Abstract
ObjectiveTo examine the association between hormonal contraception (HC) and bacterial vaginosis (BV) by systematic review and meta-analysis.MethodsMedline, Web of Science and Embase databases were searched to 24/1/13 and duplicate references removed. Inclusion criteria 1) >20 BV cases; 2) accepted BV diagnostic method; 3) measure of HC-use either as combined oestrogen-progesterone HC (combined), progesterone-only contraception (POC) or unspecified HC (u-HC); 4) ≥10% of women using HC; 5) analysis of the association between BV and HC-use presented; 6) appropriate control group. Data extracted included: type of HC, BV diagnostic method and outcome (prevalent, incident, recurrent), and geographical and clinic-setting. Meta-analyses were conducted to calculate pooled effect sizes (ES), stratified by HC-type and BV outcome. This systematic review is registered with PROSPERO (CRD42013003699).ResultsOf 1713 unique references identified, 502 full-text articles were assessed for eligibility and 55 studies met inclusion criteria. Hormonal contraceptive use was associated with a significant reduction in the odds of prevalent BV (pooled effect size by random-effects [reES] = 0.68, 95%CI0.63–0.73), and in the relative risk (RR) of incident (reES = 0.82, 95%CI:0.72–0.92), and recurrent (reES = 0.69, 95%CI:0.59–0.91) BV. When stratified by HC-type, combined-HC and POC were both associated with decreased prevalence of BV and risk of incident BV. In the pooled analysis of the effect of HC-use on the composite outcome of prevalent/incident/recurrent BV, HC-use was associated with a reduced risk of any BV (reES = 0.78, 95%CI:0.74–0.82).ConclusionHC-use was associated with a significantly reduced risk of BV. This negative association was robust and present regardless of HC-type and evident across all three BV outcome measures. When stratified by HC-type, combined-HC and POC were both individually associated with a reduction in the prevalence and incidence of BV. This meta-analysis provides compelling evidence that HC-use influences a woman’s risk of BV, with important implications for clinicians and researchers in the field.
Highlights
Bacterial Vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women, of unknown, but probable polymicrobial aetiology
Studies in which there was no analysis of the association between BV and hormonal contraception (HC)-use presented in the manuscript were excluded
There were 2566 studies identified from initial searches of Medline (n = 878), Web of Science (n = 997) and Embase (n = 697), 14 additional articles were identified by searching reference lists, and one of our own articles that was in press at the time of database searching was included
Summary
Bacterial Vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women, of unknown, but probable polymicrobial aetiology. A number of observational studies have reported that women using hormonal contraceptives have a reduced risk of prevalent [12,13,14,15] and recurrent [10,16,17] BV. With over 50% of women experiencing BV recurrence following first-line antibiotic therapies, and no significant improvement in the management of BV in the last 20 years, identifying potential modifiable practices that influence susceptibility to BV and recurrence are integral to progressing prevention and management approaches for this important and common genital tract condition. This systematic review and meta-analysis examines available data on the association between hormonal contraception (HC) use, specific types of HC-use and the outcomes of prevalent, incident and recurrent BV
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