The risk of cervical atypia in oral contraceptive users

Contraceptive strategies for reducing the risk of reproductive cancers

Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.

Association of Chlamydia trachomatis infection with cervical atypia in adolescent women with short-term or long-term use of oral contraceptives: a longitudinal study in HPV vaccinated women

OBJECTIVE

We assessed the relationship between Chlamydia trachomatis infection, duration of oral contraceptive (OC) use and cervical atypia among young adult Finnish women.

DESIGN

A longitudinal study.

SETTING AND PARTICIPANTS

Women who were included in this study participated in a community-randomised trial on the effectiveness of human papillomavirus (HPV) vaccination and C. trachomatis screening at ages 18.5 and 22 years in Finland. They completed questionnaires on both visits about sexual behaviours. The cytology test results at age 18.5 and 22 years were also available for those women. The total number of participants in this study at 18.5 years of age were 11 701 and at 22 years of age were 6618.

MAIN OUTCOME MEASURE

ORs with 95% CIs using univariable and multivariable logistic regression were used to assess the association between C. trachomatis infection, duration of OC and squamous intraepithelial lesions (SIL).

RESULTS

There were 940 cytological SIL cases at the first screening visit and 129 cytological SIL cases at the second screening visit. Among the 22 years old, more than fourfold adjusted risk of SIL was associated with C. trachomatis positivity. The HPV16/18, condom use, smoking and number of sexual partners adjusted joint effect of prolonged OC use and C. trachomatis was significantly increased (OR 4.7, 95% CI 1.7 to 12.8) in the 22-year-old women. This observed joint effect was 1.6 times higher than expected on a multiplicative scale. On additive scale, the observed relative excess risk from interaction was 1.8.

CONCLUSION

The risk of SIL in HPV vaccinated women is significantly increased if they are C. trachomatis positive and have used OC for 5 or more years. The biological basis may be lack of condom facilitated protection against sexually transmitted diseases.

TRIAL REGISTRATION NUMBER

NCT00534638.

Pharmacodynamics of combined estrogen-progestin oral contraceptives: 4. Effects on uterine and cervical epithelia

Introduction: Steroid hormones are responsible for specific changes in the endometrium during the menstrual cycle, when they are sequentially secreted and, because of this, in the early days sequential combined oral contraceptive regimens were utilized. The same basic concept has been utilized with multi-phasic regimens, in order to produce endometrial pictures mimicking the normal cycle.Areas covered: The Endometrial effects of progestins and estrogens; combined monophasic high- (50 μg), medium- (30 μg), low- (20 μg), ultralow- (15 μg) estrogen content; sequential regimens; multiphasic combinations; treatment schedules.Cervical effects of combined high-dose and sequential combinations, including evidence for an increase in malignant lesions.Expert opinion: Overall, combined oral contraceptives (COCs) inhibit normal proliferative changes and the endometrium becomes thin, narrow, with widely spaced glands and pre-decidual changes in the stroma. During the first few cycles the progestin induces a coexistence of proliferative and secretory features; with time, the picture changes because the progestin induces a down-regulation of estrogen receptors, resulting in tortuous glands similar to those in the secretory phase, but characterized by a quiescent, atrophic glandular epithelium.In the cervical epithelium, under the influence of high-dose COCs, endocervical glands became hypersecretory and in some instances, distinctive type of atypical polypoid endocervical hyperplasia is found.

Is the risk of cervical atypia associated with the interval between menarche and the start of sexual activity? A population-based cohort study

OBJECTIVE

We investigated whether the risk of cervical atypia is associated with a short interval between the age at first sexual intercourse (FSI) or age at the start of oral contraceptive (OC) use and menarche.

DESIGN

A population-based cohort study.

SETTING

Finnish women in the age range of 16-17 years old were enrolled in the PATRICIA trial of human papillomavirus (HPV) 16/18 vaccine efficacy.

PARTICIPANTS

The association of cervical atypia with the interval between FSI or start of OC use and menarche was assessed in the control arm (hepatitis A vaccinated) who had participated in biannual clinical follow-up visits for 4 years. Altogether, 913 women had normal baseline cervical cytology and answered behavioural questionnaires at enrolment and end of the follow-up.

MAIN OUTCOME MEASURE

ORs with 95% CIs using univariate and multivariable logistic regression were used to assess the association between cervical atypia and the interval between FSI or the start of OC use and menarche.

RESULTS

The mean ages at menarche, FSI and the start of OC use were 12.4, 16.0 and 16.4. Chlamydiatrachomatis infection was associated with an increased risk of cervical atypia in women with a short (<3 years) interval between menarche and FSI/start of OC use (OR 1.8, 95% CI 1.0 to 3.6 and OR 2.2, 95% CI 1.0 to 5.1). Whereas HPV 16/18 infection was associated with increased atypia risk estimates in women with a longer (≥3 years) interval (OR 1.8, 95% CI 1.1 to 2.7 and OR 1.4, 95% CI 1.0 to 2.1). In women with a short interval between menarche and FSI, early age at the start of OC use was not associated with an increased risk of cervical atypia in the univariate (OR 0.7) nor multivariable analyses.

CONCLUSION

Short interval between menarche and the age at start of sexual activity does not increase the risk of HPV-associated cervical atypia.

TRIAL REGISTRATION NUMBER

NCT00122681.