gargano V, De Rosa N, Tommaselli GA, Sparice S, Nappi C. Effects of estradiol valerate and dienogest on quality of life and sexual function according to age. Gynecol Endocrinol 2014; 30:925-8. [PMID: 25366390 DOI: 10.3109/09513590.2014.975688] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is an observational study on 102 women aged 25-45 years to evaluate if the E2V/DNG pill has any impact on quality of life (QoL) and sexual function (FSF). Thirty-nine women were younger than 35 years (group A), and 63 women were 35 years old or older (group B). At baseline and after 6 months, patients received the Italian validated version of the Short Form-36 questionnaire and the Italian validated version of the Female Sexual Function Index questionnaire. Group A showed an overall higher perception in all QoL scores at baseline and after 6-months (p < 0.05). E2V/DNG treatment did not exert any significant effect on QoL perception in group A apart from an increase in the GH domain (general health). In group B we observed a significant improvement both in GH and in VT (vitality) scores. We found a significant reduction in "lubrication" after 6 months both in group A and B (p < 0.01) and a significant improvement in "satisfaction" and "pain" scores in group A and in "desire", "satisfaction" and "total" score in group B (p < 0.01). The E2V/DNG pill is associated with a significant improvement of GH and VT and with an improvement in FSF with no difference between age groups.
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Affiliation(s)
- Costantino Di Carlo
- a Department of Obstetrics and Gynecology, University of Naples Naples Italy
| | - Virginia Gargano
- a Department of Obstetrics and Gynecology, University of Naples Naples Italy
| | - Nicoletta De Rosa
- a Department of Obstetrics and Gynecology, University of Naples Naples Italy
| | | | - Stefania Sparice
- a Department of Obstetrics and Gynecology, University of Naples Naples Italy
| | - Carmine Nappi
- a Department of Obstetrics and Gynecology, University of Naples Naples Italy
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Shakerinejad G, Hidarnia A, Motlagh ME, Karami K, Niknami S, Montazeri A. Factors predicting mood changes in oral contraceptive pill users. Reprod Health 2013; 10:45. [PMID: 24015872 PMCID: PMC3844635 DOI: 10.1186/1742-4755-10-45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 100 million women worldwide are using oral contraceptives pills (OCP) and mood changes were being as the primary reason for OCP discontinuation. The purpose of this study was to determine the prevalence and predicting factors of mood changes in oral contraceptive pills users. METHODS This was a cross-sectional study of 500 women aged 15-49 years old using low dose (LD) pills attending family planning centers in Ahwaz, Iran. Data were collected via face-to-face interviews using a structured questionnaire including items on demographic, self-efficacy and mood change. Both univarate and multiple logistic regression analyses were performed to assess the relationship between reported mood change and the independent variables. RESULTS In all 406 women reported that they did experience OCP side effects. Of these, 37.7% of women (n =153) reported mood changes due to OCP use. The results of multiple logistic regression revealed that place of living (OR =2.57, 95% CI = 1.06-6.20, p =0.03), not receiving information on OCP side effects (OR =1.80, 95% CI = 1.15-2.80, p =0.009), and lower self-efficacy (OR = 0.87, 95% CI = 0.80-0.94, p =0.001) were significant predictors of mood changes. CONCLUSION The findings from this study indicated that the prevalence of reported mood changes due to OCP use among Iranian women appeared to be consistent with other studies. In addition the findings showed that receiving information on OCP side effects from health care workers and self-efficacy were important predicting factors for mood changes. Indeed implementing educational programs and improving self-efficacy among women are recommended.
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Affiliation(s)
- Ghodratollah Shakerinejad
- Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Johnson S, Pion C, Jennings V. Current methods and attitudes of women towards contraception in Europe and America. Reprod Health 2013; 10:7. [PMID: 23384291 PMCID: PMC3599328 DOI: 10.1186/1742-4755-10-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022] Open
Abstract
Background The choice of available contraceptive methods has increased in recent years; however, recent data on women’s awareness of methods and reasons for their method choice, or reasons for changing methods, is limited. The aim of this study was to examine the use and awareness of contraceptive methods in the USA, UK, Germany, Italy and Spain. Methods Quantitative survey of heterosexual women aged 25–44 years (n=2544), with no known infertility. Questions related to knowledge and use of contraceptive methods, reasons for choice and for changing methods, and sources of advice. Results There was generally good awareness of most forms of contraception in all five countries. Awareness and current usage was greatest for the contraceptive pill (awareness >98%, usage varied from 35% [Spain] to 63% [Germany]); and male condom (awareness >95%, usage varied from 20% [Germany] to 47% [Spain]); awareness of other methods varied between countries. Doctors have the greatest influence on women’s choice of contraceptive method (>50% for all countries), and are most likely to suggest the contraceptive pill or male condom. Women’s contraceptive needs change; 4–36% of contraceptive pill users were likely to change their method within 12 months. For previous contraceptive pill users (n=377), most common reason for change was concern about side effects (from 26% [Italy] to 10% [UK]); however, awareness of many non-hormonal contraceptive methods was low. Conclusions Women aged 25–44 are aware of a wide variety of contraceptive methods, but knowledge and usage of the contraceptive pill and condoms predominates. Changing contraception method is frequent, occurring for a variety of reasons, including change in life circumstances and, for pill users, concerns about side effects.
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Affiliation(s)
- Sarah Johnson
- Clinical and Medical Affairs Manager, SPD Development Company Limited, Priory Business Park, Bedford MK44 3UP, United Kingdom.
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Burrows LJ, Basha M, Goldstein AT. The Effects of Hormonal Contraceptives on Female Sexuality: A Review. J Sex Med 2012; 9:2213-23. [DOI: 10.1111/j.1743-6109.2012.02848.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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St-André M, Stikarovska I, Gascon S. Clinical Case Rounds in Child and Adolescent Psychiatry: De Novo Self-Mutilation and Depressive Symptoms in a 17-year-old Adolescent Girl Receiving Depot-Medroxyprogesterone Acetate. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2012; 21:59-62. [PMID: 22299016 PMCID: PMC3269252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 06/27/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Contraception-induced mood changes have been identified since the 1960s. To our knowledge, there has been no reported case about self-mutilation associated to any form of contraception. We report the case of a 17-year-old adolescent girl who presented with de novo self-mutilation and depressive symptoms three and a half weeks after the administration of 150 mg of Depot-Medroxyprogesterone Acetate (DMPA). METHOD Clinical case report and literature review. Possible confounding factors are reviewed. RESULTS The patient had no personal psychiatric history and no significant family psychiatric history. A DSM-IV diagnosis of "mood disorder due to DMPA with depressive features" was formulated. There was no evidence of abnormal personality functioning. The mental status exam and collateral information validated the severity of her condition. DISCUSSION DMPA is a birth control method especially useful for adolescent girls and possible secondary mood symptoms should not limit its access. However, since depressive symptoms substantially interfere with daily functioning and may have unfortunate consequences like self-mutilation and suicidal ideation, it is important to remain vigilant regarding the onset of mood symptoms following contraceptive use in adolescent girls. This vigilance should be more specific regarding adolescent girls with a history of mood disorders, anxiety disorders, self-mutilation or family diathesis of these conditions.
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Affiliation(s)
- Martin St-André
- Sainte-Justine University Hospital Centre, Montréal, Québec
- Department of Psychiatry, Université de Montréal, Montréal, Québec
| | - Irena Stikarovska
- BC Children’s Hospital, Vancouver, British Columbia
- University of British Columbia, Vancouver, British Columbia
| | - Suzy Gascon
- Sainte-Justine University Hospital Centre, Montréal, Québec
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, Québec
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POROMAA INGERSUNDSTRÖM, SEGEBLADH BIRGITTA. Adverse mood symptoms with oral contraceptives. Acta Obstet Gynecol Scand 2012; 91:420-7. [DOI: 10.1111/j.1600-0412.2011.01333.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - BIRGITTA SEGEBLADH
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Ehsanpour S, Aghaii A, Kheirabadi GR. The association of contraceptive methods and depression. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2012; 17:234-8. [PMID: 23833619 PMCID: PMC3696218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND None of the contraceptive methods are fully side-effect free. One of the side effects that commonly causes discontinuation is mood changes and depression. The present study aimed to compare the depression between contraceptive methods including low-dose estrogen (LD) combined pills, condom and intrauterine devices (IUD). MATERIALS AND METHODS In a cross-sectional study, 216 women were selected through systematic random sampling from 10 health care center sin Isfahan in 2011. Beck Depression Inventory II was used and individual productivity characteristics were asked. Validity and reliability of Beck depression inventory have been repeatedly confirmed in Iran. Content validity the productivity characteristics questionnaire was confirmed and its reliability was measured through Cronbach's alpha correlation coefficient (calculated as 0.71). ANOVA, covariance analysis and logistic regression were used to analyze the data. FINDINGS Depression was observed in 47.8% of participants; however, there was no difference between mean score of depression in the users of three contraceptive methods. CONCLUSIONS The findings of this study showed that depression is not correlated with family planning type and fear of depression should not be an obstacle to choose between these methods. Depression is a multifactor issue. This study showed that type of family planning method in itself cannot be the cause of depression and family planners and consultants should consider this.
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Affiliation(s)
- Soheila Ehsanpour
- Department of Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezo Aghaii
- MSc Student, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Kheirabadi
- Assistant Professor of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Gholam Reza Kheirabadi, Assistant Professor of Psychiatry, Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Elaut E, Buysse A, De Sutter P, De Cuypere G, Gerris J, Deschepper E, T'Sjoen G. Relation of androgen receptor sensitivity and mood to sexual desire in hormonal contraception users. Contraception 2011; 85:470-9. [PMID: 22133661 DOI: 10.1016/j.contraception.2011.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 10/13/2011] [Accepted: 10/15/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Since very little research in this field is available, this study aims to assess the role of psychosexual, relationship, hormonal and genetic measures in the sexual desire of users of three hormonal contraceptive products [low-dose combined oral contraceptive (20 mcg ethinylestradiol/150 mcg desogestrel), progestin-only pill (75 mcg desogestrel) and vaginal ring (daily dose of 15 mcg ethinylestradiol/120 mcg etonogestrel)]. STUDY DESIGN Fifty-five couples were randomized over three groups in which the women consecutively used each product during 3 months. Both partners repeatedly filled out questionnaires on solitary and dyadic sexual desire (desire to behave sexually by oneself or towards a partner). Total and free testosterone, sex hormone binding globulin and a genetic marker of androgen receptor sensitivity [cytosine-adenine-guanine (CAG) repeat length] were assessed on blood samples of the female partners. RESULTS Sexual desire was higher in women with either short or long CAG repeats (solitary, p=.004; dyadic, p=.008). Desire levels were higher during vaginal ring use (solitary, p=.018; dyadic, p=.007). The woman's mood was found to impact her dyadic sexual desire (p<.001); this scale was also strongly associated with the male partner's dyadic sexual desire (p<.001). CONCLUSIONS The current study found evidence for a role of androgen receptor sensitivity and mood in the sexual desire of hormonal contraceptive users.
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Affiliation(s)
- Els Elaut
- Department of Sexology and Gender Problems, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
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Sucato GS, Land SR, Murray PJ, Cecchini R, Gold MA. Adolescents' experiences using the contraceptive patch versus pills. J Pediatr Adolesc Gynecol 2011; 24:197-203. [PMID: 21454110 DOI: 10.1016/j.jpag.2011.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 01/30/2011] [Accepted: 02/01/2011] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To compare use of the weekly transdermal contraceptive patch (patch) with daily combined hormonal contraceptive pills (pills) in adolescents. DESIGN Prospective longitudinal study of adolescents' self-selected (non-randomized) use of the patch or pills. SETTING Urban, university hospital-affiliated, adolescent outpatient clinic. PARTICIPANTS 13-22-year-old female adolescents seeking hormonal contraception, 40 who chose the patch and 40 who chose pills. INTERVENTIONS Data were collected via self-report on paper questionnaires at three-cycle intervals for a total of up to nine cycles. MAIN OUTCOME MEASURES Method continuation, perfect use, method satisfaction, quality of life, and side effects, including menstrual changes and perceived mood changes. RESULTS After nine cycles, 38% of patch users and 60% of pill users were still using the method they had chosen at enrollment. There were no significant differences between the groups in self-reported perfect use. No differences were found in quality of life or side effects. Both patch and pill users noted menses became lighter and more predictable and reported decreased depression prior to their menses; only the pill group reported improvement in premenstrual anger. Method satisfaction was similar in both groups except patch users were more likely to report that their contraceptive method improved normal daily activities. CONCLUSIONS Despite apparent advantages of the patch over the pill, adolescents using both methods continue to face challenges achieving perfect and sustained contraceptive use.
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Affiliation(s)
- Gina S Sucato
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Fortenberry JD, Hensel DJ. The association of sexual interest and sexual behaviors among adolescent women: a daily diary perspective. Horm Behav 2011; 59:739-44. [PMID: 21397605 PMCID: PMC3105208 DOI: 10.1016/j.yhbeh.2011.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 01/19/2011] [Accepted: 03/03/2011] [Indexed: 11/17/2022]
Abstract
Theoretical and empirical linkages of adult women's sexual interest and sexual behaviors are relatively well-established, but few data address similar issues in adolescent women. This paper reviews data from published reports of associations of adolescent women's sexual interest and various sexual behaviors. All of the papers reported data collected from a single longitudinal cohort of young women. The primary source of data collection was daily diaries, allowing close temporal pairing of sexual interest with sexual behaviors. Young women's sexual interest on a given day was consistently and independently associated with sexual activity on that day, whether the behavior was first lifetime coitus, coitus, fellatio, cunnilingus, anal intercourse, or coitus during menses. We also found no evidence of influence of hormonal contraceptives on young women's sexual interest. Taken together, these data demonstrate the relevance of sexual interest as a key factor in young women's sexuality and sexual behavior.
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Affiliation(s)
- J Dennis Fortenberry
- Section of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10th St., Indianapolis, IN 46202, USA.
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Variation in sexual behaviors in a cohort of adolescent females: the role of personal, perceived peer, and perceived family attitudes. J Adolesc Health 2011; 48:87-93. [PMID: 21185529 PMCID: PMC3052941 DOI: 10.1016/j.jadohealth.2010.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 05/04/2010] [Accepted: 05/08/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE Little is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer, and perceived family attitudes toward adolescent sexual activity influence sexual behaviors of adolescent females' over time. METHODS Between the years of 1999 and 2006, 358 English-speaking female adolescents, aged 14-17 years, were recruited from three urban adolescent clinics. Participants completed quarterly and annual questionnaires over a span of 4 years. Primary outcomes included engagement in any of the following eight sexual behaviors: kissing, having breasts touched, having genitals touched, touching partners' genitals, oral giving, oral receiving, anal, or vaginal sex. Three attitudinal scales assessed personal importance of abstinence, perceived peer beliefs about when to have sex, and perceived family beliefs that adolescent sex is negative. We used generalized estimating equations to identify predictors of each sexual behavior and compared whether personal, perceived peer, or perceived family attitudes predicted sexual behaviors over time. RESULTS The odds of reporting each sexual behavior increased with age but were lower among those whose personal or perceived family attitudes were less positive. Participants' personal attitudes toward adolescent sex were the strongest predictor of engagement in all eight sexual behaviors even after controlling for perceived peer and perceived family attitudes. CONCLUSIONS Female adolescent's personal attitudes toward abstinence appear to be the strongest predictor of engagement in a variety of sexual behaviors. Efforts to influence adolescent attitudes toward abstinence may be an important approach to reducing sexual behaviors that increase the risk of pregnancy and sexually transmitted infections.
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Bouma EMC, Riese H, Nolte IM, Oosterom E, Verhulst FC, Ormel J, Oldehinkel AJ. No associations between single nucleotide polymorphisms in corticoid receptor genes and heart rate and cortisol responses to a standardized social stress test in adolescents: the TRAILS study. Behav Genet 2010; 41:253-61. [PMID: 20680430 PMCID: PMC3044823 DOI: 10.1007/s10519-010-9385-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 07/17/2010] [Indexed: 12/31/2022]
Abstract
Previously, sequence variation in the glucocorticoid (GR) and mineralocorticoid (MR) receptor genes (NR3C1 and NR3C2, respectively) have been found to be associated with physiological stress responses to social stress tests in small samples of adult men and oral contraceptives (OC) using women. Associations between single nucleotide polymorphisms (SNPs) in the GR (23EK-rs6190, 9beta-rs6198, BclI-rs4142324) and the MR gene (I180V-rs5522 and -2G/C (rs2070951) with cortisol and heart rate responses to a performance-related social stress task (public speaking and mental arithmetic) were examined in a large sample (n = 553) of adolescents (15–17 years). To make comparisons with previous findings, associations were tested in boys (n = 277), free-cycling (FC) girls (n = 183) and OC users (n = 93). None of the previously reported associations in adults could be replicated in this large adolescent sample. Explanations for non-replication are discussed.
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Affiliation(s)
- Esther M C Bouma
- Department of Psychiatry, Interdisciplinary Center for Psychiatric Epidemiology and Groningen Graduate School Medical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Abdolrasulnia M, Shewchuk RM, Roepke N, Granstaff US, Dean J, Foster JA, Goldstein AT, Casebeer L. Management of female sexual problems: perceived barriers, practice patterns, and confidence among primary care physicians and gynecologists. J Sex Med 2010; 7:2499-508. [PMID: 20524976 DOI: 10.1111/j.1743-6109.2010.01857.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. AIM To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). METHODS A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. MAIN OUTCOME MEASURE Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. RESULTS A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients.
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Ott MA, Ofner S, Tu W, Katz BP, Fortenberry JD. Characteristics associated with sex after periods of abstinence among sexually experienced young women. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2010; 42:43-48. [PMID: 20415884 PMCID: PMC3034242 DOI: 10.1363/4204310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT Adolescent pregnancy prevention is difficult because adolescent sex is intermittent. Understanding why sexually experienced adolescents have sex after a period of abstinence will help clinicians to tailor counseling. METHODS For up to 4.5 years between 1999 and 2006, a sample of 354 adolescent women recruited at urban primary care clinics were interviewed and tested for STDs every three months, and were asked to complete three months of daily diaries twice a year. Survival analyses were used to estimate associations between intrapersonal, relationship and STD-related characteristics and the risk of ending an abstinence period with sex. RESULTS Participants reported 9,236 abstinence periods, which averaged 31 days. The risk that an abstinence period ended with sex increased steeply for periods of fewer than 17 days (short), rose less steeply for 17-39-day (intermediate) periods and was fairly steady for longer periods. For short periods, the risk increased with age, sexual interest, positive mood, partner support, relationship quality and history of STD diagnosis more than three months ago (hazard ratios, 1.02-1.2); it decreased as negative mood increased (0.98) and was reduced among adolescents with a recent STD diagnosis (0.9). For intermediate periods, the association with a recent STD diagnosis became positive (1.4). For long periods, sex was associated only with age, sexual interest and relationship quality. CONCLUSIONS To provide targeted and timely sexual health counseling, clinicians may want to ask adolescents not only whether they are sexually active but also when they last had sex.
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Affiliation(s)
- Mary A Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
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Bouma EMC, Riese H, Ormel J, Verhulst FC, Oldehinkel AJ. Adolescents' cortisol responses to awakening and social stress; effects of gender, menstrual phase and oral contraceptives. The TRAILS study. Psychoneuroendocrinology 2009; 34:884-93. [PMID: 19195792 DOI: 10.1016/j.psyneuen.2009.01.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/18/2008] [Accepted: 01/05/2009] [Indexed: 11/28/2022]
Abstract
Studies on the influence of sex hormones on cortisol responses to awakening and stress have mainly been conducted in adults, while reports on adolescents are scarce. We studied the effects of gender, menstrual cycle phase and oral contraceptive (OC) use on cortisol responses in a large sample of adolescents. Data come from TRAILS (TRacking Adolescents' Individual Lives Survey), a prospective population study of Dutch adolescents. This study uses data of 644 adolescents (age 15-17 years, 54.7% boys) who participated in a laboratory session including a performance-related social stress task (public speaking and mental arithmetic). Free cortisol levels were assessed by multiple saliva samples, both after awakening and during the laboratory session. No significant effects of gender and menstrual phase on cortisol responses to awakening were found, while girls using OC displayed a slightly blunted response (F(1, 244)=5.30, p=.02). Cortisol responses to social stress were different for boys and free-cycling girls (F(3, 494)=9.73, p<.001), and OC users and free-cycling girls (F(3, 279)=15.12, p<.001). Unexpectedly, OC users showed no response at all but displayed linearly decreasing levels F(1, 279)=19.03, p<.001) of cortisol during the social stress test. We found no effect of menstrual cycle phase on cortisol responses to social stress (F(3, 157)=0.58, p=.55). The absence of a gender difference in the adolescents' cortisol awakening response found in this study is consistent with previous reports. Our results further suggest that adolescent OC users display slightly blunted cortisol responses after awakening, and that gender differences in cortisol responses to social stress during adolescence are comparable to those described for adult populations, that is, stronger responses in men than in women. Whereas previous work in adults suggested blunted stress responses in OC users compared to men and free-cycling women, adolescent OC users showed no cortisol response. Effects of type of OC could not be studied because of low numbers of OC that were only progestin based.
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Affiliation(s)
- Esther M C Bouma
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen CC 72, University of Groningen, Groningen, The Netherlands.
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