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Mtutu RS, Alriksson-Schmidt AI, Jarl J. Oral contraceptive use in women with spina bifida in Sweden. Disabil Health J 2024; 17:101627. [PMID: 38637232 DOI: 10.1016/j.dhjo.2024.101627] [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] [Received: 11/22/2023] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Thanks to improved medical care, individuals with spina bifida (SB) live well into adulthood and go through the process of reproductive maturation and the development of sexual desires. However, access to reproductive counselling and contraceptive use has been reported to be lower for women with physical and intellectual disabilities compared to the general population. OBJECTIVE We investigated oral contraceptive use in women with SB, residing in Sweden and how use varies based on the level of lesion and demographic factors. METHODS This was a population-based case-control study using annual data from national registers from 2006 to 2015. The sample consisted of 7045 women aged 15-49 years, of which 1173 had a diagnosis of SB. χ2 tests and logistic regression were used to investigate the study objective. RESULTS The rate of oral contraceptive use in women with SB was 24.6 % compared to 34.5 % among the general population. After adjusting for potential confounders women with SB were found to have a lower probability of using oral contraceptives (OR 0.63 95 % CI 0.56-0.71) compared to women without SB. Among women with SB, those with diagnoses Q05.8 (Sacral SB without hydrocephalus) and Q05.9 (SB unspecified) had a higher likelihood of using oral contraceptives compared to other Q05 diagnoses. CONCLUSION Women with SB had a lower likelihood of being on oral contraceptives compared to the control group. Further research should investigate if the lower use indicates that oral contraceptives are not an inappropriate method of contraception for women with SB.
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Affiliation(s)
- R Samu Mtutu
- Department of Health Sciences, Lund University, Lund, Sweden.
| | | | - Johan Jarl
- Department of Clinical Sciences Malmö, Health Economics Unit, Lund University, Malmö, Sweden
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Brouillard A, Davignon LM, Turcotte AM, Marin MF. Morphologic alterations of the fear circuitry: the role of sex hormones and oral contraceptives. Front Endocrinol (Lausanne) 2023; 14:1228504. [PMID: 38027091 PMCID: PMC10661904 DOI: 10.3389/fendo.2023.1228504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background Endogenous sex hormones and oral contraceptives (OCs) have been shown to influence key regions implicated in fear processing. While OC use has been found to impact brain morphology, methodological challenges remain to be addressed, such as avoiding selection bias between OC users and non-users, as well as examining potential lasting effects of OC intake. Objective We investigated the current and lasting effects of OC use, as well as the interplay between the current hormonal milieu and history of hormonal contraception use on structural correlates of the fear circuitry. We also examined the role of endogenous and exogenous sex hormones within this network. Methods We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41). Salivary endogenous sex hormones and current users' salivary ethinyl estradiol (EE) were assessed using liquid chromatography - tandem mass spectrometry. Using structural magnetic resonance imaging, we extracted surface-based gray matter volumes (GMVs) and cortical thickness (CT) for regions of interest of the fear circuitry. Exploratory whole-brain analyses were conducted with surface-based and voxel-based morphometry methods. Results Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users. While associations with endogenous sex hormones remain unclear, we showed that EE dosage in current users had a greater influence on brain anatomy compared to salivary EE levels and progestin androgenicity, with lower doses being associated with smaller cortical GMVs. Discussion Our results highlight a sex difference for the dorsal anterior cingulate cortex GMV (a fear-promoting region), as well as a reduced CT of the ventromedial prefrontal cortex (a fear-inhibiting region) specific to current OC use. Precisely, this finding was driven by lower EE doses. These findings may represent structural vulnerabilities to anxiety and stress-related disorders. We showed little evidence of durable anatomical effects, suggesting that OC intake can (reversibly) affect fear-related brain morphology.
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Affiliation(s)
- Alexandra Brouillard
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | - Lisa-Marie Davignon
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | | | - Marie-France Marin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
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Hidalgo-Lopez E, Noachtar I, Pletzer B. Hormonal contraceptive exposure relates to changes in resting state functional connectivity of anterior cingulate cortex and amygdala. Front Endocrinol (Lausanne) 2023; 14:1131995. [PMID: 37522123 PMCID: PMC10374315 DOI: 10.3389/fendo.2023.1131995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 06/09/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Hormonal contraceptives (HCs), nowadays one of the most used contraceptive methods, downregulate endogenous ovarian hormones, which have multiple plastic effects in the adult brain. HCs usually contain a synthetic estrogen, ethinyl-estradiol, and a synthetic progestin, which can be classified as androgenic or anti-androgenic, depending on their interaction with androgen receptors. Both the anterior cingulate cortex (ACC) and the amygdala express steroid receptors and have shown differential functionality depending on the hormonal status of the participant and the use of HC. In this work, we investigated for the first time the relationship between ACC and amygdala resting state functional connectivity (rs-FC) and HC use duration, while controlling for progestin androgenicity. Methods A total of 231 healthy young women participated in five different magnetic resonance imaging studies and were included in the final analysis. The relation between HC use duration and (i) gray matter volume, (ii) fractional amplitude of low-frequency fluctuations, and (iii) seed-based connectivity during resting state in the amygdalae and ACC was investigated in this large sample of women. Results In general, rs-FC of the amygdalae with frontal areas, and between the ACC and temporoparietal areas, decreased the longer the HC exposure and independently of the progestin's androgenicity. The type of HC's progestin did show a differential effect in the gray matter volume of left ACC and the connectivity between bilateral ACC and the right inferior frontal gyrus.
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Affiliation(s)
- Esmeralda Hidalgo-Lopez
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Isabel Noachtar
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Belinda Pletzer
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
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Hidalgo-Lopez E, Engman J, Poromaa IS, Gingnell M, Pletzer B. Triple network model of brain connectivity changes related to adverse mood effects in an oral contraceptive placebo-controlled trial. Transl Psychiatry 2023; 13:209. [PMID: 37328507 PMCID: PMC10276024 DOI: 10.1038/s41398-023-02470-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/18/2023] Open
Abstract
Combined oral contraceptives (COC) are among the most commonly used contraceptive methods worldwide, and mood side effects are the major reason for discontinuation of treatment. We here investigate the directed connectivity patterns associated with the mood side effects of an androgenic COC in a double-blind randomized, placebo-controlled trial in women with a history of affective COC side effects (n = 34). We used spectral dynamic causal modeling on a triple network model consisting of the default mode network (DMN), salience network (SN) and executive control network (ECN). Within this framework, we assessed the treatment-related changes in directed connectivity associated with adverse mood side effects. Overall, during COC use, we found a pattern of enhanced connectivity within the DMN and decreased connectivity within the ECN. The dorsal anterior cingulate cortex (SN) mediates an increased recruitment of the DMN by the ECN during treatment. Mood lability was the most prominent COC-induced symptom and also arose as the side effect most consistently related to connectivity changes. Connections that were related to increased mood lability showed increased connectivity during COC treatment, while connections that were related to decreased mood lability showed decreased connectivity during COC treatment. Among these, the connections with the highest effect size could also predict the participants' treatment group above chance.
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Affiliation(s)
- Esmeralda Hidalgo-Lopez
- Department of Psychology, University of Salzburg, Salzburg, Austria.
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA.
| | - Jonas Engman
- Department of Psychology, Uppsala University, 751 85, Uppsala, Sweden
| | - Inger Sundström Poromaa
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
- Centre for Women's Mental Health during the Reproductive Lifespan, Uppsala University, 751 85, Uppsala, Sweden
| | - Malin Gingnell
- Department of Psychology, Uppsala University, 751 85, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Belinda Pletzer
- Department of Psychology, University of Salzburg, Salzburg, Austria.
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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Pletzer B, Lang C, Derntl B, Griksiene R. Weak associations between personality and contraceptive choice. Front Neurosci 2022; 16:898487. [PMID: 36389244 PMCID: PMC9648366 DOI: 10.3389/fnins.2022.898487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
Abstract
Prospective randomized controlled trials on hormonal contraceptive (HC) effects on the brain are rare due to a number of methodological challenges. Thus, much of the evidence on HC effects on the brain comes from cross-sectional studies comparing HC-users to non-users. In interpreting these findings, it is of importance to be aware of potential confounds associated with women's contraceptive choices. Previous studies have discussed age, education, social status, sexual orientation, relationship status, and tolerability of HC. Given the current trend toward a reduction in HC use and increased skepticism toward HC it seems relevant to also identify variables associated with women's attitudes toward HC and whether they may represent confounds for neuroscientific studies. In the present study, we investigated whether women's personality characteristics were associated with their choice to use or not use HC in the present, past and future and the type of HC chosen. 1,391 females aged 18-45 years participated in an online survey including the HEXACO-60 personality questionnaire, as well as two different measures of gender role, and provided information about their current and previous contraceptive status, as well as experiences with and attitudes toward contraceptive use. We compared (i) current, previous and never-users of HC, (ii) prospective users of HC to women who opposed future HC use, and (iii) current users of IUDs to current users of oral contraceptives. Results revealed that associations between personality and the decision to use or not use HC were negligible, while differences in personality were observed corresponding to contraceptive type. Current users of IUDs showed higher agreeableness and extraversion compared to current users of oral contraceptives. The results suggest that personality is more strongly associated to the choice of contraceptive type rather than the choice between hormonal and non-hormonal options.
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Affiliation(s)
- Belinda Pletzer
- Department of Psychology and Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Carmen Lang
- Department of Psychology and Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Ramune Griksiene
- Department of Neurobiology and Biophysics, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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Alfaifi M, Najmi AH, Swadi KH, Almushtawi AA, Jaddoh SA. Prevalence of contraceptive use and its association with depression among women in the Jazan province of Saudi Arabia. J Family Med Prim Care 2021; 10:2503-2511. [PMID: 34568127 PMCID: PMC8415675 DOI: 10.4103/jfmpc.jfmpc_1308_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Hormonal contraceptives (HC) are used for birth control and the treatment of premenopausal syndrome. Mood changes represent the leading reported cause of discontinuation of HC. Changes in mood vary from mild disturbances to severe clinical depression. Objectives: This study aims to estimate the prevalence of depression among HC users who visit primary health care centers in the Jazan Province of Saudi Arabia and to identify psycho-social factors that may predispose HC users to depression. Methods: A self-administered questionnaire was distributed among women who visited five primary health care centers in the Jazan Province. The survey included questions about socio-demographic information and an Arabic adaptation of the Beck Depression Inventory. Results: Among the 904 women surveyed, the prevalence of HC use was 57.3%. Mood disturbances were observed in approximately one-third of these women. There is was a significant correlation between higher depression scores and a history of depression therapy (P-value < 0.001), as moderate, severe, and extreme depression was more common in those with a history of taking depression therapy. The type of contraception used was also found to be a significant factor (P-value = 0.01) in the degree of depression. Conclusion: Approximately one-third of women using HC were shown to exhibit symptoms of mood disturbance. Working, limited social support, asked whether or not they experienced living problems in the past 2 months, and having an uncomfortable or somewhat comfortable marital relationship increased the likelihood of mood disturbances. Primary health care physicians should be aware of the relatively high prevalence of mood disturbances in women using HC, to provide support and care to patients.
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Affiliation(s)
- Mashael Alfaifi
- Department of Pharmaceutical Service, Clinical Pharmacy Section, King Saud Medical City, Jazan, Saudi Arabia
| | - Ali H Najmi
- Pharmaceutical Service Department, Clinical Pharmacy Section, King Fahad Medical City, Jazan, Saudi Arabia
| | | | - Abdullah A Almushtawi
- Department of Pharmaceutical Service, Pharmacy Section, King Saud Medical City, Jazan, Saudi Arabia
| | - Sattam A Jaddoh
- Alamal Mental Health Hospital, Ministry of Health, Jazan, Saudi Arabia
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Handayani S, Damayanti R, Ariawan I, Yelda F, Harlan S, Wahyuningrum Y, Storey D. Improving Communication Messages by Using Perceptual Mapping: Family Planning Survey in East Java and West Nusa Tenggara, Indonesia. SAGE Open Med 2021; 9:2050312121993288. [PMID: 33738099 PMCID: PMC7934029 DOI: 10.1177/2050312121993288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: Contraceptive methods vary in effectiveness, actions required of users, and side effects. This article aims to analyze the perceptions about contraceptive methods among family planning clients of the East Java and West Nusa Tenggara (NTB) provinces in Indonesia. Methods: The data were obtained from the operational research of the Improving Contraceptive Method Mix Project in Indonesia, conducted in 2015–2016 in six districts in East Java and West Nusa Tenggara. The total sample size was 12,190 women aged 15–49 years. The perceptual mapping method uses cross-sectional surveys that require the respondent to rate the level to which they associate specific elements with each other, based on similarities and differences of perceived association. The correlation matrices for six contraceptive methods and five attributes were subjected to a multidimensional scaling analysis. Results: The results showed injectable to be the most preferred method, which was positioned closest to the attributes ‘easy to use’ and ‘easy to get’, followed by pills. Implants ranked higher than other long-acting and permanent method. Conclusion: Injectables and pills were the most preferred because people believe that they were ‘easy to use’ and ‘easy to get’. The least preferred methods were tubectomy and vasectomy because the respondents thought those were not close to any attributes at all. To increase the demand for the long-acting and permanent method choice in the provinces of East Java and West Nusa Tenggara, the attributes ‘easy to use’ and ‘easy to get’ should be emphasized in the long-acting and permanent method Information Education and Communication messages.
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Affiliation(s)
- Sarah Handayani
- Public Health Science Doctoral Study Program, Faculty of Public Health, University of Indonesia, Depok, Indonesia
- Faculty of Health Sciences Universitas Muhammadiyah Prof Dr. HAMKA (UHAMKA), Jakarta Selatan, Indonesia
- Sarah Handayani, Faculty of Health Sciences Universitas Muhammadiyah Prof Dr. HAMKA (UHAMKA), Jalan Limau II/1, Kebayoran Baru, Jakarta Selatan, DKI Jakarta 12130, Indonesia.
| | - Rita Damayanti
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Iwan Ariawan
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Fitra Yelda
- Center for Health Research, Universitas Indonesia, Depok, Indonesia
| | - Sarah Harlan
- John Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | | | - Douglas Storey
- John Hopkins University Center for Communication Programs, Baltimore, MD, USA
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Standeven LR, McEvoy KO, Osborne LM. Progesterone, reproduction, and psychiatric illness. Best Pract Res Clin Obstet Gynaecol 2020; 69:108-126. [PMID: 32723604 DOI: 10.1016/j.bpobgyn.2020.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 12/26/2022]
Abstract
Mood and anxiety disorders are vastly overrepresented in women, and one important contributor to these differences is the fluctuation in sex steroids in women during the reproductive years. Considerable evidence supports a role for abnormal sensitivity to these hormonal fluctuations for some women, who develop mood symptoms associated with reproductive transitions. This chapter presents evidence of the role of endogenous progesterone and its metabolites in such mood symptoms, and then goes on to cover the evidence concerning exogenous progesterone's effects on mood. Overall, the literature does not support an association between exogenous progesterone and negative mood in the general population, but does indicate that subset of women may be vulnerable to such effects. Research is lacking on women with psychiatric illness.
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Affiliation(s)
- Lindsay R Standeven
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Lauren M Osborne
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Wongwananuruk T, Panichyawat N, Panchalee T, Jirakittidul P, Angsuwathana S, Sirimai K, Thamkhantho M, Chiravacharadej G. Comparison of change in body weight between contraception containing 30-μg ethinylestradiol/2-mg chlormadinone acetate or 30-μg ethinylestradiol/3-mg drospirenone: a randomised controlled trial. EUR J CONTRACEP REPR 2019; 25:43-48. [PMID: 31756117 DOI: 10.1080/13625187.2019.1688290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The aim of this study was to compare changes in body weight in women using a combined oral contraceptive (COC) consisting of 30-μg ethinylestradiol (EE) and 2-mg chlormadinone acetate (CMA) or a COC consisting of 30-μg EE and 3-mg drospirenone (DRSP).Methods: This randomised double-blind controlled trial (ClinicalTrials.gov NCT01608698) was conducted at a university hospital-based clinic in Thailand between June 2012 and September 2015. A total of 102 women were enrolled in the study, 99 of whom were randomised to EE/CMA (n = 45) or EE/DRSP (n = 54). Each participant was treated for six cycles. Body weight and other parameters as well as side effects were recorded at baseline and at the end of the third and sixth cycles of treatment.Results: A significant difference was observed in mean body weight change between the EE/CMA and EE/DRSP groups from both baseline to third cycle (0.51 ± 1.36 kg vs -0.43 ± 1.56 kg; p = .003) and baseline to sixth cycle (1.00 ± 1.84 kg vs -0.20 ± 2.23 kg; p = .013). The mean difference in body mass index and waist circumference had a similar trend to that of the mean difference in body weight. There was no significant difference in side effects between groups.Conclusion: A COC containing 30-µg EE/3-mg DRSP tended to confer a significantly more favourable change in body weight over a 6-month period compared with a COC containing 30-µg EE/2-mg CMA, which was associated with an increase in body weight.
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Affiliation(s)
- Thanyarat Wongwananuruk
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nalinee Panichyawat
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tachjaree Panchalee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Preeyaporn Jirakittidul
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Angsuwathana
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Korakot Sirimai
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Manopchai Thamkhantho
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gessuda Chiravacharadej
- Family Planning and Reproductive Health Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Lewis CA, Kimmig ACS, Zsido RG, Jank A, Derntl B, Sacher J. Effects of Hormonal Contraceptives on Mood: A Focus on Emotion Recognition and Reactivity, Reward Processing, and Stress Response. Curr Psychiatry Rep 2019; 21:115. [PMID: 31701260 PMCID: PMC6838021 DOI: 10.1007/s11920-019-1095-z] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We review recent research investigating the relationship of hormonal contraceptives and mood with a focus on relevant underlying mechanisms, such as emotion recognition and reactivity, reward processing, and stress response. RECENT FINDINGS Adverse effects of hormonal contraceptives (HCs) on mood seem most consistent in women with a history of depressive symptoms and/or previous negative experience with HC-intake. Current evidence supports a negativity bias in emotion recognition and reactivity in HC-users, although inconsistent to some extent. Some data, however, do indicate a trend towards a blunted reward response and a potential dysregulation of the stress response in some HC-users. HC-effects on psychological and neurophysiological mechanisms underlying mood are likely context-dependent. We provide suggestions on how to address some of the contributing factors to this variability in future studies, such as HC-dose, timing, administration-mode, and individual risk. A better understanding of how and when HCs affect mood is critical to provide adequate contraceptive choices to women worldwide.
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Affiliation(s)
- Carolin A Lewis
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103, Leipzig, Germany.
- International Max Planck Research School on Neuroscience of Communication: Function, Structure, and Plasticity, Leipzig, Germany.
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr, 14, 72076, Tuebingen, Germany.
| | - Ann-Christin S Kimmig
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr, 14, 72076, Tuebingen, Germany
- International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tuebingen, Tuebingen, Germany
| | - Rachel G Zsido
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103, Leipzig, Germany
- International Max Planck Research School on Neuroscience of Communication: Function, Structure, and Plasticity, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Alexander Jank
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Calwerstr, 14, 72076, Tuebingen, Germany
- Werner Reichardt Center for Integrative Neuroscience, University of Tuebingen, Tuebingen, Germany
- LEAD Research School and Graduate Network, University of Tuebingen, Tuebingen, Germany
| | - Julia Sacher
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1A, 04103, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University of Leipzig, Leipzig, Germany
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Hognert H, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Milsom I, Lidegaard Ø, Lindh I. Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries. BMJ Open 2018; 8:e022473. [PMID: 30381312 PMCID: PMC6224744 DOI: 10.1136/bmjopen-2018-022473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/10/2018] [Accepted: 09/14/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Compare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between countries. DESIGN Ecological study using national registry data concerning births and abortions among all women aged 15-19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008-2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008-2015 were obtained from national databases in Denmark, Norway and Sweden. SETTING Denmark, Finland, Iceland, Norway and Sweden. PARTICIPANTS Women 15-19 years old in all Nordic countries (749 709) and 13-19 years old in Denmark, Norway and Sweden (815 044). RESULTS Both annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15-19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18-19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden. CONCLUSIONS Birth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers.
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Affiliation(s)
- Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Kristina Gemzell-Danielsson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki, University Hospital, Helsinki, Finland
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics & Gynaecology, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, SE-41685 Gothenburg, Sweden
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Podolskyi V, Gemzell-Danielsson K, Marions L. Contraceptive experience and perception, a survey among Ukrainian women. BMC WOMENS HEALTH 2018; 18:159. [PMID: 30268130 PMCID: PMC6162952 DOI: 10.1186/s12905-018-0651-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 09/18/2018] [Indexed: 11/18/2022]
Abstract
Background Abortion rate in Ukraine is high and the use of effective contraceptive methods is low. Aiming to explore women’s knowledge and attitudes towards modern contraceptive methods, we performed a survey among women with a recent pregnancy. Methods A convenience sample of 500 women who had an abortion or a delivery (250 women post abortion and 250 women post partum) in Kiev, Ukraine was chosen to participate in the study. A self-administered questionnaire which included questions regarding demographics, plans for future pregnancy, and contraceptive usage, knowledge and the main barriers to contraceptive uptake was distributed. Results Most women in our study expressed a wish to postpone or refrain from future pregnancies after the current abortion or delivery. The experience of and the knowledge regarding long acting contraception (LARC) such as intrauterine contraception (IUC) and implants were however low. Barrier methods and oral contraceptives were the most commonly used methods while only a few women had used IUC. Conclusion Since most of the respondents did not want a pregnancy in the near future, the findings from this study thus indicate a low uptake for effective and acceptable contraceptive methods and especially LARC methods. Increasing the availability of LARC methods as well as adequate and updated information from providers are essential to reduce the rate of unplanned pregnancy and abortion among Ukrainian women.
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Affiliation(s)
- Volodymyr Podolskyi
- Institute of Pediatrics, Obstetrics and Gynecology of Ukraine, Kiev, Ukraine. .,Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Lena Marions
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Bengtsdotter H, Lundin C, Gemzell Danielsson K, Bixo M, Baumgart J, Marions L, Brynhildsen J, Malmborg A, Lindh I, Sundström Poromaa I. Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use. EUR J CONTRACEP REPR 2018; 23:45-51. [DOI: 10.1080/13625187.2017.1422239] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hanna Bengtsdotter
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - Cecilia Lundin
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Kristina Gemzell Danielsson
- Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Bixo
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Juliane Baumgart
- Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Agota Malmborg
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hognert H, Skjeldestad FE, Gemzell-Danielsson K, Heikinheimo O, Milsom I, Lidegaard Ø, Lindh I. High birth rates despite easy access to contraception and abortion: a cross-sectional study. Acta Obstet Gynecol Scand 2017; 96:1414-1422. [DOI: 10.1111/aogs.13232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Helena Hognert
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Finn E. Skjeldestad
- Research Group Epidemiology of Chronic Diseases; Department of Community Medicine; Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Ian Milsom
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Øjvind Lidegaard
- Department of Obstetrics & Gynecology; Faculty of Health Sciences; Rigshospitalet University Hospital; University of Copenhagen; Copenhagen Denmark
| | - Ingela Lindh
- Department of Obstetrics and Gynecology; Sahlgrenska Academy at Gothenburg University; Sahlgrenska University Hospital; Gothenburg Sweden
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Lindh I, Hognert H, Milsom I. The changing pattern of contraceptive use and pregnancies in four generations of young women. Acta Obstet Gynecol Scand 2017; 95:1264-1272. [PMID: 27538740 DOI: 10.1111/aogs.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/13/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe contraceptive use and pregnancies and their relationship to socio-economic status (SES) in four generations of young Swedish women. MATERIAL AND METHODS Questionnaires regarding contraceptive use and pregnancies were sent to random samples of 19-year-old women in 1981, 1991, 2001 and 2011 (n = 4732). RESULTS Current contraceptive use was higher in 2001 (78%) (p < 0.01) and 2011 (69%) (p < 0.05) compared with 1981 (60%) and 1991 (62%). Combined hormonal contraception (CHC) was the most common form of contraception throughout (p < 0.0001). The use of long-acting reversible contraception (LARC = implants, intrauterine contraception) and progestogen-only pills increased over time (p < 0.01). Mental side effects as a reason for CHC cessation increased over time and was the most common reason for cessation of CHC in 2011 (p < 0.001). Contraceptive use was lower in women from low SES areas (p < 0.05) in 2011. The percentage of young women who had been pregnant at ≤19 years of age was lower (p < 0.05) in the assessment from 2001 (7%) than in that in 1991 (13%) and 2011 (12%). The proportion of teenage mothers decreased from 4.4% (1981) to 1.6% (2011) (p < 0.01). More women had been pregnant at ≤19 years of age in low SES areas than in middle and high SES areas (p < 0.05). CONCLUSIONS The lowest pregnancy rate was in the cohort with the highest contraceptive use. Term pregnancies declined over time. A greater number of pregnancies in low SES areas and a change towards lower contraceptive use in low SES areas was recorded in 2011.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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16
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Lundin C, Danielsson KG, Bixo M, Moby L, Bengtsdotter H, Jawad I, Marions L, Brynhildsen J, Malmborg A, Lindh I, Sundström Poromaa I. Combined oral contraceptive use is associated with both improvement and worsening of mood in the different phases of the treatment cycle-A double-blind, placebo-controlled randomized trial. Psychoneuroendocrinology 2017; 76:135-143. [PMID: 27923181 DOI: 10.1016/j.psyneuen.2016.11.033] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Ever since the introduction of combined oral contraception (COC), one of the major reasons for discontinuing the pill use has been mood-related side effects. Moreover, women who discontinue the pill turn to less effective methods whereby the probability of an unintended conception increases. Approximately 4-10% of COC users complain of depressed mood, irritability or increased anxiety, but drug-related causality has been difficult to prove. Given the lack of randomized controlled trials in this area, we aimed to prospectively estimate the severity of adverse mood in COC users that would be as representative of general users as possible. METHODS This investigator-initiated, multi-center, randomized, double-blinded, placebo-controlled study included 202 healthy women. Women were randomized to a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo for three treatment cycles. Main outcome measure was the Daily Record of Severity of Problems (DRSP), which was filled out daily during one baseline cycle and the final treatment cycle. RESULTS Results from 84 women in the COC group and 94 women in the placebo group were analysed. COC use was associated with small, but statistically significant, increases in mean anxiety (0.22; 95% CI: 0.07-0.37, p=0.003), irritability (0.23; 95% CI: 0.07-0.38, p=0.012), and mood swings scores (0.15; 95% CI: 0.00-0.31, p=0.047) during the intermenstrual phase, but a significant premenstrual improvement in depression (-0.33; 95% CI: -0.62 to -0.05, p=0.049). Secondary analyses showed that women with previous adverse hormonal contraceptive experience reported significantly greater mood worsening in the intermenstrual phase in comparison with healthy women, p<0.05. The proportion of women who reported a clinically relevant mood deterioration did not differ between those allocated to COC (24.1%) or placebo (17.0%), p=0.262. CONCLUSION COC use is associated with small but statistically significant mood side effects in the intermenstrual phase. These findings are driven by a subgroup of women who clearly suffer from COC-related side effects. However, positive mood effects are noted in the premenstrual phase and the proportion of women with clinically relevant mood worsening did not differ between treatment groups.
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Affiliation(s)
- Cecilia Lundin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Marie Bixo
- Department of Clinical Health, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Lena Moby
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Bengtsdotter
- Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Izabella Jawad
- Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Lena Marions
- Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Agota Malmborg
- Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
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Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M, Hirschberg AL. Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2016; 101:4046-4053. [PMID: 27525531 DOI: 10.1210/jc.2016-2032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT There is a lack of knowledge about how oral contraceptives may affect sexual function. OBJECTIVE To determine whether there is a causal effect of oral contraceptives on sexuality. We hypothesized that a widely used pill impairs sexuality. DESIGN A double-blind, randomized, placebo-controlled trial. Enrollment began in February 2012 and was completed in August 2015. SETTING Karolinska University Hospital, Stockholm, Sweden. PARTICIPANTS A total of 340 healthy women, aged 18-35 years, were randomized to treatment, and 332 completed the study. INTERVENTIONS A combined oral contraceptive (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment. MAIN OUTCOME MEASURES The primary outcome was the aggregate score on the Profile of Female Sexual Function (PFSF). Secondary outcomes were the seven domains of the PFSF, the Sexual Activity Log, and the Personal Distress Scale. RESULTS Overall sexual function was similar in women in the oral contraceptive and placebo groups. The PFSF domains desire (-4.4; 95% confidence interval [CI], -8.49 to -0.38; P = .032), arousal (-5.1; 95% CI, -9.63 to -0.48; P = .030), and pleasure (-5.1; 95% CI, -9.97 to -0.32; P = .036) were significantly reduced in comparison to placebo, whereas orgasm, concern, responsiveness, and self-image were similar between groups. The mean frequency of satisfying sexual episodes and personal distress were also similar between groups. CONCLUSIONS This study shows no negative impact of a levonorgestrel-containing oral contraceptive on overall sexual function, although three of seven sexual function domains were adversely affected.
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Affiliation(s)
- Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Anna Dreber
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Eva Ranehill
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Liselott Blomberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Fernand Labrie
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Bo von Schoultz
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Magnus Johannesson
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Angelica Lindén Hirschberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
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Alvarez-Bruned L, Garcia-Continente X, Gotsens M, Pérez A, Pérez G. Trends in Inequalities in the Use of Condom by Urban Teenagers in Spain. J Urban Health 2015; 92:1065-80. [PMID: 26373424 PMCID: PMC4675735 DOI: 10.1007/s11524-015-9985-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period.
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Affiliation(s)
- Laia Alvarez-Bruned
- Faculty of Health and Life Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Xavier Garcia-Continente
- Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain.,Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research), Barcelona, Spain
| | - Mercè Gotsens
- Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Anna Pérez
- Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research), Barcelona, Spain
| | - Gloria Pérez
- Faculty of Health and Life Sciences, University Pompeu Fabra, Barcelona, Spain. .,Health Information System Service, Barcelona Agency of Public Health, Plaça Lesseps, 1, 08023, Barcelona, Spain. .,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau) (Institute of Biomedical Research), Barcelona, Spain.
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Malmborg A, Persson E, Brynhildsen J, Hammar M. Hormonal contraception and sexual desire: A questionnaire-based study of young Swedish women. EUR J CONTRACEP REPR 2015; 21:158-67. [PMID: 26406399 DOI: 10.3109/13625187.2015.1079609] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of the study was to determine whether a decrease in sexual desire is more prevalent among women using hormonal contraception than among women using hormone-free contraception, and whether a decrease increases the risk of changing to another contraceptive method. METHODS A validated questionnaire was posted to 3740 women (aged 22, 25 or 28 years) living in Sweden. Descriptive statistics were used to present the results; differences between groups were tested using χ(2) analyses. A multiple logistic regression model was used for analysis of possible confounders. RESULTS The response rate was 50%. The majority (81%) of respondents used some kind of contraception, and 88% were generally satisfied with the method used. Regardless of the type of method, 27% of hormonal contraceptive users reported a decrease in sexual desire that they attributed to their use of hormonal contraception, whereas only 12% of women using hormone-free contraception reported a decrease in sexual desire (p<0.01). This twofold risk of a decrease in sexual desire was shown in the multiple regression analysis to be independent of age group, depression, BMI, educational level and parity. However, having a partner was found to be a factor of equal importance: women with partners experienced reduced desire twice as often as women without partners. The observed odds ratio for planning to stop hormonal contraception or to change to a different type due to reduced desire was 8.16 (95% confidence interval 6.65-10.1) among women who had had the same experience during a previous period of hormonal contraceptive use. CONCLUSIONS Women using hormonal contraception were more likely to experience reduced sexual desire compared with women using hormone-free contraception. Experiencing reduced desire was a strong predictive factor for women to change contraceptive method.
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Affiliation(s)
- Agota Malmborg
- a Obstetrics and Gynecology, Department of Clinical and Experimental Medicine , Faculty of Health Sciences, Linköping University , Linköping , Sweden
| | - Elin Persson
- a Obstetrics and Gynecology, Department of Clinical and Experimental Medicine , Faculty of Health Sciences, Linköping University , Linköping , Sweden
| | - Jan Brynhildsen
- a Obstetrics and Gynecology, Department of Clinical and Experimental Medicine , Faculty of Health Sciences, Linköping University , Linköping , Sweden
| | - Mats Hammar
- a Obstetrics and Gynecology, Department of Clinical and Experimental Medicine , Faculty of Health Sciences, Linköping University , Linköping , Sweden
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Brynhildsen J. Combined hormonal contraceptives: prescribing patterns, compliance, and benefits versus risks. Ther Adv Drug Saf 2014; 5:201-13. [PMID: 25360241 DOI: 10.1177/2042098614548857] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Combined hormonal contraceptives [combined oral contraceptives (COCs)] have been available for over 50 years and the impact of this invention may not be overestimated. Today over 100 million women are current users and in Western Europe and the United States approximately 80% of women of fertile ages can be considered as ever-users. Over the years several drawbacks have been identified and media alarms on risks are frequently presented, resulting in suboptimal compliance and low compliance and continuation rates. Poor compliance and discontinuation is a big problem and is not generally identified by prescribers. During ideal use COCs offer very good protection against unwanted pregnancies, however there is a big problem with compliance and continuation and thus the 'real-life' efficacy is much lower. Reasons for poor compliance include side effects and fear of side effects and it is crucial that the prescriber gives the individual woman thorough and balanced information on the benefits and risks. Most well known is the increased risk of venous thromboembolism, but also an elevated risk of arterial thrombosis and several types of cancer has been reported. The risk estimates are low but according to the large number of users a substantial number of extra cases will occur. However, use of COCs also offers several additional health benefits with significant impact on morbidity and quality of life. COC use is associated with a substantial decrease in the risk of ovarian cancer, endometrial cancer and colorectal cancer. Moreover, COCs are a major option of treatment for women suffering from heavy menstrual bleeding and dysmenorrhea as well as hirsutism and acne vulgaris. The net effect of the additional health effects of COC- use may very well be positive, i.e. a slight increase in life expectancy.
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Affiliation(s)
- Jan Brynhildsen
- Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, SE-58185, Sweden
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Shahnazi M, Farshbaf Khalili A, Ranjbar Kochaksaraei F, Asghari Jafarabadi M, Gaza Banoi K, Nahaee J, Bayati Payan S. A comparison of second and third generations combined oral contraceptive pills' effect on mood. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e13628. [PMID: 25389478 PMCID: PMC4222004 DOI: 10.5812/ircmj.13628] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 01/20/2014] [Accepted: 06/14/2014] [Indexed: 11/20/2022]
Abstract
Background: Most women taking combined oral contraceptives (COCs) are satisfied with their contraceptive method. However, one of the most common reasons reported for discontinuation of combined oral contraceptives (COCs) is mood deterioration. Objectives: This study aimed to compare effects of the second and third generation oral contraceptive pills on the mood of reproductive women. Materials and Methods: This randomized, double-blind, controlled clinical trial was conducted in reproductive women at health centers in Tehran, Iran. Participants were randomized into the second and third generation oral contraceptive groups. Positive and negative moods were recorded using positive affect, negative affect scale (PANAS) tools at the end the second and fourth months of the study. Data analysis was carried out using ANOVA and P Values < 0.05 was considered significant. Results: Statistically significant difference was seen in positive and negative mood changes in women receiving contraceptive pills. The second generation oral contraceptive pills resulted in a decrease in positive mood (95% CI: 43.39 to 38.32 in second month and 43.39 to 26.05 in four month) and increase in negative mood (95% CI: 14.23 to 22.04 in second month and 14.23 to 32.26 in four month - P < 0.001), but the third generation led to an increase in positive mood (95% CI: 22.42 to 25.60 in second month and 22.42 to 33.87 in four month) and decrease in negative mood (95% CI: 36.78 to 31.97 in second month and 36.78 to 22.65 in four month - P < 0.001). Conclusions: Third generation combined oral contraceptive pills have a better effect on mood in women in reproductive ages than the second generation pills. It can be recommended as a proper combined oral contraceptive in Iran.
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Affiliation(s)
- Mahnaz Shahnazi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Azizeh Farshbaf Khalili
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | | | - Mohammad Asghari Jafarabadi
- Department of Biochemistry, Nutrition Therapy, Community Nutrition, School of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Kamal Gaza Banoi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Jila Nahaee
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Somayeh Bayati Payan
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Somayeh Bayati Payan, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-2177956775, E-mail:
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Josefsson A, Wiréhn AB, Lindberg M, Foldemo A, Brynhildsen J. Continuation rates of oral hormonal contraceptives in a cohort of first-time users: a population-based registry study, Sweden 2005-2010. BMJ Open 2013; 3:e003401. [PMID: 24141970 PMCID: PMC3808784 DOI: 10.1136/bmjopen-2013-003401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/03/2013] [Accepted: 09/24/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate if continuation rates in first-time users of oral hormonal contraceptives differed between different formulations and to measure if the rates were related to the prescribing categories, that is, physicians and midwives. DESIGN A longitudinal national population-based registry study. SETTING The Swedish prescribed drug register. PARTICIPANTS All women born between 1977 and 1994 defined as first-time users of hormonal contraceptives from 2007 to 2009 (n=226 211). MAIN OUTCOME MEASURES A tendency to switch the type of hormonal contraceptive within 6 months use and repeated dispensation identical to the first were estimated as percentages and relative risks (RRs). Physicians' and midwives' prescription patterns concerning the women's continuation rates of oral hormonal contraceptive type. RESULTS In Sweden, there were 782 375 women born between 1977 and 1994 at the time of the study. Of these, 226 211 women were identified as first-time users of hormonal contraceptives. Ethinylestradiol+levonorgestrel, desogestrel-only and ethinylestradiol+drospirenone were the hormonal contraceptives most commonly dispensed to first-time users at rates of 43.3%, 24.4% and 11.1%, respectively. The overall rate of switching contraceptive types in the first 6 months was 11.3%, which was highest for desogestrel-only (14.3%) and lowest for ethinylestradiol+drospirenone (6.6%). The switching rate for all three products was highest in the 16-year to 19-year age group. Having a repeated dispensation identical to the initial dispensation was highest for users of ethinylestradiol either combined with levonorgestrel or drospirenone, 81.4% and 81.2%, respectively, whereas this rate for the initial desogestrel-only users was 71.5%. The RR of switching of contraceptive type within the first 6 months was 1.35 (95% CI 1.32 to 1.39) for desogestrel-only and 0.63 (0.59 to 0.66) for ethinylestradiol+drospirenone compared with ethinylestradiol+levonorgestrel as the reference category. There were no differences in the women's continuation rates depending on the prescriber categories. CONCLUSIONS Desogestrel-only users conferred the highest switcher rate to another hormonal contraceptive within a 6-month period. Users of ethinylestradiol+levonorgestrel were more prone to switch to another product within 6 months than women using ethinylestradiol+drospirenone. These findings may be of clinical importance when tailoring hormonal contraceptives on an individual basis.
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Affiliation(s)
- Ann Josefsson
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
| | - Ann-Britt Wiréhn
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping, Sweden
| | - Malou Lindberg
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping, Sweden
- Department of Medical and Health Sciences, Primary Care, Linköping University, Linköping, Sweden
| | - Anniqa Foldemo
- Local Health Care Research and Development Unit, County Council in Östergötland, Linköping, Sweden
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Brynhildsen
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- Department of Obstetrics and Gynaecology in Linköping, County Council of Östergötland, Linköping, Sweden
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Gingnell M, Engman J, Frick A, Moby L, Wikström J, Fredrikson M, Sundström-Poromaa I. Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill--a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive. Psychoneuroendocrinology 2013; 38:1133-44. [PMID: 23219471 DOI: 10.1016/j.psyneuen.2012.11.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/02/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Most women on combined oral contraceptives (COC) report high levels of satisfaction, but 4-10% complain of adverse mood effects. The aim of this randomized, double-blinded, placebo-controlled trial was to investigate if COC use would induce more pronounced mood symptoms than placebo in women with previous history of COC-induced adverse mood. A second aim was to determine if COC use is associated with changes in brain reactivity in regions previously associated with emotion processing. METHODS Thirty-four women with previous experience of mood deterioration during COC use were randomized to one treatment cycle with a levonorgestrel-containing COC or placebo. An emotional face matching task (vs. geometrical shapes) was administered during functional magnetic resonance imaging (fMRI) prior to and during the COC treatment cycle. Throughout the trial, women recorded daily symptom ratings on the Cyclicity Diagnoser (CD) scale. RESULTS During the last week of the treatment cycle COC users had higher scores of depressed mood, mood swings, and fatigue than placebo users. COC users also had lower emotion-induced reactivity in the left insula, left middle frontal gyrus, and bilateral inferior frontal gyri as compared to placebo users. In comparison with their pretreatment cycle, the COC group had decreased emotion-induced reactivity in the bilateral inferior frontal gyri, whereas placebo users had decreased reactivity in the right amygdala. CONCLUSION COC use in women who previously had experienced emotional side effects resulted in mood deterioration, and COC use was also accompanied by changes in emotional brain reactivity. These findings are of relevance for the understanding of how combined oral contraceptives may influence mood. Placebo-controlled fMRI studies in COC sensitive women could be of relevance for future testing of adverse mood effects in new oral contraceptives.
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Affiliation(s)
- Malin Gingnell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Lindh I, Milsom I. The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study. Hum Reprod 2013; 28:1953-60. [DOI: 10.1093/humrep/det101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lindh I, Ellström AA, Milsom I. The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. Hum Reprod 2012; 27:676-82. [PMID: 22252090 DOI: 10.1093/humrep/der417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Combined oral contraceptives (COCs) are widely advocated as treatment for primary dysmenorrhoea, but their efficacy has been questioned in a Cochrane review. The aim of this study was to evaluate COCs and the influence of age on the severity of dysmenorrhoea. METHODS Postal questionnaires regarding weight/height, contraception, pregnancy history and other reproductive health factors were sent to random samples of 19-year-old women born in 1962 (n = 656), 1972 (n = 780) and 1982 (n = 666) resident in the city of Gothenburg in 1981, 1991 and 2001. The responders were assessed again 5 years later at the age of 24 years. Current severity of dysmenorrhoea was measured on each occasion by a verbal multidimensional scoring system (VMS) and by a visual analogue scale (VAS). RESULTS The severity of dysmenorrhoea was lower (P< 0.0001) in COC users compared with non-users. In a longitudinal analysis of the severity of dysmenorrhoea, COC use and increasing age, independently of each other, were associated with the severity of dysmenorrhoea (COC use, VMS score: a reduction of 0.3 units/VAS: a reduction of 9 mm, both P< 0.0001; increasing age, VMS score: a reduction of 0.1 units per 5 years, P< 0.0001/VAS: a reduction of 5 mm per 5 years, P< 0.0001). Childbirth also reduced the severity of dysmenorrhoea (VAS, P< 0.01 with a reduction of 7 mm). Women from the 82-cohort reported a greater severity of dysmenorrhoea compared with the 62 and 72 cohorts at both 19 and 24 years of age. CONCLUSIONS In this longitudinal case-control study, COC use and increasing age, independent of each other, reduced the severity of dysmenorrhoea. COC use reduced the severity of dysmenorrhoea more than increasing age and childbirth. There was a trend over time regarding the severity of dysmenorrhoea where women from the 82-cohort reported a greater severity of dysmenorrhoea compared with the 62 and 72 cohorts.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg SE-416 85, Sweden.
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Sköld A, Larsson M. Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2011; 3:43-7. [PMID: 22325801 DOI: 10.1016/j.srhc.2011.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 11/20/2011] [Accepted: 11/25/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice. STUDY DESIGN The design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%. RESULTS The women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women's fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential. CONCLUSIONS 46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.
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Affiliation(s)
- Annelie Sköld
- Department of Women's and Children's Health, Uppsala University, Sweden.
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Gemzell-Danielsson K, Thunell L, Lindeberg M, Tydén T, Marintcheva-Petrova M, Oddens BJ. Comprehensive counseling about combined hormonal contraceptives changes the choice of contraceptive methods: results of the CHOICE program in Sweden. Acta Obstet Gynecol Scand 2011; 90:869-77. [PMID: 21564028 DOI: 10.1111/j.1600-0412.2011.01180.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the influence of counseling on women's contraceptive decisions. DESIGN A cross-sectional multicenter study. SETTING Seventy Swedish family planning clinics. POPULATION Women aged 15-40 years attending for a contraceptive consultation who expressed interest in a combined hormonal contraceptive (CHC) method. METHODS Structured counseling about three CHCs and questionnaires completed after counseling from the healthcare professional. MAIN OUTCOME MEASURES Method originally requested, perceptions of CHC attributes, method chosen and reasons for the choice. RESULTS In all, 173 healthcare professionals and 1,944 women participated. The mean standard deviation (SD) age of the women was 22.6(6.1) years. After structured counseling, a majority of women (56.0%; n=1 069; 95% confidence interval (CI) 53.1-58.9) chose the daily pill, 6.2% (n=118; 95% CI 4.9-7.8) chose the weekly patch, and 22.5% (n=430; 95% CI 20.2-25.1) chose the monthly ring. The weekly patch was chosen more often after counseling (6.2 vs 2.4% before counseling; p<0.0001). The greatest change was in the proportion of women who chose the contraceptive ring after counseling (22.5% vs. 8.5% before counseling; p<0.0001). The proportion of undecided women after counseling was reduced considerably (3.9% vs. 27.8% before counseling). Among the 523 women who were undecided before counseling, 50.6% chose the pill, 10.2% the patch and 24.6% the ring, while 20.9% of women who initially requested the pill changed to another method. CONCLUSIONS Structured counseling facilitated choice of contraceptive method for most women, leading to changes in women's selection of a CHC method.
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Affiliation(s)
- Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden.
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Leval A, Sundström K, Ploner A, Dahlström LA, Widmark C, Sparén P. Assessing perceived risk and STI prevention behavior: a national population-based study with special reference to HPV. PLoS One 2011; 6:e20624. [PMID: 21674050 PMCID: PMC3107227 DOI: 10.1371/journal.pone.0020624] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To better understand trends in sexually transmitted infection (STI) prevention, specifically low prevalence of condom use with temporary partners, the aim of this study was to examine factors associated with condom use and perceptions of STI risk amongst individuals at risk, with the underlying assumption that STI risk perceptions and STI prevention behaviors are correlated. METHODS A national population-based survey on human papillomavirus (HPV) and sexual habits of young adults aged 18-30 was conducted in Sweden in 2007, with 1712 men and 8855 women participating. Regression analyses stratified by gender were performed to measure condom use with temporary partners and STI risk perception. RESULTS Men's condom use was not associated with STI risk perception while women's was. Awareness of and disease severity perceptions were not associated with either condom use or risk perception though education level correlated with condom use. Women's young age at sexual debut was associated with a higher risk of non-condom use later in life (OR 1.95 95% CI: 1.46-2.60). Women with immigrant mothers were less likely to report seldom/never use of condoms with temporary partners compared to women with Swedish-born mothers (OR 0.53 95% CI: 0.37-0.77). Correlates to STI risk perception differ substantially between sexes. Number of reported temporary partners was the only factor associated for both men and women with condom use and STI risk perception. CONCLUSIONS Public health interventions advocating condom use with new partners could consider employing tactics besides those which primarily aim to increase knowledge or self-perceived risk if they are to be more effective in STI reduction. Gender-specific prevention strategies could be effective considering the differences found in this study.
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Affiliation(s)
- Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Lindh I, Ellström AA, Milsom I. The long-term influence of combined oral contraceptives on body weight. Hum Reprod 2011; 26:1917-24. [PMID: 21507999 DOI: 10.1093/humrep/der094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a need to increase our knowledge regarding the influence of combined oral contraceptive (COC) use on individual weight change in the long term. The first aim of this study was to assess the long-term influence of COC's on body weight, and the second aim was to describe body weight increase during the fertile period. METHODS Postal questionnaires regarding weight/height, contraception, reproductive health, smoking and exercise were sent to random samples of 19-year-old women born in 1962 (n= 656) and 1972 (n = 780) resident in the city of Gothenburg, Sweden in 1981 and 1991. The responders were followed longitudinally, and the same women were contacted again every fifth year from 1986-2006 and from 1996-2006, respectively. RESULTS There was no significant difference in weight increase in the women grouped according to use or non-use of COC or duration of COC use. The two cohorts of women were grouped together in a longitudinal analysis and the following factors age, COC use, children, smoking and exercise were included in the model. The only predictor for weight increase was age (P < 0.001), resulting in a gain of 0.45 kg/year. There was no correlation between weight change and COC use or duration of COC use, number of children or exercise. Smokers decreased (P < 0.001) their weight by 1.64 kg per 15 years. Between 19 and 44 years of age, the 62-cohort had successively increased (P < 0.0001) their body weight/BMI by 10.6 kg/3.7. Women from the 72-cohort had a higher (P < 0.05) weight/BMI compared with women of the same age from the 62-cohort. CONCLUSIONS COC use was not found to be a predictor for weight increase in the long term. Body weight/BMI increased by 10.6 kg/3.7 between 19 and 44 years of age in a random sample of Swedish women born in 1962. Women from the 72-cohort had a greater body weight/BMI compared with the 62-cohort.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lindh I, Andersson Ellstrom A, Blohm F, Milsom I. A longitudinal study of contraception and pregnancies in the same women followed for a quarter of a century. Hum Reprod 2010; 25:1415-22. [DOI: 10.1093/humrep/deq095] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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