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Özcan Ö, den Elzen WPJ, Hillebrand JJ, den Heijer M, van Loendersloot LL, Fischer J, Hamer H, de Jonge R, Heijboer AC. The effect of hormonal contraceptive therapy on clinical laboratory parameters: a literature review. Clin Chem Lab Med 2024; 62:18-40. [PMID: 37419659 DOI: 10.1515/cclm-2023-0384] [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: 04/15/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023]
Abstract
Hormonal contraceptives (HC) are widely used among women in reproductive ages. In this review, the effects of HCs on 91 routine chemistry tests, metabolic tests, and tests for liver function, hemostatic system, renal function, hormones, vitamins and minerals were evaluated. Test parameters were differently affected by the dosage, duration, composition of HCs and route of administration. Most studies concerned the effects of combined oral contraceptives (COC) on the metabolic, hemostatic and (sex) steroids test results. Although the majority of the effects were minor, a major increase was seen in angiotensinogen levels (90-375 %) and the concentrations of the binding proteins (SHBG [∼200 %], CBG [∼100 %], TBG [∼90 %], VDBP [∼30 %], and IGFBPs [∼40 %]). Also, there were significant changes in levels of their bound molecules (testosterone, T3, T4, cortisol, vitamin D, IGF1 and GH). Data about the effects of all kinds of HCs on all test results are limited and sometimes inconclusive due to the large variety in HC, administration routes and dosages. Still, it can be concluded that HC use in women mainly stimulates the liver production of binding proteins. All biochemical test results of women using HC should be assessed carefully and unexpected test results should be further evaluated for both methodological and pre-analytical reasons. As HCs change over time, future studies are needed to learn more about the effects of other types, routes and combinations of HCs on clinical chemistry tests.
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Affiliation(s)
- Ömer Özcan
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Wendy P J den Elzen
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jacquelien J Hillebrand
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Martin den Heijer
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laura L van Loendersloot
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johan Fischer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Hamer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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Maaskant A, Scarsi KK, Meijer L, Roubos S, Louwerse AL, Remarque EJ, Langermans JAM, Stammes MA, Bakker J. Long-acting reversible contraception with etonogestrel implants in female macaques ( Macaca mulatta and Macaca fascicularis). Front Vet Sci 2024; 10:1319862. [PMID: 38260208 PMCID: PMC10800480 DOI: 10.3389/fvets.2023.1319862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Contraception is often required for management and population control purposes in group-housed and free-roaming non-human primates. Long-acting reversible contraceptives, including subdermal progestin-releasing implants, are preferred as they eliminate challenges associated with frequent administration. Etonogestrel (ENG)-releasing subdermal implants are reversible and long-acting for a minimum of 3 years, and are commercially available for human use as Implanon® or Nexplanon®. Methods A retrospective analysis was performed detailing the contraceptive effectiveness and reversibility of subdermal placement of one-fourth or one-third of an ENG implant (68 mg/implant) in 129 female rhesus macaques (Macaca mulatta) and 67 cynomolgus macaques (Macaca fascicularis) at the Biomedical Primate Research Centre (Rijswijk, Netherlands). Furthermore, single cross-sectional ENG serum concentrations were measured for 16 rhesus and 10 cynomolgus macaques, and hemoglobin and blood chemistry pre-ENG and at timepoints >0.5, >1.5, and > 2.5 years post-ENG insertion were evaluated for 24 rhesus macaques. Finally, data were obtained using trans-abdominal ultrasound regarding the influence of ENG on uterine volume and endometrial thickness in 14 rhesus and 11 cynomolgus macaques. Results As a contraceptive ENG was in 99.80% (CI 93.50-99.99) and 99.95% (CI 99.95-100) effective in rhesus and cynomolgus macaques, respectively. Prolonged ENG durations of implant use in 14 rhesus macaques (range 3.1-5.0 years) and eight cynomolgus macaques (range 3.2-4.0 years) resulted in no unintended pregnancies. A total of 17 female macaques were allowed to breed after ENG removal, and among them, 14 female macaques (82%) had an uneventful delivery. Serum ENG concentrations with a median ENG duration of 1.2 years (range 0.1-6.0 years) and 1.9 years (range 0.6-4.7 years) resulted in median concentrations of 112 pg./mL (range 0-305 pg./mL) and 310 pg./mL (range 183-382 pg./mL) for rhesus and cynomolgus macaques, respectively. ENG had no clinical effect on hemoglobin and blood chemistry parameters nor on the thickness of the endometrial lining or uterus volume. Conclusion This study indicates that both one-fourth and one-third of the ENG implants are effective, long-acting, reversible, and safe contraceptive to use in macaques.
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Affiliation(s)
- Annemiek Maaskant
- Biomedical Primate Research Centre, Rijswijk, Netherlands
- Department Population Health Sciences, Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Kimberly K. Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lisette Meijer
- Biomedical Primate Research Centre, Rijswijk, Netherlands
| | - Sandra Roubos
- Biomedical Primate Research Centre, Rijswijk, Netherlands
| | | | | | - Jan A. M. Langermans
- Biomedical Primate Research Centre, Rijswijk, Netherlands
- Department Population Health Sciences, Animals in Science and Society, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Jaco Bakker
- Biomedical Primate Research Centre, Rijswijk, Netherlands
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FSRH Guideline (August 2022) Progestogen-only Pills. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:1-75. [PMID: 36316023 DOI: 10.1136/bmjsrh-2022-pop] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Gunardi ER, Surya R, Syafitri I, Pasidri Y. Impact of one-rod levonorgestrel implant on the blood chemistry profile. Sci Rep 2021; 11:20141. [PMID: 34635768 PMCID: PMC8505409 DOI: 10.1038/s41598-021-99801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/01/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to investigate the effect of a one-rod levonorgestrel implant on the blood chemistry profile, including random blood glucose (RBG), haemoglobin (Hb), alanine transferase (ALT), aspartate transferase (AST), and the lipid profile, including total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. This prospective cohort study was conducted at Raden Saleh Clinic, Jakarta, from 2010 to 2012. The implants were inserted subdermally in 30 patients. The subjects were evaluated every 6 month up to 2 years. Bivariate analysis using t-test or Wilcoxon signed rank test was performed for all variables. p < 0.05 was considered a significant value. The Hb, RBG, AST, and lipid profile levels were significantly different before and 6 months after one-rod implant insertion (p < 0.05). However, for 24 months, all of the parameters were still within normal limits and did not differ clinically. One-rod levonorgestrel implant insertion has a minimal effect on all blood chemistry profiles.
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Affiliation(s)
- Eka R Gunardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Raymond Surya
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Inayah Syafitri
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yogi Pasidri
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
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Buyers E, Sass AE, Severn CD, Pyle L, Cree-Green M. Twelve-month Continuation of the Etonogestrel Implant in Adolescents With Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2021; 34:33-39. [PMID: 32919086 DOI: 10.1016/j.jpag.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/22/2020] [Accepted: 08/31/2020] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To identify why adolescents with polycystic ovary syndrome (PCOS) chose the etonogestrel (ENG) contraceptive implant, to determine the 12-month continuation rate, and to characterize factors related to discontinuation. DESIGN, SETTING, AND PARTICIPANTS Retrospective chart review of adolescents seen at a tertiary care children's hospital between July 1, 2008, and August 30, 2019, with PCOS diagnosis confirmed per National Institutes of Health criteria and ≥12-month ENG follow-up. INTERVENTIONS AND MAIN OUTCOME MEASURES Demographic characteristics, reasons for ENG insertion and removal, and information on other hormonal/contraceptive therapies were collected. Patients were categorized as ENG continuers (use ≥12 months) or discontinuers (removal at <12 months), and groups were compared. RESULTS A total of 96 patients met inclusion criteria (age 17.7 ± 2.2 years, body mass index 34.8 ± 8 kg/m2). Reasons for ENG were documented in 74% (51% contraception, 32% ease of use, 15% other, 13% estrogen avoidance). In all, 27% had never been sexually active, and 67% had had prior sexual activity. Treatments prior to ENG placement included 74% combined hormonal contraception, 20% medroxyprogesterone acetate withdrawal, and 17% depot medroxyprogesterone. A total of 77% continued ENG at 12 months. The main reasons for discontinuation were bleeding (41%), concern about weight gain (23%), and mood changes (18%). No preimplantation characteristics were independently predictive of continuation, although 100% of patients with type 2 diabetes (n = 11) continued. Patients who sought additional care, including telephone calls (41% vs 12%, P = .006) and clinic visits (64% vs 20%, P < .001) were more likely to discontinue. CONCLUSIONS The ENG implant was well tolerated in adolescents with PCOS and similar to published 12-month continuation rates.
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Affiliation(s)
- Eliza Buyers
- Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy E Sass
- Division of Adolescent Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cameron D Severn
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Laura Pyle
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Melanie Cree-Green
- Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO; Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO.
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Turner AM, Donelan EA, Kiley JW. Contraceptive Options Following Gestational Diabetes: Current Perspectives. Open Access J Contracept 2019; 10:41-53. [PMID: 31749639 PMCID: PMC6817836 DOI: 10.2147/oajc.s184821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the United States. Along with risk factors related to pregnancy, women with a history of GDM also have an increased risk of developing type 2 diabetes mellitus later in life. These women require special consideration when discussing contraception and other reproductive health issues. GDM carries a category 1 rating in the US Medical Eligibility Criteria for all contraceptive methods, which supports safety of the various methods but does not account for effectiveness. Contraceptive options differ in composition and mechanisms of action, and concerns have been raised about possible effects of contraception on metabolism. Clinical evidence is limited to suggest that hormonal contraception has significantly adverse effects on body weight, lipid, or glucose metabolism. In addition, the majority of evidence does not suggest a relationship between development of type 2 diabetes mellitus and use of hormonal contraception. Data are limited, so it is challenging to make a broad, general recommendation regarding contraception for women with a history of GDM. A woman’s history of GDM should be considered during contraceptive counseling. Discussion should focus on potential medical comorbidities and the implications of GDM on future health, with special consideration of issues including bone health, obesity, cardiovascular disease, and thrombosis risk. Providers must emphasize the importance of reliable, highly effective contraception for women with GDM, to optimize the timing of future pregnancies. This approach to comprehensive counseling will guide optimal decision-making on contraceptive use, lifestyle changes, and planning of subsequent pregnancies.
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Affiliation(s)
- Ashley M Turner
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica W Kiley
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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FSRH Guideline (April 2019) Overweight, Obesity and Contraception. BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-69. [PMID: 31053605 DOI: 10.1136/bmjsrh-2019-ooc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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8
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Mullins ES, Miller RJ, Mullins TLK. Abnormal Uterine Bleeding in Adolescent Women. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Allen S, Barlow E. Long-Acting Reversible Contraception: An Essential Guide for Pediatric Primary Care Providers. Pediatr Clin North Am 2017; 64:359-369. [PMID: 28292451 DOI: 10.1016/j.pcl.2016.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Long-acting reversible contraception (LARC) methods are 20% more effective than traditional contraceptives and are recommended by the American Academy of Pediatrics and American College of Obstetrics and Gynecology as first-line contraception for adolescent girls. Large studies show that LARC use reduces unintended pregnancies, increases user satisfaction, and prolongs duration of use. This article prepares the primary care provider (PCP) with knowledge on safety, efficacy, eligibility, confidentiality, anticipatory guidance, how to find a LARC provider, and guidance on common side effects so the PCP can confidently counsel adolescent patients on LARC methods.
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Affiliation(s)
- Suzanne Allen
- Division of Adolescent Medicine, Department of Pediatrics, U Mass Memorial Children's Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA
| | - Erin Barlow
- Division of Adolescent Gynecology, Department of Obstetrics/Gynecology, U Mass Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Division of Pediatric, Department of Pediatrics, U Mass Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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Iltemir Duvan C, Onaran Y, Aktepe Keskin E, Yüce E, Yanık B, Kafali H, Ozturk Turhan N. Effects of the etonogestrel contraceptive implant (Implanon ®) on bone metabolism during lactation: a prospective study. ACTA ACUST UNITED AC 2016; 43:113-117. [PMID: 27908964 DOI: 10.1136/jfprhc-2015-101375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/07/2016] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the effects of the etonogestrel contraceptive implant (Implanon®) on bone metabolism in lactating women using markers for bone formation and resorption. STUDY DESIGN This single-centre, prospective cohort study was conducted in Turgut Ozal University Medical Faculty Obstetrics and Gynecology Department with healthy lactating women aged between 24 and 38 years to compare the effect on bone metabolism of 6 months' use of either the implant or a non-hormonal contraceptive method. The study group (n=25) used an implant and the control group (n=25) used a non-hormonal contraceptive intrauterine device inserted 40 days' postpartum. Bone metabolism differences at the time of insertion and after 6 months were assessed quantitatively by biochemical analysis of serum and urine samples. RESULTS At baseline, serum levels of bone metabolism parameters were similar for the two groups. In the implant group, serum alkaline phosphatase (ALP) levels decreased (p=0.004) and total protein levels increased (p=0.045) at 6 months. In the control group, serum levels of bone metabolism parameters did not change at 6 months compared to baseline. However, serum levels of phosphorus (p=0.013) and ALP (p=0.003) decreased at 6 months compared to baseline. CONCLUSION Six months' postpartum use of Implanon was found to have no deleterious impact on bone turnover in healthy lactating women.
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Affiliation(s)
- Candan Iltemir Duvan
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Yuksel Onaran
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Esra Aktepe Keskin
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Ebru Yüce
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Burcu Yanık
- MD Department of Physical Therapy and Rehabilitation, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Hasan Kafali
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
| | - Nilgun Ozturk Turhan
- MD Department of Obstetrics and Gynecology, Turgut Ozal University School of Medicine, Ankara, Turkey
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Villas-Boas J, Vilodre LC, Malerba H, Pontremoli Salcedo M, Foresti Jiménez M, El Beitune P. Metabolic safety of the etonogestrel contraceptive implant in healthy women over a 3-year period. Eur J Obstet Gynecol Reprod Biol 2016; 202:51-4. [PMID: 27164485 DOI: 10.1016/j.ejogrb.2016.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/17/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To ascertain whether placement of the etonogestrel contraceptive implant induces significant changes in carbohydrate and lipid metabolism, as reflected by metabolic parameters, in healthy women. STUDY DESIGN Prospective cohort study of 213 healthy patients who received etonogestrel implants. Weight, BMI, blood pressure and a comprehensive metabolic profile were assessed at baseline, 1, 2 and 3 years. In 21 of the 213 participants, AUC for glucose levels, fasting insulin levels at baseline and year 3 (immediately before implant removal), HOMA-IR score, and the QUICK index were assessed. Parameters were expressed as median and interquartile range. The Wilcoxon test and ANOVA were used for comparison of measurements after implant placement (significance level p<0.05). RESULTS Median age was 26 years (range, 22-31.5). Results showed a trend toward increase of the variables weight (63.3-66.1) and BMI (24.7-25.7) and a decrease in TC (172-161.5), TG (75-69.5), and LDL (100.5-98.5) (p>0.05). Of the metabolic variables, FBG (85-88) and HDL (53-46) had significant differences (p<0.002). In the subgroup of 21 patients, there were reductions in insulin levels (9.65 vs. 8.4mU/dL, p=0.03), HOMA scores (2.06 vs. 1.75, p=0.02), QUICK index (0.34 vs. 0.35, p=0.03), TC (178 vs. 160mg/dL, p=0.001), HDL (51 vs. 46mg/dL, p=0.009), and LDL (110 vs. 100mg/dL, p=0.035). CONCLUSION These results provide evidence of the metabolic safety of the ENG implant in healthy women over a 3-year period. Indeed, implant placement induces changes consistent with a lower risk of insulin resistance and dyslipidemia.
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Affiliation(s)
- Jaqueline Villas-Boas
- Specialized in Obstetrics and Gynecology, Hysteroscopy, Sexually Transmitted Diseases and Sexual Violence, Porto Alegre, Brazil; Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil
| | - Luiz C Vilodre
- Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil; Obstetrics and Gynecology, Universidade Luterana do Brasil (ULBRA), Porto Alegre, Brazil
| | - Helena Malerba
- Department of Obstetrics and Gynecology, Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil; Public Health Nurse, Porto Alegre, Brazil
| | - Mila Pontremoli Salcedo
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Mirela Foresti Jiménez
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Patrícia El Beitune
- Department of Obstetrics and Gynecology, Post-Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Services of Obstetrics and Gynecology, Complexo Hospitalar Santa Casa de Porto Alegre (ISCMPA), Porto Alegre, Brazil.
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman W, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. Canadian Contraception Consensus (Part 3 of 4): Chapter 8 - Progestin-Only Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:279-300. [PMID: 27106200 DOI: 10.1016/j.jogc.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality. OUTCOMES Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the relative cost and availability of cited contraceptive methods in Canada. EVIDENCE Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis in incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). CHAPTER 8: PROGESTIN-ONLY CONTRACEPTION: Summary Statements Recommendations.
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Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S, Mirosh M, Norman WV, Pymar H, Reid R, Roy G, Varto H, Waddington A, Wagner MS, Whelan AM. Consensus canadien sur la contraception (3e partie de 4) : chapitre 8 – contraception à progestatif seul. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:301-26. [DOI: 10.1016/j.jogc.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The International Federation of Gynecology and Obstetrics and the American Congress of Obstetricians and Gynecologists support the use of new terminology for abnormal uterine bleeding (AUB) to consistently categorize AUB by etiology. The term AUB can be further classified as AUB/heavy menstrual bleeding (HMB) (replacing the term "menorrhagia") or AUB/intermenstrual bleeding (replacing the term "metrorrhagia"). Although many cases of AUB in adolescent women are attributable to immaturity of the hypothalamic-pituitary-ovarian axis, underlying bleeding disorders should be considered in women with AUB/HMB. This article reviews the new terminology for AUB, discusses important relevant features of history and examination, presents the laboratory evaluation of HMB, and describes hormonal (oral contraceptive pills, progestin-only methods, long-acting reversible contraceptives including intrauterine systems), hematologic (tranexamic acid and desmopressin), and surgical management options for AUB/HMB.
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S. Mukherjee M, Coppenrath VA, Dallinga BA. Pharmacologic Management of Types 1 and 2 Diabetes Mellitus and Their Complications in Women of Childbearing Age. Pharmacotherapy 2015; 35:158-74. [DOI: 10.1002/phar.1535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Bree A. Dallinga
- Edward M. Kennedy Community Health Center; Framingham Massachusetts
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Merki-Feld GS, Skouby S, Serfaty D, Lech M, Bitzer J, Crosignani PG, Cagnacci A, Sitruk-Ware R. European Society of Contraception Statement on Contraception in Obese Women. EUR J CONTRACEP REPR 2014; 20:19-28. [DOI: 10.3109/13625187.2014.960561] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Torkzahrani S, Heidari A, Mostafavi-Pour Z, Ahmadi M, Zal F. Amelioration of lipid abnormalities by vitamin therapy in women using oral contraceptives. Clin Exp Reprod Med 2014; 41:15-20. [PMID: 24693493 PMCID: PMC3968252 DOI: 10.5653/cerm.2014.41.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/29/2013] [Accepted: 01/15/2014] [Indexed: 11/06/2022] Open
Abstract
Objective Combined oral contraceptives (COCs) have some adverse effects on the serum lipid profile. Because hyperlipidemia is one of the risk factors in cardiovascular diseases, lipid abnormalities should be evaluated in women consuming COCs. Vitamins E and C are known to have beneficial effects on serum lipid profiles. Therefore, in this study, we evaluated the effects of vitamins E and C on serum lipids in women using COCs. Methods The study compared changes in lipid parameters with and without vitamin therapy in women consuming COCs compared to those of a control group (40 non-contraceptive users or NCU) for 4 weeks. Total cholesterol and triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels along with HDL/LDL ratios were measured for all participants. Results COC users experienced significantly higher increases in the levels of triglycerides and LDL than non-users (p<0.05). However, no significant differences were noted in the total cholesterol and HDL levels. In the treated COC group receiving vitamins E and C, the HDL level and the HDL/LDL ratio increased and the LDL and triglycerides levels decreased significantly compared with those of the other groups. Conclusion The results of our study indicate that supplementation with antioxidant vitamins E and C restores a normal lipid profile in COC users.
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Affiliation(s)
- Shahnaz Torkzahrani
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences & Health Services, Tehran, Iran
| | - Afrooz Heidari
- Department of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences & Health Services, Tehran, Iran
| | - Zohreh Mostafavi-Pour
- Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz, Iran. ; Maternal fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Ahmadi
- Department of English Language, School of Paramedical Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zal
- Department of Reproductive Biology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran. ; Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Scala C, Leone Roberti Maggiore U, Remorgida V, Venturini PL, Ferrero S. Drug safety evaluation of desogestrel. Expert Opin Drug Saf 2013; 12:433-44. [DOI: 10.1517/14740338.2013.788147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Tepper NK, Steenland MW, Marchbanks PA, Curtis KM. Laboratory screening prior to initiating contraception: a systematic review. Contraception 2012; 87:645-9. [PMID: 23040133 DOI: 10.1016/j.contraception.2012.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 07/26/2012] [Accepted: 08/07/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Certain contraceptive methods may increase the risk of adverse events for women with certain medical conditions, including some women with diabetes, hyperlipidemia, liver disease, cervical cancer, sexually transmitted infections (STIs) or human immunodeficiency virus (HIV). This review was conducted to evaluate the evidence regarding health outcomes among women with and without laboratory testing to identify certain medical conditions prior to initiating contraceptives. STUDY DESIGN The PubMed database was searched from database inception through April 2012 for all peer-reviewed articles in any language evaluating health outcomes among women who initiated certain contraceptive methods and who had or had not received glucose, lipid, liver enzyme, cervical cytology, STI or HIV screening. RESULTS The systematic review did not identify any relevant direct evidence. CONCLUSIONS While certain methods of hormonal contraception may not be safe for use by some women with diabetes, hyperlipidemia or liver disease, there is little value in screening for these conditions in asymptomatic women prior to initiation of contraceptive methods due to the low prevalence of these conditions among women of reproductive age. Although intrauterine devices (IUDs) and cervical caps should not be initiated in women with cervical cancer, the high rates of cervical screening and low incidence of cervical cancer in the United States make this scenario unlikely. Although some women at risk for, or infected with, STIs or HIV should not undergo IUD insertion, if women have been screened for STIs or HIV according to guidelines, additional screening at the time of IUD insertion is not warranted. Requiring unnecessary laboratory screening prior to initiation of contraceptive methods may impose barriers to contraceptive access, and efforts to remove such barriers are critical in reducing unintended pregnancy.
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Affiliation(s)
- Naomi K Tepper
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Guazzelli CA, de Queiroz FT, Barbieri M, Barreiros FA, Torloni MR, Araujo FF. Metabolic effects of contraceptive implants in adolescents. Contraception 2011; 84:409-12. [DOI: 10.1016/j.contraception.2011.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
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Rodriguez MI, Edelman AB. Safety and efficacy of contraception--Why should the obese woman be any different? Rev Endocr Metab Disord 2011; 12:85-91. [PMID: 21607613 DOI: 10.1007/s11154-011-9181-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The public health impact of obesity and unintended pregnancy is profound with far reaching consequences. Obese women are less likely to use contraception due to a variety of self-induced and systems-based barriers but their risk of becoming pregnant is similar to their normal weight counterparts. However, pregnancy-associated risks for obese women are higher than that of normal weight women and thus, pregnancy generally outweighs the risks of contraceptive use. Adequate counselling to prevent and/or plan for pregnancy is imperative for these women. Research that investigates the relationship between obesity and contraceptive use is urgently needed.
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Affiliation(s)
- Maria I Rodriguez
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR 97239, USA.
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