Hormonal Users Research Articles

Using 26,000 diary entries to show ovulatory changes in sexual desire and behavior.

[Correction Notice: An Erratum for this article was reported online in Journal of Personality and Social Psychology on Jun 3 2019 (see record 2019-34417-001). In the original article the number of participants available for robustness checks should have been 1,054, not 1,043; this applies to the third sentence in the abstract, the first sentence of the second paragraph in the Participants section, the first sentence of the second paragraph in the Robustness Checks section, and the subsample size of women in Table 3. The correct number of naturally cycling usable data should have been 429, not 421. The correct number of diary days should have been 26,680, not 25,948. The correct percentage of diary days in the fourth sentence in the Exclusion Criteria section should have been 5%. Figure 1 should have included guessing hypotheses (n 40) and long diary interruptions (n 41) as further reasons for exclusion, and an error in the effsize R package led to the reporting of inflated effect sizes for the differences between hormonal contraceptive users and non-users in Table 1. Figure 1, Table 1, and Table 3 have been corrected. All versions of this article have been corrected.] Previous research reported ovulatory changes in women's appearance, mate preferences, extra- and in-pair sexual desire, and behavior, but has been criticized for small sample sizes, inappropriate designs, and undisclosed flexibility in analyses. In the present study, we sought to address these criticisms by preregistering our hypotheses and analysis plan and by collecting a large diary sample. We gathered more than 26,000 usable online self-reports in a diary format from 1,054 women, of which 429 were naturally cycling. We inferred the fertile period from menstrual onset reports. We used hormonal contraceptive users as a quasi-control group, as they experience menstruation, but not ovulation. We probed our results for robustness to different approaches (including different fertility estimates, different exclusion criteria, adjusting for potential confounds, moderation by methodological factors). We found robust evidence supporting previously reported ovulatory increases in extra-pair desire and behavior, in-pair desire, and self-perceived desirability, as well as no unexpected associations. Yet, we did not find predicted effects on partner mate retention behavior, clothing choices, or narcissism. Contrary to some of the earlier literature, partners' sexual attractiveness did not moderate the cycle shifts. Taken together, the replicability of the existing literature on ovulatory changes was mixed. We conclude with simulation-based recommendations for reading the past literature and for designing future large-scale preregistered within-subject studies to understand ovulatory cycle changes and the effects of hormonal contraception. Interindividual differences in the size of ovulatory changes emerge as an important area for further study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Incidence of bone stress injury is greater in competitive female distance runners with menstrual disturbances independent of participation in plyometric training

ABSTRACT Bone stress injury (BSI) is prevalent in female distance runners. Menstrual disturbances are associated with impaired bone health in endurance athletes. This study aimed to investigate the association between menstrual function and BSI and explore whether plyometric training may protect against BSI in individuals with menstrual disturbances. Competitive female distance runners (n = 183) aged 18–40 years were surveyed for training habits, menstrual function, and BSI, during the previous 12 months. Oligo/amenorrhoea during the previous 12 months (<9 menses) was deemed to indicate menstrual disturbance; hormonal contraceptive users and those previously diagnosed with a pathology that impacted menstrual function were excluded. BSI incidence rate was 2.25 (p = 0.02, 95% CI: 1.14–4.41) times greater in oligo/amenorrhoeic than eumenorrhoeic runners. BSI incidence rate was similar in oligo/amenorrhoeic and eumenorrhoeic runners that did plyometric training, but 3.78 (p = 0.001, 95% CI: 1.68–8.5) times greater in oligo/amenorrhoeic versus eumenorrhoeic runners that did not. However, the effect of plyometrics was non-significant (menstrual function × plyometric training interaction, p = 0.06; main effect, p = 0.89). Conventional plyometric training may not reduce BSI incidence in female distance runners, but menstrual disturbances and prolonged periods of low energy availability should be avoided.

Trends in the use of hormonal contraception in Estonia 2005–2019 and the risk of arterial and venous thromboembolism: a population-based study

Purpose To describe trends in hormonal contraceptive use, incidence of thromboembolism and presence of risk factors for thromboembolism among the users in Estonia. Material and methods Data of 223 312 female patients aged 15–49 years in 2005–2019 from national health insurance databases was derived. Annual prevalence rates of hormonal contraceptive users, incidence rates of thromboembolism and prevalence rates of risk factors were calculated. Results Between 2005–2019 usage of progestogen-only contraceptives (POCs) increased steadily (from 24 to 135 users per 1000 population), whereas combined hormonal contraceptive (CHC) use declined (from 209 in 2012 to 161 users per 1000 population in 2019). During the study period, 390 cases of venous thromboembolism and 108 arterial thromboembolism coincided with hormonal contraceptive use. Incidence rate for venous thromboembolism was 5.0 (95% CI 4.5–5.5) and for arterial thromboembolism 1.4 per 10 000 person-years (95% CI 1.1–1.7) among hormonal contraceptive users. Age adjusted incidence of venous thromboembolism among CHC users was 5.8 (95% CI 4.1–8.2) times higher than in POC users. Among CHC users, 10.3% had more than one risk factor for thrombosis. Conclusions In regards to the risk of thromboembolism, wider use of POCs and declining prevalence of CHCs in Estonia is positive trend. Still, women with history of thrombosis receiving CHC is a serious concern.

Medical contraindications to combined hormonal contraceptive use among women using methods prescribed by a pharmacist

ObjectiveTo determine whether pharmacist prescription of combined hormonal contraception is associated with inappropriate prescription to women with medical contraindications. Study designWe conducted a retrosopective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016 to December 31, 2018. Our primary outcome was the proportion of women receiving a combined hormonal method who had a Medical Eligibility Category (MEC) 3 or 4 condition. We identified potential contraindications using International Classification of Disease codes. We conducted descriptive analyses of contraindication prevalence and prescription error rate by prescriber type. We used a multivariable logistic regression model to test the association between pharmacist prescriber and population characteristics. ResultsOur study sample consisted of 439,240 contraceptive users, of which 3782 (0.86%) received their prescriptions from a pharmacist. Women aged 25 to 29 were more likely than women over age 35 to receive contraception from a pharmacist (adjusted odds ratio (aOR) 2.74, 95% confidence interval [CI] 2.44–3.08). Pharmacist prescriptions were slightly less likely in rural areas (aOR 0.78, 95% CI 0.69–0.89) and among women on Medicaid, relative to those with commercial insurance (aOR 0.21, 95% CI 0.19–0.24). Among women given contraception in a clinical setting, 4.25% had evidence of an MEC 3 or 4 contraindication, compared to 0.9% for women seen by a pharmacist. Rates of prescribing a combined method to women with a potential contraindication were not meaningfully different by prescriber type (2.16% for clinicians vs 0.74% for pharmacists). ConclusionRates of contraceptive prescribing with a contraindication were relatively low and did not differ between clinicians and pharmacists. ImplicationsPharmacists can safely screen for medical contraindications to combined hormonal contraception.

Contemporary hormonal contraception and cervical cancer in women of reproductive age.

To determine cervical cancer risk associated with contemporary hormonal contraceptives, we conducted a cohort study of women aged 15 to 49 living in Denmark from 1995 to 2014, using routinely collected information about redeemed prescriptions, incident cancer and potential confounders. Poisson regression calculated adjusted cervical cancer risks among different contraceptive user groups by duration of use, time since last use, hormonal content and cancer histology. During >20 million person-years, 3643 incident cervical cancers occurred. Ever users of any hormonal contraceptives compared to never users had a relative risk (RR) of 1.19 (95% confidence interval [CI] 1.10-1.29). Increased risks were seen in current or recent users of any hormonal: RR 1.30 (95% CI 1.20-1.42) and combined: RR 1.40 (95% CI 1.28-1.53), but not progestin-only contraception: RR 0.91 (95% CI 0.78-1.07). Current or recent users of any hormonal contraception had an increased risk of both adenocarcinoma (RR 1.29, 95% CI 1.05-1.60) and squamous cancer (RR 1.31, 95% CI 1.19-1.44). The risk pattern among any hormonal and combined contraceptive users generally increased with longer duration of use and declined after stopping, possibly taking longer to disappear among prolonged users. Combined products containing different progestins had similar risks. Approximately one extra cervical cancer occurred for every 14 700 women using combined contraceptives for 1 year. Most women in our study were not vaccinated against human papillomavirus (HPV) infections. Our findings reinforce the urgent need for global interventions such as systematic screening, treatment of cervical intraepithelial neoplasia and HPV vaccination programmes to prevent cervical cancer, especially among users of combined contraceptives.

Clinical features of migraine with onset prior to or during start of combined hormonal contraception: a prospective cohort study

Many studies have described the features of menstrually related migraines but there is a lack of knowledge regarding the features of migraine in combined hormonal contraceptive users (CHC). Hormone-withdrawal migraines in the pill-free period could differ from those in the natural cycle. Gynaecologic comorbidities, like dysmenorrhea and endometriosis, but also depression or a family history might modify the course of migraine. A better understanding of migraine features linked to special hormonal situations could improve treatment. For this prospective cohort study, we conducted telephone interviews with women using a CHC and reporting withdrawal migraine to collect information on migraine frequency, intensity, triggers, symptoms, pain medication, gynaecologic history and comorbidities (n = 48). A subset of women agreed to also document their migraines in prospective diaries. The mean number of migraine days per cycle was 4.2 (± 2.7). Around 50% of these migraines occurred during the hormone-free interval. Migraine frequency was significantly higher in women who suffered from migraine before CHC start (5.0 ± 3.1) (n = 22) in comparison to those with migraine onset after CHC start (3.5 ± 2.1) (n = 26). Menstrually related attacks were described as more painful (57.5%), especially in women with migraine onset before CHC use (72%) (p < 0.02). Comorbidities were rare, except dysmenorrhea. The majority of migraine attacks in CHC users occur during the hormone-free interval. Similar as in the natural cycle, hormone-withdrawal migraines in CHC users are very intense and the response to acute medication is less good, especially in those women, who developed migraine before CHC use.

A Case Control Study on Selected Maternal Risk Factors of Molar Pregnancy

Background: The incidence of gestational trophoblastic disease varies dramatically in different regions of the world. While there are some geographical and racial variations, perhaps a higher incidence in Africa and Asia. The high incidence of molar pregnancy in some populations have been attributed to nutritional and socioeconomic factors. Some maternal biological factors also associated with molar pregnancy. This study aims to explore the various maternal risk factors associated with molar pregnancy.&#x0D; Methods: This case control study was carried out among 50 molar and 100 non-molar pregnant mothers admitted at in patient department of obstetrics and gynecology, Rajshahi Medical College Hospital from January to December 2011. The patients of molar pregnancies were selected on the basis of clinically diagnosed confirmed by ultrasonogram and histopathological examination. Controls group were selected as pregnant women of 1st &amp; 2nd trimester. With the ethical approval from the institutional review board (IRB), patients were selected after taking their written consent. A structured questionnaire and a check list were designed with considering all the variables of interest.&#x0D; Results: Out of 50 cases 48% belongs to the age group below 20 years, 17% belongs to the age group above 34years. 88% of the control groups are belongs to the age group 20-34 years. Out of 50 cases 4% had history of prior molar pregnancy, none of the control groups had prior history of mole. 46% of molar cases belongs to the blood group A, 82% in case group and 86% of control group were hormonal contraceptive users. Among the socio-demographic risk factors occupation, education, socioeconomic condition, nutritional status of the case and control group were included.&#x0D; Conclusion: Molar pregnancy largely remains as etiologic dilemma. No pregnancy is immune to develop as hydatidiform mole. As the risk factors for the disease are unclear, an attempt has been made to identify some risk factors of molar pregnancy to compare them with normal pregnancy to find out any modifiable factors.&#x0D; JOPSOM 2020; 39(2): 34-39

Forest Before Trees: Letter Stimulus and Sex Modulate Global Precedence in Visual Perception.

The global precedence effect (GPE), originally referring to processing hierarchical visual stimuli composed of letters, is characterised by both global advantage and global interference. We present herein a study of how this effect is modulated by the variables letter and sex. The Navon task, using the letters “H” and “S,” was administered to 78 males and 168 females (69 follicular women, 52 luteal women, and 47 hormonal contraceptive users). No interaction occurred between the letter and sex variables, but significant main effects arose from each of these. Reaction times (RTs) revealed that the letter “H” was identified more rapidly in the congruent condition both in the global and the local task, and the letter “S” in the incongruent condition for the local task. Also, although RTs showed a GPE in both males and females, males displayed shorter reaction times in both global and local tasks. Furthermore, luteal women showed higher d’ index (discrimination sensitivity) in the congruent condition for the local task than both follicular women and hormonal contraceptive users, as well as longer exploration time of the irrelevant level during the global task than males. We conclude that, according to the linear periodicity law, the GPE is enhanced for compound letters with straight vs. curved strokes, whereas it is stronger in males than in females. Relevantly, luteal phase of the menstrual cycle seems to tilt women to rely on finer grained information, thus exhibiting an analytical processing style in global/local visual processing.

Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia

Objective Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception. Methods The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants (N = 2151) were single, sexually active women aged 15–49 years, of whom 595 were using hormonal contraception. Results Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse (p < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users (p = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15–19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20–24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77). Conclusion Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.

Is the use of contraceptives associated with periodontal diseases? A systematic review and meta-analyses

BackgroundPrevious studies indicated an impact of hormonal contraceptive use on oral health. This systematic review aimed to investigate the evidence supporting the impact of the use of hormonal contraceptives and periodontal diseases.MethodsThis study is based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and based on the PECO acrostic. Inclusion criteria comprised observational studies including women (P), which evaluated hormonal contraceptive users (E) and hormonal contraceptive non-users (C), to verify the association between this hormonal therapy and the periodontal diseases (O). Searches were performed on 5 databases: PubMed, Scopus, Web of Science, Cochrane Library, LILACS and grey literature (OpenGrey and Google Scholar). After the selection process, the included studies were evaluated qualitatively. Moreover, quantitative data were analyzed in two meta-analyses for clinical attachment loss (CAL) and probing depth (PD). Finally, the level of certainty was measured with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) tool between periodontal clinical parameters.Results18 articles were eligible for the qualitative synthesis and 7 of them were selected for quantitative analysis. Hence, 15 of the eligible articles reported an association between the use of hormonal contraceptives and severity of periodontal disease. However, 6 articles demonstrated high risk of bias and were excluded from quantitative synthesis. The meta-analysis showed a statistically significant difference for CAL (MD 0.24 [0.09, 0.40]; p = 0.002), but in PD (MD 0.05 [− 0.05, 0.15]; p = 0.33) such difference was not identified. A very low level of evidence was found between the clinical parameters.ConclusionsThe use of hormonal contraceptives may be associated to severity of periodontal diseases. However, the quantitative analysis points to an inconclusive outcome due to the high level of heterogeneity. The association is biologically plausible, however additional studies are warranted to better elucidate the clinical significance of this possible association.

Combined Hormonal Contraceptive Usage in Women With COVID-19

Combined Hormonal Contraceptive Usage in Women With COVID-19

How safe is Contraception use among Obese Diabetic Women?

Incidence of diabetes mellitus is increasing is worldwide. The incidence of obesity is also increasing among the diabetic people. Sexually active obese women are commonly encountered nowadays due to increase in the global burden of obesity and diabetes mellitus Obesity and diabetes mellitus is associated with many health risks and a pregnant obese diabetic woman has health risks not only for herself but also to the foetus she carries. Thus, an effective birth control method is important to reduce pregnancy related complications. Though most of us are aware of management of diabetes and obesity, we may not be aware of the contraceptive usage among premenopausal women and HRT [hormone replacement therapy] use among perimenopausal women. A study was conducted to find the incidence of obese diabetics among the women attending a religious function. Later the study was extended to find the contraceptive use among the obese diabetic women and HRT usage among obese perimenopausal diabetic women. It has been found that 16/84 are prediabetic 25/84 are diabetic and 35/84 are overweight and 22/84 are obese. Follow up study was done to find out what contraceptive method was used by them and their knowledge about the contraceptive use. 77% (n=364) of the sexually active obese women are using contraception, with most of them using hormonal contraception. We are aware that some of the oral contraceptives will aggravate diabetes and obesity. Introduction: There is global increase in diabetes mellitus together with increasing incidence of obesity among women. This increase in obese diabetic women includes increasing numbers of women of a reproductive age whose reproductive health and contraception need careful consideration. We have conducted a study among obese diabetic women and their contraceptive usage. This study explored the level of knowledge, attitude, and practice of contraception usage of the sexually active obese women. Among the respondents (25.6%) were not aware of the best contraceptive for sexually active obese women. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness of health risk associated with hormonal contraceptive usage of the amongst the obese diabetic women is less. This study has revealed that there is a lack of education and counselling with regards to safe and appropriate use of contraceptive to the women who need it for family planning. Objective: This study aims to look at the knowledge, attitude and practice (KAP) in the choice of contraceptives among obese and sexually active women. Methods: This study was conducted at Ministry of Health, health facilities and Private General Practitioners’ Clinics inPeninsular Malaysia. A self-designed questionnaire was used to assess KAP of the participants. A total of 473 respondents participated in the survey. Results: 77% (n=364) of the sexually active obese women are using contraceptives. Majority used hormonal contraceptives (n=204, 56%) and barrier method was the preferred method (39%, n=142) among the others. Women with Hypertension and Type II Diabetes Mellitus have the highest rate of using hormonal contraception (51.6%, n=32, 52.6%, n=30) respectively. Both groups have low awareness on the health risk associated with hormonal contraception which was 69% and 83% respectively. Most of the respondents were satisfied with the method of contraception they use, and majority mentioned ‘Easy to take’ as the reason for using it. 32%(n=152) of the respondents have underlying medical illnesses. 24.5% thought that hormonal contraception is the best. 23.5% choose IUCD as the method of choice. Conclusion: In the first part of the study the incidence of diabetes mellitus and obesity among the women was done. In the second part the study explored the level of knowledge, attitude, and practice, of the sexually active obese women based on their sociodemographic data in the choice of the appropriate contraceptive considering their existing medical conditions and sources of procurement. Majority of obese women used non hormonal contraception and almost half of the rest chose hormonal contraception. A quarter of the respondents claimed that hormonal contraception was the best choice. Many obese women with underlying medical illnesses were on hormonal contraception. It is noted that 32.1% of obese women with underlying medical illness were still on hormonal contraception. The awareness amongst the diabetic and hypertensive respondents on health risk associated with hormonal contraceptive used was noted to be poor, being 38.7% and 42.9% respectively. The use of IUCD as the preferred and appropriate choice for those with medical conditions is very discouraging (less than 3%).

Breast cancer recurrence risk after hormonal contraceptive use in survivors of reproductive age

ObjectiveTo assess the risk of recurrence with hormonal contraceptive use in breast cancer survivors of reproductive age. Study designIn this retrospective study, women ages 18–51 years who were diagnosed with primary stage 0–3 breast cancer between 2006–2016 and subsequently entered remission were included. Patients with missing information within the cancer registry or electronic medical record and those with a history of hysterectomy and/or sterilization procedure prior to diagnosis were excluded. Hormonal contraception use was defined as being prescribed an oral contraceptive pill (OCP), patch, vaginal ring, medroxyprogesterone injection, etonogestrel implant, or levonorgestrel-releasing intrauterine device (IUD). Women were separated into two groups, hormonal contraceptive users and non-users. Basic descriptive and inferential statistics were used to compare groups as appropriate. The primary outcome reviewed was local or distant breast cancer recurrence. Secondary outcomes included all-cause mortality and pregnancy. ResultsFollowing exclusions, 1370 women remained in the cohort. Ninety-seven women (7.08 %) received a prescription for a form of hormonal contraception. When comparing groups, hormonal contraceptive users were more likely to be between 18−40 years of age (46.39 % vs. 17.99 % non-users;P < 0.01) and never smokers (68.04 % vs. 38.57 % non-users; P < 0.01). Patients did not differ between groups based on any other demographic or cancer-related characteristic, including tumor hormone receptor expression. Overall, 92 patients (6.72 %) experienced local or distant recurrence during the study period. Recurrence did not differ between groups (6.19 % users vs. 6.76 % non-users; P = 0.83). All-cause mortality and pregnancy rates also did not differ between hormonal contraceptive users and non-users. ConclusionThe study shows no increased risk of recurrence associated with hormonal contraceptive use after breast cancer diagnosis and remission.

Contraception for Women With Psychiatric Disorders.

Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices. A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives. The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions. Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.

P64 Are new LARC users less likely to use condoms than new moderately effective hormonal method users? An analysis of us women ages 15–44

Objectives: The revival of long-acting reversible contraceptives (LARC) in the US has renewed concerns regarding low levels of dual method use as a strategy for STI prevention. Whether new LARC users are less likely to use condoms than new moderately effective hormonal method (MEHM) users has yet to be examined at a population-based level.

Migraine start, course and features over the cycle of combined hormonal contraceptive users with menstrual migraine \u2013 temporal relation to bleeding and hormone withdrawal: a prospective diary-based study

BackgroundMany studies have described the features of menstrually-related migraines (MRM) in the natural cycle and the efficacy of prevention. MRM in combined hormonal contraceptive (CHC) users has scarcely been researched. Estrogen and progestin withdrawal in CHC users are both more abrupt and from higher hormone levels compared with the natural cycle. An advantage for prevention of MRM in CHC users is that the hormone withdrawal is predictable. It is unknown, whether the attacks during the hormone-free interval are associated with the hormone withdrawal or onset of bleeding. Improved understanding of this relation might contribute to better define and shorten the time interval for prevention.MethodsFor this prospective diary-based trial we collected migraine and bleeding data from CHC users with MRM in at least two of three cycles. We analyzed frequency of migraines over the whole CHC cycle. During the hormone-free phase the relation between onset of migraine and onset of bleeding was studied. We compared pain intensity and identified prolonged-migraine attacks during hormone use and the hormone-free phase.ResultsDuring the hormone-free interval the number of migraine days and the pain score/migraine day were significantly higher in comparison with the mean during hormone use. The prevalence of migraine attacks was fourfold on hormone-free days 3–6. Migraine typically started on days 1–4. Migraine in relation to bleeding mostly occurred on days − 1 to + 4. In 78% of the cycles the first migraine day occurred during bleeding days 1 ± 2 and 48% started on days − 1 and day 1. The predictability of the first bleeding day was very high.ConclusionThe day of hormone-withdrawal migraine and the first bleeding day are highly predictable in CHC users. Migraine onset is mostly day − 1 and 1 of the bleeding and on days 1–4 of the hormone-free interval. Migraine attacks of CHC users in the hormone-free interval are severe and long lasting. Further trials are necessary to investigate if this knowledge can be used to optimise prevention.

METABOLIC SYNDROME AMONG WOMEN USING HORMONAL CONTRACEPTIVES IN HARAR TOWN, EASTERN ETHIOPIA

Background: Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. Cardiovascular disease is among the most cause of death in non-communicable diseases. The use of contraceptive is incriminated to increase the risk of cardiovascular diseases and metabolic syndrome. However, there is no clear evidence and metabolic syndrome among contraceptive users is not well described. This study is therefore focused to determine the prevalence of metabolic syndrome among contraceptive users in Harar. Methods: A facility based cross sectional study was conducted from April – June 2014 to determine the prevalence of metabolic syndrome and associated factors in Harar town. 365 hormonal contraceptive users from three health centers and one hospital were consecutively included in the study. Socio-demographic data and anthropometric measurements were obtained. Venous blood was drawn from each study subjects and lipid profile and fasting serum glucose were measured photometrically. Prevalence of metabolic syndrome was determined using descriptive statistics and logistic regression analysis with 95% CI using statistical package for social science (SPSS, version 20 for windows). Result: The overall prevalence of metabolic syndrome was found to be 27.7%. Metabolic syndrome was found about 9 times more likely among women with age ≥40 years than those with age &lt;20 years (Odds Ratio (OR) 8.571; 95% CI 1.004, 73.210, p = 0.050); about 2 times more likely among those with income &gt;1,500 Ethiopian birr (ETB) than those with those &lt;1,500 ETB (OR 1.637, 95% CI 1.032-2.599, p = 0.036) and about 6 times more likely among those who used hormonal contraceptive for more than 42 weeks than those who used it for 6-17.9 weeks (OR 5.897, 95% CI 2.924-11.891, p = 0.000) Conclusion: This study revealed that metabolic syndrome is high among contraceptive users and higher than the rate of metabolic syndrome among community and other healthy working population. Contraceptive users with older age, with higher income and those who used the drug for longer time were found to have more metabolic syndrome than their counter parts.

Risky sexual behaviour and contraceptive use among young women in the Czech Republic.

This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.

Contraceptive use among women with cystic fibrosis: A pilot study linking reproductive health questions to the Cystic Fibrosis Foundation National Patient Registry

ObjectivesTo examine contraceptive use, pregnancy intention and the association of hormonal contraceptive type with adverse health outcomes among women with cystic fibrosis (CF). Study designWe recruited 150 women with CF, ages 18–49 from three adult CF programs to complete an online survey regarding their pregnancy and contraceptive use history. Survey findings were merged with retrospective clinical information from the CF Foundation Patient Registry (CFFPR). We used descriptive analyses to report contraceptive method and pregnancy frequencies, and logistic regression to examine the association between contraceptive method type and adverse health outcomes. ResultsCombined hormonal contraceptives were the most commonly used methods (42%), followed by condoms (34%), and long-acting reversible contraceptives methods (27%). Thirty-three percent (n = 50) reported ever being pregnant, half of whom reported having at least one unplanned pregnancy. We found no significant association for mucoid Pseudomonas aeruginosa infection among progestin-only (aOR 1.53, 95% CI 0.07–32.2) and estrogen-containing hormonal contraceptive users (aOR 3.9, 95 % CI 0.20–76.5). Risk of osteoporosis was elevated among women with CF who used depot-medroxyprogesterone acetate compared to non-users (OR 5.36, 95% CI 1.00–29.12). ConclusionsBoth contraceptive use and unplanned pregnancy among women with CF are common. Associations between hormonal contraceptive use and adverse pulmonary or bone outcomes among women with CF are inconclusive due to the study s small sample size. Larger studies are warranted. ImplicationsWomen with CF should be informed about the risks and benefits of contraceptives in the context of their disease. CFFPR data capturing contraceptive method use may be the most efficient way to elucidate the association of hormonal contraceptives on disease in women with CF.

Practice does not make perfect: A brief view of athletes’ knowledge on the menstrual cycle and oral contraceptives

ObjectivesTo assess the knowledge of Australian elite female athletes surrounding the menstrual cycle and oral contraceptives. DesignCross sectional survey. MethodsAustralian female athletes (n=189) representing their state and/or country in their respective sport completed a questionnaire comprising questions (multiple choice and short answer) relating to the menstrual cycle and oral contraceptives. A knowledge ‘score’ was calculated by allocating one point for each correct answer; the highest knowledge score that could be achieved was 14. Linear regression analysis was used to identify variables that were independently associated with menstrual cycle and oral contraceptive knowledge. ResultsAlmost half (47.1 %) of the athletes surveyed were currently using hormonal contraception, the majority (75.3 %) of which used an oral contraceptive pill. Nevertheless, the mean knowledge score achieved by athletes on the questionnaire was 5.03±3.06, with only 8.5 % of athletes achieving a knowledge score of 10 or above. Hormonal contraceptive use and ‘identifying as an individual athlete’ were two factors that were significantly associated with overall knowledge score (p≤0.004), with current hormonal contraceptive users and individual athletes scoring 1.79 and 1.66 points on average higher than non-users and team sport athletes, respectively. ConclusionsOur findings indicate that knowledge surrounding the menstrual cycle and oral contraceptives was low in most elite athletes. Further education is warranted to enable athletes to make informed decisions regarding hormonal contraception, and any educational interventions should be implemented across all athlete groups.