Oral contraceptives in adolescent women

Experts' view on the role of oestrogens in combined oral contraceptives: emphasis on oestetrol (E4)

Introduction

The evolution of contraception has been crucial for public health and reproductive well-being. Over the past 60 years, combined oral contraceptives (COCs) have remained an important part of the contraceptive landscape worldwide; continued development has worked toward maintaining efficacy and improving safety.

Methods

Seven global experts convened to discuss the clinical relevance of the oestrogen in COCs, focusing on the impact of the new oestrogen, oestetrol (E4). Participants then commented through an online forum on the summary content and other participants' feedback. We prepared this report to describe the experts' views, their follow-up from the open forum and the evidence supporting their views.

Results

Ethinylestradiol (EE) and oestradiol (E2) affect receptors similarly whereas E4 has differential effects, especially in the liver and breast. Adequate oestrogen doses in COCs ensure regular bleeding and user acceptability. EE and E4 have longer half-lives than E2; accordingly, COCs with EE and E4 offer more predictable bleeding than those with E2. Oestrogen type and progestin influence VTE risk; E2 poses a lower risk than EE; although promising, E4/DRSP VTE risk is lacking population-based data. COCs alleviate menstrual symptoms, impact mental health, cognition, libido, skin, and bone health.

Conclusion

Oestrogens play an important role in the contraceptive efficacy, bleeding patterns, and overall tolerability/safety of COCs. Recent studies exploring E4 combined with DRSP show promising results compared to traditional formulations, but more definitive conclusions await further research.

Oral contraceptive use is not related to gender self-concept

Oral contraceptive (OC) use is a valuable and underutilized natural experiment for examining exogenous hormone effects on aspects of cognition and behavior, especially aspects that show sex or gender differences. OC use, however, is not randomly assigned; women who use OCs may systematically differ from non-users for gender-linked reasons that potentially confound investigations of the pharmacokinetic effects of OCs. Thus, the primary aim of this study was to investigate whether OC users and non-users differ in gender self-concepts, as sociocultural factors might influence who uses OCs and why. A secondary aim was to examine whether OC users of different pill formulations differ in gender self-concept. Multivariate analyses of covariance (controlling for age) on a large sample of 395 young adult women revealed no significant differences between OC users (n = 247) and non-users (n = 148) in four aspects of gender self-concept (expressivity, instrumentality, femininity, and masculinity), with univariate effect sizes averaging d = 0.07. Moreover, inferences about group differences did not change when considering sociocultural factors (i.e., reason for OC use) or pharmacokinetic properties of the pills (i.e., androgenicity). Thus, findings indicate that differences in gender self-concept do not underlie OC use and non-use, and that the androgenicity of different OC formulations does not impact gender self-concept. Taken together, findings also highlight the specificity of exogenous ovarian hormone influences, as there are documented effects on cognition but not on personal characteristics, such as gender self-concept.

Papillary Thyroid Cancer-Promoting Activities of Combined Oral Contraceptive Components

Background:

Thyroid cancer is more common in women at reproductive age, suggesting the relationship between its high-incidence and therapeutic use of hormonal medications, such as oral contraceptives (OCPs). The aim of this study was to identify the effect of low-dose combined OCP (LD-COC) on proliferation, apoptosis, and migration of human papillary thyroid cancer (PTC) BCPAP cell line.

Materials and Methods:

BCPAP cells were cultured and treated with the combination of 90nM levonorgestrel (LNG) and 20nM ethinylestradiol (EE) for 48 hours. Afterward, using 3-(4, 5-dimethylthiazol-2-yl) -2, 5-diphenyltetrazolium bromide (MTT) assay, the proliferation of the cells was measured. Apoptosis was determined by using a Caspase-3 ELISA kit. Migratory properties of combined LNG and EE were studied through wound scratch assay. The expression levels of pro-apoptotic factor BAX, anti-apoptotic factor Bcl2, and proliferation marker Ki67 were analyzed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) and western blotting.

Results:

Upon treatment with the combination of LNG and EE, proliferation and migration of BCPAP cells were significantly enhanced. However, LNG and EE remarkably inhibited apoptosis of these cells. Furthermore, treating PTC cells with combined LNG and EE caused a marked increase in the expression of Bcl2 and Ki67 and a considerable decrease in BAX levels (P˂0.05).

Conclusion:

Our data linked the use of COCs and the progression and aggressiveness of PTC, suggesting the role of these hormonal compounds as promoting factors for PTC tumors. Despite these observations, further investigations will be required to fully establish the pathogenic impact of these medications on PTC.

Prevalence of rapid repeat pregnancy and associated factors in adolescents in Caruaru, Pernambuco

Abstract Objectives: to determine the prevalence and factors associated with the rapid repeat pregnancy (RRP) in pregnant adolescents. Methods: a cross-sectional study was carried out with pregnant adolescents assisted at the Family Health Strategies in Caruaru-PE from March to August 2013. A questionnaire with sociodemographic, economic, schooling, gynecological, obstetric and contraceptive characteristics was used. The data were analyzed in the Statistical Package for Social Sciences (SPSS), version 20. Binary logistic regression models were used. Results: among the 204 pregnant adolescents interviewed, the data of 26.5% (n = 54) multiparous were analyzed. The occurrence of RRP was 42.6% (n = 23) [95% CI 29.23-56.79]. The variables associated with RRP were non-use of contraceptive methods [OR 7.40 (CI95% 1.56-3.49)] and no previous pregnancy planning [OR 0.19 (95% CI 0.05-0.78)]. Conclusions: the percentage of RRP in adolescents was high. The non-use of contracep-tive methods increased the chances of RRP, while the no previous pregnancy planning decreased the chances of adolescents getting pregnant again without previous program-ming.

Targeting factors for change: contraceptive counselling and care of female adolescents

INTRODUCTION

Sexual and reproductive health care should empower and enable all individuals to have a sex life that is as safe and pleasurable as possible. Achievement of this goal for adolescents is often impeded by regional and sociocultural barriers.

OBJECTIVES

To review global barriers to provision of effective counselling and care of adolescents seeking advice on contraception and sexual and reproductive health and identify elements of best practice that can be adapted to meet their needs at regional level.

METHODS

Experts with clinical experience and a scholarly background in the provision of contraceptive services to adolescents participated in a stepwise process of literature review and discussion according to the agreed objectives.

RESULTS

The Global CARE (Contraception: Access, Resources, Education) group identified barriers to the access, availability and acceptance of contraception by adolescents, not only at the political and sociocultural level but also within health care practice. The group collected and summarized successful local strategies and tools suitable for adaptation in other regions. Elements of best practice for providing contraception regardless of setting or regional constraints, including required skills, knowledge, and attitudes, were also proposed.

CONCLUSION

Sharing of evidence-based best practice in delivering contraceptive services, improvements in health care provider education, and sharing of experience between countries will hopefully help to overcome the barriers to appropriate and effective counselling and care of adolescents.

Trends in the use of oral contraceptives among adolescents and young women in Spain

Background

We aimed to determine the prevalence of consumption of oral contraceptives (OCs) among adolescents and young women living in Spain and to identify the factors associated with this consumption.

Methods

We performed a cross-sectional study on the consumption of OCs by women aged 15–30 years residing in Spain. We used secondary individualized data from the 2006 (n = 2513) and 2012 (n = 1530) Spanish National Health Surveys. The dependent variable was the use of OCs in the previous 2 weeks. Independent variables included sociodemographic characteristics, comorbidity, lifestyle, and healthcare resource utilization.

The prevalence of OC consumption was analysed by investigating the changes observed between 2006 and 2012. We used multivariate logistic regression to identify the independent factors associated with OC use in each year.

Results

In 2006, 14.42 % of women reported using OCs; this percentage dropped to 10.21 % in 2012 (p < 0.05). Multivariate analysis revealed an association between OC use and visits to the gynaecologist (AOR, 5.60 [95 % CI, 2.93–10.73] in 2006; and AOR, 3.55 [95 % CI, 1.30–9.73] in 2012), Pap smear tests (AOR, 1.8 [95 % CI, 1.23–2.87] in 2006; and AOR, 2.42 [95 % CI, 1.30–4.51] in 2012), and smoking in 2006 (AOR, 1.42 [95 % CI, 1.04–1.93]).

Conclusions

There was a significant decrease in OC use from 2006 to 2012 among adolescents and young women living in Spain. In the present study, consumers of OCs were women who visited a gynaecologist more often and complied more with preventive measures such as Pap smear testing. Also, women who reported having used OCs were more likely to smoke than the rest of the study population, although the smoking habit is a risk factor for thrombotic events in women who take OCs.

Long-Term (7 Years) Follow-Up of Roux-en-Y Gastric Bypass on Obese Adolescent Patients (<18 Years)

BACKGROUND

Few data are available about obesity surgery in adolescent patients.

OBJECTIVE

To assess long-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients <18 years.

SETTING

University Hospital, Europe.

METHODS

A retrospective study of prospectively collected data of patients <18 years (childhood group; ChG) (n = 28) treated by LRYGB of which 19 were available for follow-up between 2.4 and 10.2 years (mean 7.2 years). This group of patients was matched with an adult control group (AdG) of randomly chosen patients with similar characteristics who underwent LRYGB during the same period. The extensive survey included a telephonic questionnaire.

RESULTS

19 (12 females) of the 28 patients (67.9%) were available for follow-up. Preoperatively, 3 had type 2 diabetes mellitus (T2DM), 1 arterial hypertension, 5 dyslipidemia and 1 sleep apnea. In the ChG, average BMI after 7 years dropped from 38.9 kg/m2 preoperatively to 27.5 kg/m2. In the AdG, average BMI decreased from 39.4 to 27.1 kg/m2 in the same time period (nonsignificant between groups). One patient in the ChG needed a reoperation (internal hernia) versus 3 patients in the AdG (1 leak, 2 obstructions). All patients resolved their initial comorbidities. Two of 12 female patients in the ChG became pregnant 6 and 8 years after surgery, respectively, despite seemingly adequate oral contraception. Compliance with postoperative guidelines was good in 16/19 patients in ChG and in 14/18 patients in the AdG. Overall degree of satisfaction was high: 8.2/10 (SD 1.2, range 6-10) in the ChG and 8.9/10 (SD 1.7, range 5-10) in the AdG.

CONCLUSION

LRYGB seems to be safe, provide good weight loss, and cure comorbidities in an adolescent population. Satisfaction degree is high. Inadvertent pregnancy despite conventional contraception is a possible issue.

Pounamu: E Hine: access to contraception for indigenous Mãori teenage mothers

ABSTRACT INTRODUCTION Timely and equitable access to contraception enables teenage mothers to make informed choices about their sexual and reproductive health. This study aimed to identify barriers and facilitators to contraception for Māori teenagers who become mothers. METHODS ‘E Hine’ is a longitudinal qualitative Kaupapa Māori (by Māori for Māori) study involving Māori women (aged 14–19 years), following them through pregnancy (n = 44) and the birth of their babies until their babies’ first birthdays (n = 41). This analysis focusses on contraception access pre-and post-pregnancy. FINDINGS Pre-pregnancy most participants accessed contraception or advice. Contraception use was compromised by a lack of information, negative side effects, and limited follow up. All reported their subsequent pregnancies as unplanned. Participants gave considerable thought to post-pregnancy contraception. Despite this many experienced clinical and service delays, financial barriers, and negative contraceptive side effects. There was little focus on contraception initiation and a lack of integrated care between midwives and other primary care services, leaving many participants without timely effective contraception. The system worked well when there was a contraception plan that included navigation, free access, and provision of contraception. CONCLUSION The majority of participants actively sought contraception pre- and post-conception. Despite a publicly funded system, a lack of health sector integration resulted in multiple missed opportunities to meet the needs of these teenagers for effective contraception. Health service funding formulas should define the goal as initiation of contraception rather than advice and provide funding to improve timely access to long acting reversible contraception. KEYWORDS Indigenous teenage pregnancy; contraception; barriers to contraception; Māori mothers

Transition von der Kindheit in das Erwachsenenalter bei chronischen Krankheiten

Dank des medizinischen Fortschritts erleben zunehmend mehr Kinder mit chronischen Erkrankungen das Erwachsenenalter. Patienten mit angeborenen Stoffwechselkrankheiten stellen nur eine, jedoch in ihrer Größe und Problematik besondere Gruppe heranwachsender Patienten dar. Allerdings fehlen vielfach begleitende Strukturen im Gesundheitssystem, um eine erfolgreiche Transition zu ermöglichen. Dies kann zu erheblicher Beeinträchtigung der Gesundheit der Betroffenen führen. Der Artikel beschreibt den Transitionsprozess des gesunden Adoleszenten zum jungen Erwachsenen sowie die Schwierigkeiten dieses Prozesses für chronisch kranke junge Menschen mit erhöhtem Bedarf an Gesundheitsbetreuung, die zusätzlich den Übergang aus der pädiatrischen Medizin in die Erwachsenenmedizin zu bewältigen haben.

Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review

The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system.