1
|
Ricker EA, Koltun KJ, de la Motte SJ. Hormonal contraception and medical readiness for female service members. Am J Obstet Gynecol 2024; 231:386-394. [PMID: 38810770 DOI: 10.1016/j.ajog.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/29/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024]
Abstract
Many female military service members choose to use hormonal contraception to prevent pregnancy and/or to control or suppress menses. Hormonal contraception, which comes in many different forms based on dose, estrogen/progestin type, and route of administration (oral, vaginal, transdermal, implant, intrauterine device, injectable), may cause side effects, some of which can influence military medical readiness, or the health status necessary to perform assigned missions. This expert review summarizes the evidence around common military-relevant side effects of hormonal contraception that could impact readiness, including effects on weight and body composition, bone health, psychological health, and physical performance, and serves as a tool for uniformed and civilian clinicians counseling female service members about hormonal contraception. Current evidence suggests some hormonal contraception can lead to weight and fat gain, may modulate susceptibility to mood or mental health disorders, and could impact bone mineral density and stress fracture risk; more research is needed on physical performance effects. Clinicians must be familiar with readiness considerations of each type of hormonal contraception to provide comprehensive patient education and allow for optimal shared decision-making about hormonal contraception use among female Service members. Considering the relative lack of data on the effects of nonoral hormonal contraception routes on readiness outcomes and the growing interest in long-acting reversible contraceptives among female service members, future research should continue to investigate effects of all hormonal contraception methods available to service members.
Collapse
Affiliation(s)
- Emily A Ricker
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD.
| | - Kristen J Koltun
- Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Sarah J de la Motte
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
| |
Collapse
|
2
|
Alnemr AA, Harb OA, Atia H. The efficacy of the levonorgestrel intrauterine system versus oral megestrol acetate in treating atypical endometrial hyperplasia: a superior randomized controlled trial. J Gynecol Oncol 2024; 35:e62. [PMID: 38425141 PMCID: PMC11390252 DOI: 10.3802/jgo.2024.35.e62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/18/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To compare the efficacy of the levonorgestrel intrauterine system (LNG-IUS) versus megestrol acetate (MA) in inducing complete regression among women with atypical endometrial hyperplasia (AEH) who declined hysterectomy. METHODS In this single-center, open-label randomized controlled trial, we included 148 women with AEH who declined hysterectomy. We randomized participants to receive either daily oral MA 160 mg (n=74) or apply LNG-IUS (n=74) and scheduled their follow-up by endometrial sampling at 3, 6, 9, 12, 18, and 24 months. The success rate and duration until complete regression were the primary outcomes. RESULTS The mean duration until complete regression was 5.52 months (95% confidence interval [CI]=4.85-6.18) for the LNG-IUS group versus 6.87 months (95% CI=6.09-7.64) for the megestrol group (log-rank test p-value=0.011). The cumulative regression rate after 12 months was 91.9% with the LNG-IUS versus 77% with MA (p=0.026). Weight gain in the MA group vs LNG-IUS group after one year (4.7±4 kg vs. 2.7±2.6 kg, 95% CI=0.89-3.12; p=0.001) and after two years of therapy (7.8±5.1 kg vs. 4.1±2.9 kg, 95% CI=2.29-5.06; p<0.001). CONCLUSION Compared to MA, the LNG-IUS was more efficacious in treating AEH in women who declined hysterectomy, especially those with moderate/severe obesity, with fewer adverse effects and less weight gain. Extending therapy to 12 months for persistent cases would improve regression rates with reasonable safety. Alternate hysteroscopic and office sampling seemed convenient for follow-up. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04385667.
Collapse
Affiliation(s)
- Amr A Alnemr
- Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ola A Harb
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hytham Atia
- Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| |
Collapse
|
3
|
Lv N, Guo J, Yuan Q, Shen S, Chen Q, Tong J. Feasibility and Effectiveness of Hysteroscopic Suture Fixation of the Levonorgestrel-Releasing Intrauterine System in the Treatment of Adenomyosis. J Minim Invasive Gynecol 2024; 31:57-63. [PMID: 37838016 DOI: 10.1016/j.jmig.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
STUDY OBJECTIVE To evaluate the feasibility and effectiveness of hysteroscopic suture fixation of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of adenomyosis. DESIGN A retrospective case series. SETTING Two teaching hospitals with the technology of hysteroscopic suture fixation of the LNG-IUS. PATIENTS The study reviewed 79 adenomyosis patients who received the hysteroscopic suture fixation of the LNG-IUS from January 2021 to May 2022. INTERVENTION Hysteroscopic suture fixation of the LNG-IUS to the posterior uterine wall with nondissolvable suture. MEASUREMENTS AND MAIN RESULTS All patients underwent one-year postoperative follow-up to evaluate the LNG-IUS expulsion rate, postoperative efficacy, and side effects. Two patients (2.6%) experienced expulsion of the LNG-IUS at 8 months and 12 months postoperatively, respectively. The visual analog pain scale, pictorial blood loss assessment chart score and carbohydrate antigen 125 markedly decreased after the suture fixation of the LNG-IUS compared with baseline in all patients (p <.001). Hemoglobin increased significantly (p <.001). The most common side effect was irregular bleeding, which accounted for 44.3%. The second common side effect was weight gain, which accounted for 29.2%. The composite effectiveness based on pain and bleeding showed that the effective treatment rates at 1, 3, 6, and 12 months after surgery were 92.4%, 97.4%, 96.2%, and 97.4% respectively. CONCLUSIONS Hysteroscopic suture fixation of the LNG-IUS to the uterine fundus was associated with low expulsion rates and significantly improved dysmenorrhea and bleeding.
Collapse
Affiliation(s)
- Nengyuan Lv
- Department of the Fourth School of Clinical Medicine (Drs. Lv, Yuan, Shen, Chen, and Tong), Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China
| | - Jialu Guo
- Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiaolei Yuan
- Department of the Fourth School of Clinical Medicine (Drs. Lv, Yuan, Shen, Chen, and Tong), Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China
| | - Siyi Shen
- Department of the Fourth School of Clinical Medicine (Drs. Lv, Yuan, Shen, Chen, and Tong), Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China
| | - Qianying Chen
- Department of the Fourth School of Clinical Medicine (Drs. Lv, Yuan, Shen, Chen, and Tong), Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China
| | - Jinyi Tong
- Department of the Fourth School of Clinical Medicine (Drs. Lv, Yuan, Shen, Chen, and Tong), Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Department of Obstetrics and Gynecology (Drs. Lv, Guo, Yuan, Shen, Chen, and Tong), Affiliated Hangzhou First People's Hospital, Zhejiang University of Medicine, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
4
|
Ferat RM, Haddad LB, Westhoff CL, Hubacher D. Recap of the sixth international symposium on intrauterine devices and systems for women's health. Contraception 2022; 116:14-21. [PMID: 35882359 DOI: 10.1016/j.contraception.2022.07.006] [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: 11/01/2021] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 01/31/2023]
Abstract
Due to the COVID-19 pandemic, the Sixth International Symposium on Intrauterine Devices and Systems for Women's Health was held as a series of seven 2-hour webinars between May 28, 2020, and June 22, 2021. This Symposium featured 48 different presenters and moderators covering a wide range of topics to highlight new IUD issues and update general IUD knowledge, just as it was done in previous symposia dating back to 1962 [1-5]. A total of 1346 people attended remotely to observe the events live. In this article, we share summaries of the presentations from the sixth symposium. These summaries, provided by the presenters, are meant to archive the symposium. This article gives the reader an overview of the topics and identifies the sessions' moderators and speakers charged with providing the content. Those interested in further detail, references, and information about the speakers can find more information on the conference website: www.iud2020.com. After the summaries, we share ideas for future IUD research and programmatic needs, as provided by Symposium's presenters and organizers. The authors' summaries are personal opinions and do not necessarily reflect the perspectives of the Symposium's organizers or the medical community at large. The Symposium was recorded and the sessions are available for viewing free of charge at the website, www.iud2020.comor on YouTube. As of July 2022, approximately 1700 visitors have viewed the recordings.
Collapse
Affiliation(s)
- Rachel M Ferat
- Columbia University Irving Medical Center, New York, NY, United States.
| | - Lisa B Haddad
- Population Council, Center for Biomedical Research, NY, USA
| | | | | | -
- Columbia University Irving Medical Center
| |
Collapse
|
5
|
Uterine volume, menstrual patterns, and contraceptive outcomes in users of the levonorgestrel-releasing intrauterine system: a cohort study with a five-year follow-up. Eur J Obstet Gynecol Reprod Biol 2022; 276:56-62. [DOI: 10.1016/j.ejogrb.2022.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022]
|
6
|
Toffol E, Heikinheimo O, Jousilahti P, But A, Joensuu A, Latvala A, Partonen T, Erlund I, Haukka J. Metabolomics profile of 5649 users and non-users of hormonal intrauterine devices in Finland. Am J Obstet Gynecol 2022; 227:603.e1-603.e29. [PMID: 35697093 DOI: 10.1016/j.ajog.2022.06.009] [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: 04/12/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Use of hormonal intrauterine devices has grown during the last decades. Although the hormonal intrauterine devices act mostly via local effects on uterus, measurable concentrations of levonorgestrel are absorbed into the systemic circulation. The possible metabolic changes and large scale biomarker profiles associated with the hormonal intrauterine devices have not yet been studied in detail. OBJECTIVES To examine, through the metabolomics approach, the metabolic profile of the hormonal intrauterine device use, its associations as a function of the duration of use, as well as those with after discontinuation of the hormonal intrauterine device use. STUDY DESIGN The study consists of cross-sectional analyses of five population-based surveys (FINRISK and FinHealth studies), spanning 1997-2017. All fertile aged (18-49 years) participants in the surveys with available information on hormonal contraceptive use and metabolomics data (n=5649), were included in the study. Altogether 211 metabolic measures in users of hormonal intrauterine devices (n=1006) were compared to those in non-users of hormonal contraception (n=4643) via multivariable linear regression models. In order to allow the comparison across multiple measures, association magnitudes are reported in SD units of difference in biomarker concentration compared to the reference group. RESULTS After adjustment for covariates, levels of 141 metabolites differed in current users of hormonal intrauterine devices compared to non-users of hormonal contraception (median difference in biomarker concentration: 0.09 SD): lower levels of particle concentration of larger lipoprotein subclasses, triglycerides, cholesterol and derivatives, apolipoproteins A and B, fatty acids, glycoprotein acetyls and aromatic amino acids. The metabolic pattern of the hormonal intrauterine device use did not change according to the duration of use. When comparing previous users and never-users of hormonal intrauterine devices, no significant metabolic differences emerged. CONCLUSIONS The use of hormonal intrauterine devices was associated with several moderate metabolic changes, previously associated with reduced arterial cardiometabolic risk. The metabolic effects were independent of the duration of use of the hormonal intrauterine devices. Moreover, the metabolic profiles were similar after discontinuation of the hormonal intrauterine devices and in never-users.
Collapse
Affiliation(s)
- Elena Toffol
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna But
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anni Joensuu
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Iris Erlund
- Department of Government Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
7
|
Deese J, Brache V, Bahamondes L, Salinas A, Jorge A, Veiga N, Fuchs R, Miller A, Taylor D, Halpern V, Dorflinger L. Contraceptive effectiveness, pharmacokinetics, and safety of Sayana® Press when injected every four months: a multicenter phase 3 trial. EClinicalMedicine 2022; 44:101273. [PMID: 35128365 PMCID: PMC8804165 DOI: 10.1016/j.eclinm.2022.101273] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Sayana Press® is a 3-monthly contraceptive injection approved by regulatory agencies in more than 40 countries worldwide. Existing effectiveness and pharmacokinetics (PK) data suggest that high contraceptive efficacy may be maintained if the reinjection interval of Sayana Press is extended from 3 to 4 months. METHODS We conducted a phase 3 trial at three sites in the Dominican Republic, Brazil, and Chile from September 2017 through April 2020. We enrolled 750 women at risk of pregnancy who agreed to use Sayana Press off-label every 4 months (3 treatment cycles) for 12 months. The effectiveness cohort included 710 participants randomized equally to receive injections in the abdomen or thigh. Forty additional participants received injections in the back of the upper arm for comparative PK analyses. The primary outcome was pregnancy, defined by a positive urine pregnancy test confirmed by ultrasound and/or serum human chorionic gonadotropin. Secondary outcomes included PK, safety, and acceptability. Laboratory and trial Sponsor staff were blind to injection site. This study is registered with ClinicalTrials.gov, number NCT03154125. FINDINGS There were no pregnancies during follow-up; the Pearl Index during 629.3 woman-years (WY) of follow-up in the primary effectiveness analysis was 0.00 (95% CI 0.00, 0.59). Pharmacokinetic profiles differed by injection site, with higher geometric mean (GM) medroxyprogesterone acetate concentrations for the abdomen than the thigh and arm. At month 8, significantly higher GM concentrations were observed in the abdomen and the thigh as compared to the arm, as well as at month 12 in the abdomen as compared to the arm. Injection site reactions were reported by 10.7% of participants. INTERPRETATION Both pregnancy and PK results confirm that Sayana Press is a highly effective contraceptive method when administered every 4 months. These findings may inform modification of the dosing schedule, or duration of the grace period for reinjection, or both, to reduce overall drug exposure while maintaining contraceptive efficacy. FUNDING This work is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), provided to FHI 360 through Cooperative Agreement AID-OAA-A-15-00,045, and a grant from the Gates Foundation. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID, the United States Government, or the Gates Foundation, nor does any mention of trade names, commercial products, or organizations imply endorsement by FHI 360, USAID, the United States Government, or the Gates Foundation.
Collapse
Affiliation(s)
- Jennifer Deese
- Women's Global Health Imperative, Global Public Health Impact Center, RTI International, 3040 East Cornwalis Road, Research Triangle Park, NC 27709, United States
- Corresponding author.
| | | | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil
| | - Abril Salinas
- Instituto Chileno de Medicina Reproductiva, Universidad de Chile, Chile
| | | | - Nelio Veiga
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, Sao Paulo, Brazil
| | - Rachael Fuchs
- Biostatistics and Data Sciences, FHI 360, 359 Blackwell Street, Durham, NC 27701, United States
| | - Ashley Miller
- Science Facilitation, FHI 360, 359 Blackwell Street, Durham, NC 27701, United States
| | - Doug Taylor
- Product Development and Introduction, FHI 360, 359 Blackwell Street, Durham, NC 27701, United States
| | - Vera Halpern
- Product Development and Introduction, FHI 360, 359 Blackwell Street, Durham, NC 27701, United States
| | - Laneta Dorflinger
- Product Development and Introduction, FHI 360, 359 Blackwell Street, Durham, NC 27701, United States
| |
Collapse
|
8
|
Beksinska M, Issema R, Beesham I, Lalbahadur T, Thomas K, Morrison C, Hofmeyr G, Steyn PS, Mugo N, Palanee-Phillips T, Ahmed K, Nair G, Baeten JM, Smit J. Weight change among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Findings from a randomised, multicentre, open-label trial. EClinicalMedicine 2021; 34:100800. [PMID: 33898953 PMCID: PMC8056402 DOI: 10.1016/j.eclinm.2021.100800] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is limited evidence on the impact of the use of progestin-only hormonal contraception (POC) on weight change. We conducted a secondary analysis of prospective weight change among women enrolled in the Evidence for Contraceptive options and HIV Outcomes (ECHO) trial. METHODS The ECHO trial was conducted at 12 sites in eSwatini, Kenya, South Africa and Zambia between December 2015 and October 2018. HIV negative, women aged 16-35 years, desiring contraception, were randomised (1:1:1) to either 3-monthly intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant or copper intrauterine device (IUD). Follow-up was up to 18 months. Weight (kg) was measured at baseline and study exit. Analysis was performed as intention to treat (ITT) and time on continuous contraceptive use. The primary outcome of this secondary analysis is weight change from study enrolment to the final visit at study month 12-18. The ECHO trial is registered with ClinicalTrials.gov, NCT02550067. FINDINGS 7829 women were randomly assigned to DMPA-IM (n = 2609), copper IUD (n = 2607) or LNG implant (n = 2613). The ITT population included 7014 women 2293 DMPA-IM group, 2372 copper IUD group and 2349 LNG group) who were not lost to follow-up, pregnant on study, or missing weight data. The mean weight increased in all groups but was significantly different in magnitude: 3.5 kg (SD = 6.3), 2.4 kg (SD = 5.9) and 1.5 kg (SD = 5.7) in the DMPA-IM, LNG implant and copper IUD groups, respectively. Comparative differences between groups were (2.02 kg (95% CI, 1.68, 2.36, p < 0.001) for DMPA-IM versus copper IUD, 0.87 kg (0.53,1.20 p < 0.001) for LNG implant compared to copper IUD and 1.16 kg (0.82, 1.50, p < 0.001) for DMPA-IM compared with LNG implant. Results for continuous contraceptive use were similar. INTERPRETATION We found differences in weight gain between POC users compared to the non-hormonal copper IUD group over 12-18 months of use. Women using POCs should be counselled about this potential side effect when choosing a contraceptive method.
Collapse
Affiliation(s)
- Mags Beksinska
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Rodal Issema
- Department of Epidemiology, University of Washington, Seattle, WA 98104, United States
| | - Ivana Beesham
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Tharnija Lalbahadur
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Katherine Thomas
- Department of Global Health, University of Washington, Seattle, WA 98104, United States
| | | | - G.Justus Hofmeyr
- Effective Care Research Unit, University of the Witwatersrand, Walter Sisulu University, East London, South Africa; University of Botswana, Gaborone, Botswan
| | - Petrus S. Steyn
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nelly Mugo
- Department of Global Health, University of Washington, Seattle, WA 98104, United States
- Center for Clinical Research (CCR), Kenya Medical Research Institute (KEMRI), Kenya
| | - Thesla Palanee-Phillips
- University of the Witwatersrand, Wits Reproductive Health and HIV Institute (Wits RHI), Johannesburg, South Africa
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA 98104, United States
| | - Jenni Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| |
Collapse
|
9
|
Bahamondes L. Weight change among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception did not influence early discontinuation. EClinicalMedicine 2021; 34:100857. [PMID: 33912819 PMCID: PMC8066404 DOI: 10.1016/j.eclinm.2021.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 10/26/2022] Open
Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynaecology, University of Campinas Faculty of Medical Sciences, Campinas, SP 13084-971, Brazil
| |
Collapse
|
10
|
Mathez ALG, Monteagudo PT, do Nascimento Verreschi IT, Dias-da-Silva MR. Levonorgestrel correlates with less weight gain than other progestins during hormonal replacement therapy in Turner Syndrome patients. Sci Rep 2020; 10:8298. [PMID: 32427839 PMCID: PMC7237408 DOI: 10.1038/s41598-020-64992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/22/2020] [Indexed: 01/15/2023] Open
Abstract
Turner Syndrome (TS) is associated with an increased risk of cardiovascular and metabolic complications. Furthermore, TS women need hormone replacement therapy (HRT), of which progestins can influence body weight. We aimed to analyze the metabolic and weight profile in a cohort of 111 TS women. They started receiving estrogen at 15.8 (±3.6) years old, with no change in hypertension, dysglycemia, and dyslipidemia incidence but with a tendency to increase overweight (p = 0.054). As the first used type of progestin, most had received cycles of 10 days per month of medroxyprogesterone (MPA) or levonorgestrel (LNG), then shifted to micronized progesterone (MP), which has currently become the most used one. By multiple linear regression analysis, we found that the prolonged use of MPA, LNG, or MP showed no metabolic change except for weight gain. The percentage of annual BMI increment was positive for all progestins used in TS women (MPA 2.2 ± 2.2; LNG 0.2 ± 1.2; and MP 2.2 ± 2.6 kg/m2), but LNG seemed to best prevent on weight gain over time (p < 0.05). In conclusion, metabolic comorbidities are prevalent in TS even before the HRT regimen, and LNG performed better on less weight gain than MPA and MP in our cohort of the TS population.
Collapse
Affiliation(s)
- Andréia Latanza Gomes Mathez
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Patrícia Teófilo Monteagudo
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
| | | | - Magnus Régios Dias-da-Silva
- Endocrinology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.,Laboratory of Molecular and Translational Endocrinology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
11
|
Turner AM, Donelan EA, Kiley JW. Contraceptive Options Following Gestational Diabetes: Current Perspectives. Open Access J Contracept 2019; 10:41-53. [PMID: 31749639 PMCID: PMC6817836 DOI: 10.2147/oajc.s184821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Gestational diabetes mellitus (GDM) complicates approximately 7% of pregnancies in the United States. Along with risk factors related to pregnancy, women with a history of GDM also have an increased risk of developing type 2 diabetes mellitus later in life. These women require special consideration when discussing contraception and other reproductive health issues. GDM carries a category 1 rating in the US Medical Eligibility Criteria for all contraceptive methods, which supports safety of the various methods but does not account for effectiveness. Contraceptive options differ in composition and mechanisms of action, and concerns have been raised about possible effects of contraception on metabolism. Clinical evidence is limited to suggest that hormonal contraception has significantly adverse effects on body weight, lipid, or glucose metabolism. In addition, the majority of evidence does not suggest a relationship between development of type 2 diabetes mellitus and use of hormonal contraception. Data are limited, so it is challenging to make a broad, general recommendation regarding contraception for women with a history of GDM. A woman’s history of GDM should be considered during contraceptive counseling. Discussion should focus on potential medical comorbidities and the implications of GDM on future health, with special consideration of issues including bone health, obesity, cardiovascular disease, and thrombosis risk. Providers must emphasize the importance of reliable, highly effective contraception for women with GDM, to optimize the timing of future pregnancies. This approach to comprehensive counseling will guide optimal decision-making on contraceptive use, lifestyle changes, and planning of subsequent pregnancies.
Collapse
Affiliation(s)
- Ashley M Turner
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily A Donelan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica W Kiley
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
12
|
Kontrazeptionsbeginn in der Pubertät – wann, wie, womit? Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Während der Pubertät stellen sich Mädchen in der Praxis oft mit Fragen bezüglich und dem Wunsch nach einer Verhütung vor. Diese Beratung ist eine besondere Herausforderung, da gerade in der Adoleszenz die zuverlässige Kontrazeption zur Vermeidung ungewollter Schwangerschaften sehr wichtig ist und die Jugendlichen durch Nebenwirkungen der Kontrazeptiva nicht verunsichert werden sollten. Dennoch ist es aus medizinischer Sicht obligat, Kontraindikationen wie beispielsweise ein erhöhtes Thromboserisiko oder Wechselwirkungen mit einer bestehenden Medikation abzuklären, um dann gemeinsam mit der Jugendlichen ein geeignetes Kontrazeptivum auszuwählen. Neben der am häufigsten verwendeten Verhütungsmethode in der Adoleszenz – kombinierte Hormonpräparate, auch ggf. im Langzyklus – sollten die Mädchen umfassend über Barrieremethoden, insbesondere über den zusätzlichen Gebrauch von Kondomen zum Schutz vor Geschlechtskrankheiten, über Notfallkontrazeption und über lang wirksame kontrazeptive Maßnahmen informiert werden.
Collapse
|
13
|
|
14
|
Ciccone MA, Whitman SA, Conturie CL, Brown N, Dancz CE, Özel B, Matsuo K. Effectiveness of progestin-based therapy for morbidly obese women with complex atypical hyperplasia. Arch Gynecol Obstet 2019; 299:801-808. [PMID: 30706187 DOI: 10.1007/s00404-019-05059-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/18/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE While progestins can effectively treat women with complex atypical hyperplasia (CAH), the impact of body habitus on treatment outcome is not well studied. We examine the association between body mass index (BMI) and progestin treatment outcomes. METHODS We conducted a retrospective cohort study of patients diagnosed with hyperplasia between 2003 and 2011. Demographics, past medical history, BMI, hormonal therapy, and histologic treatment response were abstracted. Patients with CAH who received progestin therapy were examined, and rates of regression were assessed. RESULTS Of 623 patients identified, 117 had CAH and satisfied the inclusion criteria. Median age was 34, and nearly, two-thirds (64%) were nulliparous. Mean BMI was 40.2, and 81% were obese (BMI 30-39.9: 36%, BMI ≥ 40: 45%). 103 patients (88%) received systemic progestin therapy and 14 patients (12%) received levonorgestrel-releasing intrauterine devices (LNG-IUS). 47 patients (40%) had a complete response to progestin-based therapy. BMI had no effect on the rate of complete response. The proportions of CAH patients with complete regression after hormonal therapy were BMI < 30: 39%, 30-39.9: 40%, and ≥ 40: 36% (P = 0.73). Women treated with LNG-IUS displayed higher rates of complete regression than those receiving systemic therapy (62% versus 38%, P = 0.096), and those with class III obesity were more likely than non-obese patients to receive LNG-IUS although neither reached statistical significance (< 40: 6.7% versus ≥ 40: 17%, P = 0.09). CONCLUSION In this morbidly obese population, response to progestin therapy was generally low; body habitus did not impact treatment outcome for CAH, but local therapy may be more effective than systemic therapy.
Collapse
Affiliation(s)
- Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA
| | - Stephanie A Whitman
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Charlotte L Conturie
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Niquelle Brown
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christina E Dancz
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Begum Özel
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA, 90089, USA.
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
15
|
Glisic M, Shahzad S, Tsoli S, Chadni M, Asllanaj E, Rojas LZ, Brown E, Chowdhury R, Muka T, Franco OH. Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25:1042-1052. [PMID: 29745237 PMCID: PMC6039863 DOI: 10.1177/2047487318774847] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/13/2018] [Indexed: 01/11/2023]
Abstract
Aims The association between progestin-only contraceptive (POC) use and the risk of various cardiometabolic outcomes has rarely been studied. We performed a systematic review and meta-analysis to determine the impact of POC use on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension and diabetes. Methods and results Nineteen observational studies (seven cohort and 12 case-control) were included in this systematic review. Of those, nine studies reported the risk of venous thromboembolism, six reported the risk of myocardial infarction, six reported the risk of stroke, three reported the risk of hypertension and two studies reported the risk of developing diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction and stroke for oral POC users versus non-users based on the random effects model were 1.06 (95% confidence interval (CI) 0.70-1.62), 0.98 (95% CI 0.66-1.47) and 1.02 (95% CI 0.72-1.44), respectively. Stratified analysis by route of administration showed that injectable POC with a RR of 2.62 (95% CI 1.74-3.94), but not oral POCs (RR 1.06, 95% CI 0.7-1.62), was associated with an increased risk of venous thromboembolism. A decreased risk of venous thromboembolism in a subgroup of women using an intrauterine levonorgestrel device was observed with a RR of 0.53 (95% CI 0.32-0.89). No effect of POC use on blood pressure was found, but there was an indication for an increased risk of diabetes with injectable POCs, albeit non-significant. Conclusions This systematic review and meta-analysis suggests that oral POC use is not associated with an increased risk of developing various cardiometabolic outcomes, whereas injectable POC use might increase the risk of venous thromboembolism.
Collapse
Affiliation(s)
- Marija Glisic
- Department of Epidemiology, Erasmus
Medical Center, The Netherlands
| | - Sara Shahzad
- Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge, Cambridge,
England
| | - Stergiani Tsoli
- Department of Population Health, London
School of Hygiene and Tropical Medicine, UK
- Centre for Longitudinal Studies,
University College London, UK (current address)
| | - Mahmuda Chadni
- Nuffield Department of Population
Health, University of Oxford, England
| | - Eralda Asllanaj
- Department of Epidemiology, Erasmus
Medical Center, The Netherlands
| | - Lyda Z Rojas
- Department of Epidemiology, Erasmus
Medical Center, The Netherlands
| | - Elizabeth Brown
- Nuffield Department of Population
Health, University of Oxford, England
| | - Rajiv Chowdhury
- Cardiovascular Epidemiology Unit,
Department of Public Health and Primary Care, University of Cambridge, Cambridge,
England
| | - Taulant Muka
- Department of Epidemiology, Erasmus
Medical Center, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus
Medical Center, The Netherlands
| |
Collapse
|
16
|
Bahamondes L, Brache V, Ali M, Habib N. A multicenter randomized clinical trial of etonogestrel and levonorgestrel contraceptive implants with nonrandomized copper intrauterine device controls: effect on weight variations up to 3 years after placement. Contraception 2018; 98:181-187. [PMID: 29777663 DOI: 10.1016/j.contraception.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/27/2018] [Accepted: 05/05/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate weight changes in women randomized to either the etonogestrel (ENG)- or the levonorgestrel (LNG)-releasing contraceptive implants and to compare with users of the TCu380A intrauterine device (IUD). STUDY DESIGN A multicenter randomized trial with 1:1 allocation ratio of the ENG and the LNG implants with nonrandomized, age-matched control group of women choosing TCu380A IUD. The primary objective was to assess contraceptive efficacy and method continuation rates and, secondarily, the incidence of common complaints and side effects (including weight changes) associated with use of the three contraceptives. All women were enrolled in nine centers at seven countries. Weight change was evaluated from time at device(s) placement. Confounders were sociodemographic, baseline weight and body mass index, center and time from insertion. We used a linear mixed-effects regression modeling with random intercept and slope. Weight was compared between the two implants groups and between the implants and the IUD groups through linear mixed multivariable regression model. RESULTS A total of 995, 997 and 971 users in the ENG implant, LNG implant and IUD groups, respectively, were included. At 36 months of use, ENG and LNG implant users had similar significant mean weight increase of 3.0 kg [95% confidence interval (CI) 2.5-3.5] and 2.9 kg (95% CI 2.4-3.4), respectively (p<.0001), while IUD users had an increase of 1.1 kg (95% CI 0.5-1.7) (p=.0003). On adding the group-time interaction term to the stratified baseline weight models, implant users gained 0.759 kg (standard error [SE] .11) and 0.787 kg (SE .22) more weight than their IUD-user counterparts per year since placement if their baseline weight was in the category 51-69 kg (p<.0001) or ≥70 kg (p=.0005), respectively. CONCLUSIONS ENG and LNG implant as well as IUD users had a small but significant weight increase with little clinical significance during the 3 years of follow-up, and it was slightly higher among implant than IUD users weighing >50 kg. IMPLICATIONS These findings must be useful for clinicians to counsel implant users which could improve method continuation.
Collapse
Affiliation(s)
- Luis Bahamondes
- Family Planning Clinic, Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil.
| | - Vivian Brache
- Profamilia, Biomedical Research Department, Santo Domingo, Dominican Republic
| | - Moazzam Ali
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ndema Habib
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
17
|
Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol 2017; 130:e251-e269. [PMID: 29064972 DOI: 10.1097/aog.0000000000002400] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid (1, 2). The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management. The management of clinical challenges associated with LARC use is beyond the scope of this document and is addressed in Committee Opinion No. 672, Clinical Challenges of Long-Acting Reversible Contraceptive Methods (3).
Collapse
|
18
|
Rocha ALL, Campos RR, Miranda MMS, Raspante LBP, Carneiro MM, Vieira CS, Reis FM. Safety of hormonal contraception for obese women. Expert Opin Drug Saf 2017; 16:1387-1393. [PMID: 28988524 DOI: 10.1080/14740338.2018.1389893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis. Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis. Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.
Collapse
Affiliation(s)
- Ana Luiza L Rocha
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Rayana R Campos
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Marina M S Miranda
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Laio B P Raspante
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Márcia M Carneiro
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| | - Carolina S Vieira
- b Department of Gynecology and Obstetrics, Medical School of Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , Brazil.,c Population Council , New York , NY , USA
| | - Fernando M Reis
- a Department of Gynecology and Obstetrics , Universidade Federal de Minas Gerais , Belo Horizonte , Brazil
| |
Collapse
|
19
|
de Melo AS, Dos Reis RM, Ferriani RA, Vieira CS. Hormonal contraception in women with polycystic ovary syndrome: choices, challenges, and noncontraceptive benefits. Open Access J Contracept 2017; 8:13-23. [PMID: 29386951 PMCID: PMC5774551 DOI: 10.2147/oajc.s85543] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is an endocrine disorder among women of reproductive age characterized by chronic anovulation and polycystic ovary morphology and/or hyperandrogenism. Management of clinical manifestations of PCOS, such as menstrual irregularities and hyperandrogenism symptoms, includes lifestyle changes and combined hormonal contraceptives (CHCs). CHCs contain estrogen that exerts antiandrogenic properties by triggering the hepatic synthesis of sex hormone-binding globulin that reduces the free testosterone levels. Moreover, the progestogen present in CHCs and in progestogen-only contraceptives suppresses luteinizing hormone secretion. In addition, some types of progestogens directly antagonize the effects of androgens on their receptor and also reduce the activity of the 5α reductase enzyme. However, PCOS is related to clinical and metabolic comorbidities that may limit the prescription of CHCs. Clinicians should be aware of risk factors, such as age, smoking, obesity, diabetes, systemic arterial hypertension, dyslipidemia, and a personal or family history, of a venous thromboembolic event or thrombophilia. This article reports a narrative review of the available evidence of the safety of hormonal contraceptives in women with PCOS. Considerations are made for the possible impact of hormonal contraceptives on endocrine, metabolic, and cardiovascular health.
Collapse
Affiliation(s)
- Anderson Sanches de Melo
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Sales Vieira
- Department of Gynecology and Obstetrics, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
20
|
Lam C, Murthy AS. Depo-Provera (depot medroxyprogesterone acetate) use after bariatric surgery. Open Access J Contracept 2016; 7:143-150. [PMID: 29386945 PMCID: PMC5683152 DOI: 10.2147/oajc.s84097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2) or obese (body mass index >30 kg/m2). In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA) and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE). The obesity-associated increase in VTE should be mitigated by surgically induced weight loss. The concurrent use of DMPA in the post bariatric surgical period should not further increase the risk of VTE.
Collapse
Affiliation(s)
| | - Amitasrigowri S Murthy
- Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine.,New York University Langone Medical Center, New York, NY, USA
| |
Collapse
|
21
|
Lopez LM, Ramesh S, Chen M, Edelman A, Otterness C, Trussell J, Helmerhorst FM. Progestin-only contraceptives: effects on weight. Cochrane Database Syst Rev 2016; 2016:CD008815. [PMID: 27567593 PMCID: PMC5034734 DOI: 10.1002/14651858.cd008815.pub4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. POCs include injectables, intrauterine contraception, implants, and oral contraceptives. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. OBJECTIVES The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. SEARCH METHODS Until 4 August 2016, we searched MEDLINE, CENTRAL, POPLINE, LILACS, ClinicalTrials.gov, and ICTRP. For the initial review, we contacted investigators to identify other trials. SELECTION CRITERIA We considered comparative studies that examined a POC versus another contraceptive method or no contraceptive. The primary outcome was mean change in body weight or mean change in body composition. We also considered the dichotomous outcome of loss or gain of a specified amount of weight. DATA COLLECTION AND ANALYSIS Two authors extracted the data. Non-randomized studies (NRS) need to control for confounding factors. We used adjusted measures for the primary effects in NRS or the results of matched analysis from paired samples. If the report did not provide adjusted measures for the primary analysis, we used unadjusted outcomes. For RCTs and NRS without adjusted measures, we computed the mean difference (MD) with 95% confidence interval (CI) for continuous variables. For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% CI. MAIN RESULTS We found 22 eligible studies that included a total of 11,450 women. With 6 NRS added to this update, the review includes 17 NRS and 5 RCTs. By contraceptive method, the review has 16 studies of depot medroxyprogesterone acetate (DMPA), 4 of levonorgestrel-releasing intrauterine contraception (LNG-IUC), 5 for implants, and 2 for progestin-only pills.Comparison groups did not differ significantly for weight change or other body composition measure in 15 studies. Five studies with moderate or low quality evidence showed differences between study arms. Two studies of a six-rod implant also indicated some differences, but the evidence was low quality.Three studies showed differences for DMPA users compared with women not using a hormonal method. In a retrospective study, weight gain (kg) was greater for DMPA versus copper (Cu) IUC in years one (MD 2.28, 95% CI 1.79 to 2.77), two (MD 2.71, 95% CI 2.12 to 3.30), and three (MD 3.17, 95% CI 2.51 to 3.83). A prospective study showed adolescents using DMPA had a greater increase in body fat (%) compared with a group not using a hormonal method (MD 11.00, 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (MD -4.00, 95% CI -6.93 to -1.07). A more recent retrospective study reported greater mean increases with use of DMPA versus Cu IUC for weight (kg) at years 1 (1.3 vs 0.2), 4 (3.5 vs 1.9), and 10 (6.6 vs 4.9).Two studies reported a greater mean increase in body fat mass (%) for POC users versus women not using a hormonal method. The method was LNG-IUC in two studies (reported means 2.5 versus -1.3; P = 0.029); (MD 1.60, 95% CI 0.45 to 2.75). One also studied a desogestrel-containing pill (MD 3.30, 95% CI 2.08 to 4.52). Both studies showed a greater decrease in lean body mass among POC users. AUTHORS' CONCLUSIONS We considered the overall quality of evidence to be low; more than half of the studies had low quality evidence. The main reasons for downgrading were lack of randomizations (NRS) and high loss to follow-up or early discontinuation.These 22 studies showed limited evidence of change in weight or body composition with use of POCs. Mean weight gain at 6 or 12 months was less than 2 kg (4.4 lb) for most studies. Those with multiyear data showed mean weight change was approximately twice as much at two to four years than at one year, but generally the study groups did not differ significantly. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.
Collapse
Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Shanthi Ramesh
- University of North CarolinaDepartment of Obstetrics and Gynaecology4012 Old Clinic Building, CB 7570Chapel HillNC ‐ North CarolinaUSA27599
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alison Edelman
- Oregon Health & Science UniversityDept. of Obstetrics and GynecologyPortlandOregonUSA
| | | | - James Trussell
- Princeton UniversityOffice of Population researchWallaca HallPrincetonNew JerseyUSANJ 08544
| | - Frans M Helmerhorst
- Leiden University Medical CenterDept. of Clinical EpidemiologyPO Box 9600Albinusdreef 2LeidenNetherlandsNL 2300 RC
| | | |
Collapse
|
22
|
Effect of oral versus intrauterine progestins on weight in women undergoing fertility preserving therapy for complex atypical hyperplasia or endometrial cancer. Gynecol Oncol 2016; 140:234-8. [DOI: 10.1016/j.ygyno.2015.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/02/2015] [Accepted: 12/13/2015] [Indexed: 12/21/2022]
|