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Coombs CV, O'Leary TJ, Tang JCY, Fraser WD, Greeves JP. Hormonal contraceptive use, bone density and biochemical markers of bone metabolism in British Army recruits. BMJ Mil Health 2023; 169:9-16. [PMID: 33722817 DOI: 10.1136/bmjmilitary-2020-001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Hormonal contraceptive use might impair bone health and increase the risk of stress fracture by decreasing endogenous oestrogen production, a central regulator of bone metabolism. This cross-sectional study investigated bone density and biochemical markers of bone metabolism in women taking hormonal contraceptives on entry to basic military training. METHODS Forty-five female British Army recruits had biochemical markers of bone metabolism, areal bone mineral density (aBMD) and tibial speed of sound (tSOS) measured at the start of basic military training. Participants were compared by their method of hormonal contraception: no hormonal contraception (NONE), combined contraceptive pill (CP) or depot-medroxyprogesterone acetate (DMPA) (20±2.8 years, 1.64±0.63 m, 61.7±6.2 kg). RESULTS aBMD was not different between groups (p≥0.204), but tSOS was higher in NONE (3%, p=0.014) when compared with DMPA users. Beta C-terminal telopeptide was higher in NONE (45%, p=0.037) and DMPA users (90%, p=0.003) compared with CP users. Procollagen type 1 N-terminal propeptide was higher in DMPA users compared with NONE (43%, p=0.045) and CP users (127%, p=0.001), and higher in NONE compared with CP users (59%, p=0.014). Bone alkaline phosphatase was higher in DMPA users compared with CP users (56%, p=0.044). CONCLUSIONS DMPA use was associated with increased bone turnover and decreased cortical bone integrity of the tibia. Lower cortical bone integrity in DMPA users was possibly mediated by increased intracortical remodelling, but trabecular bone was not affected by contraceptive use.
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Affiliation(s)
| | - T J O'Leary
- Army Health and Performance Research, British Army, Andover, UK
| | - J C Y Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - W D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK.,Departments of Endocrinology and Clinical Biochemistry, Norfolk and Norwich University Hospital, Norwich, UK
| | - J P Greeves
- Army Health and Performance Research, British Army, Andover, UK .,Norwich Medical School, University of East Anglia, Norwich, UK
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2
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Lantzouni E, Grady R. Eating Disorders in Children and Adolescents: A Practical Review and Update for Pediatric Gynecologists. J Pediatr Adolesc Gynecol 2021; 34:281-287. [PMID: 33486085 DOI: 10.1016/j.jpag.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/14/2021] [Indexed: 01/14/2023]
Abstract
Eating disorders (EDs) are common among female adolescents and young adults and can have serious and diverse health consequences. Pediatric gynecology providers have the opportunity to play a vital role in the recognition of EDs in this population. Early medical detection and referral for appropriate evidence-based treatment can lead to better health outcomes for youth. In this article we aim to increase the awareness of the pediatric gynecologist of typical and subtle presentations of EDs, provide guidance for screening, discuss common and serious medical complications, and review treatment considerations for gynecologic issues in patients with EDs.
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Affiliation(s)
- Eleni Lantzouni
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rosheen Grady
- Division of Adolescent Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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Eick C, Klinger-König J, Zylla S, Hannemann A, Budde K, Henning AK, Pietzner M, Nauck M, Völzke H, Grabe HJ, Hertel J. Broad Metabolome Alterations Associated with the Intake of Oral Contraceptives Are Mediated by Cortisol in Premenopausal Women. Metabolites 2021; 11:metabo11040193. [PMID: 33805221 PMCID: PMC8064380 DOI: 10.3390/metabo11040193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
The use of oral contraceptives (OCs) has been associated with elevated blood cortisol concentrations. However, metabolic downstream effects of OC intake are not well described. Here, we aimed to determine if the blood metabolome is associated with the use of OCs and to estimate if these associations might be statistically mediated by serum cortisol concentrations. Plasma metabolites measured with the Biocrates AbsoluteIDQ p180 Kit and serum cortisol concentrations measured by an immunoassay were determined in 391 premenopausal women (116 OC users) participating in two independent cohorts of the Study of Health in Pomerania (SHIP). After correction for multiple testing, 27 metabolites were significantly associated with OC intake in SHIP-TREND (discovery cohort), of which 25 replicated in SHIP-2. Inter alia, associated metabolites included 12 out of 38 phosphatidylcholines with diacyl residue, 7 out of 14 lysophosphatidylcholines and 5 out of 21 amino acids. The associations with phosphatidylcholines were statistically mediated by cortisol, whereas lysophosphatidylcholines showed no mediation effect. The results represent a step toward a better understanding of the metabolic consequences of OC intake. Connecting cortisol with metabolic consequences of OC intake could help to understand the mechanisms underlying adverse effects. The blood metabolome may serve as a biomarker for identifying users at high risk for developing such adverse effects.
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Affiliation(s)
- Clara Eick
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17489 Greifswald, Germany; (C.E.); (H.J.G.); or (J.H.)
| | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17489 Greifswald, Germany; (C.E.); (H.J.G.); or (J.H.)
- Correspondence: ; Tel.: +49-(0)-3834-86-22166
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, D-17489 Greifswald, Germany;
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, D-17489 Greifswald, Germany;
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
| | - Ann Kristin Henning
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany; (S.Z.); (A.H.); (K.B.); (A.K.H.); (M.P.); (M.N.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, D-17489 Greifswald, Germany;
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, D-17489 Greifswald, Germany;
- Institute for Community Medicine, University Medicine Greifswald, D-17489 Greifswald, Germany
| | - Hans J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17489 Greifswald, Germany; (C.E.); (H.J.G.); or (J.H.)
- German Center for Neurodegenerative Disease (DZNE), Site Rostock/Greifswald, D-17489 Greifswald, Germany
| | - Johannes Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17489 Greifswald, Germany; (C.E.); (H.J.G.); or (J.H.)
- School of Medicine, National University of Ireland, H91 CF50 Galway, Ireland
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The Impact of Progestin-only Contraception on Adolescents with Macromastia. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3421. [PMID: 33680669 PMCID: PMC7929442 DOI: 10.1097/gox.0000000000003421] [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: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Progestin-only contraception has become increasingly popular among adolescents. However, patients, parents, and providers share concerns regarding the potential impact that progestin-only contraception may have on breast growth. We sought to explore the impact of progestin-only contraception on breast hypertrophy and symptomatology in adolescents with macromastia.
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Abstract
Adolescence is a critical time for the acquisition of peak bone mass. There are modifiable factors that may influence bone health in an adolescent. For those at risk for bone fragility, initial management includes optimization of calcium and vitamin D, weight-bearing exercise, and maintenance of a normal body weight. In certain scenarios, bisphosphonate treatment is indicated, as is reviewed. How hormonal contraceptives affect bone mineral density is unclear, but in patients with risk factors or known bone fragility, prescribers should consider their skeletal effects. Some conditions, including restrictive eating disorders and primary ovarian insufficiency, warrant long-term monitoring of bone health.
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Golden NH. Bones and Birth Control in Adolescent Girls. J Pediatr Adolesc Gynecol 2020; 33:249-254. [PMID: 31972296 DOI: 10.1016/j.jpag.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022]
Abstract
Peak bone mass acquisition during adolescence is an important determinant of adult bone health. Knowledge about the effects of different contraceptives on peak bone mass acquisition could influence choice of method recommended. This review summarizes normal bone acquisition during adolescence, discusses methods of assessing bone health in this age group, and reviews the effects of different contraceptive options on bone health, both in adults and in adolescents. Based on the evidence, long-acting reversible contraceptives do not appear to affect peak bone mass acquisition or future fracture risk and remain the first-line contraceptive choice for adolescents. Oral contraceptives with doses of ethinyl estradiol greater than 30 μg should be used in preference to lower-dose preparations, and the adverse effects of depo medroxyprogesterone acetate (DMPA) on bone health are reversible on discontinuation of the medication. Concerns about bone health should not prevent use of DMPA in an adolescent who prefers this method.
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Affiliation(s)
- Neville H Golden
- Lucile Packard Children's Hospital, Stanford, Stanford University School of Medicine, Palo Alto, California.
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7
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Hampson E. A brief guide to the menstrual cycle and oral contraceptive use for researchers in behavioral endocrinology. Horm Behav 2020; 119:104655. [PMID: 31843564 DOI: 10.1016/j.yhbeh.2019.104655] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022]
Abstract
There is increasing evidence that reproductive hormones exert regulatory effects in the central nervous system that can influence behavioral, cognitive, perceptual, affective, and motivational processes. These effects occur in adults and post-pubertal individuals, and can be demonstrated in humans as well as laboratory animals. Large changes in 17β-estradiol and progesterone occur over the ovarian cycle (i.e., the menstrual cycle) and afford a way for researchers to explore the central nervous system (CNS) effects of these hormones under natural physiological conditions. Increasingly, oral contraceptives are also being studied, both as another route to understanding the CNS effects of reproductive hormones and also as pharmacological agents in their own right. This mini-review will summarize the basic physiology of the menstrual cycle and essential facts about oral contraceptives to help novice researchers to use both paradigms effectively.
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Affiliation(s)
- Elizabeth Hampson
- Department of Psychology and Graduate Program in Neuroscience, University of Western Ontario, London, ON N6A 5C2, Canada.
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8
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Abstract
Although pregnancy and abortion rates have declined in adolescents, unintended pregnancies remain unacceptably high in this age group. The use of highly effective methods of contraception is one of the pillars of unintended pregnancy prevention and requires a shared decision making process within a rights based framework. Adolescents are eligible to use any method of contraception and long-acting reversible contraceptives, which are “forgettable” and highly effective, may be particularly suited for many adolescents. Contraceptive methods may have additional non-contraceptive benefits that address other needs or concerns of the adolescent. Dual method use should be encouraged among adolescents for the prevention of both unintended pregnancies and sexually transmitted infections. Health care providers have an important role to play in ensuring that adolescents have access to high quality and non-judgmental reproductive health care services and contraceptive methods in adolescent-friendly settings that recognize the unique biopsychosocial needs of the adolescent.
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Affiliation(s)
- Nicole Todd
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Amanda Black
- Department of Obstetrics and Gynecology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, Canada
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Ackerman KE, Singhal V, Slattery M, Eddy KT, Bouxsein ML, Lee H, Klibanski A, Misra M. Effects of Estrogen Replacement on Bone Geometry and Microarchitecture in Adolescent and Young Adult Oligoamenorrheic Athletes: A Randomized Trial. J Bone Miner Res 2020; 35:248-260. [PMID: 31603998 PMCID: PMC7064307 DOI: 10.1002/jbmr.3887] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 02/04/2023]
Abstract
Oligoamenorrheic athletes (OAs) have lower bone mineral density (BMD) and greater impairment of bone microarchitecture, and therefore higher fracture rates compared to eumenorrheic athletes. Although improvements in areal BMD (aBMD; measured by dual-energy X-ray absorptiometry) in OAs have been demonstrated with transdermal estrogen treatment, effects of such treatment on bone microarchitecture are unknown. Here we explore effects of transdermal versus oral estrogen versus no estrogen on bone microarchitecture in OA. Seventy-five OAs (ages 14 to 25 years) were randomized to (i) a 100-μg 17β-estradiol transdermal patch (PATCH) administered continuously with 200 mg cyclic oral micronized progesterone; (ii) a combined 30 μg ethinyl estradiol and 0.15 mg desogestrel pill (PILL); or (iii) no estrogen/progesterone (NONE) and were followed for 12 months. Calcium (≥1200 mg) and vitamin D (800 IU) supplements were provided to all. Bone microarchitecture was assessed using high-resolution peripheral quantitative CT at the distal tibia and radius at baseline and 1 year. At baseline, randomization groups did not differ by age, body mass index, percent body fat, duration of amenorrhea, vitamin D levels, BMD, or bone microarchitecture measurements. After 1 year of treatment, at the distal tibia there were significantly greater increases in total and trabecular volumetric BMD (vBMD), cortical area and thickness, and trabecular number in the PATCH versus PILL groups. Trabecular area decreased significantly in the PATCH group versus the PILL and NONE groups. Less robust differences between groups were seen at the distal radius, where percent change in cortical area and thickness was significantly greater in the PATCH versus PILL and NONE groups, and changes in cortical vBMD were significantly greater in the PATCH versus PILL groups. In conclusion, in young OAs, bone structural parameters show greater improvement after 1 year of treatment with transdermal 17β-estradiol versus ethinyl estradiol-containing pills, particularly at the tibia. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Sports Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Division of Endocrinology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA, USA
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10
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Bachrach LK. Hormonal Contraception and Bone Health in Adolescents. Front Endocrinol (Lausanne) 2020; 11:603. [PMID: 32973688 PMCID: PMC7472551 DOI: 10.3389/fendo.2020.00603] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Hormonal contraception is prescribed commonly to adolescents for myriad indications from pregnancy prevention to treatment for acne, hirsutism or dysmenorrhea. Although use of these hormones generally has no effect or benefits bone health in mature premenopausal women, the same may not be true for adolescents. The teen years are a critical period for acquiring peak bone strength. Sex hormones, growth hormone, and insulin-like growth factors (IGFs) interact to modulate the changes in bone size, geometry, mineral content, and microarchitecture that determine skeletal strength. Combined oral contraceptives (COCs) and intramuscular depo medroxyprogesterone (DMPA) can compromise the expected gains in adolescence by altering estrogen and IGF concentrations. Use of these medications has been associated with slower accrual of bone mineral density (BMD) and increased fracture risk in some studies. Far less is known about the skeletal effects of the newer long acting reversible contraceptives (LARCs). This review takes a critical look at the gaps in current knowledge of the skeletal effects of COCs, DMPA, and LARCs and underscores the need for additional research.
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Rizzo ADCB, Goldberg TBL, Biason TP, Kurokawa CS, Silva CCD, Corrente JE, Nunes HRC. One-year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives. J Pediatr (Rio J) 2019; 95:567-574. [PMID: 29959901 DOI: 10.1016/j.jped.2018.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of two low-dose combined oral contraceptives on bone metabolism in adolescents for one year. METHODS This was a quasi-experimental study. The adolescents were divided into three groups: oral contraceptives 1 (n=42) (20μg EE/150μg desogestrel), oral contraceptives 2 (n=66) (30μg EE/3mg drospirenone), and a control group (n=70). Adolescents underwent anthropometric assessment and densitometry (dual-energy X-ray). Bone age and bone formation markers (osteocalcin and bone alkaline phosphatase) were evaluated. The oral contraceptives users were evaluated again after 12 months. Linear regression analysis was used to indirectly study the effect of each additional year of chronological age on anthropometric and densitometric variables as well as on bone markers in the control group. RESULTS At study entry, no significant differences were observed between the oral contraceptives 1, oral contraceptives 2, and controls in the analyzed variables. Linear regression analysis showed an increase in bone mineral density and bone mineral content for each additional year. There was a significant reduction in bone alkaline phosphatase levels; no significant difference was observed for osteocalcin in control individuals. Comparison of dual-energy X-ray variables at baseline and after one year showed no significant differences in the oral contraceptives 1 or oral contraceptives 2 groups. A significant reduction in bone alkaline phosphatase and osteocalcin levels was observed in both the oral contraceptives 1 and oral contraceptives 2 groups. CONCLUSION Adolescent women gain peak bone mass during this phase of life. Two low-dose combined oral hormonal contraceptives were associated with lower bone gain and lower bone formation markers than in untreated controls.
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Affiliation(s)
- Anapaula da Conceição Bisi Rizzo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil
| | - Tamara Beres Lederer Goldberg
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil.
| | - Talita Poli Biason
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Programa de Pós-graduação em Ginecologia, Obstetrícia e Mastologia, Botucatu, SP, Brazil
| | - Cilmery Suemi Kurokawa
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Pediatria, Centro de Pesquisa Pediátrica Clínica e Experimental, Botucatu, SP, Brazil
| | | | - José Eduardo Corrente
- Universidade Estadual Paulista (UNESP), Instituto de Biociências, Departamento de Estatística, Botucatu, SP, Brazil
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Rizzo ADCB, Goldberg TBL, Biason TP, Kurokawa CS, Silva CCD, Corrente JE, Nunes HRC. One‐year adolescent bone mineral density and bone formation marker changes through the use or lack of use of combined hormonal contraceptives. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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No. 313-Menstrual Suppression in Special Circumstances. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e7-e17. [DOI: 10.1016/j.jogc.2018.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kirkham YA, Ornstein MP, Aggarwal A, McQuillan S. N° 313 - Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:e18-e29. [DOI: 10.1016/j.jogc.2018.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wandresen G, Sgarbi F, Nisihara R. Management of contraceptives and menstrual complaints in patients with Down syndrome. Gynecol Endocrinol 2019; 35:103-108. [PMID: 30324830 DOI: 10.1080/09513590.2018.1501017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Enhanced health care for patients with Down syndrome (DS) results in improved overall quality of life and longer life expectancy. The main gynecologic complaints of patients with DS and their caregivers relate to menstrual cycles, hygiene and reproductive issues. Certain aspects, such as age of menarche, menstrual cycles, internal genitalia, and hormone profile are similar to those observed in the general population. However, individuals with DS may have a higher incidence of other disorders related to menstruation, such as hypothyroidism, epilepsy and use of anticonvulsants. Contraceptive measures for individuals with DS can be used for both contraception and control of menstrual symptoms. The physician must be to make an individualized recommendation aimed at offering the most efficient and least invasive method with the fewest side effects. Among medical options are oral contraceptives, quarterly injectable medroxyprogesterone acetate, oral progesterone, a levonorgestrel-releasing intrauterine system, transdermal patch and vaginal rings. Surgical methods, including hysterectomy, endometrial ablation, or tubal ligation, are rarely considered because they raise ethical and legal questions. This article reviews the literature and basic guidelines to assist physicians who attend adolescent girls and women with DS to provide guidance on the appropriate management of the main gynecologic complaints of this population.
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Affiliation(s)
- Gustavo Wandresen
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
| | - Fernanda Sgarbi
- b Medicine Department , Positivo University , Curitiba , Brazil
| | - Renato Nisihara
- a Post Graduate Program in Gynecology and Obstetrics, Universidade Federal do Paraná , Curitiba , Brazil
- b Medicine Department , Positivo University , Curitiba , Brazil
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17
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Abstract
The female athlete triad is a medical condition observed in physically active females involving three components: 1) low energy availability with or without disordered eating, 2) menstrual dysfunction, and 3) low bone density. An individual does not need to show clinical manifestations of all three components of the female athlete triad simultaneously to be affected by the condition. Consequences of these clinical conditions may not be completely reversible, so prevention, early diagnosis, and intervention are critical. All athletes are at risk of the female athlete triad, regardless of body build or sport. All active females should be assessed for components of the triad and further evaluation should be performed if one or more components are identified. The obstetrician-gynecologist has the opportunity to screen athletes for components of the female athlete triad at comprehensive visits for preventive care. Using the menstrual cycle as a vital sign is a useful tool for identifying athletes at risk of female athlete triad and should be an integral part of the preparticipatory sports physical. The goal of treatment for those diagnosed with female athlete triad is restoration of regular menses as a clinical marker of reestablishment of energy balance and enhancement of bone mineral density. The female athlete triad is a result of energy imbalance; thus, adjusting the energy expenditure and energy availability is the main intervention. Pharmacologic treat-ment may be considered when nonpharmacologic treatment has failed. A team approach involving the patient, obstetrician-gynecologist, sports nutritionist, coaches, parents, and mental health care provider, if indicated, is optimal.
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Suppression menstruelle en présence de circonstances particulières. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:S484-S495. [DOI: 10.1016/j.jogc.2016.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Eating disorders in children and adolescents: what does the gynecologist need to know? Curr Opin Obstet Gynecol 2016; 28:381-92. [DOI: 10.1097/gco.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Beltz AM, Hampson E, Berenbaum SA. Oral contraceptives and cognition: A role for ethinyl estradiol. Horm Behav 2015; 74:209-17. [PMID: 26122296 DOI: 10.1016/j.yhbeh.2015.06.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/22/2015] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Abstract
This article is part of a Special Issue "Estradiol and cognition". Estrogens have been seen to play a role in human cognitive abilities, but questions remain about the cognitive impact of ethinyl estradiol, which is contained in many oral contraceptives (OCs). Inconsistencies in past studies likely reflect small samples and heterogeneous groups of OC users. The aims of the present work were to examine OC effects on sex-typed spatial and verbal abilities by (a) comparing mental rotations and expressional fluency in normally-cycling (NC) women and men to OC users considered as a heterogeneous group and then to homogeneous groups of OC users created by classifying pills according to their active constituents, and (b) determining the relation between synthetic hormone doses in OCs and mental rotations and expressional fluency. Participants were 136 men, 93 NC women, and 148 OC users, including homogeneous monophasic (n = 55) and triphasic (n = 43) OC groups, aged 18 to 30 years. Significant effects of OC use were seen in homogeneous group comparisons but not when OC users were considered as a heterogeneous group. On mental rotations, men outperformed women, and monophasic OC users outperformed NC women. The latter difference may be attributable to estradiol, as ethinyl estradiol was inversely related to spatial ability among OC users and was lower in monophasic than in triphasic users. On expressional fluency, NC women and monophasic OC users outperformed men, and monophasic users outperformed triphasic users. Thus, results show the importance of ethinyl estradiol and of considering pill constituents when studying the cognitive effects of OCs.
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Affiliation(s)
- Adriene M Beltz
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Elizabeth Hampson
- Department of Psychology, University of Western Ontario, London, Ontario N6A 5C2, Canada.
| | - Sheri A Berenbaum
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA; Department of Pediatrics, The Pennsylvania State University, University Park, PA 16802, USA.
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Jackowski SA, Baxter-Jones ADG, McLardy AJ, Pierson RA, Rodgers CD. The associations of exposure to combined hormonal contraceptive use on bone mineral content and areal bone mineral density accrual from adolescence to young adulthood: A longitudinal study. Bone Rep 2015; 5:e333-e341. [PMID: 28580404 PMCID: PMC5440951 DOI: 10.1016/j.bonr.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background The association of long term combined hormone based contraceptives (CHC) use on bone mineral content (BMC) and areal bone mineral density (aBMD) development remains controversial, as it appears that the relationship may be age-dependent. The purpose of this study was to investigate the long-term associations of CHC exposure on the accrual of bone parameters from adolescence into young-adulthood. Methods 110 women (67 exposed to CHC) were drawn from the Pediatric Bone Mineral Accrual Study (PBMAS). Serial measures of total body (TB), lumbar spine (LS) and femoral neck (FN) BMC and aBMD were assessed by DXA (a total of 950 scans) and aligned by biological age (BA, years from peak height velocity [PHV]). Multilevel random effects models were constructed to assess the time dependent associations between annual CHC exposure and the development of bone parameters. Results After BA, height, lean tissue mass, fat mass, calcium and vitamin D intake, and physical activity were controlled, it was observed that those individuals exposed to CHC 6-years post PHV developed significantly less (−0.00986 ± 0.00422 g/cm2) TB aBMD than their non CHC exposed peers. Additionally, there were significant BA by CHC exposure interactions, where CHC exposure 6-years or more post PHV resulted in developing less TB BMC (−4.94 ± 2.41 g), LS BMC (−0.29 ± 0.11 g) and LS aBMD (−0.00307 ± 0.00109 g/cm2). One year after the attainment of PHV, CHC users were predicted to have 1.2% more TB BMC, 3.8% more LS BMC and 1.7% more LS aBMD than non-users. At 9-years post PHV the predicted differences showed that CHC users had 0.9% less TB BMC and 2.7% less LS BMC and 1.6% less LS BMD than those not exposed to CHC. Conclusions CHC may not hinder the development of BMC or aBMD during adolescence; however, exposure 6-years or more after PHV may be detrimental. The effects of combined hormone contraceptive (CHC) exposure on bone mass were assessed. CHC exposure resulted in developing significantly less (− 9.86 ± 4.22 g/cm2) TB aBMD. CHC exposure 6-years after PHV resulted in significantly less BMC and aBMD. CHC may not hinder adolescent bone development, but may be detrimental after growth.
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Affiliation(s)
- Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Ashlee J McLardy
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carol D Rodgers
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Begum RA, Ali L, Takahashi O, Fukui T, Rahman M. Bone mineral density: reference values and correlates for Bangladeshi women aged 16-65 years. J Orthop Sci 2015; 20:522-8. [PMID: 25627245 DOI: 10.1007/s00776-015-0695-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Studies examining the reference values of bone mineral density (BMD) and their patterns at different ages are largely based on data generated from developed countries. The objective of this study was to estimate reference values of BMD, along with their correlates, for women living in urban and suburban areas of Bangladesh. METHODS Dual-energy X-ray absorptiometry scans were performed on 500 women 16-65 years of age. Reference values at the lumbar spine (LS) and femoral neck (FN) were estimated after adjusting for height and weight. In addition, multiple linear regression analysis was used to examine correlates of BMD at the LS and FN. RESULTS Mean BMD was highest at the LS and FN in women 16-19 (1.001-1.007 g/cm(2)) and 16-22 years of age (0.880-0.888 g/cm(2)), respectively, and gradually declined with increasing age thereafter. BMD decreased at an annual rate of 0.0027 g/cm(2) at the LS and 0.0046 g/cm(2) at the FN among women aged 16-45 years. For women 46-65 years of age, the respective figures were 0.0073 and 0.0083 g/cm(2). In both age groups, body weight was positively associated with BMD at both sites, and with height only at the LS. In addition, years of pill use was positively associated with BMD at the LS among women aged 16-45 years. BMD levels at both sites began to decline during the early twenties among Bangladeshi women. CONCLUSIONS Age-specific BMD data generated in this study could be useful for interpreting bone densitometry data among women in Bangladesh and other South Asian countries.
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Affiliation(s)
- Rowshan Ara Begum
- Department of Reproductive and Child Health, Bangladesh University of Health Science, Mirpur, Dhaka, Bangladesh
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Biason TP, Goldberg TBL, Kurokawa CS, Moretto MR, Teixeira AS, Nunes HRDC. Low-dose combined oral contraceptive use is associated with lower bone mineral content variation in adolescents over a 1-year period. BMC Endocr Disord 2015; 15:15. [PMID: 25990414 PMCID: PMC4443632 DOI: 10.1186/s12902-015-0012-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 03/26/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Low-dose combined oral contraceptives (COCs) can interfere with bone mass acquisition during adolescence. This study aimed to evaluate bone mineral density (BMD) and bone mineral content (BMC) in female adolescents taking a standard low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) over a 1-year period and to compare their data with those of healthy adolescents from the same age group not taking COCs. METHODS This was a non-randomized parallel-control study with a 1-year follow-up. Sixty-seven adolescents aged from 12 to 19 years, divided into COC users (n = 41) taking 20 μg ethinylestradiol/150 μg desogestrel and COC non-user controls (n = 26), were evaluated by bone densitometry examinations at baseline and after 12 months. Comparisons between the groups at the study onset were performed using the Mann-Whitney test with the significance level fixed at 5% or p < 0.05. Comparisons between the groups at the study onset and after 12 months were based on variations in the median percentages for bone mass variables. RESULTS The COC users presented with low bone mass acquisition in the lumbar spine, and had BMD and BMC median variations of 2.07% and +1.57%, respectively, between the measurements at baseline and 12 months. The control group had median variations of +12.16% and +16.84% for BMD and BMC, respectively, over the same period. The total body BMD and BMC showed similar evolutions during the study in both groups. Statistical significance (p < 0.05) was seen for the BMC percentage variation between COC users and non-users. CONCLUSIONS Use of a low-dose COC (ethinylestradiol 20 μg/desogestrel 150 μg) was associated with lower bone mass acquisition in adolescents during the study period. TRIAL REGISTRATION Registry Number, RBR-5h9b3c.
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Affiliation(s)
- Talita Poli Biason
- Department of Pediatrics, Adolescent Medicine Discipline, Graduate Program in Gynecology, Obstetrics, and Mastology, Botucatu School of Medicine, São Paulo State University (UNESP), São Paulo, Brazil.
| | - Tamara Beres Lederer Goldberg
- Department of Pediatrics, Adolescent Medicine Discipline, Graduate Program in Gynecology, Obstetrics, and Mastology, Botucatu School of Medicine, São Paulo State University (UNESP), São Paulo, Brazil.
| | - Cilmery Suemi Kurokawa
- Clinical and Experimental Pediatrics Research Center, Department of Pediatrics, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil.
| | - Maria Regina Moretto
- Clinical and Experimental Pediatrics Research Center, Department of Pediatrics, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil.
| | - Altamir Santos Teixeira
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu School of Medicine, São Paulo State University (UNESP), São Paulo, Brazil.
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Fedorenko M, Wagner ML, Wu BY. Survey of risk factors for osteoporosis and osteoprotective behaviors among patients with epilepsy. Epilepsy Behav 2015; 45:217-22. [PMID: 25812937 DOI: 10.1016/j.yebeh.2015.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 12/26/2014] [Accepted: 01/04/2015] [Indexed: 11/19/2022]
Abstract
The prevalence of risk factors for osteoporosis in persons with epilepsy, patients' awareness of their risk, and their engagement in osteoprotective behaviors were assessed in this study. Two hundred and sixty patients with epilepsy (F=51.5%, average age=42) completed a survey tool. Of 106 patients with a dual energy X-ray absorptiometry (DXA) result, 52% had low bone mineral density, and 11% had osteoporosis. The results suggest that the majority of patients with epilepsy do not engage in bone-protective behaviors. Those who have undergone a DXA scan may be more likely to take calcium and vitamin D supplementation compared with those who did not undergo a DXA scan, but they do not engage in other osteoprotective behaviors. Many patients did not accurately report their DXA results, indicating that better patient education is warranted.
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Affiliation(s)
- Marianna Fedorenko
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Mary L Wagner
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA.
| | - Brenda Y Wu
- Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 125 Patterson Street, New Brunswick, NJ 08901, USA.
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Abstract
OBJECTIVE To provide a Canadian consensus document for health care providers with recommendations for menstrual suppression in patients with physical and/or cognitive challenges or those who are undergoing cancer treatment in whom menstruation may have a deleterious effect on their health. OPTIONS This document reviews the options available for menstrual suppression, its specific indications, contraindications, and side effects, both immediate and long-term, and the investigations and monitoring necessary throughout suppression. OUTCOMES Clinicians will be better informed about the options and indications for menstrual suppression in patients with cognitive and/or physical disabilities and patients undergoing chemotherapy, radiation, or other treatments for cancer. EVIDENCE Published literature was retrieved through searches of Medline, EMBASE, OVID, and the Cochrane Library using appropriate controlled vocabulary and key words (heavy menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability, physical disability, learning disability). Results were restricted to systematic reviews, randomized controlled trials, observation studies, and pilot studies. There were no language or date restrictions. Searches were updated on a regular basis and new material was incorporated into the guideline until September 2013. Grey (unpublished) literature was identified through searching 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 evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS There is a need for specific guidelines on menstrual suppression in at-risk populations for health care providers. Recommendations 1. Menstrual suppression and therapeutic amenorrhea should be considered safe and viable options for women who need or want to have fewer or no menses. (II-2A) 2. Menstrual suppression should not be initiated in young women with developmental disabilities until after the onset of menses. (II-2B) 3. Combined hormonal or progesterone-only products can be used in an extended or continuous manner to obtain menstrual suppression. (I-A) 4. Gynaecologic consultation should be considered prior to the initiation of treatment in all premenopausal women at risk for abnormal uterine bleeding from chemotherapy. (II-1A) 5. Leuprolide acetate or combined hormonal contraception should be considered highly effective in preventing abnormal uterine bleeding when initiated prior to cancer treatment in premenopausal women at risk for thrombocytopenia. (II-2A).
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Rashed AN, Hsia Y, Wilton L, Ziller M, Kostev K, Tomlin S. Trends and patterns of hormonal contraceptive prescribing for adolescents in primary care in the U.K. ACTA ACUST UNITED AC 2014; 41:216-22. [PMID: 25398724 DOI: 10.1136/jfprhc-2013-100724] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hormonal contraceptives are the most common method used worldwide by teenagers to prevent unwanted pregnancies. To date there are limited data about such use by teenagers in the UK. This study investigated trends and patterns of hormonal contraceptive prescribing to adolescents aged 12-18 years in UK primary care between 2002 and 2011. METHODS A retrospective cohort study using the IMS Disease Analyzer database was conducted. All females aged 12-18 years with ≥1 prescription for a contraceptive drug between 1 January 2002 and 31 December 2011 were included. Annual prevalence of contraceptive drug prescribing was calculated, and indications for prescribing, and types of contraceptive drug prescribed, were examined. RESULTS In 2002, 13.7% (6135/44 532) of female adolescents received prescriptions for hormonal contraceptives, compared to 19.0% (6597/34 676) in 2011. The majority of female adolescents [2002: 76.2% (4676/6135); 2011: 65.7% (4334/6597)] received a contraceptive drug for 'contraceptive management'. The combined oral contraceptive (COC), 'progestogen+estrogen', was the most commonly prescribed. Although use of progestogen-only contraceptives was lower than COCs, the number of patients who received desogestrel pills and etonogestrel implants increased during the study period; levonorgestrel pill use declined. Only one injectable progestogen, long-acting depot medroxyprogesterone acetate, was prescribed. CONCLUSIONS Use of hormonal contraceptives among adolescents increased between 2002 and 2011, and COC usage was dominant. The increasing use of hormonal contraceptives in adolescents, especially in younger adolescents, warrants further investigation, including research into the long-term safety of these medicines in this age group.
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Affiliation(s)
- Asia N Rashed
- Research Associate, Institute of Pharmaceutical Science, King's College London, King's Health Partners, London and Honorary Research Pharmacist, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Yingfen Hsia
- Research Fellow, University College London, School of Pharmacy, London, UK and Research Fellow, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Lynda Wilton
- Honorary Research Consultant, University College London, School of Pharmacy, London, UK
| | - May Ziller
- Gynaecologist, Department of Gynaecology, University Hospital of Giessen and Marburg GmbH, Marburg, Germany
| | - Karel Kostev
- Research Consultant, IMS HEALTH Epidemiology, Frankfurt, Germany
| | - Stephen Tomlin
- Honorary Clinical Reader, Institute of Pharmaceutical Science, King's College London, King's Health Partners, London and Consultant Pharmacist, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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Abstract
The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost-benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.
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Abstract
Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report.
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Bahamondes L. Does the use of hormonal contraceptives affect bone mineral density? ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.2.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Interpretation of bone mineral density (BMD) results in premenopausal women is particularly challenging, since the relationship between BMD and fracture risk is not the same as for postmenopausal women. In most cases, Z scores rather than T scores should be used to define "low BMD" in premenopausal women. The finding of low BMD in a premenopausal woman should prompt thorough evaluation for secondary causes of bone loss. If a secondary cause is found, management should focus on treatment of this condition. In a few cases where the secondary cause cannot be eliminated, treatment with a bone active agent to prevent bone loss should be considered. In women with no fractures and no known secondary cause, low BMD is associated with microarchitectural defects similar to young women with fractures; however, no longitudinal data are available to allow use of BMD to predict fracture risk. BMD is likely to be stable in these women with isolated low BMD, and pharmacologic therapy is rarely necessary. Assessment of markers of bone turnover and follow-up bone density measurements can help to identify those with an ongoing process of bone loss that may indicate a higher risk for fracture, and possible need for pharmacologic intervention.
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Affiliation(s)
- Adi Cohen
- Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8-864, 630 West 168th St, New York, NY, 10032, USA,
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Abstract
Oral contraceptives are used by numerous women very often throughout a prolonged period of time and more and more and more frequently early in life, within the first reproductive years. According to the close relationship between estrogen and bone metabolism, the question of the impact of combined oral contraceptive (COC) on bone needs to be addressed. During adulthood, most studies have reported that COC, even those containing a low dose of ethinyl-estradiol had neutral or possibly beneficial effect on bone health. Use of COC within the perimenopausal years prevents the activation of bone metabolism and the decrease in bone mass. In adolescent girls, the skeletal effect of COC is of greater concern. Recent data suggest that the oral contraception may impede the development of peak bone mass, particularly when started within the teen years. Initiation of COC within the first 3 years after menarche would be a strong determinant of bone mass acquisition impairment. Whether this bone impact is also dependent on the dose of ethinyl-estradiol has not been fully elucidated. To date epidemiological studies did not report association between use of combined oral contraceptive and the risk of fracture.
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Affiliation(s)
- Florence Trémollieres
- Centre de Ménopause, Hôpital Paule de Viguier, TSA 70034, 330 Avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
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Nappi C, Bifulco G, Tommaselli GA, Gargano V, Di Carlo C. Hormonal contraception and bone metabolism: a systematic review. Contraception 2012; 86:606-21. [DOI: 10.1016/j.contraception.2012.04.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/19/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Gomez MT, Carlson GM, Van Dooren K. Practical Approaches to Supporting Young Women With Intellectual Disabilities and High Support Needs With Their Menstruation. Health Care Women Int 2012; 33:678-94. [DOI: 10.1080/07399332.2012.684812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Teen pregnancy prevention on a LARC: an update on long-acting reversible contraception for the primary care provider. Curr Opin Pediatr 2012; 24:439-45. [PMID: 22732635 DOI: 10.1097/mop.0b013e328354cc62] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This update will highlight recent research and recommendations on long-acting reversible contraception (LARC) in the teen population, in order to make primary care providers more comfortable counseling on these methods in the medical home. LARC methods, which include intrauterine devices (IUDs) and subdermal hormonal implants, are used by only a small minority of sexually active teens, despite their endorsement by professional organizations as effective and well tolerated birth control options in this population. RECENT FINDINGS Recent studies show a lack of knowledge about LARC methods among young women, as well as persistent misconceptions among providers regarding who is eligible for LARC use. Existing trials of small numbers of adolescents generally show enthusiasm for its use among teens who are educated about LARC, high satisfaction rates among users of subdermal implants and IUDs, as well as varying pregnancy and continuation rates. SUMMARY The existing research on LARC shows promise for these methods in the teen population. However, larger trials are needed to establish accurate data on satisfaction, continuation, and failure rates, as well as to explore other barriers to use. Medical home providers should stay informed of research on LARC in order to improve contraceptive counseling to young women.
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Warholm L, Petersen KR, Ravn P. Combined oral contraceptives' influence on weight, body composition, height, and bone mineral density in girls younger than 18 years: a systematic review. EUR J CONTRACEP REPR 2012; 17:245-53. [PMID: 22758931 DOI: 10.3109/13625187.2012.692411] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Combined oral contraceptives (COCs) are increasingly used by adolescents. The aim of this review is to investigate the evidence regarding COCs' influence on weight, height and bone mineral density (BMD) in girls younger than 18 years. METHOD Systematic literature search using PubMed/Medline and Scopus (January 1990-February 2012) on COCs for girls under 18 years of age and the possible influence on body parameters. MeSH terms: Oral contraception; Adolescent; Weight; Body composition; Height; Bone mineral density. RESULTS There is no evidence that COCs induce weight gain in girls younger than 18 years. Obese girls are not at higher risk of gaining weight. COCs do not cause changes in body fat and lean mass beyond the changes caused by natural development. Moreover, growth and stature are unaffected. Few studies indicate that COCs have a negative impact on BMD, but the evidence is presently too limited for definite conclusions. CONCLUSION Studies in young users are few. Presently, there are no indications of a negative impact of COCs on weight, body composition or height. Lesser increases in BMD cannot be excluded. As the demand for COCs is increasing among the youngest girls, there is a need for prospective studies addressing this issue.
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Early weight gain related to later weight gain in adolescents on depot medroxyprogesterone acetate. Obstet Gynecol 2012; 117:793-797. [PMID: 21422849 DOI: 10.1097/aog.0b013e31820f387c] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether early weight gain in adolescents on depot medroxyprogesterone acetate (DMPA) predicts continued excessive weight gain and identify risk factors of early weight gain. METHODS Adolescents (n=97) initiating DMPA were eligible to participate. Height and weight were assessed at baseline and at 6, 12, and 18 months. Early weight gain was defined as more than a 5% weight gain after 6 months of DMPA use. Mean body mass index (BMI) at 6-month intervals was estimated based on early weight-gain status (5% or less gain compared with greater than 5% gain). Analysis of variance modeling was used to compare group BMI at each time point. Repeated-measures analysis of covariance modeling was used to explore the association between early weight gain and percentage change in BMI at 12 and 18 months of DMPA use. RESULTS Twenty patients (21%) had early weight gain. Mean BMI for the 5% or less group and greater than 5% group was 23.4 and 24.5 (P=.31), 23.3 and 26.6 (P=.009), 24.2 and 28.7 (P=.007), and 25.7 and 32.1 (P=.01) at 0, 6, 12, and 18 months, respectively. Early weight gain was significantly associated with percentage change in BMI at 12 and 18 months (P<.001). No risk factors for early weight gain were identified. CONCLUSION Adolescents who experience more than 5% weight gain after 6 months of DMPA use are at risk for continued excessive weight gain. Weight gain after 6 months on DMPA can be used to identify adolescents at risk for continued weight gain, and appropriate counseling can be done at this time point. LEVEL OF EVIDENCE II.
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Cibula D, Skrenkova J, Hill M, Stepan JJ. Low-dose estrogen combined oral contraceptives may negatively influence physiological bone mineral density acquisition during adolescence. Eur J Endocrinol 2012; 166:1003-11. [PMID: 22436400 DOI: 10.1530/eje-11-1047] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim was to evaluate changes of bone mineral density (BMD) and markers of bone turnover in healthy adolescents, and in adolescent users of combined oral contraceptives (COCs) with different ethinylestradiol (EE) contents. METHODS In this prospective crossover study, 56 healthy females (15-19.5 years) with desire to use hormonal contraception were randomized to COC with either 30 or 15 μg of EE in crossover design of 9-month intervention each in reverse order. Nonusers of the same age (n=28) served as controls. BMD at lumbar spine (LS), total femur, femoral neck, distal radius, and total body, and serum markers (N-propeptide of type I procollagen, and type I collagen C-telopeptide) were measured at baseline and after 9 and 18 months. RESULTS In COC nonusers, BMD significantly increased at LS and radius, while markers decreased. In COC users, BMD did not increase, with the exception of LS BMD in the 30 μg COC group (P<0.05). In the crossover design, a difference between the low- and very low-dose COC users was found in LS BMD changes (P<0.05), where increase in BMD was more impaired in the 15 μg COC users. The skeletal effects of COC remained significant after adjustments for age and smoking status. Markers declined faster in COC users during the first period, while they remained stable or even increased during the second 9 months. CONCLUSION Physiological acquisition of LS BMD during adolescent age may be prevented by use of COC, especially those containing very low dose of EE.
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Affiliation(s)
- David Cibula
- Department of Obstetrics and Gynecology, Faculty of Medicine 1, Charles University, Prague, Czech Republic
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Ziglar S, Hunter TS. The effect of hormonal oral contraception on acquisition of peak bone mineral density of adolescents and young women. J Pharm Pract 2012; 25:331-40. [PMID: 22572223 DOI: 10.1177/0897190012442066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maximizing bone mass in youth is touted as the best strategy to offset the natural losses of aging and the menopausal transition. Not achieving maximum peak bone mineral density (BMD) is an independent risk factor for osteoporosis and thus a public health concern. Adolescence is a critical time of bone mineralization mediated by endogenous estradiol. Research has shown that the highest velocity of bone mass accrual occurs 1 year before menarche and after the first 3 years. Low-peak attainment of BMD in young women is associated with contributing factors such as diets low in calcium, eating disorders, lack of exercise, smoking, and low estrogen states. Oral contraceptives (OCs) suppress endogenous estradiol production by suppressing the hypothalamic-pituitary-ovarian axis. Thus, OCs, by replacing endogenous estradiol with ethinyl estradiol (EE), establish and maintain new hormone levels. The early initiation and the use of very low dose of EE raises the possibility that bone mass accrual at a critical time of bone mineralization in young women or adolescents may be jeopardized. This review examines the studies of BMD in adolescents and young women that use combination hormonal contraception. Some studies had inherent limitations, such as small trial, poor control of confounders, failure to exclude women with prior use of hormonal contraceptives, or prior pregnancy from control groups. The vast majority of reviewed studies showed OCs containing 20 to 30 µg of EE interfere with acquisition of peak BMD. Limited numbers of studies examine the effects of OCs containing 35 µg on adolescents and young adults. Additionally, studies are needed evaluating the progestin component of OCs as their differing androgenic properties may affect bone mineralization as well.
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Affiliation(s)
- Susan Ziglar
- Wingate University School of Pharmacy, Wingate, NC 28174, USA.
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Kaore SN, Langade DK, Yadav VK, Sharma P, Thawani VR, Sharma R. Novel actions of progesterone: what we know today and what will be the scenario in the future? J Pharm Pharmacol 2012; 64:1040-62. [DOI: 10.1111/j.2042-7158.2012.01464.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Abstract
Objectives
This article is aimed to review the novel actions of progesterone, which otherwise is considered as a female reproductive hormone. The article focuses on its important physiological actions in males too and gives an overview of its novel perspectives in disorders of central and peripheral nervous system.
Key findings
Progesterone may have a potential benefit in treatment of traumatic brain injury, various neurological disorders and male related diseases like benign prostatic hypertrophy (BPH), prostate cancer and osteoporosis. Norethisterone (NETA), a progesterone derivative, decreases bone mineral loss in male castrated mice suggesting its role in osteoporosis. In the future, progesterone may find use as a male contraceptive too, but still needs confirmatory trials for safety, tolerability and acceptability. Megestrol acetate, a progesterone derivative is preferred in prostatic cancer. Further, it may find utility in nicotine addiction, traumatic brain injury (recently entered Phase III trial) and Alzheimer's disease, diabetic neuropathy and crush injuries. Studies also suggest role of progesterone in stroke, for which further clinical trials are needed. The non genomic actions of progesterone may be in part responsible for these novel actions.
Summary
Although progesterone has shown promising role in various non-hormonal benefits, further clinical studies are needed to prove its usefulness in conditions like stroke, traumatic brain injury, neuropathy and crush injury. In male related illnesses like BPH and prostatic Ca, it may prove a boon in near future. New era of hormonal male contraception may be initiated by use of progesterone along with testosterone.
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Affiliation(s)
- Shilpa N Kaore
- Department of Pharmacology, Peoples College of Medical Sciences & Research Center, Bhopal, Madhya Pradesh, India
| | - Deepak Kumar Langade
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Vijay Kumar Yadav
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Parag Sharma
- Department of Pharmacology, Peoples College of Medical Sciences & RC, Bhopal, Madhya Pradesh, India
| | - Vijay R Thawani
- Department of Pharmacology, VCSG GMSRI, Srinagar and Pauri Garhwal, Uttarakhand, India
| | - Raj Sharma
- Department of Pharmacology, Govt medical College, Jagdalpur, Chhatisgarh, India
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Pitts SAB, Feldman HA, Dorale A, Gordon CM. Bone mineral density, fracture, and vitamin D in adolescents and young women using depot medroxyprogesterone acetate. J Pediatr Adolesc Gynecol 2012; 25:23-6. [PMID: 22078997 DOI: 10.1016/j.jpag.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To evaluate bone mineral density (BMD) in adolescents and young adults treated with depot medroxyprogesterone acetate (DMPA). DESIGN, SETTING, PARTICIPANTS Eighty-three healthy subjects, 13-20 years old, who received at least 3 DMPA injections in an urban adolescent clinic and underwent dual energy x-ray absorptiometry (DXA) were evaluated by chart review. MAIN OUTCOME MEASURES Anthropometric data, DMPA use, BMD of the spine and hip, fracture history, and vitamin D status were collected. RESULTS Subjects were a median age of 16.4 years old (range 13-20 years) when DMPA was initiated. The median number of DMPA injections was 5 (range 3-18) before the first DXA. At the spine and hip, respectively, BMD was normal (Z-score > -1.0 SD) for most subjects (79%, 86%). Subjects who received > 5 injections were more likely to have low spinal BMD (Z-score ≤ -2.0 SD) at first DXA (P = .018). In 15 subjects with repeat DXA measurements, after an additional median 6 injections, spinal BMD Z-score decreased by -0.33 ± 0.10 (mean ± SD, P = .004), as did absolute BMD at the hip (-0.019 ± 0.007 g/cm(2), P = .014). History of fracture was not associated with initial or subsequent BMD measurements. Most (12/13, 92.3%) subjects with vitamin D measurements were deficient (25-hydroxy vitamin D < 20 ng/mL). CONCLUSIONS Most subjects on DMPA had normal BMD at first DXA. Low spinal BMD was associated with longer DMPA use, and some BMD measurements declined with prolonged use. Fracture history is not an absolute contraindication to DMPA use in this population. Studies are needed to determine possible benefits of vitamin D supplementation in DMPA users.
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Affiliation(s)
- Sarah A B Pitts
- Division of Adolescent/Young Adult Medicine, Children's Hospital Boston, MA, USA
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Abstract
Gonadal steroids, including androgens and oestrogens, play a critical part in bone metabolism, and conditions associated with a deficiency of gonadal steroids can reduce BMD in adults and impair bone accrual in adolescents. In addition, other associated hormone alterations, for example, insulin-like growth factor 1 deficiency or high cortisol levels, can further exacerbate the effect of hypogonadism on bone metabolism, as can factors such as calcium and vitamin D deficiency, low body weight and exercise status. This Review discusses the effects of different hypogonadal states on bone metabolism in female adolescents and young adults, with particular emphasis on conditions associated with low energy availability, such as anorexia nervosa and athletic amenorrhoea, in which many factors other than hypogonadism affect bone. In contrast to most hypogonadal conditions, in which replacement of gonadal steroids is sufficient to normalize bone accrual rates and BMD, gonadal steroid replacement may not be sufficient to normalize bone metabolism in these states of energy deficit.
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Affiliation(s)
- Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, BUL 457, 55 Fruit Street, Boston, MA 02114, USA.
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Bitzer J, Simon JA. Current issues and available options in combined hormonal contraception. Contraception 2011; 84:342-56. [DOI: 10.1016/j.contraception.2011.02.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 02/14/2011] [Accepted: 02/24/2011] [Indexed: 11/16/2022]
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Scholes D, Hubbard RA, Ichikawa LE, LaCroix AZ, Spangler L, Beasley JM, Reed S, Ott SM. Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation. J Clin Endocrinol Metab 2011; 96:E1380-7. [PMID: 21752879 PMCID: PMC3167673 DOI: 10.1210/jc.2010-3027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear. OBJECTIVE The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adult OC users and discontinuers of two estrogen doses, relative to nonusers. DESIGN AND SETTING This was a prospective cohort study, Group Health Cooperative. PARTICIPANTS Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%. MAIN OUTCOME MEASURE The main outcome measure was BMD measured at 6-month intervals for 24-36 months. RESULTS After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32% < 30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter). CONCLUSIONS Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.
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Affiliation(s)
- Delia Scholes
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, 16th Floor, Seattle, Washington 98101, USA.
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Long-term assessment of forearm bone mineral density in postmenopausal former users of depot medroxyprogesterone acetate. Contraception 2011; 84:122-7. [DOI: 10.1016/j.contraception.2010.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 11/04/2010] [Accepted: 11/08/2010] [Indexed: 11/21/2022]
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Abstract
Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.
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MESH Headings
- Adolescent
- Adult
- Bone Density/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/therapeutic use
- Female
- Fractures, Bone/chemically induced
- Fractures, Bone/epidemiology
- Humans
- Lactation
- Perimenopause
- Practice Guidelines as Topic
- Risk Factors
- Young Adult
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Affiliation(s)
- Michelle M Isley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA.
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