Longitudinal assessment of coagulation potential before, during, and following an in vitro fertilization cycle

INTRODUCTION

The association between estrogen and hypercoagulability is well-established but little is known about coagulation dynamics during IVF. Our goal was to measure coagulation potential prior to, during, and following an IVF cycle and to investigate differences by conception outcome.

MATERIALS AND METHODS

Patients undergoing IVF with fresh embryo transfer at a single academic center using oral contraceptive pills for cycle batching underwent evaluation of thrombin generation using the calibrated automated thrombogram at multiple points during the IVF cycle. Multiple thrombin generation parameters were compared across timepoints and by IVF cycle outcome using ANOVA repeated measures analysis.

RESULTS

Of the 17 patients included, 11 conceived. There was a significant increase in peak and total thrombin generation in the entire cohort between the pre-treatment natural follicular phase and following a short course of oral contraceptive pills used for cycle batching. Further increase in these parameters was seen at the time of oocyte retrieval. In the pre-treatment natural follicular phase, patients who conceived had lower peak thrombin generation. There were changes throughout the cycle for factors II, V, VIII, X, XI, XII, antithrombin, and tissue factor pathway inhibitor. Only Factor XI was distinguishable by conception status; values were lower at all visits in patients who conceived.

CONCLUSION

Increases in coagulation potential are seen in patients undergoing IVF following a short course of oral contraceptive pills for cycle batching and continue during controlled ovarian hyperstimulation. Those who conceived were seen to have lower peak thrombin generation in the pre-treatment natural follicular phase.

Cerebral venous sinus thrombosis due to desogestrel intake in a young lady: A case report

Cerebral Venous Sinus Thrombosis (CVST) is a subtype of venous thromboembolism, which occurs in the dural venous sinuses. Blockage of the venous drainage of the brain leads to the development of hemorrhages. Strokes can hence develop in any individual, irrespective of age or sex. CVST is a very serious condition requiring immediate thrombolysis to prevent residual neurological deficits. We report the case of a lady aged 25 years, who presented to the emergency department with a severe diffuse headache for 4 days, associated with vomiting. This was followed by multiple episodes of seizures and altered sensorium the previous day. She had been taking desogestrel for the past 2 months. On examination, the patient was unconscious and febrile (102.8 F). On admission, Glasgow Coma Scale score of E2V2M3 and bilateral extensor plantar response were noted. Signs of meningeal irritation were absent. Her pupils were mid-dilated, sluggishly reactive to light, and papilledema was present bilaterally. Based on imaging studies, she was diagnosed with a case of CVST. Her homocysteine levels were elevated. She recovered on appropriate treatment and was discharged on Ryle's feeding tube after 26 days of hospital stay with a Glasgow Coma Scale score of E4V5M6 and a flexor plantar response. The case emphasizes the need to rule out CVST in young adult females on oral contraceptive pills (OCP) presenting with severe neurological dysfunction. Vigilant screening, clinical suspicion and timely management can help cut down the associated mortality and morbidity in such cases.

Gap in knowledge of health benefits and risks of combined oral contraceptives among Lebanese women

BACKGROUND

Oral Contraceptive Pills (OCPs) are among the most commonly used forms of contraception, but they are associated with several health benefits and risks. This study aims to determine the gap in knowledge of the underlying health benefits and risks of OCPs among Lebanese women and to identify the factors that might influence their beliefs.

METHODS

A questionnaire was completed by 817 Lebanese women aged 18-64 years old and assessed sociodemographic details, medical information, contraceptive practices, knowledge of underlying health benefits and risks, and information needs related to OCPs.

RESULTS

Among the total participants, 41.5% of women reported using OCPs at some point in their lives yet 46.6% denied receiving information about their benefits and 48% denied receiving information about their risks. The mean total OCP knowledge score was 5.70 out of 25, the mean OCP risk knowledge score was 4.09 out of 15, and the mean OCP benefit knowledge score was 0.77 out of 6. Sociodemographic factors associated with greater total knowledge, risk knowledge and benefit knowledge included OCP usage, being a student, confidence in one's knowledge and satisfaction with one's information. Both the total and risk knowledge scores were found to be higher in women who found that receiving information related to OCPs was important. Finally, participants who lived in central governates had greater total knowledge scores, whereas those with higher levels of education and a family history of endometrial cancer demonstrated better benefit knowledge.

CONCLUSIONS

This study highlighted the poor knowledge of health benefits and risks associated with OCP use among Lebanese women and the associated sociodemographic factors that might influence their beliefs.

Painful bruising: Gynecology, hematology, or just pill bias? A case report

A 23-year-old woman, G0, presented to the emergency department with painful bruising of the legs shortly after starting an oral contraceptive pill. The presumed diagnosis was pill-induced ecchymosis, and she was instructed to discontinue the medication. Her bruising resolved. However, the working diagnosis was later questioned as the patient had used other oral contraceptive pills in the past without any adverse reaction. In addition, there is robust literature associating these medications with thrombosis, not bruising. The patient later disclosed that she had concomitantly started an oral hair supplement along with her oral contraceptive pill. Analysis of the supplement contents revealed that it contained extract of Aesculus hippocastanum, a herbal anticoagulant, making this a much more plausible explanation for the ecchymosis. She then resumed the original oral contraceptive pill alone without any reaction. The case highlights how cognitive bias resulted in a misdiagnosis. Specifically, this case introduces the concept of pill bias, as the patient's unexplained bruising was presumed to be a result of her use of an oral contraceptive despite the lack of evidence to support this claim. This bias has the potential to impact clinical decision-making and lead to clinical errors.

Oral contraceptive pills shortage in Lebanon amidst the economic collapse: a nationwide exploratory study

BACKGROUND

The political instability, economic crisis, and devaluation of the national currency left Lebanese females suffering from a scarcity of oral contraceptive pills (OCPs). Therefore, we aimed to identify the incidence of OCPs shortage in Lebanon and its impact on women's sexual and reproductive health, as well as physical and psychological well-being.

METHODS

Community pharmacies were selected randomly across Lebanon, using a stratified sampling approach, where female clients asking for OCPs were interviewed using a standardized data collection form.

RESULTS

A total of 440 females were interviewed. More than three-quarters of the participants (76.4%) reported not finding their preferred OCPs brands, almost 40% were affected by the increased prices, and 28.4% declared stockpiling OCPs. More than half of the participants using OCPs for pregnancy prevention reported adopting alternative traditional contraceptive methods (55.3%). Unplanned pregnancy was reported by 9.5% of participants, where 75% of them disclosed intentional abortion while the remaining (25%) reported experiencing a spontaneous miscarriage. Other consequences of OCPs shortage included mood disturbances (52.3%), dysregulation of menses (49.7%), dysmenorrhea (21.1%), weight gain (19.6%), acne (15.7%), and hirsutism (12.5%). Of the participants taking OCPs for birth control, 48.6% reported a reduced frequency of sexual intercourse, which led to conflicts with their partners (46%) and a decreased libido (26.7%).

CONCLUSIONS

OCPs shortage has seriously and negatively exposed women to various undesirable consequences including unplanned pregnancy and dysregulation of menses. Therefore, there is an urgent need to bring the attention of healthcare authorities to support the national pharmaceutical industry in manufacturing affordable OCPs generics to meet women's reproductive health demands.

Menstrual Management Choices in Transgender and Gender Diverse Adolescents

PURPOSE

Transgender and gender diverse patients who are assigned female at birth may request menstrual management to alleviate an increased dysphoria due to menses. The objective of this study is to describe the initiation and use over time of menstrual management methods (MMMs) in transgender and gender diverse adolescents.

METHODS

A retrospective chart review was conducted of patients in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, identified as transgender or gender diverse, and had achieved menarche. A descriptive statistical analysis was performed.

RESULTS

Of 133 patients, 119 (90%) identified as transgender male, 11 (8%) as gender nonbinary, and 3 (2%) as another gender identity. Mean age was 15 (standard deviation 1.6) years. Only 12 (9%) patients had ever been sexually active. During the study period, 48 (36%) used gender-affirming testosterone. At the initial visit, 114 (86%) patients were not using an MMM. Of 80 patients who initiated a new MMM, 3 (4%) chose continuous oral contraceptive pills, 65 (83%) used norethindrone acetate (NETA), and 9 (11%) planned levonorgestrel intrauterine device (IUD) insertion. At 1 year, 56 patients were using NETA and 20 had an IUD in place.

DISCUSSION

This study provides data on MMM choice in transgender and gender diverse adolescents using these methods almost exclusively for menstrual management and not contraception. Although few patients were using an MMM at baseline, most opted to start a method when given the opportunity. The most common methods were NETA or an levonorgestrel IUD.

Age, female sex, and oral contraceptive use are risk factors for anterior cruciate ligament reconstruction: A nationwide database study

BACKGROUND

The purpose of this study was to investigate risk factors affecting anterior cruciate ligament (ACL) tears and outcomes following ACL reconstruction in males versus females. This study also analyzed oral contraceptive pill (OCP) use, demographics (e.g., body mass index [BMI], age group), comorbidities (e.g., diabetes, hypertension), and post-operative systemic complications (e.g., anemia, malignant hyperthermia) in patients undergoing ACL reconstruction.

METHODS

Medical records of patients undergoing ACL reconstruction from 2010-2018 were queried from the PearlDiver administrative claims database current procedural terminology (CPT) and international classification of disease (ICD) codes. The following information was collected using ICD-9/ICD-10 codes: concurrent use of OCPs, concomitant meniscus repair, demographics, age, comorbidities, and systemic complications. The number of ACL reconstructions in females and males were analyzed using multivariate regressions.

RESULTS

Of 11,498 ACL reconstructions, 5,967 (51.9%) were in females and 5,531 (48.1%) were in males. The majority of patients were ages 15-19 (24.1%) and were not obese (BMI < 30 kg/m²) (35.9%). A greater proportion of female patients undergoing ACL reconstruction were between 15-19 years old (P < 0.001) and obese (BMI > 40 kg/m²) (P < 0.001). A larger proportion of females aged 15-39 taking OCPs underwent ACL reconstruction compared to those not taking OCPs within the same age group (P < 0.001).

CONCLUSION

ACL tears are more common in female patients compared to males and are more commonly treated with ACL reconstruction. This study identified several factors that may be associated with the increased risk of ACL tears in females, including young age (age 15-39), obesity (BMI > 40 kg/m²), and the use of OCPs prior to ACL reconstruction, which warrant further investigation and attention from surgeons.

The effect of oral contraceptive use on cortisol reactivity to the Trier Social Stress Test: A meta-analysis

BACKGROUND

Some research suggests that oral contraceptive pills (OCPs) blunt the cortisol stress response, thus OCP users are often excluded from stress research. The current study examined changes in salivary cortisol among females taking OCPs and naturally cycling (NC) females after exposure to the Trier Social Stress Test (TSST).

METHODS

The literature search included the terms "oral contraceptives" OR "oral contraception" OR "birth control" OR "birth control pill" AND "Trier Social Stress Test" OR "TSST" AND "cortisol" OR "salivary cortisol." A total of 14 studies with 36 independent samples were included in the meta-analysis. Participant information, including pre- and post- TSST measures of salivary cortisol, and subgroup (i.e., OCP or menstrual cycle phase), were extracted. Additional study characteristics including age, length of stressor, type of OCP, time of day the cortisol samples were collected, and type of cortisol assay used were also considered.

RESULTS

Findings from the current meta-analysis indicated that changes in salivary cortisol in NC participants following the TSST, D = 4.31, SE = 0.53, 95% CI = 3.27, 5.35, were greater than the changes observed in participants on OCPs D = 1.50, SE = 0.30, 95% CI = 0.91, 2.09. Study effects were heterogeneous, Fisher's Z = 10.87, Q = 620.57, p = < 0.001. Between-phase analyses were also conducted.

CONCLUSIONS

Results demonstrate that OCPs blunt cortisol reactivity relative to NC females. There was significant heterogeneity, except between OCP and follicular phase groups. Implications for research design and methodology are discussed.

Obliterative Portal Venopathy Caused by Oral Contraceptive Pills: A Case Report

Oral contraceptive pills (OCPs) have a known prothrombotic effect. Obliterative portal venopathy (OPV) can be seen in patients with underlying hypercoagulability. We present a case of a 19-year-old female patient taking OCPs who presented with obstructive jaundice. Her main concern was pruritis. An extensive workup was done to reach a diagnosis but it came back negative. A liver biopsy showed OPV. This was thought secondary to her OCP use. Her OCPs were discontinued which resulted in a complete resolution of her symptoms and laboratory abnormalities. Cases with a direct relationship between OPV and OCP use are extremely rare. More studies are required to establish a correlation between OPV and OCPs. OPV should be considered in the differential diagnosis among patients with obstructive jaundice without an obvious cause, especially in patients taking OCPs. Treatment is stopping the OCPs with close follow-up to confirm disease resolution.

Acute pulmonary embolism in a patient with mild COVID-19 symptoms: a case report

Background

The venous thromboembolism (VTE) is a frequent condition, which may worsen the prognosis of hospitalized COVID-19 patients. Nevertheless, the incidence of this complication is unknown in patients with mild COVID-19 symptoms.

Case summary

A 26-year-old female nurse, who had been taking oral contraceptive pills (OCPs) treatment for the last 2 years, developed mild COVID-19 symptoms (rhinitis and anosmia). She underwent isolation at home and was subsequently followed up with telehealth visits. Fifteen days after her initial presentation, she developed acute onset sudden dyspnoea. On physical examination, she was found to be tachycardic with normal pulse oximetry. The initial risk score for VTE was moderate and laboratory results showed increased D-dimer level without other relevant findings. Computed tomography pulmonary angiography was performed, which confirmed low-risk subsegmental pulmonary embolism.

Discussion

Venous thromboembolism in patients who present with severe COVID-19 symptoms has already been described in the literature; its incidence is greater in patients hospitalized in intensive care units. Efforts to prevent VTE based on risk scores are widely recognized. However, the relationship in patients who present with mild COVID-19 symptoms and VTE is still unknown. Recently, experts on this field have introduced thromboprophylaxis guidelines including ambulatory patients based on the severity of COVID-19 symptoms and pro-thrombotic risk. Our patient showed no major risk for developing VTE; therefore, the VTE could be associated with SARS-CoV-2 infection or the eventual pro-thrombotic association with the concomitant use of OCPs.

Oral contraceptive use and premenstrual syndrome among sexually active female university students in Cameroon

Introduction

premenstrual syndrome (PMS) is a prevalent health problem affecting women of reproductive age and some young women use oral contraceptive pills (OCPs) to prevent unwanted pregnancy. However, the association between OCP use and the experience of symptoms of PMS has not been studied in Cameroon. We examined the association between the use of OCPs and PMS among female university students in Cameroon.

Methods

we used data extracted from a larger study on sexual and reproductive health that was conducted between July and August 2018 among female university students at the University of Yaoundé 1, Cameroon. A pre-tested, validated and paper-based self-administered questionnaire was used to collect data. We extracted data (demographic and health characteristics, contraceptive use and experience of PMS) for the 424 sexually active students who participated in the larger study. We used Poisson regression analysis to examine the association between OCP use and PMS and conducted stratified analysis to determine effect modification. The level of statistical significance was set at p≤0.05.

Results

the median age of the 424 sexually active female university students was 23 years (IQR=21-25). About 77.8% of participants self-reported to have experienced symptoms of PMS prior to their last menstrual period. The most commonly reported symptoms of PMS were breast tenderness (55.7%), acne/pimples (39.2%) and abdominal pain (31.1%). After adjusting for confounders in multivariate analysis, we found a statistically significant relationship between the use of OCPs and experience of symptoms of PMS. Current OCP users had a slightly increased risk (PR=1.21; 95%CI, 1.09-1.32, p<0.001) of developing symptoms of PMS compared to non-pill users. We found that age modified the effect of this association. Among older students (≥25 years), the direction of the effect was strongly positive and statistically significant (APR=1.32; 95%CI, 1.12-1.56, p=0.001).

Conclusion

the proportion of female university students who reported to have experienced symptoms of PMS prior to their last menstrual period was high. The use of OCPs was positively associated with the risk of developing symptoms of PMS and this relationship was modified by age. Further studies in Cameroon and other sub-Saharan African countries are required to understand this relationship.

The impacts of pill contraceptive low-dose on plasma levels of nitric oxide, homocysteine, and lipid profiles in the exposed vs. non exposed women: as the risk factor for cardiovascular diseases

Background

Consuming oral contraceptive pills is one of the methods for preventing pregnancy worldwide. As using the pills has always caused the greatest concern for the likelihood of developing cardiovascular diseases and also given the limited conducted studies in this regard, this study was carried out to determine the impacts of low dose birth control pills on plasma levels of nitric oxide, homocysteine, and lipid profiles in the exposed vs. non exposed women as the risk factors for cardiovascular diseases.

Methods

This was a combined cohort study conducted on 100 women, having the age range 20–35 years and normal menstrual cycles, referred to the health care centers in Yazd, Iran. The demographic data were obtained through face to face interviews performed by the researcher. Anthropometric indexes were measured and biochemical factors were determined by testing blood samples. Then, using SPSS 16 and statistical independent t-test and Chi- square, the data were analyzed.

Results

The mean ± standard deviations of plasma levels of homocysteine, nitric oxide, cholesterol, triglyceride, Low Density Lipoprotein, and High Density Lipoprotein levels in the group consumed low dose contraceptive pills were 3.84 ± 2.35 μmol/l, 181.36 ± 90.44 μM, 180.7 ± 38.28 mg/dl, 129.82 ± 47.92 mg/ dl, 101.42 ± 30.66 mg/dl, and 56.46 ± 8.42 mg/dl, There were significant statistical differences between those consuming the pills and those not consuming the pills regarding cholesterol (P < 0.05).

Conclusion

Consuming Low Dose contraceptive pills can increase the plasma levels of cholesterol, triglyceride, and Low Density Lipoprotein levels; i.e. this condition is called dyslipidemia. On the other hand, there were no changes in the levels of homocysteine and nitric oxide in the healthy women consuming the pills; therefore, the pills may not develop cardiovascular diseases in healthy women. Accordingly, it is recommended that the health care providers prescribe the pills for the women with cautions.

Oral contraceptives provide protection against anterior cruciate ligament tears: a national database study of 165,748 female patients

Objective: Anterior cruciate ligament (ACL) tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears.Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15-49. Female experiencing an ACL tear and undergoing surgery (CPT 29,888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Chi-squared testing was used to assess for significant differences in the rate of ACL reconstruction for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years.Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There was a total of 569 (0.69%) ACL reconstructions in the non-OCP group and 465 (0.56%) in the OCP group (p< 0.001). In the non-OCP group, patients aged 15-19 accounted for 29.35% of all ACL reconstructions, whereas, in the OCP group, this same age group only accounted for 13.33%. Among all age groups, the odds ratios for experiencing an ACL reconstruction while on OCP was 0.82 (χ² = 0.001, 95% CI 0.72-0.92) compared to not using OCP. This protective effect was driven primarily by the 15-19 age group (odds ratio 0.37 (χ² < 0.001, 95% CI 0.27-0.50)). The number need to treat for OCP usage in the 15-19 age group was six patients.Conclusions: OCPs have a protective effect on ACL tear, especially in the 15-19 age group, which exhibited a 63% reduction in the rate of tear. Consideration should be given to prescribing OCPs to younger athletes, after careful assessment of the risks of these commonly prescribed medications.Level of evidence: III.

Does oral contraceptives pretreatment affect the pregnancy outcome in polycystic ovary syndrome women undergoing ART with GnRH agonist protocol?

This study aims to investigate whether oral contraceptive pills (OCP) pretreatment impairs pregnancy outcomes in polycystic ovary syndrome (PCOS) women undergoing GnRH agonist protocol. A total of 1025 couples underwent their first cycle of in vitro fertilization. Patients were divided into GnRH agonist protocol group (LP group) and OCP dual suppression GnRH agonist protocol group (OC-LP group). Logistic regressions were performed to estimate the risk factors affecting live birth following fresh embryo transfer between groups. Frozen-thawed embryos from the first oocyte retrieval cycle were replaced into uterus for women did not get live birth. Cumulative live birth rates between groups were compared by Kaplan-Meier survival analysis. Serum luteinizing hormone level, endometrial thickness, and live birth rate were significantly reduced in the OC-LP group in fresh cycle. Thinner endometrium, higher progesterone, and poorer embryo quality were independent risk factors for failure in getting live birth following fresh embryo transfer. However, cumulative live birth rate, medium embryo transfer attempts required to achieve live birth were comparable between groups. OCP pretreatment in GnRH agonist protocol does not seem to impair the pregnancy outcome when calculated by cumulative live birth rate in PCOS women.

[Contraception for adolescent : CNGOF Contraception guidelines]

OBJECTIVE

The goal is to establish dialogue and determine the needs and skill levels of adolescence. This concerns sexuality, the prevention of STIs, the informed choice of contraception to avoid an unplanned pregnancy. MéTHODES: A systematic review based on literature about contraception AND teenagers was performed using Pubmed, Cochrane, national and international recommendations.

RESULTS

The surveillance of the teenager contraception must integrate more specifically: global health with a stability of weight and corpulence, a sufficient calcium intake, the prevention of the sexually transmitted infections (STIs) and the vaccination against HPV. The 1st consultations with adolescent girls are an essential moment for dialogue in order to develop sexuality education. Main themes are: prevention of STIs with the use of condoms, detection of situations of precariousness or sexual abuse, and finally adherence to treatment to avoid unplanned pregnancy. Use of condoms associated with regular contraception is essential to assure a barrier against sexually transmitted infections (STIs) (NP1). To preserve the patient confidentiality, the patient is received alone (Grade B). She must be reassured about respect of anonymity and availability of free treatment. Clinical examination collects weight, height, BMI and blood pressure (Grade C). It is important to give them the choice of contraceptive method and provide objective information on the different contraceptive methods (NP2). If there are any contraindications, when the first prescription is a pill, it must be a 1st or 2nd generation pill with levonorgestrel. For some experts, it would be important to prescribe a pill at 30μg EE for better efficacy in case of forgetfulness in very young patients and for the good maintenance of bone mineralization (NP4). Information on long-acting reversible contraceptives, or LARCs, is essential. These contraceptive methods have proved their efficacy and their place in the first intention. (NP1).

CONCLUSION

Prescribing contraception to a teenage girl requires the adaptation of the best treatment to her needs to prevent an unwanted pregnancy. This requires good information on prevention of STIs and on different methods of contraception in a confidence climate.

Family planning provision in pharmacies and drug shops: an urgent prescription

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning (FP) services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of FP services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops. To integrate this setting that provides convenience, confidentiality, access to user-controlled contraceptive methods (i.e., pills, condoms and potentially Sayana Press®) and a gateway to clinic-based FP services, we propose three promising practices that should be encouraged in future interventions to increase access to quality FP services.

Misreporting of contraceptive hormone use in clinical research participants

Objective

Researchers traditionally rely on participant self-report for contraceptive use. We hypothesized that self-reported contraceptive use by clinical research participants may disagree with objectively measured hormonal status.

Study design

We enrolled women in Harare, Zimbabwe, aged 18–34, who by self-report had not used hormonal or intrauterine contraception for >30 days, or depot medroxyprogesterone acetate for >10 months, into a study designed to assess biologic changes with contraceptive initiation and use. Blood samples obtained at enrollment and each follow-up visit (N=1630 from 447 participants) were evaluated by mass spectrometry for exogenous hormones. We individually interviewed a subset of participants (n=20) with discrepant self-reported and measured serum hormones to better understand nondisclosure of contraceptive use.

Results

Discrepant with self-reported nonuse of hormonal contraception, synthetic progestogens were detectable in 120/447 (27%, 95% confidence interval 23%–31%) enrolled women. Measured exogenous hormones consistent with use of contraceptive pills (n=102), injectables (n=20) and implants (n=3) were detected at enrollment, with 7 women likely using >1 contraceptive. In-depth interviews revealed that participants understood the requirement to be hormone free at enrollment (100%). Most (85%) cited partner noncooperation with condoms/withdrawal and/or pregnancy concerns as major reasons for nondisclosed contraceptive use. All interviewed women (100%) cited access to health care as a primary motivation for study participation. Of participants who accurately reported nonuse of hormonal contraception at enrollment, 41/327 (12.5%) had objective evidence of nonstudy progestin use at follow-up that disagreed with self-reported nonuse.

Conclusions

Women joining contraceptive research studies may misrepresent their use of nonstudy contraceptive hormones at baseline and follow-up. Objective measures of hormone use are needed to ensure that study population exposures are accurately categorized.

Implications statement

Among Zimbabwean women participating in a contraceptive research study, 27% had objective evidence of use of nonstudy contraceptives at enrollment that disagreed with self-report. Studies that rely on self-report to identify contraceptive hormone exposure could suffer from significant misclassification.

Hormonal contraception and the development of autoimmunity: A review of the literature

Estrogens and progestins are known to have profound effects on the immune system and may modulate the susceptibility to autoimmune diseases. A comprehensive literature search was carried out using PubMed for any of 153 autoimmune disease terms and the terms contraception, contraceptive, or their chemical components with limits of Humans + Title or Abstract. Over 1,800 titles were returned and scanned, 352 papers retrieved and reviewed in depth and an additional 70 papers retrieved from the bibliographies. Based on this review, substantial evidence exists linking the use of combined oral contraceptives to a lower incidence of hyperthyroidism, an increase in multiple sclerosis, ulcerative colitis, Crohn's disease, Systemic Lupus Erythematosus, and interstitial cystitis. Progesterone only contraceptives are linked to progesterone dermatitis and in one large developing world concurrent cohort study are associated with increases in arthropathies and related disorders, eczema and contact dermatitis, pruritis and related conditions, alopecia, acne, and urticaria. Hormonal contraceptives modulate the immune system and may influence the susceptibility to autoimmune diseases with significant increases in risk for several autoimmune diseases.

SUMMARY

Hormonal contraceptives (HCs), such as the "pill," Norplant, and vaginal rings, are very potent hormones that have effects on the immune system, which is made up of white blood cells and lymph nodes and normally defends the body against invading bacteria, viruses and parasites. This review looked at the association of HC use to the development of autoimmune diseases, where the immune system turns against the body and causes damage to organs. There is good evidence that HC use is associated with an increased risk of several serious autoimmune diseases such as Crohn's disease (which causes inflammation of the bowels), Lupus (which causes inflammation in many organs), and interstitial cystitis (which causes inflammation in the bladder). Several other rarer autoimmune diseases are also linked to HC use. People contemplating the use of HCs should be informed of these risks.

Does the Oral Contraceptive Pill Increase Plasma Intercellular Adhesion Molecule-1, Monocyte Chemoattractant Protein-1, and Tumor Necrosis Factor-α Levels in Women with Polycystic Ovary Syndrome: A Pilot Study

STUDY OBJECTIVE

Polycystic ovary syndrome (PCOS), the most common endocrinopathy of women, is a state of chronic low-grade inflammation and is closely linked to type 2 diabetes mellitus and cardiovascular disease. Oral contraceptive pills (OCPs), is the usual first choice of treatment in women with PCOS. Because OCP use has been linked to the risk of venous thrombosis and there are limited data on the effect of OCP use on the inflammatory state of women with PCOS, our objective was to compare the levels of intercellular adhesion molecule (ICAM)-1, tumor necrosis factor (TNF)-α, and monocyte chemoattractant protein (MCP)-1 between drug-naive and OCP-treated women with PCOS. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Consequent to women diagnosed with PCOS on the basis of Rotterdam 2003 criteria, either treated with OCPs (ethinylestradiol 0.03 mg, levonogestrel-0.15 mg) for a period of 6 months (n = 50) or drug-naive (n = 51) were enrolled in this cross-sectional study.

RESULTS

The mean ages of patients and control participants were comparable (21.99 ± 4.78 vs 21.92 ± 5.83 years; P = .947) as was body mass index (24.47 ± 3.92 vs 23.66 ± 3.43; P = .271). Clinical and androgen excess symptoms were significantly better in the OCP group compared with the drug-naive group (P = .01, P = .04). Total cholesterol and low-density lipoprotein cholesterol levels were significantly higher in the OCP group (P = .01). Plasma ICAM-1 levels, TNF-α levels, and MCP-1 levels showed a higher trend in patients but reached statistical significance only in cases of ICAM-1 and TNF-α (P = .01).

CONCLUSION

OCP treatment of 6 months increases plasma ICAM-1, MCP-1, and TNF-α levels among women with PCOS, although OCPs significantly help in ameliorating features of hyperandrogenism and regularizing menstrual cycles. These cytokines correlate positively with many metabolic parameters including plasma glucose, lipids, and homeostatic model assessment-insulin resistance. Further investigation with well designed, randomized, longitudinal studies might help to ascertain the effect of OCPs on proinflammatory profiles among women with PCOS.

High-risk sexual behaviors while on depot medroxyprogesterone acetate as compared to oral contraception

Background

Depot medroxyprogesterone acetate (DMPA) contraceptive use is associated with an increased risk for Chlamydia infection. However, prior studies inadequately account for potential differences in sexual behavior between users of DMPA and users of other contraceptive methods. In this study we compare sexual risk-taking behavior in women using DMPA to women using oral contraceptive pills (OCP) to assess risk of Chlamydia trachomatis infection.

Methods

In this cross-sectional study of 630 reproductive-aged women seeking routine gynecologic care (449 OCP and 181 DMPA users) sexual risk-taking was evaluated by use of the Safe Sex Behavior Questionnaire, a validated measure of sexual behaviors and attitudes. All women were screened for Chlamydia. Logistic regression estimated the association of contraceptive choice, sexual behaviors, and Chlamydia infection.

Results

Oral contraceptive pill users differed from DMPA users in age, race, marital status, education level, and pregnancy history (p-values all <0.05). Oral contraceptive pill users had used their method of contraception for longer average duration (p < 0.01) and reported greater frequency of condom use (p < 0.01). Eleven (2.5%) OCP and 2 (1.1%) DMPA users had Chlamydia (p = NS).

Conclusions

Oral contraceptive pill and DMPA users differed with respect to both demographic factors and frequency of condom use. Odds of current Chlamydia infection did not differ between OCP and DMPA users when controlling for sexual risk-taking or demographic factors, though due to low Chlamydia rates in our population, this study was underpowered to detect this difference.

Impact and mechanistic role of oral contraceptive pills on the number and epithelial type of ovarian cortical inclusion cysts; a clinicopathology and immunohistochemical study

Background

Ovarian epithelial cancers are among the most lethal women's cancers. There is no doubt about the preventive role of oral contraceptive pills (OCPs) in development of ovarian cancers. But, there are limited numbers of studies to address the effect of these agents on the number of cortical inclusion cysts (CICs), their epithelial type and suppression of the metaplastic phenomenon by these pills. The aim of this study was to clarify the role of these agents in the prevention of these cyst formation and tubal metaplasia and also examine the mesenchymal-epithelial transition theory in this context by immunohistochemical methods.

Methods

The representative section(s) of ovarian cortex from a total number of 201 consecutive total abdominal hysterectomy with bilateral or unilateral salpingo-oophorectomy specimens were examined for mean number of CICs and their epithelial type between two groups of the patients. Group A included the patients who were on oral contraceptive pills for more than 5 years. All of the subjects with other contraceptive methods or a history of less than 5 years contraceptive pills usage were stratified in group B. Sections from 20 cases in which more than five inclusion cysts were found, were selected for IHC staining with calretinine and PAX8 as markers for mesothelium and mullerian epithelium respectively.

Results

The mean age of the patients was 51.67 years with no significant differences between two groups. The mean number of cysts were 1.27 and 3.23 in group A and B respectively (P =0.0001). Similarly the mean number of CICs, lined by tubal epithelium, was significantly different between two groups (0.65 vs 2.65, P =0.0001). In IHC staining 123 out of 150 CICs (82 %) were PAX+ while only 7 CICs (4.8 %) showed positive reaction for calretinin irrespective of type of epithelium.

Conclusion

Our findings showed that the use of OCP for more than five years in women, significantly prevents development of cortical inclusion cysts in the ovaries which lined by tubal (PAX8 positive) type epithelium. These findings may explain the alternative mechanism of oral contraceptive pills or long time use of progesterone in suppression of tubal type overgrowth and subsequently prevention of ovarian epithelial cancers.

A Randomised Controlled Trial Comparing the Efficacy and Side-Effects of Intravaginal Ring (Nuvaring(®)) With Combined Oral Hormonal Preparation in Dysfunctional Uterine Bleeding

INTRODUCTION

Combined Oral Contraceptive (COC) pills are being used in patients of abnormal uterine bleeding, especially adolescents and reproductive age women considering their need for contraception. It decreases the blood loss due to haemostatic effect of estrogen and also regularizes the cycle. Intravaginal route has been found to be effective and acceptable; Gastrointestinal absorption and hepatic first-pass metabolism is avoided and steady, uniform blood concentration is achieved. Bioavailability of estrogen and progestogen through oral and vaginal route are same. The convenience of once-a-month administration is another major advantage.

MATERIALS AND MATHODS

Sixty women fulfilling inclusion criteria were randomised into 2 groups in 1:1 ratio. In one group (n=30), monthly insertion of Nuvaring(®)) was done for three consecutive months. Nuvaring(®) releases 15μg ethinyl estradiol and 120 μg etonogesterol daily. The other group (n=30) received COC pill containing 30μg EE and 150 μg levonorgestrel for three consecutive months. Primary outcome measures were change in menstrual cycle pattern and pictorial Blood Loss Assessment chart (PBAC) score. Other Parameters included side effects, change in haemoglobin and weight. Data was analyzed by statistical software SPSS 20.

RESULTS

Both Nuvaring(®) and COC were found to significantly decrease blood loss in each cycle. Decrease in PBAC score was more in Nuvaring(®) group compared to COC, however difference was not significant. Ideal bleed (IB) was frequently higher for Nuvaring(®) group than COC in all 3 cycles, although no statistically significant difference was observed between groups (p-value=0.286). Late withdrawl, intermenstural spotting was higher in COC group. Compliance was better and women were more satisfied in Nuvaring(®) group compared to COC group. Minor side effects like headache, mastalgia, nausea and mood changes were seen in both groups, which were not significant. Continuation rate was significantly higher in Nuvaring® group. 30% women discontinued treatment in OCP group after 3 month compare to 10% in Nuvaring(®) group.

CONCLUSION

Present study shows Nuvaring(®) to be as effective as COC in controlling heavy menstural bleed, better cycle control, with minor acceptable systemic side effects.

RETRACTED: Calcium versus oral contraceptive pills containing drospirenone for the treatment of mild to moderate premenstrual syndrome: a double blind randomized placebo controlled trial

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editorial Board for the following reason: This single-author publication which reports the conducting of a large 3-arm randomised controlled trial, with no missing data from 210 recruited patients, has been questioned as implausible. The authors have been unable to provide supporting documents to provide an explanation.

Effect of Oral Contraceptive Pills on the Blood Serum Enzymes and DNA Damage in Lymphocytes Among Users

The continuous use of synthetic hormones as contraceptive pill or hormonal replacement therapy among women is increasing day by day. The widespread use of different formulations as oral contraceptives by women throughout their reproductive cycle has given rise to a serious concern for studying the effects of oral contraceptives on enzymatic profile and DNA damage in peripheral blood lymphocytes among users. The present study was carried out on women taking oral contraceptives. The study was based on the questionnaire having the information of reproductive history, fasting, age, health, nature of menstrual cycle, bleeding and other disease. The profile of the blood serum enzymes i.e. alkaline phosphatase (ALP), gamma glutamyl transferase (GGT), lactate dehydrogenase (LDH), aminotransferases (SGOT and SGPT), serum proteins (albumin and globulin) and DNA damage in lymphocytes was studied among users and non-users. The results of the present study suggest that OCs not only effects enzymatic activity but also results in DNA damage that may vary with the duration of using oral contraceptives. A significant increase in LDH, GGT, SGPT, SGOT, globulin and decrease in ALP as well as albumin was found among users as compared to non-users. The observed DNA damage was more in users as compared to non-users. Hormonal contraceptives seem to exert DNA damage and also have significant effects on blood serum enzymes.

Oral and injectable contraceptive use and HIV acquisition risk among women in four African countries: a secondary analysis of data from a microbicide trial

OBJECTIVE

To assess the effect of oral and injectable contraceptive use compared to nonhormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial.

STUDY DESIGN

This is a prospective cohort study using data from women enrolled in HIV Prevention Trials Network protocol 035. At each quarterly visit, participants were interviewed about self-reported contraceptive use and sexual behaviors and underwent HIV testing. Cox proportional hazards regression was used to assess the effect of injectable and oral hormonal contraceptive use on HIV acquisition.

RESULTS

The analysis included 2830 participants, of whom 106 became HIV infected (4.07 per 100 person-years). At baseline, 1546 (51%) participants reported using injectable contraceptives and 595 (21%) reported using oral contraceptives. HIV incidence among injectable, oral and nonhormonal contraceptive method users was 4.72, 2.68 and 3.83 per 100 person-years, respectively. Injectable contraceptive use was associated with a nonstatistically significant increased risk of HIV acquisition [adjusted hazard ratio (aHR)=1.17; 95% confidence interval (CI) 0.70, 1.96], while oral contraceptive use was associated with a nonstatistically significant decreased risk of HIV acquisition (aHR=0.76; 95% CI 0.37,1.55).

CONCLUSION

In this secondary analysis of randomized trial data, a marginal, but nonstatistically significant, increase in HIV risk among women using injectable hormonal contraceptives was observed. No increased HIV risk was observed among women using oral contraceptives. Our findings support the World Health Organization's recommendation that women at high risk for acquiring HIV, including those using progestogen-only injectable contraception, should be strongly advised to always use condoms and other HIV prevention measures.

IMPLICATIONS

Among Southern African women participating in an HIV prevention trial, women using injectable hormonal contraceptives had a modest increased risk of HIV acquisition; however, this association was not statistically significant. Continued research on the relationship between widely used hormonal contraceptive methods and HIV acquisition is essential.

Impact of the federal contraceptive coverage guarantee on out-of-pocket payments for contraceptives: 2014 update

Background

The Affordable Care Act requires most private health plans to cover contraceptive methods, services and counseling, without any out-of-pocket costs to patients; that requirement took effect for millions of Americans in January 2013.

Study design

Data for this study come from a subset of the 1842 women aged 18–39 years who responded to all four waves of a national longitudinal survey. This analysis focuses on the 892 women who had private health insurance and who used a prescription contraceptive method during any of the four study periods. Women were asked about the amount they paid out of pocket in an average month for their method of choice.

Results

Between fall 2012 and spring 2014, the proportion of privately insured women paying zero dollars out of pocket for oral contraceptives increased substantially, from 15% to 67%. Similar changes occurred among privately insured women using injectable contraception, the vaginal ring and the intrauterine device.

Conclusions

The implementation of the federal contraceptive coverage requirement appears to have had a notable impact on the out-of-pocket costs paid by privately insured women, and that impact has increased over time.

Implications

This study measures the out-of-pocket costs for women with private insurance prior to the federal contraceptive coverage requirement and after it took effect; in doing so, it highlights areas of progress in eliminating these costs.

Changes in out-of-pocket payments for contraception by privately insured women during implementation of the federal contraceptive coverage requirement

BACKGROUND

As part of the Affordable Care Act, a federal requirement for private health plans to cover contraceptive methods, services and counseling, without any out-of-pocket costs to patients, took effect for millions of Americans in January 2013.

STUDY DESIGN

Data for this study come from a subset of the 3207 women aged 18-39 years who responded to two waves of a national longitudinal survey. This analysis focused on the 889 women who were using hormonal contraceptive methods in both the fall 2012 and spring 2013 waves and the 343 women who used the intrauterine device at either wave. Women were asked about the amount they paid out of pocket in an average month for their method of choice.

RESULTS

Between Wave 1 and Wave 2, the proportion of privately insured women paying zero dollars out of pocket for oral contraceptives increased substantially, from 15% to 40%; by contrast, there was no significant change among publicly insured or uninsured women (whose coverage was not affected by the new federal requirement). Similar changes were seen among privately insured women using the vaginal ring.

CONCLUSIONS

The initial implementation of the federal contraceptive coverage requirement appears to have had a notable impact on the out-of-pocket costs paid by privately insured women. Additional progress is likely as the requirement phases in to apply to more private plans, but with evidence that not all methods are being treated equally, policymakers should consider stepped-up oversight and enforcement of the provision.

IMPLICATIONS

This study measures the out-of-pocket costs for women with private, public and no insurance prior to the federal contraceptive coverage requirement and after it took effect; in doing so, it highlights areas of progress in eliminating these costs and areas that need further progress.

Hypertension in women

One in 4 adults has hypertension worldwide, which equates to approximately 1 billion individuals. Hypertension is a leading cause of death, and lowering blood pressure prevents mortality and morbidity in women and men. Although men have higher blood pressures compared with women at all ages, older women have a slightly higher prevalence of hypertension, and hypertension is more often uncontrolled in women. Hypertension associated with pregnancy and polycystic ovary syndrome is unique to women. Exogenous hormone administration in the form of oral contraceptives, and rarely postmenopausal hormone replacement, contributes to the burden of hypertension in women. Renovascular hypertension due to fibromuscular dysplasia is more common in women. Hypertension treatment should focus on lowering blood pressure and treating additional cardiovascular risk factors, and there is no evidence to support gender-specific approaches to lowering blood pressure and modifying cardiovascular risk.