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Miller HE, Kruger SL, Panelli DM. Mental health conditions and contraception: current landscape, reproductive health and obstetric outcomes, and clinical guidance. Curr Opin Obstet Gynecol 2024; 36:81-87. [PMID: 38170628 DOI: 10.1097/gco.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review presents the epidemiology of mental health conditions among reproductive aged people, common adverse reproductive outcomes, the hormonal profile of contraception and its relationship with psychiatric outcomes, and updated information for clinicians providing contraceptive counselling for this population. RECENT FINDINGS There is variability among contraceptive behaviours and patterns across those who have mental health conditions, impacting reproductive, psychiatric, and perinatal outcomes. The endocrinology of hormonal contraceptives is well understood, however, the impacts of steroidal hormones on mental health outcomes continue to be less understood. Overall, hormonal contraceptives are safe to use among those with mental health conditions, and among those using selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. Additional considerations are needed when prescribing contraception among people who may be at risk of poor adherence, who use certain classes of antidepressants, antipsychotics, antiepileptics, and who are <6 weeks postpartum. SUMMARY Barriers to effective contraceptive use should be addressed and myths on negative psychiatric impacts of hormonal contraceptives should be dispelled. Healthcare clinicians should seek out opportunities to become proficient in contraception counselling to improve health outcomes among people with mental health conditions.
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Affiliation(s)
- Hayley E Miller
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology
| | - Samantha L Kruger
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology
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Jahanfar S, Maurer O, Lapidow A, Oberoi AR, Steinfeldt M, Ali M. A meta-analysis into the mediatory effects of family planning utilization on complications of pregnancy in women of reproductive age. PLoS One 2024; 19:e0294475. [PMID: 38498424 PMCID: PMC10947693 DOI: 10.1371/journal.pone.0294475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/01/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Despite conflicting findings in the current literature regarding the correlation between contraceptives and maternal health consequences, statistical analyses indicate that family planning may decrease the occurrence of such outcomes. Consequently, it is crucial to assess the capability of family planning to mitigate adverse maternal health outcomes. OBJECTIVES This review investigates the effects of modern contraceptive use on maternal health. SEARCH METHODS This systematic review is registered on Prospero (CRD42022332783). We searched numerous databases with an upper date limit of February 2022 and no geographical boundaries. SELECTION CRITERIA We included observational studies, including cross-sectional, cohort, case-control studies, and non-RCT with a comparison group. We excluded systematic reviews, scoping reviews, narrative reviews, and meta-analyses from the body of this review. MAIN RESULTS The review included nineteen studies, with five studies reporting a reduction in maternal mortality linked to increased access to family planning resources and contraceptive use. Another three studies examined the impact of contraception on the risk of preeclampsia and our analysis found that preeclampsia risk was lower by approximately 6% among contraceptive users (95% CI 0.82-1.13) compared to non-users. Two studies assessed the effect of hormonal contraceptives on postpartum glucose tolerance and found that low-androgen contraception was associated with a reduced risk of gestational diabetes (OR 0.84, 95% CI 0.58-1.22), while DMPA injection was possibly linked to a higher risk of falling glucose status postpartum (OR 1.42, 95% CI 0.85-2.36). Two studies evaluated high-risk pregnancies and births in contraceptive users versus non-users, with the risk ratio being 30% lower among contraceptive users of any form (95% CI 0.61, 0.80). None of these results were statistically significant except the latter. In terms of adverse maternal health outcomes, certain contraceptives were found to be associated with ectopic pregnancy and pregnancy-related venous thromboembolism through additional analysis.
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Affiliation(s)
- Shayesteh Jahanfar
- Department of Public Health and Community Medicine, Director of Tufts University, Boston, MA, United States of America
- Affiliate of Cochrane US, Tufts University School of Medicine, Boston, MA, United States of America
| | - Olivia Maurer
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Amy Lapidow
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Anjali Rajkumari Oberoi
- Affiliate of Cochrane US, Tufts University School of Medicine, Boston, MA, United States of America
| | - Meredith Steinfeldt
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States of America
| | - Moazzam Ali
- WHO Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Rojo MG, Lloret MRP, Gironés JG. Oral manifestations in women using hormonal contraceptive methods: a systematic review. Clin Oral Investig 2024; 28:184. [PMID: 38427087 PMCID: PMC10907424 DOI: 10.1007/s00784-024-05573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. MATERIALS AND METHODS This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined. RESULTS Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias. CONCLUSIONS Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome. CLINICAL RELEVANCE The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.
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Affiliation(s)
- Marta García Rojo
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain
| | - Miguel Ramón Pecci Lloret
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain.
| | - Julia Guerrero Gironés
- Gerodontology and Special Care Dentistry Unit, Faculty of Medicine, IMIB-Arrixaca, Morales Meseguer Hospital, University of Murcia, Murcia, 30008, Spain
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Schrager S, Fox K, Lee R. Abnormal Uterine Bleeding Associated With Hormonal Contraception. Am Fam Physician 2024; 109:161-166. [PMID: 38393800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Abnormal uterine bleeding is a common and bothersome symptom in people using hormonal contraception, and it can lead to discontinuation of reliable methods of contraception and unintended pregnancies. Clinicians should counsel individuals about the potential for abnormal bleeding at initiation of the contraceptive method. After considering and excluding other potential causes of abnormal uterine bleeding, clinicians can offer treatment options specific to each hormonal contraceptive method. This article includes algorithms to help clinicians treat abnormal uterine bleeding in people using levonorgestrel intrauterine devices, depo-medroxyprogesterone acetate, progestin implant, progestin-only pills, and combined hormonal contraception. For patients with levonorgestrel intrauterine devices, physicians should first ensure that the device is correctly placed within the uterus, then consider nonsteroidal anti-inflammatory drugs as a first-line treatment for abnormal uterine bleeding; estradiol can be used if nonsteroidal anti-inflammatory drugs are ineffective. For depo-medroxyprogesterone acetate or progestin implant users, combined oral contraceptives or nonsteroidal anti-inflammatory drugs may be considered. For patients using norethindrone progestin-only pills, changing to drospirenone progesterone-only pills may help reduce the bleeding. In people using combined hormonal contraception, it may be helpful to increase estrogen content from 20 mcg to 35 mcg per day, decrease the hormone-free interval (from seven to four or five days) in people using cyclic contraception, or start a trial of low-dose doxycycline. For continuous combined contraception users, adding a hormone-free interval of four or five days can help regulate bleeding patterns.
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Affiliation(s)
| | - Kelita Fox
- Henry Ford Family Medicine Residency Program, Michigan State University, Detroit, Michigan
| | - Rachel Lee
- Henry Ford Family Medicine Residency Program, Michigan State University, Detroit, Michigan
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Barcellona D, Grandone E, Marongiu F. Hormones and thrombosis: the dark side of the moon. Blood Transfus 2024; 22:46-54. [PMID: 37235737 PMCID: PMC10812887 DOI: 10.2450/bloodtransfus.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/03/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The main drawback of oral contraceptives (OC) and hormone replacement therapy (HRT) is an increased risk of venous and, to a lesser extent, arterial thrombosis. MATERIALS AND METHODS This narrative, case-based review describes the effect of available estrogens and progestogens on the hemostatic system and their potential impact on the risk of thrombosis. Clinical cases are used to illustrate different options for prescribing OC and HRT in the real-word. The aim is to offer discussion topics that could be helpful to guide the choice of different hormonal treatments over a woman's lifetime and in the presence of risk factors. RESULTS We describe physio-pathological changes occurring during the administration of hormonal therapies. Furthermore, we analyze the risk of venous and arterial thrombosis associated with different products, routes of administration and additional risk factors. New hormonal preparations, such as estradiol combined with dienogest, as well as non-oral hormonal therapies, are suggested to decrease thrombotic risk significantly. DISCUSSION The availability of many products and different routes of administration allow most women to safely use contraception, as well as HRT. We encourage careful counselling instead of inflexible or fearful behavior, as expanding options and choices will allow women to make the best decisions for their health.
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Affiliation(s)
- Doris Barcellona
- Department of Medical Sciences and Public Health, Hemostasis and Thrombosis Unit, University of Cagliari and AOU of Cagliari, Italy
| | - Elvira Grandone
- Thrombosis and Hemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
- Obstetrics/Gynecology Department, University of Foggia, Foggia, Italy
- Obstetrics/Gynecology and Perinatal Medicine Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesco Marongiu
- Hemostasis and Thrombosis Unit, AOU of Cagliari, Cagliari, Italy
- Fondazione Arianna, Anticoagulazione.it, Bologna, Italy
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Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H. The Effects of Hormonal Contraceptives on the Sleep of Women of Reproductive Age. Sleep Med Clin 2023; 18:435-448. [PMID: 38501516 DOI: 10.1016/j.jsmc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Research about the effects of hormonal contraceptives on sleep has been performed but is subjected to important levels of methodological heterogeneity. Hormonal contraceptives impact sleep, but the direction of this association is not clear. Most studies describe a negative sleep profile among contraceptive users, including increased sleepiness, insomnia symptoms, decreased sleep efficiency, and a reduced overall sleep quality. Hormonal intrauterine contraceptives are associated with less negative effects. More research on the field, especially randomized controlled trials, is needed to increase the level and certainty of evidence about the effects of hormonal contraceptives on sleep.
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Affiliation(s)
- Andréia Gomes Bezerra
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP: 04024-002, São Paulo, Brazil
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP: 04024-002, São Paulo, Brazil; Sleep Institute, Rua Marselhesa, 500 - CEP: 04020-060, São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP: 04024-002, São Paulo, Brazil; Sleep Institute, Rua Marselhesa, 500 - CEP: 04020-060, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP: 04024-002, São Paulo, Brazil; Sleep Institute, Rua Marselhesa, 500 - CEP: 04020-060, São Paulo, Brazil
| | - Helena Hachul
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - CEP: 04024-002, São Paulo, Brazil; Sleep Institute, Rua Marselhesa, 500 - CEP: 04020-060, São Paulo, Brazil.
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Parks AL, Stevens SM. NSAIDs and hormonal contraceptives are linked to VTE in women with no previous thrombotic disease. Ann Intern Med 2023; 176:JC143. [PMID: 38048580 DOI: 10.7326/j23-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
SOURCE CITATION Meaidi A, Mascolo A, Sessa M, et al. Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ. 2023;382:e074450. 37673431.
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Affiliation(s)
- Anna L Parks
- University of Utah, Salt Lake City, Utah, USA (A.L.P.)
| | - Scott M Stevens
- Intermountain Medical Center and University of Utah, Salt Lake City, Utah, USA (S.M.S.)
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Bala NS, Stanek JR, Vesely SK, Cronin RM, Creary SE, Roe AH, Xu W, O’Brien SH. Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception. Blood Adv 2023; 7:6140-6150. [PMID: 37585480 PMCID: PMC10582388 DOI: 10.1182/bloodadvances.2023010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Patients with sickle cell disease (SCD) are at a risk of thromboembolism (TE), and use of hormonal contraception can further increase that risk. This study aims to assess patterns of hormonal contraceptive use and compare risk of contraception-related TE between combined hormonal contraceptives (CHCs) and progestin-only contraceptives (POCs). Patients with SCD aged between 12 and 44 years with a new prescription of a hormonal contraceptive in the Centers for Medicare and Medicaid Services Medicaid Analytic eXtract database (2006-2018) were followed up to 1 year. We identified 7173 new users: 44.6% initiated CHC and 55.4% initiated POC. Combined oral contraceptive pills (OCPs; 36.5%) and progestin-only depot medroxyprogesterone acetate (33.9%) were the most frequently prescribed agents. A total of 1.8% of contraception users had a new diagnosis of TE within 1 year of the first identified contraception prescription. There were no significant differences in TE event rates between CHC and POC users (17.2 and 24.7 events per 1000 person-years, respectively). In patients prescribed OCP, there were no differences in TE event rates based on estrogen dose or progestin generation. Transdermal patch had a 2.4-fold increased risk of TE as compared with that of OCP. Although limited by the retrospective study design and use of administrative claims data, this study found no significant differences in TE rates between new users of CHC and POC in patients with SCD. Careful evaluation of underlying TE risk factors should be considered for each patient with SCD before initiation of hormonal contraception.
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Affiliation(s)
- Natasha S. Bala
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
| | - Joseph R. Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma, Oklahoma City, OK
| | - Robert M. Cronin
- Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH
| | - Susan E. Creary
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Wendy Xu
- Division of Health Services Management and Policy, The Ohio State University, College of Public Health, Columbus, OH
| | - Sarah H. O’Brien
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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Harris E. Blot Clot Risk Higher When Pain Relievers Used With Hormonal Contraception. JAMA 2023; 330:1319. [PMID: 37728948 DOI: 10.1001/jama.2023.17823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
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Bjørke-Monsen AL, Varsi K, Sakkestad ST, Ulvik A, Ebbing C, Ueland PM. Lower levels of the neuroprotective tryptophan metabolite, kynurenic acid, in users of estrogen contraceptives. Sci Rep 2023; 13:16370. [PMID: 37773439 PMCID: PMC10541439 DOI: 10.1038/s41598-023-43196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
Changes in kynurenine metabolites are reported in users of estrogen containing contraception. We have assessed kynurenines, vitamin B6, vitamin B2 and the inflammation markers, C-reactive protein (CRP) and neopterin, in healthy, never-pregnant women between 18 and 40 years (n = 123) and related this to their use of hormonal contraception. The population included 58 women, who did not use hormonal contraceptives (non-users), 51 users of estrogen-containing contraceptives (EC-users), and 14 users of progestin only contraceptives (PC-users). EC-users had significantly lower plasma kynurenic acid (KA) and higher xanthurenic acid (XA) levels compared to non-users. Serum CRP was significantly higher and negatively associated with both vitamin B6 and B2 status in EC-user compared to non-users. No significant differences in any parameters were seen between PC-users and non-users (p > 0.1). The low KA and high XA concentration in users of estrogen containing contraception resemble the biochemical profile observed in vitamin B6 deficiency. The hormonal effect may result from interference with the coenzyme function of vitamin B6 and B2 for particular enzymes in the kynurenine metabolism. KA has been suggested to be neuroprotective and the significantly reduced concentration in EC-users may be of importance in the observed increased risk of mood disorders among users of oral contraceptives.
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Affiliation(s)
- Anne-Lise Bjørke-Monsen
- Laboratory of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway.
- Laboratory of Medical Biochemistry, Førde Central Hospital, Førde, Norway.
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway.
| | - Kristin Varsi
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | | | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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White L, Losciale JM, Squier K, Guy S, Scott A, Prior JC, Whittaker JL. Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females. Br J Sports Med 2023; 57:1195-1202. [PMID: 37225254 DOI: 10.1136/bjsports-2022-106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. DESIGN Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. ELIGIBILITY Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. RESULTS Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. CONCLUSION Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO CRD42021224582 on 8 January 2021.
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Affiliation(s)
- Lynita White
- Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Guy
- City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Hansen ESH, Aasbjerg K, Moeller AL, Meaidi A, Gade E, Ulrik CS, Torp-Pedersen C, Backer V. Hormonal Contraceptives Are Associated With an Increase in Incidence of Asthma in Women. J Allergy Clin Immunol Pract 2023; 11:2484-2490.e3. [PMID: 37178764 DOI: 10.1016/j.jaip.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Use of exogenous female sex hormones is associated with the development of asthma, but the question of whether the effect is protective or harmful remains unresolved. OBJECTIVE To investigate whether initiation of hormonal contraceptive (HC) treatment was associated with development of asthma. METHODS We performed a register-based, exposure-matched cohort study including women who initiated HC treatment of any kind between 10 and 40 years of age and compared the incidence of asthma with women who did not initiate HCs. Asthma was defined as 2 redeemed prescriptions of inhaled corticosteroids within 2 years. Data were analyzed using Cox regression models adjusted for income and urbanization. RESULTS We included 184,046 women with a mean age of 15.5 years (SD 1.5 y), in which 30,669 initiated HC treatment and 153,377 did not. We found that initiation of HCs was associated with an increased hazard ratio (HR) of developing new asthma by 1.78 (95% CI 1.58-2.00; P < .001). The cumulative risk of new asthma was 2.7% after 3 years among users of HCs compared with 1.5% in nonusers. In the different subtypes of HCs, second- and third-generation contraceptives carried significant associations (second-generation HR 1.76; 95% CI 1.52-2.03; P < .001; third-generation HR 1.62 95% CI 1.23-2.12; P < .001). The association with increased incidence was seen only in women younger than 18 years. CONCLUSIONS In this study, first-time users of HCs had an increased incidence of asthma compared with nonusers. Clinicians prescribing HCs should be aware that airway symptoms may develop.
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Affiliation(s)
- Erik Soeren Halvard Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Kristian Aasbjerg
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Amalie Lykkemark Moeller
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Cancer Surveillance and Pharmacoepidemiology Department, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Amani Meaidi
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Gade
- The Fertility Partnership-Stork Fertility Clinic, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Cancer Surveillance and Pharmacoepidemiology Department, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Otorhinolaryngology, Rigshospitalet, University of Copenhagen, Denmark
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Batur P, Yao M, Bucklan J, Soni P, Suneja A, Farrell R, Mays M. Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk. Headache 2023; 63:813-821. [PMID: 36752588 DOI: 10.1111/head.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To clarify how factors such as estrogen dose and migraine history (including migraine subtype) impact ischemic stroke risks associated with combined hormonal contraceptive (CHC) use. BACKGROUND CHC use in those with migraine with aura has been restricted due to concerns about stroke risk. METHODS We conducted a case-control analysis of stroke risk associated with estrogen dose and migraine history among CHC users in a large tertiary care center. All women aged 18-55 who used a CHC between January 1, 2010, and December 31, 2019, were identified. Those with a stroke diagnosis were identified using ICD codes and confirmed via chart and imaging review. Details of personal and family medical history, stroke evaluation, ethinyl estradiol dosing (EE; ≥30 vs. <30 μg), and demographics were collected. From a random sample of 20,000 CHC users without stroke, a control cohort (n = 635) was identified and matched based on patient characteristics, medical and family histories, as well as stroke risk factors, to assess association between migraine diagnosis, migraine subtype, estrogen dose, and stroke. RESULTS Of the 203,853 CHC users in our cohort, 127 had confirmed stroke (0.06%; CI 0.05%, 0.07%). In unadjusted analyses, a higher number of patients in the case cohort had a diagnosis of migraine (34/127, 26.8%) compared to controls (109/635, 17.2%; p = 0.011). Stroke risk was higher with ≥30-μg EE doses compared to those using a <30-μg dose (OR, 1.52; CI 1.02, 2.26; p = 0.040). Compared to no migraine, personal history of migraine increased the odds of stroke (OR, 2.00; CI 1.27, 3.17; p = 0.003). Compared to no migraine, stroke risk was not significantly increased in those with migraine with aura, but migraine without aura increased the risk (OR, 2.35; CI 1.32, 4.2; p = 0.004). CONCLUSIONS Overall stroke risk in our cohort of CHC users was low. When CHCs are used in those with migraine, formulations containing ≤30 μg EE are preferred. Shared decision-making should include discussions about ischemic stroke risks in patients with migraine, even those without aura.
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Affiliation(s)
- Pelin Batur
- Department of Ob/Gyn & Women's Health Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Ohio, Cleveland, USA
| | - Julia Bucklan
- Center for Neurologic Restoration, Neurologic Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Payal Soni
- Center for Neurologic Restoration, Neurologic Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Aarushi Suneja
- Genomic Medicine Institute, Cleveland Clinic, Ohio, Cleveland, USA
| | - Ruth Farrell
- Center for Bioethics, Cleveland Clinic, Ohio, Cleveland, USA
| | - Maryann Mays
- Center for Neurologic Restoration, Neurologic Institute, Cleveland Clinic, Ohio, Cleveland, USA
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Qureshy Z, Lokken RP, Kakar S, Grab J, Mehta N, Sarkar M. Influence of progestin-only hormonal use on hepatocellular adenomas: A retrospective cohort study. Contraception 2023; 119:109915. [PMID: 36476331 PMCID: PMC10266542 DOI: 10.1016/j.contraception.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Exogenous estrogen is associated with growth of hepatocellular adenomas (HCAs), although the influence of progestin-only agents is unknown. We therefore evaluated the association of progestin-only agents on HCA progression compared to no hormone exposure and compared to estrogen exposure in female patients. STUDY DESIGN In this single-center, retrospective cohort study of reproductive-aged female patients (ages 16-45) with diagnosed HCAs between 2003 and 2021, we evaluated radiographic HCA growth during discrete periods of well-defined exogenous hormone exposures. RESULTS A total of 34 patients were included. Nineteen (55.9%) had follow-up scans during periods without hormone exposure, 7 (20.6%) during estrogen exposure, and 8 (23.5%) during progestin-only exposure. Over a median follow-up of 11 months, percent change in sum of adenoma diameters from baseline to last available scan was -15.0% with progestin-only agents versus 29.4% with estrogen exposure (p = 0.04), and -7.4% with no hormonal exposure (p = 0.52 compared to progestin-only). Greater than 10% growth was observed in two individuals (25.0%) with progestin-only agent use (one patient on high-dose progestin for menorrhagia) versus five individuals (71.4%) with estrogen use (p = 0.13), and 7 (36.8%) with no exogenous hormone use (p = 0.68 vs progestin-only). CONCLUSIONS During discrete periods of progestin-only use, HCA growth overall declined, similar to declining growth during periods without exogenous hormonal exposure. This differed from discrete periods of exogenous estrogen exposure, during which time HCAs demonstrated overall increased growth. Though larger studies are needed, these findings support recent guidance supporting progestin-only agents for female patients with HCAs seeking non-estrogen alternatives for contraception. IMPLICATIONS In this small retrospective study, we observed overall decrease in HCA size during discrete periods of progestin-only contraception use, similar to that observed during periods without exogenous hormone exposure, supporting their use as a safe alternative to estrogen-containing contraceptives in this patient population.
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Affiliation(s)
- Zoya Qureshy
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - R Peter Lokken
- Department of Radiology, Division of Interventional Radiology, University of California San Francisco, San Francisco, CA, United States
| | - Sanjay Kakar
- Department of Pathology, University of California San Francisco, San Francisco, CA, United States
| | - Joshua Grab
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States
| | - Neil Mehta
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States; Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Monika Sarkar
- Department of Medicine, UCSF Liver Center, University of California San Francisco, San Francisco, CA, United States; Department of Medicine, Division of Gastroenterology/Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.
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15
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Fitzpatrick D, Pirie K, Reeves G, Green J, Beral V. Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case-control study and meta-analysis. PLoS Med 2023; 20:e1004188. [PMID: 36943819 PMCID: PMC10030023 DOI: 10.1371/journal.pmed.1004188] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Current or recent use of combined oral contraceptives (containing oestrogen+progestagen) has been associated with a small increase in breast cancer risk. Progestagen-only contraceptive use is increasing, but information on associated risks is limited. We aimed to assess breast cancer risk associated with current or recent use of different types of hormonal contraceptives in premenopausal women, with particular emphasis on progestagen-only preparations. METHODS AND FINDINGS Hormonal contraceptive prescriptions recorded prospectively in a UK primary care database (Clinical Practice Research Datalink [CPRD]) were compared in a nested case-control study for 9,498 women aged <50 years with incident invasive breast cancer diagnosed in 1996 to 2017, and for 18,171 closely matched controls. On average, 7.3 (standard deviation [SD] 4.6) years of clinical records were available for each case and their matched controls prior to the date of diagnosis. Conditional logistic regression yielded odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer by the hormonal contraceptive type last prescribed, controlled for age, GP practice, body mass index, number of recorded births, time since last birth, and alcohol intake. MEDLINE and Embase were searched for observational studies published between 01 January 1995 and 01 November 2022 that reported on the association between current or recent progestagen-only contraceptive use and breast cancer risk in premenopausal women. Fixed effects meta-analyses combined the CPRD results with previously published results from 12 observational studies for progestagen-only preparations. Overall, 44% (4,195/9,498) of women with breast cancer and 39% (7,092/18,171) of matched controls had a hormonal contraceptive prescription an average of 3.1 (SD 3.7) years before breast cancer diagnosis (or equivalent date for controls). About half the prescriptions were for progestagen-only preparations. Breast cancer ORs were similarly and significantly raised if the last hormonal contraceptive prescription was for oral combined, oral progestagen-only, injected progestagen, or progestagen-releasing intrauterine devices (IUDs): ORs = 1.23 (95% CI [1.14 to 1.32]; p < 0.001), 1.26 (95% CI [1.16 to 1.37]; p < 0.001), 1.25 (95% CI [1.07 to 1.45]; p = 0.004), and 1.32 (95% CI [1.17 to 1.49]; p < 0.001), respectively. Our meta-analyses yielded significantly raised relative risks (RRs) for current or recent use of progestagen-only contraceptives: oral = 1.29 (95% CI [1.21 to 1.37]; heterogeneity χ25 = 6.7; p = 0.2), injected = 1.18 (95% CI [1.07 to 1.30]; heterogeneity χ28 = 22.5; p = 0.004), implanted = 1.28 (95% CI [1.08 to 1.51]; heterogeneity χ23 = 7.3; p = 0.06), and IUDs = 1.21 (95% CI [1.14 to 1.28]; heterogeneity χ24 = 7.9; p = 0.1). When the CPRD results were combined with those from previous published findings (which included women from a wider age range), the resulting 15-year absolute excess risk associated with 5 years use of oral combined or progestagen-only contraceptives in high-income countries was estimated at: 8 per 100,000 users from age 16 to 20 years and 265 per 100,000 users from age 35 to 39 years. The main limitation of the study design was that, due to the nature of the CPRD data and most other prescription databases, information on contraceptive use was recorded during a defined period only, with information before entry into the database generally being unavailable. This means that although our findings provide evidence about the short-term associations between hormonal contraceptives and breast cancer risk, they do not provide information regarding longer-term associations, or the impact of total duration of contraceptive use on breast cancer risk. CONCLUSIONS This study provides important new evidence that current or recent use of progestagen-only contraceptives is associated with a slight increase in breast cancer risk, which does not appear to vary by mode of delivery, and is similar in magnitude to that associated with combined hormonal contraceptives. Given that the underlying risk of breast cancer increases with advancing age, the absolute excess risk associated with use of either type of oral contraceptive is estimated to be smaller in women who use it at younger rather than at older ages. Such risks need be balanced against the benefits of using contraceptives during the childbearing years.
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Affiliation(s)
- Danielle Fitzpatrick
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Kirstin Pirie
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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16
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Wang J, Qian MF, Jeng MR, Teng JMC. Assessment of Hormonal Contraceptive Utilization and Associated Odds of Hypercoagulopathy in Patients with Venous Malformations Using a National Claims Database. Clin Drug Investig 2023; 43:141-145. [PMID: 36626046 DOI: 10.1007/s40261-022-01228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Vascular anomalies that exhibit a slow velocity of blood flow, specifically venous malformations (VM), are associated with hypercoagulability. There is limited literature on the utilization of hormonal contraceptives (HCs) and the development of clotting events in female individuals diagnosed with VM. OBJECTIVE We aimed to characterize HC utilization and associated odds of hypercoagulopathy in patients with VM of child-bearing age. METHODS Using a national administrative claims database, we identified female patients with VM aged 15-49 years and a control population, matched for age and length of insurance enrollment, from 2016 to 2021. Multivariable logistic regression was used to estimate the odds of hypercoagulation events associated with HC use. RESULTS Two hundred and sixty-seven (47.2%) patients with VM and 1284 (45.4%) control patients utilized HCs during the study period. Oral contraceptives were the most common HC for patients with and without VM (73.8% and 76.9% of those taking HCs, respectively), and estrogen-containing combination HCs (70.4% in patients with VM and 75.9% in controls) were more prevalent than progestin-only HCs in both populations. Despite a heightened baseline odds of hypercoagulopathy in patients with VM relative to patients without VM (odds ratio = 12.54; 95% confidence interval 7.73-20.3), HC use was not associated with an increased odds of hypercoagulation in the VM subpopulation (odds ratio = 0.82; 95% confidence interval 0.46-1.46). In contrast, tobacco use (odds ratio = 2.12; 95% confidence interval 1.09-4.12) and a history of coagulopathy (odds ratio = 3.92; 95% confidence interval 1.48-10.36) were predictive of thromboembolic events in the VM cohort. CONCLUSIONS These findings suggest that patients with VM may safely use HCs with careful consideration of other risk factors for thromboses.
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Affiliation(s)
- Jami Wang
- Western University of Health Sciences, Pomona, CA, USA
| | - Mollie F Qian
- Stanford University School of Medicine, Stanford, CA, USA
| | - Michael R Jeng
- Department of Pediatrics-Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joyce M C Teng
- Department of Dermatology, Stanford University School of Medicine, 700 Welch Road, 3rd Floor, Suite 301 MC 5896, Palo Alto, CA, 94304-5896, USA.
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17
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Kleiverda G, Dehue GCG, Gomperts RJ. [Mifepristone: from pre- to post-protection]. Ned Tijdschr Geneeskd 2022; 166:D6877. [PMID: 36300464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
All current hormonal contraceptives have side effects and contraindications related to estrogens and progestins. Users are often dissatisfied with this. There is a great need for a new contraceptive drug without these hormones with the associated side effects and contraindications; with also a favorable bleeding profile; that can be used orally and not daily; that can serve as a contraceptive and after-care and can also be used on demand. Mifepristone 50 mg seems to provide the answer to all these wishes but is not (yet) registered in the Netherlands.
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18
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Wiegers HMG, Knijp J, van Es N, Coppens M, Moll S, Klok FA, Middeldorp S. Risk of recurrence in women with venous thromboembolism related to estrogen-containing contraceptives: Systematic review and meta-analysis. J Thromb Haemost 2022; 20:1158-1165. [PMID: 35108438 PMCID: PMC9303980 DOI: 10.1111/jth.15661] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/23/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. OBJECTIVE To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen-containing contraceptives. METHODS Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen-containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient-years were pooled using Knapp-Hartung random-effects meta-analysis. Incidence rates were reported separately based on study follow-up duration (≤1 year, 1-5 years, and >5 years) and for several subgroups. RESULTS A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%-CI: 1.10-2.23; I2 = 82%) per 100 patient-years. Recurrence rates per 100 patient-years were 2.73 (95%-CI: 0.00-3643; I2 = 80%) for studies with ≤1 year follow-up, 1.35 (95%-CI: 0.68-2.68; I2 = 44%) for studies with 1-5 years follow-up, and 1.42 (95%-CI: 0.84-2.42; I2 = 78%) for studies with >5 years follow-up. CONCLUSION Among women with VTE associated with estrogen-containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short-term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short-term anticoagulants are needed.
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Affiliation(s)
- Hanke M. G. Wiegers
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Jannet Knijp
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Nick van Es
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Stephan Moll
- Division of HematologyDepartment of MedicineUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Frederikus A. Klok
- Department of Medicine ‐ Thrombosis and HaemostasisLeiden University Medical CentreLeidenThe Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine &Radboud Institute of Health Sciences (RIHS)Radboud University Medical CentreNijmegenThe Netherlands
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Abstract
Meningiomas are common intracranial tumors with a female predominance. Their etiology is still poorly documented. The role of sexual hormones has long been evoked, and data have been conflicting across studies. However, a dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the progestin cyproterone acetate (CPA) has recently been established. CPA-associated meningiomas seem to be mainly located in the anterior and middle skull base, are more likely to be multiple, may harbor P1K3CA mutations in up to one-third of cases, and are more common with a longer duration of treatment. A similar but lower risk of meningiomas has been recently reported with the use of chlormadinone acetate and nomegestrol acetate as progestin treatments. Concerning hormonal replacement therapy (HRT) in menopausal patients, evidence from epidemiological studies seem to favor an increased risk of meningiomas in treated patients although a recent study failed to show an increased growth of meningiomas in HRT treated vs nontreated patients. Until larger studies are available, it seems wise to recommend avoiding HRT in patients with meningiomas. Evidence from published data does not seem to support an increased risk of meningiomas with oral contraceptive oral contraceptive (OR) use. Data are too scarce to conclude on fertility treatments. Based on studies demonstrating the expression of hormonal receptors in meningiomas, therapies targeting these receptors have been tried but have failed to show an overall favorable clinical outcome in meningioma treatment.
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Affiliation(s)
- Mirella Hage
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Oana Plesa
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Isabelle Lemaire
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | - Marie Laure Raffin Sanson
- Centre Hospitalier Universitaire Ambroise Paré, Service d'Endocrinologie Diabétologie et Nutrition, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
- EA4340, Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé Simone Veil, F-78423 Montigny-le-Bretonneux, France
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20
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Calçada MMS, Alves AMR. Hormonal Contraceptives and Post-fertilization Effects. Issues Law Med 2022; 37:29-80. [PMID: 36629790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Hormonal contraceptives are widely used for birth control and therapeutic purposes. The mechanism of action proposed for these compounds can be found in several scientific journals published to date. The present work consists in a scoping review of a convenience sample of papers regarding the mechanisms of action of each of the three main classes of hormonal contraceptives available. Different parameters and biological consequences associated with their use were also reviewed. Based on these data, we evaluated the probability of embryo loss due to the use of hormonal contraceptives. Evidence indicates the probability of embryo loss due to post-fertilization effects.
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Affiliation(s)
- Marta M S Calçada
- Marta M. S. Calçada is a religious sister at the "Fraternidade Arca de Maria". She obtained a degree in Chemical Engineering and a Master's degree in Biologic Engineering from the IST of the University of Lisbon, Portugal. She also obtained a Bachelor's degree in Theology from the UCP in Petrópolis - RJ, Brazil
| | - Anderson M R Alves
- Anderson M. R. Alves is a priest of the diocese of Petrópolis (RJ - Brazil). He obtained a Bachelor's degree in Theology from the University of Navarro, Spain, a Master's degree in Moral Theology and a PhD in Philosophy from the PUSC (Rome, Italy). He is a professor at the Catholic University of Petrópolis, Brazil
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21
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Regidor PA, Colli E, Palacios S. Overall and bleeding-related discontinuation rates of a new oral contraceptive containing 4 mg drospirenone only in a 24/4 regimen and comparison to 0.075 mg desogestrel. Gynecol Endocrinol 2021; 37:1121-1127. [PMID: 34402728 DOI: 10.1080/09513590.2021.1963432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Progestin-only pills do not increase the risk of venous thromboembolism, stroke, and myocardial infarction but are associated with poor cycle control. A novel estrogen-free pill containing only drospirenone (DRSP) to improve bleeding patterns and tolerability and reduce discontinuation rates has been introduced into the market. The present study aims to describe the improvement in the acceptability of this DRSP-only pill, e.g. regarding the bleeding profile and the reduction in discontinuation rates due to unacceptable bleeding compared to desogestrel (DSG). STUDY DESIGN Double-blind, double-dummy prospective phase III study in healthy women aged 18-45 years evaluating a total of 858 women with 6691 DRSP and 332 women with 2487 DSG treatment cycles. RESULTS Overall, 82 (9.6%) women in the DRSP group and 44 (13.3%) women in the DSG group experienced treatment-emergent adverse events (TEAEs) leading to premature termination of the trial meaning that 32% more women in the DRSP group finished the trial in comparison to the DSG group (based on the AUC of Kaplan-Meier's curves). Discontinuation rates due to abnormal bleeding were 3.7% for DRSP and 7.3% for DSG users. This is a 55.7% lower discontinuation rate in the DRSP group compared to the DSG group. CONCLUSIONS This report describes the improvement in acceptability and bleeding profile of women using the new DRSP-only oral contraceptive compared to DSG, providing a better quality of life and adherence to the contraceptive method as demonstrated by lower discontinuation rates of women using the estrogen-free DRSP-only pill.
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22
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Adegoke TE, Sabinari IW, Areola ED, Ajao F, Asafa OO, Soluoku TK, Bello A, Adesanmi AM, Yusuf SO, Omoleye A, Ayinla MT, Olatunji LA. Inhibition of dipeptidyl peptidase-4 averts free fatty acids deposition in the hearts of oral estrogen-progestin contraceptive-induced hyperinsulinemic female rats. Can J Physiol Pharmacol 2021; 99:1316-1323. [PMID: 34310895 DOI: 10.1139/cjpp-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Free fatty acid (FFA) deposition in non-adipose tissues such as the heart is a characteristic of insulin resistant states which feature hyperinsulinemia and dipeptidyl peptidase-4 (DPP-4) activation. Estrogen-progestin oral contraceptives (OC) treatment reportedly increased DPP-4 activity in rat tissue, and DPP-4 inhibitors have anti-diabetic and anti-inflammatory properties. This study aims to investigate the effects of DPP-4 inhibition on cardiac FFA deposition in estrogen-progestin-treated female rats. From our data, estrogen-progestin OC exposure in female rats led to elevated plasma insulin, cardiac DPP-4 activity, FFA and triglyceride (TG) accumulation, TG/high-density lipoprotein cholesterol (TG/HDL-C) ratio, adenosine deaminase/xanthine oxidase/uric acid pathway (ADA/XO/UA), lipid peroxidation, glycogen synthase activity, and alanine phosphatase; whereas cardiac glucose-6-phosphate dehydrogenase, Na+/K+-ATPase and nitric oxide (NO) were decreased. However, DPP-4 inhibition resulted in decreased plasma insulin, cardiac DPP-4 activity, FFA, TG, TG/HDL-C ratio, and alkaline phosphatase. These were accompanied by reduced ADA/XO/UA pathway, lipid peroxidation, and augmented NO and Na+/K+-ATPase in estrogen-progestin OC-treated rats. DPP-4 inhibition attenuated cardiac lipid deposition accompanied by reduced activity in the ADA/XO/UA pathway in estrogen-progestin OC-treated female rats. DPP-4 is therefore a plausible therapeutic target in cardiometabolic disorders.
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Affiliation(s)
- Tolulope Eniola Adegoke
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Isaiah Woru Sabinari
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Damilare Areola
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Folasade Ajao
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
- Department of Physiology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Olayinka Olawale Asafa
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Talha Kolade Soluoku
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Abdullahi Bello
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Adejoke Mosunmade Adesanmi
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Shukurat Olaide Yusuf
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - AyokunleOlusuyi Omoleye
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Mariam Tayo Ayinla
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Lawrence Aderemi Olatunji
- HOPE Cardiometabolic Research Team, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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23
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Abstract
Estrogens have pleiotropic effects on many reproductive and non-reproductive tissues and organs including the mammary gland, uterus, ovaries, vagina, and endothelium. Estrogen receptor α functions as the principal mediator of estrogenic action in most of these tissues. Estetrol (E4) is a native fetal estrogen with selective tissue actions that is currently approved for use as the estrogen component in a combined oral contraceptive and is being developed as a menopause hormone therapy (MHT, also known as hormone replacement therapy). However, exogenous hormonal treatments, in particular MHTs, have been shown to promote the growth of preexisting breast cancers and are associated with a variable risk of breast cancer depending on the treatment modality. Therefore, evaluating the safety of E4-based formulations on the breast forms a crucial part of the clinical development process. This review highlights preclinical and clinical studies that have assessed the effects of E4 and E4-progestogen combinations on the mammary gland and breast cancer, focusing in particular on the estrogenic and anti-estrogenic properties of E4. We discuss the potential advantages of E4 over current available estrogen-formulations as a contraceptive and for the treatment of symptoms due to menopause. We also consider the potential of E4 for the treatment of endocrine-resistant breast cancer.
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Affiliation(s)
- Anne Gallez
- Laboratory of Biology, Tumors and Development, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Isabelle Dias Da Silva
- Laboratory of Biology, Tumors and Development, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Vincent Wuidar
- Laboratory of Biology, Tumors and Development, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Jean-Michel Foidart
- Laboratory of Biology, Tumors and Development, GIGA-Cancer, University of Liège, Liège, Belgium
| | - Christel Péqueux
- Laboratory of Biology, Tumors and Development, GIGA-Cancer, University of Liège, Liège, Belgium.
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Tennilä J, Jääskeläinen J, Utriainen P, Voutilainen R, Häkkinen M, Auriola S, Morin-Papunen L, Liimatta J. PCOS Features and Steroid Profiles Among Young Adult Women with a History of Premature Adrenarche. J Clin Endocrinol Metab 2021; 106:e3335-e3345. [PMID: 34060603 PMCID: PMC8372635 DOI: 10.1210/clinem/dgab385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Premature adrenarche (PA) may increase the risk for polycystic ovary syndrome (PCOS). OBJECTIVE To study features of PCOS in young adult women with a history of PA. METHODS Thirty PA and 42 control females were followed from prepuberty to young adulthood (median age 18.1 years). The main outcome measures were ovarian function, the use of contraceptives, and clinical and biochemical indicators of hyperandrogenism. RESULTS We found no differences in the use of hormonal contraceptives (50 vs 50%, PA vs controls, respectively; P > .999), indication for using contraceptives (P = .193), or in the history of oligo- (17 vs 26%, P = .392) and amenorrhea (0 vs 0%, P > .999). Among women not using hormonal contraceptives, those with a history of PA had a higher prevalence of hirsutism (27 vs 0%, P = .023) but not acne (87 vs 67%, P = .252). Steroid profiles were broadly comparable between the groups, but PA women had lower sex hormone-binding globulin (SHBG) concentrations (30.1 vs 62.4 nmol/L, P < .001) resulting in higher free androgen index (3.94 vs 2.14, P < .001). The difference in SHBG levels persisted through body mass index adjustment. SHBG correlated negatively with the homeostasis model assessment for insulin resistance (r -0.498, P = .003). Anti-Müllerian hormone concentrations were comparable between the groups (39.3 vs 32.1 pmol/L, P = .619). CONCLUSION PA was not associated with evident ovarian dysfunction in young adult women. However, women with a history of PA had decreased SHBG levels and thus, increased bioavailability of circulating androgens.
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Affiliation(s)
- Jussi Tennilä
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Jarmo Jääskeläinen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Pauliina Utriainen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Raimo Voutilainen
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Merja Häkkinen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland
- Medical Research Center and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Jani Liimatta
- Kuopio Pediatric Research Unit, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- Correspondence: Jani Liimatta, MD, PhD, Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, FI-70029 Kuopio, Finland.
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Rajendiran G. Not All Hepatocellular Adenomas are Caused by the Hormonal Oral Contraceptive. S D Med 2021; 74:302-303. [PMID: 34449989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This is a case report of a female patient with multiple hepatocellular adenomas secondary to the glycogen storage disease 1a with asymptomatic and late adult-onset presentation. Even though the patient was taking a hormonal oral contraceptive, it was important to identify the genetic disorder and ensure adequate metabolic control which is considered a modifier of the adenoma formation and progression. It is also imperative that the patient gets monitored for the adenoma-to-hepatocellular carcinoma transformation.
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Affiliation(s)
- Govarthanan Rajendiran
- Sanford USD Medical Center, Sioux Falls, South Dakota
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Estetrol/drospirenone (Nextstellis) - a new combination oral contraceptive. Med Lett Drugs Ther 2021; 63:101-2. [PMID: 34181632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
MESH Headings
- Administration, Oral
- Androstenes/administration & dosage
- Androstenes/adverse effects
- Contraceptives, Oral/administration & dosage
- Contraceptives, Oral/adverse effects
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Drug Administration Schedule
- Drug Interactions
- Estetrol/administration & dosage
- Estetrol/adverse effects
- Female
- Humans
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Affiliation(s)
- Daniel I Spratt
- The Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Maine Medical Center, Portland ME
- Corresponding author: Daniel Spratt, MD, Division of Reproductive Endocrinology and Infertility, Maine Medical Center, Portland, ME 04102, Phone: 207-771-5549,
| | - Rachel J Buchsbaum
- Division of Hematology/Oncology, Tufts University School of Medicine, Boston MA (RB)
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Mosorin ME, Haverinen A, Ollila MM, Nordström T, Jokelainen J, Keinänen-Kiukaanniemi S, Puukka K, Ruokonen A, Auvinen J, Piltonen T, Morin-Papunen L, Tapanainen JS. Current use of combined hormonal contraception is associated with glucose metabolism disorders in perimenopausal women. Eur J Endocrinol 2020; 183:619-626. [PMID: 33105101 DOI: 10.1530/eje-20-0406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The use of combined hormonal contraceptives (CHCs) worsens glucose tolerance, but the risk for glucose metabolism disorders remains controversial. DESIGN The study is a prospective longitudinal population-based cohort study. METHODS The study was based on a cohort population that comprised 1879 women born in 1966. At age 46, the women answered a questionnaire on contraceptive use and underwent an oral glucose tolerance test. Glucose metabolism indices were evaluated in current CHC (n = 153), progestin-only contraceptive (POC, n = 842), and non-hormonal contraceptive users (n = 884). RESULTS In the entire study population, current CHC use was significantly associated with prediabetes (OR: 2.0, 95% CI: 1.3-3.2) and type 2 diabetes (OR: 3.3, 95% CI: 1.1-9.7) compared to non-hormonal contraceptive use. After 5 years of use, the prediabetes risk increased 2.2-fold (95% CI: 1.3-3.7) and type 2 diabetes risk increased 4.5-fold (95% CI: 1.5-13.5). Compared with the current POC use, current CHC use was significantly associated with prediabetes (OR: 1.9, 95% CI: 1.2-3.0). Current POC use was not associated with any glucose metabolism disorders. The results prevailed after adjusting for BMI and socioeconomic status. CONCLUSIONS CHC use in perimenopausal women was associated with a significantly increased risk of glucose metabolism disorders. This association should be considered in women with increased metabolic risk.
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Affiliation(s)
- Maria-Elina Mosorin
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and Medical Research Center, and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Oulu, Finland
| | - Annina Haverinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Meri-Maija Ollila
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and Medical Research Center, and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Oulu, Finland
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Katri Puukka
- Nordlab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Aimo Ruokonen
- Nordlab Oulu, Medical Research Center Oulu, Oulu University Hospital and Department of Clinical Chemistry, University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Terhi Piltonen
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and Medical Research Center, and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Oulu, Finland
| | - Laure Morin-Papunen
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and Medical Research Center, and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Oulu, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu and Medical Research Center, and PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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29
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Affiliation(s)
- Chrisandra Shufelt
- Smidt Heart Institute, Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alexis LeVee
- Smidt Heart Institute, Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Los Angeles, California
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30
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Affiliation(s)
- Rossella E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Petrick JL, McMenamin ÚC, Zhang X, Zeleniuch-Jacquotte A, Wactawski-Wende J, Simon TG, Sinha R, Sesso HD, Schairer C, Rosenberg L, Rohan TE, Robien K, Purdue MP, Poynter JN, Palmer JR, Lu Y, Linet MS, Liao LM, Lee IM, Koshiol J, Kitahara CM, Kirsh VA, Hofmann JN, Graubard BI, Giovannucci E, Gaziano JM, Gapstur SM, Freedman ND, Florio AA, Chong DQ, Chen Y, Chan AT, Buring JE, Freeman LEB, Bea JW, Cardwell CR, Campbell PT, McGlynn KA. Exogenous hormone use, reproductive factors and risk of intrahepatic cholangiocarcinoma among women: results from cohort studies in the Liver Cancer Pooling Project and the UK Biobank. Br J Cancer 2020; 123:316-324. [PMID: 32376888 PMCID: PMC7374167 DOI: 10.1038/s41416-020-0835-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) arises from cholangiocytes in the intrahepatic bile duct and is the second most common type of liver cancer. Cholangiocytes express both oestrogen receptor-α and -β, and oestrogens positively modulate cholangiocyte proliferation. Studies in women and men have reported higher circulating oestradiol is associated with increased ICC risk, further supporting a hormonal aetiology. However, no observational studies have examined the associations between exogenous hormone use and reproductive factors, as proxies of endogenous hormone levels, and risk of ICC. METHODS We harmonised data from 1,107,498 women who enroled in 12 North American-based cohort studies (in the Liver Cancer Pooling Project, LCPP) and the UK Biobank between 1980-1998 and 2006-2010, respectively. Cox proportional hazards regression models were used to generate hazard ratios (HR) and 95% confidence internals (CI). Then, meta-analytic techniques were used to combine the estimates from the LCPP (n = 180 cases) and the UK Biobank (n = 57 cases). RESULTS Hysterectomy was associated with a doubling of ICC risk (HR = 1.98, 95% CI: 1.27-3.09), compared to women aged 50-54 at natural menopause. Long-term oral contraceptive use (9+ years) was associated with a 62% increased ICC risk (HR = 1.62, 95% CI: 1.03-2.55). There was no association between ICC risk and other exogenous hormone use or reproductive factors. CONCLUSIONS This study suggests that hysterectomy and long-term oral contraceptive use may be associated with an increased ICC risk.
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Affiliation(s)
- Jessica L Petrick
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
- Slone Epidemiology Center, Boston University, Boston, MA, USA.
| | - Úna C McMenamin
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Xuehong Zhang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- NYU Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Tracey G Simon
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Howard D Sesso
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine Schairer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, CA, USA
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jill Koshiol
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Victoria A Kirsh
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J Michael Gaziano
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Andrea A Florio
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Dawn Q Chong
- Division of Medical Oncology, National Cancer Centre, Singapore, Singapore
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Andrew T Chan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Julie E Buring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jennifer W Bea
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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32
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Bchtawi AK, Issa BSM, Jørgensen EF, Lidegaard Ø. [Hormonal contraceptive use, depression and suicide]. Ugeskr Laeger 2020; 182:V12190713. [PMID: 32584759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hormonal contraception is widely used among young women, and mood changes are common side effects. Little focus has been drawn towards more serious mood disorders. Recent investigations have shown an association between hormonal contraceptive use and depression, suicide attempt and suicide. The highest relative risks for those side effects have been reported among adolescents. All types of hormonal contraceptive methods seem to influence women's mood. In this review, we recommend a greater focus on potential psychological side effects and increased attention when prescribing hormonal contraceptive products.
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Cervenka I, Al Rahmoun M, Mahamat-Saleh Y, Fournier A, Boutron-Ruault MC, Severi G, Caini S, Palli D, Ghiasvand R, Veierod MB, Botteri E, Tjønneland A, Olsen A, Fortner RT, Kaaks R, Schulze MB, Panico S, Trichopoulou A, Dessinioti C, Niforou K, Sieri S, Tumino R, Sacerdote C, Bueno-de-Mesquita B, Sandanger TM, Colorado-Yohar S, Sánchez MJ, Gil Majuelo L, Lujan-Barroso L, Ardanaz E, Merino S, Isaksson K, Butt S, Ljuslinder I, Jansson M, Travis RC, Khaw KT, Weiderpass E, Dossus L, Rinaldi S, Kvaskoff M. Exogenous hormone use and cutaneous melanoma risk in women: The European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2020; 146:3267-3280. [PMID: 31506954 DOI: 10.1002/ijc.32674] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/25/2019] [Indexed: 03/25/2024]
Abstract
Evidence suggests an influence of sex hormones on cutaneous melanoma risk, but epidemiologic findings are conflicting. We examined the associations between use of oral contraceptives (OCs) and menopausal hormone therapy (MHT) and melanoma risk in women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Information on exogenous hormone use at baseline was derived from country-specific self-administered questionnaires. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Over 1992-2015, 1,696 melanoma cases were identified among 334,483 women, whereof 770 cases among 134,758 postmenopausal women. There was a positive, borderline-significant association between OC use and melanoma risk (HR = 1.12, 95% CI = 1.00-1.26), with no detected heterogeneity across countries (phomogeneity = 0.42). This risk increased linearly with duration of use (ptrend = 0.01). Among postmenopausal women, ever use of MHT was associated with a nonsignificant increase in melanoma risk overall (HR = 1.14, 95% CI = 0.97-1.43), which was heterogeneous across countries (phomogeneity = 0.05). Our findings do not support a strong and direct association between exogenous hormone use and melanoma risk. In order to better understand these relations, further research should be performed using prospectively collected data including detailed information on types of hormone, and on sun exposure, which may act as an important confounder or effect modifier on these relations.
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Affiliation(s)
- Iris Cervenka
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie Al Rahmoun
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Yahya Mahamat-Saleh
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Agnès Fournier
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Gianluca Severi
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research, Prevention and Oncology Network Institute (ISPRO), Florence, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research, Prevention and Oncology Network Institute (ISPRO), Florence, Italy
| | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marit B Veierod
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Edoardo Botteri
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - Salvatore Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | | | - Clio Dessinioti
- Hellenic Health Foundation, Athens, Greece
- 1st Department of Dermatology Andreas Syggros Hospital University of Athens, Athens, Greece
| | | | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano Via Venezian, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Azienda Sanitaria Provinciale (ASP), Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Torkjel M Sandanger
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Sandra Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellin, Colombia
| | - Maria J Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Biomedical Research Institute ibs.GRANADA, University of Granada, Granada, Spain
| | - Leire Gil Majuelo
- Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Ministry of Health of the Basque Government, San Sebastian, Spain
| | - Leila Lujan-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Gran Via de L'Hospitalet, Barcelona, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Karolin Isaksson
- Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Salma Butt
- Department of Clinical Sciences Lund, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Ingrid Ljuslinder
- Department of Radiation Sciences, Oncology, Norrlands University Hospital, Umeå, Sweden
| | - Malin Jansson
- Department of Surgery and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kay-Tee Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Marina Kvaskoff
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
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Godfrey EM, Mody S, Schwartz MR, Heltshe SL, Taylor-Cousar JL, Jain R, Sufian S, Josephy T, Aitken ML. Contraceptive use among women with cystic fibrosis: A pilot study linking reproductive health questions to the Cystic Fibrosis Foundation National Patient Registry. Contraception 2020; 101:420-426. [PMID: 32109430 PMCID: PMC7494372 DOI: 10.1016/j.contraception.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To examine contraceptive use, pregnancy intention and the association of hormonal contraceptive type with adverse health outcomes among women with cystic fibrosis (CF). STUDY DESIGN We recruited 150 women with CF, ages 18-49 from three adult CF programs to complete an online survey regarding their pregnancy and contraceptive use history. Survey findings were merged with retrospective clinical information from the CF Foundation Patient Registry (CFFPR). We used descriptive analyses to report contraceptive method and pregnancy frequencies, and logistic regression to examine the association between contraceptive method type and adverse health outcomes. RESULTS Combined hormonal contraceptives were the most commonly used methods (42%), followed by condoms (34%), and long-acting reversible contraceptives methods (27%). Thirty-three percent (n = 50) reported ever being pregnant, half of whom reported having at least one unplanned pregnancy. We found no significant association for mucoid Pseudomonas aeruginosa infection among progestin-only (aOR 1.53, 95% CI 0.07-32.2) and estrogen-containing hormonal contraceptive users (aOR 3.9, 95 % CI 0.20-76.5). Risk of osteoporosis was elevated among women with CF who used depot-medroxyprogesterone acetate compared to non-users (OR 5.36, 95% CI 1.00-29.12). CONCLUSIONS Both contraceptive use and unplanned pregnancy among women with CF are common. Associations between hormonal contraceptive use and adverse pulmonary or bone outcomes among women with CF are inconclusive due to the study s small sample size. Larger studies are warranted. IMPLICATIONS Women with CF should be informed about the risks and benefits of contraceptives in the context of their disease. CFFPR data capturing contraceptive method use may be the most efficient way to elucidate the association of hormonal contraceptives on disease in women with CF.
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Affiliation(s)
- Emily M Godfrey
- Department of Family Medicine and Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Sheila Mody
- Division of Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Malaika R Schwartz
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonya L Heltshe
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Cystic Fibrosis Foundation Therapeutics Development Network, Seattle Children s Research Institute, Seattle, WA, USA
| | - Jennifer L Taylor-Cousar
- Departments of Medicine and Pediatrics, Divisions of Pulmonary, Critical Care and Sleep Medicine and Pediatric Pulmonary Medicine, National Jewish Health, Denver, CO, USA
| | - Raksha Jain
- Internal Medicine, Pulmonary and Critical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sandra Sufian
- Departments of Medical Education and of Disability and Human Development, University of Illinois at Chicago College of Medicine and College of Applied Health Sciences, Chicago, IL, USA
| | - Tatiana Josephy
- Department of Family Medicine and Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Moira L Aitken
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Abstract
The aim of the present study was to evaluate whether hormone therapy containing dienogest is effective in reducing endometrioma size. A retrospective observational study was conducted on 116 women with endometrioma which was evaluated after 6 and 12 months of either no treatment (n = 46), or hormonal therapy containing dienogest (n = 70), without (DNG; n = 34) or with ethinylestradiol (DNG/EE; n = 36). Median (interquartile range) cyst diameter (23.0 mm (21.0 mm)) and volume (9941.2 mm3 (14240.1 mm3)) of untreated were similar to cyst diameter (25.0 mm (14.5 mm) and volume (7587.7 mm3 (13806.2 mm3)) of treated women. After 12 months, endometrioma volume did not vary in untreated women (-34.0 mm3 (55595.0 mm3); -0.77% (93.9%)) while it significantly decreased (-5400 mm3 (15378.7 mm3); -100.0% (27.7%); p<.0001) during hormone therapy. Volume decrease was linearly related to endometrioma volume ([Formula: see text] R2 = 0.899, p<.0001). The effect tended to be greater during DNG alone than DNG/EE (-100.0% (0.0%) vs. -87.9% (47.7%); p<.0004). Cyst disappearance was observed in 4.4% of untreated cases and in 57.1% of cases on hormone therapy (p<.0001) (38.9% with DNG/EE and 76.5% with DNG; p<.03). The early diagnosis and treatment of endometrioma with dienogest-based hormone therapy may be effective in controlling cyst growth and in reducing the need for surgery.
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Affiliation(s)
- Anjeza Xholli
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Gabriele Filip
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Francesca Previtera
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Clinic, Hospital San Martino-IRCCS, University of Genova, Genova, Italy
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Drospirenone (Slynd) - a new progestin-only oral contraceptive. Med Lett Drugs Ther 2020; 62:18-9. [PMID: 32022787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
MESH Headings
- Androstenes/administration & dosage
- Androstenes/adverse effects
- Androstenes/therapeutic use
- Contraceptives, Oral, Hormonal/administration & dosage
- Contraceptives, Oral, Hormonal/adverse effects
- Contraceptives, Oral, Hormonal/therapeutic use
- Contraceptives, Oral, Synthetic/administration & dosage
- Contraceptives, Oral, Synthetic/adverse effects
- Contraceptives, Oral, Synthetic/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Norethindrone/administration & dosage
- Norethindrone/adverse effects
- Norethindrone/therapeutic use
- Progesterone Congeners/administration & dosage
- Progesterone Congeners/adverse effects
- Progesterone Congeners/therapeutic use
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Olaniyi KS, Woru Sabinari I, Olatunji LA. l-glutamine supplementation exerts cardio-renal protection in estrogen-progestin oral contraceptive-treated female rats. Environ Toxicol Pharmacol 2020; 74:103305. [PMID: 31790957 DOI: 10.1016/j.etap.2019.103305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/01/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
Glycogen and lipid disruptions represent a spectrum of metabolic disorders that are crucial risk factors for cardiovascular disease in estrogen-progestin oral contraceptive (COC) users. l-glutamine (GLN) has been shown to exert a modulatory effect in metabolic disorders-related syndromes. We therefore hypothesized that GLN supplementation would protect against myocardial and renal glycogen-lipid mishandling in COC-treated animals by modulation of Glucose-6-phosphate dehydrogenase (G6PD) and xanthine oxidase (XO) activities. Adult female Wistar rats were randomly allotted into control, GLN, COC and COC + GLN groups (six rats per group). The groups received vehicle (distilled water, p.o.), GLN (1 g/kg), COC containing 1.0 μg ethinylestradiol plus 5.0 μg levonorgestrel and COC plus GLN respectively, daily for 8 weeks. Data showed that treatment with COC led to metabolically-induced obesity with correspondent increased visceral and epicardial fat mass. It also led to increased plasma, myocardial and renal triglyceride, free fatty acid, malondialdehyde (MDA), XO activity, uric acid content and decreased glutathione content and G6PD activity. In addition, COC increased myocardial but not renal glycogen content, and increased myocardial and renal glycogen synthase activity, increased plasma and renal lactate production and plasma aspartate transaminase/alanine aminotransferase (AST/ALT) ratio. However, these alterations were attenuated when supplemented with GLN except plasma AST/ALT ratio. Collectively, the present results indicate that estrogen-progestin oral contraceptive causes metabolically-induced obesity that is accompanied by differential myocardial and renal metabolic disturbances. The findings also suggest that irrespective of varying metabolic phenotypes, GLN exerts protection against cardio-renal dysmetabolism by modulation of XO and G6PD activities.
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Affiliation(s)
- Kehinde Samuel Olaniyi
- HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria; Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Isaiah Woru Sabinari
- HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - Lawrence Aderemi Olatunji
- HOPE Cardiometabolic Research Team & Department of Physiology, College of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria.
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38
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Křepelka P. New estrogen-free oral hormonal contraceptive (Estrogene free ill-EFP). Ceska Gynekol 2020; 85:222-225. [PMID: 33562977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Methods of hormonal contraception are an important tool in the implementation of family planning. Although the primary design of hormonal contraceptives was based on a combination of estrogenic and progestogenic components, the most important component of hormonal contraceptives is the progestin molecule responsible for the anti-gonadotropic effect leading to ovulation inhibition, increased cervical mucus viscosity and endometrial desynchronization. The combination of progestins with estrogens has improved the bleeding profile, but it has increased the risk of cardiovascular complications, particularly deep venous thrombosis and pulmonary embolism, in patients at specific risk. The development of purely progestogenic contraceptives is being conducted to eliminate these cardiovascular risks. A new hormonal contraceptive based on oral drospirenone alone at a daily dose of 4 mg administered in a 24-active tablet + 4 days hormone-free interval shows contraceptive efficacy and bleeding profile consistent with combined hormonal contraceptives and high safety profile as the risk of deep vein thrombosis and pulmonary embolism does not increase according to recent clinical studies. It appears to be a very effective alternative to combination products suitable for a wide range of users.
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Gallart Úbeda V, Elía Martínez JM, Puerta de Diego R, Elía Martínez I, Valero Inigo JC. [Multiple osteonecrosis. Update and case report]. Rehabilitacion (Madr) 2020; 54:63-67. [PMID: 32007184 DOI: 10.1016/j.rh.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
Multifocal osteonecrosis is defined as the presence of osteonecrosis in three or more osseous sites. It is an infrequent entity representing less than 3% of cases among osteonecrosis patients. Multifocal osteonecrosis has been associated with systemic diseases, with patients at highest risk being those with lupus erythematosus, transplant recipients and those with haematological disorders or prolonged high-dose glucocorticoid treatment. The area most prone to disturbances is the femoral head. The pathogenesis of this particular disorder has not been fully defined, although several risk factors have been identified. We report the case of a young woman with abnormal hemostatic factors and a history of glucocorticoid and oral contraceptive therapy who developed bilateral hip osteonecrosis, followed by shoulder ON. The present article also provides an extensive literature review of the aetiology and treatment of multifocal ON.
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Affiliation(s)
- V Gallart Úbeda
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - J M Elía Martínez
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - R Puerta de Diego
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - I Elía Martínez
- Servicio de Radiodiagnóstico, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J C Valero Inigo
- Servicio de Anestesia y Reanimación, Hospital de Sagunto, Valencia, España
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40
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Abstract
Untoward side effects of pharmaceuticals can result in considerable morbidity and expense to the health care system. There is likely a sizable fraction of the hypertensive population with disease either induced or exacerbated by polypharmacy. The elevation of blood pressure in drug-induced hypertension occurs through a variety of mechanisms, most notably, sodium and fluid retention, activation of the renin-angiotensin-aldosterone system, alteration of vascular tone, or a combination of these pathways. Recognition of common medications causing drug-induced hypertension is important to effectively control blood pressure. The epidemiology, pathophysiology, and management of these agents are discussed.
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Affiliation(s)
- Matthew C Foy
- Division of Nephrology, Louisiana State University Health Science Center, 5246 Brittany Dr, Baton Rouge, LA 70808, USA
| | - Joban Vaishnav
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
| | - Christopher John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 416, Baltimore, MD 21287, USA.
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Dichtel LE, Schorr M, Loures de Assis C, Rao EM, Sims JK, Corey KE, Kohli P, Sluss PM, McPhaul MJ, Miller KK. Plasma Free Cortisol in States of Normal and Altered Binding Globulins: Implications for Adrenal Insufficiency Diagnosis. J Clin Endocrinol Metab 2019; 104:4827-4836. [PMID: 31009049 PMCID: PMC6735741 DOI: 10.1210/jc.2019-00022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 01/31/2023]
Abstract
CONTEXT Accurate diagnosis of adrenal insufficiency is critical because there are risks associated with overdiagnosis and underdiagnosis. Data using liquid chromatography tandem mass spectrometry (LC/MS/MS) free cortisol (FC) assays in states of high or low cortisol-binding globulin (CBG) levels, including cirrhosis, critical illness, and oral estrogen use, are needed. DESIGN Cross-sectional. OBJECTIVE Determine the relationship between CBG and albumin as well as total cortisol (TC) and FC in states of normal and abnormal CBG. Establish the FC level by LC/MS/MS that best predicts TC of <18 μg/dL (497 nmol/L) (standard adrenal insufficiency diagnostic cutoff) in healthy individuals. SUBJECTS This study included a total of 338 subjects in four groups: healthy control (HC) subjects (n = 243), patients with cirrhosis (n = 38), intensive care unit patients (ICU) (n = 26), and oral contraceptive (OCP) users (n = 31). MAIN OUTCOME MEASURE(S) FC and TC by LC/MS/MS, albumin by spectrophotometry, and CBG by ELISA. RESULTS TC correlated with FC in the ICU (R = 0.91), HC (R = 0.90), cirrhosis (R = 0.86), and OCP (R = 0.70) groups (all P < 0.0001). In receiver operator curve analysis in the HC group, FC of 0.9 μg/dL (24.8 nmol/L) predicted TC of <18 μg/dL (497 nmol/L; 98% sensitivity, 91% specificity; AUC, 0.98; P < 0.0001). Decreasing the cutoff to 0.7 μg/dL led to a small decrease in sensitivity (92%) with similar specificity (91%). CONCLUSIONS A cutoff FC of <0.9 μg/dL (25 nmol/L) in this LC/MS/MS assay predicts TC of <18 μg/dL (497 nmol/L) with excellent sensitivity and specificity. This FC cutoff may be helpful in ruling out adrenal insufficiency in patients with binding globulin derangements.
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Affiliation(s)
- Laura E Dichtel
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Laura E. Dichtel, MD, MHS, Neuroendocrine Unit, Massachusetts General Hospital, BUL457B, 55 Fruit Street, Boston, Massachusetts 02114. E-mail:
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | - Elizabeth M Rao
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica K Sims
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen E Corey
- Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Puja Kohli
- Harvard Medical School, Boston, Massachusetts
- Division of Pulmonology and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Patrick M Sluss
- Harvard Medical School, Boston, Massachusetts
- Clinical Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael J McPhaul
- Endocrinology, Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Mayhew A, Ermias Y, Zapata LB, Pagano HP, Tepper NK. Health Care Provider Attitudes Toward Safety of Selected Hormonal Contraceptives in Breastfeeding Women. Matern Child Health J 2019; 23:1079-1086. [PMID: 31069600 PMCID: PMC10983027 DOI: 10.1007/s10995-019-02743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Little is known about provider attitudes regarding safety of selected hormonal contraceptives among breastfeeding women. METHODS Using a nationwide survey, associations were analyzed between provider characteristics and perception of safety of combined oral contraceptives (COCs) in breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors and depot medroxyprogesterone acetate (DMPA) in breastfeeding women < 1 month postpartum and ≥ 1 month postpartum. RESULTS Approximately 68% of public-sector providers considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among non-physicians versus physicians (adjusted odds ratios [aOR] range 0.34-0.51) and those with a focus on adolescent health/pediatrics versus reproductive health (aOR 0.68, 95% confidence interval [CI] 0.47-0.99). Most public-sector providers considered DMPA safe for breastfeeding women during any time postpartum, with lower odds among non-physicians versus physicians (aOR range 0.20-0.54) and those with primary clinical focus other than reproductive health (aOR range 0.26-0.65). The majority of office-based physicians considered COCs safe for breastfeeding women ≥ 1 month postpartum without other venous thrombosis risk factors, with lower odds among those who did not use, versus those who used, CDC's contraceptive guidance (aOR 0.40, 95% CI 0.21-0.77). Most office-based physicians also considered DMPA safe for breastfeeding women during any time postpartum. CONCLUSIONS FOR PRACTICE A high proportion of providers considered use of selected hormonal contraceptives safe for breastfeeding women, consistent with evidence-based guidelines. However, certain provider groups might benefit from education regarding the safety of these methods for breastfeeding women.
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Affiliation(s)
- Allison Mayhew
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Yokabed Ermias
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - H Pamela Pagano
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-74, Atlanta, GA, 30341, USA.
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43
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Mendel A, Bernatsky S, Pineau CA, St-Pierre Y, Hanly JG, Urowitz MB, Clarke AE, Romero-Diaz J, Gordon C, Bae SC, Wallace DJ, Merrill JT, Buyon J, Isenberg DA, Rahman A, Ginzler EM, Petri M, Dooley MA, Fortin P, Gladman DD, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón G, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim S, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Sanchez-Guerrero J, Bruce IN, Costedoat-Chalumeau N, Vinet E. Use of combined hormonal contraceptives among women with systemic lupus erythematosus with and without medical contraindications to oestrogen. Rheumatology (Oxford) 2019; 58:1259-1267. [PMID: 30753683 PMCID: PMC6821299 DOI: 10.1093/rheumatology/kez014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/26/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the prevalence of combined hormonal contraceptives (CHCs) in reproductive-age women with SLE with and without possible contraindications and to determine factors associated with their use in the presence of possible contraindications. METHODS This observational cohort study included premenopausal women ages 18-45 years enrolled in the SLICC Registry ⩽15 months after SLE onset, with annual assessments spanning 2000-2017. World Health Organization Category 3 or 4 contraindications to CHCs (e.g. hypertension, aPL) were assessed at each study visit. High disease activity (SLEDAI score >12 or use of >0.5 mg/kg/day of prednisone) was considered a relative contraindication. RESULTS A total of 927 SLE women contributed 6315 visits, of which 3811 (60%) occurred in the presence of one or more possible contraindication to CHCs. Women used CHCs during 512 (8%) visits, of which 281 (55%) took place in the setting of one or more possible contraindication. The most frequently observed contraindications were aPL (52%), hypertension (34%) and migraine with aura (22%). Women with one or more contraindication were slightly less likely to be taking CHCs [7% of visits (95% CI 7, 8)] than women with no contraindications [9% (95% CI 8, 10)]. CONCLUSION CHC use was low compared with general population estimates (>35%) and more than half of CHC users had at least one possible contraindication. Many yet unmeasured factors, including patient preferences, may have contributed to these observations. Further work should also aim to clarify outcomes associated with this exposure.
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Affiliation(s)
- Arielle Mendel
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yvan St-Pierre
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Juanita Romero-Diaz
- Division of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Rheumatology Department, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Daniel J Wallace
- Cedars-Sinai Medical Centre, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York School of Medicine, New York, NY, USA
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Anne Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Paul Fortin
- Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Québec City, Quebec, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Disease and Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristján Steinsson
- Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
| | - Rosalind Ramsey-Goldman
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Munther A Khamashta
- Lupus Research Unit, Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Graciela Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ola Nived
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | | | - Manuel Ramos-Casals
- Joseph Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Giuillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth C Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Section 4242, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anca Askanase
- Division of Rheumatology, Columbia University Medical Center, New York, NY, USA
| | - Jorge Sanchez-Guerrero
- Department of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal and Dermatological Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Nathalie Costedoat-Chalumeau
- Centre de Reference Maladies Auto-immunes et Systemiques Rares, Service de Medecine Interne, Hospital Cochin, Paris, France
| | - Evelyne Vinet
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW We examine recent studies that investigate the effects of hormonal contraception on mood in different populations of women, including women in the general population and women with diagnosed psychiatric and gynecologic disorders. We address the mechanisms of several types of hormonal contraceptives and assess how these may affect mood and gynecologic disorders. RECENT FINDINGS The effects of hormonal contraceptives seem to be most relevant in selected subsets of women, as they may promote improved mental health in particular psychiatric disorders such as PMDD. Currently, there is no consistent evidence for negative effects of most hormonal contraceptives in the general population. Even though some studies reveal that certain individuals appear susceptible to negative mood effects from some forms of hormonal contraceptives, more research is needed to better identify these susceptible individuals.
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Affiliation(s)
- Thalia Robakis
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA.
| | - Katherine E Williams
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
| | - Lexi Nutkiewicz
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
| | - Natalie L Rasgon
- Psychiatry & Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, USA
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Abstract
Today health professionals are not only required to know medicine, but scientific reading, interpretation, and communication of new data. The new information about contraception and hormonal therapies must be analyzed by gynecologists to determine whether or not the new data are applicable to their patients and if it has an impact on their health. Recently a new study of hormonal contraceptives and the risk of breast cancer was published. In this study, the investigators found an elevation of the relative risk of breast cancers on the users versus the nonusers of hormonal contraception. After analyzing the publication and other data available, it is our opinion that it is a very low increase of the risk and its impact should be evaluated case by case, not forgetting to take into account the numerous beneficial effects that hormonal contraception have.
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Affiliation(s)
- Patricio Barriga
- a School of Medicine , Finis Terrae University , Santiago , Chile
| | | | - Arnaldo Porcile
- c Faculty of Medicine , Universidad de Chile , Santiago , Chile
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Sufa B, Abebe G, Cheneke W. Dyslipidemia and associated factors among women using hormonal contraceptives in Harar town, Eastern Ethiopia. BMC Res Notes 2019; 12:120. [PMID: 30832721 PMCID: PMC6399905 DOI: 10.1186/s13104-019-4148-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Dyslipidemia is abnormal amount of lipid in blood. Hormonal contraceptives affect lipid metabolism and can enhance the risk of vascular disease like atherosclerosis. In Harar, among contraceptive users, biochemical changes follow up is almost none and magnitude of dyslipidemia is not known. Therefore this study is designed to determine prevalence of dyslipidemia and its predisposing factors. Accordingly, cross-sectional study was conducted from April to June 2014 among hormonal contraceptive users from three health centers and one hospital. Socio-demographic data, anthropometric measurements, and blood biochemical tests were performed for every participant. Descriptive statistics and logistic regression analysis with 95% confidence interval using SPSS was used. RESULT Totally 365 participants were included and the prevalence of dyslipidemia was 34.8%. The mean levels ± standard deviation of total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), the total cholesterol to HDL ratio, and triglyceride were 186 ± 27 mg/dl, 121 ± 31 mg/dl, 45.21 ± 7.7 mg/dl, 4.44, and 108 ± 3.45 mg/dl, respectively. Age, fasting blood sugar, drinking coffee twice and eating no vegetables 4 times/week were identified as predictors of dyslipidemia. In conclusion, hormonal contraceptive users of Harar have high rate of dyslipidemia. This result emphasizes the urgent need for a public health strategy for prevention, early detection, and treatment of dyslipidemia.
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Affiliation(s)
- Berhanu Sufa
- Department of Medical Laboratory Science, Harar Health Science College, Harar, Ethiopia
| | - Gemeda Abebe
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Waqtola Cheneke
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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47
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Lambat Emery S, Kalovidouri A, David-Montefiore E. Recurrent Mondor's breast disease -- Hormonal contraceptive involvement. Breast Dis 2019; 38:31-33. [PMID: 30530952 DOI: 10.3233/bd-180346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mondor's disease can be a challenging diagnosis. The case we present is of a 29 year-old Brazilian woman, under combined hormonal contraception, who consulted for a painful lump on her right breast. She presented a complete resolution after a local treatment of heparinoid cream and a non-steroidal anti-inflammatory oral treatment, but relapsed 18 months later. Oral combined hormonal contraception was the only "risk factor" found, in this case, and the modification of the latter helped resolve the relapse clinical symptoms.
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Affiliation(s)
- S Lambat Emery
- Department of Gynecology, Geneva University hospitals (HUG), Switzerland
| | - A Kalovidouri
- Department of Radiology, Geneva University hospitals (HUG), Switzerland
| | - E David-Montefiore
- Department of Gynecology, Geneva University hospitals (HUG), Switzerland
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48
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Havlín M. Hormonal contraception used by adolescents and the risk of thromboembolic disease. Cas Lek Cesk 2018; 157:358-362. [PMID: 30650980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article summarizes the basic options for contraceptive security of adolescent girls, including benefits and risks of hormonal contraception. It also draws attention to the broader social context of unwanted pregnancies in this age group. Points out the main aspects of the care for young people and the most common health problems influencing use of contraceptives. Second part deals in detail with pathogenesis of thromboembolic disease and analyzes the major risk factors for its occurrence. It discusses the relationship between thrombophilic mutations to hormonal treatment and presents prescribing recommendations for risk groups of women. This text mainly underlines that the emergence of thromboembolism is multifactorial. Keywords: adolescent girl, unwanted pregnancy, hormonal contraception, risk factors of thromboembolism, prescribing recommendations.
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49
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Bernier M, Jonville-Bera AP. [Drug and food interactions with contraceptives: CNGOF Contraception Guidelines]. Gynecol Obstet Fertil Senol 2018; 46:786-791. [PMID: 30385357 DOI: 10.1016/j.gofs.2018.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The risk of drug interaction with hormonal contraceptives should be anticipated as it may lead to unplanned pregnancies. These are frequently reported with some drugs, such as antiepileptics, and with some contraceptive methods, such as the implant, not always understood by patients as hormonal contraception. OBJECTIVES The aim of this work was to review all drugs and foods at risk of interaction with contraceptives. METHODS The official recommendations established by the French Agency for the safety of medicinal products have been taken into account, supported by a review of the literature. RESULTS There is a risk of drug-drug interaction with all hormonal contraceptives regardless of their route of administration. Most interactions lead to a decrease in the effectiveness of hormonal contraceptives. If an enzyme inducer drug is started in a woman with an hormonal contraception, it is recommended, if the treatment is short, to use an additional mechanical contraception (barrier method) for the duration of the treatment and the cycle following its arrest and if the treatment is long, it is recommended to choose a non-hormonal contraceptive method. On the contrary, some drugs may increase ethinylestradiol levels and potentially the risk of complications. Exceptionally, it is the hormonal contraceptive that will alter the pharmacokinetics of another drug, for example, lamotrigine. CONCLUSIONS The risk of drug interaction leading to a decrease in the contraceptive effectiveness needs to be known to prescribers in order to be taken into account when prescribing any new drug in a woman with hormonal contraception (and whatever its route of administration).
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Affiliation(s)
- M Bernier
- Centre régional de pharmacovigilance, hôpital de Cimiez, CHU de Nice, 4, avenue Victoria, BP 1179, 06003 Nice cedex 1, France
| | - A-P Jonville-Bera
- Centre régional de pharmacovigilance Centre-Val de Loire, CHRU de Tours, 37044 Tours cedex, France.
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50
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Robin G, Plouvier P, Delesalle AS, Rolland AL. [Effectiveness and use of hormonal contraceptives (except for intrauterine devices): CNGOF Contraception Guidelines]. ACTA ACUST UNITED AC 2018; 46:845-857. [PMID: 30413374 DOI: 10.1016/j.gofs.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/20/2022]
Abstract
Hormonal contraceptives remain among the most popular methods used by women. The purpose of this work is to review the effectiveness and use of these different methods. In addition, some side-effects are feared and/or frequently reported by users of hormonal contraceptives: unscheduled bleeding, acne, catamenial migraines, weight gain, libido and/or mood disorders. In this review of the literature, the accountability of hormonal contraceptives for the occurrence of some of these side-effects was discussed and a management strategy was proposed.
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Affiliation(s)
- G Robin
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
| | - P Plouvier
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; Service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - A-S Delesalle
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; Service de gynécologie-obstétrique, centre hospitalier régional de Saint-Omer, route de Blendecques, 62570 Helfaut, France
| | - A-L Rolland
- Service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France; Service de gynécologie-obstétrique, maternité de Beaumont, 80, rue de Beaumont, 59100 Roubaix, France
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