Contraceptive use among women with inflammatory bowel disease: An updated systematic review.

Contraceptive use among women with inflammatory bowel disease: A systematic review

Contraceptive Conundrum: Use of Hormonal Contraceptives Is Associated With an Increased Risk of Suicide Attempt and Suicide.

Behavioral Correlates of Biologic Maturity of the Cervix in Adolescents

Oral contraceptives and cervical cancer.

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

To evaluate the effect of oral and injectable hormonal contraception on the risk of HIV acquisition among women in South Africa and Zimbabwe. Secondary data analysis of 4913 sexually active women aged 18-49 years followed for up to 24 months in the Methods for Improving Reproductive Health in Africa (MIRA) phase III effectiveness trial of the diaphragm and lubricant gel for HIV prevention. Participants were interviewed quarterly about contraception and sexual behavior and were tested for pregnancy, HIV, and other sexually transmitted infections. We used a Cox proportional hazards marginal structural model, weighted by the inverse probability of hormonal contraception use, to compare the risk of HIV acquisition among nonpregnant women reporting use of combined oral contraceptive pills (COC), progestin-only pills (POP), and/or injectable hormonal contraception to women not using these methods. During the study, 283 participants seroconverted. Use of oral contraceptives (POP or COC) was not associated with HIV risk [adjusted hazard ratio (HRa) = 0.86, 95% confidence interval (CI) 0.32, 1.78]. Injectable hormonal contraception was associated with a small nonsignificant risk of HIV infection (HR(a) = 1.34, 95% CI 0.75, 2.37). The effect of injectable hormonal contraception was similar in the unweighted site-adjusted only (HR(a) = 1.32, 95% CI 1.00, 1.74) and baseline factor adjusted models (HR(a) = 1.27, 95% CI 0.94, 1.72). In this study, oral contraceptives were not associated with HIV acquisition. There is substantial uncertainty in the effect of injectable hormonal contraception on HIV risk. These findings underscore the importance of dual protection with condoms and the need for diverse contraceptive options for women at risk of HIV infection.

Hormonal contraception after use of ulipristal acetate as emergency contraception: A systematic review.

Scientific background A large proportion of women of reproductive age in Germany use various methods of pregnancy prevention (contraception), among them various hormone-based methods. Hormonal contraceptives may be divided into combined estrogen-progestogen contraceptives (pills, skin patches, vaginal rings), progestogen-only contraceptives (pills, injections, implants, hormone spirals) and emergency contraceptives. Research questions The evaluation addressed the question of benefits and risks of hormonal contraceptives, their economic effects as well as their ethical-social and legal implications. Methods A systematic literature search was conducted in April 2006 starting from 2000. The evaluation is primarily based on systematic reviews. Results In perfect use, all hormonal contraceptives excluding emergency contraceptives proved to be the most effective reversible contraceptive methods (rate of unintended pregnancies 0.05% to 0.3%). However, the typical use of oral contraceptives, injections, skin patches, and vaginal rings, which also considers possible application errors, showed a lower contraceptive efficacy (rate of unintended pregnancies 3% to 8%). It was lower than that of copper spirals. The risk of venous thromboembolism increased three to six times in users of hormonal contraceptives, the risks of stroke and myocardial infarction two to three times. The risk declined after discontinuation of use. The effects were estrogen-dose and progestogen-type dependent. The use of hormonal contraceptives showed a relative risk of ovarian and endometrial carcinomas of approximately 0.5 or 0.7, of breast and cervical cancer of approximately 1.2 or 1.6. The effect remained several years after discontinuation of use. The results concerning hepatocellular carcinoma suggested a carcinogenic effect. In women with acne, an improvement due to use of hormonal contraceptives was proven. Cervical chlamydial infections were more frequent in users of hormonal contraception. Headache appeared mostly only at the beginning of the use of combined oral contraceptives. Progestogen-only contraceptives worsened the results of the glucose tolerance test. A review of low evidence reported further risks of hormonal contraceptives (concerning menstrual problems, ovarian cysts, bone density, thyroid diseases and rheumatoid arthritis) as well as further benefits (concerning blood pressure and Crohn’s disease). Hormonal spirals were shown to be more effective than spirals which do not release hormones. In emergency contraception, Levonorgestrel was more effective than the Yuzpe method. Most other proven differences between hormonal contraceptives were related to menstrual problems. After spirals with or without hormone release, the other hormonal contraceptives were shown in typical use to be the second most cost-effective reversible methods of contraception. Discussion The addressed questions could be answered only on relatively low evidence level, partly only for applications with estrogen doses which are not used in Germany any more. The transferability of the results of the analysed primary health-economics studies on the current situation in Germany is limited (clinical assumptions from out-dated information sources of low evidence levels, cost assumptions from the American health system). Conclusions In perfect use, hormonal contraceptives have to be classified as the most effective reversible contraceptive methods. For the individual decision concerning the use of hormonal contraception, benefits should be related to the additional risks. Alternative methods such as spirals should be prioritised if perfect use seems to be impossible. In this case, spirals are also preferable from health-economics perspective. No ethical-social or legal conclusions can be derived from the available data.

Importance: Since the 1960s, an increase in the use of oral contraceptives (OC) and other hormonal contraceptives has mirrored a decreased incidence of ovarian and endometrial cancers in the US. With improved access and increased contraceptive options over time, it is important to follow trends of use and consider how changing patterns can affect gynecologic cancer risks. Objective: To evaluate trends in OC use and intrauterine device (IUD) use among reproductive aged women in the US. Methods: Nationally representative data from the National Health and Nutrition Examination Survey (NHANES, N=19,216) and the National Survey for Family Growth (NSFG, N=26,262) were used to determine current OC and IUD use among reproductive aged women in the US. Women with prior hysterectomy, bilateral oophorectomy or that were post-menopausal were excluded due to ineligibility for standard OCs. Adjusted logistic regression and unadjusted Joinpoint models (to determine inflection points) were used to evaluated trends in contraceptive use between 1999-2017. We used questionnaire data from continuous NHANES and NSFG cycles from 1999/2000 to 2015/16 and 2006/08 to 2015/17, respectively. Within each survey, temporal trends in OC use were assessed overall and by race, age, gravidity, education and BMI. OC formulation/generation were determined from current prescriptions in NHANES. Trends in IUD use were evaluated in NSFG. Results: Since 1999, self-reported OC use overall decreased annually by 3% in NHANES [OR 0.97 (95%CI 0.96, 0.99) P=0.001] and 4% in NSFG [0.96 (0.94, 0.97) P<0.001]. Annual percent change estimates from unadjusted joinpoint regression also suggested consistent decreases over time. Proportion of OC use by generation of progestin across all cycles was stable with an average of 42.3% 3rd generation, 31.3% 1st, 17.0% 2nd, and 9.5% 4th (the latter was limited to cycles from 2003/04 to 2015/16). Decreases in OC use over time did not vary by categories of race, age, education or BMI. However, trends in OC use varied significantly by gravidity in NHANES (Phet=0.05). OC use for nulligravid women was stable over time, while reported OC use decreased 4% annually in gravid women [OR 0.96 (0.94-0.98) P<0.001]. IUD use increased by 14% each year [OR 1.14 (1.11, 1.17) P<0.001]; 76.5% of users reported hormonal IUD use in the 2015/17 cycle. The largest uptake of IUD use (32% increase per year [OR 1.32 (1.21, 1.43) P<0.001]) occurred among nulligravid women, which was historically, a contraindication for IUD use. Conclusions: IUD use is increasing at a rate faster than that of the decreasing rate of OC use. There is some suggestion that like OC use, IUD use also reduces ovarian and endometrial cancer risks, although associations with hormonal IUDs are less clear. As such, the changing landscape of contraceptive practices in the US may alter future trends in ovarian and endometrial cancers and thus requires further surveillance. Citation Format: Lauren A. King, Kara A. Michels, Barry I. Graubard, Britton Trabert. Trends in oral contraceptive and intrauterine device use among reproductive aged women in the US from 1999-2017 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5760.

Objetivo: Identificar na literatura as evidências científicas sobre os eventos adversos, oriundos do uso de anticoncepcional hormonal oral por mulheres. Método: Revisão integrativa de literatura, tendo como fonte de pesquisa as bases de dados Periódico da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, da Biblioteca Virtual em Saúde, PUBMED e Google Acadêmico, usando os descritores de busca “anticoncepcionais orais” AND “eventos adversos”. Com essa busca foram encontradas inicialmente 202 publicações. Após realizar seleção foram incluídos 17 artigos científicos na revisão. Os textos foram submetidos a análise de conteúdo semântica. Resultados: Foram levantadas três categorias: o uso de anticoncepcionais orais: aspectos clínicos e teóricos; associação entre o uso de anticoncepcionais orais e os eventos trombóticos; relação entre o uso de anticoncepcionais orais, neoplasias e doenças cardiovasculares. Conclusão: Contribuirá para que enfermeiros orientem as mulheres na escolha do método de anticoncepção, levando em consideração as possíveis complicações decorrentes do uso prolongado dos anticoncepcionais orais hormonais composto de estrogênio.Descritores: Anticoncepcionais Orais; Saúde Reprodutiva; Saúde Sexual; Saúde da Mulher.Evidence of adverse effects on oral hormonal contraceptive use in women: integrative reviewObjective: To identify in the literature the scientific evidence on adverse events arising from the use of oral hormonal contraceptives in women. Method: Integrative literature review, using the databases of the Virtual Health Library and the Journal of the Coordination for the Improvement of Higher Education Personnel as a research source, using the search keywords “oral contraceptives” AND “adverse events”. With this search, 202 publications were initially found, after making a selection, 17 scientific articles were included in the review. The texts were submitted to semantic content analysis. Results: Three categories were raised: the use of oral contraceptives: clinical and theoretical aspects; association between the use of oral contraceptives and thrombotic events; relationship between the use of oral contraceptives, neoplasms and cardiovascular diseases. Conclusion: It will help nurses to guide women in choosing the contraceptive method, taking into account the possible complications resulting from the prolonged use of hormonal oral contraceptives composed of estrogen.Descriptors: Oral Contraceptives; Reproductive Health; Sexual Health; Women's Health.Evidencia de efectos adversos sobre el uso de anticonceptivos hormonales orales en mujeres: revisión integradoraObjetivo: Identificar en la literatura la evidencia científica sobre eventos adversos derivados del uso de anticonceptivos hormonales orales en mujeres. Método: Revisión integral de la literatura, utilizando las bases de datos de la Biblioteca Virtual de Salud y la Revista de Coordinación para la Mejora del Personal de Educación Superior como fuente de investigación, utilizando las palabras clave de búsqueda "anticonceptivos orales" Y "eventos adversos". Con esta búsqueda, inicialmente se encontraron 202 publicaciones, luego de hacer una selección, se incluyeron 17 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon tres categorías: el uso de anticonceptivos orales: aspectos clínicos y teóricos; asociación entre el uso de anticonceptivos orales y eventos trombóticos; relación entre el uso de anticonceptivos orales, neoplasias y enfermedades cardiovasculares. Conclusión: Ayudará a las enfermeras a guiar a las mujeres a elegir el método anticonceptivo, teniendo en cuenta las posibles complicaciones derivadas del uso prolongado de anticonceptivos orales hormonales compuestos de estrógenos.Descriptores: Anticonceptivos Orales; Salud Reproductiva; Salud Sexual; Salud de la Mujer.

Background:Female patients are more likely than male patients to experience various musculoskeletal (MSK) injuries. Because MSK tissues are sensitive to the female hormones relaxin, estrogen, and progesterone, studies have examined whether hormonal contraceptives, which change female hormone levels, can alter the female MSK injury risk. These studies have reached contradictory conclusions, leaving unclear the influence of hormonal contraception on female MSK injury risk.Hypothesis:Hormonal contraceptives act to decrease female soft tissue injury risk and soft tissue laxity.Study Design:Systematic review; Level of evidence, 3.Methods:Reviewers searched for clinically relevant studies evaluating the relationship between hormonal contraceptive use and soft tissue injuries, soft tissue laxity, muscle injuries, and muscle strength in the PubMed, Cochrane, Scopus, CINAHL, and Embase databases. Studies meeting inclusion criteria were scored by 2 independent researchers for risk of bias, imprecision, inconsistency, and indirectness with a template designed using the British Medical Journal Clinical Evidence GRADE (Grades of Recommendation Assessment, Development and Evaluation) scoring system and GRADEPro guidelines. Scores were uploaded into the GRADEPro scoring system software, which calculated each study’s final GRADE score (very low, low, moderate, or high quality).Results:A total of 29 studies met inclusion criteria. Of the 7 studies evaluating oral contraceptive (OC) use and soft tissue injury risk, only 2 received a high quality-of-evidence score; all other studies received a very low score. The high-quality studies concluded that OC use decreases anterior cruciate ligament (ACL) injury risk. Only 1 of the 10 studies evaluating OC use and soft tissue laxity was found to have a high quality of evidence; this study determined that OC use decreases ACL laxity.Conclusion:Higher quality studies suggest that OCs decrease a female patient’s risk of ACL injuries and ACL laxity. The strength of these findings, however, is weak. Female patients are up to 8 times more likely to tear their ACLs than male patients. OCs may serve a therapeutic role in decreasing the sex disparity in ACL injury rates.

Prospective Clinical Trials Designed to Assess the Use of Hormonal Contraceptives and Risk of HIV Acquisition

Oral contraceptives are known to influence the risk of cancers of the female reproductive system. Evidence regarding the relationship between injectable contraceptives and these cancers is limited, especially in black South Africans, among whom injectable contraceptives are used more commonly than oral contraceptives. We analysed data from a South African hospital-based case-control study of black females aged 18-79 y, comparing self-reported contraceptive use in patients with breast (n = 1,664), cervical (n = 2,182), ovarian (n = 182), and endometrial (n = 182) cancer, with self-reported contraceptive use in 1,492 control patients diagnosed with cancers with no known relationship to hormonal contraceptive use. We adjusted for potential confounding factors, including age, calendar year of diagnosis, education, smoking, alcohol, parity/age at first birth, and number of sexual partners. Among controls, 26% had used injectable and 20% had used oral contraceptives. For current and more recent users versus never users of oral or injectable contraceptives, the odds ratios (ORs) for breast cancer were significantly increased in users of oral and/or injectable contraceptives (OR 1.66, 95% CI 1.28-2.16, p<0.001) and separately among those exclusively using oral (1.57, 1.03-2.40, p = 0.04) and exclusively using injectable (OR 1.83, 1.31-2.55, p<0.001) contraceptives; corresponding ORs for cervical cancer were 1.38 (1.08-1.77, p = 0.01), 1.01 (0.66-1.56, p = 0.96), and 1.58 (1.16-2.15, p = 0.004). There was no significant increase in breast or cervical cancer risk among women ceasing hormonal contraceptive use ≥10 y previously (p = 0.3 and p = 0.9, respectively). For durations of use ≥5 y versus never use, the ORs of ovarian cancer were 0.60 (0.36-0.99, p = 0.04) for oral and/or injectable contraceptive use and 0.07 (0.01-0.49, p = 0.008) for injectable use exclusively; corresponding ORs for endometrial cancer were 0.44 (0.22-0.86, p = 0.02) and 0.36 (0.11-1.26, p = 0.1). In this study, use of oral and of injectable hormonal contraceptives was associated with a transiently increased risk of breast and cervical cancer and, for long durations of use, with a reduced risk of ovarian and endometrial cancer. The observed effects of injectable and of oral contraceptives on cancer risk in this study did not appear to differ substantially.