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Perkins N. Vaginal atrophy and genital pain in women on depot medroxyprogesterone acetate contraceptive injection. Aust N Z J Obstet Gynaecol 2024; 64:160-164. [PMID: 37817446 DOI: 10.1111/ajo.13757] [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: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
Depot medroxyprogesterone acetate causes a hypo-estrogenic state in over half of users although clinical vaginal atrophy causing superficial dyspareunia is thought rarely to occur. This is a case series of ten women using depot medroxyprogesterone acetate who presented with superficial dyspareunia and clinical vaginal atrophy. The women were treated with vaginal estriol cream and their contraception was discontinued or changed. All patients had either a complete resolution of symptoms or a substantial improvement at follow-up, and the clinical and laboratory findings of vaginal atrophy had resolved. This case series demonstrates that vaginal atrophy may occur more frequently than previously thought.
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Affiliation(s)
- Nicky Perkins
- Auckland Sexual Health Service, Te Whatu Ora/Te Toka Tumai, Auckland, New Zealand
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2
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Yuksel N, Whelan AM. A practice tool for initiating and managing combined hormonal contraceptives for contraception: Assessment, decision-making and monitoring. Can Pharm J (Ott) 2024; 157:30-38. [PMID: 38125635 PMCID: PMC10729716 DOI: 10.1177/17151635231215061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Nese Yuksel
- Faculty of Pharmacy & Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Edmonton, Alberta
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3
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Garagiola ML, Thorne SA. Pregnancy Considerations in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:301-313. [PMID: 38161671 PMCID: PMC10755828 DOI: 10.1016/j.cjcpc.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 01/03/2024]
Abstract
The majority of women with repaired tetralogy of Fallot are able to tolerate pregnancy with a low risk of cardiovascular events. However, proactive contraceptive advice, prepregnancy counselling, and care by a pregnancy heart team with expertise in congenital heart disease are key to ensuring a good outcome for mother and baby. Maternal and fetal risks are increased in the presence of severe valvular stenosis, poorly tolerated arrhythmia, significant ventricular dysfunction, and cyanosis. It is unusual to see cyanotic adults with tetralogy of Fallot, whether unoperated or shunt palliated; pregnancy risks are greatly reduced by completing their repair before pregnancy is undertaken. The multidisciplinary pregnancy heart team should make a risk-stratified pregnancy care plan using a combination of published scoring systems and an individualized assessment of the patient's comorbidities. Low-risk patients may have the majority of their care and give birth in local units, whereas those at high risk should be managed and give birth in a tertiary centre with high-level expertise and intensive care facilities. Age-appropriate conversations about future childbearing and safe and reliable contraception should be part of routine follow-up from teenage years, so that women with tetralogy of Fallot can control their own fertility and make informed decisions about having children.
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Affiliation(s)
- Maria L. Garagiola
- Division of Cardiology, University Health Network and Mount Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Sara A. Thorne
- Division of Cardiology, University Health Network and Mount Sinai Health System, University of Toronto, Toronto, Ontario, Canada
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4
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Kirubarajan A, Li X, Yau M, Yu C, Got T, Li Q, Huszti E, Leung S, Thangavelu N, Sobel M. Awareness, knowledge, and misconceptions of adolescents and young people regarding long-acting reversible contraceptives: a systematic review and meta-analysis. Fertil Steril 2022; 118:168-179. [DOI: 10.1016/j.fertnstert.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/04/2022]
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5
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Tafler K, Kuriya A, Gervais N, Leyland N. Guideline No. 417: Prevention of Venous Thromboembolic Disease in Gynaecological Surgery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:82-96.e1. [PMID: 33878456 DOI: 10.1016/j.jogc.2021.04.003] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary objective of this clinical practice guideline is to provide gynaecologists with an algorithm and evidence to guide the use of thromboprophylaxis in gynaecological surgery. TARGET POPULATION All patients undergoing gynaecological surgery for benign or malignant indications. BENEFITS, HARMS, AND COSTS The implementation of this guideline will benefit patients undergoing gynaecological surgery and provide physicians with a standard algorithm for the use of perioperative thromboprophylaxis. EVIDENCE The following search terms were entered into MEDLINE, Google Scholar, and Cochrane in 2017 and 2018: VTE, PE, DVT, thromboprophylaxis, gynaecological surgery, heparin, graduated compression stocking, intermittent pneumatic stocking, obesity, pediatrics, minimally invasive surgery, heparin induced thrombocytopenia, regional anesthesia). Articles included were randomized controlled trials, meta-analyses, systematic reviews, and observational studies. Additional publications were identified from the reference lists of these articles. There were no date limits, but search results were limited to English language articles only. Searches were updated and incorporated into the guideline up to September 2018. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED USERS Gynaecologists and other members of the surgical team. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
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Cvetkovic A, King E, Skerritt L, Loutfy M, Tseng A, Murray M, van Schalkwyk J, Boucoiran I, Marcotte S, Hankins C, Savoie É, de Pokomandy A, Pick N, Tkachuk S, Rowe T, Smaill F, Walmsley S. A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:278-295. [PMID: 36338461 PMCID: PMC9629258 DOI: 10.3138/jammi-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women's health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women's health and sexual and reproductive health care needs are not being met. METHODS In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women's health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. RESULTS We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women's health care topics when seeing a patient during a visit. CONCLUSIONS It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women's health issues.
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Affiliation(s)
- Anna Cvetkovic
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth King
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Julie van Schalkwyk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Suzanne Marcotte
- Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Édénia Savoie
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Neora Pick
- Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Timothy Rowe
- Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada
| | - Fiona Smaill
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Walmsley
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
Women and girls with spina bifida have specific health care concerns. It is essential that they, and their health care providers have access to information to help them make healthy choices throughout their lifespan. This article aims to address key aspects of health pertinent to girls and women with spina bifida and outlines the SB Women's Health Guidelines for the Care of People with Spina Bifida. Further research into this area is needed.
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Affiliation(s)
- Anne Berndl
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret Nosek
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Huston, TX, USA
| | - Ashley Waddington
- Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON, Canada
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Monterrosa-Castro A, Redondo-Mendoza V, Monterrosa-Blanco A. Current Knowledge of Progestin-Only Pills. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment: ACOG Committee Opinion, Number 817. Obstet Gynecol 2021; 137:e7-e15. [PMID: 33399429 DOI: 10.1097/aog.0000000000004209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT Obstetrician-gynecologists frequently are consulted either before the initiation of cancer treatment to request menstrual suppression or during an episode of severe heavy bleeding to stop bleeding emergently. Adolescents presenting emergently with severe uterine bleeding usually require only medical management; surgical management rarely is required. Surgical management should be considered for patients who are not clinically stable, or for those whose conditions are not suitable for medical management or have failed to respond appropriately to medical management. When used continuously, combined hormonal contraceptives are effective for producing amenorrhea, although complete amenorrhea cannot be guaranteed. The risk of venous thromboembolism in patients with cancer is compounded by multiple factors, including presence of metastatic or fast-growing, biologically aggressive cancers; hematologic cancers; treatment-related factors such as surgery or central venous catheters; and the number and type of comorbid conditions. Although as a group, patients undergoing cancer treatment are at elevated risk of venous thromboembolism compared with the general population, this risk may be extremely elevated for certain patients and existing guidance on risk stratification should be consulted. The decision to use estrogen in patients with cancer should be tailored to the individual patient after collaborative consideration of the risk-benefit ratio with the patient and the health care team; the patient should be closely monitored for known adverse effects such as liver toxicity and venous thromboembolism.
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1660-1675. [PMID: 31640866 DOI: 10.1016/j.jogc.2019.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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11
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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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12
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Sachedin A, Todd N. Dysmenorrhea, Endometriosis and Chronic Pelvic Pain in Adolescents. J Clin Res Pediatr Endocrinol 2020; 12:7-17. [PMID: 32041388 PMCID: PMC7053437 DOI: 10.4274/jcrpe.galenos.2019.2019.s0217] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022] Open
Abstract
Most adolescents will experience discomfort during menstruation. Due to normalization of dysmenorrhea, there is delay to diagnosis and treatment. Non-steroidal anti-inflammatories are a first line treatment. Adolescents can safely be offered menstrual suppression with combined hormonal contraception, and progestin-only options. When the above are ineffective, gonadotropin releasing hormone agonists with add back treatment can be considered. Transabdominal ultrasound is indicated when first line treatments do not improve symptoms. Endometriosis should be considered in adolescents who experience ongoing pain despite medical treatment. If laparoscopy is performed and endometriosis visualized, it should be treated with either excision or ablation. Women with endometriosis should be counselled on menstrual suppression until fertility is desired. Management of chronic pain requires the involvement of a multi-disciplinary team.
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Affiliation(s)
- Aalia Sachedin
- The Royal Children’s Hospital, Department of Paediatric & Adolescent Gynaecology, Melbourne, Australia
| | - Nicole Todd
- University of British Columbia, Vancouver General Hospital, Diamond Health Centre, Vancouver, Canada
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13
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 392 - Grossesse et obésité maternelle Partie 2 : Planification en équipe de l'accouchement et soins post-partum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1676-1693. [PMID: 31640867 DOI: 10.1016/j.jogc.2019.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIF La présente directive clinique aborde les aspects essentiels des soins prénataux chez les femmes atteintes d'obésité. La partie 1 porte sur la préconception et les soins prénataux. La partie 2 porte sur la planification en équipe de l'accouchement et les soins post-partum. UTILISATEURS CONCERNéS: Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières, anesthésiologistes) qui prodiguent des soins relatifs à la grossesse auprès de femmes atteintes d'obésité. POPULATION CIBLE Femmes atteintes d'obésité qui sont enceintes ou prévoient le devenir. DONNéES PROBANTES: Des recherches ont été menées en consultant les ressources de Statistique Canada, de Medline et de Cochrane Library en vue d'en tirer la littérature relativement aux effets de l'obésité durant la grossesse sur les soins prénataux et intrapartum, la morbidité et la mortalité maternelles, l'anesthésie obstétricale ainsi que sur la morbidité et la mortalité périnatales. Seuls les résultats de revues systématiques, d'essais cliniques randomisés ou comparatifs et d'études observationnelles ont été retenus. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été mises à jour régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en septembre 2018. Nous avons également tenu compte de la littérature grise (non publiée) obtenue sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes pertinents, dans des collections de directives cliniques et des registres d'essais cliniques, et auprès d'associations nationales et internationales de médecins spécialistes. MéTHODES DE VALIDATION: Le contenu et les recommandations ont été rédigés et acceptés par les auteurs. Les membres du comité de médecine fœto-maternelle ont ensuite passé en revue le contenu et formulé des commentaires aux fins d'examen. Enfin, le conseil d'administration de la Société des obstétriciens et gynécologues du Canada (SOGC) a approuvé la publication de la version définitive de la directive. Les points de désaccord ont été abordés lors de réunions pour enfin arriver à un consensus. La qualité des données et des recommandations a été déterminée à l'aide des critères d'évaluation décrits par le Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICE ET COûTS: La mise en place des recommandations des présentes directives peut améliorer la reconnaissance des fournisseurs de soins obstétricaux relativement aux problèmes qui touchent les personnes enceintes atteintes d'obésité, notamment au moyen de stratégies de prévention clinique; de la communication entre l'équipe de soins de santé, la patiente et la famille; et de la planification de l'équipement et des ressources humaines. Il est à espérer que les organismes régionaux, provinciaux et fédéraux participeront à la formation et au soutien en matière de soins coordonnés pour les personnes enceintes atteintes d'obésité. MISE à JOUR DE LA DIRECTIVE CLINIQUE: Les directives de la SOGC sont automatiquement passées en revue 5 ans après leur publication. Les auteurs peuvent toutefois proposer une autre date de réévaluation s'ils croient qu'une période de 5 ans est trop courte ou trop longue en fonction de leurs connaissances du sujet à titre d'experts en la matière. PROMOTEURS La présente directive a été élaborée à l'aide de ressources financées par la SOGC. DéCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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Nethery E, Schummers L, Maginley KS, Dunn S, Norman WV. Household income and contraceptive methods among female youth: a cross-sectional study using the Canadian Community Health Survey (2009-2010 and 2013-2014). CMAJ Open 2019; 7:E646-E653. [PMID: 31690652 PMCID: PMC6944121 DOI: 10.9778/cmajo.20190087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low socioeconomic status is one of many barriers that may limit access to family planning services. We aimed to examine the relation between household income and contraceptive methods among female youth in Canada. METHODS Our study population included sexually active females aged 15-24 who were trying to avoid pregnancy. We used cross-sectional data from the 2009-2010 and 2013-2014 cycles of the Canadian Community Health Survey to compare household income and other sociodemographic covariates for those using oral contraceptives, injectable contraceptives, condoms or a dual method (condoms plus oral or injectable contraceptives). RESULTS Of female youth at risk for unintended pregnancy, 59.2% reported using oral contraceptives, 29.0% used dual methods, 16.8% used condoms only, 2.5% used injectable contraceptives and 13.6% did not use contraception. In multiple regression models, lower annual household income (< $80 000) was associated with decreased use of oral contraceptives (relative risk [RR] 0.85, 95% confidence interval [CI] 0.80-0.91) and dual methods (RR 0.81, 95% CI 0.71-0.91), increased use of condoms (RR 1.36, 95% CI 1.11-1.67) and injectable contraceptives (RR 1.69, 95% CI 0.98-2.92), and a greater risk of contraceptive nonuse (RR 1.19, 95% CI 0.94-1.50). INTERPRETATION We found that lower household income was associated with decreased use of oral contraceptives and increased reliance on injectable contraceptives and condoms only. Young, low-income females may face barriers to accessing the full range of contraceptive methods available in Canada. Easier access to affordable contraception may decrease the number of female youth at risk for unintended pregnancy due to financial barriers.
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Affiliation(s)
- Elizabeth Nethery
- School of Population and Public Health (Nethery, Maginley, Norman) and Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Toronto, Ont.; Faculty of Public Health & Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Laura Schummers
- School of Population and Public Health (Nethery, Maginley, Norman) and Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Toronto, Ont.; Faculty of Public Health & Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - K Suzanne Maginley
- School of Population and Public Health (Nethery, Maginley, Norman) and Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Toronto, Ont.; Faculty of Public Health & Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Sheila Dunn
- School of Population and Public Health (Nethery, Maginley, Norman) and Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Toronto, Ont.; Faculty of Public Health & Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- School of Population and Public Health (Nethery, Maginley, Norman) and Department of Family Practice (Schummers, Norman), University of British Columbia, Vancouver, BC; Department of Family and Community Medicine (Dunn), University of Toronto; Women's College Research Institute (Dunn), Toronto, Ont.; Faculty of Public Health & Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
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15
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Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI, Bote-Bonaechea B, Montejo ÁL. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med 2019; 8:E908. [PMID: 31242625 PMCID: PMC6617135 DOI: 10.3390/jcm8060908] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/06/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022] Open
Abstract
In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women's pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring.
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Affiliation(s)
- Nerea M Casado-Espada
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Rubén de Alarcón
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Javier I de la Iglesia-Larrad
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Berta Bote-Bonaechea
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
| | - Ángel L Montejo
- Psychiatry Service, Institute of Biomedical Research of Salamanca (IBSAL), University Clinical Hospital of Salamanca, Paseo San Vicente, SN 37007 Salamanca, Spain.
- Nursing School E.U.E.F., University of Salamanca, Av. Donantes de Sangre SN 37007 Salamanca, Spain.
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Vaz-Luis I, Partridge AH. Exogenous reproductive hormone use in breast cancer survivors and previvors. Nat Rev Clin Oncol 2018; 15:249-261. [DOI: 10.1038/nrclinonc.2017.207] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Estrogen-progestins and progestins for the management of endometriosis. Fertil Steril 2016; 106:1552-1571.e2. [DOI: 10.1016/j.fertnstert.2016.10.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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