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Palma F, Costa AR, Neves J, Pacheco A, Almeida MC, Bombas T, Silva DP. Perception of oral contraception – do women think differently from gynaecologists? EUR J CONTRACEP REPR 2023; 28:125-131. [PMID: 36971323 DOI: 10.1080/13625187.2023.2185482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE This study aimed to assess the experience and satisfaction with contraceptives and use of Combined Oral Contraceptives (COC) by women and compare their perceptions with those of gynaecologists. METHODS This was a multicentre survey study conducted in Portugal, during April and May, 2021 with women using contraceptives and gynaecologists. Online quantitative questionnaires were carried out. RESULTS A total of 1508 women and 100 gynaecologists were included. Cycle control was the pill non-contraceptive benefit most valued by gynaecologists and women. For gynaecologists, the main pill concern was the risk of thromboembolic events, but they believed that weight gain was the main concern for their patients. The pill was the most used contraceptive (70%) and women were largely (92%) satisfied. The pill was associated with health risks for 85% of users, mainly thrombosis (83%), weight gain (47%), and cancer (37%). The attributes of the pill most valued by women are contraceptive efficacy (82%), followed by low risk of thromboembolic events (68%), good cycle control (60%), non-interference with libido and mood (59%) and weight (53%). CONCLUSION Most women use contraceptive pills and are generally satisfied with their contraceptive. Cycle control was the most valued non-contraceptive benefit for gynaecologists and women, agreeing with physicians' beliefs about women. On the other hand, contrary to physicians' beliefs, that women's main concern is weight gain, women are mainly concerned with risks associated with contraceptives. Thromboembolic events are women's and gynaecologists most valued risk. Finally, this study indicates the need for physicians to better understand what COC users really fear.
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Oguz SH, Yildiz BO. An Update on Contraception in Polycystic Ovary Syndrome. Endocrinol Metab (Seoul) 2021; 36:296-311. [PMID: 33853290 PMCID: PMC8090477 DOI: 10.3803/enm.2021.958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in reproductive-aged women, characterized by hyperandrogenism, oligo/anovulation, and polycystic ovarian morphology. Combined oral contraceptives (COCs), along with lifestyle modifications, represent the first-line medical treatment for the long-term management of PCOS. Containing low doses of estrogen and different types of progestin, COCs restore menstrual cyclicity, improve hyperandrogenism, and provide additional benefits such as reducing the risk of endometrial cancer. However, potential cardiometabolic risk associated with these agents has been a concern. COCs increase the risk of venous thromboembolism (VTE), related both to the dose of estrogen and the type of progestin involved. Arterial thrombotic events related to COC use occur much less frequently, and usually not a concern for young patients. All patients diagnosed with PCOS should be carefully evaluated for cardiometabolic risk factors at baseline, before initiating a COC. Age, smoking, obesity, glucose intolerance or diabetes, hypertension, dyslipidemia, thrombophilia, and family history of VTE should be recorded. Patients should be re-assessed at consecutive visits, more closely if any baseline cardiometabolic risk factor is present. Individual risk assessment is the key in order to avoid unfavorable outcomes related to COC use in women with PCOS.
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Affiliation(s)
- Seda Hanife Oguz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent Okan Yildiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
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San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, Martín-Moreno JM, Rico-Campà A, Gea A. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond) 2019; 44:320-329. [PMID: 31467420 DOI: 10.1038/s41366-019-0442-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The use of oral contraceptives (OC) has been suggested to represent a potential risk factor for the development of obesity. However, the available literature assessing the relationship between OC use and the development of obesity is still scarce and characterised by controversial heterogeneity. We prospectively evaluated the association between the use of OC and the development of obesity in female participants of a middle-aged and free-living cohort. METHODS The study population included 4920 female Spanish university graduates, initially nonobese women, with mean age (standard deviation) 28.2 (5.4) years. The study population was followed up for a mean of 8.6 (3.7) years. Self-reported use of OC and body mass index were assessed at baseline and biennially during follow-up. We used generalized estimating equation models to evaluate the association between exposure to OC and the development of obesity. RESULTS After adjusting for potential confounders, baseline OC use was associated with higher odds of new-onset obesity during the full follow-up period (multivariable-adjusted odds ratio [OR] = 1.78; 95% Confidence Interval [CI]: 1.01-3.15). The continued use of OC for periods of time longer than 2 years was significantly associated with a higher risk of developing obesity (OR = 2.82, 95% CI: 1.17-6.82). CONCLUSIONS According to our prospective cohort study, OC use is significantly associated with higher odds of obesity development, especially when the use of OC is steady and extends over periods of more than 2 years.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Miguel A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - José M Martín-Moreno
- Department of Preventive Medicine & INCLIVA, University of Valencia, Valencia, Spain
| | - Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain. .,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain. .,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
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Zgliczynska M, Szymusik I, Sierocinska A, Bajaka A, Rowniak M, Sochacki-Wojcicka N, Wielgos M, Kosinska-Kaczynska K. Contraceptive Behaviors in Polish Women Aged 18-35-a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2723. [PMID: 31366184 PMCID: PMC6695758 DOI: 10.3390/ijerph16152723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
The aim was to evaluate contraceptive behaviors, and factors affecting them, in the population of Polish-speaking women. A cross-sectional study was performed on 6763 women, current contraceptive users, aged 18 to 35. An anonymous and voluntary questionnaire written in Polish, containing 33 questions, was distributed online from January to February 2017. The Internet and doctors were the most popular sources of information about contraception (82% and 73%, respectively). Upon choosing contraception, women paid the most attention to its efficacy (85%) and its impact on health (59%). The most common methods were combined oral contraceptives (38%) and condoms (24%). In total, 51% had chosen hormonal contraception, of which 68% experienced side effects. The most frequent were decreased libido (39%) and weight gain (22%). Factors associated with the usage of hormonal or non-hormonal contraception were: education, relationship status, parenthood, number of sexual partners, frequency of intercourses, sources of information about contraception, and factors considered most important when choosing a contraceptive method. The choice between short-acting and long-acting reversible contraception was influenced by age, relationship status, parenthood, smoking, sources of information about contraception, and factors considered most important when choosing a contraceptive method. Wide access to contraception, high-quality education, and counselling should become priorities in family planning healthcare.
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Affiliation(s)
- Magdalena Zgliczynska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Iwona Szymusik
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland.
| | - Aleksandra Sierocinska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Armand Bajaka
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Martyna Rowniak
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Nicole Sochacki-Wojcicka
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Miroslaw Wielgos
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Katarzyna Kosinska-Kaczynska
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
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de Medeiros SF. Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome. Reprod Biol Endocrinol 2017; 15:93. [PMID: 29216881 PMCID: PMC5721684 DOI: 10.1186/s12958-017-0313-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a complex condition with high risk for dyslipidemia, dysglycemia, venous thromboembolism, cardiovascular disease and metabolic syndrome. Because the combined oral contraceptive (COC) use has also been associated with impaired fasting glucose, insulin resistance and increased risk of thromboembolism disease, it is rationale to think that the combination of oral contraceptive and PCOS could make it worse or increase the risks. OBJECTIVE To examine the current data regarding potential additional risks and benefits of contraceptive use, highlights the major gap in knowledge for designing future studies and, when possible, suggests an adequate COC formulation for a determined PCOS phenotype. METHODS English-language publications reporting on the influence of COCS in the development of venous thromboembolism in PCOS patients published until 2017 were searched using PubMed, Cochrane database, and hand search of references found in consulted articles. Ranges of collected data are given; the pooled data are presented as median and first and third quartiles. Wilcoxon signed-ranks test for paired samples was used to compare before-after original data. P value was set at 0.05. RESULTS Most of COCs preparations significantly decrease androgens, and increase sex-hormone binding globulin. Therefore, the benefits of COCs are clear in patients with proved hyperandrogenemia. Regarding the impact of COCs on carbohydrate metabolism of PCOS subjects, the data were inconsistent but they tended to show no additional risk. Regarding lipids, most COCs consistently increased high-density lipoprotein cholesterol, triglycerides and total cholesterol concentrations but the clinical implications of these changes need additional studies. CONCLUSION The review showed consistent beneficial effect of COCs, particularly for hyperandrogenemic PCOS patients. The benefit size of COC's use by normoandrogenemic PCOS patients is uncertain and need more investigation. The effects of COC use on carbohydrate metabolism of women with PCOS are still unresolved since most studies are observational but the current results demonstrated that COCs do not make their levels worse and may improve insulin sensitivity. The impact of COCs on lipids of PCOS patients seems to be clearer and most preparations increase total cholesterol, high-density lipoprotein cholesterol and triglycerides. In summary, it is important to balance the potential benefits and risks of the COCs individually before prescribing them for PCOS women.
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Affiliation(s)
- Sebastião Freitas de Medeiros
- Department of Gynecology and Obstetrics, Medical School, Federal University of Mato Grosso, Cuiabá, MT, 78055-728, Brazil.
- Tropical Institute of Reproductive Medicine, Cuiabá, MT, Brazil.
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Kobayashi T, Sugiura K, Ojima T. Risks of thromboembolism associated with hormone contraceptives in Japanese compared with Western women. J Obstet Gynaecol Res 2017; 43:789-797. [PMID: 28422361 DOI: 10.1111/jog.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
We extracted 581 thromboembolic events associated with combined oral contraceptives (COC) that occurred between 2004 and 2013 in Japan, from the Pharmaceuticals and Medical Devices Agency database. The most common thromboembolic events associated with COC were deep vein thrombosis, pulmonary embolism and their combination. The reported thromboembolic events increased year by year, in association with an increase in the quantity of prescribed low-dose estrogen progestin after approval for health insurance coverage for dysmenorrhea in 2008 in Japan. The incidence of venous thromboembolism (VTE) in Japanese COC users is estimated to be lower compared with their Western counterparts. In contrast, the frequency of all thromboembolic events peaked at 90 days from the start of COC, as in Western studies. The risk of VTE in the overweight group (body mass index ≥ 25 kg/m2 ) was more than twofold higher than in the standard group, and age-specific incidence rate rose sharply after the age of 40. There were different VTE risks according to progestin type in Japan as in Western countries, but a definite conclusion about risk according to progestin type was not able to be reached at present. As for the risk of arterial embolism and thrombosis, the difference by progestin type was small, but it became higher at ≥50 years of age. Last, mortality rate caused by thromboembolism is extremely low among COC users.
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Affiliation(s)
- Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Kazuko Sugiura
- Department of Reproductive Health Nursing/Midwifery, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Lindh I, Hognert H, Milsom I. The changing pattern of contraceptive use and pregnancies in four generations of young women. Acta Obstet Gynecol Scand 2017; 95:1264-1272. [PMID: 27538740 DOI: 10.1111/aogs.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/13/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to describe contraceptive use and pregnancies and their relationship to socio-economic status (SES) in four generations of young Swedish women. MATERIAL AND METHODS Questionnaires regarding contraceptive use and pregnancies were sent to random samples of 19-year-old women in 1981, 1991, 2001 and 2011 (n = 4732). RESULTS Current contraceptive use was higher in 2001 (78%) (p < 0.01) and 2011 (69%) (p < 0.05) compared with 1981 (60%) and 1991 (62%). Combined hormonal contraception (CHC) was the most common form of contraception throughout (p < 0.0001). The use of long-acting reversible contraception (LARC = implants, intrauterine contraception) and progestogen-only pills increased over time (p < 0.01). Mental side effects as a reason for CHC cessation increased over time and was the most common reason for cessation of CHC in 2011 (p < 0.001). Contraceptive use was lower in women from low SES areas (p < 0.05) in 2011. The percentage of young women who had been pregnant at ≤19 years of age was lower (p < 0.05) in the assessment from 2001 (7%) than in that in 1991 (13%) and 2011 (12%). The proportion of teenage mothers decreased from 4.4% (1981) to 1.6% (2011) (p < 0.01). More women had been pregnant at ≤19 years of age in low SES areas than in middle and high SES areas (p < 0.05). CONCLUSIONS The lowest pregnancy rate was in the cohort with the highest contraceptive use. Term pregnancies declined over time. A greater number of pregnancies in low SES areas and a change towards lower contraceptive use in low SES areas was recorded in 2011.
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Affiliation(s)
- Ingela Lindh
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Helena Hognert
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Agnew MK, Asa CS, Clyde VL, Keller DL, Meinelt A. A survey of bonobo (Pan paniscus) oral contraceptive pill use in North American zoos. Zoo Biol 2016; 35:444-453. [DOI: 10.1002/zoo.21310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mary K. Agnew
- AZA Reproductive Management Center; Saint Louis Zoo; St. Louis Missouri
| | - Cheryl S. Asa
- AZA Reproductive Management Center; Saint Louis Zoo; St. Louis Missouri
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Risks of thromboembolism associated with hormonal contraceptives related to body mass index and aging in Japanese women. Thromb Res 2016; 137:11-16. [DOI: 10.1016/j.thromres.2015.11.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022]
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Canadian Contraception Consensus Chapter 2 Contraceptive Care and Access. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:S13-S19. [DOI: 10.1016/s1701-2163(16)39371-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Brötzner CP, Klimesch W, Doppelmayr M, Zauner A, Kerschbaum HH. Resting state alpha frequency is associated with menstrual cycle phase, estradiol and use of oral contraceptives. Brain Res 2014; 1577:36-44. [PMID: 25010817 PMCID: PMC4152552 DOI: 10.1016/j.brainres.2014.06.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/10/2014] [Accepted: 06/27/2014] [Indexed: 11/22/2022]
Abstract
Ongoing intrinsic brain activity in resting, but awake humans is dominated by alpha oscillations. In human, individual alpha frequency (IAF) is associated with cognitive performance. Noticeable, performance in cognitive and emotional tasks in women is associated with menstrual cycle phase and sex hormone levels, respectively. In the present study, we correlated frequency of alpha oscillation in resting women with menstrual cycle phase, sex hormone level, or use of oral contraceptives. Electroencephalogram (EEG) was recorded from 57 women (aged 24.07 ± 3.67 years) having a natural menstrual cycle as well as from 57 women (aged 22.37 ± 2.20 years) using oral contraceptives while they sat in an armchair with eyes closed. Alpha frequency was related to the menstrual cycle phase. Luteal women showed highest and late follicular women showed lowest IAF or center frequency. Furthermore, IAF as well as center frequency correlated negatively with endogenous estradiol level, but did not reveal an association with endogenous progesterone. Women using oral contraceptives showed an alpha frequency similar to women in the early follicular phase. We suggest that endogenous estradiol modulate resting alpha frequency.
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Affiliation(s)
- Christina P Brötzner
- Department of Cell Biology, University of Salzburg, Salzburg, Austria; Department of Physiological Psychology, University of Salzburg, Salzburg, Austria
| | - Wolfgang Klimesch
- Department of Physiological Psychology, University of Salzburg, Salzburg, Austria; Center for Neurocognitive, Research, University of Salzburg, Salzburg, Austria
| | - Michael Doppelmayr
- Center for Neurocognitive, Research, University of Salzburg, Salzburg, Austria; Department of Sportscience, University of Mainz, Mainz, Germany
| | - Andrea Zauner
- Department of Physiological Psychology, University of Salzburg, Salzburg, Austria
| | - Hubert H Kerschbaum
- Department of Cell Biology, University of Salzburg, Salzburg, Austria; Center for Neurocognitive, Research, University of Salzburg, Salzburg, Austria.
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Rashid M, Kader M. Parental Gender Equality and Use of Oral Contraceptives Among Young Women: A Longitudinal, Population-based Study in Sweden. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:309-14. [PMID: 25077078 PMCID: PMC4114007 DOI: 10.4103/1947-2714.136905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little is known about how parental gender equality early in their children lives can influence daughters' decision to use contraceptive pills. AIM The study aimed at exploring whether maternal working time and paternity leave in Sweden during the first two years of their daughters' lives is associated with the use of oral contraceptives when they are adolescents or young adults. MATERIALS AND METHODS The study population was selected from a cohort of all Swedish fathers and mothers who had their first child together between 1988 and 1989 (n = 57,520 family units). Multivariate logistic regression was used to estimate the association. RESULTS Mothers' longer working time was mildly associated with daughters' oral contraceptive pill use, though no clear trend was observed. Longer paternity leave periods (>30 days) were not associated with use of oral contraceptives among their daughters, but 1-30 day periods showed a mild positive association. CONCLUSION For maternal working time, there seems to be an association, but trends by working hours are not clear. There is no clear association between paternity leave during the first two years of their daughters' life and the use of oral contraceptives when they are adolescents and young adults.
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Affiliation(s)
- Mamunur Rashid
- Departments of Public Health Sciences, Karolinska Institute, Stockholm, Sweden ; Division of Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Manzur Kader
- Departments of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Asare GA, Santa S, Ngala RA, Asiedu B, Afriyie D, Amoah AG. Effect of hormonal contraceptives on lipid profile and the risk indices for cardiovascular disease in a Ghanaian community. Int J Womens Health 2014; 6:597-603. [PMID: 24940082 PMCID: PMC4051713 DOI: 10.2147/ijwh.s59852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Hormonal contraceptives (HCs) have been shown to alter lipid profile among various population groups with different patterns of dyslipidemia and cardiovascular (CV) risk. The study aimed at determining the lipid profile pattern and CV risk in a Ghanaian cohort. Methods Purposive random sampling was done. Forty-seven and 19 cases were on oral contraceptives (OCs) and injectable contraceptives (ICs), respectively; five were on subdermal implant. Twenty-four non-users served as controls. Biodemographic and lipid profiles were determined. Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), and very-low-density lipid lipoprotein cholesterol (VLDLC), were determined. Castelli index I and II were calculated. Results The mean age difference between the HC and control groups was insignificant. However, diastolic blood pressure (BP) differences were significant (P=0.006). The body mass index (BMI) of the OC and IC groups were significantly different from the control group (P=0.003 and P=0.008, respectively). TC levels for the control and case groups were 3.35±0.62 mmol/L and 4.07±0.91 mmol/L, respectively (P=0.002). LDLC levels for the control and case groups were 1.74±0.57 mmol/L and 2.38±0.84 mmol/L, respectively (P=0.003). Castelli index I (TC/HDLC) and II (LDLC/HDLC) were significantly different between the control and OC groups (P=0.026 and P=0.014, respectively). Spearman’s rho correlation showed significant influence of HC use on TG (P=0.026), TC (P=0.000), LDLC (P=0.004), and VLDLC (P=0.026) over time. Conclusion HC use is associated with significant increases in BMI, diastolic BP, TC, LDLC, and Castelli index I and II. These changes carry a potential risk in the development of CV disease.
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Affiliation(s)
- George A Asare
- Department of Medical Laboratory Sciences, University of Ghana School of Allied Health Sciences (SAHS), Korle-bu, Ghana
| | - Sheila Santa
- Department of Medical Laboratory Sciences, University of Ghana School of Allied Health Sciences (SAHS), Korle-bu, Ghana
| | - Robert A Ngala
- Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernice Asiedu
- Department of Medical Laboratory Sciences, University of Ghana School of Allied Health Sciences (SAHS), Korle-bu, Ghana
| | - Daniel Afriyie
- Department of Pharmacology, University of Ghana Medical School Korle-bu, Ghana
| | - Albert Gb Amoah
- Department of Medicine, University of Ghana Medical School, Korle-bu, Ghana
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Domecq JP, Prutsky G, Mullan RJ, Sundaresh V, Wang AT, Erwin PJ, Welt C, Ehrmann D, Montori VM, Murad MH. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98:4646-54. [PMID: 24092830 PMCID: PMC5399491 DOI: 10.1210/jc.2013-2374] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/16/2013] [Indexed: 12/12/2022]
Abstract
CONTEXT Polycystic ovary syndrome (PCOS) is common among women of childbearing age and the available pharmacological therapies have different side-effect profiles. OBJECTIVE We summarized the evidence about the side effects of oral contraceptive pills, metformin, and anti-androgens in women with PCOS. DATA SOURCE Sources included Ovid Medline, OVID EMBASE, OVID Cochrane Library, Web of Science, Scopus, PsycInfo, and CINAHL from inception through April 2011. STUDY SELECTION We included comparative observational studies enrolling women with PCOS who received the agents of choice for at least 6 months and reported adverse effects. DATA EXTRACTION Using a standardized, piloted, and Web-based data extraction form and working in duplicate, we abstracted data from each study and performed meta-analysis when possible. DATA SYNTHESIS We found 22 eligible studies of which 20 were randomized. No study reported severe side effects (eg, lactic acidosis, thromboembolic episodes, liver toxicity, cancer incidence, or pregnancy loss). Meta-analysis demonstrated no significant change in weight in oral contraceptive pills or flutamide users. Indirect evidence from populations without PCOS demonstrated no increased risk of lactic acidosis with metformin, only case reports of liver toxicity with flutamide (no comparative evidence), and increased relative risk difference of venous thromboembolism with oral contraceptive pills but very low absolute risk. Evidence on mortality, cardiovascular mortality, and cancer was inconclusive. CONCLUSIONS Drugs commonly used to treat PCOS appear to be associated with very low risk of severe adverse effects although data are extrapolated from other populations.
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Affiliation(s)
- Juan Pablo Domecq
- MD, MPH, Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
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Efficacy, Safety, and Tolerability of a Monophasic Oral Contraceptive Containing Nomegestrol Acetate and 17β-Estradiol. Obstet Gynecol 2012; 119:989-99. [DOI: 10.1097/aog.0b013e318250c3a0] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Hirschberg AL. Sex hormones, appetite and eating behaviour in women. Maturitas 2012; 71:248-56. [PMID: 22281161 DOI: 10.1016/j.maturitas.2011.12.016] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/23/2011] [Indexed: 01/07/2023]
Abstract
Sex hormones play essential roles in the regulation of appetite, eating behaviour and energy metabolism and have been implicated in several major clinical disorders in women. Estrogen inhibits food intake, whereas progesterone and testosterone may stimulate appetite. This review describes recent findings concerning interactions between sex hormones and neuroendocrinological mechanisms in the control of appetite and eating in women. Furthermore, we are gaining insights into the roles played by sex hormones in the development of eating disorders and obesity. For instance, androgens may promote bulimia by stimulating appetite and reducing impulse control, a proposal supported by the observation that antiandrogenic treatment attenuates bulimic behaviour. Androgens are also involved in the pathophysiology of abdominal obesity in women. On the other hand, hormone replacement therapy with estrogen counteracts the weight gain and accumulation of abdominal fat associated with the menopausal transition. In conclusion, sex hormones and/or agents that exhibit similar activities may provide novel strategies for the treatment of eating disorders and android obesity, two of the most serious health problems for women today.
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Affiliation(s)
- Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
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