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Li HJ, Esencan E, Song Y, Taylor HS, Cho Y, Vash-Margita A. Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102562. [PMID: 38759792 DOI: 10.1016/j.jogc.2024.102562] [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: 12/12/2023] [Revised: 04/10/2024] [Accepted: 04/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis. METHODS Retrospective chart review of women aged 14-25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis. RESULTS Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix. CONCLUSIONS Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females.
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Affiliation(s)
- Howard J Li
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Ecem Esencan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yue Song
- Yale School of Public Health, Yale University, New Haven, CT, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Yonghee Cho
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alla Vash-Margita
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.
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Bala NS, Stanek JR, Vesely SK, Cronin RM, Creary SE, Roe AH, Xu W, O’Brien SH. Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception. Blood Adv 2023; 7:6140-6150. [PMID: 37585480 PMCID: PMC10582388 DOI: 10.1182/bloodadvances.2023010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Patients with sickle cell disease (SCD) are at a risk of thromboembolism (TE), and use of hormonal contraception can further increase that risk. This study aims to assess patterns of hormonal contraceptive use and compare risk of contraception-related TE between combined hormonal contraceptives (CHCs) and progestin-only contraceptives (POCs). Patients with SCD aged between 12 and 44 years with a new prescription of a hormonal contraceptive in the Centers for Medicare and Medicaid Services Medicaid Analytic eXtract database (2006-2018) were followed up to 1 year. We identified 7173 new users: 44.6% initiated CHC and 55.4% initiated POC. Combined oral contraceptive pills (OCPs; 36.5%) and progestin-only depot medroxyprogesterone acetate (33.9%) were the most frequently prescribed agents. A total of 1.8% of contraception users had a new diagnosis of TE within 1 year of the first identified contraception prescription. There were no significant differences in TE event rates between CHC and POC users (17.2 and 24.7 events per 1000 person-years, respectively). In patients prescribed OCP, there were no differences in TE event rates based on estrogen dose or progestin generation. Transdermal patch had a 2.4-fold increased risk of TE as compared with that of OCP. Although limited by the retrospective study design and use of administrative claims data, this study found no significant differences in TE rates between new users of CHC and POC in patients with SCD. Careful evaluation of underlying TE risk factors should be considered for each patient with SCD before initiation of hormonal contraception.
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Affiliation(s)
- Natasha S. Bala
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
| | - Joseph R. Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma, Oklahoma City, OK
| | - Robert M. Cronin
- Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH
| | - Susan E. Creary
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Wendy Xu
- Division of Health Services Management and Policy, The Ohio State University, College of Public Health, Columbus, OH
| | - Sarah H. O’Brien
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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White L, Losciale JM, Squier K, Guy S, Scott A, Prior JC, Whittaker JL. Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females. Br J Sports Med 2023; 57:1195-1202. [PMID: 37225254 DOI: 10.1136/bjsports-2022-106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. DESIGN Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. ELIGIBILITY Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. RESULTS Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. CONCLUSION Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO CRD42021224582 on 8 January 2021.
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Affiliation(s)
- Lynita White
- Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Guy
- City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Porwal K, Sharma S, Kumar S, Tomar MS, Sadhukhan S, Rajput S, Kulkarni C, Shrivastava A, Kumar N, Chattopadhyay N. Hormonal and non-hormonal oral contraceptives given long-term to pubertal rats differently affect bone mass, quality and metabolism. Front Endocrinol (Lausanne) 2023; 14:1233613. [PMID: 37664835 PMCID: PMC10470083 DOI: 10.3389/fendo.2023.1233613] [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: 06/02/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction We investigated the effects of hormonal and non-hormonal oral contraceptives (OCs) on bone mass, mineralization, composition, mechanical properties, and metabolites in pubertal female SD rats. Methods OCs were given for 3-, and 7 months at human equivalent doses. The combined hormonal contraceptive (CHC) was ethinyl estradiol and progestin, whereas the non-hormonal contraceptive (NHC) was ormeloxifene. MicroCT was used to assess bone microarchitecture and BMD. Bone formation and mineralization were assessed by static and dynamic histomorphometry. The 3-point bending test, nanoindentation, FTIR, and cyclic reference point indentation (cRPI) measured the changes in bone strength and material composition. Bone and serum metabolomes were studied to identify potential biomarkers of drug efficacy and safety and gain insight into the underlying mechanisms of action of the OCs. Results NHC increased bone mass in the femur metaphysis after 3 months, but the gain was lost after 7 months. After 7 months, both OCs decreased bone mass and deteriorated trabecular microarchitecture in the femur metaphysis and lumbar spine. Also, both OCs decreased the mineral: matrix ratio and increased the unmineralized matrix after 7 months. After 3 months, the OCs increased carbonate: phosphate and carbonate: amide I ratios, indicating a disordered hydroxyapatite crystal structure susceptible to resorption, but these changes mostly reversed after 7 months, indicating that the early changes contributed to demineralization at the later time. In the femur 3-point bending test, CHC reduced energy storage, resilience, and ultimate stress, indicating increased susceptibility to micro-damage and fracture, while NHC only decreased energy storage. In the cyclic loading test, both OCs decreased creep indentation distance, but CHC increased the average unloading slope, implying decreased microdamage risk and improved deformation resistance by the OCs. Thus, reduced bone mineralization by the OCs appears to affect bone mechanical properties under static loading, but not its cyclic loading ability. When compared to an age-matched control, after 7 months, CHC affected 24 metabolic pathways in bone and 9 in serum, whereas NHC altered 17 in bone and none in serum. 6 metabolites were common between the serum and bone of CHC rats, suggesting their potential as biomarkers of bone health in women taking CHC. Conclusion Both OCs have adverse effects on various skeletal parameters, with CHC having a greater negative impact on bone strength.
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Affiliation(s)
- Konica Porwal
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
| | - Shivani Sharma
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Saroj Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | | | - Sreyanko Sadhukhan
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Swati Rajput
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | - Chirag Kulkarni
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
| | | | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology and Centre for Research in Anabolic Skeletal Targets in Health and Illness (ASTHI), Council of Scientific & Industrial Research-Central Drug Research Institute, Lucknow, India
- Academy of Scientifc and Innovative Research (AcSIR), Ghaziabad, India
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Orsolini LR, Goldberg TBL, Caldeirão TD, Cristiane da Silva C, Rizzo ADCB, Biason TP, Teixeira AS, Carvalho Nunes HR. Bone impact after two years of low-dose oral contraceptive use during adolescence. PLoS One 2023; 18:e0285885. [PMID: 37289781 PMCID: PMC10249826 DOI: 10.1371/journal.pone.0285885] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE Data regarding the use and effect of hormonal contraceptives on bone mass acquisition during adolescence are contradictory. The present study was designed to evaluate bone metabolism in two groups of healthy adolescents using combined oral contraceptives (COC). METHODS A total of 168 adolescents were recruited from 2014 to 2020 in a non-randomized clinical trial and divided into three groups. The COC1 group used 20 μg Ethinylestradiol (EE)/150 μg Desogestrel and the COC2 group used 30 μg EE/3 mg Drospirenone over a period of two years. These groups were compared to a control group of adolescent non-COC users. The adolescents were submitted to bone densitometry by dual-energy X-ray absorptiometry and measurement of bone biomarkers, bone alkaline phosphatase (BAP), and osteocalcin (OC) at baseline and 24 months after inclusion in the study. The three groups studied were compared at the different time points by ANOVA, followed by Bonferroni's multiple comparison test. RESULTS Incorporation of bone mass was greater in non-users at all sites analyzed (4.85 g in lumbar Bone mineral content (BMC)) when compared to adolescents of the COC1 and COC2 groups, with a respective increase of 2.15 g and loss of 0.43g in lumbar BMC (P = 0.001). When comparing subtotal BMC, the control increased 100.83 g, COC 1 increased 21.46 g, and COC 2 presented a reduction of 1.47 g (P = 0.005). The values of bone markers after 24 months are similar for BAP, being 30.51 U/L (± 11.6) for the control group, 34.95 U/L (± 10.8) for COC1, and 30.29 U/L for COC 2 (± 11.5) (P = 0.377). However, when we analyzed OC, we observed for control, COC 1, and COC 2 groups, respectively, 13.59 ng/mL (± 7.3), 6.44 ng/mL (± 4.6), and 9.48 ng/mL (± 5.9), with P = 0.003. Despite loss to follow-up occurring in the three groups, there were no significant differences between the variables in adolescents at baseline who remained in the study during the 24-month follow-up and those who were excluded or lost to follow-up. CONCLUSION Bone mass acquisition was compromised in healthy adolescents using combined hormonal contraceptives when compared to controls. This negative impact seems to be more pronounced in the group that used contraceptives containing 30 μg EE. CLINICAL TRIAL REGISTRATION http://www.ensaiosclinicos.gov.br, RBR-5h9b3c. "Low-dose combined oral contraceptive use is associated with lower bone mass in adolescents".
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Affiliation(s)
- Lilian Rodrigues Orsolini
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Tamara Beres Lederer Goldberg
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Talita Domingues Caldeirão
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Anapaula da Conceição Bisi Rizzo
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Talita Poli Biason
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Altamir Santos Teixeira
- Department of Tropical Diseases and Diagnostic Imaging, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Helio Rubens Carvalho Nunes
- Statistical Consultant, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Peruga M, Piwnik J, Lis J. The Impact of Progesterone and Estrogen on the Tooth Mobility. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020258. [PMID: 36837459 PMCID: PMC9965278 DOI: 10.3390/medicina59020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Progesterone and estrogen modify the bone metabolism directly related to the periodontium, this study aimed at answering the question whether fluctuations in the levels of these hormones or the use of their synthetic equivalents in modern contraceptives have a significant impact on the natural tooth mobility (TM) in its alveolus. Materials and Methods: Sixty healthy women who had never been pregnant and when interviewed reported either (1) having regular menstruations every 28-30 days or (2) taking oral two-phase two-ingredient hormonal contraceptives formed, respectively, groups M and S in the study. TM evaluated as the Periotest value (PTV) was checked in the menstruation, ovulation, and luteal phases of the menstrual cycle (group M) and on the days corresponding to the moment of the menstrual cycle in group S. Results: Although the PTV-s were within the limits of norm, the canines and the molars were always more stable than the other teeth. In group M, the TM was statistically comparable (p > 0.05) in the menstrual and ovulation phases, thus significantly increased (p < 0.001) in the luteal phase. The TM remained constant (p = 0.758) in all studies in group S. The results demonstrated that the canines and the molars in the luteal phase were significantly more mobile in group M than in group S (p < 0.001), although increased mobility of the teeth in group M affected the canines and the first molars to a significantly lesser degree than the other teeth. Conclusions: However, since women between 20 and 30 years old constitute the majority of ortho-dontic patients, possible determination of the optimum moment of force application in relation to the sex hormones cycle, namely, to its luteal phase, is clinically very promising.
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Affiliation(s)
| | - Joanna Piwnik
- Physics and Applied Informatics, 92-321 Łódź, Poland
| | - Joanna Lis
- Adult Orthodontics Clinic, Department of Dentofacial Orthopedics and Orthodontics, Wroclaw Medical University, 50-376 Wrocław, Poland
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7
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Gong XL, Raile K, Slowikowska-Hilczer J, Pienkowski C, Quinkler M, Roehle R, Nordenström A, Neumann U. Physical and Reported Subjective Health Status in 222 Individuals with XY Disorder of Sex Development. J Endocr Soc 2021; 5:bvab103. [PMID: 34258493 PMCID: PMC8271184 DOI: 10.1210/jendso/bvab103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Context Little is known about the physical health of individuals with 46,XY disorders of sex development (DSD). Objective To assess physical and reported subjective health of individuals with XY DSD. Methods As part of the dsd-LIFE study, patients with an XY DSD condition were analyzed in different diagnosis groups for metabolic parameters, comorbidities, metabolic syndrome, bone outcomes, and reported subjective health. Findings were evaluated by descriptive statistics. Results A total of 222 patients with XY DSD were included with a mean age of 28.8 ± 12.2 years, mean height of 175.3 ± 7.7 cm, mean weight of 74.3 ± 20.0 kg, and mean body mass index of 24.1 ± 6.0 kg/m2. Obesity rate was not increased when descriptively compared with Eurostat data. Fourteen patients had metabolic syndrome (14/175; 8.0%). In descriptive comparison with data from the DECODE study and World Health Organization, subjects fared better in the categories waist circumference, glucose, triglyceride, cholesterol, and high-density lipoprotein. Of participants with available bone health data, 19/122 (15.6%) patients had a Z-score ≤ –2.0 at lumbar spine indicating lowered bone mineral density (BMD). Mostly gonadectomized individuals with complete androgen insensitivity syndrome (CAIS) and no estrogen therapy had lowered BMD at lumbar spine. Individuals with XY DSD performed poorly in the category subjective health in descriptive comparison with Eurostat data. Conclusion Participants reported a lower subjective health status than Eurostat data but their overall metabolic health status was good. Decreased BMD at lumbar spine was especially present in gonadectomized individuals with CAIS and no estrogen therapy.
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Affiliation(s)
- Xin Li Gong
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - Klemens Raile
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatric Endocrinology and Diabetology, Berlin, Germany
| | | | - Catherine Pienkowski
- Reference Center for Rare Gynecological Pathologies, Pediatric Endocrinology Unit, Children's Hospital, CHU Toulouse, France
| | | | - Robert Roehle
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Coordinating Center for Clinical Studies, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Nordenström
- Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Uta Neumann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for chronic sick children, Department of Pediatric Endocrinology, Berlin, Germany
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8
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Lagler FB, Hirschfeld S, Kindblom JM. Challenges in clinical trials for children and young people. Arch Dis Child 2021; 106:321-325. [PMID: 33077422 DOI: 10.1136/archdischild-2019-318676] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/07/2020] [Accepted: 09/12/2020] [Indexed: 01/21/2023]
Abstract
There is a well-known knowledge gap regarding the efficacy and safety of medicines in children of all ages and children are often treated with medicines off-label. Children are thus deprived of treatment based on the same quality of information that guides treatment in adults. The knowledge gap regarding efficacy and safety of medicines in children has been acknowledged by authorities and is reflected in legislation both in North America and in the European Union. Recent reports on the effects of legislation indicates that paediatric clinical trials remain a challenge.Paediatric clinical trials are needed in the entire developmental age spectrum and are especially needed in certain therapy areas. Paediatric clinical trials have special features compared with trials in adults, and these need to be taken into account. These special features include scientific issues related to small samples and heterogeneity, the consent/assent procedure, the need for age-appropriate study information, specific outcomes and safety issues related to development and maturation. Competence in paediatric clinical trials is required in both designing, planning, co-ordinating and organising paediatric clinical trials, as well as research infrastructure and networks to increase power and disseminate information and expert advice. Strengthening of paediatric clinical research is essential to facilitate generating the data that will let children enjoy new medical advances in a similar manner as adults.
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Affiliation(s)
- Florian B Lagler
- Institute for Inherited Metabolic Diseases and Department of Pediatrics, Paracelsus Medical University, Clinical Research Center Salzburg GmBH, Strubergasse 21, Salzburg, Austria.,European Society of Developmental, Perinatal and Pediatric Pharmacology (ESDPPP) council, Leuven, Belgium
| | - Steven Hirschfeld
- Uniformed Services University of the Health Sciences, 4201 Jones Bridge Road, Bethesda, Maryland, 20814 USA
| | - Jenny M Kindblom
- European Society of Developmental, Perinatal and Pediatric Pharmacology (ESDPPP) council, Leuven, Belgium .,Pediatric Clinical Research Center, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Goteborg, Sweden
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9
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Li L, Tran D, Zhu H, Balimane P, Willett G, Zhao P, Gerrard SE, Vogelsong KM, Wang Y, Seo SK. Use of Model-Informed Drug Development to Streamline Development of Long-Acting Products: Can These Successes Be Translated to Long-Acting Hormonal Contraceptives? Annu Rev Pharmacol Toxicol 2020; 61:745-756. [PMID: 32997600 DOI: 10.1146/annurev-pharmtox-031120-015212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Long-acting contraceptives are the most effective reversible contraceptive methods. Increasing patients' access to these contraceptives may translate into fewer unintended pregnancies and lead to substantial individual and public health benefits. However, development of long-acting products can be complex and challenging. This review provides (a) an overview of representative development programs for long-acting antipsychotics as cases for conceptual translation to long-acting contraceptives, (b) several case examples on how modeling and simulation have been used to streamline the development of long-acting products, and (c) examples of challenges andopportunities in developing long-acting contraceptives and information on how exposure-response relationships of commonly used progestins may enable regulators and developers to rely on prior findings of effectiveness and safety from an approved contraceptive to streamline the development of long-acting contraceptives. The US Food and Drug Administration is seeking assistance from stakeholders to provide data from studies in which pharmacokinetic and pharmacodynamic or clinical outcomes of hormonal contraceptives were evaluated and not previously submitted.
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Affiliation(s)
- Li Li
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
| | - Doanh Tran
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
| | - Hao Zhu
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
| | - Praveen Balimane
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
| | - Gerald Willett
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA
| | - Ping Zhao
- Bill & Melinda Gates Foundation, Seattle, Washington 98109, USA
| | | | | | - Yaning Wang
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
| | - Shirley K Seo
- Office of Clinical Pharmacology, Office of Translational Science, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland 20993, USA;
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10
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Golden NH. Bones and Birth Control in Adolescent Girls. J Pediatr Adolesc Gynecol 2020; 33:249-254. [PMID: 31972296 DOI: 10.1016/j.jpag.2020.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/24/2022]
Abstract
Peak bone mass acquisition during adolescence is an important determinant of adult bone health. Knowledge about the effects of different contraceptives on peak bone mass acquisition could influence choice of method recommended. This review summarizes normal bone acquisition during adolescence, discusses methods of assessing bone health in this age group, and reviews the effects of different contraceptive options on bone health, both in adults and in adolescents. Based on the evidence, long-acting reversible contraceptives do not appear to affect peak bone mass acquisition or future fracture risk and remain the first-line contraceptive choice for adolescents. Oral contraceptives with doses of ethinyl estradiol greater than 30 μg should be used in preference to lower-dose preparations, and the adverse effects of depo medroxyprogesterone acetate (DMPA) on bone health are reversible on discontinuation of the medication. Concerns about bone health should not prevent use of DMPA in an adolescent who prefers this method.
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Affiliation(s)
- Neville H Golden
- Lucile Packard Children's Hospital, Stanford, Stanford University School of Medicine, Palo Alto, California.
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11
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Merki-Feld GS, Bitzer J. Contraception in adolescents with anorexia nervosa. Is there evidence for a negative impact of combined hormonal contraceptives on bone mineral density and the course of the disease? EUR J CONTRACEP REPR 2020; 25:213-220. [PMID: 32336145 DOI: 10.1080/13625187.2020.1743826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: Adolescents with anorexia nervosa (AN) are at increased risk of unplanned pregnancies and bone loss, due to low oestrogen levels and low use of efficient contraception. The negative impact of combined hormonal contraceptives (CHC) on peak bone mass during adolescence might limit wider use in anorexic women. Another issue limiting CHC use is the concern, that CHC-induced cyclic bleeding reduces the motivation for further weight gain and thus exerts a negative impact on recovery. We wanted to find evidence based answers about the impact of CHC use on bone health and course of the disease in adolescents with AN.Methods: We performed a narrative review of the current literature investigating the effect of CHC or progestin-only contraceptives on bone density, body shape and course of disease in young women with anorexia.Results: There is no evidence that CHC use aggravates the bone loss associated with AN. In long-term users CHC exert a protective effect. Anorexic women using CHC showed at least the same or a greater weight gain in comparison with controls. Eating disorder attitudes did not worsen.Conclusion: We conclude, that at present there is no evidence, that use of CHC by AN patients has a negative impact on bone density or the course of disease.
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Affiliation(s)
| | - Johannes Bitzer
- Department of Obstetrics and Gynaecology, Basel University Hospital, Basel, Switzerland
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12
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Bachrach LK. Hormonal Contraception and Bone Health in Adolescents. Front Endocrinol (Lausanne) 2020; 11:603. [PMID: 32973688 PMCID: PMC7472551 DOI: 10.3389/fendo.2020.00603] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
Hormonal contraception is prescribed commonly to adolescents for myriad indications from pregnancy prevention to treatment for acne, hirsutism or dysmenorrhea. Although use of these hormones generally has no effect or benefits bone health in mature premenopausal women, the same may not be true for adolescents. The teen years are a critical period for acquiring peak bone strength. Sex hormones, growth hormone, and insulin-like growth factors (IGFs) interact to modulate the changes in bone size, geometry, mineral content, and microarchitecture that determine skeletal strength. Combined oral contraceptives (COCs) and intramuscular depo medroxyprogesterone (DMPA) can compromise the expected gains in adolescence by altering estrogen and IGF concentrations. Use of these medications has been associated with slower accrual of bone mineral density (BMD) and increased fracture risk in some studies. Far less is known about the skeletal effects of the newer long acting reversible contraceptives (LARCs). This review takes a critical look at the gaps in current knowledge of the skeletal effects of COCs, DMPA, and LARCs and underscores the need for additional research.
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13
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LaBrie JW, Boyle S, Earle A, Almstedt HC. Heavy Episodic Drinking Is Associated With Poorer Bone Health in Adolescent and Young Adult Women. J Stud Alcohol Drugs 2019; 79:391-398. [PMID: 29885146 DOI: 10.15288/jsad.2018.79.391] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Osteoporosis is a costly bone disease characterized by low bone mineral density (BMD) that primarily affects postmenopausal women. One factor that may lead to osteoporosis is a failure to reach peak bone mass (PBM) in early adulthood. In older adults and animal models, heavy episodic drinking (HED) has been found to predict failure to reach PBM. However, this relationship has yet to be investigated in adolescent human females. METHOD Female college students (N = 87; 60% White) reported age at menarche, hormonal contraceptive use, physical activity, smoking habits, and HED history via an online survey and then received a dual energy x-ray absorptiometry bone scan to assess both lean body mass and BMD at the lumbar spine. RESULTS Frequent HED (having four or more drinks within 2 hours on 115 or more occasions since the start of high school, which is approximately equal to 1.6 episodes per month over this period) was associated with decreased vertebral BMD even when variables most commonly associated with bone health (lean body mass, physical activity, age at menarche, smoking, and oral contraception use) were controlled for. However, early HED initiation (beginning HED at age 15 years or younger) was not significantly related to BMD. CONCLUSIONS This is the first study to assess the impacts of early HED initiation and frequent HED during adolescence on the bone health of young women. Results suggest frequency of HED before reaching PBM, but not age at initiation, may be negatively related to skeletal health during young adulthood. These findings encourage research into the association between HED and BMD in late adolescence.
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Affiliation(s)
- Joseph W LaBrie
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Sarah Boyle
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Andrew Earle
- Department of Psychology, Loyola Marymount University, Los Angeles, California
| | - Hawley C Almstedt
- Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, California
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14
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French KD, Emanuele D. Osteoporosis: Increasing Screening and Treatment for Postmenopausal Women. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Goshtasebi A, Subotic Brajic T, Scholes D, Beres Lederer Goldberg T, Berenson A, Prior JC. Adolescent use of combined hormonal contraception and peak bone mineral density accrual: A meta-analysis of international prospective controlled studies. Clin Endocrinol (Oxf) 2019; 90:517-524. [PMID: 30614555 PMCID: PMC6850432 DOI: 10.1111/cen.13932] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/06/2018] [Accepted: 01/04/2019] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Many women use combined hormonal contraceptives (CHC) during adolescence during which they are accruing peak areal bone mineral density (BMD) that relates to lifetime fracture risk. To build BMD requires formation with which CHC-related exogenous oestrogen may interfere. We compared peak BMD accrual in adolescents using and not using CHC. DESIGN/PARTICIPANTS We performed literature searches for prospective published peer-reviewed articles providing 12- to 24-month BMD change in adolescent (12- to 19-year-old) women using CHC vs CHC-unexposed control women. METHODS Meta-analyses used random-effects models to assess BMD change rate at lumbar spine (LS) and other sites in adolescent CHC users vs CHC nonusers. RESULTS Literature searches yielded 84 publications of which nine were eligible. Adolescent-only data were sought from cohorts with wider age inclusions. The 12-month LS meta-analysis with eight paired comparisons in 1535 adolescents showed a weighted mean BMD difference of -0.02 (95% confidence interval [CI]: -0.05 to 0.00) g/cm2 in CHC-exposed adolescents (P = 0.04). The 24-month LS meta-analysis with five paired comparisons in 885 adolescents showed a highly significant weighted mean BMD difference of -0.02 (95% CI: -0.03 to -0.01) g/cm2 in CHC-exposed adolescents (P = 0.0006). Heterogeneities by I2 were 96% and 85%, respectively. Insufficient data for other bone sites precluded quantitative analysis. CONCLUSION Given that adolescent exposure to CHC appears to be increasing, this evidence for potential impairment of peak spinal BMD accrual is of concern and suggests a potential public health problem. Randomized controlled trial data are needed to determine CHC effects on adolescent bone health.
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Affiliation(s)
- Azita Goshtasebi
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and MetabolismUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Women’s Health Research InstituteVancouverBritish ColumbiaCanada
| | - Tatjana Subotic Brajic
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and MetabolismUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Delia Scholes
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WashingtonSeattleWashington
| | - Tamara Beres Lederer Goldberg
- Postgraduate Program in Gynecology, Obstetrics, and MastologyDiscipline of Adolescent MedicineDepartment of PediatricsBotucatu Medicine SchoolSão Paulo State University (UNESP)BotucatuSãoBrazil
| | - Abbey Berenson
- Department of Obstetrics & GynecologyThe University of Texas Medical BranchGalvestonTexas
| | - Jerilynn C. Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and MetabolismUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- British Columbia Women’s Health Research InstituteVancouverBritish ColumbiaCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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16
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17
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Shah D, Patil M. Consensus Statement on the Use of Oral Contraceptive Pills in Polycystic Ovarian Syndrome Women in India. J Hum Reprod Sci 2018; 11:96-118. [PMID: 30158805 PMCID: PMC6094524 DOI: 10.4103/jhrs.jhrs_72_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: To provide consensus recommendations for health-care providers on the use of oral contraceptive pills (OCPs) in polycystic ovarian syndrome (PCOS) women in India. Participants: Extensive deliberations, discussions, and brainstorming were done with different fraternities (specialists) being involved. These included endocrinologists, gynecologists, reproductive endocrinologists, dermatologists, public health experts, researchers, and a project manager with a team to develop the guideline. Evidence: Published literature was retrieved through searches of Medline and The Cochrane Database from January 2003 to December 2017 using appropriate-controlled vocabulary (e.g., oral contraceptive pills, polycystic ovarian syndrome, long term outcomes, infertility). Clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies' publications and data were also reviewed to suggest the recommendations.
Process: The working group for guideline committee included members from the PCOS Society (India), Indian Society for Assisted Reproduction, The Mumbai Obstetric and Gynecological Society, The Endocrine Society of India, Indian Association of Dermatologists, Venereologists and Leprologists, Cosmetic Dermatology Society (India), Academicians from Medical Colleges, National Institute for Research in Reproductive Health, and a Research Associate. The core team included five reproductive endocrinologists, five gynecologists, five dermatologists, three endocrinologists, two public health experts and one research associate.
Conclusions: This consensus statement provides the guidance/recommendations for Indian practitioners regarding the use of OCP in women with PCOS. PCOS is one of the common endocrinopathies encountered in gynecological/endocrine practice. The spectrum of this disorder may range from prepubertal girls with premature pubarche, young girls with hirsutism, acne and anovulatory cycles, married women with infertility, and elderly women. Although obesity is a common feature for most PCOS patients, 'lean PCOS' also exists. For several years, OCPs have played an important role in the symptom management of PCOS women. This is due to the fact that OCPs decrease the luteinizing hormone, reduce androgen production, and increase sex hormone-binding globulin, which binds androgens. Several new formulations of OCPs have been developed to decrease the side effects. This includes use of less androgenic progestins and lower doses of ethinyl estradiol. These consensus recommendations help the health provider to choose the right type of OCPs, which will alleviate the symptoms with least side effects. It also gives insight into the indications, contraindications, and concerns regarding its short, intermediate and long-term use.
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Affiliation(s)
- Duru Shah
- President PCOS Society of India, Mumbai, Maharashtra, India.,Director Gynaecworld the Center for Women's Health and Fertility, Mumbai, Maharashtra, India
| | - Madhuri Patil
- Scientific Coordinator, The PCOS Society of India, Bengaluru, Karnataka, India.,Editor, Journal of Human Reproductive Sciences, Bengaluru, Karnataka, India.,Clinical Director and Principal, Dr. Patil's Fertility and Endoscopy Clinic, Bengaluru, Karnataka, India
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18
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Abstract
Contraception services should be part of routine health care maintenance in reproductive-aged women, especially in light of the fact that approximately 50% of pregnancies in the United States remain unplanned. Barrier methods, especially condoms, may play a role in sexually transmitted disease prevention but are less efficacious for pregnancy avoidance. There are several available hormonal contraceptive options, including the combination hormonal pill, progestin-only pill, combination hormonal patches and rings, injectable progestins, implantable progestins, intrauterine devices (copper or progestin), and permanent sterilization. These methods have varying efficacy, often related to patient compliance or tolerance of side effects.
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Affiliation(s)
- Erin E Tracy
- Vincent Obstetrics and Gynecology, Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Founders 406, 55 Fruit Street, Boston, MA 02114, USA.
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19
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Prior JC. HOW CAN WE PROTECT PEAK BONE MASS AND FUTURE BONE HEALTH FOR ADOLESCENT WOMEN? - BY SUPPORTING OVULATION AND AVOIDING COMBINED HORMONAL CONTRACEPTION USE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2017; 35:121-124. [PMID: 28977329 PMCID: PMC5496723 DOI: 10.1590/1984-0462/;2017;35;2;00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jerilynn Celia Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism [Centro para Pesquisa sobre Ciclo Menstrual e Ovulação, Endocrinologia e Metabolismo], University of British Columbia, Vancouver, Canadá
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20
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Gersten J, Hsieh J, Weiss H, Ricciotti NA. Effect of Extended 30 μg Ethinyl Estradiol with Continuous Low-Dose Ethinyl Estradiol and Cyclic 20 μg Ethinyl Estradiol Oral Contraception on Adolescent Bone Density: A Randomized Trial. J Pediatr Adolesc Gynecol 2016; 29:635-642. [PMID: 27287084 DOI: 10.1016/j.jpag.2016.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 05/04/2016] [Accepted: 05/25/2016] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To compare changes in lumbar spine bone mineral density after 12 months of a 91-day extended regimen or 28-day combined oral contraceptive with those in a healthy reference group not using hormonal contraceptives. DESIGN Phase 2, multicenter, open-label, randomized, controlled study. SETTING Forty-five academic centers, clinical research centers, and community practices in the United States. PARTICIPANTS Eight hundred twenty-nine postmenarcheal adolescent girls aged 12-18 years. INTERVENTIONS Adolescents were randomly assigned to 91-day levonorgestrel (LNG)/ethinyl estradiol (EE) extended regimen (84 days of LNG 150 μg/EE 30 μg with 7 days of EE 10 μg [LNG/EE extended regimen]) or 28 days of LNG/EE (21 days of LNG 100 μg/EE 20 μg with 7 days of placebo [LNG/EE 21/7]) for 12 months. A reference group not seeking hormonal contraception was also evaluated. MAIN OUTCOME MEASURES The primary end point was mean percent change in lumbar spine bone mineral density measured using dual-energy x-ray absorptiometry. RESULTS Of 1361 adolescents randomized/enrolled, 829 were included in the primary analysis. Mean changes in lumbar spine bone mineral density were +2.26% with LNG/EE extended regimen, +1.45% with LNG/EE 21/7, and +2.50% in the reference group. Noninferiority of the LNG/EE extended regimen compared with the reference group was shown. A statistically significant treatment difference was found between LNG/EE 21/7 and the reference group (1.05%; 95% confidence interval, 0.61%-1.49%) but not between LNG/EE extended regimen and the reference group (0.23%; 95% confidence interval, -0.20% to 0.67%). No new safety signals were noted. CONCLUSION Compared with the reference group, bone accrual was statistically significantly lower among LNG/EE 21/7 users but not among LNG/EE 30-μg extended regimen users. Additional research is needed to clarify the clinical relevance of these findings.
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Affiliation(s)
- Janet Gersten
- New Age Medical Research Corporation, Miami, Florida.
| | - Jennifer Hsieh
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pennsylvania
| | - Herman Weiss
- Teva Global Medical Affairs, Petach Tikva, Israel
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21
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Prior JC. Adolescents’ Use of Combined Hormonal Contraceptives for Menstrual Cycle–Related Problem Treatment and Contraception: Evidence of Potential Lifelong Negative Reproductive and Bone Effects. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23293691.2016.1196080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Laryea DO, Ankobeah F, Morhe ESK, Amoako YA, Spangenberg K. Characteristics and contributory factors for injectable contraceptive usage among women in Kumasi, Ghana. Contracept Reprod Med 2016; 1:8. [PMID: 29201397 PMCID: PMC5693482 DOI: 10.1186/s40834-016-0019-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/20/2016] [Indexed: 12/29/2022] Open
Abstract
Background Preferred methods of contraception vary from country to country. Family Planning services have been available on a large scale in Ghana since the 1980’s and their use has contributed to gradual decline in the total fertility rate from 6.4 in 1988 to 4.2 in 2014. Since their introduction in Ghana in the early 1990’s, Injectable contraceptives have seen increasing patronage and are currently the most preferred method of contraception. We set out to identify possible factors contributing to the preference for injectable contraceptives among women in Ghana. Methods We conducted a descriptive cross-sectional survey of women accessing contraceptive services at the Family Planning Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Women who reported for the second dose of their injections were eligible to be selected for participation in the study. Informed consent was obtained from eligible participants. Data was collected using a structured questionnaire in January and February 2011. Data captured included age, marital status, highest level of education completed, religion, ethnicity and employment status, previous contraceptive use, sources of contraceptive information and reasons for choosing injectable contraceptives. Quantitative data was entered into a Microsoft Access Database and analysed using Epi Info Version 7.1.4. Qualitative data was analysed thematically. Results A total of 247 respondents participated in the study. One hundred and seventy three (70.0 %) were using Depot Medroxyprogesterone Acetate and 74 (30.0 %) were using NorethisteroneEnanthate/Estradiol Valerate. The mean age for women on Depot Medroxyprogesterone Acetate was higher than those on NorethisteroneEnanthate/Estradiol Valerate (p < 0.001). The effectiveness of method, recommendation from other users, low incidence of forgetfulness and the relatively longer intervals for administration were the commonest reasons for the use of injectables among respondents. The majority of users, 225 (91.1 %), were satisfied with the method and will recommend it to other potential users. Only 10.8 % of the 68 respondents reporting undesirable effects of the injectables intend to change the method. Conclusion A high level of satisfaction exists among current users of injectables in Ghana and is influenced by a variety of factors. Strategies to increase the uptake of injectables can go a long way to increase the contraceptive prevalence rate and reduce the unmet need for Family Planning in Ghana.
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Affiliation(s)
| | - Frank Ankobeah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel S K Morhe
- Department of Obstetrics and Gynaecology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Yaw Ampem Amoako
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kathryn Spangenberg
- Directorate of Family Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Jain V, Wotring VE. Medically induced amenorrhea in female astronauts. NPJ Microgravity 2016; 2:16008. [PMID: 28725726 PMCID: PMC5516549 DOI: 10.1038/npjmgrav.2016.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 12/28/2022] Open
Abstract
Medically induced amenorrhea can be achieved through alterations in the normal regulatory hormones via the adoption of a therapeutic agent, which prevents menstrual flow. Spaceflight-related advantages for medically induced amenorrhea differ according to the time point in the astronaut's training schedule. Pregnancy is contraindicated for many pre-flight training activities as well as spaceflight, therefore effective contraception is essential. In addition, the practicalities of menstruating during pre-flight training or spaceflight can be challenging. During long-duration missions, female astronauts have often continuously taken the combined oral contraceptive pill to induce amenorrhea. Long-acting reversible contraceptives (LARCs) are safe and reliable methods used to medically induce amenorrhea terrestrially but as of yet, not extensively used by female astronauts. If LARCs were used, daily compliance with an oral pill is not required and no upmass or trash would need disposal. Military studies have shown that high proportions of female personnel desire amenorrhea during deployment; better education has been recommended at recruitment to improve uptake and autonomous decision-making. Astronauts are exposed to similar austere conditions as military personnel and parallels can be drawn with these results. Offering female astronauts up-to-date, evidence-based, comprehensive education, in view of the environment in which they work, would empower them to make informed decisions regarding menstrual suppression while respecting their autonomy.
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Affiliation(s)
- Varsha Jain
- National Institute for Health Research, London, UK
- King's College London, London, UK
- Queen Mary's University, London, UK
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Virginia E Wotring
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Pharmacology, Baylor College of Medicine, Houston, TX, USA
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24
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Modesto W, Bahamondes MV, Bahamondes L. Prevalence of Low Bone Mass and Osteoporosis in Long-Term Users of the Injectable Contraceptive Depot Medroxyprogesterone Acetate. J Womens Health (Larchmt) 2015; 24:636-40. [PMID: 26098552 DOI: 10.1089/jwh.2014.5077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone mineral density (BMD) loss among depot medroxyprogesterone acetate (DMPA) users is a controversial issue. Aspects under debate include whether the number of years of use has any effect on continuous BMD loss, whether this loss will stabilise over the years of use or if it will progress to low bone mass, osteoporosis and an increased fracture risk. The aim of this study was to compare the difference in osteoporosis and low bone mass between DMPA and copper intrauterine device (Cu-IUD) users. METHODS This was a cross-sectional study that evaluated BMD at the lumbar spine and femoral neck in 47 long-term DMPA users and 41 Cu-IUD users as control group. BMD was measured by dual-energy X-ray absorptiometry. The participants were 27 to 57 years of age, had used either DMPA or a Cu-IUD uninterruptedly for at least ten years, had initiated use of the method prior to 40 years of age and had follicle stimulating hormone values <40 mIU/mL. RESULTS Findings showed that 68.1% and 36.6% of the DMPA and Cu-IUD users, respectively, had low bone mass and 29.8% and 2.4% of DMPA and Cu-IUD users, respectively, had osteoporosis. BMD decreased as the number of years of DMPA use increased. CONCLUSION Long-term DMPA use was associated with low bone mass and osteoporosis in women who had used the method for 10 years or more. DMPA users with longer time of use showed a greater bone mass loss.
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Affiliation(s)
- Waleska Modesto
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas , Campinas, São Paulo, Brazil
| | - M Valeria Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas , Campinas, São Paulo, Brazil
| | - Luis Bahamondes
- Human Reproduction Unit, Department of Obstetrics and Gynaecology, School of Medical Sciences and the National Institute of Hormones and Women's Health, University of Campinas , Campinas, São Paulo, Brazil
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25
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Jackowski SA, Baxter-Jones ADG, McLardy AJ, Pierson RA, Rodgers CD. The associations of exposure to combined hormonal contraceptive use on bone mineral content and areal bone mineral density accrual from adolescence to young adulthood: A longitudinal study. Bone Rep 2015; 5:e333-e341. [PMID: 28580404 PMCID: PMC5440951 DOI: 10.1016/j.bonr.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background The association of long term combined hormone based contraceptives (CHC) use on bone mineral content (BMC) and areal bone mineral density (aBMD) development remains controversial, as it appears that the relationship may be age-dependent. The purpose of this study was to investigate the long-term associations of CHC exposure on the accrual of bone parameters from adolescence into young-adulthood. Methods 110 women (67 exposed to CHC) were drawn from the Pediatric Bone Mineral Accrual Study (PBMAS). Serial measures of total body (TB), lumbar spine (LS) and femoral neck (FN) BMC and aBMD were assessed by DXA (a total of 950 scans) and aligned by biological age (BA, years from peak height velocity [PHV]). Multilevel random effects models were constructed to assess the time dependent associations between annual CHC exposure and the development of bone parameters. Results After BA, height, lean tissue mass, fat mass, calcium and vitamin D intake, and physical activity were controlled, it was observed that those individuals exposed to CHC 6-years post PHV developed significantly less (−0.00986 ± 0.00422 g/cm2) TB aBMD than their non CHC exposed peers. Additionally, there were significant BA by CHC exposure interactions, where CHC exposure 6-years or more post PHV resulted in developing less TB BMC (−4.94 ± 2.41 g), LS BMC (−0.29 ± 0.11 g) and LS aBMD (−0.00307 ± 0.00109 g/cm2). One year after the attainment of PHV, CHC users were predicted to have 1.2% more TB BMC, 3.8% more LS BMC and 1.7% more LS aBMD than non-users. At 9-years post PHV the predicted differences showed that CHC users had 0.9% less TB BMC and 2.7% less LS BMC and 1.6% less LS BMD than those not exposed to CHC. Conclusions CHC may not hinder the development of BMC or aBMD during adolescence; however, exposure 6-years or more after PHV may be detrimental. The effects of combined hormone contraceptive (CHC) exposure on bone mass were assessed. CHC exposure resulted in developing significantly less (− 9.86 ± 4.22 g/cm2) TB aBMD. CHC exposure 6-years after PHV resulted in significantly less BMC and aBMD. CHC may not hinder adolescent bone development, but may be detrimental after growth.
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Affiliation(s)
- Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Ashlee J McLardy
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roger A Pierson
- Department of Obstetrics, Gynecology and Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carol D Rodgers
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Begum RA, Ali L, Takahashi O, Fukui T, Rahman M. Bone mineral density: reference values and correlates for Bangladeshi women aged 16-65 years. J Orthop Sci 2015; 20:522-8. [PMID: 25627245 DOI: 10.1007/s00776-015-0695-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Studies examining the reference values of bone mineral density (BMD) and their patterns at different ages are largely based on data generated from developed countries. The objective of this study was to estimate reference values of BMD, along with their correlates, for women living in urban and suburban areas of Bangladesh. METHODS Dual-energy X-ray absorptiometry scans were performed on 500 women 16-65 years of age. Reference values at the lumbar spine (LS) and femoral neck (FN) were estimated after adjusting for height and weight. In addition, multiple linear regression analysis was used to examine correlates of BMD at the LS and FN. RESULTS Mean BMD was highest at the LS and FN in women 16-19 (1.001-1.007 g/cm(2)) and 16-22 years of age (0.880-0.888 g/cm(2)), respectively, and gradually declined with increasing age thereafter. BMD decreased at an annual rate of 0.0027 g/cm(2) at the LS and 0.0046 g/cm(2) at the FN among women aged 16-45 years. For women 46-65 years of age, the respective figures were 0.0073 and 0.0083 g/cm(2). In both age groups, body weight was positively associated with BMD at both sites, and with height only at the LS. In addition, years of pill use was positively associated with BMD at the LS among women aged 16-45 years. BMD levels at both sites began to decline during the early twenties among Bangladeshi women. CONCLUSIONS Age-specific BMD data generated in this study could be useful for interpreting bone densitometry data among women in Bangladesh and other South Asian countries.
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Affiliation(s)
- Rowshan Ara Begum
- Department of Reproductive and Child Health, Bangladesh University of Health Science, Mirpur, Dhaka, Bangladesh
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Pocius KD, Dutton CR. Update on Hormonal Contraception and Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-014-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Contraception is a pillar in reducing adolescent pregnancy rates. The American Academy of Pediatrics recommends that pediatricians develop a working knowledge of contraception to help adolescents reduce risks of and negative health consequences related to unintended pregnancy. Over the past 10 years, a number of new contraceptive methods have become available to adolescents, newer guidance has been issued on existing contraceptive methods, and the evidence base for contraception for special populations (adolescents who have disabilities, are obese, are recipients of solid organ transplants, or are HIV infected) has expanded. The Academy has addressed contraception since 1980, and this policy statement updates the 2007 statement on contraception and adolescents. It provides the pediatrician with a description and rationale for best practices in counseling and prescribing contraception for adolescents. It is supported by an accompanying technical report.
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Abstract
A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians' long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.
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Carr B, Dmowski WP, O'Brien C, Jiang P, Burke J, Jimenez R, Garner E, Chwalisz K. Elagolix, an oral GnRH antagonist, versus subcutaneous depot medroxyprogesterone acetate for the treatment of endometriosis: effects on bone mineral density. Reprod Sci 2014; 21:1341-51. [PMID: 25249568 DOI: 10.1177/1933719114549848] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This randomized double-blind study, with 24-week treatment and 24-week posttreatment periods, evaluated the effects of elagolix (150 mg every day, 75 mg twice a day) versus subcutaneous depot medroxyprogesterone acetate (DMPA-SC) on bone mineral density (BMD), in women with endometriosis-associated pain (n = 252). All treatments induced minimal mean changes from baseline in BMD at week 24 (elagolix 150 mg: -0.11%/-0.47%, elagolix 75 mg: -1.29%/-1.2%, and DMPA-SC: 0.99%/-1.29% in the spine and total hip, respectively), with similar or less changes at week 48 (posttreatment). Elagolix was associated with improvements in endometriosis-associated pain, assessed with composite pelvic signs and symptoms score (CPSSS) and visual analogue scale, including statistical noninferiority to DMPA-SC in dysmenorrhea and nonmenstrual pelvic pain components of the CPSSS. The most common adverse events (AEs) in elagolix groups were headache, nausea, and nasopharyngitis, whereas the most common AEs in the DMPA-SC group were headache, nausea, upper respiratory tract infection, and mood swings. This study showed that similar to DMPA-SC, elagolix treatment had minimal impact on BMD over a 24-week period and demonstrated similar efficacy on endometriosis-associated pain.
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Affiliation(s)
- Bruce Carr
- Department of Obstetrics and Gynecology, Reproductive Endocrinology & Infertility Fellowship Program, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W Paul Dmowski
- Institute for the Study and Treatment of Endometriosis, Oak Brook, IL, USA
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Modesto W, Bahamondes MV, Silva dos Santos P, Fernandes A, Dal’Ava N, Bahamondes L. Exploratory study of the effect of lifestyle counselling on bone mineral density and body composition in users of the contraceptive depot-medroxyprogesterone acetate. EUR J CONTRACEP REPR 2014; 19:244-9. [DOI: 10.3109/13625187.2014.924098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
OBJECTIVE To estimate the effect of using two methods of hormonal contraceptives (depot medroxyprogesterone acetate) or an oral contraceptive pill (OCP) containing 20 micrograms ethinyl estradiol and 0.15 mg desogestrel) on serum glucose and insulin levels, as well as predictors of any observed changes. METHODS Fasting glucose and insulin levels were measured on 703 white, African-American, and Hispanic women using depot medroxyprogesterone acetate, OCPs, or nonhormonal birth control at baseline and every 6 months thereafter for 3 years. Participants also completed questionnaires containing demographic and behavioral measures every 6 months. Mixed-model regression analyses were used to estimate changes over time in glucose and insulin levels by method, along with their predictors. RESULTS Depot medroxyprogesterone acetate, but not OCP, users experienced slightly greater increases in glucose and insulin as compared with nonhormonal users (P<.001). Among depot medroxyprogesterone acetate users, a small but steady increase in serum glucose levels (2 mg/dL at 6 months to 3 mg/dL at 30 months) was observed throughout the first 30 months, but it leveled off after that. In contrast, serum insulin levels showed an upward (3 units at 6 months to 4 units at 18 months) trend for the first 18 months of depot medroxyprogesterone acetate use and then remained almost flat thereafter. Elevation of insulin and glucose levels was slightly more pronounced in obese and overweight depot medroxyprogesterone acetate users than those who were normal weight. CONCLUSION Use of depot medroxyprogesterone acetate, but not very-low-dose OCPs containing desogestrel, can lead to slightly higher fasting glucose and insulin levels. LEVEL OF EVIDENCE II.
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Menstrual suppression in the adolescent. J Pediatr Adolesc Gynecol 2013; 26:132-7. [PMID: 23158755 DOI: 10.1016/j.jpag.2012.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/23/2022]
Abstract
Menstrual suppression, the use of contraceptive methods to eliminate or decrease the frequency of menses, is often prescribed for adolescents to treat menstrual disorders or to accommodate patient preference. For young women using hormonal contraceptives, there is no medical indication for menstruation to occur monthly, and various hormonal contraceptives can be used to decrease the frequency of menstruation with different side effect profiles and rates of amenorrhea. This article reviews the different modalities for menstrual suppression, common conditions in adolescents which may improve with menstrual suppression, and strategies for managing common side effects.
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Abstract
Oral contraceptives are used by numerous women very often throughout a prolonged period of time and more and more and more frequently early in life, within the first reproductive years. According to the close relationship between estrogen and bone metabolism, the question of the impact of combined oral contraceptive (COC) on bone needs to be addressed. During adulthood, most studies have reported that COC, even those containing a low dose of ethinyl-estradiol had neutral or possibly beneficial effect on bone health. Use of COC within the perimenopausal years prevents the activation of bone metabolism and the decrease in bone mass. In adolescent girls, the skeletal effect of COC is of greater concern. Recent data suggest that the oral contraception may impede the development of peak bone mass, particularly when started within the teen years. Initiation of COC within the first 3 years after menarche would be a strong determinant of bone mass acquisition impairment. Whether this bone impact is also dependent on the dose of ethinyl-estradiol has not been fully elucidated. To date epidemiological studies did not report association between use of combined oral contraceptive and the risk of fracture.
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Affiliation(s)
- Florence Trémollieres
- Centre de Ménopause, Hôpital Paule de Viguier, TSA 70034, 330 Avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
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Goeckenjan M, Merkle E, Rabe T. Kontrazeption bei Mädchen und Jugendlichen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2013. [DOI: 10.1007/s10304-012-0498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Luz S Porter
- Florida International University, Miami, FL, USA.
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Berenson AB, Rahman M. A randomized controlled study of two educational interventions on adherence with oral contraceptives and condoms. Contraception 2012; 86:716-24. [PMID: 22840278 DOI: 10.1016/j.contraception.2012.06.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 06/13/2012] [Accepted: 06/14/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND The study was conducted to examine the effectiveness of two different interventions on oral contraception (OC) adherence and condom use. STUDY DESIGN A total of 1,155 women 16-24 years of age requesting OC were randomized to receive either face-to-face behavioral counseling and education at their baseline clinic visit (C group; n=383) or this same intervention followed by monthly phone calls for 6 months (C+P group; n=384) or standard care (S group; n=388). Phone interviews at 3, 6 and 12 months after the initial visit as well as a medical record review assessed OC continuation, condom use and several other secondary and clinically meaningful outcomes such as pregnancy and sexually transmitted infection (STI) rates and correct use of pills. RESULTS The interventions did not have a significant effect on OC continuation after 3 (C+P: 58%; C: 50%; S: 55%), 6 (39%; 32%; 37%) or 12 months (20%; 18%; 20%) (p>.05). Condom use at last sexual intercourse did not differ by intervention methods (p>.05). Moreover, no effect was observed on pregnancy [S=48 (12.4%), C =63 (16.5%), C+P=52 (13.5%); p=.22] and STI [S=18 (4.6%), C=12 (3.1%), C+P=13 (3.4%); p=.50] rates, and mean number of correctly used pill packs (p=.06). However, those randomized to C+P were more likely than C and S patients to identify a cue and report that the cue worked as a reminder to take their OC on time based on 3 and 6 months follow-up information (p<.01 for all relationships). CONCLUSIONS Neither intervention in this study improved OC adherence among young women.
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Affiliation(s)
- Abbey B Berenson
- Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX 77555, USA.
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Ziglar S, Hunter TS. The effect of hormonal oral contraception on acquisition of peak bone mineral density of adolescents and young women. J Pharm Pract 2012; 25:331-40. [PMID: 22572223 DOI: 10.1177/0897190012442066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maximizing bone mass in youth is touted as the best strategy to offset the natural losses of aging and the menopausal transition. Not achieving maximum peak bone mineral density (BMD) is an independent risk factor for osteoporosis and thus a public health concern. Adolescence is a critical time of bone mineralization mediated by endogenous estradiol. Research has shown that the highest velocity of bone mass accrual occurs 1 year before menarche and after the first 3 years. Low-peak attainment of BMD in young women is associated with contributing factors such as diets low in calcium, eating disorders, lack of exercise, smoking, and low estrogen states. Oral contraceptives (OCs) suppress endogenous estradiol production by suppressing the hypothalamic-pituitary-ovarian axis. Thus, OCs, by replacing endogenous estradiol with ethinyl estradiol (EE), establish and maintain new hormone levels. The early initiation and the use of very low dose of EE raises the possibility that bone mass accrual at a critical time of bone mineralization in young women or adolescents may be jeopardized. This review examines the studies of BMD in adolescents and young women that use combination hormonal contraception. Some studies had inherent limitations, such as small trial, poor control of confounders, failure to exclude women with prior use of hormonal contraceptives, or prior pregnancy from control groups. The vast majority of reviewed studies showed OCs containing 20 to 30 µg of EE interfere with acquisition of peak BMD. Limited numbers of studies examine the effects of OCs containing 35 µg on adolescents and young adults. Additionally, studies are needed evaluating the progestin component of OCs as their differing androgenic properties may affect bone mineralization as well.
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Affiliation(s)
- Susan Ziglar
- Wingate University School of Pharmacy, Wingate, NC 28174, USA.
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Berenson AB, Rahman M. Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density. Contraception 2012; 86:481-7. [PMID: 22464408 DOI: 10.1016/j.contraception.2012.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/22/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The study was conducted to estimate the effect of depot medroxyprogesterone acetate (DMPA) and oral contraceptives (OC) containing 20 mcg ethinyl estradiol on serum B12 and whether observed changes impact bone mineral density (BMD). STUDY DESIGN Serum B12 and BMD at the lumbar spine and femoral neck were measured on 703 women using OC, DMPA or nonhormonal (NH) birth control at baseline and every 6 months thereafter for 3 years. RESULTS OC and DMPA users experienced greater decreases in B12 than NH users (p<.001). A sharp decrease in B12 was observed during the first 6 months of hormonal contraceptive use (OC: 97 pg/mL and DMPA: 64 pg/mL) in contrast to 14 pg/mL among NH users (20%, 13% and 3% of their baseline values, respectively). Over the following 30 months, B12 levels of OC users remained almost flat, while DMPA users had a further 22-unit decrease. Very few women demonstrated B12 deficiency. Moreover, B12 levels were not associated with BMD. CONCLUSION Hormonal contraception causes B12 levels to decrease, but this does not appear to be clinically significant or affect BMD.
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Affiliation(s)
- Abbey B Berenson
- Department of Obstetrics and Gynecology and Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX 77555, USA.
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Gai L, Jia Y, Zhang M, Gai P, Wang S, Shi H, Yu X, Liu Y. Effect of two kinds of different combined oral contraceptives use on bone mineral density in adolescent women. Contraception 2012; 86:332-6. [PMID: 22364818 DOI: 10.1016/j.contraception.2012.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 01/16/2012] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Steroid hormonal contraceptives are highly effective and widely used. Most studies have shown a negative effect of combined oral contraceptives (COCs) on the bone mineral density (BMD) of adolescents. The study was conducted to compare BMD among users of ethinylestradiol/desogestrel, users of ethinylestradiol/cyproterone acetate and nonhormonal control subjects in women aged 16-18 years. STUDY DESIGN The study included 450 women 16-18 years of age. One hundred fifty women were using ethinylestradiol/desogestrel, 150 women were using ethinylestradiol/cyproterone acetate, and 150 women were using nonhormonal contraception as control subjects. BMD ofthe lumbar spine and femoral neck was obtained using dual-energy X-ray absorptiometry, and mean BMD changes in COCs users and nonusers were compared. RESULTS At 24 months of treatment, lumbar spine and femoral neck mean BMD values in women (n=127) who used ethinylestradiol/desogestrel were slightly lower compared with baseline, but these effects did not reach statistical significance (p=.837 and p=.630, respectively). The mean lumbar spine and femoral neck BMD values in women (n=134) who used ethinylestradiol/cyproterone acetate were slightly higher compared with baseline, but there was no statistical significance (p=.789 and p=.756, respectively). The increases in mean percent change in lumbar spine and femoral neck BMD in the ethinylestradiol/cyproterone acetate group were less than those in the control group (1.88% vs. 0.30% and 0.98% vs. 0.49%, respectively). There were no significant differences in mean BMD of the lumbar spine and femoral neck between the users of ethinylestradiol/desogestrel or ethinylestradiol/cyproterone acetate and nonusers (p>.05). CONCLUSION Our study indicates that 2 years of COCs therapy had no significant effect on bone density in adolescents, but it remains unknown whether therapy longer than 2 years has a significant adverse effect on the attainment of peak bone mass.
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Affiliation(s)
- Ling Gai
- Key Laboratory for Improving Birth Outcome Technique, Shandong Provincial Institute of Science and Technology for Family Planning, Jinan, Shandong 250002, China.
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Kruger MC, Kruger IM, Wentzel-Viljoen E, Kruger A. Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover. Nutr Res 2012; 31:748-58. [PMID: 22074799 DOI: 10.1016/j.nutres.2011.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 12/16/2022]
Abstract
Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the North West Province of South Africa (Prospective Urban and Rural Epidemiology-South Africa project). Fasting blood samples were taken; and participants were interviewed to complete questionnaires on self-reported diseases, fractures, and dietary intakes. Bone health markers were assessed in a subgroup of 658 women older than 45 years. Specific lifestyle risk factors identified were inactivity, smoking, injectable progestin contraception use, and high alcohol consumption. Dietary risk factors identified were low calcium and high animal protein, phosphorous, and sodium intakes. The 25(OH)D3 and C-terminal telopeptide (CTX) levels were significantly higher in the rural vs the urban women older than 50 years. Parathyroid hormone (PTH) levels increased with age in both groups. The 25(OH)D levels were inversely correlated with CTX and PTH in rural women. In urban women, PTH and CTX were correlated while dietary calcium was inversely correlated with CTX and PTH with 25(OH)D3. The combination of low dietary calcium (<230 mg/d), marginally insufficient 25(OH)D3 status, and raised PTH may result in increased bone resorption. Further research is required to assess bone health and fracture risk in black African women.
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Affiliation(s)
- Marlena C Kruger
- Institute of Food, Nutrition and Human Health, Massey University, Palmerston North, New Zealand.
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Rahman M, Berenson AB. Self-perception of weight gain among multiethnic reproductive-age women. J Womens Health (Larchmt) 2011; 21:340-6. [PMID: 22136297 DOI: 10.1089/jwh.2011.2982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the accuracy of self-perception of weight gain and its correlates in a multiethnic reproductive-age population of women. METHODS A total of 608 women (balanced by contraceptive methods and race/ethnicity) self-reported their perceptions of weight gain at baseline and every 6 months thereafter for 36 months. Data regarding body weight, height, and other covariates were also obtained. Women with at least two follow-up visits were included in the final analysis. Generalized estimating equations (GEE) models were used to examine correlates of the accuracy of self-perception of weight gain over time. RESULTS Overall, 466 women had at least two follow-up visits with 1744 total observations over 36 months. In total, 44%, 30%, 19%, 12%, and 8% observations had at least 1, 2, 3, 4, and 5 kg weight gain in 6 months while 59%, 67%, 73%, 78%, and 85% of women accurately recognized it, respectively. Depot medroxyprogesterone (DMPA) users were more likely than nonhormonal method users (69%/51%, 76%/59%, 81%/63%, 85%/59%, and 93%/71%), and blacks more likely than whites (70%/51%, 76%/59%, 83%/65%, 90%/68%, and 95%/78%) (p<0.05 for all) to recognize weight gains of 1, 2, 3, 4, and 5 kg. The differences remained significant after adjusting for covariates using GEE. A significant difference was also observed between DMPA and oral contraceptive users. CONCLUSIONS Inability to recognize weight gain is common among young women. Both race/ethnicity and contraceptive methods influence the accurate perception of weight gain. Clinicians should provide patient-specific counseling to address the frequent inaccuracies to recognize weight gain.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas 77555-0587, USA.
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Scholes D, Hubbard RA, Ichikawa LE, LaCroix AZ, Spangler L, Beasley JM, Reed S, Ott SM. Oral contraceptive use and bone density change in adolescent and young adult women: a prospective study of age, hormone dose, and discontinuation. J Clin Endocrinol Metab 2011; 96:E1380-7. [PMID: 21752879 PMCID: PMC3167673 DOI: 10.1210/jc.2010-3027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear. OBJECTIVE The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adult OC users and discontinuers of two estrogen doses, relative to nonusers. DESIGN AND SETTING This was a prospective cohort study, Group Health Cooperative. PARTICIPANTS Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%. MAIN OUTCOME MEASURE The main outcome measure was BMD measured at 6-month intervals for 24-36 months. RESULTS After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32% < 30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter). CONCLUSIONS Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.
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Affiliation(s)
- Delia Scholes
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Avenue, 16th Floor, Seattle, Washington 98101, USA.
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Abstract
Combination hormonal contraception and progestin-only contraception (including depot medroxyprogesterone acetate [DMPA]) are effective and convenient forms of reversible contraception that millions of women use worldwide. In recent years, observations of reduced bone mineral density in current users of these methods have led to concerns that this hormone-induced bone loss might translate into long-term increased fracture risk. Special focus has been placed on adolescent users who have not yet attained their peak bone mass as well as perimenopausal users. In 2004, the FDA added a black box warning to DMPA package labeling warning of the risk of significant bone loss and cautioning against long-term use (> 2 years). This article reviews evidence on the use of hormonal contraception and its effect on bone density in adolescent, premenopausal, and perimenopausal populations. Recommendations from reproductive healthcare organizations are reviewed and clinical recommendations are provided.
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MESH Headings
- Adolescent
- Adult
- Bone Density/drug effects
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/adverse effects
- Contraceptive Agents, Female/therapeutic use
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/therapeutic use
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/therapeutic use
- Female
- Fractures, Bone/chemically induced
- Fractures, Bone/epidemiology
- Humans
- Lactation
- Perimenopause
- Practice Guidelines as Topic
- Risk Factors
- Young Adult
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Affiliation(s)
- Michelle M Isley
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, USA.
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Le YCL, Rahman M, Berenson AB. Perceived weight gain as a correlate of physical activity and energy intake among white, black, and Hispanic reproductive-aged women. J Womens Health (Larchmt) 2010; 19:1987-93. [PMID: 20831440 DOI: 10.1089/jwh.2009.1776] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To estimate the effects of perception of weight gain on women's physical activity and eating behaviors over time. METHODS A total of 608 women self-reported their experience regarding perceived weight gain and physical activity at baseline and every 6 months thereafter for 36 months. Data about dietary habits were obtained every 12 months. Longitudinal relationships of perceived weight gain with physical activity and total energy intake were assessed using mixed model regression analysis after adjusting for age, race/ethnicity, obesity, and lifestyle variables. Effect of body esteem scores on physical activity and energy intake was also examined. RESULTS At baseline, of 608 reproductive-aged women, 129 (21.2%) reported perceived weight gain, whereas 479 (78.8%) did not. Perceived weight gain was not associated with changes in physical activity over the period of 36 months (-8.04 min/week, 95% confidence interval [CI] -20.80-4.72 min/week, p = 0.22). A separate mixed model based on annual follow-up data over 36 months showed that those who perceived weight gain were more likely to have higher energy intake over time (112 Kcal/day higher, 95% CI 23-200 Kcal/day, p = 0.01). Body esteem was not associated with changes in physical activity over time (-0.13 min, 95% CI -0.44-0.18 min, p = 0.41) or energy intake over time (< 1 Kcal/day, 95% CI -2-2 Kcal/day, p = 0.82). CONCLUSIONS Neither perceived weight gain nor body esteem was associated with increased physical activity or decreased total energy intake. Rather, increased energy intake was observed among women who perceived weight gain. Future research should look at additional potential cues to action for behavior changes related to physical activity or energy intake.
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Affiliation(s)
- Yen-Chi L Le
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Texas, USA
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Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstet Gynecol 2010; 115:982-988. [PMID: 20410772 PMCID: PMC2886596 DOI: 10.1097/aog.0b013e3181da9423] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare the National Institutes of Health's (NIH) body mass index (BMI)-based classification to identify obesity in comparison with the World Health Organization (WHO), which uses percent body fat, among white, black, and Hispanic reproductive-aged women. METHODS Body weight, height, BMI, and percent body fat (dual-energy X-ray absorptiometry generated) were determined for 555 healthy adult women aged 20-33 years (mean+/-standard deviation 26.5+/-4.0 years). Diagnostic accuracy of the NIH-based obesity definition (BMI of 30 kg/m or higher) was determined using the WHO criterion standard (percent body fat greater than 35%). RESULTS Obesity as defined by the NIH (BMI 30 kg/m or higher) and by WHO (percent body fat greater than 35%) classified 205 (36.9%) and 350 (63.1%) of the women as obese, respectively. The NIH-defined obesity cutoff values had 47.8%, 75.0%, and 53.9% sensitivity in white, black and Hispanic, women, respectively. White and Hispanic women had 2.9% greater percent body fat than black women for a given BMI. Receiver operating characteristics curves analyses showed that the respective sensitivities improved to 85.6%, 81.3%, and 83.2%, and that 311 women (56.0%) were classified as obese as a whole when race or ethnic-specific BMI cutoff values driven by our data (BMI at or above 25.5, 28.7, and 26.2 kg/m for white, black, and Hispanic women, respectively) were used to detect percent body fat-defined obesity. CONCLUSION Current BMI cutoff values recommended by the NIH failed to identify nearly half of reproductive-aged women who met the criteria for obesity by percent body fat. Using race or ethnic-specific BMI cutoff values would more accurately identify obesity in this population than the existing classification system.
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Affiliation(s)
- Mahbubur Rahman
- From the Department of Obstetrics and Gynecology and the Center for Interdisciplinary Research in Women's Health, Galveston, Texas
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Racial differences in the association between body fat distribution and lipid profiles among reproductive-age women. DIABETES & METABOLISM 2010; 36:278-85. [PMID: 20409740 DOI: 10.1016/j.diabet.2010.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/22/2010] [Accepted: 01/26/2010] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to examine the racial and ethnic differences in the relationship between body fat distribution variables and serum lipid profiles. METHODS Secondary data analyses were conducted on 708 healthy women (204 blacks, 247 whites and 257 Hispanics), aged 16-33 years, seen in an outpatients clinic for contraception. Pearson correlation and multivariable linear regression techniques were used to identify racial/ethnic differences in the relationship between lipid profiles and body fat after adjusting for lean mass as well as demographic and lifestyle variables. RESULTS All body fat distribution variables were significantly associated with total cholesterol (TC) (r=0.14 to 0.26), triglycerides (TG) (r=0.13 to 0.46), HDL cholesterol (r=-0.13 to -0.34), cholesterol-to-HDL ratio (r=0.20 to 0.50) and atherogenic index of plasma (AIP) (r=0.16 to 0.49). Significant racial/ethnic differences were observed in many associations. After adjusting for lean mass, and other demographic and lifestyle factors, the study showed that black women demonstrated significantly weaker associations than their white and Hispanic counterparts using multivariable linear regression procedures. CONCLUSION The relationship between lipid profiles and body fat distribution variables varies by race/ethnicity in reproductive-age women. A better understanding of these racial/ethnic differences has important implications for clinical and public-health efforts in targeting the prevention of cardiovascular disease (CVD).
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Predictors of higher bone mineral density loss and use of depot medroxyprogesterone acetate. Obstet Gynecol 2010; 115:35-40. [PMID: 20027031 DOI: 10.1097/aog.0b013e3181c4e864] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify possible predictive factors of higher bone loss, defined as at least 5%, at the spine or femoral neck, over time in depot medroxyprogesterone acetate (DMPA) users. METHODS Bone mineral density (BMD) was measured at the lumbar spine and femoral neck every 6 months in 240 white, African-American, and Hispanic women using DMPA. For the purpose of analysis, an arbitrary value of at least 5% BMD loss from the baseline value after 24 months of DMPA use at either the lumbar spine or the femoral neck was considered as higher BMD loss. Logistic regression analysis was then used to examine factors predictive of at least 5% BMD loss at either site. RESULTS Of the initial 240 DMPA users, 95 completed 24 months of follow-up. Forty-five of the 95 DMPA users (47.4%) had at least 5% BMD loss at the lumbar spine or femoral neck by 24 months. Multivariable logistic regression model showed that at least 5% BMD loss was associated with current smoking (adjusted odds ratio [OR] 3.88, 95% confidence interval [CI] 1.26-11.96), calcium intake (in 100 mg) (OR 0.81, 95% CI 0.65-0.99), and parity (OR 0.49, 95% CI 0.29-0.82). Age, race or ethnicity, previous contraceptive use, and body mass index were not associated with higher BMD loss. CONCLUSION The risk of higher BMD loss associated with DMPA use may be reduced by quitting smoking and increasing calcium intake. Having had a child is also protective. LEVEL OF EVIDENCE II.
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Scholes D, Ichikawa L, LaCroix AZ, Spangler L, Beasley JM, Reed S, Ott SM. Oral contraceptive use and bone density in adolescent and young adult women. Contraception 2010; 81:35-40. [PMID: 20004271 PMCID: PMC2822656 DOI: 10.1016/j.contraception.2009.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 07/04/2009] [Accepted: 07/07/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most of the millions of oral contraceptive (OC) users are under 30 years of age and in the critical period for bone mass accrual. STUDY DESIGN This cross-sectional study of 606 women aged 14-30 years examined both OC duration and estrogen dose and their association with bone mineral density (BMD) at the hip, spine, and whole body (dual-energy X-ray absorptiometry). RESULTS Of 389 OC users and 217 nonusers enrolled, 50% were adolescents (14-18 years). Of OC users, 38% used "low-dose" OCs [<30 mcg ethinyl estradiol (EE)]. In adolescents, mean BMD differed by neither OC duration nor EE dose. However, 19- to 30-year-old women's mean BMD was lower with longer OC use for spine and whole body (p=.004 and p=.02, respectively) and lowest for >12 months of low-dose OCs for the hip, spine and whole body (p=.02, .003 and .002, respectively). CONCLUSIONS Prolonged use of today's OCs, particularly <30 mcg EE, may adversely impact young adult women's bone density while using these agents.
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Affiliation(s)
- Delia Scholes
- Group Health Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
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Rahman M, Berenson AB. Racial difference in lean mass distribution among reproductive-aged women. Ethn Dis 2010; 20:346-352. [PMID: 21305820 PMCID: PMC3076634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE Lean mass is an important determinant of bone mineral density (BMD) accrual, yet data regarding its correlates based on multiethnic premenopausal women are lacking. We examined the influence of age, race/ethnicity, and lifestyle variables on total and regional lean mass distribution in this population. DESIGN A cross-sectional study was conducted on 708 healthy Black, White, and Hispanic women aged 16-33 years who were seen in an outpatient clinic. In addition, 218 of these women were followed for up to 36 months to observe changes in the relevant variables. We measured body weight, height, and lean mass distribution using a digital scale, wall-mounted stadiometer, and dual-energy absorptiometry (DXA), respectively. Multiple linear regression and mixed-model regression analyses were used to model the relationship of age, race/ethnicity and lifestyle variables to total and regional lean mass. RESULTS For a given body mass index (BMI), Black women had higher total body lean mass (LM(total)) and leg lean mass (LM(leg)) than White and Hispanic women. Hispanic women had significantly lower LM(total), trunk lean mass (LM(trunk)), and LM(leg) than Black and White women. The difference between Blacks and Whites with regard to LM(total) significantly magnified with increasing BMI. Weight-bearing exercise and age at menarche were positively associated with lean mass variables, while parity was negatively associated with LM(leg). LM(total) and LM(trunk) increased over 36 months. Calcium intake was positively associated with increase in LM(totaI) over time. CONCLUSIONS Our study shows that racial differences exist in the distribution of lean mass for a given BMI among reproductive-aged women.
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Affiliation(s)
- Mahbubur Rahman
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston TX 77555-0587, USA.
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