non-HC Users Research Articles

Women’s preferences for menstrual bleeding frequency in 12 European countries: the Inconvenience Due to Women’s Monthly Bleeding (ISY) survey

Objectives: Our aim was to assess the level of inconvenience associated with menstrual bleeding and determine how many women across 12 European countries would prefer a bleeding frequency of less than once a month and what would motivate their choice.Methods: A 15-min quantitative online survey was conducted in two waves among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989). The first wave was carried out in Austria, Belgium, France, Italy, Poland and Spain, in February 2015, and the results have been published. The second wave was conducted in the Czech Republic, Germany, Hungary, Portugal, Latvia and the Netherlands, between August and September 2015.Results: The menstrual period was significantly longer (5.0 versus 4.6 days) and heavier (15 versus 7%) in non-HC users than in CHC users (p < .0001). Given the choice, ∼60% of women would like less frequent menstrual bleeding. There was heterogeneity in the preference across countries. Sexuality, social life, work and sporting activities were key factors affecting women’s preference.Conclusion: The majority of women in the 12 European countries would prefer to reduce the frequency of menstrual periods. Quality of life was the main factor affecting their preference.

Prediction value of anti-Mullerian hormone (AMH) serum levels and antral follicle count (AFC) in hormonal contraceptive (HC) users and non-HC users undergoing IVF-PGD treatment

Use of hormone contraceptives (HC) is very popular in the reproductive age and, therefore, evaluation of ovarian reserve would be a useful tool to accurately evaluate the reproductive potential in HC users. We conducted a retrospective cohort study of 41 HC users compared to 57 non-HC users undergoing IVF-preimplantation genetic diagnosis (PGD) aiming to evaluate the effect of HC on the levels of anti-Mullerian hormone (AMH), small (2–5 mm), large (6–10 mm) and total antral follicle count (AFC) and the ability of these markers to predict IVF outcome. Significant differences in large AFC (p = 0.04) and ovarian volume (p < 0.0001) were seen, however, there were no significant differences in small and total AFC or in serum AMH and FSH levels. Oocyte number significantly correlated with AMH and total AFC in HC users (p < 0.001) while in non-HC users these correlations were weaker. In HC users, the significant predictors of achieving <6 and >18 oocytes were AFC (ROC-AUC; 0.958, p = 0.001 and 0.883, p = 0.001) and AMH (ROC-AUC-0.858, p = 0.01 and 0.878, p = 0.001), respectively. The predictive values were less significant in non-HC users. These findings are important in women treated for PGD, in ovum donors and for assessing the fertility prognosis in women using HC and wishing to postpone pregnancy.

Could misreporting of condom use explain the observed association between injectable hormonal contraceptives and HIV acquisition risk?

ObjectiveSome observational studies have suggested an association between the use of hormonal contraceptives (HC) and HIV acquisition. One major concern is that differential misreporting of sexual behavior between HC users and nonusers may generate artificially inflated risk estimates. Study designWe developed an individual-based model that simulates the South African HIV serodiscordant couples analyzed for HC–HIV risk by Heffron et al. (2012). We varied the pattern of misreporting condom use between HC users and nonusers and reproduced the trial data under the assumption that HC use is not associated with HIV risk. The simulated data were analyzed using Cox proportional hazards models, adjusting for the reported level of condom use. ResultsIf HC users overreport condom use more than nonusers, an apparent excess risk could be observed even without any biological effect of HC on HIV acquisition. With 45% overreporting by HC users (i.e., 9 out of every 20 sex acts reported with condoms are actually unprotected) and accurate condom reporting by nonusers, a true null effect can be inflated to give an observed hazard ratio (HR̂) of 2.0. In a different population with lower overall reported condom use, artificially high HR̂s can only be generated if non-HC users underreport condom use. ConclusionDifferential condom misreporting can theoretically produce inflated HR̂ values for an association between HC and HIV even without a true association. However, to produce a doubling of HIV risk that is entirely spurious requires substantially different levels of misreporting among HC users and nonusers, which may be unrealistic. ImplicationsConsiderably differential amounts of condom use misreporting by HC users and nonusers would be needed to produce entirely spurious observed levels of excess HIV acquisition risk among HC users when there is actually no true association.

Women’s preferences for menstrual bleeding frequency: results of the Inconvenience Due to Women’s Monthly Bleeding (ISY) survey

Objectives: Our aim was to assess the level of inconvenience associated with monthly bleeding, determine how many women would prefer a bleeding frequency of less than once a month, and what would motivate their choice. Methods: A 15-min quantitative online survey was carried out among 2883 women aged between 18 and 45 years in six European countries (Austria, Belgium, France, Italy, Poland and Spain). Results: Of those surveyed, 1319 women used a combined hormonal contraceptive (CHC group) and 1564 used a non-hormonal contraceptive or no contraceptive (non-HC group). The menstrual period was significantly longer (5 vs. 4.5 days), heavier (16% vs. 8% heavy menstrual flow) and associated with more symptoms (6.1 vs. 5.6) in non-HC users than in CHC users (p < 0.0001). More than half of the women in each group reported pelvic pain, bloating/swelling, mood swings and irritability, but the rate was significantly higher in the non-HC group. Given the choice, 57% of women in both groups said they would opt for longer intervals between periods. Sexuality, social life, work and sporting activities were key factors affecting their decision. Conclusions: The majority of women would prefer to have menstrual periods less than once a month, with a frequency ranging from once every 3 months to no periods at all. This can be explained by the desire to avoid the unpleasant aspects of menstruation and its negative impact on private and professional life.

Combined Hormonal Contraception and Women’s sexual function: a cross-sectional pilot study in a Cohort of Danish women

Objective: To investigate the relationship between combined hormonal contraception (CHC) and women’s sexual function with special emphasis on the type of progestin in the CHC Methods: A community sample of 252 healthy, sexually active women aged 18 to 35 completed a questionnaire including the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and questions about contraception use. Participants were divided into 151 users of CHC, also subdivided into progestin-type subgroups, and 101 users of non-hormonal or no contraception (non-HC). Results: Significantly fewer women using CHC reported sexual distress (p=0.038) compared to non-HC users, but the number reporting sexual problems did not differ (p=0.081). In subgroup analyses, significantly fewer women in the ‘other progestin’-CHC group reported sexual problems (p<0.001) and sexual distress (p=0.008) compared to women in the anti-androgenic progestin-CHC group. Significantly, fewer women in the ‘other progestin’-CHC group reported sexual problems (p=0.003) and sexual distress (p=0.006) versus women in the non-HC group. Results remained significant after controlling for age, relationship, children living at home, alcohol consumption, and smoking. Conclusions: Women using CHC containing anti-androgenic progestins more often reported sexual problems and sexual distress than women using CHC with other types of progestins.

P2-S1.08 Dual contraceptive use among adolescents and young adults: correlates and implications for condom use and STI outcomes

BackgroundSimultaneous use of condoms and other contraceptive methods (“dual use”) provides the maximum protection against unintended pregnancies and sexually transmitted disease (STD). Some studies show condom use wanes among dual...

Effect of Hormonal Contraceptive Use Before HIV Seroconversion on Viral Load Setpoint Among Women in Rakai, Uganda

High viral load (VL) setpoint is a marker for rapid HIV progression. Few studies have examined whether use of hormonal contraception (HC) prior to HIV seroconversion affects VL setpoint. We determined VL setpoints in 285 HIV seroconverters using blood samples collected 6 months or more after estimated HIV seroconversion but before disease progression to CD4 ≤ 250 or WHO Stage 3 or 4. We used multivariate linear regression to estimate the effect of HC use before HIV seroconversion on VL setpoint, and multivariate Cox regression to estimate the hazards ratio of death associated with VL setpoint. Of 285 women, 42 (15%) reported using HC before HIV seroconversion. Mean VL setpoint was 4.49 (SD 0.79) log10 copies per milliliter among women who used HC before HIV seroconversion and 4.47 (SD 0.86) among non-HC users (P = 0.88). In multivariate analysis, HC before HIV seroconversion was not associated with VL setpoint (+0.11 log10 copies/mL; P = 0.47). Higher socioeconomic status was associated with lower VL setpoint (-0.43 log10 copies/mL; P = 0.04). VL setpoints above the median were associated with faster time to death (adjHR: 2.54, 95% confidence interval: 1.30 to 4.98, P < 0.01). Use of HC before HIV seroconversion was not associated with elevated VL setpoint.

Long Term Ingestion of Hormonal Contraceptive Agents – The Exogenous Factor for the Increased Generation of Reactive Oxygen Species (ROS)?

In three different in-vivo studies the formation of reactive oxygen species (ROS) was investigated utilizing the blood of healthy women who use hormonal contraception (HC) and a control group of non-HC users. ROS were quantified by a validated, commercially available photometric kit. In the first study ROS were measured in blood of women from various regions of the Austrian territory. The findings revealed that women using HC had significantly higher ROS levels in the blood (mean 572 + 136 FORT; one FORT unit represents 0,26 mg hydrogen peroxide per litre) than the non-HC group, HC (347 + 80 FORT). In the second study, ROS from female students of pharmacy were measured. The results were similar to the first investigation: 519 + 92 FORT in the group using HC and 331 + 68 FORT in the controlled non-HC group. These outcomes are statistically significant (p

Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection

The use of hormonal contraception (HC) is increasing in HIV-infected women. Both HC and HIV infection have been associated with adverse metabolic outcomes. We investigated the association of progestin-only and combined (estrogen/progestin) HC with disorders of glucose and lipid metabolism in HIV-infected and uninfected women. Linear mixed models evaluated the association of HC type with fasting high density lipoprotein, low density lipoprotein, triglycerides, the homeostasis model assessment estimate of insulin resistance (HOMA-IR), and glucose in 885 HIV-infected and 408 HIV-uninfected women from the Women's Interagency HIV Study seen between October 2000 and September 2005. Compared with non-HC users, progestin-only HC was independently associated with lower HDL [-3 mg/dL; 95% confidence interval (CI) -5, -1 in HIV-infected and -6 mg/dL; 95% CI: -9, -3 in HIV-uninfected women] and greater HOMA-IR (+0.86; 95% CI: 0.51-1.22 and +0.56; 95% CI: 0.12-1.01). Combined HC was associated with higher HDL (+5 mg/dL; 95% CI: 2-7 and +5 mg/dL; 95% CI: 3-7). HIV-infected women using progestin-only HC have lower HDL and greater HOMA-IR than HIV-infected non-HC users. Combined HC may be preferred in HIV-infected women of reproductive age at risk for cardiovascular disease, but interactions with antiretroviral therapy that may impair contraceptive efficacy have been reported. Alternative HC methods that minimize adverse outcomes but maintain efficacy require further study.