The effects of oral versus intravaginal hormonal contraception on the vaginal epithelium

Abstract

OBJECTIVE: Features of the vaginal epithelium and local immune response play an important role in HIV receptivity. Potentially modifiable local factors that might influence the risk of vaginal transmission of HIV infection include the thickness of the vaginal epithelium and the distribution of specific immune cell types. Our objective was to determine the impact of combination hormonal contraception administered orally or vaginally on the thickness and Langerhan cell populations of the vaginal epithelium.DESIGN: Randomized, single blind pilot studyMATERIALS AND METHODS: Sexually active, reproductive-aged women with no recent hormonal exposure were randomized to receive either the vaginal ring (R) (120mcg etonogestrel/15mcg ethinyl estradiol (EE)) or an oral contraceptive pill (P) (150mcg desogestrel/ 30mcg EE) for six 28-day cycles. Punch biopsies of the vaginal fornicies were obtained prior to initiation of hormonal contraception (V1) and repeated after three (V2) and six months (V3) of hormonal exposure. Specimens were fixed in formalin and paraffin-embedded. Serial 3um sections were cut for hematoxylin and eosin staining and for immunohistochemistry. Mucosal thickness and Langerhan cell number were compared using independent and paired T tests.RESULTS: A total of 14 subjects (7 R, 7 P) were randomized and had an initial biopsy. Of these, 10 (5 R, 5 P) returned for a biopsy at during the 3rd cycle, and 6 (2 R, 4 P) during the 6th cycle. While the initial mucosal thickness did not differ between groups 185μM Ring and Patch), it tended to be maintained (210μM V1, 175μM V2) in Ring users, but declined slightly in Pill users (160μM V1, 150μM V2); these differences were not significant within or between groups. Langerhan cell populations were similar across all comparisons.CONCLUSIONS: Use of a vaginal ring contraceptive may maintain vaginal mucosal thickness better than oral contraceptives, but there is no impact on Langerhan cell population. OBJECTIVE: Features of the vaginal epithelium and local immune response play an important role in HIV receptivity. Potentially modifiable local factors that might influence the risk of vaginal transmission of HIV infection include the thickness of the vaginal epithelium and the distribution of specific immune cell types. Our objective was to determine the impact of combination hormonal contraception administered orally or vaginally on the thickness and Langerhan cell populations of the vaginal epithelium. DESIGN: Randomized, single blind pilot study MATERIALS AND METHODS: Sexually active, reproductive-aged women with no recent hormonal exposure were randomized to receive either the vaginal ring (R) (120mcg etonogestrel/15mcg ethinyl estradiol (EE)) or an oral contraceptive pill (P) (150mcg desogestrel/ 30mcg EE) for six 28-day cycles. Punch biopsies of the vaginal fornicies were obtained prior to initiation of hormonal contraception (V1) and repeated after three (V2) and six months (V3) of hormonal exposure. Specimens were fixed in formalin and paraffin-embedded. Serial 3um sections were cut for hematoxylin and eosin staining and for immunohistochemistry. Mucosal thickness and Langerhan cell number were compared using independent and paired T tests. RESULTS: A total of 14 subjects (7 R, 7 P) were randomized and had an initial biopsy. Of these, 10 (5 R, 5 P) returned for a biopsy at during the 3rd cycle, and 6 (2 R, 4 P) during the 6th cycle. While the initial mucosal thickness did not differ between groups 185μM Ring and Patch), it tended to be maintained (210μM V1, 175μM V2) in Ring users, but declined slightly in Pill users (160μM V1, 150μM V2); these differences were not significant within or between groups. Langerhan cell populations were similar across all comparisons. CONCLUSIONS: Use of a vaginal ring contraceptive may maintain vaginal mucosal thickness better than oral contraceptives, but there is no impact on Langerhan cell population.