The effects of oral contraceptives on androgen levels and their relevance to premenstrual mood and sexual interest: a comparison of two triphasic formulations containing norgestimate and either 35 or 25 μg of ethinyl estradiol

Combined estrogen-progestin oral contraceptives and female sexuality: an updated review

INTRODUCTION

Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options.

OBJECTIVES

The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability.

METHODS

A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health.

RESULTS

Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time.

CONCLUSION

Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.

Correlation of sexual desire with sexual hormone binding globulin and free androgen index in women using combined contraceptives

PURPOSE

To correlate the sexual desire levels with sexual hormone binding globulin and free androgen index in women taking different types of hormonal contraceptives (HCs) containing ethinylestradiol (EE), oestradiol valerate (E2V), 17β-oestradiol (E2), or estetrol (E4), combined or in phasic formulation with different progestogens having antiandrogenic properties.

METHODS

Three hundred and sixty-seven women (age range 18-46) participated in the study. SHBG and total testosterone (TT) were measured, and the Free Androgen Index (FAI) was calculated. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively.

RESULTS

The highest SHBG values and the lowest FAIs were obtained of women on HCs containing EE than those of women on HCs containing E2V/17β E2 or E4 (p < 0.001). Desire scores and FSFI total scores were lower in women on HCs with EE than in those using HCs containing E2V, 17β E2, or E4 (p ≤ 0.001). The women who were on HCs containing EE reported FSDS levels higher than those containing all the other types of oestrogen. Finally, sexual desire and FSFI total scores had a negative correlation with the SHBG values and a positive correlation with FAI percentage (p ≤ 0.0001).

CONCLUSIONS

A minority of women using HCs with EE might experience a decreased sexual desire. This was not observed in women on HCs containing E2V, 17 E2, or E4. To avoid HC discontinuation, due to sexual desire reduction, HCs having minor antiandrogenic effects could be taken into consideration.

Mental Health Symptoms in Oral Contraceptive Users During Short-Term Hormone Withdrawal

Importance

Hormonal contraception has been linked to mood symptoms and the ability to recognize emotions after short periods of treatment, whereas the mental health of users of long-term hormonal contraceptives has had limited investigation.

Objective

To evaluate whether short-term hormonal withdrawal, which users of combined oral contraceptives (COCs) undergo once a month (pill pause), was associated with altered mood and emotional recognition in long-term users of COCs.

Design, Setting, and Participants

This case-control study included a community sample of individuals assigned female sex at birth who identified as women and used COC for 6 months or longer. The control group included women with natural menstrual cycles who otherwise fulfilled the same inclusion criteria. The study was conducted between April 2021 and June 2022 in Salzburg, Austria.

Exposure

COC users and women with natural menstrual cycles were tested twice within a month, once during their active pill phase or luteal phase and once during their pill pause or menses.

Main Outcomes and Measures

Negative affect, anxiety, and mental health problems were assessed during each session. The percentage increase in mental health symptoms was calculated during the pill pause compared with that during the active intake phase in COC users. How this change compared with mood fluctuations along the menstrual cycle in women with natural menstrual cycles was assessed.

Results

A total of 181 women aged 18 to 35 years (mean [SD] age, 22.7 [3.5] years) were included in the analysis (61 women with androgenic COC use, 59 with antiandrogenic COC use, 60 women with a menstrual cycle not taking COCs). COC users showed a 12.67% increase in negative affect (95% CI, 6.94%-18.39%), 7.42% increase in anxiety (95% CI, 3.43%-11.40%), and 23.61% increase in mental health symptoms (95% CI, 16.49%-30.73%; P < .001) during the pill pause compared with the active intake phase. The effect size of this change did not differ depending on progestin type (negative affect: F1,117 = 0.30, P = .59; state anxiety: F1,117 = 2.15, P = .15; mental health: F1,117 = .16, P = .69) or ethinylestradiol dose (negative affect: F1,57 = .99, P = .32; state anxiety: F1,57 = 2.30, P = .13; mental health: F1,57 = .14, P = .71) was comparable with mood changes along the menstrual cycle in women with natural cycles (negative affect: F2,175 = 0.13, P = .87; state anxiety: F2,175 = 0.14, P = .32; mental health: F2,175 = 0.65, P = .52). Mood worsening during the pill pause was more pronounced in women with higher baseline depression scores (negative affect increase of 17.95% [95% CI, 7.80%-28.10%] in COC users with higher trait depression [BDI >8]). Emotion recognition performance did not differ between active pill phase and pill pause.

Conclusions and Relevance

In this case-control study of long-term COC users, withdrawal from contraceptive steroids during the pill pause was associated with adverse mental health symptoms similar to those experienced by women during menses with withdrawal from endogenous steroids. These results question the use of the pill pause from a mental health perspective. Long-term COC users may benefit more from the mood-stabilizing effects of COCs in cases of continuous intake.

The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature

OBJECTIVE

Over the past decades, an increasing number of women have been using hormonal contraception. The potential role of sex hormones in regulating vegetative, psychophysiological, and cognitive functions has been highlighted in several studies, and there is a need to further understand the impact of hormonal contraception on women's quality of life, especially as regards psychological health and sexuality.

METHODS

We conducted a narrative review aimed at clarifying the mechanisms involved in the interaction between sex hormones and the brain, also focusing on the association between hormonal contraception and mood and sexual function.

RESULTS

Our findings clarified that hormonal contraception may be associated with depressive symptoms, especially among adolescents, and with sexual dysfunction. However, the evidence included in this review was conflicting and did not support the hypothesis that hormonal contraception directly causes depressive symptoms, major depressive disorder, or sexual dysfunction.

CONCLUSIONS

The optimal hormonal contraception should be identified in the context of shared decision making, considering the preferences and needs of each woman, as well as her physical and psychosexual conditions.

The heart as judge: Association of heart rate variability with moral judgment-A replication study

There is growing research into contributing processes and biological correlates of moral inclinations. Recently, a negative association between utilitarianism and resting heart rate variability (HRV) as an indicator of cardiac vagal tone / parasympathetic activity was reported. We aimed to replicate and extend these findings by additionally investigating the sympathetic parameter electro-dermal activity (EDA), but found no associations in the total sample (N = 157). However, when taking sex and the use of combined oral contraceptives (COC) into account, we found a positive association between HRV and estimated deontology in women using COC and men, while in free cycling women there was a negative association. While no direct replication, our results also point to associations between higher HRV and decreased endorsement of harmful actions that serve a greater good. Unlike HRV, EDA showed no associations with moral judgements. In addition, there were correlations between personality traits and moral judgement.

The Specificities of Elite Female Athletes: A Multidisciplinary Approach

Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.

Hormonal contraceptive use and depressive symptoms: systematic review and network meta-analysis of randomised trials

BACKGROUND

Observational studies suggest that hormonal contraceptive use may increase depressive symptoms in women, but it is unclear whether the effect is causal.

AIMS

To quantitatively examine the evidence from randomised clinical trials for the link between hormonal contraceptive use and depressive symptoms.

METHOD

We performed a systematic review and network meta-analysis of randomised clinical trials comparing women randomised to any form of a hormonal contraceptive with women randomised to any other form of a (non-)hormonal contraceptive or placebo. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, EMCare and EMBASE, from inception to 1 May 2020. Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A random-effect Bayesian network meta-analysis was conducted, with change in depressive symptoms between baseline and three cycles as outcome.

RESULTS

This review identified 3492 records, of which 14 trials were eligible and 12 could be included in the network meta-analysis. These trials included 5833 participants (mean age per study range: 16.8-32.4 years) and compared 10 different interventions. Compared with placebo, hormonal contraceptive use did not cause worsening of depressive symptoms (standardised mean difference: median, -0.04; range, -0.17 [95% credible interval -0.46 to 0.13] to 0.13 [95% credible interval -0.28 to 0.56]).

CONCLUSIONS

This study suggests that hormonal contraceptive use does not lead to an increase in depressive symptoms in adult women. Future studies should include first-time users, to confirm the results in young women.

Androgenic morality? Associations of sex, oral contraceptive use and basal testosterone levels with moral decision making

Aside from cultural, psychological, or situational factors, differences in moral judgements might also be influenced by biological variables. Since previous studies have reported stronger utilitarian tendencies in men, the relationship between testosterone and moral judgments has gained interest. Utilitarian judgements focus on the consequences of an action in terms of a cost-benefit analysis while deontological judgements are based on rules that are independent of an action's outcome or of situational features. We investigated decisions in moral dilemma situations in N = 157 young adults using a process dissociation approach to allow an independent estimate of underlying utilitarianism and deontology. Significant effects of sex (p = .009) and endocrine status (p = .011) on utilitarianism were found with the highest levels in men and the lowest in free cycling women while oral contraceptive users fell in between. Furthermore, there were correlations of salivary testosterone with utilitarianism in free cycling women (r = .303) and with deontology in men (r = -0.263) while no significant associations between testosterone and moral choices were found in oral contraceptive users. However, the duration of contraceptive use correlated negatively with deontology (r = -.316). The findings underscore the role of sex, endocrine status as well as testosterone in moral judgements but also point to specific associations depending on sex and oral contraceptive use.

Risk of sexual dysfunction with progestin-based contraceptives in women of child-bearing age

PURPOSE

To examine whether there is a positive association between sexual dysfunction (SD) and different types of progestin-based contraceptives.

METHODS

Nested case-control study in women of child-bearing age (15-45 years) from the IQVIA® Ambulatory electronic medical record database from 2008 to 2018. Cases defined by diagnosis of sexual dysfunction identified by international classification for disease clinical modification code 9th and 10th. Each case was matched to four controls and rates of prescriptions of the following were compared: levonorgestrel intra-uterine device (IUD), progestin, and ethinyl estradiol (EE) combined oral contraceptive (COC) formulations including levonorgestrel, norgestimate, drospirenone, desogestrel, norethindrone, and norgestrel; etonogestrel vaginal ring; and medroxyprogesterone injection.

RESULTS

Overall, 6689 cases of patients with SD were matched to 26,756 matched controls. Compared with matched controls, more subjects with SD used levonorgestrel IUD (OR 1.24, 95% CI 1.08-1.44), EE-levonorgestrel COC (OR 1.18, 95% CI 1.00-1.41), EE-drospirenone (OR 1.28, 95% CI 1.00-1.67), and medroxyprogesterone (OR 1.38, 95% CI 1.12-1.70). The use of norgestrel exhibited a protective effect (OR 0.83, 95% CI 0.73-0.95). When using the EE-levonorgestrel COC as a comparator, norgestrel users exhibited a protective effect (OR 0.70, 95% CI 0.57-0.87) while no other contraceptives showed a statistically significant difference in association with SD.

CONCLUSION

Our study found an increase in the use of levonorgestrel (COC and IUD), drospirenone, and medroxyprogesterone in subjects with SD. The risk of contraceptives did not differ when compared with oral levonorgestrel. The small association size and lack of difference between drug formulations suggest a minimal impact of progestin-based contraceptives on sexual dysfunction.

Levonorgestrel vs combined oral contraceptive pills in treatment of female acne and hirsutism

Combined oral contraception was used in many studies for treatment of acne and hirsutism. However, levonorgestrel (LNG) alone has not been evaluated before. Our objective is to evaluate the efficacy of oral contraceptive (OC) pills containing LNG and ethinyl estradiol (EE) compared with LNG only for the treatment of acne and hirsutism in a randomized, controlled prospective clinical trial. Eighty females (20 with acne, 20 with hirsutism, and 40 healthy females) received LNG + EE or LNG only for 6 months. Assessment of acne by global acne grading system (GAGS) and hirsutism by modified Ferriman-Gallwey scale (MFGS) grading system and serum free testosterone was measured before and 6 months after treatment. Serum free testosterone was significantly higher before treatment in acne and hirsutism patients compared to control group (P < .000). In acne patients, after 6 months of treatment with LNG/EE, serum free testosterone, and (GAGS), were significantly decreased compared to LNG only (P < .000). In hirsutism group, after 6 months of treatment with LNG/EE, serum free testosterone and (MFGS), were nonsignificantly decreased compared to LNG only. OCs containing either LNG/EE or LNG seem to be effective and safe treatment for acne and hirsutism.

Estrogen-progestin oral contraceptive and nicotine exposure synergistically confers cardio-renoprotection in female Wistar rats

Approximately fifty percent of premenopausal women who smoke cigarettes or on nicotine replacement therapy are also on hormonal contraceptives, especially oral estrogen-progestin. Oral estrogen-progestin therapy has been reported to promote insulin resistance (IR) which causes lipid influx into non-adipose tissue and impairs Na⁺/K⁺ -ATPase activity, especially in the heart and kidney. However, the effects of nicotine on excess lipid and altered Na⁺/K⁺ -ATPase activity associated with the use of estrogen-progestin therapy have not been fully elucidated. This study therefore aimed at investigating the effect of nicotine on cardiac and renal lipid influx and Na⁺/K⁺ -ATPase activity during estrogen-progestin therapy. Twenty-four female Wistar rats grouped into 4 (n = 6/group) received (p.o.) vehicle, nicotine (1.0 mg/kg) with or without estrogen-progestin steroids (1.0 μg ethinyl estradiol and 5.0 μg levonorgestrel) and estrogen-progestin only daily for 6 weeks. Data showed that estrogen-progestin treatment or nicotine exposure caused IR, hyperinsulinemia, increased cardiac and renal uric acid, malondialdehyde, triglyceride, glycogen synthase kinase-3, plasminogen activator inhibitor-1, reduced bilirubin and circulating estradiol. Estrogen-progestin treatment led to decreased cardiac Na⁺/K⁺-ATPase activity while nicotine did not alter Na⁺/K⁺-ATPase activity but increased plasma and tissue cotinine. Renal Na⁺/K⁺-ATPase activity was not altered by the treatments. However, all these alterations were reversed following combined administration of oral estrogen-progestin therapy and nicotine. The present study therefore demonstrates that oral estrogen-progestin therapy and nicotine exposure synergistically prevents IR-linked cardio-renotoxicity with corresponding improvement in cardiac and renal lipid accumulation, oxidative stress, inflammation and Na⁺/K⁺-ATPase activity.

Nomegestrol acetate/17beta-estradiol does not negatively alter the vascular resistance of clitoral arteries: a prospective, exploratory study

The effect of nomegestrol acetate/estradiol (NOMAC/E2) on clitoral and uterine vascularization has never been evaluated. We aimed to investigate, in women consulting for contraceptive needs, the possible changes in clitoral and uterine arteries hemodynamic parameters after 6 months treatment with NOMAC/E2 as compared with other hormonal contraceptives (HCs). In this observational, prospective pilot study, ten women were enrolled. Color Doppler ultrasound was performed on the clitoral and uterine arteries at baseline and after 6 months treatment with NOMAC/E2 (n = 5) or other HCs (n = 5). NOMAC/E2 did not exert any significant effect on clitoral vascular resistance expressed by the pulsatility index (PI); conversely, treatment with other HCs significantly increased this parameter (p = 0.04). The change in clitoral PI between the two groups retained a statistically significant difference even after adjusting for age. In the NOMAC/E2 group, at follow-up, uterine artery PI and acceleration were significantly reduced (p = 0.04), whereas no significant differences were observed in the HCs group; however, the change in uterine artery parameters did not differ significantly between the two groups. NOMAC/E2, differently from other COCs, does not negatively alter the vascular resistance of clitoral arteries and appears as a good contraceptive choice to protect both cardiovascular and sexual health.

Changes in premenstrual symptoms in women starting or discontinuing use of oral contraceptives

It is not clear whether oral contraceptive (OC) treatment affects premenstrual symptoms in women. The aim of the present study was to evaluate changes in premenstrual symptoms (PMS) in women starting to use or discontinuing the use of OCs. Twenty-four healthy women with no previous diagnosis of premenstrual dysphoric disorder were included in this study with a prospective crossover design. Nineteen women completed daily ratings of somatic and mood symptoms during two hormonally different cycles, during a normal menstrual cycle and while using OCs. The menstrual cycle phases were hormonally verified and the low-dose, monophasic OCs were used in a 21/7 regimen. The onset of OC use significantly decreased premenstrual somatic symptoms, but it did not affect mood symptoms. In the women who discontinued OC use, no significant changes in neither somatic nor mood symptoms appeared in the premenstrual phase.

The Potential of Hormonal Contraception to Influence Female Sexuality

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.

[Effectiveness and use of hormonal contraceptives (except for intrauterine devices): CNGOF Contraception Guidelines]

Hormonal contraceptives remain among the most popular methods used by women. The purpose of this work is to review the effectiveness and use of these different methods. In addition, some side-effects are feared and/or frequently reported by users of hormonal contraceptives: unscheduled bleeding, acne, catamenial migraines, weight gain, libido and/or mood disorders. In this review of the literature, the accountability of hormonal contraceptives for the occurrence of some of these side-effects was discussed and a management strategy was proposed.

Identifying teenage sexual abuse victims by questions on their daily lives

Child sexual abuse (CSA) is an international public health problem. While general practitioners are perhaps ideally positioned to detect CSA, a lack of simple tools and their discomfort in bringing up such a sensitive subject reduce the likelihood of its being brought up and flagged in primary care. However, it may be possible to identify victims of CSA by observing its consequences on student well-being, overall well-being and risk behavior. This study investigate the predictive value of daily life events possibly associated with CSA: relationship difficulties with peers and teachers, autolytic attempts, self-mutilation, low self-esteem, addiction, poor body image, physical and psychological violence, low quality of sleep. We carried out a crosssectional survey involving a representative sample of 1719 15 year-old adolescents enrolled in 192 randomly drawn schools from two French regions. In their classrooms, they filled out a version of the Health Behavior in School-Aged Children international (HBSC) self-questionnaire. Compared to their coevals, these youth were more likely to regularly consume cannabis, OR 4.40 [1.85; 10.48] and to express fear of violence, OR 2.05 [1.28; 3,28]. They were less likely to feel satisfied about their weight, OR 2.24 [1.13; 4.40] and more likely to feel unaccepted by others, OR 1.65 [1.03; 2.65]. The C-index (concordance statistic) taking into account gender, regular cannabis consumption, fear of violence, not having the right weight and not being accepted by others, was 0.79. The C-index also including self mutilation and autolytic attempts was 0.83. Indirect thematic could likewise facilitate detection and identification of CSA.

The relationship between the use of combined hormonal contraception with a predominance of gestagens and the selected types of female body in young women from the region of Lower Silesia

Oral contraceptive agents are currently the most popular and one of the most effective methods for preventing pregnancy. The data shows that over 300 million women in the world use contraceptive drugs containing synthetic hormones to avoid an unwanted pregnancy. Their effects may affect other systems, leading to the occurrence of various problems associated with the use of the drug. The aim of the study is to estimate the frequency of prevalence of subjective effects associated with the use of combined hormonal contraception with a predominance of gestagens by young women Surveys were conducted among female students of Wrocław universities from December 2010 to January 2011. They covered 257 women aged statistically 23.58 (SD=2.95). They were divided into three age classes: 19-22, 23-24, 25- 28. The individual age of menarche and the hormonal type of body were determined. Only persons with a gestagenic or estrogenic type of body were qualified for the study. Results: 64.6% of all respondents declared the use of hormonal contraception. Combined agents with a predominance of gestagens constituted 87% in this group. Their use brings both positive (90%) and negative (65%) aspects. The most common positive effects include high contraceptive effectiveness, regulation of menstruation and minimisation of skin problems. The most frequent negative effects include: weight gain, spotting, breast swelling and decreased libido. Surprisingly, the study did not show any correlation between the hormonal type and the occurrence of side effects. There was no significant statistical relationship between the type of hormonal contraception used and the hormonal type.

Long-acting reversible contraception (LARC) with the intrauterine system with levonorgestrel (6 mcg/d): observational study on the acceptability, quality of life, and sexuality in Italian women

This observational study was conducted in healthy premenopausal women, who presented themselves for contraception with an intrauterine system (IUS) releasing LNG (6 mcg/d) (Jaydess®, Bayer, Germany) at the outpatient Family Planning Clinics of the Departments of Obstetrics and Gynaecology of the Universities of Cagliari and Sassari (CA/SS), University-Hospitals of CA/SS (Italy). After a screening visit, 31 women without contraindications to Jaydess® were included in the study. No difficulty in Jaydess® insertion (Ji) was found in 87% of subjects, with pelvic pain (PP) (visual analogic scale, VAS:5.33 ± 2.54) reported by 27/31 subjects at the Ji. Pelvic pain was reported by 17/31 subjects on the first day (VAS: 3.07 ± 3.1), 16/31 subjects on the second day (VAS:2.37 ± 2.71), and 11/31 subjects on the third day (VAS:1.18 ± 2.02) from Ji, with a significant (p < .001) decrease in the intensity. The primary purposes of the study were to evaluate whether a 12-month-treatment (12-M-T) with Jaydess® interferes on either the quality of life (QoL) or sexuality. Jaydess® did not modify either QoL or sexuality in the 25 subjects who completed the 12-M-T. Throughout the 12-M-T, PP, or pregnancies were not found; the menstrual blood loss was significantly (p < .0001) reduced, and the intensity VAS of dysmenorrhea (#14 subjects) significantly (p < .001) improved.

Molecular basis of androgen action on human sexual desire

Reproduction is a fundamental process for the species maintenance and the propagation of genetic information. The energy expenditure for mating is overtaken by motivational stimuli, such as orgasm, finely regulated by steroid hormones, gonadotropins, neurotransmitters and molecules acting in the brain and peripheral organs. These functions are often investigated using animal models and translated to humans, where the androgens action is mediated by nuclear and membrane receptors converging in the regulation of both long-term genomic and rapid non-genomic signals. In both sexes, testosterone is a central player of this game and is involved in the regulation of sexual desire and arousal, and, finally, in reproduction through cognitive and peripheral physiological mechanisms which may decline with aging and circadian disruption. Finally, genetic variations impact on reproductive behaviours, resulting in sex-specific effect and different reproductive strategies. In this review, androgen actions on sexual desire are evaluated, focusing on the molecular levels of interaction.

Improvement of Low Sexual Desire Due to Antiandrogenic Combined Oral Contraceptives After Switching to an Oral Contraceptive Containing 17β-Estradiol

OBJECTIVES

To investigate the effects of a combined oral contraceptive (COC) containing 17β-estradiol (E2) 1.5 mg and nomegestrol acetate 2.5 mg (NOMAC/E2) on the sexual health of women affected by low sexual desire due to COCs containing ethinylestradiol.

MATERIALS AND METHODS

Eighty-three women (age range 19-32) participated in the study. Sex hormone-binding globulin (SHBG), total testosterone (TT), and free androgen index (FAI) were measured. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively. Hormonal levels were measured and questionnaires were administered before the women switched COC NOMAC/E2 usage (baseline) and at the 3-month (first) and 6-month (second) follow-ups.

RESULTS

SHBG reduction (p < 0.001), TT (p < 0.05), and FAI increases (p < 0.001) were observed during the first and second follow-ups with respect to baseline values. Sexual desire increased from baseline to the first and second follow-ups (p < 0.001). At baseline, the total FSFI score was 22 ± 1.5 and the FSDS score was 16.6 ± 1.3, both indicating sexual dysfunction with sexual distress. At the first follow-up, the total FSFI score and the FSDS score increased toward sexual health values, being 28.3 ± 1.6 and 12.1 ± 1.5, respectively (p < 0.001). At the second follow-up, the FSFI score had risen to 30.6 ± 1.3 (p < 0.001) and the FSDS score had dropped to 8.3 ± 1.4 (p < 0.001).

CONCLUSIONS

COCs containing E2 are an innovation that could help women to not suffer from low sexual desire during hypoandrogenic COC usage.

Is There Any Impact of Copper Intrauterine Device on Female Sexual Functioning?

INTRODUCTION

Intrauterine Device (IUD) is the most preferred modern contraceptive method in Turkey. Female Sexual Dysfunction (FSD) is defined as lack of one or more of the components in the sexual response cycle which includes sexual desire, impaired arousal and inability achieving an orgasm or pain with intercourse. FSD has multi-factorial aetiology. Advanced age and menopause, fatigue and stress, psychiatric and neurologic disease, childbirth, pelvic floor or bladder dysfunction, endometriosis, uterine fibroids, hypertension obesity, medication and substances, hormonal contraceptives, relationship factors are known risk factors for FSD.

AIM

To investigate if IUD has any impact on female sexual functioning.

MATERIALS AND METHODS

In this cross-sectional study subjects were divided into two groups. Study group consisted of 92 IUD-users (mean 5.1±1.2 years) and the control group consisted of 83 women with no contraception. Female Sexual Function Index (FSFI) questionnaire was performed to both two groups. Women with a total score lower than 26.5 were considered as having sexual dysfunction.

RESULTS

The prevalence of FSD was 57.1% among participants. IUD users had a lower total FSFI score comparing to control group but the difference was not statistically different (p=0.983). A positive correlation was found between total FSFI score and duration of IUD (p=0.003).

CONCLUSION

No difference was found in terms of sexual dysfunction between IUD users and women with no contraception. The prevalence of FSD was very high in both groups which may be attributed to the socio-cultural factors such as embarrassment of women due to conservatism.

Oral contraceptive use and fracture risk around the menopausal transition

OBJECTIVE

The effect of oral contraceptive (OC) use on risk of fracture remains unclear, and use during later reproductive life may be increasing. To determine the association between OC use during later reproductive life and risk of fracture across the menopausal transition, we conducted a population-based case-control study in a Pacific Northwest HMO, Group Health Cooperative.

METHODS

For the January 2008 to March 2013 interval, 1,204 case women aged 45 to 59 years with incident fractures, and 2,275 control women were enrolled. Potential cases with fracture codes in automated data were adjudicated by electronic health record review. Potential control women without fracture codes were selected concurrently, sampling based on age. Participants received a structured study interview. Using logistic regression, associations between OC use and fracture risk were calculated as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Participation was 69% for cases and 64% for controls. The study sample was 82% white; mean age was 54 years. The most common fracture site for cases was the wrist/forearm (32%). Adjusted fracture risk did not differ between cases versus controls for OC use in the 10 years before menopause (OR 0.90, 95% CI 0.74, 1.11); for OC use after age 38 (OR 0.94, 95% CI 0.78, 1.14); for duration of use, or for other OC exposures.

CONCLUSIONS

The current study does not show an association between fractures near the menopausal transition and OC use in the decade before menopause or after age 38. For women considering OC use at these times, fracture risk does not seem to be either reduced or-reassuringly-increased.

The relationship between stress, HPA axis functioning and brain structure in first episode psychosis over the first 12 weeks of treatment

Stress and abnormal hypothalamic-pituitary-adrenal axis functioning have been implicated in the early phase of psychosis and may partly explain reported changes in brain structure. This study used magnetic resonance imaging to investigate whether biological measures of stress were related to brain structure at baseline and to structural changes over the first 12 weeks of treatment in first episode patients (n=22) compared with matched healthy controls (n=22). At baseline, no significant group differences in biological measures of stress, cortical thickness or hippocampal volume were observed, but a significantly stronger relationship between baseline levels of cortisol and smaller white matter volumes of the cuneus and anterior cingulate was found in patients compared with controls. Over the first 12 weeks of treatment, patients showed a significant reduction in thickness of the posterior cingulate compared with controls. Patients also showed a significant positive relationship between baseline cortisol and increases in hippocampal volume over time, suggestive of brain swelling in association with psychotic exacerbation, while no such relationship was observed in controls. The current findings provide some support for the involvement of stress mechanisms in the pathophysiology of early psychosis, but the changes are subtle and warrant further investigation.

Oral contraceptive use and psychiatric disorders in a nationally representative sample of women

The purpose of this study is to examine the association between oral contraceptive use (any current use, duration, and type) and major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) in a nationally representative sample of women in the USA. Data were drawn from 1,105 women aged 20-39 in the National Health and Nutrition Examination Surveys from 1999 to 2004. The associations between self-reported use of oral contraceptives in the past year and DSM-IV diagnosed and subthreshold MDD, GAD, and PD in the past year were assessed comparing oral contraceptive users to all non-users, former users, and former long-term users. Women using oral contraceptives had a lower past-year prevalence of all disorders assessed, other than subthreshold MDD. When adjusted for confounders, women using oral contraceptives in the past year had significantly lower odds of subthreshold PD, compared to former users (odds ratio (OR) = 0.34, 95 % CI 0.14-0.84). Effects estimates were strongest for monophasic (versus multiphasic) oral contraceptive users. Hormonal contraceptive use was associated with reduced risk of subthreshold PD. A potential mental health benefit of hormonal contraceptives has substantial public health implications; prospective longitudinal studies are needed to confirm whether hormonal contraceptive use improves mental health.

Epidemiology of hormonal contraceptives-related venous thromboembolism

For many years, it has been well documented that combined hormonal contraceptives increase the risk of venous thromboembolism (VTE). The third-generation pill use (desogestrel or gestodene (GSD)) is associated with an increased VTE risk as compared with second-generation (levonorgestrel) pill use. Other progestins such as drospirenone or cyproterone acetate combined with ethinyl-estradiol (EE) have been investigated. Most studies have reported a significant increased VTE risk among users of these combined oral contraceptives (COCs) when compared with users of second-generation pills. Non-oral combined hormonal contraception, such as the transdermal patch and the vaginal ring, is also available. Current data support that these routes of administration are more thrombogenic than second-generation pills. These results are consistent with the biological evidence of coagulation activation. Overall, the estrogenic potency of each hormonal contraceptive depending on both EE doses and progestin molecule explains the level of thrombotic risk. Some studies have shown a similar increased VTE risk among users of COCs containing norgestimate (NGM) as compared with users of second-generation pill. However, for this combination, biological data, based on quantitative assessment of sex hormone-binding globulin or haemostasis parameters, are not in agreement with these epidemiological results. Similarly, the VTE risk associated with low doses of EE and GSD is not biologically plausible. In conclusion, newer generation formulations of hormonal contraceptives as well as non-oral hormonal contraceptives seem to be more thrombogenic than second-generation hormonal contraceptives. Further studies are needed to conclude on the combinations containing NGM or low doses of EE associated with GSD.

Cycle-Related Changes in Mood, Sexual Desire, and Sexual Activity in Oral Contraception-Using and Nonhormonal-Contraception-Using Couples

Findings on women's sexuality across the menstrual cycle are inconsistent. One relatively consistent finding is a midcycle and premenstrual peak in sexual desire in freely cycling women. Results on the cycle-related effects on sexual behavior are less clear. Large proportions of reproductive-aged women use combined oral contraception (COC), but studies on potential cycle-related shifts in sexual desire and behavior are sparse. A prospective diary study assessed sexual desire, sexual behavior, and mood in 89 heterosexual couples. Women were using one of four contraceptive methods: (1) nonhormonal contraception, (2) low-dose COC containing 20 mcg ethinylestradiol and 75 mcg gestoden or desogestrel, (3) COC containing 35 mcg ethinylestradiol and 2 mg cyproteronacetate, and (4) COC containing 30 mcg ethinylestradiol and 3 mg drospirenone. No cycle effects of sexual desire were established in the COC group, but frequency of sexual intercourse declined in the last days of active pill taking. These results were similar in both female and male partners. Negative affect did not covary with sexual desire.

Ethynilestradiol 20 mcg plus Levonorgestrel 100 mcg: Clinical Pharmacology

Estroprogestins (EPs) are combinations of estrogen and progestin with several actions on women's health. The different pharmacological composition of EPs is responsible for different clinical effects. One of the most used low-dose EP associations is ethinylestradiol 20 mcg plus levonorgestrel 100 mcg in monophasic regimen (EE20/LNG100). This review summarizes clinical pharmacology, cycle control, and effects on lipid and glucose metabolism, coagulation, body weight/body composition, acne, and sexuality of EE20/LNG100. Overall, EE20/LNG100 combination is safe and well tolerated, and in several studies the incidence of adverse events in the treated group was comparable to that of the placebo group. Cycle control was effective and body weight/body composition did not vary among treated and untreated groups in most studies. The EE20/LNG100 combination shows mild or no effect on lipid and glucose metabolism. Lastly, EE20/LNG100 is associated with a low risk of venous thromboembolism (VTE). In conclusion, in the process of decision making for the individualization of EPs choice, EE20/LNG100 should be considered for its favorable clinical profile.

Measurement of testosterone in human sexuality research: methodological considerations

Testosterone (T) and other androgens are incorporated into an increasingly wide array of human sexuality research, but there are a number of issues that can affect or confound research outcomes. This review addresses various methodological issues relevant to research design in human studies with T; unaddressed, these issues may introduce unwanted noise, error, or conceptual barriers to interpreting results. Topics covered are (1) social and demographic factors (gender and sex; sexual orientations and sexual diversity; social/familial connections and processes; social location variables), (2) biological rhythms (diurnal variation; seasonality; menstrual cycles; aging and menopause), (3) sample collection, handling, and storage (saliva vs. blood; sialogogues, saliva, and tubes; sampling frequency, timing, and context; shipping samples), (4) health, medical issues, and the body (hormonal contraceptives; medications and nicotine; health conditions and stress; body composition, weight, and exercise), and (5) incorporating multiple hormones. Detailing a comprehensive set of important issues and relevant empirical evidence, this review provides a starting point for best practices in human sexuality research with T and other androgens that may be especially useful for those new to hormone research.

The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis

BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many years, to our knowledge no systematic review concerning this issue had been performed. This systematic review and meta-analysis was performed to evaluate the effect of COCs on concentrations of total T, free T and SHBG in healthy women and to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T and free T.

METHODS

A review of the literature was performed using database searches (MEDLINE, EMBASE and the Cochrane Central Register of Clinical Trials) and all publications (from inception date until July 2012) investigating the effect of COCs on androgen levels in healthy women were considered eligible for selection. Three reviewers were involved in study selection, data extraction and critical appraisal. For the meta-analysis, data on total T, free T and SHBG were extracted and combined using random effects analysis. Additional subgroup analyses were performed to evaluate differences between the various types of COCs (e.g. estrogen dose, type of progestin) and the assays used to assess total T or free T.

RESULTS

A total of 151 records were identified by systematic review and 42 studies with a total of 1495 healthy young women (age range: 18-40 years) were included in the meta-analysis. All included studies were experimental studies and 21 were non-comparative. Pooling of the results derived from all the included papers showed that total T levels significantly decreased during COC use [mean difference (MD) (95% confidence interval, CI) -0.49 nmol/l (-0.55, -0.42); P < 0.001]. Significantly lower levels of free T were also found [relative change (95% CI) 0.39 (0.35, 0.43); P < 0.001], with a mean decrease of 61%. On the contrary, SHBG concentrations significantly increased during all types of COC use [MD (95% CI) 99.08 nmol/l (86.43, 111.73); P < 0.001]. Subgroup analyses revealed that COCs containing 20-25 µg EE had similar effects on total and free T compared with COCs with 30-35 µg EE. In addition, suppressive effects on T levels were not different when comparing different types of progestins. However, subgroup analyses for the estrogen dose and the progestin type in relation to changes in SHBG levels did show significant differences: COCs containing second generation progestins and/or the lower estrogen doses (20-25 µg EE) were found to have less impact on SHBG concentrations.

CONCLUSIONS

The current literature review and meta-analysis demonstrates that COCs decrease circulating levels of total T and free T and increase SBHG concentrations. Due to the SHBG increase, free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T, but both affect SHBG. The clinical implications of suppressed androgen levels during COC use remain to be elucidated.

The pharmacokinetics and pharmacodynamics of dehydroepiandrosterone during use of an ethinylestradiol- and drospirenone-containing oral contraceptive

BACKGROUND

Combined oral contraceptives (COCs) reduce the levels of ovarian and adrenal androgens. Co-administration of dehydroepiandrosterone (DHEA) may normalise androgen levels during COC use.

OBJECTIVE

To investigate the effect of the addition of DHEA to a COC on the pharmacokinetics (PK) and pharmacodynamics (PD) of DHEA and its sulphate (DHEA-S), and on levels of total and free testosterone (T).

METHODS

In a prospective, randomised, double-blind, placebo-controlled, cross-over study involving 21 female volunteers, the PK and PD of DHEA and DHEA-S were investigated during the use of one cycle of a COC containing 30 μg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) with and without daily co-administration of 50 mg DHEA.

RESULTS

Treatment during one cycle with a COC containing EE and DRSP reduces the exposure to DHEA and DHEA-S by at least 20%. This loss of adrenal androgens can be fully compensated by daily oral co-administration of 50 mg DHEA. With DHEA co-administration total T levels rise significantly (1.44 nmol/L with DHEA vs. 0.82 nmol/L with placebo; p < 0.001). Free T levels decrease significantly with both DHEA and placebo treatment, but significantly less during co-administration of DHEA (6.34 pmol/L with DHEA vs. 3.96 pmol/L with placebo; p < 0.001).

CONCLUSION

By adding DHEA to a COC the loss of adrenal and ovarian androgens can be restored.

The influence of combined oral contraceptives on female sexual desire: a systematic review

OBJECTIVES

To determine the relationship between the use of combined oral contraceptives (COCs) and sexual desire based on a systematic review of the literature.

METHODS

MEDLINE Complete, Google Scholar and the Cochrane Library were searched for articles published between 1975 and 2011, reporting the effects of oral contraceptives on sexual desire. Reports fully meeting all the predefined criteria were analysed and included in a final reference list. In addition, a review of the reference list of selected articles was carried out.

RESULTS

We evaluated 36 studies (1978-2011; 13,673 women). Of the COC users (n = 8,422), 85% reported an increase (n = 1,826) or no change (n = 5,358) in libido and 15% reported a decrease (n = 1,238). We found no significant difference in sexual desire in the case of COCs with 20-35 μg ethinylestradiol; libido decreased only with pills containing 15 μg ethinylestradiol.

CONCLUSIONS

The majority of COC users report no significant change in libido although in most studies a decline in plasma levels of free testosterone and an increase in those of sex hormone binding globulin were observed.

Premenstrual dysphoric disorder and severe premenstrual syndrome in adolescents

Numerous epidemiologic studies have demonstrated that premenstrual disorders (PMDs) begin during the teenage years. At least 20 % of adolescents experience moderate-to-severe premenstrual symptoms associated with functional impairment. Premenstrual syndrome (PMS) consists of physical and/or psychological premenstrual symptoms that interfere with functioning. Symptoms are triggered by ovulation and resolve within the first few days of menses. The prevalence of premenstrual dysphoric disorder (PMDD), a severe form of PMS accompanied by affective symptoms, is likely equal to or higher than in adults. The diagnosis of a PMD requires a medical and psychological history and physical examination but it is the daily prospective charting of bothersome symptoms for two menstrual cycles that will clearly determine if the symptoms are related to a PMD or to another underlying medical or psychiatric diagnosis. The number and type of symptoms are less important than the timing. Randomized controlled trials of pharmacologic treatments in teens with moderate-to-severe PMS and PMDD have yet to be performed. However, clinical experience suggests that treatments that are effective for adults can be used in adolescents. PMS can be ameliorated by education about the nature of the disorder, improving calcium intake, performing exercise and reducing stress, but to treat severe PMS or PMDD pharmacologic therapy is usually required. Eliminating ovulation with certain hormonal contraceptive formulations or gonadotropin-releasing hormone agonists will be discussed. Serotonergic agonists are a first-line therapy for adults, and some serotonin reuptake inhibitors such as fluoxetine and escitalopram can be administered safely to teens.

Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation

CONTEXT

Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear.

OBJECTIVE

The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adult OC users and discontinuers of two estrogen doses, relative to nonusers.

DESIGN AND SETTING

This was a prospective cohort study, Group Health Cooperative.

PARTICIPANTS

Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%.

MAIN OUTCOME MEASURE

The main outcome measure was BMD measured at 6-month intervals for 24-36 months.

RESULTS

After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32% < 30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter).

CONCLUSIONS

Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.

Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life

INTRODUCTION

A new oral contraceptive containing the natural estrogen estradiol and a 19-nortestosterone derivate dienogest (DNG) in a four-phasic 28-day regimen may be used by women.

AIM

To investigate the quality of sexual life of healthy women on estradiol valerate and DNG (E2V/DNG) oral contraceptive.

METHODS

Fifty-seven women (age range 18-48 years) were enrolled. The Short Form-36 (SF-36) questionnaire to assess quality of life (QoL) was administered at baseline and at the 26th day of both the 3rd and 6th cycles of oral contraceptive (OC) intake. The Short Personal Experience Questionnaire (SPEQ) to measure the change of sexual behavior was used at the 2nd, 7th, 14th, 21st, 26th, and 28th days of the baseline cycle, as well as at the same days of both the 3rd and 6th cycle of contraceptive intake.

MAIN OUTCOME MEASURE

The SF-36 and the SPEQ questionnaires.

RESULTS

Women reported QoL improvement at the 3rd (P < 0.05) and at the 6th cycles (P < 0.01). By SPEQ, improvement of sexuality during the 3rd and the 6th cycle with respect to baseline experience was observed (P < 0.05). The frequency of sexual activity remained basically unchanged (P = NS). Enjoyment and desire improved at the 6th cycle with respect to the 3rd cycle (P < 0.05). All women reported decreased dyspareunia at the 3rd and 6th cycles (P < 0.05). Interestingly, desire, arousal, orgasm, enjoyment, and sexual activity improved, reaching a peak around the 14th day of the menstrual cycle (P < 0.05). At the 3rd and 6th cycle, women on OCs were sexually cyclic, but the peak improvement of desire, arousal, orgasm, enjoyment, and sexual activity appeared around the 7th day of OC intake (P < 0.05).

CONCLUSION

Reduced hormone-free interval is a new concept in low-dose OC regimens. Moreover, the E2V/DNG multiphasic extended regimen has been found to positively modify the sexuality of users.

Elevated eating disorder symptoms in women with a history of oral contraceptive side effects

Previous research suggests a link between gonadal hormones and eating disorder symptomatology. This study examined the role of gonadal hormones and hormonal sensitivity in eating disorder (ED) symptoms by using oral contraceptive (OC) side effect history as an indicator of hormonal sensitivity. A questionnaire containing two scales of the Eating Disorder Inventory-2 and an OC side effect scale was completed by 174 healthy women who had used OCs. Histories of emotional and physical OC side effects were evaluated as predictors of body dissatisfaction and drive for thinness. Women with a history of negative OC side effects had higher levels of ED symptoms. After controlling for body mass index (BMI) and depression scores, OC side effect history remained a significant predictor of body dissatisfaction and drive for thinness. The experience of OC side effects may indicate a greater risk for increased eating disorder symptoms. The findings provide further support for a hormonal link to ED symptoms, as women who are more "sensitive" to exogenous gonadal hormones also experience more ED symptoms.

Seasonal variation of salivary testosterone in men, normally cycling women, and women using hormonal contraceptives

Humans' endogenous testosterone concentrations vary over a number of temporal scales, with little known about variation longer than monthly cycles. Past studies of seasonal or circannual variation have principally used male participants and have produced inconsistent results. Thus, little is known about how testosterone concentrations fluctuate throughout the year, whether such variation differs between men and women, and whether there are influences of hormonal contraceptive use. The present study collected saliva samples from a large sample (N=718) of men and women, each collected at one time point within a relatively uniform distribution over a full calendar year. Both men and normally-cycling women displayed seasonal variation in salivary testosterone concentrations, such that testosterone concentrations are maximal in the fall and minimal in the summer. Notably, normally-cycling women had testosterone concentrations that were over 100% greater at their maximum in fall compared to their minimum in summer. Women using hormonal contraceptives not only had consistently lower endogenous testosterone concentrations, but also showed a flatter seasonal testosterone profile. The implications for studies of psychology and human behavioral endocrinology are discussed.

Sexy thoughts: effects of sexual cognitions on testosterone, cortisol, and arousal in women

Previous research suggests that sexual stimuli increase testosterone (T) in women and shows inconsistent effects of sexual arousal on cortisol (C), but effects of cognitive aspects of arousal, rather than behaviors or sensory stimuli, are unclear. The present study examined whether sexual thoughts affect T or C and whether hormonal contraceptive (HC) use moderated this effect, given mixed findings of HC use confounding hormone responses. Participants (79 women) provided a baseline saliva sample for radioimmunoassay. We created the Imagined Social Situation Exercise (ISSE) to test effects of imagining social interactions on hormones, and participants were assigned to the experimental (sexual) or one of three control (positive, neutral, stressful) conditions. Participants provided a second saliva sample 15 min post-activity. Results indicated that for women not using HCs, the sexual condition increased T compared to the stressful or positive conditions. In contrast, HC using women in the sexual condition had decreased T relative to the stressful condition and similar T to the positive condition. The effect was specific to T, as sexual thoughts did not change C. For participants in the sexual condition, higher baseline T predicted larger increases in sexual arousal but smaller increases in T, likely due to ceiling effects on T. Our results suggest that sexual thoughts change T but not C, baseline T levels and HC use may contribute to variation in the T response to sexual thoughts, and cognitive aspects of sexual arousal affect physiology.

Conventional vs. extended-cycle oral contraceptives on the quality of sexual life: comparison between two regimens containing 3 mg drospirenone and 20 µg ethinyl estradiol

INTRODUCTION

Women may use new oral contraceptives (OC) having flexible extended-cycle regimens with a reduced hormone-free interval.

AIM

To study the changes of the quality of sexual life in users of the traditional 21/7 or extended-cycle 24/4 OC regimens both containing 3 mg drospirenone and 20 µg ethinyl estradiol.

METHODS

One hundred fifteen women (age range 18-37 years) were enrolled. Fifty-four women were randomly placed on traditional OC standard regimen, administered for 21 days, followed by a 7-day hormone-free interval (group A); and 61 women were placed on extended-cycle OC regimen covering 24 days of the cycle with a 4-day hormone-free interval (group B). The Short Form-36 (SF-36) validate questionnaire to assess quality of life (QoL) and the Short Personal Experience Questionnaire (SPEQ) to measure the changes of sexual behavior were administered before starting OC intake and at the 3rd and 6th cycle follow-ups.

MAIN OUTCOME MEASURE

The SF-36 and the SPEQ questionnaires.

RESULTS

Group A women reported QoL improvement during the 6th cycle on all the scales (P < 0.05). Group B women reported QoL improvement during the 3rd and 6th cycle (P < 0.05). Satisfaction with sexual activity, arousal, orgasm, and desire increased during the 3rd cycle in women on the group B (P < 0.05). Group A women did not report any change in all SPEQ items. At the 6th cycle, group B women reported better sexual experience than baseline in all SPEQ items (P < 0.05). All subjects who were affected by dyspareunia before OC intake reported decreased genital pain associated with intercourse at the 3rd and 6th cycle of both OC regimens (P < 0.05).

CONCLUSION

Women could use OCs in a subjective flexible modality. The extended-cycle OC might produce positive effects on the quality of sexual life, enforcing the concept of tailoring an OC to a woman.

Oral contraceptives vs injectable progestin in their effect on sexual behavior

OBJECTIVE

We sought to compare sexual function and hormone concentrations in combined oral contraceptive (COC) and injectable progestin users.

STUDY DESIGN

Sexually active COC and depot medroxyprogesterone acetate (DMPA) users completed the Female Sexual Function Index (FSFI) questionnaire, a demographic data form, and had serum testosterone and estradiol levels measured. Multiple linear regression was used to measure associations of interest.

RESULTS

Among 50 subjects enrolled, COC users had lower levels of free testosterone compared to DMPA users (0.2 vs 0.6 pg/mL; P < .0001) and higher levels of estradiol (75.8 vs 62.8 pg/mL; P = .0057), but scores of desire (4.2 vs 3.8; P = .27), scores of arousal (5.0 vs 4.8; P = .46), or total scores (30.1 vs 28.8; P = .28) were no different. Demographic characteristics were similar except for ethnicity, level of education, gravidity, parity, and frequency of intercourse. In multivariate analysis, birth control type was not significantly associated with desire score or total FSFI score.

CONCLUSION

While users of COC and DMPA have significantly different sex hormone levels, they are not different in sexual function as measured by the FSFI.