Effects Of Combined Hormonal Contraceptives Research Articles

Quality of life of patients with uterine fibroids

BACKGROUND: Currently, there is an elevation in the incidence of uterine fibroids in increasingly younger women of reproductive age. Taking into account the current trend of late motherhood, this cohort of patients is interested in using reliable reversible contraception. Combined hormonal contraceptives meet these criteria and are able to neutralize the clinical manifestations of uterine fibroids, thereby improving the quality of life of patients. At the same time, some combined hormonal contraceptives users may experience a decrease in libido and a change in their psycho-emotional state as a manifestation of the side effects of these drugs. AIM: The aim of this study was to assess the effect of combined hormonal contraceptives on the quality of life in patients with uterine fibroids. MATERIALS AND METHODS: This study involved 100 patients with uterine fibroids (F3–F6 according to classification of the International Federation of Gynecology and Obstetrics, without indications for surgical treatment) and 30 healthy women aged 18 to 49 years. For contraceptive purposes, 40 participants with uterine fibroids used combined hormonal contraceptives containing ethinyl estradiol (group I) and 60 patients with uterine fibroids did not use any medications (group II). The following validated questionnaires were used for patients with uterine fibroids — at the beginning and after 6 months, and for healthy women in the control group (group III) — once upon entry into the study: Short Form-36, Female Sexual Function Index, and Beck Depression Inventory. A comparative statistical analysis of the studied parameters over time was carried out. RESULTS: At baseline, a lower quality of life was noted in patients with uterine fibroids compared to the control group (Short Form-36): 94 ± 6 vs 102 ± 11 points, respectively (p 0.05). After 6 months, patients in group I showed positive dynamics with increasing in the total Short Form-36 from 95 ± 4 to 98 ± 5 points (p 0.05) compared to patients in group II: 94 ± 6 and 93 ± 5 points (p 0.05). We revealed no changes in the Female Sexual Function Index in the study groups — at baseline: 24.8 ± 8.9 (group I), 23.9 ± 9.5 (group II), and 27.8 ± 4.7 (group III); and after 6 months: 26.4 ± 9.2 (group I) and 23.9 ± 10.0 (group II) (p 0.05 for all comparisons). When comparing the results of a questionnaire on the Beck scale, no dynamics were determined in patients with uterine fibroids, including those who used combined hormonal contraceptives. CONCLUSIONS: The study demonstrated a lower quality of life in patients with uterine fibroids compared to healthy women and an improved quality of life in patients with uterine fibroids using combined hormonal contraceptives. We showed no negative effects of contraceptive drugs on libido and emotional state in women with uterine fibroids who used combined hormonal contraceptives for 6 months.

Use of combined hormonal contraceptives in women with uterine fibroids: opinions of practitioners

BACKGROUND:Uterine fibroids are increasingly diagnosed in patients of reproductive age. Combined hormonal contraceptives provide reliable protection against unwanted pregnancy and help to reduce or eliminate various clinical manifestations of uterine fibroids. In practice, obstetrician-gynecologists have barriers to prescribing combined hormonal contraceptives to patients with uterine fibroids.
 AIM:The aim of this work was to study the features of the clinical approach of obstetrician-gynecologists to the management of patients with uterine fibroids interested in combined hormonal contraception.
 MATERIALS AND METHODS:The method of voluntary anonymous questioning was applied to 366 obstetrician-gynecologists. The work experience of 62.1% (n= 227) of doctors was 10 years or more. The questionnaire included questions about various aspects of the use of combined hormonal contraceptives for contraception in women with uterine fibroids.
 RESULTS:Only every second (47.5%;n= 174) obstetrician-gynecologist correctly assigns uterine fibroids to the first category of acceptability for combined hormonal contraceptives. The presence of an asymptomatic submucous myomatous node (FIGO 12) or dysmenorrhea in women with uterine fibroids is considered by 29.0% (n= 106) and 5.7% (n= 21) of obstetrician-gynecologists, respectively, as a contraindication to the use of combined hormonal contraceptives. Every ninth participant (11.4%;n= 42) believes that the presence of uterine fibroids limits the duration of use of combined hormonal contraceptives for contraception to 15 years. Almost half (45.6%;n= 167) of the respondents believe that combined hormonal contraceptives have various effects on uterine fibroids (cause regression or growth of fibroids, increase the risk of new fibroids). More than half (53.3%;n= 195) of the respondents are not informed about the reduction in the risk of developing uterine fibroids when using combined hormonal contraceptives for five years or more.
 CONCLUSIONS:In the analyzed cohort of experienced obstetrician-gynecologists, we identified their barriers to prescribing combined hormonal contraceptives for contraception for women with uterine fibroids. Those are incomplete awareness of the acceptance criteria for combined hormonal contraceptives and insufficient awareness of the lack of effect of combined hormonal contraceptives on the size of existing myomatous nodes and a decrease in the risk of developing uterine fibroids when using combined hormonal contraceptives for five or more years.

Neuropsychological side effects of combined hormonal contraceptives for the treatment of mild symptoms. Bioethical assessment of its adequacy

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.

Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke

Migraine with aura and combined hormonal contraceptives are independently associated with an increased risk of ischemic stroke. However, little is known about whether there are any joint effects of migraine and hormonal contraceptives on risk of stroke. We sought to estimate the incidence of stroke in women of reproductive age and examine the association among combined hormonal contraceptive use, migraine type (with or without aura), and ischemic stroke. This study used a nationwide health care claims database and employed a nested case-control study design. Females ages 15-49 years with first-ever stroke during 2006 through 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification inpatient services diagnosis codes. Four controls were matched to each case based on age. Migraine headache with and without aura was identified using inpatient or outpatient diagnosis codes. Current combined hormonal contraceptive use was identified using the National Drug Code from the pharmacy database. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals of ischemic stroke by migraine type and combined hormonal contraceptive use. From 2006 through 2012, there were 25,887 ischemic strokes among females ages 15-49 years, for a cumulative incidence of 11 strokes/100,000 females. Compared to those with neither migraine norcombined hormonal contraceptive use, the odds ratio of ischemic stroke was highest among those with migraine with aura using combined hormonal contraceptives (odds ratio, 6.1; 95% confidence interval, 3.1-12.1); odds ratios were also elevated for migraine with aura without combined hormonal contraceptive use (odds ratio, 2.7; 95% confidence interval, 1.9-3.7), migraine without aura and combined hormonal contraceptive use (odds ratio, 1.8; 95% confidence interval, 1.1-2.9), and migraine without aura without combined hormonal contraceptive use (odds ratio, 2.2; 95% confidence interval, 1.9-2.7). The joint effect of combined hormonal contraceptives and migraine with aura was associated with a 6-fold increased risk of ischemic stroke compared with neither risk factor. Use of combined hormonal contraceptives did not substantially further increase risk of ischemic stroke among women with migraine without aura. Determining migraine type is critical in assessing safety of combined hormonal contraceptives among women with migraine.

Contraceptive options for women with premenstrual dysphoric disorder: current insights and a narrative review.

Premenstrual syndrome and its most severe form, premenstrual dysphoric disorder (PMDD), are two well-defined clinical entities that affect a considerable number of women. Progesterone metabolites and certain neurotransmitters, such as gamma-aminobutyric acid and serotonin, are involved in the etiology of this condition. Until recently, the only treatment for women with PMDD was psychoactive drugs, such as selective serotonin reuptake inhibitors. Several years ago, there has been evidence of the beneficial role of combined hormonal contraceptives in controlling PMDD symptoms. Oral combined hormonal contraceptives that contain drospirenone in a 24+4-day regimen are the only drugs that have been approved by US Food and Drug Administration for the treatment of PMDD, but there is scientific evidence that other agents, with other formulations and regimens, could also be effective for the treatment of this condition. However, it remains unclear whether the beneficial effect of combined hormonal contraceptives is associated with the type of estrogen or progestogen used or the treatment regimen.

The effect of combined hormonal contraceptives use on brain reactivity during response inhibition

Objectives Cognitive control, which can be described as the ability to moderate impulses, has not previously been investigated in users of combined hormonal contraception (CHC). Given the suggested modulatory role of ovarian steroids in prefrontal dopaminergic function, which in turn taps into cognitive control, this randomised, double-blinded, placebo-controlled oral contraceptive trial set out to investigate the brain activity pattern during response inhibition in CHC users.Methods Thirty-four women were randomised to one treatment cycle with a levonorgestrel-containing CHC or placebo. The women performed a Go/NoGo task to measure brain activity during response inhibition by use of event-related functional magnetic resonance imaging (fMRI) prior to and during the CHC/placebo treatment cycle.Results No differences between CHC and placebo users in number of correct inhibitions were found during treatment, but only women on CHC significantly improved their performance between the baseline and treatment assessments. During the treatment cycle CHC users displayed decreased activity in the right middle frontal gyrus in comparison with placebo users. No other significant activations were evident between treatment groups or within groups.Conclusion Overall, CHC use had marginal effects on brain activity during response inhibition. If anything, the findings of the study may suggest reduced effort or increased efficiency in maintaining orbitofrontal cortex inhibitory cognitive control when using a combined oral contraceptive.

Effects of combined hormonal contraception on health and wellbeing: Women's knowledge in northern Italy

Objectives We investigated levels of knowledge of the effects of combined hormonal contraceptives (CHCs) on general/reproductive health and physical/psychosexual wellbeing.Methods A cross-sectional study was conducted in two university hospitals in northern Italy. Healthy current-, past- and never CHC users (n = 545; age 18–44 years) completed a self-administered questionnaire.Results Ninety-three percent of current-, 74% of past-, and 56% of never users believed they were sufficiently informed (χ2: 67.1; p = 0.001) about the benefits and risks of CHCs. Respondents mentioned: (i) a reduced risk of ovarian (67%) and endometrial (53%) cancer; (ii) an increased risk of thrombosis (82%); (iii) an increased risk of breast cancer (45%); (iv) a decreased fertility (19%) and no influence on risk of sexually transmitted infections (48%); (v) a reduced risk of menstrual abnormalities (77%) and acne (79%); (vi) less dysmenorrhoea (83%) and more headache (56%), weight gain (74%), increased appetite (51%), leg cramps (77%), mood swings (45%), vaginal dryness (47%), and low sex drive (48%). Beliefs about diseases/conditions and symptoms were influenced by CHC use.Conclusions CHC use is linked to good knowledge of risks and benefits. Our data suggest HCPs must be proactive in providing relevant information so that women can choose their contraception with a balanced insight of side effects.Chinese 摘要：目的我们调查复方激素避孕药（CHCs）对全身/生殖健康以及身体/心理健康影响的知识水平。方法一项横断面研究在意大利北部的两所大学医院进行。目前使用、过去使用和从没使用CHC的受访者（N =545；年龄18–44岁）完成自填问卷。结果93%目前使用CHC、74%过去使用CHC和56%从没使用CHC的受访者认为他们被充分告知了CHC的好处和风险（χ2: 67.1；p =0.001）。受访者提到：（i）卵巢癌的风险降低（67%）和子宫内膜癌的风险降低（53%）；（ii）血栓形成的风险增加（82%）；（iii）乳腺癌的风险增加（45%）；（iv）生育率降低（19%），对性传播疾病的风险没有影响（48%）；（v）月经异常的风险降低（77%）、痤疮的风险降低（79%）；（vi）痛经减少（83%）、头痛增加（56%），体重增加（74%），食欲增加（51%），小腿抽筋（77%），情绪波动（45%），阴道干涩（47%），和性欲降低（48%）。使用CHC使其对疾病/健康状况和症状的观念受到了影响。结论CHC使用与良好的风险和受益的知识相关。我们的数据表明，医疗专业人员必须主动提供相关信息，从而使女性能平衡各种副作用后选择他们的避孕方法。

Combined hormonal contraceptive use is associated with lower serum antimullerian hormone levels

There are conflicting reports of the effect of oral contraceptive use on serum AMH. Recent publications suggest hormonal contraception decreases the AMH produced by granulosa cells of the early growing follicles through inhibition of follicular development. We investigated the effect of combined hormonal contraceptives on AMH levels in an oocyte donor population.

A select issue in the postpartum period: contraception

A select issue in the postpartum period: contraception

Effects of Oral and Transvaginal Ethinyl Estradiol on Hemostatic Factors and Hepatic Proteins in a Randomized, Crossover Study

The use of combined hormonal contraceptives with ethinyl estradiol (EE) and a progestin results in alterations in potential biomarkers of venous thromboembolism risk. Evaluation of the impact of delivery route on these changes is difficult due to an interaction between EE and the progestin component. The aim of the study was to compare the impact of oral and vaginal administration of EE alone on hemostatic variables and estrogen-sensitive liver proteins. This was a single-center, randomized, crossover study with two treatment cycles separated by a washout cycle. The study was conducted in an academic outpatient center. Fourteen healthy postmenopausal women were enrolled; 13 completed the study and were included in the analyses. Participants were randomized to receive EE (15 microg/d) delivered by oral tablet or vaginal ring for 21 d in one of two treatment sequences. Changes in plasma concentration or activity of 10 hemostatic variables and six estrogen-sensitive liver proteins between baseline and d 21 of treatment were the primary outcomes. Prothrombin fragment 1 + 2 plasma level was unaffected by treatment or delivery route. Angiotensinogen (expressed as plasma level of angiotensin I) increased similarly with oral and vaginal delivery; mean (sd) increases were 2757 (1033) and 2864 (893) ng /ml, respectively (P = 0.0002). Alterations in other study variables, except total cholesterol, were similar with oral and vaginal administration. Our results provide evidence that the customary effects of combined hormonal contraceptives on hemostatic variables and estrogen-sensitive liver proteins are largely related to EE and independent of delivery route during short-term treatment.