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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 2023; 24:199-223. [PMID: 36539678 DOI: 10.1007/s40257-022-00746-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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Wunder D. [The Thromboembolism Risk with Combined Hormonal Contraceptives: Current Status and Prescribing Practice]. PRAXIS 2023; 112:199-204. [PMID: 36919316 DOI: 10.1024/1661-8157/a003990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The Thromboembolism Risk with Combined Hormonal Contraceptives: Current Status and Prescribing Practice Abstract. The use of combined hormonal contraceptives (CHC) increases not only the risk for venous thromboembolism, but also for arterial thromboembolism. The risk for thromboembolism is the same for non-oral CHC (patches, vaginal rings) as for oral CHC. Risk factors such as age >35, obesity, smoking and a positive family history need to be recognized and considered in contraceptive counselling. Elaborate information concerning risks and benefits is mandatory. This applies to first-time as well as long-term users. Careful investigation of the history is required, and the risk factors need to be re-evaluated at yearly prescription. It is also very important to inform the patients about the early symptoms of thrombosis or pulmonary embolism, so that therapy can be started immediately. Apart from these risks, CHC may have beneficial effects on organs such as the ovaries, the endometrium and the general well-being for many women. When prescribing a CHC for the first time or when changing to another preparation, one should always weigh up whether certain benefits justify prescribing a preparation with a slightly higher risk of thrombosis compared to the second-generation pill or preparations with Estradiol/Nomegestrolacetat. Women who are already using a third-generation pill or a pill with drospirenone or cyproterone acetate and feel comfortable with it do not need to switch to another preparation (provided no new risk factors have arisen). For women with increased risks, i.e. several relative contraindications or one absolute contraindication, safe alternatives to CHC include progestogen-only preparations, intrauterine devices containing copper or levonorgestrel or, after family planning has been completed, surgical methods (sterilisation/vasectomy).
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Affiliation(s)
- Dorothea Wunder
- Gynécologie/Obstétrique, PMA et Endocrinologie Gynécologique, Hôpital Cantonal Fribourg, HFR, Villars-sur-Glâne, Schweiz
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Olsen TS, Andersen KK. Absolute risk of ischemic and hemorrhagic stroke in Danish women using oral contraceptives. Acta Neurol Scand 2022; 145:565-570. [PMID: 35089604 DOI: 10.1111/ane.13584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Uncertainty exists for the absolute risk of ischemic and hemorrhagic stroke in users of oral contraceptives (OCs). Estimates greatly vary between countries. In Denmark, absolute risk of ischemic stroke (IS) is estimated to be 21 per 100,000 person-years. Risk of cerebral hemorrhage (CH) is unknown. Using the Danish Stroke Registry, we investigated absolute risk of IS and CH in users of OC. MATERIAL AND METHODS For the Danish female population aged 15-49 years during 2003-2011, we obtained information on hospital admission for IS and CH and current use of OC from Danish nationwide registries. We defined current use of OC as redeeming at least two OC prescriptions within the previous year. RESULTS The Danish female population years 2003-2011 consisted mean of 1,246,142 women per year. Of these, 29.6% were OC users. In the study period, OC users had 291 IS and 14 CH. Absolute risk of IS in OC users was 8.8 per 100,000 person-years and of CH it was 0.4 per 100,000 person-years. CONCLUSIONS In OC users, absolute risk of IS was 8.8 per 100,000 person-years. This is more than half that of the risk previously assumed in Denmark. Risk of CH in OC users was very low and 0.4 per 100,000 person-years.
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Affiliation(s)
- Tom Skyhøj Olsen
- Department of Neurology Bispebjerg University Hospital Copenhagen Denmark
| | - Klaus Kaae Andersen
- Section of Statistics Danish Cancer Society Research Center Copenhagen Denmark
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Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. Int J Mol Sci 2022; 23:ijms23084110. [PMID: 35456928 PMCID: PMC9030414 DOI: 10.3390/ijms23084110] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 02/08/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous and extremely common disease with symptoms that vary with the age of the patient, typically characterized by hyperandrogenism, chronic oligo-anovulation, and/or several metabolic disorders. The syndrome includes various phenotypes, and the pathogenesis is multifactorial, often involving insulin resistance. This feature is closely related to ovarian dysfunction, inflammation, hyperandrogenism, and metabolic disorders, which characterize and complicate the syndrome. Therapy currently considers both lifestyle improvements and medications, and must be tailored on a case-by-case basis. To date, the published studies have not arrived at a definition of the most suitable therapy for each individual case and many of the drugs used are still off-label. In this review, we discuss some controversial diagnostic and therapeutic aspects of PCOS, such as the role of insulin resistance, inflammation, and hyperandrogenism. We also evaluated the advantages and disadvantages of contraceptive therapy and antiandrogens.
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Wunder D, Merki-Feld G. Thromboembolierisiko unter kombinierten hormonellen Kontrazeptiva – aktueller Stand und Verschreibungspraxis. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Setyawan J, Mu F, Yarur A, Zichlin ML, Yang H, Fernan C, Billmyer E, Downes N, Azimi N, Strand V. Risk of thromboembolic events and associated risk factors, including treatments, in patients with immune-mediated diseases. Clin Ther 2021; 43:1392-1407.e1. [PMID: 34238587 DOI: 10.1016/j.clinthera.2021.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/07/2021] [Accepted: 06/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study assessed the association between thromboembolic events (TEs) and immune-mediated diseases (IMDs) and characterized the risk profile of TEs among patients with IMDs. METHODS An administrative claims database (2014-2018) was used to identify adults with ≥2 diagnoses on different dates for ≥1 IMD (IMD cohort; ankylosing spondylitis, atopic dermatitis, inflammatory bowel disease, multiple sclerosis, psoriasis, psoriatic arthritis, rheumatoid arthritis, and systemic lupus erythematosus); patients without an IMD diagnosis were assigned to the non-IMD cohort. Patients in the IMD cohort were matched 1:1 to patients in the non-IMD cohort on age, sex, and index date. Incremental risk of TE (ie, deep vein thrombosis [DVT], pulmonary embolism [PE], myocardial infarction [MI], and ischemic stroke [IS]) was assessed using adjusted incidence rate ratios (aIRRs) to control for covariates in both cohorts. Risk factors for TEs were assessed in the IMD cohort and included age, female sex, comorbidities, baseline TEs, non-IMD treatments, and IMD treatments. FINDINGS A total of 182,431 patients were included in each cohort (mean age, [51.3] years; 64.3% female). A higher proportion of patients in the IMD cohort versus the non-IMD cohort had ≥1 baseline TE (4.1% vs 2.7%; P < 0.0001). The IMD cohort had a 1.80 (95% CI, 1.68-1.92; P < 0.0001) times higher rate of TEs versus patients in the non-IMD cohort. After adjustments, patients in the IMD cohort had a 1.49 (95% CI, 1.40-1.59; P < 0.0001) times higher rate of TEs versus patients in the non-IMD cohort. Similar results were observed across individual TEs (DVT: aIRR = 1.78; PE: aIRR = 1.66; MI: aIRR = 1.17; IS: aIRR = 1.35; all P < 0.05). Risk factor profiles varied by TE. The greatest risk factor was respective TE during baseline (eg, patients with baseline DVT had 41.1 times the rate of DVT during the study period vs patients without baseline DVT; P < 0.001). Comorbidities, such as cardiovascular diseases, type 2 diabetes, and peripheral vascular disease, were associated with increased rates of MI (IRR = 2.60, 1.30, and 1.54, respectively; all P < 0.05) and IS (IRR = 1.53, 1.54, and 1.24, respectively; all P < 0.05). Janus kinase inhibitors were associated with an increased rate of PE (IRR = 2.52; P < 0.05) and nonsignificant, numerically higher rates of DVT (IRR = 1.23; P = NS) and IS (IRR = 1.82; P = NS). Sphingosine 1-phosphate receptor modulators were associated with decreased rates of TEs (DVT: IRR = 0.61, P = NS; PE: IRR = 0.30, P = NS; MI: IRR = 0.54, P = NS; IS: IRR = 0.33, P < 0.05). IMPLICATIONS The risk of TEs was higher among patients with IMD versus patients without IMD; several factors may affect this risk.
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Affiliation(s)
| | - Fan Mu
- Analysis Group Inc, Boston, Massachusetts.
| | - Andres Yarur
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | | | | | | | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California
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Jang YS, Lee ES, Kim YK. Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience. Obstet Gynecol Sci 2021; 64:337-344. [PMID: 33794564 PMCID: PMC8290149 DOI: 10.5468/ogs.20374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/15/2021] [Accepted: 03/23/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Combined oral contraceptives (COCs) are used for various reasons. However, venous thromboembolism (VTE), a significant side effect, can be fatal. This study reports the first case series in Korea involving patients with COC-associated VTE registered at a university hospital. METHODS This study recruited 13 patients diagnosed with COC-associated VTE between June 2006 and May 2018. Risk factors, including age, body mass index, smoking habits, estrogen dosage, type of progestin, and duration of COC use, were evaluated. RESULTS Among patients with VTE, 9 showed pulmonary embolism (PE) concomitant with deep vein thrombosis (DVT). However, the remaining patients showed DVT (1 patient), PE (1 patient), and cerebral venous thrombosis (2 patients). The median duration between the onset of symptoms and a hospital visit was 3 days, and it sometimes took as long as 32 days. Among the 10 patients with PE, 1 high-risk group and 2 intermediate-high risk groups were treated with tissue plasminogen activators before anticoagulants. There were no cases of recurrence among patients who continued to take anticoagulants for 3 months. CONCLUSION These findings emphasize that healthcare professionals who prescribe or dispense COCs to women must inform them of the risk of VTE, including the risk factors, differences in risk depending on the type of progestin present in the product, and pertinent signs and symptoms. Efforts should also be made to inform patients of VTE, even through information campaigns such as brochures. Most importantly, women should remain alert for signs and symptoms of VTE when using COCs.
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Affiliation(s)
- Yong-Su Jang
- Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan,
Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Yang-Ki Kim
- Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
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Treger S, Ackerman S, Kaplan V, Ghanem S, Nadir Y. Progestin type affects the increase of heparanase level and procoagulant activity mediated by the estrogen receptor. Hum Reprod 2021; 36:61-69. [PMID: 33306105 DOI: 10.1093/humrep/deaa263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/22/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does progestin have an effect on heparanase level and procoagulant activity? SUMMARY ANSWER Progestin increases the heparanase level and procoagulant activity via the estrogen receptor and the magnitude of the effect depends on the progestin type. WHAT IS KNOWN ALREADY Users of combined oral contraceptives (COCs) containing third- and fourth-generation progestins have a higher risk of venous thrombosis compared to those employing second-generation progestins. Heparanase protein is capable of degrading heparan sulfate (HS) chains and enhancing activation of the coagulation system. We have previously demonstrated that estrogen enhances the expression and procoagulant activity of heparanase. STUDY DESIGN, SIZE, DURATION Estrogen and progestin receptor positive breast carcinoma cell lines: EMT6, T47D and MCF-7 were compared to the MDA-231 breast carcinoma cell line devoid of these receptors. This observational study incorporated 45 users of third-generation COCs progestins, 21 users of fourth-generation COCs progestins and 28 individuals not using hormonal therapy and not pregnant per history. PARTICIPANTS/MATERIALS, SETTING, METHODS Second-generation progestin-levonorgestrel, third-generation progestin-desogastrel (DSG), an estrogen receptor antagonist-ICI 182.780 and a progestin receptor antagonist-mifepristone, were added to cell lines. Heparanase level and procoagulant activity, HS levels, tissue factor (TF) activity and factor Xa levels were evaluated in the plasma of the study group. MAIN RESULTS AND THE ROLE OF CHANCE Levonorgestrel and DSG increased heparanase levels in the cells and medium. The effect of DSG was more prominent and additive to that of estrogen. The effect was inhibited by ICI 182.780. In the plasma of COC users, heparanase procoagulant activity, HS levels, TF activity and factor Xa levels were significantly higher compared to controls. In COC pills containing the same dose of estrogen, the procoagulant effect of drospirenone was significantly stronger than that of DSG and gestodene. LIMITATIONS, REASONS FOR CAUTION The limitations of the study include a small number of participants in each study group, although the results are statistically significant and evaluated by several different coagulation parameters. WIDER IMPLICATIONS OF THE FINDINGS The study demonstrates a new mechanism through which progestin affects coagulation system activation and shows that this effect is progestin type-dependent. Development of a progestin derivative with an attenuated effect on heparanase procoagulant activity may reduce thrombotic risk. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. Y.N. is named in a European patent application No. IL201200027 filed on 18 January 2012. Other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sharon Treger
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shanny Ackerman
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Victoria Kaplan
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shourouk Ghanem
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Okoth K, Chandan JS, Marshall T, Thangaratinam S, Thomas GN, Nirantharakumar K, Adderley NJ. Association between the reproductive health of young women and cardiovascular disease in later life: umbrella review. BMJ 2020; 371:m3502. [PMID: 33028606 PMCID: PMC7537472 DOI: 10.1136/bmj.m3502] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To consolidate evidence from systematic reviews and meta-analyses investigating the association between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease. DESIGN Umbrella review. DATA SOURCES Medline, Embase, and Cochrane databases for systematic reviews and meta-analyses from inception until 31 August 2019. REVIEW METHODS Two independent reviewers undertook screening, data extraction, and quality appraisal. The population was women of reproductive age. Exposures were fertility related factors and adverse pregnancy outcomes. Outcome was cardiovascular diseases in women, including ischaemic heart disease, heart failure, peripheral arterial disease, and stroke. RESULTS 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years. All except three reviews were of moderate quality. A narrative evidence synthesis with forest plots and tabular presentations was performed. Associations for composite cardiovascular disease were: twofold for pre-eclampsia, stillbirth, and preterm birth; 1.5-1.9-fold for gestational hypertension, placental abruption, gestational diabetes, and premature ovarian insufficiency; and less than 1.5-fold for early menarche, polycystic ovary syndrome, ever parity, and early menopause. A longer length of breastfeeding was associated with a reduced risk of cardiovascular disease. The associations for ischaemic heart disease were twofold or greater for pre-eclampsia, recurrent pre-eclampsia, gestational diabetes, and preterm birth; 1.5-1.9-fold for current use of combined oral contraceptives (oestrogen and progesterone), recurrent miscarriage, premature ovarian insufficiency, and early menopause; and less than 1.5-fold for miscarriage, polycystic ovary syndrome, and menopausal symptoms. For stroke outcomes, the associations were twofold or more for current use of any oral contraceptive (combined oral contraceptives or progesterone only pill), pre-eclampsia, and recurrent pre-eclampsia; 1.5-1.9-fold for current use of combined oral contraceptives, gestational diabetes, and preterm birth; and less than 1.5-fold for polycystic ovary syndrome. The association for heart failure was fourfold for pre-eclampsia. No association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment. CONCLUSIONS From menarche to menopause, reproductive factors were associated with cardiovascular disease in women. In this review, presenting absolute numbers on the scale of the problem was not feasible; however, if these associations are causal, they could account for a large proportion of unexplained risk of cardiovascular disease in women, and the risk might be modifiable. Identifying reproductive risk factors at an early stage in the life of women might facilitate the initiation of strategies to modify potential risks. Policy makers should consider incorporating reproductive risk factors as part of the assessment of cardiovascular risk in clinical guidelines. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019120076.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Swanepoel AC, Bester J, de Lange-Loots Z. Mechanical and Physical Behavior of Fibrin Clot Formation and Lysis in Combined Oral Contraceptive Users. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2020; 26:1007-1013. [PMID: 32778190 DOI: 10.1017/s1431927620024289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Combined oral contraceptives (COCs) are commonly prescribed and increase the risk of venous thromboembolism (VTE). We have previously found that two COCs, both containing drospirenone (DRSP) and ethinyl estradiol (EE), cause spontaneous fibrin formation in whole blood. The aim of this study was, therefore, to use platelet-poor plasma (PPP) from the same cohort of DRSP/EE users to determine the impact of these COCs on the fibrin component, specifically the fibrin clot viscoelasticity, turbidimetry, and biophysical traits. PPP from 25 females per test group and a control group (n = 25) were analyzed using thromboelastography (TEG), turbidimetry, and scanning electron microscopy. The results highlight abnormal fibrin clot formation, lysis, and architecture; DRSP/20EE showed the greatest effect. DRSP/EE use increased the fibrin fiber diameter and showed dense matted clots. Only when the influence of COCs on the structural properties and behavior of fibrin fibers during thrombus formation and lysis is better understood are we able to predict and prevent coagulopathies associated with these synthetic hormones. Clinical practitioners should take this into consideration for female patients that either have comorbidities, which could burden the coagulation system, or may be exposed to external factors that could increase their risk for VTE.
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Affiliation(s)
- Albe Carina Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia0007, South Africa
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom2520, South Africa
| | - Janette Bester
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia0007, South Africa
| | - Zelda de Lange-Loots
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom2520, South Africa
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Anamthathmakula P, Winuthayanon W. Mechanism of semen liquefaction and its potential for a novel non-hormonal contraception†. Biol Reprod 2020; 103:411-426. [PMID: 32529252 PMCID: PMC7523691 DOI: 10.1093/biolre/ioaa075] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Semen liquefaction is a proteolytic process where a gel-like ejaculated semen becomes watery due to the enzymatic activity of prostate-derived serine proteases in the female reproductive tract. The liquefaction process is crucial for the sperm to gain their motility and successful transport to the fertilization site in Fallopian tubes (or oviducts in animals). Hyperviscous semen or failure in liquefaction is one of the causes of male infertility. Therefore, the biochemical inhibition of serine proteases in the female reproductive tract after ejaculation is a prime target for novel contraceptive development. Herein, we will discuss protein components in the ejaculates responsible for semen liquefaction and any developments of contraceptive methods in the past that involve the liquefaction process.
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Affiliation(s)
- Prashanth Anamthathmakula
- School of Molecular Biosciences, Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| | - Wipawee Winuthayanon
- School of Molecular Biosciences, Center for Reproductive Biology, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
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Swanepoel AC, Bester J, Emmerson O, Soma P, Beukes D, van Reenen M, Loots DT, du Preez I. Serum Metabolome Changes in Relation to Prothrombotic State Induced by Combined Oral Contraceptives with Drospirenone and Ethinylestradiol. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 24:404-414. [PMID: 32471328 DOI: 10.1089/omi.2020.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The association between hypercoagulability and use of drospirenone (DRSP) and ethinylestradiol (EE) containing combined oral contraceptives (COCs) is an important clinical concern. We have previously reported that the two formulations of DRSP combined with EE (namely, DRSP/20EE and DRSP/30EE) bring about a prothrombotic state in hemostatic traits of female users. We report here the serum metabolomic changes in the same study cohort in relation to the attendant prothrombotic state induced by COC use, thus offering new insights on the underlying biochemical mechanisms contributing to the altered coagulatory profile with COC use. A total of 78 healthy women participated in this study and were grouped as follows: control group not using oral contraceptives (n = 25), DRSP/20EE group (n = 27), and DRSP/30EE group (n = 26). Untargeted metabolomics revealed changes in amino acid concentrations, particularly a decrease in glycine and an increase in both cysteine and lanthionine in the serum, accompanied by variations in oxidative stress markers in the COC users compared with the controls. Of importance, this study is the first to link specific amino acid variations, serum metabolites, and the oxidative metabolic profile with DRSP/EE use. These molecular changes could be linked to specific biophysical coagulatory alterations observed in the same individuals. These new findings lend evidence on the metabolomic substrates of the prothrombotic state associated with COC use in women and informs future personalized/precision medicine research. Moreover, we underscore the importance of an interdisciplinary approach to evaluate venous thrombotic risk associated with COC use.
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Affiliation(s)
- Albe Carina Swanepoel
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Janette Bester
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Odette Emmerson
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Prashilla Soma
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Derylize Beukes
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Mari van Reenen
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Du Toit Loots
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Ilse du Preez
- Human Metabolomics, North-West University, Potchefstroom, South Africa
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Shaukat F, Keeling S. Contraception in Systemic Lupus Erythematosus (SLE). CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beck KR, Thompson GR, Odermatt A. Drug-induced endocrine blood pressure elevation. Pharmacol Res 2019; 154:104311. [PMID: 31212012 DOI: 10.1016/j.phrs.2019.104311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022]
Abstract
Patients with uncontrolled hypertension are at risk for cardiovascular complications. The majority of them suffers from unidentified forms of hypertension and a fraction has so-called secondary hypertension with an identifiable cause. The patient's medications, its use of certain herbal supplements and over-the-counter agents represent potential causal factors for secondary hypertension that are often overlooked. The current review focuses on drugs that are likely to elevate blood pressure by affecting the human endocrine system at the level of steroid synthesis or metabolism, mineralocorticoid receptor activity, or by affecting the catecholaminergic system. Drugs with known adverse effects but where benefits outweigh their risks, drug candidates and market withdrawals are reviewed. Finally, potential therapeutic strategies are discussed.
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Affiliation(s)
- Katharina R Beck
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and the Department of Medical Microbiology and Immunology, University of California Davis Medical Center, Davis, California, USA
| | - Alex Odermatt
- Swiss Centre for Applied Human Toxicology and Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
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Oliveira CARD, Dos Reis Araujo T, Aguiar GDS, da Silva Junior JA, Vettorazzi JF, Freitas IN, Oliveira KMD, Boschero AC, Bonfleur ML, Clarke JR, Henriques HN, Ribeiro RA. Combined oral contraceptive in female mice causes hyperinsulinemia due to β-cell hypersecretion and reduction in insulin clearance. J Steroid Biochem Mol Biol 2019; 190:54-63. [PMID: 30923014 DOI: 10.1016/j.jsbmb.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/23/2019] [Accepted: 03/23/2019] [Indexed: 12/19/2022]
Abstract
Oral contraception is the most commonly used interventional method in the world. However, several women employ the continuous use of these hormones to avoid pre- and menstruation discomforts. Some studies indicate that oral contraceptives are associated with disturbances in glycemia and the effects of the use of a continuous regime are poorly elucidated. Herein, we evaluated the effects of the continuous administration of a combined oral contraceptive (COC) composed by ethinyl estradiol (EE) and drospirenone (DRSP) on glucose homeostasis in female mice. Adult Swiss mice received 0.6 μg EE and 60 μg DRSP (COC group) or vehicle [control (CTL)] daily by gavage for 35 days. COC treatment had no effect on body weight or adiposity, but increased uterus weight and induced hepatomegaly. Importantly, COC females displayed normal glycemia and glucose tolerance, but hyperinsulinemia and lower plasma C-peptide/insulin ratio, indicating reduced insulin clearance. Furthermore, COC mice displayed reduced protein content of the β subunit of the insulin receptor (IRβ) in the liver. Additionally, pancreatic islets isolated from COC mice secreted more insulin in response to increasing glucose concentrations. This effect was associated with the activity of steroid hormones, since INS-1E cells incubated with EE plus DRSP also secreted more insulin. Therefore, we provide the first evidence that the continuous administration of EE and DRSP lead to hyperinsulinemia, due to enhancement of insulin secretion and the reduction of insulin degradation, which possibly lead to the down-regulation of hepatic IRβ. These findings suggest that the continuous administration of COC could cause insulin resistance with the prolongation of treatment.
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Affiliation(s)
| | - Thiago Dos Reis Araujo
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Gésily de Souza Aguiar
- Universidade Federal do Rio de Janeiro, Campus UFRJ-Macaé Professor Aloísio Teixeira, Macaé, RJ, Brazil
| | | | - Jean Franciesco Vettorazzi
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Israelle Netto Freitas
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Kênia Moreno de Oliveira
- Universidade Federal do Rio de Janeiro, Campus UFRJ-Macaé Professor Aloísio Teixeira, Macaé, RJ, Brazil
| | - Antonio Carlos Boschero
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Maria Lúcia Bonfleur
- Centro de Ciências Biológicas e da Saúde, Universidade Estadual do Oeste do Paraná (UNIOESTE), Cascavel, PR, Brazil
| | - Júlia Rosauro Clarke
- Núcleo de Neurociências da Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Campus UFRJ-Ilha do Fundão, RJ, Brazil
| | - Helene Nara Henriques
- Universidade Federal do Rio de Janeiro, Campus UFRJ-Macaé Professor Aloísio Teixeira, Macaé, RJ, Brazil
| | - Rosane Aparecida Ribeiro
- Universidade Federal do Rio de Janeiro, Campus UFRJ-Macaé Professor Aloísio Teixeira, Macaé, RJ, Brazil.
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Menshawy A, Ismail A, Abdel-Maboud M, El-Din AA, Elgebaly A, Gadelkarim M, Bahbah EI, Abdelghany MF, Samy A, Abbas AM. Effect of chlormadinone acetate versus drospirenone-containing oral contraceptives on the endocrinal features of women with polycystic ovary syndrome: Systematic review and meta-analysis of randomized clinical trials. J Gynecol Obstet Hum Reprod 2019; 48:763-770. [PMID: 30940512 DOI: 10.1016/j.jogoh.2019.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a serious endocrinal disorder in women of reproductive age. Hormonal treatment with oral contraceptives, containing estrogen (ethinyl-estradiol, EE) with progestogen (drospirenone, DRSP) or (chlormadinone acetate, CMA), has improved symptoms and biomarkers of PCOS. OBJECTIVE The aim of the present meta-analysis is to compare the effects of EE/DRSP versus EE/CMA on the endocrinal features of women with PCOS. DATA SOURCES Several electronic databases were searched for combinations of the following relevant MeSH terms were used: (ethinyl-estradiol OR EE) AND (drospirenone OR DRSP) AND (chlormadinone acetate OR CMA) AND (polycystic ovary syndrome). METHODS Records were screened for eligible studies and data were extracted to an online data extraction form. Outcomes of Ferryman-Gallwey score (FGS), body mass index, dehydroepiandrosterone sulfate (DHEAS), free androgen index, sex hormone-binding globulin, delta-4-androstenedione (A) and total testosterone levels (T) were pooled as weighted mean difference (WMD) and 95% confidence interval (CI) in a fixed effect meta-analysis model. RESULTS Three RCTs (EE/DRSP: n = 98 and EE/CMA: n = 87) were pooled in the analysis. The overall effect favoured EE/DRSP over EE/CMA in reducing (A) levels after three months (WMD -0.63; 95% CI [-0.94, -0.32], P < 0.001), FGS after six months (WMD -0.44; 95% CI [-0.99, -0.19], P = 0.0006), and total (T) after three months (WMD -0.12; 95% CI [-0.23, -0.01], P = 0.03). CONCLUSIONS EE/DRSP showed a more potent effect than EE/CMA in the reduction of FGS after six months, (A) levels and (T) levels after three months in patients with PCOS.
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Affiliation(s)
- Amr Menshawy
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Ammar Ismail
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Mohamed Abdel-Maboud
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Alaa Alaa El-Din
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | - Ahmed Elgebaly
- Faculty of Medicine, Al-Azhar University, Al-Azhar Medical Students' Association, Cairo, Egypt
| | | | - Eshak I Bahbah
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed F Abdelghany
- Department of Obstetrics and Gynaecology, Faculty of Medicine, South Valley University, Egypt
| | - Ahmed Samy
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Assiut University, Egypt.
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FSRH Guideline (January 2019) Combined Hormonal Contraception (Revision due by January 2024). BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-93. [PMID: 30665985 DOI: 10.1136/bmjsrh-2018-chc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Emmerson O, Bester J, Lindeque BG, Swanepoel AC. The Impact of Two Combined Oral Contraceptives Containing Ethinyl Estradiol and Drospirenone on Whole Blood Clot Viscoelasticity and the Biophysical and Biochemical Characteristics of Erythrocytes. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2018; 24:713-728. [PMID: 30588913 DOI: 10.1017/s1431927618015453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Venous thrombosis is associated with combined oral contraceptive (COC) use. We investigated the impact of two ethinyl estradiol (EE) and drospirenone (DRSP) containing COCs (3 mg DRSP/20 µg EE and 3 µg DRSP/30 µg EE) on the viscoelasticity of whole blood clots along with the biophysical and biochemical characteristics of erythrocytes. Thromboelastography (TEG) analysis showed a tendency toward a hypercoagulable state in the COCs groups that was more pronounced with higher EE concentrations. Light microscopy and scanning electron microscopy (SEM) showed rouleaux formation of erythrocytes and alterations to the erythrocyte shape for both COC groups, which was attributed to membrane damage. SEM analysis showed spontaneous activation of fibrin and platelets in the COC groups, along with interactions between erythrocytes and platelets and/or fibrin. Confocal microscopy confirmed compromised membrane integrity in the COC groups compared to controls. Global thrombosis test analysis showed increased platelet activation and low thrombolysis in both COC groups when compared to controls. In conclusion, DRSP/EE formulations impact erythrocytes' biophysical and biochemical properties to cause a shift in hemostasis to a prothrombotic state. Although these effects are mostly subclinical the long-term effects and risks involved with the use of these hormones should be considered carefully for each individual.
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Affiliation(s)
- Odette Emmerson
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Janette Bester
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Barend G Lindeque
- 2Department of Obstetrics and Gynaecology,School of Medicine, Faculty of Health Sciences,University of Pretoria,P.O. Box 667,Pretoria 0001,South Africa
| | - Albe C Swanepoel
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
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von Beckerath O, Santosa F, Waldhausen R, Moerchel C, Kröger K. Thromboembolic disease in females and males aged 10 to 39 years in Germany. VASA 2018; 47:483-489. [PMID: 30200845 DOI: 10.1024/0301-1526/a000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We analysed differences in hospitalization rates for venous diseases such as pulmonary embolism (PE), deep vein thrombosis (DVT), sinus vein thrombosis (SVT), portal vein thrombosis (PVT), and Budd-Chiari syndrome (BCS) as well as for arterial diseases such as myocardial infarction (MI) and embolic stroke (ES) in females and males aged 10 to 39 years. PATIENTS AND METHODS Detailed lists of hospitalizations with the principal and additional diagnoses for PE (ICD-code I26.0 + I26.9), DVT (I80.0-I80.9), SVT (I67.6), PVT (I81), BCS (I82.0), MI (I21.0-I21.9), and ES (I63.1 + I63.4) in males and females aged 10 to 39 years in the years 2006 to 2015 were provided by the Federal Statistical Office in Germany. RESULTS Considering the 10-year period there were more female than male cases hospitalized with the principal diagnoses for PE, DVT, SVT, and BCS. Looking at the principal diagnosis of the year 2015, one can see a steep increase in numbers of hospitalization for PE, DVT, and SVT in females ranging from the ages 12 to 13 and 14 to 15 years compared to males. The curves of PE and DVT meet again in the age group between 32 and 33 years, but not for SVT. The greatest differences are seen at the end of the second and at the beginning of the third decade of life. In contrast, MI was more frequent in young males beginning at the age of 18 to 19 years. The number of female and male cases with ES and PVT were almost similar in the different age groups. CONCLUSIONS The presented data show higher hospitalization rates for females in the age group 10 to 39 years for different venous thrombosis but not for MI and ES.
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Affiliation(s)
| | - Frans Santosa
- 2 Medical Faculty Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
| | | | - Christian Moerchel
- 3 General Practitioner, Mainz, Germany.,4 Thrombose Initiative e. V., Mainz, Germany
| | - Knut Kröger
- 1 Department of Angiology, Helios Klinikum Krefeld, Germany.,4 Thrombose Initiative e. V., Mainz, Germany
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Sugiura K, Ojima T, Urano T, Kobayashi T. The incidence and prognosis of thromboembolism associated with oral contraceptives: Age-dependent difference in Japanese population. J Obstet Gynaecol Res 2018; 44:1766-1772. [PMID: 29998477 PMCID: PMC6175086 DOI: 10.1111/jog.13706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/20/2018] [Indexed: 12/01/2022]
Abstract
Aim We analyzed the incidence and prognosis of thromboembolism associated with combined oral contraceptives (COCs) by age groups in Japan. Methods A total of 581 events of venous thromboembolism (VTE) and arterial thromboembolism (ATE) associated with COCs were analyzed from the Pharmaceuticals and Medical Devices Agency database from 2004 to 2013. In a statistical analysis, a good‐prognosis group included recovery cases and a poor‐prognosis group involved unrecovered cases with some sequela and fatal cases. The significant difference between these two groups was calculated by Pearson's chi‐square test, and the age‐specific tendency and the trend of differences in prognosis according to different hormonal contraceptives were examined by Cochran–Armitage trend test. Results A total of 543 events were analyzed except 38 events due to unknown age, in which DVT only was the most frequent, followed by cerebral infarction, PE with DVT, PE only, cerebral vein thromboses. ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041). Good‐prognosis group was common (291 cases in VTE and 83 cases in ATE), followed by poor‐prognosis group (46 cases in VTE and 34 cases in ATE). All ATE cases had a significantly poorer prognosis in comparison with all VTE cases (P < 0.0001). Types of progestin and age difference, however, showed no trend in the differences between good‐prognosis group and poor‐prognosis group (P = 0.3548 and P = 0.6097). Conclusion Thromboembolic events were the most frequent in the 40s. The ATE ratio for overall thromboembolism tended to increase with advancing age. All ATE cases had a significantly poorer prognosis in comparison with all VTE cases.
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Affiliation(s)
- Kazuko Sugiura
- Department of Reproductive Health Nursing/Midwifery, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Shizuoka, Japan
| | - Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Shizuoka, Japan
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Oedingen C, Scholz S, Razum O. Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: The role of the progestogen type and estrogen dose. Thromb Res 2018; 165:68-78. [DOI: 10.1016/j.thromres.2018.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
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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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Drospirenone-Containing Oral Contraceptive Pills and the Risk of Venous Thromboembolism: An Assessment of Risk in First-Time Users and Restarters. Drug Saf 2018; 40:583-596. [PMID: 28382493 DOI: 10.1007/s40264-017-0525-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The effects of drospirenone-containing combined oral contraceptives (COCs) on the risk of venous thromboembolism (VTE) remain controversial due to the challenge in distinguishing between first-time users and restarters, and their different underlying VTE risks, in healthcare databases. OBJECTIVES The aim of this study was to describe the challenge of studying the risk of VTE among first-time users of drospirenone-containing COCs in a healthcare database and assess the risk among first-time users and restarters. METHODS We used data from the Clinical Practice Research Datalink to construct two cohorts. The first-time user cohort included all women aged 16-45 years who received a first ever prescription of drospirenone- or levonorgestrel-containing COCs between May 2002 and March 2015. The restarter cohort included those who were restarting a COC after a period of non-use of ≥6 months. Cox proportional hazards models adjusted for high dimensional propensity scores were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS The final cohorts included 55,139 first-time users (3582 drospirenone and 51,557 levonorgestrel) and 162,959 restarters (23,191 drospirenone and 139,768 levonorgestrel). The adjusted HR of VTE associated with drospirenone versus levonorgestrel was 3.19 (95% CI 1.12-9.08) for first-time users and 1.96 (95% CI 1.12-3.41) for restarters. CONCLUSIONS We found an elevated risk of VTE associated with drospirenone-containing COCs in comparison with levonorgestrel-containing COCs in both cohorts. While left truncation of healthcare databases is a concern for the identification of first-time users, the use of a more explicit cohort of restarters suggests a doubling of VTE risk with drospirenone-containing COCs.
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Santosa F, Moysidis T, Moerchel C, Bufe A, Kröger K. Pulmonary embolism in young people. Hamostaseologie 2017; 34:88-92. [DOI: 10.5482/hamo-13-05-0028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/18/2013] [Indexed: 11/05/2022] Open
Abstract
Zusammenfassung
Ziele: Es gibt eine anhaltende Diskussion über die Auswirkungen der hormonalen Kon-trazeption auf die Inzidenz von venösen Thromboembolien (VTE) bei jungen Frauen. Spezifische Daten für die Größe des Problems und ihre Veränderungen in den letzten Jahren in Deutschland sind nicht verfügbar. Daher untersuchten wir die Häufigkeit von VTE bei hospitalisierten jungen Menschen und analysierten geschlechtsspezifische Unterschiede.
Patienten und Methoden: Detaillierte Listen aller Lungenembolien (LE), kodiert als I26, und tiefer Venenthrombosen (TVT), kodiert als I80, bei Patienten im Alter von 10 bis 39 Jahre, die in den Jahren 2005 bis 2011 ins Krankenhaus eingeliefert worden waren, stellte das Statistische Bundesamt zur Verfügung.
Ergebnisse: Beginnend im Alter von 12–13 Jahren wurde für Frauen im Vergleich zu Männern eine höhere Anzahl von LE und TVT als Hauptdiagnose dokumentiert. Dieser geschlechtsspezifische Unterschied verschwindet im Alter von 32–33 Jahren. Dieser Unterschied in der Gesamtzahl der LE als Hauptdiagnose zwischen Männern und Frau-en innerhalb dieses Lebensabschnitts von 20 Jahre erhöhte sich von 318 in 2005 auf 606 im Jahr 2010 und sank auf 505 im Jahr 2011. Die Differenzierung in LE mit und ohne akutes cor pulmonale zeigte insbesondere eine spezifische Erhöhung der LE ohne akutes cor pulmonale bei jungen Frauen innerhalb dieser sieben Jahre. Ähnliche Änderungen konnten nicht für TVT als Hauptdiagnose gezeigt werden.
Schlussfolgerung: Die präsentierten Daten aus der deutschen DRG-Statistik zeigen einen dysproportional höheren Anstieg der Hospitalisierung junger Frauen mit Lungenembolie als Hauptdiagnose in den vergangenen Jahren. Die möglichen Ursachen der hormonalen Kon-trazeption für diesen Anstieg müssen weiter aufgeklärt werden.
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Comparing the androgenic and estrogenic properties of progestins used in contraception and hormone therapy. Biochem Biophys Res Commun 2017; 491:140-146. [PMID: 28711501 DOI: 10.1016/j.bbrc.2017.07.063] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
Abstract
Progestins used in endocrine therapies bind to multiple steroid receptors and are associated with several side-effects. It is thus important to understand the relationship between steroid receptor cross-reactivity and the side-effect profile of progestins. In cell lines that express negligible levels of steroid receptors, we report for the first time the binding affinities, potencies and efficacies of selected progestins from different generations determined in parallel. We show that the progestins bind to the androgen receptor (AR) with similar affinities to each other and progesterone, while none bind estrogen receptor (ER)-β, and only norethisterone acetate, levonorgestrel and gestodene bind ERα. Comparative dose-response analysis revealed that progestins from the first three generations display similar androgenic activity to the natural androgen dihydrotestosterone for transactivation, while norethisterone acetate, levonorgestrel and gestodene are ERα agonists. We show for the first time that the anti-androgenic properties of progesterone and drospirenone are similar to the well-known AR antagonist hydroxyflutamide, while nomegestrol acetate is more potent and nestorone less potent than both hydroxyflutamide and progesterone. Moreover, we are the first to report that the older progestins, unlike progesterone and the fourth generation progestins, are efficacious ERα agonists for transrepression, while the selected progestins from the second and third generation are efficacious AR agonists for transrepression. Considering the progestin potencies and their reported free serum concentrations relative to dihydrotestosterone and estradiol, our results suggest that the progestins are likely to exert AR-, but not ERα- or ERβ-mediated effects in vivo.
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Swanepoel AC, Emmerson O, Pretorius E. Effect of Progesterone and Synthetic Progestins on Whole Blood Clot Formation and Erythrocyte Structure. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:607-617. [PMID: 28480839 DOI: 10.1017/s1431927617000484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Combined oral contraceptive (COC) use is a risk factor for venous thrombosis (VT) and related to the specific type of progestin used. VT is accompanied by inflammation and pathophysiological clot formation, that includes aberrant erythrocytes and fibrin(ogen) interactions. In this paper, we aim to determine the influence of progesterone and different synthetic progestins found in COCs on the viscoelasticity of whole blood clots, as well as erythrocyte morphology and membrane ultrastructure, in an in vitro laboratory study. Thromboelastography (TEG), light microscopy, and scanning electron microscopy were our chosen methods. Our results point out that progestins influence the rate of whole blood clot formation. Alterations to erythrocyte morphology and membrane ultrastructure suggest the presence of eryptosis. We also note increased rouleaux formation, erythrocyte aggregation, and spontaneous fibrin formation in whole blood which may explain the increased risk of VT associated with COC use. Although not all COC users will experience a thrombotic event, individuals with a thrombotic predisposition, due to inflammatory or hematological illness, should be closely monitored to prevent pathological thrombosis.
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Larivée N, Suissa S, Khosrow-Khavar F, Tagalakis V, Filion KB. Drospirenone-containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies. BJOG 2017; 124:1490-1499. [DOI: 10.1111/1471-0528.14623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 01/11/2023]
Affiliation(s)
- N Larivée
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - S Suissa
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
- Department of Medicine, McGill University; McGill University; Montreal QC Canada
| | - F Khosrow-Khavar
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
| | - V Tagalakis
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal QC Canada
- Division of General Internal Medicine; Jewish General Hospital; Montreal QC Canada
| | - KB Filion
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal QC Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal QC Canada
- Department of Medicine, McGill University; McGill University; Montreal QC Canada
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Kobayashi T, Sugiura K, Ojima T. Risks of thromboembolism associated with hormone contraceptives in Japanese compared with Western women. J Obstet Gynaecol Res 2017; 43:789-797. [PMID: 28422361 DOI: 10.1111/jog.13304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022]
Abstract
We extracted 581 thromboembolic events associated with combined oral contraceptives (COC) that occurred between 2004 and 2013 in Japan, from the Pharmaceuticals and Medical Devices Agency database. The most common thromboembolic events associated with COC were deep vein thrombosis, pulmonary embolism and their combination. The reported thromboembolic events increased year by year, in association with an increase in the quantity of prescribed low-dose estrogen progestin after approval for health insurance coverage for dysmenorrhea in 2008 in Japan. The incidence of venous thromboembolism (VTE) in Japanese COC users is estimated to be lower compared with their Western counterparts. In contrast, the frequency of all thromboembolic events peaked at 90 days from the start of COC, as in Western studies. The risk of VTE in the overweight group (body mass index ≥ 25 kg/m2 ) was more than twofold higher than in the standard group, and age-specific incidence rate rose sharply after the age of 40. There were different VTE risks according to progestin type in Japan as in Western countries, but a definite conclusion about risk according to progestin type was not able to be reached at present. As for the risk of arterial embolism and thrombosis, the difference by progestin type was small, but it became higher at ≥50 years of age. Last, mortality rate caused by thromboembolism is extremely low among COC users.
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Affiliation(s)
- Takao Kobayashi
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Kazuko Sugiura
- Department of Reproductive Health Nursing/Midwifery, Nagoya City University Graduate School of Nursing, Nagoya, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Tyrosine kinase-targeting drugs-associated heart failure. Br J Cancer 2017; 116:1366-1373. [PMID: 28399109 PMCID: PMC5482733 DOI: 10.1038/bjc.2017.88] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/17/2017] [Accepted: 02/23/2017] [Indexed: 02/02/2023] Open
Abstract
Background: The impact of cancer therapies on cardiac disease in the general adult cancer survivor population is largely unknown. Our objective was to evaluate which tyrosine kinase-targeting drugs are associated with greater risk for new-onset heart failure (HF). Methods: A nested case–control analysis was conducted within a cohort of 27 992 patients of Clalit Health Services, newly treated with a tyrosine kinase-targeting, and/or chemotherapeutic drug, for a malignant disease, between 1 January 2005 and 31 December 2012. Each new case of HF was matched to up to 30 controls from the cohort on calendar year of cohort entry, age, gender, and duration of follow-up. Main outcome measure was odds ratio (OR) with 95% confidence interval (CI) of new-onset HF. Results: There were 936 incident cases of HF during 71 742 person-years of follow-up. Trastuzumab (OR 1.90, 95% CI 1.46–2.49), cetuximab (OR 1.72, 1.10–2.69), panitumumab (OR 3.01, 1.02–8.85), and sunitinib (OR 3.39, 1.78–6.47) were associated with increased HF risk. Comorbidity independently associated with higher risk in a multivariable conditional regression model was diabetes mellitus, hypertension, chronic renal failure, ischaemic heart disease, valvular heart disease, arrhythmia, and smoking. Conclusions: Trastuzumab, cetuximab, panitumumab, and sunitinib are associated with increased risk for new-onset HF.
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Selvan P, Piran P, Balucani C, Tark B, Adler Z, Levine SR. Stroke and Etonogestrel/Ethinyl Estradiol Ring (NuvaRing): Clinical, Radiological, and Prognostic Features. J Stroke Cerebrovasc Dis 2017; 26:608-617. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.11.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022] Open
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Glintborg D, Andersen M. MANAGEMENT OF ENDOCRINE DISEASE: Morbidity in polycystic ovary syndrome. Eur J Endocrinol 2017; 176:R53-R65. [PMID: 27601016 DOI: 10.1530/eje-16-0373] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/17/2016] [Accepted: 09/05/2016] [Indexed: 12/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition in premenopausal women. The syndrome is characterized by hyperandrogenism, irregular menses and polycystic ovaries when other etiologies are excluded. Obesity, insulin resistance and low vitamin D levels are present in more than 50% patients with PCOS, these factors along with hyperandrogenism could have adverse effects on long-term health. Hyperinflammation and impaired epithelial function were reported to a larger extent in women with PCOS and could particularly be associated with hyperandrogenism, obesity and insulin resistance. Available data from register-based and data linkage studies support that metabolic-vascular and thyroid diseases, asthma, migraine, depression and cancer are diagnosed more frequently in PCOS, whereas fracture risk is decreased. Drug prescriptions are significantly more common in PCOS than controls within all diagnose categories including antibiotics. The causal relationship between PCOS and autoimmune disease represents an interesting new area of research. PCOS is a lifelong condition and long-term morbidity could be worsened by obesity, sedentary way of life, Western-style diet and smoking, whereas lifestyle intervention including weight loss may partly or fully resolve the symptoms of PCOS and could improve the long-term prognosis. In this review, the possible implications of increased morbidity for the clinical and biochemical evaluation of patients with PCOS at diagnosis and follow-up is further discussed along with possible modifying effects of medical treatment.
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Affiliation(s)
- Dorte Glintborg
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
| | - Marianne Andersen
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
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Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril 2016; 107:43-51. [PMID: 27793376 DOI: 10.1016/j.fertnstert.2016.09.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
While venous thromboembolism (VTE) is rare in young women of reproductive age, combined oral contraceptives increase the risk of VTE. In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation.
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Louw-du Toit R, Perkins MS, Snoep JL, Storbeck KH, Africander D. Fourth-Generation Progestins Inhibit 3β-Hydroxysteroid Dehydrogenase Type 2 and Modulate the Biosynthesis of Endogenous Steroids. PLoS One 2016; 11:e0164170. [PMID: 27706226 PMCID: PMC5051719 DOI: 10.1371/journal.pone.0164170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022] Open
Abstract
Progestins used in contraception and hormone replacement therapy are synthetic compounds designed to mimic the actions of the natural hormone progesterone and are classed into four consecutive generations. The biological actions of progestins are primarily determined by their interactions with steroid receptors, and factors such as metabolism, pharmacokinetics, bioavailability and the regulation of endogenous steroid hormone biosynthesis are often overlooked. Although some studies have investigated the effects of select progestins on a few steroidogenic enzymes, studies comparing the effects of progestins from different generations are lacking. This study therefore explored the putative modulatory effects of progestins on de novo steroid synthesis in the adrenal by comparing the effects of select progestins from the respective generations, on endogenous steroid hormone production by the H295R human adrenocortical carcinoma cell line. Ultra-performance liquid chromatography/tandem mass spectrometry analysis showed that the fourth-generation progestins, nestorone (NES), nomegestrol acetate (NoMAC) and drospirenone (DRSP), unlike the progestins selected from the first three generations, modulate the biosynthesis of several endogenous steroids. Subsequent assays performed in COS-1 cells expressing human 3βHSD2, suggest that these progestins modulate the biosynthesis of steroid hormones by inhibiting the activity of 3βHSD2. The Ki values determined for the inhibition of human 3βHSD2 by NES (9.5 ± 0.96 nM), NoMAC (29 ± 7.1 nM) and DRSP (232 ± 38 nM) were within the reported concentration ranges for the contraceptive use of these progestins in vivo. Taken together, our results suggest that newer, fourth-generation progestins may exert both positive and negative physiological effects via the modulation of endogenous steroid hormone biosynthesis.
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Affiliation(s)
- Renate Louw-du Toit
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| | - Meghan S Perkins
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| | - Jacky L Snoep
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| | - Karl-Heinz Storbeck
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| | - Donita Africander
- Department of Biochemistry, University of Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
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Larivée N, Suissa S, Eberg M, Joseph L, Eisenberg MJ, Abenhaim HA, Filion KB. Drospirenone-containing combined oral contraceptives and the risk of arterial thrombosis: a population-based nested case-control study. BJOG 2016; 124:1672-1679. [DOI: 10.1111/1471-0528.14358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- N Larivée
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
| | - S Suissa
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
- Division of Clinical Epidemiology; Department of Medicine; McGill University; Montreal Quebec Canada
| | - M Eberg
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
| | - L Joseph
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
- Division of Clinical Epidemiology; McGill University Health Centre; Montreal Quebec Canada
| | - MJ Eisenberg
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
- Division of Cardiology; Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - HA Abenhaim
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
- Department of Obstetrics and Gynecology; Jewish General Hospital; McGill University; Montreal Quebec Canada
| | - KB Filion
- Center for Clinical Epidemiology; Lady Davis Institute; Jewish General Hospital; Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational Health; McGill University; Montreal Quebec Canada
- Division of Clinical Epidemiology; Department of Medicine; McGill University; Montreal Quebec Canada
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Schuemie MJ, Trifirò G, Coloma PM, Ryan PB, Madigan D. Detecting adverse drug reactions following long-term exposure in longitudinal observational data: The exposure-adjusted self-controlled case series. Stat Methods Med Res 2016; 25:2577-2592. [DOI: 10.1177/0962280214527531] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most approaches used in postmarketing drug safety monitoring, including spontaneous reporting and statistical risk identification using electronic health care records, are primarily suited to pick up only acute adverse drug effects. With the availability of increasingly larger electronic health record and administrative claims databases comes the opportunity to monitor for potential adverse effects that occur only after prolonged exposure to a drug, but analysis methods are lacking. We propose an adaptation of the self-controlled case series design that uses the notion of accumulated exposure to capture long-term effects of drugs and evaluate extensions to correct for age and recurrent events. Several variations of the approach are tested on simulated data and two large insurance claims databases. To evaluate performance a set of positive and negative control drug–event pairs was created by medical experts based on drug product labels and review of the literature. Performance on the real data was measured using the area under the receiver operator characteristics curve. The best performing method achieved an area under the receiver operator characteristics curve of 0.86 in the largest database using a spline model, adjustment for age, and ignoring recurrent events, but it appears this performance can only be achieved with very large data sets.
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Affiliation(s)
- Martijn J Schuemie
- Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Observational Medical Outcomes Partnership, Foundation for the National Institutes of Health, Bethesda, USA
| | - Gianluca Trifirò
- Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Preciosa M Coloma
- Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick B Ryan
- Observational Medical Outcomes Partnership, Foundation for the National Institutes of Health, Bethesda, USA
- Janssen Research and Development LLC, Titusville, USA
| | - David Madigan
- Observational Medical Outcomes Partnership, Foundation for the National Institutes of Health, Bethesda, USA
- Department of Statistics, Columbia University, New York, USA
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Swanepoel AC, Visagie A, Pretorius E. Synthetic Hormones and Clot Formation. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2016; 22:878-886. [PMID: 27515365 DOI: 10.1017/s1431927616011478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Combined oral contraceptives (COCs), colloquially referred to as "the pill," have been regarded as a medical breakthrough, as they have improved the lives of countless women, from simplifying family planning to the treatment of acne, endometriosis, polycystic ovarian syndrome, and dysmenorrhea. Unfortunately, COC usage has been associated with an increased occurrence of venous thrombosis and therefore a systemic hypercoagulable state in susceptible females. Here we discuss the health risks of COC usage and use viscoelastic and morphological techniques to investigate the effect of different COC constituents on clot formation, particularly fibrin network packaging and whole blood viscoelasticity. Viscoelastic properties of whole blood showed gender-specific changes while morphological alterations were person-specific, regardless of gender. Using scanning electron microscopy and thromboelastography provides great insight regarding fibrin packaging and the development of a hypercoagulable state in high-risk individuals. We proposed a three-step approach where (1) an individual's coagulation profile baseline is determined, after which (2) the "ideal" combination of constituents is prescribed, and (3) the coagulation profile of the individual is monitored to assess possible risk of thrombosis. Only in following such an individualized patient-oriented approach will we be able to avoid the many health issues due to COC usage in susceptible females.
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Affiliation(s)
- Albe C Swanepoel
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
| | - Amcois Visagie
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
| | - Etheresia Pretorius
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
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Agnew MK, Asa CS, Clyde VL, Keller DL, Meinelt A. A survey of bonobo (Pan paniscus) oral contraceptive pill use in North American zoos. Zoo Biol 2016; 35:444-453. [DOI: 10.1002/zoo.21310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Mary K. Agnew
- AZA Reproductive Management Center; Saint Louis Zoo; St. Louis Missouri
| | - Cheryl S. Asa
- AZA Reproductive Management Center; Saint Louis Zoo; St. Louis Missouri
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De Leo V, Musacchio MC, Cappelli V, Piomboni P, Morgante G. Hormonal contraceptives: pharmacology tailored to women's health. Hum Reprod Update 2016; 22:634-46. [PMID: 27307386 DOI: 10.1093/humupd/dmw016] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 01/29/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In recent years, several new oral contraceptives have become available. In some ways, they represent an evolution in terms of individualization and compliance on the part of women. The new formulations make it increasingly possible to prescribe a specific hormonal contraceptive on an individual basis. METHODS A systematic literature search of PubMed was performed using the following combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptive'. Only English-language papers published between January 2000 and July 2014 were included in our analysis. The present review analyzes all aspects of the choice of oral contraceptives in the different phases of a woman's life in detail. RESULTS Regarding the estrogen component, lowering the dose of ethinylestradiol (EE) helped reduce associated side effects. Natural estradiol is now available and represents a valid alternative to EE. And regarding progestins, the dose has changed over time, as well as the endocrine and metabolic characteristics. These are the fruit of much research into improvement of old products (19-nor-progesterone-derived progestins) with androgenic effects and testing of new molecules with improved metabolic neutrality in terms of insulin sensitivity and lipid parameters. New progestins were a genuine turning point because they greatly reduced major side effects, such as water retention, and their anti-androgenic properties made them indicated for all forms of hyperandrogenism associated with acne and mild hirsutism. The associations of estradiol/dienogest and estradiol/nomegestrol acetate are the most suitable contraceptives for women with abundant menstrual bleeding and can increase the number of potential users of hormonal contraception. CONCLUSION Progress in the provision of new oral contraceptives has improved the risk/benefit ratio, by increasing benefits and reducing risks. The present challenge is to tailor contraceptives to individual needs in terms of efficacy and protection of reproductive health.
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Affiliation(s)
- Vincenzo De Leo
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci 14, 53100 Siena, Italy
| | - Maria Concetta Musacchio
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci 14, 53100 Siena, Italy
| | - Valentina Cappelli
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci 14, 53100 Siena, Italy
| | - Paola Piomboni
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci 14, 53100 Siena, Italy
| | - Giuseppe Morgante
- Department of Molecular and Developmental Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci 14, 53100 Siena, Italy
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Weill A, Dalichampt M, Raguideau F, Ricordeau P, Blotière PO, Rudant J, Alla F, Zureik M. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ 2016; 353:i2002. [PMID: 27164970 PMCID: PMC4862376 DOI: 10.1136/bmj.i2002] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen. DESIGN Observational cohort study. SETTING Data from the French national health insurance database linked with data from the French national hospital discharge database. PARTICIPANTS 4 945 088 women aged 15-49 years, living in France, with at least one reimbursement for oral contraceptives and no previous hospital admission for cancer, pulmonary embolism, ischaemic stroke, or myocardial infarction, between July 2010 and September 2012. MAIN OUTCOME MEASURES Relative and absolute risks of first pulmonary embolism, ischaemic stroke, and myocardial infarction. RESULTS The cohort generated 5 443 916 women years of oral contraceptive use, and 3253 events were observed: 1800 pulmonary embolisms (33 per 100 000 women years), 1046 ischaemic strokes (19 per 100 000 women years), and 407 myocardial infarctions (7 per 100 000 women years). After adjustment for progestogen and risk factors, the relative risks for women using low dose oestrogen (20 µg v 30-40 µg) were 0.75 (95% confidence interval 0.67 to 0.85) for pulmonary embolism, 0.82 (0.70 to 0.96) for ischaemic stroke, and 0.56 (0.39 to 0.79) for myocardial infarction. After adjustment for oestrogen dose and risk factors, desogestrel and gestodene were associated with statistically significantly higher relative risks for pulmonary embolism (2.16, 1.93 to 2.41 and 1.63, 1.34 to 1.97, respectively) compared with levonorgestrel. Levonorgestrel combined with 20 µg oestrogen was associated with a statistically significantly lower risk than levonorgestrel with 30-40 µg oestrogen for each of the three serious adverse events. CONCLUSIONS For the same dose of oestrogen, desogestrel and gestodene were associated with statistically significantly higher risks of pulmonary embolism but not arterial thromboembolism compared with levonorgestrel. For the same type of progestogen, an oestrogen dose of 20 µg versus 30-40 µg was associated with lower risks of pulmonary embolism, ischaemic stroke, and myocardial infarction.
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Affiliation(s)
- Alain Weill
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - Marie Dalichampt
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - Fanny Raguideau
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
| | - Philippe Ricordeau
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - Pierre-Olivier Blotière
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - Jérémie Rudant
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - François Alla
- Department of Studies in Public Health, French National Health Insurance, 75986 Paris Cedex 20, France
| | - Mahmoud Zureik
- French National Agency for Medicines and Health Products Safety, Saint-Denis, France
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Abstract
INTRODUCTION This paper reviews the risk of thrombosis with use of different types of hormonal contraception in women of different ages. AREAS COVERED Combined hormonal contraceptives with desogestrel, gestodene, drospirenone or cyproterone acetate (high-risk products) confer a sixfold increased risk of venous thromboembolism as compared with nonusers, and about twice the risk as compared with users of products with norethisterone, levonorgestrel or norgestimate (low-risk products). Transdermal patches and vaginal ring belong to high-risk products. The risk of thrombotic stroke and myocardial infarction is increased 50 - 100% with use of combined products, with little difference in risk between different progestins. Progestin-only products do not confer any increased risk of venous or arterial thrombosis, except for progestin depot, which may double the risk of venous thrombosis. EXPERT OPINION First choice in women below 35 years should be a combined low-risk pill, that is, with a second-generation progestin, with the lowest compliable dose of estrogen. Young women with risk factors of thrombosis such as age above 35 years, genetic predispositions, adiposity, polycystic ovary syndrome, diabetes, smoking, hypertension or migraine with aura should not use high-risk products, but should primarily consider progestin-only products, and be careful to use low-risk combined products.
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Affiliation(s)
- Øjvind Lidegaard
- University of Copenhagen, Department of Obstetrics and Gynecology, Faculty of Health Science, 4232, Rigshospitalet , Copenhagen 2100 , Denmark
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Fan X, Chen X, Wang C, Dai J, Lu Y, Wang K, Liu J, Zhang J, Wu X. Drospirenone enhances GPIb-IX-V-mediated platelet activation. J Thromb Haemost 2015; 13:1918-24. [PMID: 26264726 DOI: 10.1111/jth.13109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 07/31/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epidemiologic studies recently revealed that using drospirenone (DRSP)-containing contraceptives is associated with an increased risk of thrombosis in women. However, the underlying causality is unclear. OBJECTIVE To study the effects of DRSP on coagulation in vitro and the probable mechanisms involved. METHODS First, the effects of DRSP on the activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) and fibrinogen (FIB) were measured. Then, the effects of DRSP on platelet activation were investigated in response to low levels of collagen, adenosine 5'-diphosphate (ADP), thrombin, U46619, adrenaline and botrocetin/von Willebrand factor (VWF). RESULTS DRSP has no direct effect on APTT, PT, TT, FIB and platelet aggregation induced by low levels of collagen, ADP, thrombin, U46619 or adrenaline. However, DRSP enhances botrocetin/VWF-induced platelet aggregation and VWF receptor glycoprotein Ib-IX-V (GPIb-IX-V)-mediated signaling. This enhancement can be blocked by the progesterone receptor membrane component 1 (PGRMC1) inhibitor AG205, or by the ADP scavenger apyrase and the cyclooxygenase inhibitor indomethacin. CONCLUSIONS Although DRSP did not directly induce platelet activation, it obviously facilitated VWF receptor GPIb-IX-V-mediated platelet activation. The potential DRSP-binding protein PGRMC1 may play a role in this process. Our study also suggested that the inhibition of thromboxane A2 production and the activation of ADP receptors might prevent the side-effects of DRSP.
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Affiliation(s)
- X Fan
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Chen
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - C Wang
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Dai
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Y Lu
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - K Wang
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Liu
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - J Zhang
- Department of Cardiology, Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - X Wu
- Department of Biochemistry and Molecular Cell Biology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Roach RE, Helmerhorst FM, Lijfering WM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev 2015; 2015:CD011054. [PMID: 26310586 PMCID: PMC6494192 DOI: 10.1002/14651858.cd011054.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Combined oral contraceptives (COCs) have been associated with an increased risk of arterial thrombosis, i.e. myocardial infarction or ischemic stroke. However, as these diseases are rare in young women and as many types of combined oral contraception exist, the magnitude of the risk and the effect of different hormonal contents of COC preparations remain unclear. OBJECTIVES To estimate the risk of myocardial infarction or ischemic stroke in users compared with non-users of different types, doses and generations of combined oral contraception. SEARCH METHODS We searched electronic databases (MEDLINE (1966 to July 08, 2015), EMBASE (1980 to July 08, 2015), Popline (1970 to July 08, 2015) and LILACS (1985 to July 08, 2015) for eligible studies, without language restrictions. SELECTION CRITERIA We included observational studies that recruited women in the reproductive age group (18 to 50 years) and compared the risk of myocardial infarction or ischemic stroke between users and non-users of COCs. DATA COLLECTION AND ANALYSIS Two review authors independently selected relevant studies and extracted data. We pooled relative risks ()(combined odds ratios and one incidence rate ratio) and 95% confidence intervals (CIs) for myocardial infarction or ischemic stroke in users versus non-users of COCs.We combined the outcomes of myocardial infarction and ischemic stroke and also analysed these outcomes separately. Analyses were stratified according to estrogen dose and progestagen type. MAIN RESULTS In total, we identified 1298 publications through the search strategy. We included 28 publications reporting on 24 studies. COC users were at increased risk of myocardial infarction or ischemic stroke compared with non-users: relative risk (RR) 1.6 (95% CI 1.3-1.9).These RRs were similar for myocardial infarction (1.6, 95% CI 1.2 to 2.1) and ischemic stroke (1.7, 95% CI 1.5 to 1.9). The risks did not vary clearly according to the generation of progestagen or according to progestagen type. When we stratified preparations according to estrogen dose, the risk of myocardial infarction or ischemic stroke seemed to increase with higher doses of estrogen. AUTHORS' CONCLUSIONS This meta-analysis showed that the risk of myocardial infarction or ischemic stroke was 1.6-fold increased in women using COCs . The risk was highest for pills with > 50 microgram estrogen. When combined with the results of studies on the risk of venous thrombosis in COC users, it seems that the COC pill containing levonorgestrel and 30 μg of estrogen is the safest oral form of hormonal contraception.
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Affiliation(s)
- Rachel E.J. Roach
- Leiden University Medical CenterDepartment of EpidemiologyLeidenNetherlands2300 RC
| | - Frans M Helmerhorst
- Leiden University Medical CenterDept. of Clinical EpidemiologyPO Box 9600Albinusdreef 2LeidenNetherlandsNL 2300 RC
| | - Willem M. Lijfering
- Leiden University Medical CenterDepartment of EpidemiologyLeidenNetherlands2300 RC
| | - Theo Stijnen
- Leiden University Medical CenterDepartment of Medical StatisticsPO Box 9600LeidenNetherlands2300 RC
| | - Ale Algra
- University Medical Center UtrechtJulius Center for Health Sciences and Primary Care/University Department of Neurology and NeurosurgeryPO Box 85500UtrechtNetherlands3508 GA
| | - Olaf M Dekkers
- Leiden University Medical CenterDepartment of Clinical EpidemiologyPO Box 9600LeidenNetherlands2300 RC
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Dragoman M, Curtis KM, Gaffield ME. Combined hormonal contraceptive use among women with known dyslipidemias: a systematic review of critical safety outcomes. Contraception 2015; 94:280-7. [PMID: 26272309 DOI: 10.1016/j.contraception.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Dyslipidemias represent a spectrum of lipid disorders that are important risk factors for cardiovascular disease. In addition, elevated triglycerides are known to be associated with pancreatitis. Though less clear, it is possible that dyslipidemias may also contribute to risk for venous thromboembolism (VTE). Ethinyl estradiol and progestogen, contained within combined hormonal contraception, are known to impact lipid metabolism. OBJECTIVES To evaluate from the literature whether use of combined hormonal contraception (CHC), including combined oral contraception (COC) pills, transdermal patch, vaginal ring or injectables, modifies the relative risk of acute myocardial infarction (MI), stroke, VTE or pancreatitis among women with known dyslipidemias and to determine if existing lipid abnormalities worsen with CHC use. METHODS PubMed and the Cochrane Library databases were searched for all articles in all languages published between inception and September 2014 relevant to dyslipidemia, CHC use and serious adverse events (MI, stroke, VTE or pancreatitis). The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force. RESULTS From 306 articles identified by our search strategy, 3 articles met inclusion criteria. In a poor-quality case-control study, women with hypercholesterolemia but no COC use had an increased risk of MI (adjusted odds ratio [adj OR] 3.3, 95% confidence interval [CI] 1.6-6.8), as did women who used COCs but did not have hypercholesterolemia (adj OR 2.0, 95% CI 1.4-2.8), compared with non-COC users without hypercholesterolemia; women with both COC use and hypercholesterolemia had an adjusted OR of 24.7 (95% CI 5.6-108.5) compared with women with neither risk factor. A poor-quality cohort study examined COC users and reported that women with dyslipidemia had increased risk for VTE [crude risk ratio (RR) 1.39, 95% CI 1.04-1.85] and transient ischemic attacks or cerebrovascular accidents (CVAs) (RR 1.76, 95% CI 1.51-2.06) compared to those without dyslipidemia. Another poor-quality cohort study provided direct evidence on changes in lipid levels among COC users with dyslipidemia. A minority of women with elevated total cholesterol or triglyceride levels at baseline showed normal results (25% and 28%, respectively) after 6 cycles of COC use. No evidence regarding risks associated with use of other CHC methods was identified. No evidence was identified for the outcome of pancreatitis. CONCLUSION Limited data from poor-quality observational studies suggest that women with known dyslipidemias using CHC may be at increased risk for MI and may experience a minimal increase in risk for CVA or VTE. No evidence was identified on risk for pancreatitis in this context. The impact of CHC exposure on the status of lipid abnormalities over time, an intermediate marker for disease, is also unclear. Given the significant limitations of this body of evidence, the importance of access to effective contraception and theoretical concerns raised about the use of CHCs by women with known dyslipidemias, additional rigorous studies are needed to best estimate true associations. Contraceptive decision making should include consideration of both the known and theoretical risks of a given CHC method, safety and acceptability of alternative contraceptive methods, and risks associated with unintended pregnancy.
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Affiliation(s)
- Monica Dragoman
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary E Gaffield
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Lete I, Chabbert-Buffet N, Jamin C, Lello S, Lobo P, Nappi RE, Pintiaux A. Haemostatic and metabolic impact of estradiol pills and drospirenone-containing ethinylestradiol pills vs. levonorgestrel-containing ethinylestradiol pills: A literature review. EUR J CONTRACEP REPR 2015; 20:329-43. [DOI: 10.3109/13625187.2015.1050091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ 2015; 350:h2135. [PMID: 26013557 PMCID: PMC4444976 DOI: 10.1136/bmj.h2135] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the association between use of combined oral contraceptives and risk of venous thromboembolism, taking the type of progestogen into account. DESIGN Two nested case-control studies. SETTING General practices in the United Kingdom contributing to the Clinical Practice Research Datalink (CPRD; 618 practices) and QResearch primary care database (722 practices). PARTICIPANTS Women aged 15-49 years with a first diagnosis of venous thromboembolism in 2001-13, each matched with up to five controls by age, practice, and calendar year. MAIN OUTCOME MEASURES Odds ratios for incident venous thromboembolism and use of combined oral contraceptives in the previous year, adjusted for smoking status, alcohol consumption, ethnic group, body mass index, comorbidities, and other contraceptive drugs. Results were combined across the two datasets. RESULTS 5062 cases of venous thromboembolism from CPRD and 5500 from QResearch were analysed. Current exposure to any combined oral contraceptive was associated with an increased risk of venous thromboembolism (adjusted odds ratio 2.97, 95% confidence interval 2.78 to 3.17) compared with no exposure in the previous year. Corresponding risks associated with current exposure to desogestrel (4.28, 3.66 to 5.01), gestodene (3.64, 3.00 to 4.43), drospirenone (4.12, 3.43 to 4.96), and cyproterone (4.27, 3.57 to 5.11) were significantly higher than those for second generation contraceptives levonorgestrel (2.38, 2.18 to 2.59) and norethisterone (2.56, 2.15 to 3.06), and for norgestimate (2.53, 2.17 to 2.96). The number of extra cases of venous thromboembolism per year per 10,000 treated women was lowest for levonorgestrel (6, 95% confidence interval 5 to 7) and norgestimate (6, 5 to 8), and highest for desogestrel (14, 11 to 17) and cyproterone (14, 11 to 17). CONCLUSIONS In these population based, case-control studies using two large primary care databases, risks of venous thromboembolism associated with combined oral contraceptives were, with the exception of norgestimate, higher for newer drug preparations than for second generation drugs.
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Affiliation(s)
- Yana Vinogradova
- Division of Primary Care, University Park, Nottingham, NG2 7RD UK
| | - Carol Coupland
- Division of Primary Care, University Park, Nottingham, NG2 7RD UK
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Gourbil M, Grandvuillemin A, Beyens MN, Massy N, Gras V, D'Amico A, Miremont-Salamé G, Petitpain N. Thromboembolic events in women exposed to hormonal contraception or cyproterone acetate in 2012: a cross-sectional observational study in 30 French public hospitals. Drug Saf 2015; 37:269-82. [PMID: 24634164 DOI: 10.1007/s40264-014-0149-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the context of the European reassessment of the benefit-risk balance of hormonal contraceptives, French data about thromboembolic events were requested. OBJECTIVE The aim of this study was to determine the number of patients exposed to hormonal contraception or cyproterone acetate among hospitalized females diagnosed with a thromboembolic event in 2012, to retrospectively analyze specific risk factors of venous and arterial thromboembolism and to assess the magnitude of the under-reporting of such events to the national pharmacovigilance system. METHODS This cross-sectional study included 15- to 49-year-old women with pulmonary embolism, venous cerebral thrombosis, ischemic stroke, or myocardial infarction, hospitalized in 2012, and identified within the computerized hospital databases of 30 French teaching hospitals. RESULTS Among the 2,966 cases identified, 803 (27.1 %) patients had been exposed to a hormonal contraceptive (747) or to cyproterone acetate (56). Among these, there were 452 venous thromboembolic events (VTEs) and 351 arterial thromboembolic events (ATEs). Age ≥40 years and personal thrombophilia diagnosed after the event were the main VTE risk factors, while current smoking and age ≥40 years were the main ATE risk factors. The mean number of associated risk factors was significantly lower for VTE than for ATE (1.1 vs 2.3). The proportion of cases with no risk factors was higher for third- and fourth-generation than for first- and second-generation combined oral contraceptives. Overall, the under-reporting rate was 92.5 % (95 % CI 70.0-97.3). CONCLUSION This study highlighted the need to strengthen the knowledge of patients and health professionals about thromboembolic risk factors at the first prescription and renewal of hormonal contraceptives.
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Affiliation(s)
- Mathilde Gourbil
- Regional Pharmacovigilance Centre, University Hospital, 69424, Lyon, France
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Erol N, Karaagac AT, Kounis NG. Dangerous triplet: Polycystic ovary syndrome, oral contraceptives and Kounis syndrome. World J Cardiol 2014; 6:1285-1289. [PMID: 25548619 PMCID: PMC4278164 DOI: 10.4330/wjc.v6.i12.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/28/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome is characterized by ovulatory dysfunction, androgen excess and polycystic ovaries and is associated with hypertension, diabetes, metabolic syndrome and cardiovascular events. Oral contraceptives constitute first-line treatment, particularly when symptomatic hyperandrogenism is present. However, these drugs are associated with cardiovascular events and hypersensitivity reactions that pose problem in differential diagnosis and therapy. We present a 14 year-old female with polycystic ovary syndrome taking oral contraceptive and suffering from recurrent coronary ischemic attacks with increased eosinophils, and troponin levels suggesting Kounis syndrome.
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Merki-Feld GS, Skouby S, Serfaty D, Lech M, Bitzer J, Crosignani PG, Cagnacci A, Sitruk-Ware R. European Society of Contraception Statement on Contraception in Obese Women. EUR J CONTRACEP REPR 2014; 20:19-28. [DOI: 10.3109/13625187.2014.960561] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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