First Use Of Oral Contraceptives Research Articles

Association between age at first oral contraceptive use and breast cancer in women-Nouakchott, Mauritania, May - October 2021

Introduction: In Mauritania, breast cancer affects 44.9 women per 100,000 inhabitants in 2020 and is the most common cancer. In a context where two- thirds of women use oral contraceptives and nearly one-third of marriages are early, this study examines the association between the age of first use of oral contraceptives and breast cancer among women in Mauritania. Methods: A case-control study (192 cases for 192 controls) was conducted at the Nouakchott Oncology Center from 01 May 2021 to 31 October 2021. A case was defined and so was a witness. A logistic regression was performed with SAS® 9.4 software to estimate the odds ratio of breast cancer associated with age of first oral contraceptive use independent of other characteristics. Results: Half of the patients were from Nouakchott (50.5%), 41.7%, 57.8% and 85.4% were married, uneducated and housewives, respectively. The median age was similar in cases and controls. About 11% of cases and 18.7% of controls used oral contraceptives for the first time before the age of 24, and more than 64% had never used oral contraceptives. After adjusting for possible confounders, age at first oral contraceptive use (<24 years) was significantly associated with breast cancer (adjusted OR = 3.07, 95% CI 1.09-8.82; p = 0.0372) independently of other characteristics. Conclusions: The study shows that the age of first use of oral contraceptives, less than 24 years, is a risk factor for breast cancer in women followed at the Nouakchott Oncology Center. Sensitization of women on alternative contraceptive methods and early marriage is recommended.

Association of oral contraceptives and tubal ligation with antimüllerian hormone.

Oral contraceptives (OCs) and tubal ligation are commonly used methods of contraception that may impact ovarian function. Few studies have examined the association of these factors with antimüllerian hormone (AMH), a marker of ovarian aging. We examined the association of OC use and tubal ligation with AMH in the Nurses' Health Study II prospective cohort among a subset of 1,420 premenopausal participants who provided a blood sample in 1996-1999. History of OC use and tubal ligation were reported in 1989 and updated every 2 years until blood collection. We utilized generalized linear models to assess whether mean AMH levels varied by duration of and age at first use of OCs and history, age, and type of tubal ligation. In multivariable models adjusted for smoking, reproductive events, and other lifestyle factors, we observed a significant, inverse association between duration of OC use and mean AMH levels (P for trend = 0.036). Compared to women without a tubal ligation, AMH levels were significantly lower when the procedure included a clip, ring, or band (1.04 ng/ml vs 1.72 ng/ml, P < 0.01). AMH levels were not associated with age at first use of OCs or age at tubal ligation. Our analysis found an association between duration of OC use and certain types of tubal ligation with mean AMH levels. Further research is warranted to confirm the long-term association of these widely used contraceptive methods with AMH.

Effect of age at first use of oral contraceptives on breast cancer risk: An updated meta-analysis.

We evaluated the relationship between the age at first use of oral contraceptives (OC) and breast cancer (BC) risk. We searched PubMed, Embase, and related reviews published through June 28, 2018, and used summary relative risk (RR) and 95% confidence intervals (CIs) to evaluate the cancer risks, and fixed-effects dose-response meta-analysis to assess potential linear and non-linear dose-response relationships. We included 10 studies, with 8585 BC cases among 686,305 participants. The pooled RR for BC was 1.24 (95% CI: 1.10-1.41), with moderate heterogeneities (I = 66.5%, P < .001). No significant publication bias was found (P = .584 for Begg test, P = .597 for Egger test). A linear dose-response relationship between the age at first OC use and BC risk was detected (P = .518 for non-linearity). Subgroup analyses were restricted to studies done by BC subtypes, region, sample size, follow-up time and study quality. Inconsistent consequences with no statistical significance were explored when limited to studies from Western countries, study quality <7, sample size <10,000, follow-up time <5 years, and BC subtypes defined by estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2) expression status in tumor tissue. Sensitivity analyses indicated that our results were stable and reliable after removing each study in turn and omitting studies of adjusted unreported variables. A significant linear relationship between the age at first OC use and BC risk was confirmed. No further consistent differences are noted in multiple aspects of BC subtypes defined by progesterone or ER status.

한국여성의 경구 피임약 이용과 유방암

Breast cancer is increasing at a remarkable rate in Korea. We investigated the association between oral contraceptive use and breast cancer in Korean women. Using the 5th Korea National Health and Nutrition Examination Survey data, 8,495 women aged over 30 years are analyzed. Furthermore, the data used in this study is obtained using a complex sampling method in order that it is generalized. The previous studies in Korea, were not statistically significant due to the relatively short duration during which oral contraceptives had been available. However, the longer duration of oral contraceptive use exhibits tendency to increase the risk of breast cancer. Women using oral contraceptives, particularly for more than two years have an increased occurrence of breast cancer compared with women who do not use oral contraceptives. This result reflects the late introduction of oral contraceptives in Korea compared with developed countries. The recent increase in interest about the use of oral contraceptives has been increasing for a variety of reasons. Therefore, it is necessary for continuous and specific clinical studies to examine the connections between the first use of oral contraceptives, oral contraceptives use duration, adverse effects of oral contraceptives and breast cancer in order to develop strategies for preventing breast cancer.

Hormonal and reproductive influences and risk of melanoma in women.

Evidence linking female hormones to the development of malignant melanoma has been contradictory. The purpose of this study was to examine the risk of melanoma in relation to exogenous and endogenous hormonal variables in women, including oral contraceptives, replacement oestrogens, pregnancy, and menopause. Hormonal and reproductive factors were evaluated using data from a personal-interview population-based case-control study of melanoma in women conducted in Connecticut during 1987-1989. Caucasian female incident invasive melanoma cases (n = 308) were confirmed by standardized histopathological review. Caucasian female controls (n = 233) were selected by random digit dialling and frequency-matched on age. Data were analysed using multivariate logistic regression. Ever being pregnant, age at first pregnancy, current use of replacement oestrogens, ever use of oral contraceptives, duration of use of oral contraceptives, and age at first use of oral contraceptives were not associated with melanoma. Among other variables, cases were more than twice as likely as controls to report a single pregnancy lasting >6 months, but this association lacked a dose-response relationship. Menopause and body mass index were not independently associated with risk of melanoma. However, this analysis did suggest that menopause and body mass index may be interactive risk factors. Melanoma cases were three times more likely than controls to be obese and report natural menopause when compared to thin/acceptable premenopausal women (OR = 3.00, 95% CI: 1.03-8.73). These data do not provide strong evidence that hormonal and reproductive factors are associated with risk of melanoma in women, although the few positive results should be explored further.

Early oral contraceptive use and breast cancer among premenopausal women: final report from a study in southern Sweden.

In southern Sweden during the 1960s, women began to use oral contraceptives (OCs) extensively at a young age. This case-control study investigates the relationship between the use of OCs and breast cancer development in women in southern Sweden diagnosed in the early 1980s. The risk for breast cancer after OC use among premenopausal women was modeled, after adjustment was made for age, age at menarche, and age at first full-term pregnancy or parity. Both the duration of OC use before 25 years of age and commencement of OC use at a young age were associated with a significant increase in the risk of breast cancer as well as a significant trend. The duration of OC use before the first full-term pregnancy was associated with an increased risk of breast cancer, but it did not show a significant trend. The total duration of OC use was weakly, but not significantly, associated with breast cancer development. The odds ratio for women starting OC use before 20 years of age was 5.8 [95% confidence interval (CI), 2.6-12.8]; for women using OCs for greater than 5 years before age 25, it was 5.3 (95% CI, 2.1-13.2); and for women using OCs for greater than or equal to 8 years before first full-term pregnancy, it was 2.0 (95% CI, 0.8-4.7). In multivariate analyses including the different measurements of OC use, only starting age of OC use was significantly associated with breast cancer. The exposure-response relationship between duration of OC use and risk of breast cancer depended on the age at first use of OCs. Given a fixed duration of OC use, the risk increased with younger starting age of OC use. The findings point to the importance of the early reproductive years as risk determinants for breast cancer after OC use.

VARIATIONS IN THE REPORTING OF MENSTRUAL HISTORIES

This investigation examined the accuracy of recall of females to questions concerning ages at memarche, natural and surgical menopause, first use of oral contraceptives and mean menstrual cycle length and variance. A sample of 160 women who had recorded their menstrual and reproductive events as they occurred were administered a questionnaire concerning these events, with responses compared to the original data. For the variables age at menarche, age at natural memopause, age at surgical menopause and age at first use of oral contraceptives, the percentage of women who correctly recalled within a year ranged from 75% to 90%. Recollection of menstrual cycle length and variability by interview was considered unreliable. These findings are encouraging regarding the ability to recall the age when certain menstrual and reproductive events occur, but not for menstrual cycle intervals or patterns. Because these women were well-educated and had once recorded study variables, these results might be considered optimal.

Ovulation Suppressors, Psychological Functioning, and Marital Adjustment

In a series of 39 couples (studied intensively over a four-year period which began just before their first use of oral contraceptives) 15 wives used the pills throughout the study, while 9 discontinued them permanently. Side effects were equivalent in both of these groups and were therefore nonpredictive of who would stop taking the pills. The wives who continued to take the pills were relatively more responsible and more intellectually and socially effective than their husbands. Relative to their husbands, they also preferred sexual intercourse more often than did the wives who discontinued. Husbands of the wives who discontinued were more concerned about propriety and reputation than were husbands of the wives who continued. Psychological functioning of both husband and wife tended to improve in the couples continuing the use of the pills as compared to the ones who did not. Of special note, depression decreased and sexual interest increased in those who continued. Three unplanned pregnancies in the ten women who discontinued the pills permanently or temporarily would indicate a need for caution in the recommendation of ovulation suppressor contraception for couples in which the husband is clearly the dominant spouse.