Combined Oral Contraceptive Pill Research Articles

Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial

ObjectivesTo evaluate the clinical effectiveness of long acting progestogens compared with the combined oral contraceptive pill in preventing recurrence of endometriosis related pain.DesignThe PRE-EMPT (preventing recurrence of endometriosis) pragmatic, parallel...

Double bad luck: pulmonary embolism and vaginal bleeding - a case report

BackgroundPulmonary embolism is a common and potentially fatal condition. Exogenous estrogens in contraceptives are associated with an increased risk of venous thrombo-embolism. However, discontinuation of a combined oral contraceptive can lead to severe withdrawal bleeding in an anticoagulated patient.Case presentationWe report a case of a 47-year-old female who presented to the emergency room with a two-day history of worsening shortness of breath and chest pain. Her chronic medication included a combined oral contraceptive pill. Transthoracic echocardiogram showed pulmonary hypertension and right ventricular dilatation. Computerized tomography scan revealed bilateral pulmonary embolism. She received thrombolysis with alteplase and was started on rivaroxaban. Five days after discharge, however, she was readmitted with severe vaginal bleeding.Discussion and conclusionWe describe a case of submassive pulmonary embolism, treated with thrombolysis and anticoagulation, who developed severe vaginal bleeding after stopping the contraceptive pill. This case highlights the importance of detailed menstrual history taking when initiating anticoagulation in women. Discontinuation of oral contraceptives, while important in reducing the risk of recurrent thrombosis, could be postponed until the end of the recommended course of anticoagulation and until a safe alternative form of contraception has been established, if required.

Use of combined oral contraceptive pills in women with and without PCOS: A longitudinal population-based cohort study

Use of combined oral contraceptive pills in women with and without PCOS: A longitudinal population-based cohort study

Abstract PS10-01: Hormonal Contraception and Breast Cancer Risk for Carriers of Germline Pathogenic Variants in BRCA1 and BRCA2

Abstract BACKGROUND: Current use of hormonal contraception is associated with a 20-30% relative increase in the risk of breast cancer (BC) for women in the general population compared with never using. Longer duration of use is associated with higher risk, and the risk remains elevated above that of never users for at least 5 years after cessation. Most published data are for various formulations of the combined oral contraceptive pill, but associations are similar for progestogen-only contraceptives, including intrauterine devices. For women in the general population who use hormonal contraceptives in their 20s and 30s, when baseline BC risk for most women is low, these increased relative risks translate into only small increases in absolute risk. It is unclear whether use of hormonal contraceptives increases BC risk for women carrying a germline BRCA1 or BRCA2 pathogenic variant (PV). These women are at markedly higher risk of early-onset BC, so even slightly increased relative risks could translate to important increases in their absolute risk of BC. This study assessed the association between use of any hormonal contraception and BC risk for BRCA1 and BRCA2 PV carriers using individual participant data from four prospective cohorts. METHODS: Data from females born after 1920 with a PV in BRCA1 or BRCA2 and no history of cancer or bilateral mastectomy at cohort entry were analyzed. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for BC (invasive disease or ductal carcinoma in situ) associated with use of hormonal contraceptives for at least 1 year, with age as the timescale, entry at cohort enrolment, and censoring at the earlier of bilateral mastectomy, death, diagnosis of another cancer or last follow-up. Analyses were adjusted for study, birth cohort, first-degree family history of BC, parity, premenopausal bilateral oophorectomy and menopausal status. Current use of hormonal contraceptives was defined as use within the previous year, to account for cessation of use due to BC symptoms or clinical investigation. RESULTS: Of 3,882 BRCA1 and 1,509 BRCA2 PV carriers, 53% and 71%, respectively had ever used hormonal contraceptives (for at least one year). The median cumulative duration of hormonal contraceptive use was 4.8 and 5.7 years, respectively. Overall, 488 BRCA1 and 191 BRCA2 PV carriers developed incident BC during a median of 5.9 and 5.6 years of follow-up, respectively. For BRCA1 PV carriers, use of hormonal contraceptives for at least 1 year was associated with increased BC risk (HR [95% CI]: 1.29 [1.04-1.60] p=0.019). BC risk increased with longer cumulative duration of hormonal contraceptive use (HR [95% CI]: 1.13 [0.88-1.45] p=0.35, 1.48 [1.11-1.96] p=0.007 and 1.56 [1.13-2.17] p=0.007 for 1-5, 6-10 and >10 years of use, respectively), with an estimated proportional increase in risk of 3% (1%-5%, p=0.002) for each additional year of use. For BRCA2 PV carriers, there was no evidence that current or past use, or cumulative duration of use, were associated with increased risk of BC, but confidence intervals on the HRs were wide. CONCLUSION: Hormonal contraceptive use is associated with an increased risk of BC for women carrying PVs in BRCA1 and risk increases with cumulative duration of use. Hormonal contraceptives are an important healthcare option for women; they provide excellent contraceptive efficacy and reduce risks of ovarian and endometrial cancer. Decisions about use of hormonal contraceptives in women at increased risk for BC due to BRCA1 PVs need to carefully weigh the risks and benefits; while shorter-term use may result in only small increases, prolonged cumulative use may result in larger increases in absolute BC risk that may not be acceptable to some women. Citation Format: Kelly-Anne Phillips, Joanne Kotsopoulos, Susan Domchek, James Chamberlain, Julie Bassett, Amber Aeilts, Irene Andrulis, Saundra Buys, Wanda Cui, Mary Daly, Andrea Eisen, William Foulkes, Michael Friedlander, Jacek Gronwald, John Hopper, Esther John, Beth Karlan, Raymond Kim, Jan Lubiński, Kelly Metcalfe, Katherine Nathanson, Christian F. Singer, Heather Symecko, Nadine Tung, Steven Narod, Mary Beth Terry, Roger Milne. Hormonal Contraception and Breast Cancer Risk for Carriers of Germline Pathogenic Variants in BRCA1 and BRCA2 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS10-01.

Combined estrogen-progestin oral contraceptives and female sexuality: an updated review.

Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options. The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability. A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health. Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time. Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.

Ovarian Cancer Risk-Reduction and Screening in BRCA1/2 Mutation Carriers.

Objective: To determine the utilization of risk-reducing strategies and screening protocols for ovarian cancer in female BRCA1/2 carriers. Methods: This study was a sub-analysis of female participants from a larger multicenter, cross-sectional survey of BRCA1/2 mutation carriers unaffected by cancer. The questionnaire was administered electronically via email at four institutions located in the northeast United States. Data were analyzed with Fisher's exact test. Results: The survey was completed by 104 female BRCA mutation carriers. BRCA subtypes included 54.3% BRCA2, 41.0% BRCA1, and 2.9% both. The age at which patients underwent genetic testing varied 21.2% were 18-24 years, 25.0% were 25-34 years, 29.8% were 35-44 years, and 24.0% were 45 years or older. Nearly, all respondents (97.1%) reported that a provider had discussed risk-reducing surgeries. Of the 79 females who underwent genetic testing before 45 years of age, 53.2% reported that a health care provider recommended taking combined oral contraceptive pills (COCs) to reduce their risk of ovarian cancer, and, of these women, 88.1% chose to use them. COCs were offered at higher rates among women who were younger at the age of genetic testing (18-24: 86%, 25-34: 62%, 35-44: 23%; p < 0.0001). Approximately half (55.8%) of the respondents reported having been offered increased screening for possible early detection of ovarian cancer, of which 81.0% chose to undergo screening. The majority utilized a combination of transvaginal ultrasound and serum CA125 measurements. There were no differences observed in screening utilization based on BRCA mutation type. Conclusion: In our cohort of female BRCA mutation carriers, risk-reducing surgery was offered to almost all women, whereas only half were offered risk-reducing medication and/or increased screening. Further investigation is needed to identify barriers to the utilization of risk-reducing strategies among this high-risk population.

Anti-obesity pharmacological agents for polycystic ovary syndrome: A systematic review and meta-analysis to inform the 2023 international evidence-based guideline.

This systematic review and meta-analysis evaluated the efficacy of anti-obesity agents for hormonal, reproductive, metabolic, and psychological outcomes in polycystic ovary syndrome (PCOS) to inform the 2023 update of the International Evidence-based Guideline on PCOS. We searched Medline, EMBASE, PsycInfo, and CINAHL until July 2022 with a 10-year limit to focus on newer agents. Eleven trials (545 and 451 participants in intervention and control arms respectively, 12 comparisons) were included. On descriptive analyses, most agents improved anthropometric outcomes; liraglutide, semaglutide and orlistat appeared superior to placebo for anthropometric outcomes. Meta-analyses were possible for two comparisons (exenatide vs. metformin and orlistat + combined oral contraceptive pill [COCP] vs. COCP alone). On meta-analysis, no differences were identified between exenatide versus metformin for anthropometric, biochemical hyperandrogenism, and metabolic outcomes, other than lower fasting blood glucose more with metformin than exenatide (MD: 0.10mmol/L, CI 0.02-0.17, I2= 18%, 2 trials). Orlistat + COCP did not improve metabolic outcomes compared with COCP alone (fasting insulin MD: -8.65 pmol/L, -33.55 to 16.26, I2= 67%, 2 trials). Published data examining the effects of anti-obesity agents in women with PCOS are very limited. The role of these agents in PCOS should be a high priority for future research.

Utility of Individualised Homoeopathic Medicine in Treatment of Polycystic Ovarian Syndrome - A Case Series

Introduction: Polycystic ovarian syndrome (PCOS) is one the most common endocrinological pathology of female reproductive organs especially in reproductive age group. According to WHO currently 8-13% females are suffering from PCOS worldwide while, 70% of the cases remain undiagnosed. The seriousness of the disease is attributed to it for being a leading cause of female infertility due to anovulation. The comprehensive effect of hyperandrogenism and menstrual irregularities leads to adverse psychological consequences in a female’s life. Its conventional treatment includes diet management, combined-oral contraceptive pills (OCPs), dexamethasone, metformin etc. which may have side-effects like increased weight, nausea, vomiting, thrombosis and many more. Alternative medicine like Homoeopathic treatment with Individualised and holistic approach can provide a gentle management for PCOS. This article contains a series of four cases showing successful treatment of PCOS and emphasizes its effectiveness as a potential alternative to present conventional medicines available for PCOS. Conclusion: Homoeopathic treatment was given with Individualised medicines which were selected exclusively in each case. This treated PCOS in a gentle and short frame of time in all four cases. The medicines prescribed were Pulsatilla nigricans in two cases, Sabina and Folliculinum in other two cases respectively. Since incidences of PCOS is increasing day-by-day such evidence-based medicinal studies need to be conducted to elaborate scope of Homoeopathic treatment in polycystic ovarian disease.

Premenstrual Syndrome's Impact on Work-Related Quality of Life Among Jordanian Nurses.

Introduction Premenstrual syndrome (PMS) is a regular clinical condition that affects most women during their reproductive years. Its related symptoms may be linked to a decrease in women's quality of life. Female nurses may be more susceptible to PMS due to the demanding nature of their job. The importance of nurses' jobs and how their quality of life will affect patients and themselves in parallel make female nurses a population that is worth investigating. Our objective is to estimate the level of PMS among Jordanian nurses and assess the potential impact of PMS on work-related quality of life among them. Methods A cross-sectional study was conducted on 210 nurses who completed a questionnaire regarding demographic data, menstrual characteristics, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality-of-Life Scale (WRQoL). The nurses were classified as having or not having PMS according to the PSST. Results The prevalence of PMS was 60.5%, the results showed a significantly lower mean WRQoL score for nurses with PMS (mean = 65.47, SD = 15.38) compared to nurses without PMS (mean = 70.54, SD = 14.47). The multivariable regression model revealed that the adjusted odds ratios for age, combined oral contraceptive pill (COCP) use, family history, severe dysmenorrhea, job and career satisfaction, and stress at work were 0.90 (95% CI = 0.84, 0.96), 5.18 (95% CI = 1.33, 20.17), 2.52 (95% CI = 1.23, 5.18), 11.78 (95% CI = 2.48, 56.02), 0.92 (95% CI = 0.85, 0.99), and 1.20 (95% CI = 1.01, 1.42), respectively. Conclusion PMS is quite prevalent among Jordanian nurses, with a negative impact on their work-related quality of life. Healthcare managers might implement special regulations for female nurses with PMS to improve their work-related quality of life. This research suggests that PMS is a substantial factor in the low work-related quality of life among Jordanian nurses.

Guidelines of care for the management of acne vulgaris

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9years or older. The objective of this study was to provide evidence-based recommendations for the management of acne. A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Analysis is based on the best available evidence at the time of the systematic review. These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Hormonal contraceptive use is associated with altered bone structural and metabolic responses to military training in women: An observational cohort study

Military training increases tibial density and size. Female sex hormones may influence the adaption of bone to loading, but it is unknown if women using different hormonal contraceptives adapt similarly to military training. One hundred and sixteen women (57 women not using hormonal contraceptives [non-users], 38 combined oral contraceptive pill [COCP] users, 21 depot medroxyprogesterone acetate [DMPA] users) completed this study. Tibial volumetric bone mineral density (vBMD) and geometry were measured by peripheral quantitative computed tomography (4 %, 14 %, 38 %, and 66 % sites) at the start (week 1) and end (week 14) of British Army basic training. Circulating markers of bone and calcium metabolism were measured at weeks 1, 2, 4, 6, 10, and 14. Training increased trabecular vBMD at the 4 % site, periosteal perimeter at the 14 % and 66 % sites, and total area, cortical area, cortical thickness, and bone strength at all sites (0.1 to 1.6 %, p ≤ 0.009), with no differences between hormonal contraceptive groups (p ≥ 0.127). Trabecular vBMD increased at the 14 % site in non-users (0.8 %, p = 0.005), but not in COCP or DMPA users (p ≥ 0.205). Periosteal perimeter increased at the 38 % site in COCP (0.4 %, p < 0.001) and DMPA (0.5 %, p < 0.001) users, but not in non-users (p = 0.058). Training had no effect on periosteal perimeter at the 4 % site or cortical vBMD or endosteal perimeter at any site (p ≥ 0.168). βCTX decreased and PINP increased during training with no difference between hormonal contraceptive groups. Training increased iPTH in non-users, but not COCP or DMPA users. Hormonal contraceptives may exert site-specific effects on the mechanobiology of bone, with higher endogenous oestradiol promoting trabecularisation and inhibiting periosteal expansion in non-users compared with hormonal contraceptive users.

Reproductive health among women living with HIV attending Melbourne Sexual Health Centre for HIV care from February 2019 to February 2020.

Women living with HIV are a minority population with unique care needs. Rates of unintended pregnancy are higher among women living with HIV versus HIV negative women. However, uptake of contraception among women living with HIV including long-acting-reversible contraceptives (LARCs) remains low. This quality improvement project aimed to identify gaps in reproductive healthcare for women living with HIV attending Melbourne Sexual Health Centre (MSHC). We performed a retrospective review of women living with HIV attending MSHC for HIV care February 2019-February 2020. Women aged over 45years were excluded. Primary outcomes included proportion using contraception, methods used and whether a sexual or reproductive health history had been taken in the past year. A total of 100 women were included, predominantly born overseas (Asia, 38%; sub-Saharan Africa, 34%). Of these, 5% were pregnant, 16% were trying to conceive and 1% were undergoing elective oocyte preservation. Of the remaining 74 women, 48.6% were using any form of contraception, including 17.6% women using less-effective methods (withdrawal and condoms), 6.8% using the combined oral contraceptive pill, 18.9% using LARCs and 5.4% using permanent methods. Sexual activity status was documented for 61% women, 1% declined to answer and not documented for 38% women. Rate of contraceptive use in this study was lower than previously reported among women living with HIV in Australia; however, our findings suggest contraceptive methods may be changing in light of undetectable equals untransmittable and increased fertility desires. Discussions regarding sexual activity and reproductive health were limited. Mechanisms to increase clinician-patient discourse regarding these important issues should be explored.

Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition.

The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.

Potassium levels in women with polycystic ovary syndrome using spironolactone for long-term.

Spironolactone (SPL) has been used to manage hyperandrogenic manifestations in women with polycystic ovary syndrome (PCOS), but data on the risk of hyperkalemia in this population are scarce. The aim of this study was to evaluate the incidence of hyperkalemia in women with PCOS using SPL in the long term. Single-centre retrospective study. Inclusion and analysis of 98 treatment periods in 78 women with PCOS (20 of whom were duplicates, returning after treatment interruption for a mean of 38 months) who received SPL for a minimum of 12 months and had at least three measurements of potassium levels over time. Clinical and hormonal profiles before and during SPL treatment. Mean age was 29.1 (SD: 9.6) years, and body mass index was 32.2 (SD: 8.1) kg/m². Nine patients had diabetes, and 22 had prediabetes. SPL was used in combination with combined oral contraceptive pills in 55 participants and progestin-only pills/long-acting reversible contraception in 28; metformin was added in 35, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in 15. Median SPL dose was 100 (range: 50-150) mg. A total of 327 serum potassium measurements were obtained (84 pre-exposure and 243 postexposure). Four potassium measurements were above the reference range before exposure and 19 during exposure. All potassium measurements above the reference range during follow-up were classified as mild hyperkalemia (5.1-5.5 mEq/L). The present findings suggest that women with PCOS, without kidney or heart disease, using SPL combined with hormonal contraception for managing clinical hyperandrogenism have a low incidence of hyperkalemia and well-tolerated minor adverse effects.

Correlation of Forced Vital Capacity and Peak Expiratory Flow Rate with Serum Estrogen and Progesterone Levels in Combined Oral Contraceptive Pill (COCP) User

Background: Combined oral contraceptive pill (COCP) is the most commonly used contraceptive method in Bangladesh. This COCP has some effects on different organs including the lungs. So, there may be a relationship between forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with serum estrogen and progesterone levels in combined oral contraceptive pill (COCP) users.&#x0D; Objective: To observe the relationship between FVC and PEFR with serum estrogen and progesterone levels in combined oral contraceptive pill users (COCP-U).&#x0D; Methodology: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between July 2017 and June 2018. A total of 30 apparently healthy young women, age ranged 20 to 30 years were included in this study, who were combined oral contraceptive pill users (COCP-U) for at least 6 months. Another 30 age and BMI matched combined oral contraceptive pill nonusers (COCP-NU) were also taken as control for comparison. FVC and PEFR of all the subjects were measured by using Digital Auto Spirometer (MINATO AS-507). Moreover, their serum estrogen and progesterone levels were done to observe their levels and also to observe the relationship between them if present. Statistical analysis was done by Independent t-test and Pearson’s Correlation Coefficient test.&#x0D; Result: Spirometric parameters like FVC and PEFR were significantly higher in COCP-U women than those of nonuser women. Moreover, the mean serum estrogen and progesterone levels were also significantly higher in COCP users in comparison to those of non-users. Here, FVC showed positive and PEFR showed negative correlation with serum estrogen level and FVC showed negative, PEFR showed positive correlation with serum progesterone level in COCP users, though the relationships were statistically non-significant. &#x0D; Conclusion: The positive correlation of FVC and PEFR with serum estrogen and progesterone indicates, that improvement of pulmonary function occurs in COCP-U due to its estrogen and progesterone contents, which may be by increasing the strength of the muscles along with decreased airway resistance.&#x0D; J Shaheed Suhrawardy Med Coll 2022; 14(1): 37-42

Innovative Medical Treatments for Endometriosis

This presentation will focus on the following innovative areas in medical treatments for endometriosis. Where were we, say, a decade ago compared to where we are now? What diagnostic techniques should we employ to define the population we should treat? Does gold standard surgical treatment help patients avoid unwanted medical treatment - or should it now be the other way round? Do we still believe that medical treatment is not indicated for infertility related to endometriosis? What are the genuinely evidence-based innovative medical treatments for endometriosis? Consensus statements and guidelines represent a clear line in the sand of what may be considered gold standard practice of the time – the World Endometriosis Society’s consensus on current management of endometriosis (2013) 1 provides a good perspective on where we were around a decade ago; the ESHRE Guideline (2022) 2 reflects best practice today. There is growing consensus that a laparoscopic (+/- histological) diagnosis is no longer practical, or indeed needed, in most cases to implement the whole gamut of medical treatment, even though the entire evidence base for treating endometriosis hinges on laparoscopic diagnosis. Hence, “in 2023, there is a strong case for treatment of endometriosis to be based on a clinical diagnosis of ‘likely endometriosis’ supported by imaging findings, when appropriate, in lieu of a traditional diagnosis by laparoscopy +/- histology”. Following laparoscopic surgery, those not intending to conceive should consider the levonorgestrel intrauterine system or combined oral contraceptive pill for at least 18-24 months to reduce the recurrence of endometriosis-related pain symptoms; 2 following surgery for either endometriomas or deep endometriosis, long term hormone therapy should be considered to reduce the chance of recurrence.2 Given the respective evidence bases, progestin hormone therapy may be preferable to the combined oral contraceptive pill to turn the tide of increasing prevalence of endometriosis. 3 While medical treatment has not been recommended to improve fertility, indeed a delaying effect on fertility through medical treatment has traditionally been highlighted, innovative analysis methods, including network meta-analysis, have raised the question whether some medical treatments (dydrogesterone and GnRH agonists) might benefit fertility – and this is merit-worthy of further investigation. GnRH antagonists and aromatase inhibitors are the innovative medical treatments that have shifted from ‘showing potential’ to ‘recommended’, so we will delve into the data supporting this to discover that, for aromatase inhibitors, this remains far from convincing, but for GnRH antagonists, these present a genuine innovative medical treatment option for those suffering from endometriosis.

#342 : Asherman’s Syndrome Attributed to Genital Tuberculosis: A Case Report

Background: Asherman’s syndrome is a rare pathology secondary to intrauterine adhesion formation characterized by menstrual disorders and reproductive dysfunction. Although the cause intrauterine adhesion is thought to be associated with vigorous curettage or previous uterine surgery, other causes such as tuberculosis or schistosomiasis leading to intrauterine adhesion, are particularly important in developing countries. Case Presentation: A 33-year-old, multiparous woman, has applied for care to our hospital after 6 months of secondary amenorrhea. Other than occasional untreated heavy vaginal discharge, she had no past medical history nor prior uterine surgical procedure. No one in her family was treated for tuberculosis. Previously she was given combination oral contraceptive pills for 2 months, with no desirable outcome. On June 2022, we conducted a transvaginal ultrasound, with several features suggestive of uterine synechiae i.e. interrupted endometrial line in sagittal plain, small focal cystic areas within endometrium, and hyperechoic lesion with and without posterior shadowing. We decided to perform a hysteroscopy, with findings of mottled endometrium across the fundus and corpus of the uterus. Adhesiolysis was performed. An intrauterine foley catheter was inserted to prevent the reformation of adhesions. The specimen from this procedure were collected for pathology testing, with positive result for endometrial tuberculosis with caseous necrosis. The patient was treated with anti-tuberculosis drugs for 9 months. Upon completion of her tuberculosis treatment, she received combination oral contraceptive pills for endometrial restoration. She had her first period on May 2022, but only scanty bleeding occurred. On July 2022, she had two days of period with heavier blood flow. She is still closely observed. Conclusion: Asherman’s syndrome attributed to genital tuberculosis may emerge in otherwise healthy individual especially in countries where tuberculosis is prevalent. Although the results of hysteroscopic adhesiolysis in Asherman’s syndrome are encouraging, unfortunately, women with Asherman’s syndrome due to genital tuberculosis have poorer prognosis for restoration of menstrual function as there is usually complete destruction of endometrium by the mycobacterial disease. Well-designed clinical trials are needed to determine the most appropriate diagnostic and therapeutic modalities.

Reproductive care in Thai women with diabetes mellitus: a descriptive cross-sectional study

BackgroundPre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM.MethodsThis descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically.ResultsA total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM.ConclusionsAlthough highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care.

What are the effects of combined oral contraceptive pill (OCP) for women with primary dysmenorrhea?

What are the effects of combined oral contraceptive pill (OCP) for women with primary dysmenorrhea?

Identification and Management of Radiation-Induced Premature Ovarian Failure

Premature ovarian failure (POF) is the dysfunction of ovarian follicles resulting in amenorrhea before the natural age of menopause. For women with locally advanced cervical cancer (LACC), POF is caused by chemoradiation due to the cytotoxic effects of radiation on the ovary. The diagnosis is confirmed with an FSH level in the postmenopausal range. The recommendation is for all patients with POF to take hormone replacement therapy (HRT) through the average age of natural menopause (age 50-51). The goal of this study is to determine how POF was managed in a large cohort of premenopausal women with LACC receiving pelvic RT. We retrospectively reviewed medical charts of premenopausal patients who underwent RT for LACC at an academic hospital from 2010 to 2020. Data regarding the type and duration of RT, demographics, and survival was obtained. The following data points were obtained from clinic notes documented after radiation treatment started: FSH levels, estradiol levels, menstrual history, menopausal symptoms. Additionally, data regarding HRT initiation was extracted, including the type of HRT and the department of the prescribing provider. Descriptive analysis was performed to determine the frequency of each variable of interest including patient characteristics, receipt hormone therapy, type of hormone therapy and menopausal symptoms. A total of 45 premenopausal patients treated for locally advanced cervical cancer with a median age of 39 (range 22- 50 years) were included. 51% (n = 23) of the patients were started on hormone therapy either during or post radiation treatment. 20 patients had documented menopausal symptoms. Most frequently reported symptoms included hot flashes (80%), fatigue (25%) and anxiety (15%). Most (78%) women received combination oral contraceptive pills (OCP) and some also received an estrogen patch/cream. 38% (n = 7) of patients started the HRT post RT while 61% (11) patients started during RT treatment. Of the available data, HRT was prescribed by a radiation oncologist 39% of the time and a gynecologic oncologist 35% of the time. The onset of POF was identified clinically by the onset of hypo-estrogen vasomotor symptoms. FSH levels were not routinely checked prior to prescribing HRT. The most commonly prescribed HRT was the combination oral contraceptive pill, which was prescribed and managed by both radiation oncologists and gynecologic oncologists. Our study illustrates the need for a standardized method to routinely assess the onset of POF while undergoing radiation treatment. With frequent follow-ups, radiation oncologists have the opportunity to identify early signs POF and provide adequate treatment. Additional studies are needed to evaluate if patients initiated and maintained HRT for the recommended length of time.