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Bitzer J, Bouchard C, Zatik J, Weyers S, Piltonen T, Suturina L, Apolikhina I, Gemzell-Danielsson K, Jost M, Creinin MD, Foidart JM. Effects of E4/DRSP on self-reported physical and emotional premenstrual and menstrual symptoms: data from the phase 3 clinical trial in Europe and Russia. EUR J CONTRACEP REPR 2024:1-10. [PMID: 38904165 DOI: 10.1080/13625187.2024.2359117] [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: 12/16/2023] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To describe the effects of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg on physical and emotional premenstrual and menstrual symptoms. MATERIALS AND METHODS We used Menstrual Distress Questionnaire (MDQ) data from a phase-3 trial (NCT02817828) in Europe and Russia with participants (18 - 50 years) using E4/DRSP for up to 13 cycles. We assessed mean changes in MDQ-t-scores from baseline to end of treatment in premenstrual (4 days before most recent flow) and menstrual (most recent flow) scores for 4 MDQ domains in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain. RESULTS Of 1,553 treated participants, 1,398(90.0%), including 531(38%) starters, completed both MDQs. Starters reported improvements for premenstrual Pain (-1.4), Water Retention (-3.3) and Negative Affect (-2.5); and for menstrual Pain (-3.5), Water Retention (-3.4), and Negative Affect (-2.7) (all p < 0.01). For switchers, no changes were significant except an increase in premenstrual (+1.0, p = 0.02) and menstrual (+1.5, p = 0.003) Water Retention. We observed a change in symptom intensity in >40% of participants for Cramps, Backache and Fatigue (domain Pain), Painful or Tender Breast and Swelling (domain Water Retention) and Mood Swings and Irritability (domain Negative Affect). CONCLUSION E4/DRSP starters experienced significant improvements in the domains Pain, Water Retention and Negative Affect particularly benefiting those with more severe baseline symptoms. Switchers showed minimal changes.
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Affiliation(s)
- Johannes Bitzer
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | | | - János Zatik
- Szent Anna Szuleszeti, Nogyogyaszati es Ultrahang Maganrendelo, Debrecen, Hungary
| | - Steven Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - Terhi Piltonen
- Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Larisa Suturina
- Department of Reproductive Health Protection, Scientific Center for Family Health and Human Reproduction, Irkutsk, Russian Federation
| | - Inna Apolikhina
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov, Ministry of Healthcare of Russia, Moscow, Russia
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Maud Jost
- Estetra SRL, an affiliate company of Mithra Pharmaceuticals, Liège, Belgium
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of CA, Sacramento, California, USA
| | - Jean-Michel Foidart
- Department of Gynaecology and Obstetrics, University of Liège, Liège, Belgium
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Vegunta S, Houston LE, Nicholson NA, David PS. Counseling Women About Sexual Health Effects of Contraceptives. J Womens Health (Larchmt) 2024. [PMID: 38848279 DOI: 10.1089/jwh.2023.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Lisa E Houston
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Nicola A Nicholson
- Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Paru S David
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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Gassen J, Mengelkoch S, Shanmugam D, Pearson JT, van Lamsweerde A, Benhar E, Hill SE. Longitudinal changes in sexual desire and attraction among women who started using the Natural Cycles app. Horm Behav 2024; 162:105546. [PMID: 38640590 DOI: 10.1016/j.yhbeh.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.
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Affiliation(s)
- Jeffrey Gassen
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America.
| | - Summer Mengelkoch
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Plaza 300, Los Angeles, CA 90095-7076, United States of America
| | - Divya Shanmugam
- Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, Cambridge, MA 02139, United States of America
| | - Jack T Pearson
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | | | - Eleonora Benhar
- Natural Cycles Nordic AB, Sankt Eriksgatan 63 B, 112 34 Stockholm, Sweden
| | - Sarah E Hill
- Texas Christian University, Department of Psychology, 2955 S. University Dr., Fort Worth, TX 76129, United States of America
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Saadedine M, Faubion SS. Hormonal Contraception and Sexual Function: A Review, Clinical Insights, and Management Considerations. Obstet Gynecol Clin North Am 2024; 51:381-395. [PMID: 38777490 DOI: 10.1016/j.ogc.2024.02.008] [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: 05/25/2024]
Abstract
Most sexually active women of reproductive age have used contraception, with hormonal methods constituting approximately 40% of contraceptive choices. Among these hormonal options, combined oral contraceptives stand out as the most selected. Within this same demographic, sexual issues are prevalent. Although specific hormonal contraceptives have been implicated in sexual dysfunction among these women, the correlation lacks consistency across studies and varies between different types of hormonal contraception. This article assesses the available literature on the associations between various hormonal contraceptive methods and sexual function and provides practical management insights.
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Affiliation(s)
- Mariam Saadedine
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA
| | - Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Center for Women's Health, Mayo Clinic, Rochester, MN, USA.
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Oppenheimer A, Boitrelle F, Nicolas‐Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand 2024; 103:799-823. [PMID: 38226426 PMCID: PMC11019533 DOI: 10.1111/aogs.14768] [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: 07/16/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Sexual function of patients with endometriosis should be assessed by patient-reported outcome measures (PROMs) that present high reliability and validity. The objective was to study the PROMs used to assess sexual function for patients with endometriosis to improve their selection for research and clinical practice. MATERIAL AND METHODS We performed a systematic literature review from January 2000 to September 2023. All studies including women with confirmed endometriosis and assessing sexual quality of life or sexual function or sexual distress were retrieved. Different properties of PROMs used for sexual dysfunction were assessed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Properties evaluated were: structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness. This literature review was registered on Prospero as 2018 CRD42018102278. RESULTS Seventy-four articles with evaluation of sexual function were included. Of the 25 PROMs assessing sexual function, the Female Sexual Function Index (FSFI) was the most frequently used (34/74 [45.9%] items), followed by the Female Sexual Distress Scale (9/74 [12.2%] items) and the Sexual Activity Questionnaire (SAQ) (8/74 [10.8%] items). The most commonly used measurement properties were "hypothesis testing" and "responsiveness". The PROMs with a high level of evidence for these two measurement properties were the FSFI, the SAQ, the Short Sexual Functioning Scale, the Sexual Satisfaction Scale for Women, Sexual Quality of Life-Female, the Brief Profile of Female Sexual Function, and the Sexual Health Outcomes in Women Questionnaire. The FSFI questionnaire appeared to be more relevant for evaluating medical treatment, and the SAQ for evaluating surgical treatment. Only one instrument was specific to endometriosis (the Subjective Impact of Dyspareunia Inventory [SIDI]). CONCLUSIONS In this systematic literature review of sexual function assessment questionnaires in endometriosis, the FSFI and the SAQ questionnaires emerged as having the best measurement properties according to the COSMIN criteria. The FSFI questionnaire appears to be suited for evaluating medical treatment, and the SAQ for surgical treatment. The SIDI is the only specific questionnaire, but its responsiveness remains to be defined.
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Affiliation(s)
- Anne Oppenheimer
- EA 7285 Research Unit “Risk and Safety in Clinical Medicine for Women and Perinatal Health”Versailles‐Saint‐Quentin University (UVSQ)Montigny‐le‐BretonneuxFrance
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Department of Reproductive MedicineClinique de La MuetteParisFrance
| | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology and CECOSPoissy HospitalPoissyFrance
- Department BREED, UVSQ, INRAEParis Saclay UniversityJouy‐en‐JosasFrance
| | | | - Arnaud Fauconnier
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Centre Hospitalier Intercommunal de Poissy‐Saint‐Germain‐en‐LayeDepartment of Gynecology and ObstetricsPoissyFrance
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Gawronska J, Cao C, Wang R, Keon Yon D, Rahmati M, Jewiss M, Smith L. Disparities in the prevalence of suicidal ideation according to oral contraceptive pill use among US women: A cross-sectional study. Health Sci Rep 2024; 7:e2048. [PMID: 38629111 PMCID: PMC11020109 DOI: 10.1002/hsr2.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Background and Aims The relationship between oral contraceptive pill (OCP) and suicidal ideation remains unclear. This study aims to estimate the prevalence of suicidal ideation among US women and evaluate their associates overall and according to OCP use status. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2012 were used to calculate the prevalence and associates of suicidal ideation in women using OCP. Suicidal ideation was assessed using the Patient Health Questionnaire-9. Overall and OCP-specific weighted prevalence of suicidal ideation were estimated. Multivariable logistic regressions were used to investigate overall and OCP-specific associates. Results The prevalence of suicidal ideation was 3.6% with no evident disparity between OCP groups, suggesting that OCP use is not associated with increased prevalence of suicidal ideation. Smoking was inversely associated with suicidal ideation in the former users of OCP. In the overall population, the prevalence of suicidal ideation was greater in those who were: Black or Hispanic, smoking, taking antidepressants, those with lower educational attainment, and women with low and middle income. Conclusion Our findings suggest that OCP use was not associated with increased prevalence of suicidal ideation. Unique associates were identified among different OCP groups.
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Affiliation(s)
- Julia Gawronska
- The Center for Health, Performance and WellbeingAnglia Ruskin UniversityCambridgeUK
| | - Chao Cao
- Department of Medical Oncology Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, College of Public Health and Health ProfessionsUniversity of FloridaGainesvilleFloridaUSA
| | - Dong Keon Yon
- Department of PediatricsKyung Hee University College of MedicineSeoulRepublic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical CenterKyung Hee University College of MedicineSeoulRepublic of Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human SciencesLorestan UniversityKhoramabadIran
- Department of Physical Education and Sport Sciences, Faculty of Literature and HumanitiesVali‐E‐Asr University of RafsanjanRafsanjanIran
| | - Matthew Jewiss
- Cambridge Center for Sport and Exercise SciencesAnglia Ruskin UniversityCambridgeUK
| | - Lee Smith
- The Center for Health, Performance and WellbeingAnglia Ruskin UniversityCambridgeUK
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Krapf JM, Goldstein AT. Combined estrogen-progestin oral contraceptives and female sexuality: an updated review. Sex Med Rev 2024:qeae011. [PMID: 38515302 DOI: 10.1093/sxmrev/qeae011] [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: 09/18/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options. OBJECTIVES The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability. METHODS A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health. RESULTS Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time. CONCLUSION Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.
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Affiliation(s)
- Jill M Krapf
- Center for Vulvovaginal Disorders Florida, Tampa, FL 33609, United States
| | - Andrew T Goldstein
- Center for Vulvovaginal Disorders New York, New York, NY 10036, United States
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Naghdi M, Farshbaf-Khalili A, Nahaee J, Hakimi P, Shahnazi M. The effect of lavender on mood disorders associated with the use of combined oral contraceptives (COCs): a triple-blinded randomized controlled trial. BMC Complement Med Ther 2024; 24:118. [PMID: 38459484 PMCID: PMC10921632 DOI: 10.1186/s12906-024-04419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The use of contraceptive methods is influenced by their effectiveness, availability, and minimal side effects. OCPs are one of the most effective and widely used methods of pregnancy prevention worldwide. This method not only prevents pregnancy but also helps prevent and treat other diseases. One of the main reasons for discontinuing this method is the emotional disturbances associated with its use. Lavender is an evergreen, fragrant plant that has gained significant attention for its anti-anxiety effects. This study was conducted to investigate the effect of lavender essential oil capsules on mood disorders during the use of COCs. METHODS This triple-blinded clinical trial was conducted on 60 married women (aged 15-49 years old) who were consumers of COCs, referring to 26 health centers in Tabriz, Iran. The participants were randomly assigned to either the intervention (consuming one gelatin capsule containing 80 mg LEO daily) or control (consuming one placebo capsule daily) group. The intervention continued for 56 days. Scores for positive and negative were determined using the Positive and Negative Affect Schedule (PANAS) questionnaire; and for stress, depression, and anxiety were measured using the DASS-21 questionnaire on day's 28th and 56th post-intervention. Data analysis was conducted using the t-test and ANOVA with repeated measures, and a p-value of < 0.05 was considered significant for all analyses. RESULTS A statistically significant difference was observed in mood disorders, stress, and depression between women receiving LEO or placebo. The consumption of LEO increased the positive mood on day 28 [MD (95% CI): 4.5 (2.1 to 7.0), p = 0.001] and day 56 [5.9 (3.4 to 8.3), p < 0.001] while decreased the negative mood on day 28 [MD (95% CI): -3.5 (-5.3 to -1.3), p < 0.001] and day 56 [-4.3 (-6.3 to -2.2), p < 0.001], stress on day 28 [MD (95% CI): -4.9 (-7.1 to -2.8), p = 0.001] and day 56 [-5.3 (-7.6 to -3.1), p < 0. 001], and depression on day 28 [MD (95% CI): -3.0 (-4.9 to 1.1), p = 0.003] and day 56 [-3.1 (-5.0 to 1.2), p = 0.002]. There was no statistically significant difference between the two groups in terms of anxiety. CONCLUSIONS The consumption of LEO with COCs improved mood disorders and reduced stress and depression. The use of hormonal contraceptives and mood changes should be considered by providers. Therefore, regarding the possibility of mood changes, it is expected that appropriate counseling and education will be provided to women who consume COC., providing appropriate solutions, including the simultaneous use of LEO.
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Affiliation(s)
- Mina Naghdi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azizeh Farshbaf-Khalili
- Physical Medicine and Rehabilitation Research Centre, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Jila Nahaee
- Department of Midwifery, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Parvin Hakimi
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Shahnazi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Schuh KM, Ahmed J, Kwak E, Xu CX, Davis TT, Aronoff CB, Tronson NC. A mouse model of oral contraceptive exposure: Depression, motivation, and the stress response. Horm Behav 2024; 158:105470. [PMID: 38061232 DOI: 10.1016/j.yhbeh.2023.105470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 02/05/2024]
Abstract
Hormonal contraceptives, including oral contraceptives (OCs), regulate hormonal cycles and broadly affect physiological processes, including stress responsivity. Whereas many users describe overall improved mood, up to 10 % of OC users experience adverse effects, including depression and anxiety. Given the link between regulation of hypothalamic-pituitary-adrenal (HPA) axis, stress exposure, and risk for depression, it is likely that OC-effects on stress mediate increased risk or increased resilience to these disorders. In this study, we developed and characterized a tractable mouse model of OC exposure with which to identify the mechanisms underlying OC modulation of brain, behavior, and mood. Specifically, we aimed to determine whether translationally relevant doses of OC-hormones in mice mimic changes in stress responsivity observed in humans taking OCs and describe behavioral changes during OC exposure. Young adult female C57Bl/6 N mice received daily ethinyl estradiol (EE) and levonorgestrel (LVNG) in 10 % sucrose, EE and drospirenone (DRSP) in 10 % sucrose, or 10 % sucrose alone. Translationally relevant doses of EE + LVNG-exposure, but not EE + DRSP, suppressed the acute stress response, consistent with effects observed in human OC users. EE + LVNG caused a specific anhedonia-like effect, without broad changes in stress-coping behavior, other depression-like behaviors, or anxiety-like behaviors. The suppression of regular estrous cycling, together with the blunting of the corticosterone response to acute stress, demonstrate the utility of this model for future studies to identify the mechanisms underlying OC interactions with stress, motivation, and risk for depression.
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Affiliation(s)
- Kristen M Schuh
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Jabir Ahmed
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Esther Kwak
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Cecilia X Xu
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Tronjay T Davis
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Chloe B Aronoff
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Natalie C Tronson
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, United States of America.
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10
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Jaafar K, Nabhan E, Daoud R, Nasser Z. Prevalence of anxiety and depression among Lebanese women using oral contraceptives: a cross-sectional study. BMC Womens Health 2024; 24:47. [PMID: 38233890 PMCID: PMC10795317 DOI: 10.1186/s12905-024-02897-4] [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: 06/17/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Oral contraceptives (OCs) are used worldwide, including Lebanese women. However, the association between OCs use and anxiety or depression remains unclear. This study aims to assess the prevalence of anxiety and depression among Lebanese women using oral contraceptive pills and investigate the differential impact of combined oral contraceptives (COCs) versus progestogen-only pills (POPs) on mental health outcomes. METHODS A cross-sectional study was conducted among a sample of Lebanese women using OCs between January and March 2023. Nine hundred nighty seven out of the 2051 women who took part in the survey met our criteria and were included in this study. Data on anxiety and depression were collected using validated and reliable scales, the Arabic versions of the Generalized Anxiety Disorder-7 Questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses, including multivariate analysis, were performed to assess the association between OCs type (COC vs. POP) and anxiety/depression. RESULTS The prevalence of anxiety and depression among Lebanese women taking OCs was found to be 39.9% and 64.3%, respectively. Furthermore, the study revealed that POP users had 2.8 times higher odds of developing anxiety (adjusted odds ratio ORadj = 2.8 with 95% confidence interval CI of 1.770 to 4.435) p-value < 0.001 and 9.2 times higher odds of developing depression (adjusted odds ratio ORadj = 9.2 with 95% confidence interval CI of 5.790 to 14.506) p-value < 0.001 compared to COC users. CONCLUSION The results of this study shed light on the elevated prevalence of anxiety and depression among Lebanese women using OCs and emphasized the varying effects of COCs and POPs on their mental health outcomes. Further research is needed to comprehensively understand this association, considering both the dosage and specific type of oral contraceptive to improve the overall well-being of women using these contraceptives.
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Affiliation(s)
- Kamel Jaafar
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, Lebanese University, Hadath, Lebanon.
- Neurosciences Research Center, Lebanese University, Hadath, Lebanon.
| | - Elias Nabhan
- Neurosciences Research Center, Lebanese University, Hadath, Lebanon
- Faculty of Medical Sciences, Department of Internal Medicine, Cardiology Division, University of Balamand, Beirut, Lebanon
| | - Rama Daoud
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Zeina Nasser
- Faculty of Medical Sciences, Neurosciences Research Center, Lebanese University, Hadath, Lebanon
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Diamond B, Sheeder J, Lazorwitz A. An exploratory study on the possible association of serum etonogestrel concentrations with mood concerns and symptoms among contraceptive implant users. Contraception 2024; 129:110298. [PMID: 37802462 PMCID: PMC10842501 DOI: 10.1016/j.contraception.2023.110298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To evaluate if inter-individual variability in serum etonogestrel (ENG) concentrations accounts for variability in mood-related side effects among ENG implant users. STUDY DESIGN Participants underwent a single-time blood draw for measurement of serum ENG concentrations using a liquid-chromatography mass-spectrometry assay, and completed a questionnaire at enrollment that retrospectively assessed mood-related side effects during the period of implant use. For a subset of participants, Patient Health Questionnaire-9 (PHQ-9) scores, obtained for other clinical purposes, were also compared. We used independent medians tests and linear regression to evaluate associations between mood symptoms and serum ENG concentrations as our primary outcome. RESULTS Among 900 enrolled participants, 34% (306/900) reported mood changes on the baseline questionnaire. Of these, 31 (3.4%) participants also had documented PHQ-9 scores. Serum ENG concentrations (median 126.9 pg/mL [range 39.4-695.1]) were not associated with reported mood changes on the questionnaire (p = 0.19) or on the PHQ-9 (β = 0.00, 95% CI -0.03, 0.03). CONCLUSION Pharmacokinetic variability does not explain the inter-individual variability in mood-related side effects among ENG implant users. IMPLICATIONS Mood-related side effects and altered mental health metrics are commonly reported by etonogestrel contraceptive implant users but demonstrate wide inter-individual variability. Individual differences in serum drug levels do not appear to account for this variability in mood-related side effects, and so future research should focus on novel personal factors.
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Affiliation(s)
- Breea Diamond
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, USA
| | - Jeanelle Sheeder
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, USA
| | - Aaron Lazorwitz
- University of Colorado Anschutz Medical Campus, Department of Obstetrics and Gynecology, Division of Family Planning, Aurora, CO, USA.
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Blumenstock SM, Barber JS. Hormonal Contraception Use and Sexual Frequency across Young Women's Intimate Relationships. JOURNAL OF SEX RESEARCH 2023; 60:1283-1296. [PMID: 35435786 PMCID: PMC9576816 DOI: 10.1080/00224499.2022.2059649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
We examined whether hormonal contraception (HC) use predicts sexual frequency throughout and across young women's intimate relationships. From 2008-2012, the Relationships Dynamics and Social Life Study collected weekly surveys over 2.5 years, and included 893 women (aged 18-19 at baseline) who reported 2,547 intimate relationships across 32,736 weeks. Three-level logistic multilevel models assessed the weekly probability of sexual intercourse based on 1) weekly HC use (vs. nonuse) and 2) duration of HC use, both accounting for several relational and individual characteristics, including relationship duration. Women had more frequent sexual intercourse when they were using HC than when they were not (predicted probabilities .65 vs .41). The weekly probability of sexual intercourse increased sharply within the first month of HC initiation (by about 27 percentage points), remained high for several months, then began to slowly decline (yet remained above that of nonuse). When separated by method type, similar trajectories were found for the pill, ring, and IUD/implant; following the initial increase, steeper declines in intercourse frequency were found for the contraceptive injectable, eventually dropping below pre-initiation levels. Findings signify the immediate influence of reduced pregnancy fears in facilitating sexual intercourse among young women, which may decline as HC use continues long-term.
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Affiliation(s)
| | - Jennifer S. Barber
- Kinsey Institute, Indiana University, Bloomington, IN, United States
- Department of Sociology, Indiana University, Bloomington, IN, United States
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13
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Belcher RE, Sim D, Meykler M, Owens-Walton J, Hassan N, Rubin RS, Malik RD. A qualitative analysis of female Reddit users' experiences with low libido: how do women perceive their changes in sexual desire? J Sex Med 2023; 20:287-297. [PMID: 36763942 DOI: 10.1093/jsxmed/qdac045] [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: 05/02/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The true prevalence of low sexual desire among women is disputed among researchers due to the complex nature and presentation of women's sexual problems. AIM To qualitatively analyze the aspects of libido/sexual desire frequently discussed by Reddit users and compare them with the current understanding of female sexual well-being and sexual desire disorders. METHODS By using the Reddit application programming interface, the TwoXChromosomes subreddit was queried for posts with the keywords libido and sex drive. Posts that were deleted or unrelated to themes of libido/sex drive were excluded. A total of 85 threads-63 queried from the keyword libido and 22 from sex drive-and approximately 2900 comments were qualitatively analyzed per the grounded theory approach. Five independent researchers read and coded each thread to identify dominant themes and emergent concepts. OUTCOMES Outcomes of interest included codes related to sexual dysfunction, libido, orgasm, masturbation, types of sex, psychology, relationships, intimacy, treatment, medications, and health care. RESULTS Posters were primarily heterosexual women in their 20s and 30s. The code categories with the highest frequency were relationships (22.7%, n = 272), libido (22.2%, n = 210), psychological (20.2%, n = 191), medications (7.29%, n = 69), and intimacy (6.0%, n = 57). Users frequently described a decrease in libido secondary to medications, particularly antidepressants and hormonal birth control. Many users discussed the challenges of navigating a relationship with low sexual desire and the resulting sexual distress. Posters described feelings of sadness, anxiety, and guilt due to their low desire. Additionally, users discussed the role that sex plays in relationships, whether as a way to develop intimacy between partners or to achieve orgasm. Finally, posters expressed dissatisfaction with health care addressing their concerns surrounding sexual desire. CLINICAL IMPLICATIONS The study findings-namely, the impact of medications on sexual health, the interaction of sexual desire and mental health, and cited examples of inadequate sexual health care-can help guide sexual well-being research, diagnosis, and public policy. STRENGTHS AND LIMITATIONS Using Reddit as a data source allowed for the analysis of women's experiences outside the preestablished concepts of female sexual desire. Limitations to the study include the potential for posts to be deleted by moderator guidelines, the young demographic distribution of Reddit users, and the popularity-based structure of subreddit threads. CONCLUSION Our results emphasize the psychosocial aspects of sexual desire and the need to redefine sexual problems to encompass the complex nature of female sexual well-being.
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Affiliation(s)
- Rachael E Belcher
- School of Medicine, University of Maryland, Baltimore, MD 21201, United States
| | - Danielle Sim
- School of Medicine, University of Maryland, Baltimore, MD 21201, United States
| | - Marcella Meykler
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Jeunice Owens-Walton
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States
| | - Naeemul Hassan
- University of Maryland, College Park, MD 20742, United States
| | - Rachel S Rubin
- Department of Urology, Georgetown University, Georgetown, Washington, DC 20007, United States
| | - Rena D Malik
- Department of Urology, University of Maryland, Baltimore, MD 21201, United States
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Abdollahpour S, Ashrafizaveh A, Azmoude E. Effects of the Combined Contraceptive Vaginal Ring on Female Sexual Function: A Systematic Review and Meta-analysis. Malays J Med Sci 2023; 30:21-30. [PMID: 36875197 PMCID: PMC9984104 DOI: 10.21315/mjms2023.30.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/29/2021] [Indexed: 03/05/2023] Open
Abstract
There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was conducted on the intervention studies published in the past years to clarify these contradictions. The existing literature on the subject was reviewed by searching through such databases as PubMed, Scopus, ISI Web of Sciences, Embase, Cochrane Library and Google Scholar up to July 2021. Before-after intervention studies that had examined the effect of vaginal rings on females' sexual function were collected as well. In total, five studies with 369 participants were included in quantitative syntheses. Pooled results from the random-effect model showed that NuvaRing had a positive effect on females' sexual function three months after insertion (WMD: 2.48; 95% CI: 0.30, 4.67; P = 0.026); however, this effect was not significant after 6 months (WMD: 4.38; 95% CI: -4.95, 13.72; P = 0.357). Meta-regression analysis suggested that the effect of this device is associated with users' age and body mass index 3 months after insertion. No publication bias was found by Egger's test or funnel plots. Overall, the results of this meta-analysis support the view that vaginal ring use is associated with a positive effect on the sexual function of women 3 months after insertion, while the effect of this device on the sexual function of women was insignificant after 6 months. However, given the dearth of available data, it is not possible to reach a definite conclusion on the effect of vaginal rings on females' sexual function.
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Affiliation(s)
- Sedigheh Abdollahpour
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Ashrafizaveh
- Department of Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Elham Azmoude
- Department of Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
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15
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Psychological side effects of hormonal contraception: a disconnect between patients and providers. Contracept Reprod Med 2023; 8:9. [PMID: 36647102 PMCID: PMC9842494 DOI: 10.1186/s40834-022-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Existing literature about the psychological side effects of hormonal contraception (HC) is limited. The goal of this study is to better characterize patients' subjective experiences with HC, its side effects, and contraception counseling. METHODS This is a cross-sectional, survey-based study using a convenience sample of patients who had used HC at some point in their lives. Recruitment occurred from June 2021-February 2022. RESULTS Of the 188 responses included in the analysis, 43.6% reported experiencing mood changes as a side effect of HC at some point in their lives. The most common reason participants cited for discontinuing or switching contraception methods was side effects (48.3%). Participants with a history of psychiatric illness were significantly more likely to report mood changes as a side effect of their HC (61.2%) compared to participants with no history of psychiatric illness (29.5%). Among patients with a history of psychiatric illness, 38.8% responded that their psychiatric symptoms worsened with HC while only 11.2% responded that their symptoms improved with HC. The majority (83%) of participants responded that their provider never mentioned the possibility of psychological side effects during contraception counseling. If/when they experienced side effects associated with their HC, 22.7% of participants disagreed that their provider adequately addressed their concerns. CONCLUSION These findings suggest that mood changes may be among the most common perceived side effects of HC and speak to a disconnect between patients and providers when it comes to discussing the possibility of psychological side effects with HC.
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16
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Alziyadi SH, AlNemari SM, AlOsaimi MM, AlSufyani ME, AlReefi TM, AlShanbari SF, Koursan SMS. Oral Contraceptive Use and its Association with Depression among Women in Taif, Saudi Arabia. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2023. [DOI: 10.51847/6pmm8jcqwn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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17
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Hill SE, Mengelkoch S. Moving beyond the mean: Promising research pathways to support a precision medicine approach to hormonal contraception. Front Neuroendocrinol 2023; 68:101042. [PMID: 36332783 DOI: 10.1016/j.yfrne.2022.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022]
Abstract
Women's psychological and behavioral responses to hormonal contraceptive (HC) treatment can be highly variable. One of the great challenges to researchers seeking to improve the experiences of women who use HCs is to identify the sources of this variability to minimize unpleasant psychobehavioral side-effects. In the following, we provide recommendations for programs of research aimed at identifying sources of heterogeneity in women's experiences with HC. First, we review research demonstrating person- and prescription- based heterogeneity in women's psychobehavioral responses to HCs. Next, we identify several promising person- and prescription- based sources of this heterogeneity that warrant future research. We close with a discussion of research approaches that are particularly well-suited to address the research questions raised in article. Together, this review provides researchers with several promising research pathways to help support the development of a precision medicine approach to HC treatment.
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Yang Q, Lagerberg T, Sjölander A, Bertone-Johnson ER, Fang F, Ye W, Chang Z, Valdimarsdóttir UA, Lu D. Use of hormonal contraceptives and antidepressants and risks of suicidal behavior and accidents among women with premenstrual disorders: a nationwide cohort study. BMC Med 2022; 20:482. [PMID: 36522649 PMCID: PMC9753283 DOI: 10.1186/s12916-022-02671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Women with premenstrual disorders (PMDs) are at increased risks of suicidal behavior and accidents. However, the effect of PMD first-line treatment on such risks have not been assessed. METHODS To study the association between use of hormonal contraceptives or antidepressants and subsequent risks of suicidal behavior and accidents among women with PMDs. We conducted a nationwide register-based cohort study with between- and within-individual analyses in Sweden. All women with a clinical diagnosis/indication of PMDs recorded in the Patient Register and the Prescribed Drug Register during 1987-2011 were included (n = 23 029, age 15-52 years). Information on hormonal contraceptives and antidepressants prescribed for these women was obtained from the Prescribed Drug Register. Events of suicidal behavior (complete suicide and suicide attempt) and accidents were separately identified through the Patient and the Causes of Death Registers. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of suicidal behavior and accidents after use of hormonal contraceptives or antidepressants were estimated in between-individual and within-individual analyses (i.e., comparing the risk between use and no use in the same individual) using Poisson regression. RESULTS Women with PMDs were followed for a median of 6.2 years. Compared to no use of hormonal contraceptives, use of hormonal contraceptives was associated with a lower risk of suicidal behavior in both between-individual (IRR 0.76, 0.43-1.34) and within-individual analyses (IRR 0.65, 0.51-0.83). These risk reductions were primarily restricted to combined products (IRR 0.18, 0.07-0.47 and 0.19, 0.08-0.42 in between- and within-individual analyses) and observed among women with/without psychiatric comorbidities (p for interaction 0.830 and 0.043 in between- and within-individual analyses). Yet, the use of hormonal contraceptives was not consistently associated with risk of accidents between between-individual (IRR 1.13, 1.01-1.27) and within-individual analyses (IRR 1.01, 0.92-1.11). Use of antidepressants was associated with a higher risk of suicidal behavior and accidents in both between- and within-individual analyses. CONCLUSIONS Our findings suggest that use of hormonal contraceptives, particularly combined products, is associated with reduced rates of suicidal behaviors, but not accidents, among women with PMDs. The estimates for antidepressants may be biased by indication.
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Affiliation(s)
- Qian Yang
- Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA.,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA-02115, USA
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 12A, 171 77, Stockholm, Sweden.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA-02115, USA
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Kappen M, Raeymakers S, Weyers S, Vanderhasselt MA. Stress and rumination in Premenstrual Syndrome (PMS): Identifying stable and menstrual cycle-related differences in PMS symptom severity. J Affect Disord 2022; 319:580-588. [PMID: 36162688 DOI: 10.1016/j.jad.2022.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/24/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Since the inclusion of Premenstrual Dysphoric Disorder (PMDD) as a mood disorder in the DSM-5, Premenstrual Syndrome (PMS) symptoms have received more attention from researchers and clinicians. In this large-scale study, we investigated core psychological concepts relevant to mood disorder vulnerability between people with 1) no to mild, 2) moderate to severe, and 3) PMDD levels of PMS symptoms. Several trait measures related to mood disorders including depressive symptoms, feelings of stress and anxiety, and ruminative thinking were measured (single measurement, N = 380) along with state (momentary) reports of stress and stress-related perseverative thinking (measured twice, once in the follicular and once in the premenstrual/luteal phase, N = 237). We consistently observed that participants with higher severity of PMS symptoms also scored higher on depression, anxiety, stress, and rumination (trait measures). We also found consistent increases in momentary stress and stress-related perseverative ruminative thinking with increased PMS symptoms at each of our two test moments (in the middle of the follicular and premenstrual/luteal phase respectively). Interestingly, we did not find significant differences between our two test moments for any group, despite PMS being characterized by specific systems in the premenstrual/luteal phase. However, this could be due to noise surrounding the testing moments due to the temporal resolution of the questionnaires and the menstrual cycle estimation method. Nevertheless, these results suggest that stress and rumination are important psychological mechanisms to consider in PMS. Future PMS research studying stress and rumination on a day-to-day basis in combination with hormonal measures is warranted.
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Affiliation(s)
- Mitchel Kappen
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
| | - Sofie Raeymakers
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | - Steven Weyers
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University Hospital Ghent, Department of Psychiatry and Medical Psychology, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
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20
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Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review. J Clin Med 2022; 11:jcm11237212. [PMID: 36498786 PMCID: PMC9738496 DOI: 10.3390/jcm11237212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Endometriosis is a systemic medical condition characterized by endometrial tissue that is abnormally implanted in extrauterine sites, including the central nervous system. In this article, we reported the case of a patient with presumed cerebral endometriosis who was diagnosed with bipolar disorder and panic disorder and systematically reviewed the literature for previously reported neuropsychiatric symptoms in patients with cerebral and cerebellar endometriosis. The PubMed, Scopus, and Web of Science bibliographic databases were searched according to the PRISMA guidelines. Seven previous case reports were found and described. While neurological disturbances dominated the clinical picture in the cases retrieved from the literature, our patient represented the first case to show both neurological and psychiatric manifestations. Atypical features of bipolar disorder including chronic mood instability, mixed episodes, and excitatory interepisodic symptoms were highlighted. During the neuropsychological evaluation, a dysexecutive profile consistent with frontal lobe pathology was evidenced. We hypothesized that the course and features of the illness were largely influenced by the presence of documented brain lesions compatible with endometrial implants, especially in the frontal region. Accordingly, patients with endometriosis who exhibit neurological as well as mental symptoms should be investigated for cerebral lesions.
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21
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Kransdorf LN, Files JA. Women, Mood and Cognition. J Womens Health (Larchmt) 2022; 31:1686-1689. [PMID: 34448597 DOI: 10.1089/jwh.2021.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Lisa N Kransdorf
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Julia A Files
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
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22
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Pletzer B, Lang C, Derntl B, Griksiene R. Weak associations between personality and contraceptive choice. Front Neurosci 2022; 16:898487. [PMID: 36389244 PMCID: PMC9648366 DOI: 10.3389/fnins.2022.898487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022] Open
Abstract
Prospective randomized controlled trials on hormonal contraceptive (HC) effects on the brain are rare due to a number of methodological challenges. Thus, much of the evidence on HC effects on the brain comes from cross-sectional studies comparing HC-users to non-users. In interpreting these findings, it is of importance to be aware of potential confounds associated with women's contraceptive choices. Previous studies have discussed age, education, social status, sexual orientation, relationship status, and tolerability of HC. Given the current trend toward a reduction in HC use and increased skepticism toward HC it seems relevant to also identify variables associated with women's attitudes toward HC and whether they may represent confounds for neuroscientific studies. In the present study, we investigated whether women's personality characteristics were associated with their choice to use or not use HC in the present, past and future and the type of HC chosen. 1,391 females aged 18-45 years participated in an online survey including the HEXACO-60 personality questionnaire, as well as two different measures of gender role, and provided information about their current and previous contraceptive status, as well as experiences with and attitudes toward contraceptive use. We compared (i) current, previous and never-users of HC, (ii) prospective users of HC to women who opposed future HC use, and (iii) current users of IUDs to current users of oral contraceptives. Results revealed that associations between personality and the decision to use or not use HC were negligible, while differences in personality were observed corresponding to contraceptive type. Current users of IUDs showed higher agreeableness and extraversion compared to current users of oral contraceptives. The results suggest that personality is more strongly associated to the choice of contraceptive type rather than the choice between hormonal and non-hormonal options.
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Affiliation(s)
- Belinda Pletzer
- Department of Psychology and Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Carmen Lang
- Department of Psychology and Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Ramune Griksiene
- Department of Neurobiology and Biophysics, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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Tronson NC, Schuh KM. Hormonal contraceptives, stress, and the brain: The critical need for animal models. Front Neuroendocrinol 2022; 67:101035. [PMID: 36075276 DOI: 10.1016/j.yfrne.2022.101035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/26/2022] [Accepted: 09/01/2022] [Indexed: 01/10/2023]
Abstract
Hormonal contraceptives are among the most important health and economic developments in the 20thCentury, providing unprecedented reproductive control and a range of health benefits including decreased premenstrual symptoms and protections against various cancers. Hormonal contraceptives modulate neural function and stress responsivity. These changes are usually innocuous or even beneficial, including their effects onmood. However, in approximately 4-10% of users, or up to 30 million people at any given time, hormonal contraceptives trigger depression or anxiety symptoms. How hormonal contraceptives contribute to these responses and who is at risk for adverse outcomes remain unknown. In this paper, we discussstudies of hormonal contraceptive use in humans and describe the ways in which laboratory animal models of contraceptive hormone exposure will be an essential tool for expanding findings to understand the precise mechanisms by which hormonal contraceptives influence the brain, stress responses, and depression risk.
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Affiliation(s)
- Natalie C Tronson
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
| | - Kristen M Schuh
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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Gemzell-Danielsson K, Cagnacci A, Chabbert-Buffet N, Douxfils J, Foidart JM, Kubba A, Lasa LIL, Mansour D, Neulen J, Neves J, Palma F, Römer T, Ski RS, Tóth V. A novel estetrol-containing combined oral contraceptive: European expert panel review. CESKA GYNEKOLOGIE 2022; 87:440-452. [PMID: 36543594 DOI: 10.1080/13625187.2022.2093850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Despite considerable advances in recently developed combined oral contraceptives (COCs), resulting in lower rates of adverse events while maintaining contraceptive efficacy, there is interest in further innovation. MATERIALS AND METHODS Estetrol (E4), a native oestrogen, and progestin drospirenone (DRSP) were combined in a new COC. A European expert panel reviewed the pharmacology, efficacy, and safety and tolerability of this combination. Their findings are presented as a narrative review. RESULTS E4 15mg/DRSP 3 mg in a 24/4 regimen provided effective contraception with good cycle control, characterised by a predictable regular bleeding pattern and minimal unscheduled bleeding, together with a good safety profile. The combination was associated with high user satisfaction, wellbeing, and minimal changes in body weight. The effects on endocrine and metabolic parameters were limited, and the combination was found to have a limited impact on liver function and lipid and carbohydrate metabolism. Moreover, its effect on several haemostatic parameters was lower than that of comparators containing ethinyl oestradiol (EE) 20mg/DRSP 3 mg and EE 30mg/levonorgestrel 150mg. CONCLUSION E4 15 mg/DRSP 3 mg provides safe and effective contraception, with high user satisfaction and predictable bleeding. Further research will evaluate the long-term safety of the COC.
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Concas A, Serra M, Porcu P. How hormonal contraceptives shape brain and behavior: A review of preclinical studies. Front Neuroendocrinol 2022; 66:101017. [PMID: 35843303 DOI: 10.1016/j.yfrne.2022.101017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022]
Abstract
Steroid hormones influence different aspects of brain function, including development, neurogenesis, neuronal excitability, and plasticity, thus affecting emotional states, cognition, sociality, and reward. In women, their levels fluctuate across the lifespan and through the reproductive stages but are also altered by exogenous administration of hormonal contraceptives (HC). HC are widely used by women throughout their fertile life both for contraceptive and therapeutic benefits. However, awareness of their effects on brain function and behavior is still poorly appreciated, despite the emerging evidence of their action at the level of the central nervous system. Here, we summarize results obtained in preclinical studies, mostly conducted in intact female rodents, aimed at investigating the neurobiological effects of HC. HC can alter neuroactive hormones, neurotransmitters, neuropeptides, as well as emotional states, cognition, social and sexual behaviors. Animal studies provide insights into the neurobiological effects of HC with the aim to improve women's health and well-being.
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Affiliation(s)
- Alessandra Concas
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Mariangela Serra
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Patrizia Porcu
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy.
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Higgins JA, Kramer RD, Wright KQ, Everett B, Turok DK, Sanders JN. Sexual Functioning, Satisfaction, and Well-Being Among Contraceptive Users: A Three-Month Assessment From the HER Salt Lake Contraceptive Initiative. JOURNAL OF SEX RESEARCH 2022; 59:435-444. [PMID: 33560155 PMCID: PMC8349922 DOI: 10.1080/00224499.2021.1873225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Few large, longitudinal studies document multiple contraceptive methods' effects on sexual functioning, satisfaction, and well-being. We leveraged data from the HER Salt Lake Contraceptive Initiative, a prospective cohort study with patient surveys at baseline, one month, and three months. Surveys assessed bleeding changes, contraceptive-related side effects, sexual functioning and satisfaction, and perceptions of methods' impact on sexual well-being. Individuals in the final sample (N = 2,157) initiated either combined oral contraceptives, levonorgestrel intrauterine devices (IUDs), copper IUDs, implants, injectables, or vaginal rings. Across methods, participants exhibited minimal changes in sexual function (Female Sexual Function Index-6 scores) or satisfaction (New Scale of Sexual Satisfaction scores) over three months. However, many perceived contraception-related changes to sexual well-being. Half (51%) reported their new method had made their sex life better; 15% reported it had made their sex life worse. Sexual improvements were associated with decreased vaginal bleeding, fewer side effects, and IUD use. Negative sexual impacts were associated with physical side effects (e.g., bloating and breast tenderness), increased bleeding, and vaginal ring use. In conclusion, contraceptive users did not experience major changes in sexual functioning or satisfaction over three months, but they did report subjective sexual changes, mostly positive, due to their method.
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Affiliation(s)
- Jenny A. Higgins
- Departments of Obstetrics and Gynecology and Gender and Women’s Studies, University of Wisconsin
| | - Renee D. Kramer
- Department of Population Health Sciences, University of Wisconsin
| | | | - Bethany Everett
- Department of Sociology, University of Utah
- Department of Obstetrics and Gynecology, University of Utah
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah
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Novick AM, Johnson RL, Lazorwitz A, Belyavskaya A, Berkowitz L, Norton A, Sammel MD, Epperson CN. Discontinuation of hormonal contraception due to changes in mood and decreases in sexual desire: the role of adverse childhood experiences. EUR J CONTRACEP REPR 2022; 27:212-220. [PMID: 35133231 DOI: 10.1080/13625187.2022.2030702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate if adverse childhood experiences are associated with hormonal contraception discontinuation due to mood and sexual side effects. MATERIALS AND METHODS Women, ages 18-40 (N = 826), with current and/or previous hormonal contraceptive use completed surveys on demographics, contraceptive history, and the Adverse Childhood Experiences Questionnaire. We characterised women into high (≥2 adverse experiences) and low (0 or 1) adverse childhood experience groups. We calculated risk ratios for associations between adverse childhood experiences and outcomes of interest using log binomial generalised linear models, and adjusted for relevant demographic variables. RESULTS Women in the high adverse childhood experiences group (n = 355) were more likely to report having discontinued hormonal contraception due to decreases in sexual desire (adjusted risk ratio 1.44, 1.03-2.00, p = .030). Covariates included age, current hormonal contraception use, and various demographic variables associated with discontinuation. Adverse childhood experiences were not associated with mood or sexual side effects among current (n = 541) hormonal contraceptive users. CONCLUSIONS Self-reported adverse childhood experiences were associated with greater likelihood of discontinuing hormonal contraception due to behavioural side effects, particularly decreases in sexual desire. Identification of risk factors for behavioural side effects can assist patients and clinicians in making informed choices on contraception that minimise risk of early discontinuation.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Aaron Lazorwitz
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Anna Belyavskaya
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Lily Berkowitz
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Aileen Norton
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA.,Department of Family Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
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Schmidt NM, Hennig J, Munk AJL. Event-Related Potentials in Women on the Pill: Neural Correlates of Positive and Erotic Stimulus Processing in Oral Contraceptive Users. Front Neurosci 2022; 15:798823. [PMID: 35058744 PMCID: PMC8764149 DOI: 10.3389/fnins.2021.798823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aims: Exposure toward positive emotional cues with - and without - reproductive significance plays a crucial role in daily life and regarding well-being as well as mental health. While possible adverse effects of oral contraceptive (OC) use on female mental and sexual health are widely discussed, neural processing of positive emotional stimuli has not been systematically investigated in association with OC use. Considering reported effects on mood, well-being and sexual function, and proposed associations with depression, it was hypothesized that OC users showed reduced neural reactivity toward positive and erotic emotional stimuli during early as well as later stages of emotional processing and also rated these stimuli as less pleasant and less arousing compared to naturally cycling (NC) women. Method: Sixty-two female subjects (29 NC and 33 OC) were assessed at three time points across the natural menstrual cycle and corresponding time points of the OC regimen. Early (early posterior negativity, EPN) and late (late positive potential, LPP) event-related potentials in reaction to positive, erotic and neutral stimuli were collected during an Emotional Picture Stroop Paradigm (EPSP). At each appointment, subjects provided saliva samples for analysis of gonadal steroid concentration. Valence and arousal ratings were collected at the last appointment. Results: Oral contraceptive users had significantly lower endogenous estradiol and progesterone concentrations compared to NC women. No significant group differences in either subjective stimulus evaluations or neural reactivity toward positive and erotic emotional stimuli were observed. For the OC group, LPP amplitudes in reaction to erotic vs. neutral pictures differed significantly between measurement times across the OC regimen. Discussion: In this study, no evidence regarding alterations of neural reactivity toward positive and erotic stimuli in OC users compared to NC was found. Possible confounding factors and lines for future research are elaborated and discussed.
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Affiliation(s)
- Norina M. Schmidt
- Department of Differential and Biological Psychology, University of Giessen, Giessen, Germany
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Delvaux T, Jespers V, Benova L, van de Wijgert J. Acceptability and Satisfaction of Contraceptive Vaginal Rings in Clinical Studies: A Systematic Review and Narrative Synthesis. Front Glob Womens Health 2022; 2:799963. [PMID: 34970653 PMCID: PMC8712726 DOI: 10.3389/fgwh.2021.799963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Acceptability of and satisfaction with contraceptive methods are paramount for uptake and continuation. In the current context of multipurpose prevention of pregnancy and sexually transmitted diseases/HIV development, it is critical to have a better understanding of acceptability of and satisfaction with the contraceptive vaginal ring (CVR) including sexual satisfaction. The objective of this study was to review the evidence about acceptability of CVRs and general and sexual satisfaction of users. Methods: We searched PubMed, CINAHL, and Web of Science (until December 31, 2020) and selected original studies documenting actual use of hormonal CVR and explicitly addressing any of the 3 outcomes. Results: Of a total of 1,129 records screened, 46 studies were included. Most studies (n = 43, 93%) were prospective, conducted in high-income settings (n = 35), and reported on NuvaRing® use (n = 31). Overall, 27 (59%) studies included a comparison group, 38 (82%) studies used exclusively quantitative questionnaires, with qualitative only (n = 4, 9%), or mixed methods (n = 4, 9%) studies being less common. Ease of CVR insertion/removal/reinsertion was high in all the settings and improved with time of use, with qualitative studies supporting these findings. When mentioned, ring-related events were associated with discontinuation, and results on continuation of use were mixed. Among NuvaRing® studies, general satisfaction (being satisfied or very satisfied) was between 80 and 90% and tended to mirror continuation. Sexual satisfaction was less commonly reported and results were mixed. Overall, limited information was provided on actual CVR experiences of women (and men) and cultural norms that may affect sexuality and CVR use. Conclusion: Positive aspects of acceptability of and satisfaction with CVRs were reported, but ring-related events and factors, which may affect long-term CVR use, deserve further study. More information is needed on actual experiences of women using CVRs, relationship aspects, male partner opinions, and contextual norms to better understand the acceptability of and satisfaction with CVRs.
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Affiliation(s)
| | - Vicky Jespers
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Lenka Benova
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Janneke van de Wijgert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Rothschild CW, Richardson BA, Guthrie BL, Kithao P, Omurwa T, Mukabi J, Callegari LS, Lokken EL, John-Stewart G, Unger JA, Kinuthia J, Drake AL. Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study. BJOG 2021; 129:926-937. [PMID: 34839583 PMCID: PMC9035040 DOI: 10.1111/1471-0528.17032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women. DESIGN A prospective cohort study. SETTING Five counties in Western Kenya. PARTICIPANTS Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS Patient-reported side effect symptoms, method switch, and discontinuation were reported through weekly text message-based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS Prevalence, hazards ratio (HR). RESULTS Among 825 women, 44% were using implants, 43% injectables, 7% intrauterine device, and 6% oral contraceptive pills at enrollment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow-up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95%CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95%CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95%CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95%CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (adjusted hazard ratio [aHR] 2.39, 95%CI 1.20-4.77), weight changes (aHR 2.72, 95%CI 1.47-4.68), and sexual side effects (aHR 2.42, 95%CI 1.40-4.20). CONCLUSIONS Addressing irregular bleeding, weight changes, and sexual side effects through development of new products that minimize these specific side effects and anticipatory counseling may reduce method-related discontinuation.
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Affiliation(s)
| | - Barbra A Richardson
- Departments of Biostatistics and Global Health, University of Washington, Seattle, USA, Division of Vaccine and Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Brandon L Guthrie
- Departments of Global Health and Epidemiology, University of Washington, Seattle, USA
| | | | | | | | - Lisa S Callegari
- Departments of Obstetrics & Gynecology and Health Services, University of Washington, Seattle, USA
| | - Erica L Lokken
- Department of Global Health, University of Washington, Seattle, USA
| | - Grace John-Stewart
- Departments of Global Health, Epidemiology, Medicine, and Pediatrics, University of Washington, Seattle, USA
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, USA
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Zettermark S, Khalaf K, Perez-Vicente R, Leckie G, Mulinari D, Merlo J. Population heterogeneity in associations between hormonal contraception and antidepressant use in Sweden: a prospective cohort study applying intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). BMJ Open 2021; 11:e049553. [PMID: 34598985 PMCID: PMC8488727 DOI: 10.1136/bmjopen-2021-049553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES From a reproductive justice framework, we aimed to investigate how a possible association between hormonal contraceptive (HC) and antidepressants use (as a proxy for depression) is distributed across intersectional strata in the population. We aimed to visualise how intersecting power dynamics may operate in combination with HC use to increase or decrease subsequent use of antidepressants. Our main hypothesis was that the previously observed association between HC and antidepressants use would vary between strata, being more pronounced in more oppressed intersectional contexts. For this purpose, we applied an intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy approach. DESIGN Observational prospective cohort study using record linkage of national Swedish registers. SETTING The population of Sweden. PARTICIPANTS All 915 954 women aged 12-30 residing in Sweden 2010, without a recent pregnancy and alive during the individual 1-year follow-up. PRIMARY OUTCOME MEASURE Use of any antidepressant, meaning being dispensed at least one antidepressant (ATC: N06A) during follow-up. RESULTS Previously mentally healthy HC users had an OR of 1.79 for use of antidepressants compared with non-users, whereas this number was 1.28 for women with previous mental health issues. The highest antidepressant use were uniformly found in strata with previous mental health issues, with highest usage in women aged 24-30 with no immigrant background, low income and HC use (51.4%). The largest difference in antidepressant use between HC users and non-users was found in teenagers, and in adult women of immigrant background with low income. Of the total individual variance in the latent propensity of using antidepressant 9.01% (healthy) and 8.16% (with previous mental health issues) was found at the intersectional stratum level. CONCLUSIONS Our study suggests teenagers and women with immigrant background and low income could be more sensitive to mood effects of HC, a heterogeneity important to consider moving forward.
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Affiliation(s)
- Sofia Zettermark
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kani Khalaf
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Raquel Perez-Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - George Leckie
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Center for Multilevel Modelling, School of Education, University of Bristol, Bristol, UK
| | - Diana Mulinari
- Department of Gender Studies, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Center for Primary Health Care Research, Region Skåne, Region Skane Health Care, Malmö, Sweden
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van 't Hof SR, Cera N. Specific factors and methodological decisions influencing brain responses to sexual stimuli in women. Neurosci Biobehav Rev 2021; 131:164-178. [PMID: 34560132 DOI: 10.1016/j.neubiorev.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022]
Abstract
Most of the neuroimaging studies on sexual behavior have been conducted with male participants, leading to men-based models of sexual arousal. Here, possible factors and methodological decisions that might influence brain responses to sexual stimuli, specifically for the inclusion of women, will be reviewed. Based on this review, we suggest that future studies consider the following factors: menstrual phase, hormonal contraception use, history of sexual or psychiatric disorders or diseases, and medication use. Moreover, when researching sexual arousal, we suggest future studies assess sexual orientation and preferences, that women should select visual sexual stimuli, and a longer duration than commonly used. This review is thought to represent a useful guideline for future research in sexual arousal, which hopefully will lead to a higher inclusion of women and therefore more accurate neurobiological models of sexual arousal.
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Affiliation(s)
| | - Nicoletta Cera
- Centre for Psychology at University of Porto -CPUP, Faculty of Psychology and Education Sciences, University of Porto, Portugal
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Fake news et contraception. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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The importance of use of the FSFI questionnaire in gynecology and venerology: a pilot study. Postepy Dermatol Alergol 2021; 38:480-485. [PMID: 34377131 PMCID: PMC8330857 DOI: 10.5114/ada.2021.107934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction The Female Sexual Function Index (FSFI) is recognized as an excellent tool for assessing female sexuality and screening female sexual dysfunction, but it also has important venereological implications as sexually transmitted diseases result from human behaviour in the sexual sphere. It is influenced by socio-economic, psychological and cultural factors. Aim To present the results of an attempt to implement FSFI in gynaecological practice. Material and methods The study comprised 91 women aged 20-35 (mean: 24.3 ±4.0) undergoing prophylactic gynaecological examinations. All of them voluntarily agreed to fill in the FSFI questionnaire, and provide data on weight, height, hormone treatments, the age of menarche and sexual initiation and information essential in health promotion and prevention, including the prevention of sexually transmitted diseases. Results The average age of the first sexual intercourse was 18.2 ±2.4. The total FSFI score ranged from 3.8 to 35.1 points (mean: 27.4 ±6.5). As many as 34.1% of the women presented with FSFI < 27.50, suggesting an increased risk of sexual dysfunction. Patients' age as well as the age of menarche were both negatively correlated with desire. The mean FSFI scores for almost all of the domains and the FSFI total score were higher for women taking oral contraceptives, although statistically significant differences were detected only for the orgasm domain. Conclusions A high percentage of sexually active Polish women presented with FSFI below the threshold, suggesting some grade of sexual dysfunction. Gynaecological and STI medical history should be extended to include issues related to female sexual function.
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Lara LADS, Scalco SCP, Rufino AC, Paula SRCD, Fernandes ES, Pereira JMDL, França SSD, Reis S, Almeida SBD, Vale FBC, Lerner T, Carvalho YMVD, Abdo CHN, Oliveira FFLD. Management of hypoactive sexual desire disorder in women in the gynecological setting. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:417-424. [PMID: 34182585 PMCID: PMC10303879 DOI: 10.1055/s-0041-1731410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Sheila Reis
- Sociedade Brazileira de Estudos em Sexualidade Humana, Rio de Janeiro, RJ, Brazil
| | | | | | - Théo Lerner
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Carbone MG, Campo G, Papaleo E, Marazziti D, Maremmani I. The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J Clin Med 2021; 10:jcm10081616. [PMID: 33920306 PMCID: PMC8069439 DOI: 10.3390/jcm10081616] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is a chronic inflammatory condition, which is distinguished by the presence of the endometrial-like glands and stroma outside the uterine cavity. Pain and infertility are the most commonly expressed symptoms, occurring in 60% and 40% of cases, respectively. Women with endometriosis, especially those with pelvic pain, also have a greater vulnerability to several psychiatric disorders. There is, in particular, a tendency to contract affective or anxiety disorders as well as panic-agoraphobic and substance use disorders. Endometriosis with pelvic pain, infertility and psychic vulnerability usually leads to disability and a markedly lower quality of life for women of reproductive age. Thus, the burden of endometriosis is not limited to the symptoms and dysfunctions of the disease; it extends to the social, working and emotional spheres, leading to a severe impairment of global functioning. An analysis of scientific literature revealed a close relationship between specific temperamental traits, the expression of several psychiatric symptoms, chronicity of pain, risk of substance use and lower probability of a positive outcome. Endometriosis symptoms and the impact of related psychological consequences, increased vulnerability and the possible onset of psychiatric symptoms may influence coping strategies and weaken resilience, so triggering a vicious cycle leading to a marked deterioration in the quality of life. A multidisciplinary approach consisting of a medical team composed of gynecologists, psychologists, psychiatrists, experts in Dual Disorder, algologists and sexologists, would guarantee the setting of a target and taking the best decision on a personalized treatment plan. That approach would allow the prompt detection of any psychopathological symptoms and improve the endometriosis-related physical symptoms, bringing a healthier quality of life and a greater likelihood of a positive outcome.
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Affiliation(s)
- Manuel Glauco Carbone
- PISA-School of Experimental and Clinical Psychiatry, 56100 Pisa, Italy;
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| | - Giovanni Campo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
| | - Enrico Papaleo
- Obstetrics and Gynecology Department, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.C.); (E.P.)
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Donatella Marazziti
- 1st Psychiatric Unit, Department of Clinical and Experimental Medicine, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy;
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
| | - Icro Maremmani
- Saint Camillus International University of Health and Medical Sciences-UniCamillus, 00131 Rome, Italy
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Lucca, Italy
- Vincent P. Dole Dual Disorder Unit, 2nd Psychiatric Unit, Santa Chiara University Hospital, University of Pisa, 56100 Pisa, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy
- Correspondence: ; Tel.: +39-050-993045
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Espitia De La Hoz FJ. One-year incidence of low libido in women using levonorgestrel subdermal implant as contraception. Cohort study. Armenia, Colombia, 2014-2019. ACTA ACUST UNITED AC 2021; 72:33-42. [PMID: 33878812 PMCID: PMC8372765 DOI: 10.18597/rcog.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/22/2022]
Abstract
Objetivo: Definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: Estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG Resultados: Participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: Es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.
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Wood SN, Karp C, Zimmerman L. Women's sexual experiences as a side effect of contraception in low- and middle-income countries: evidence from a systematic scoping review. Sex Reprod Health Matters 2021; 28:1763652. [PMID: 32530748 PMCID: PMC7888024 DOI: 10.1080/26410397.2020.1763652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Contraception is essential to preventing unintended pregnancy. While contraceptive use has increased significantly over the past decade, discontinuation and gaps in use remain common. Although women cite side effects as the reason for discontinuing or stopping methods, little is known about the specific ways in which contraception affects women's sexual experiences. This systematic scoping review aimed to understand how contraceptive-induced side effects relating to women's sexual experiences have been measured, classified, and explored in the literature, specifically in low- and middle-income countries (LMICs). Studies were eligible for inclusion if they were peer-reviewed, English-language articles published between 2003 and 2018 that examined women's sexual experiences related to their use of modern contraception, including sexual satisfaction, arousal, sexual dysfunction, discomfort, vaginal dryness, sexual frequency, and relationship or partner dynamics. Study populations were restricted to women of reproductive age in LMICs. Twenty-two studies were deemed eligible for inclusion, comprising a range of methods and geographies. Emergent sexual experience themes included: menstrual issues impacting sexual experience; libido; lubrication; sexual pleasure; dyspareunia; and female sexual function. Results highlight the variability in measures used, lack of a women-centred perspective, and void in research outside of high-income countries to study the influence of contraception on women's sexual experiences. Very few studies focused on women's sexual experiences as the primary outcome or predictor. Providers should adopt woman-centred contraceptive counselling that considers women's relationships. Further research is needed to disentangle the nuanced effects of contraception on women's sex lives, contraceptive decision-making, and method continuation.
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Affiliation(s)
- Shannon N Wood
- Assistant Scientist, Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Assistant Scientist, Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Linnea Zimmerman
- Assistant Professor, Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Jensen MCH, Jørgensen L, Gemzell-Danielsson K, Sundström Poromaa I, Schroll JB. Hormonal contraceptive use and depression. Hippokratia 2021. [DOI: 10.1002/14651858.cd013838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Inger Sundström Poromaa
- Women's and Children's Health, Research Group; Reproductive Health; Uppsala University; Hvidovre Denmark
| | - Jeppe B Schroll
- Department of Obstetrics and Gynaecology; Copenhagen University Hospital Hvidovre; Hvidovre Denmark
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Schaefer M, Iravani B. No Evidence That Hormonal Contraceptives Affect Chemosensory Perception. Iperception 2021; 12:2041669520983339. [PMID: 33613953 PMCID: PMC7871097 DOI: 10.1177/2041669520983339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/03/2020] [Indexed: 01/03/2023] Open
Abstract
The use of oral contraceptives (OC) in the form of a hormonal pill has been widespread for decades. Despite its popularity and long-time use, there is still much ambiguity and anecdotal reports about a range of potential side effects. Here, we addressed the potential effect of OC use on chemosensory perception. Previous research has almost exclusively focused on olfaction, but we expanded this to the trigeminal system and the sense of taste. We used Bayesian statistics to compare the olfactory, trigeminal, and taste detection abilities between a group of 34 normal cycling women and a group of 26 women using OC. Our results indicated that odor, trigeminal, and taste thresholds were not affected by the use of OC. Moreover, neither odor perception, nor taste perception was affected; all with Bayes factors consistently favoring the null hypothesis. The only exception to these results was odor identification where Bayes factors indicated inconclusive evidence. We conclude that effects of OC use on chemosensory perception are unlikely, and if present, likely are of no to little behavioral relevance.
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Affiliation(s)
- Martin Schaefer
- Martin Schaefer, Karolinska Institutet, Tomtebodavägen 18A, Stockholm 171 77, Sweden.
| | - Behzad Iravani
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Abstract
While contraceptive drugs have enabled many people to decide when they want to have a baby, more than 100 million unintended pregnancies each year in the world may indicate the contraceptive requirement of many people has not been well addressed yet. The vagina is a well-established and practical route for the delivery of various pharmacological molecules, including contraceptives. This review aims to present an overview of different contraceptive methods focusing on the vaginal route of delivery for contraceptives, including current developments, discussing the potentials and limitations of the modern methods, designs, and how well each method performs for delivering the contraceptives and preventing pregnancy.
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Robert CA, Caraballo-Rivera EJ, Isola S, Oraka K, Akter S, Verma S, Patel RS. Demographics and Hospital Outcomes in American Women With Endometriosis and Psychiatric Comorbidities. Cureus 2020; 12:e9935. [PMID: 32968596 PMCID: PMC7505646 DOI: 10.7759/cureus.9935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives To explore sociodemographic differences and hospital outcomes in endometriosis patients with versus without psychiatric comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012-2014), and included 63,160 females with primary diagnosis of endometriosis. We used descriptive statistics and Pearson’s chi-square test to measure the differences in demographics and utilization of gynecologic procedures by the presence of psychiatric comorbidities. Results Psychiatric comorbidities were present in 18.7% inpatients with endometriosis. About three-fourth of these inpatients were in reproductive age group 26-45 years (75.7%) and were whites (79.1%). Psychiatric comorbidities were seen more in females from middle-income families and from the midwest region of the US. There was no significant difference in the utilization of gynecological procedures by the presence of psychiatric comorbidities. However, inpatients with psychiatric comorbidities had a longer mean length of stay (2.5 vs. 2.3 days) and total charges ($35,489 vs. $34,673) compared to the non-psychiatric cohort. Anxiety disorders predominated at 45% in patients with endometriosis followed by depressive disorder (31.3%), psychotic disorders (12.3%), and drug abuse (6.3%). Conclusion Endometriosis with psychiatric comorbidities is prevalent in young white females from a middle-income family. Anxiety and depressive disorders are most prevalent and are associated with extended hospitalization stay and higher charges, thereby negatively impacting the healthcare burden compared to those without psychiatric comorbidities.
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Affiliation(s)
| | | | - Sasank Isola
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Kosisochukwu Oraka
- Medicine, Vinnytsia National Medical University, N.I Pirogov, Vinnytsia, UKR
| | - Sabiha Akter
- Psychiatry, Bergen New Bridge Medical Center, Paramus, USA
| | - Shikha Verma
- Psychiatry and Behavioral Health, Rosalind Franklin University, North Chicago, USA.,Child and Adolescent Psychiatry, Rogers Behavioral Health, Kenosha, USA
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Guo MY, Sodhi M, Khosrow-Khavar F, Etminan M. Risk of sexual dysfunction with progestin-based contraceptives in women of child-bearing age. Eur J Clin Pharmacol 2020; 77:133-140. [PMID: 32803291 DOI: 10.1007/s00228-020-02983-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine whether there is a positive association between sexual dysfunction (SD) and different types of progestin-based contraceptives. METHODS Nested case-control study in women of child-bearing age (15-45 years) from the IQVIA® Ambulatory electronic medical record database from 2008 to 2018. Cases defined by diagnosis of sexual dysfunction identified by international classification for disease clinical modification code 9th and 10th. Each case was matched to four controls and rates of prescriptions of the following were compared: levonorgestrel intra-uterine device (IUD), progestin, and ethinyl estradiol (EE) combined oral contraceptive (COC) formulations including levonorgestrel, norgestimate, drospirenone, desogestrel, norethindrone, and norgestrel; etonogestrel vaginal ring; and medroxyprogesterone injection. RESULTS Overall, 6689 cases of patients with SD were matched to 26,756 matched controls. Compared with matched controls, more subjects with SD used levonorgestrel IUD (OR 1.24, 95% CI 1.08-1.44), EE-levonorgestrel COC (OR 1.18, 95% CI 1.00-1.41), EE-drospirenone (OR 1.28, 95% CI 1.00-1.67), and medroxyprogesterone (OR 1.38, 95% CI 1.12-1.70). The use of norgestrel exhibited a protective effect (OR 0.83, 95% CI 0.73-0.95). When using the EE-levonorgestrel COC as a comparator, norgestrel users exhibited a protective effect (OR 0.70, 95% CI 0.57-0.87) while no other contraceptives showed a statistically significant difference in association with SD. CONCLUSION Our study found an increase in the use of levonorgestrel (COC and IUD), drospirenone, and medroxyprogesterone in subjects with SD. The risk of contraceptives did not differ when compared with oral levonorgestrel. The small association size and lack of difference between drug formulations suggest a minimal impact of progestin-based contraceptives on sexual dysfunction.
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Affiliation(s)
- Michael Y Guo
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Mohit Sodhi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Department of Anesthesia, Pharmacology and Therapeutics, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada
| | - Farzin Khosrow-Khavar
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, Department of Anesthesia, Pharmacology and Therapeutics, The Eye Care Center, University of British Columbia, Room 323-2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
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Huang M, Li G, Liu J, Li Y, Du P. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020; 17:1942-1955. [PMID: 32694069 DOI: 10.1016/j.jsxm.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/09/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND A growing body of research investigates the sexual functioning status in women with contraceptives use; however, the evidence is still inconclusive. AIM To examine whether contraceptives use is associated with a higher risk of female sexual dysfunction (FSD). METHODS The electronic databases MEDLINE, Embase, Cochrane Library databases, and PsychINFO were systematically screened for eligible studies before December 2019. We only included those studies assessing women's sexual functioning by the Female Sexual Function Index (FSFI). This study was registered on the PROSPERO (ID: CRD42020167723, http://www.crd.york.ac.uk/PROSPERO). OUTCOMES The strength of the association between contraceptives use and risk of FSD was presented by calculating the standard mean dierences (SMDs) and the relative risk (RR) with a 95% confidence interval (CI). The pooled results were calculated using a random-effects model. RESULTS A total of 12 studies (7 cross-sectional studies, 3 cohorts, and 1 case-control study) involving 9,427 participants were included. The mean age in the contraceptive users ranged from 22.5 ± 2.4 years to 38.2 ± 4.6 years, while the mean age in the nonusers was 22.5 ± 2.4 years to 36.0 ± 1.0 years. Pooled results showed that no significant difference in the total FSFI scores was observed between contraceptives use and noncontraception (SMD = -1.03, 95% CI: -2.08 to 0.01, P = .053; heterogeneity: I2 = 98.2%, P < .001). In line with this finding, the pooled RR also yielded no association between contraception use and the risk of FSD (RR = 1.29, 95% CI: 0.72-2.28, P = .392; heterogeneity: I2 = 76.0%, P = .0015). However, the subscale sexual desire showed a significant reduction in women who received contraceptives than those did not use contraception (SMD = -1.17, 95% CI: -2.09 to -0.24, P = .014; heterogeneity: I2 = 97.7%, P < .001), while no significant differences were found in sexual arousal, lubrication, orgasm, satisfaction, and pain domain. CLINICAL IMPLICATIONS Though evidence from this meta-analysis did not support an association between contraceptives use and the risk of FSD, the sexual desire could be significantly impaired by contraceptives use. STRENGTHS & LIMITATIONS This is the first meta-analysis quantifying the relationship between contraceptives use and the risks of FSD. However, substantial heterogeneities were presented across the included studies. CONCLUSION No direct association between contraceptives use and the risk of FSD was found. Nevertheless, declining sexual desire was significantly associated with contraceptives use. Additional double-blind, randomized, placebo-controlled trials are still warranted. Huang M, Li G, Liu J, et al. Is There an Association Between Contraception and Sexual Dysfunction in Women? A Systematic Review and Meta-analysis Based on Female Sexual Function Index. J Sex Med 2020;17:1942-1955.
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Affiliation(s)
- Minger Huang
- Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Guangqing Li
- Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Jiajun Liu
- Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Yingxiong Li
- Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Pei Du
- Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China.
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Standeven LR, McEvoy KO, Osborne LM. Progesterone, reproduction, and psychiatric illness. Best Pract Res Clin Obstet Gynaecol 2020; 69:108-126. [PMID: 32723604 DOI: 10.1016/j.bpobgyn.2020.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 12/26/2022]
Abstract
Mood and anxiety disorders are vastly overrepresented in women, and one important contributor to these differences is the fluctuation in sex steroids in women during the reproductive years. Considerable evidence supports a role for abnormal sensitivity to these hormonal fluctuations for some women, who develop mood symptoms associated with reproductive transitions. This chapter presents evidence of the role of endogenous progesterone and its metabolites in such mood symptoms, and then goes on to cover the evidence concerning exogenous progesterone's effects on mood. Overall, the literature does not support an association between exogenous progesterone and negative mood in the general population, but does indicate that subset of women may be vulnerable to such effects. Research is lacking on women with psychiatric illness.
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Affiliation(s)
- Lindsay R Standeven
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Lauren M Osborne
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Not All Progestins are Created Equally: Considering Unique Progestins Individually in Psychobehavioral Research. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2020. [DOI: 10.1007/s40750-020-00137-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Gomez AM, Arteaga S, Aronson N, Goodkind M, Houston L, West E. No Perfect Method: Exploring How Past Contraceptive Methods Influence Current Attitudes Toward Intrauterine Devices. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1367-1378. [PMID: 31429033 DOI: 10.1007/s10508-019-1424-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 05/22/2023]
Abstract
Little research on contraceptive decision-making takes a holistic perspective to understand women's contraceptive journeys throughout the reproductive life course. This analysis investigated how Black and Latina women's past experiences with contraceptive use and acquisition impact their feelings and attitudes toward future use of intrauterine devices (IUDs). We utilized data from in-depth interviews that explored contraceptive decision-making and knowledge of, interest in, and attitudes toward IUDs among 38 young Black and Latina women collected in 2013 in the San Francisco Bay Area. Here, we focused on the IUD decision-making process among a subsample of 32 women who were not using or had not previously used an IUD. Overall, we found a strong link between past contraceptive experiences and attitudes regarding future use of IUDs. Notably, participants often referenced experiences of side effects with previous methods when explaining their interest-or lack thereof-in IUD use, as well as made links between contraceptive attributes they had experienced positively and attributes of the IUD. A minority of participants described being satisfied with their current method, resulting in a lack of interest in considering IUD use. More than half of participants described distrust, either in healthcare providers owing to previous negative interactions and contraceptive failures of provider-recommended methods or owing to family members' and friends' negative experiences with IUDs. This distrust undergirded their lack of interest in the IUD. These findings highlight the importance of locating contraceptive decision-making in the broader context of reproductive journeys.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Natasha Aronson
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Molly Goodkind
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Livia Houston
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
| | - Erica West
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, USA
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Malmborg A, Brynte L, Falk G, Brynhildsen J, Hammar M, Berterö C. Sexual function changes attributed to hormonal contraception use - a qualitative study of women experiencing negative effects. EUR J CONTRACEP REPR 2020; 25:169-175. [PMID: 32216483 DOI: 10.1080/13625187.2020.1736545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To increase the understanding of women who experience negative effects on sexual function when using hormonal contraception.Methods: We performed 24 in-depth interviews with women who had previously experienced negative sexual function effects while using hormonal contraceptives. The thematic analysis method was used.Results: 'After experience comes insight', 'Lubrication and desire go hand in hand', 'Mental wellbeing comes before desire' and 'The contraceptive counsellor potentially facilitates insight and decision-making' were the main themes found in the study.Conclusions: This selected group of women described lubrication difficulties and decreased sexual desire associated with both contraceptive use and the menstrual cycle. Contraceptive use became easier with age and with better understanding. The contraceptive counsellor could facilitate the process. Further choice between hormonal or non-hormonal contraceptive methods depended primarily on experienced adverse effects on mood, and secondarily on sexual function, weighed against the advantages or disadvantages experienced during the person's own menstrual cycle.
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Affiliation(s)
- Agota Malmborg
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Louise Brynte
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gabriella Falk
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jan Brynhildsen
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mats Hammar
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Quality of life and mental health in adolescent users of oral contraceptives. Results from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Qual Life Res 2020; 29:2209-2218. [PMID: 32144614 PMCID: PMC7363664 DOI: 10.1007/s11136-020-02456-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/17/2022]
Abstract
Objective Using data from the nationwide, cross-sectional KiGGS (German Health Interview and Examination Survey for Children and Adolescents) study, we investigated whether hormonal contraception in adolescents aged 15 to 17 years was linked to health-related quality of life and mental health problems. Methods Study participants had undergone standardized recordings of blood pressure and measurements of serum 25-hydroxyvitamin D [25(OH)D]. Quality of life was assessed by self- and parent-rated KINDL-R questionnaires, whereas mental health problems were screened by means of the Strengths and Difficulties Questionnaire (SDQ). Results Self-rated quality of life was similar between users (n = 522) and non-users (n = 1173, 69.2%) of oral contraceptives (69.2 ± 11.2 vs. 69.2 ± 11.0, p = 0.943), as was the parent-rated version (72.9 ± 10.6 vs. 72.9 ± 10.5, p = 0.985). Likewise, no significant differences were observed between the two groups with respect to both self- (10.9 ± 4.4 vs. 10.8 ± 4.6, p = 0.732) and parent-rated SDQ scores (7.2 ± 4.8 vs. 7.0 ± 4.6. p = 0.390). However, serum 25(OH)D (59.5 ± 32.9 vs. 46.1 ± 28.0 nmol/L, p < 0.001) and mean arterial blood pressure (88.2 ± 7.4 vs. 86.5 ± 7.7 mmHg, p < 0.001) were significantly higher in users than in non-users. There was a trend towards a higher rate of psychotropic drug prescription in participants taking oral contraceptive pills as compared to those not receiving hormonal contraception (17.8% vs. 14.4%, p = 0.052). A series of linear regression models with either KINDL-R or SDQ as dependent variable confirmed that there were no associations between components of mental well-being and contraceptive drug use, irrespective of whether self- or parent-ratings were included in these models. Conclusions In a large, representative sample of German adolescents, exposure to exogenous contraceptive hormones was associated with higher arterial blood pressure and serum 25(OH)D concentration, whereas hormonal contraception was not linked to health-related quality of life or mental well-being.
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