Combined Oral Contraceptives Research Articles

Assessment of Quadriceps Muscle Strength and Thickness in Adolescents with Polycystic Ovary Syndrome: A Case-control and Longitudinal Follow-up Study.

No studies have investigated muscle strength and thickness in adolescents with polycystic ovary syndrome (PCOS). We investigated whether there were changes in quadriceps muscle thickness and strength between adolescents with PCOS and controls. Secondly, we evaluated the effects of six months of combined oral contraceptive (COC) treatment on the quadriceps muscle. The study included 20 adolescents with PCOS and 20 healthy adolescents. The isokinetic dynamometer for the knee muscle strengths and hand dynamometer for grip strength, and ultrasound for quadriceps muscle thickness were used. These measurements were repeated after six months of COCs treatment in the patient group. Age, weight, height, pubertal stage, Physical Activity Questionnaire scores, quadriceps muscle thickness, grip strength and all isokinetic knee strength values were similar between patients and controls (all p>0.05). Compared to baseline, weight, height, quadriceps strength and lipid profile increased (all p<0.05). According to subgroup analyses, significant (and greater) increases in quadriceps muscle strength were found in COC-containing levonorgestrel users (n=6) than in cyproterone acetate users (n=13) (both p<0.05). Quadriceps muscle thickness and strength values were similar between PCOS patients and controls. Significant and greater increases were observed in quadriceps muscle strength in levonorgestrel users than cyproterone acetate users. Further longitudinal studies with larger samples evaluating the COCs with different androgenic capacity are awaited to confirm our preliminary findings.

Clinical effectiveness of progestogens compared to combined oral contraceptive pills in the treatment of endometriosis: A systematic review and meta-analysis.

Endometriosis involves the growth of endometrium-like cells outside the uterus, affecting reproductive-aged women. Symptoms such as dysmenorrhea, pelvic pain, and infertility significantly impair quality of life. Among therapeutic options, progestogens have demonstrated efficacy in managing pain and reducing recurrence rates. This study aimed to compare the clinical effectiveness of progestogens versus combined oral contraceptive pills in alleviating pelvic pain, dyspareunia, dysmenorrhea, and associated side effects. A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Cochrane Central Register of Controlled Trials, with the last search conducted in October 2024. The review was registered under PROSPERO registration number CRD42024609658. Studies were included regardless of language, publication year, or country. Articles not comparing progestogens and combined oral contraceptives or lacking relevant outcomes were excluded, as were abstracts, theses, case reports, opinion pieces, and correspondence. Risk of bias was assessed using the modified Cochrane Risk of Bias tool 2.0 for randomized studies. Seven studies, including 948 patients (476 receiving progestogens), met inclusion criteria. The meta-analysis found no significant differences between progestogens and COCPs for pelvic pain (SMD = 0.02; 95% CI: -0.37 to 0.40; P = 0.04; I2=66.7%), dysmenorrhea (SMD = 0.00; 95% CI: -0.19 to 0.19), dyspareunia (SMD = 0.21; 95% CI: -0.42 to 0.85; P = 0.02; I2=81.4%), or psychological health (SMD = 0.01; 95% CI: -0.21 to 0.23; P = 0.19; I2=39.1%). Similarly, no significant differences were observed in side effects, including breast tenderness, weight gain, amenorrhea, and bleeding. Progestogens and COCPs demonstrate comparable efficacy in managing pelvic pain, dysmenorrhea, dyspareunia, and psychological health, with similar side effect profiles. These findings suggest both treatments are equally effective options for symptom management in endometriosis.

A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management.

Recent research has proven that peripheral (PS) and central sensitization (CS), mental health, and myofascial dysfunction all play a role, alongside nociception, in the genesis and in the perpetuation of endometriosis' symptoms. However, such components of pain are still largely ignored in clinical practice, although not considering such contributors may entail serious consequences on women's health, including the choice of unnecessary surgery and leaving the real causes of pain untreated. At the present time, we are facing a paradox by which 25-40% of women who undergo laparoscopic surgery for pelvic pain do not have an obvious diagnosis, while the percentage of women with endometriosis who have signs of CS, of depressive or anxiety disorders, or who have an increased pelvic muscle tone ammounts to 41-55%, 15-88% and 28-73%, respectively. Moving from the widely-accepted stepwise approach suggested for endometriosis management, which consists in the initial prescription of low-dose combined oral contraceptives (COCs) or of a progestin monotherapy, followed by GnRH analogues and, ultimately, by surgery, when COCs and progestins have proven ineffective or are not tolerated or contraindicated, we propose an integration of such model which takes into account the identification and the simultaneous treatment of all pain contributors. Our objective is to encourage physicians' awareness of the need of a multidisciplinary, multimodal approach to endometriosis-related pain, and ultimately to promote a reduction in the number of unnecessary surgeries.

Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists.

Acne impairs quality of life, often leads to permanent scars, and causes psychological distress. This review aims to update dermatologists on the Federal Drug Administration (FDA)-approved and off-label use of combined oral contraceptives (COC), clascoterone, spironolactone, and emerging hormonal therapies for acne treatment. We reviewed current literature on hormonal acne treatments and discussed common patient concerns, barriers to care, and individualized care needs. Different brands and dosings of COC have generally similar efficacy in treating acne. Dermatologists should discuss contraceptive options and provide individualized shared decision-making with patients based on patient preferences, contraceptive needs, comorbidity profile, access, and cost. Spironolactone is an effective acne treatment with clinical trial data to support its use as a first-line acne treatment for women with acne. Potassium monitoring is of low value for patients on spironolactone unless patients have specific risk factors for hyperkalemia. Clascoterone is a safe and effective topical anti-androgen for the treatment of acne in men and women with limited systemic effects on reproductive hormones. Hormonal therapies are essential strategies to treat acne. Clinicians should expand the use of existing and emerging hormone therapy as part of their acne treatment strategies.

Comparative study on the effects of combined oral contraceptives and dienogest in women with endometriosis‑associated chronic pelvic pain.

To compare the effects of five combined oral contraceptives (COCs) - ethinylestradiol (EE) 30μg/dienogest (DNG) 2mg, EE 20μg/drospirenone (DRSP) 3mg, 17β-estradiol (E2) 1.5mg/nomegestrol acetate (NomAc) 2.5mg,estetrol (E4) 15mg/DRSP 3mg and estradiol valerate (E2V)/DNG - and DNG 2mg daily in women with endometriosis-associated chronic pelvic pain (CPP), dysmenorrhea and dyspareunia. This study was performed from October 2018 to March 2023. A database was set up to collect data from women in each of the six treatment groups. The level of endometriotic pain was measured using a visual analogue scale (VAS). Follow-up was performed at 3 and 6months. The intragroup analysis showed an improvement in the VAS score from baseline to 6-month follow-up for each group (p<0.001). Intergroup analysis showed that women on COCs containing E2 or E4 had a greater improvement in CCP than women on COCs containing EE (at 3months, p≤0.001; at 6months, p≤0.009). Women on E4 15mg/DRSP 3mg showed a similar improvement to women on DNG at both 3- and 6-month follow-up, and greater improvement compared with women on COCs containing E2 at 6-month follow-up (p=0.02). Greater improvement in dysmenorrhea and dyspareunia was seen in women on COCs containing E2 and E4, and DNG compared with women on COCs containing EE (p≤0.001). COCs containing E2 or E4 could be a better treatment for women with endometriosis-associated pain than COCs containing EE. They may represent a suitable alternative to the use of DNG, particularly for women who do not want to become pregnant.

Preoperative Medication for Ovarian Endometrioma Reduces Cyst Size and PainBut Not rASRM score.

To investigate the impact of preoperative hormonal medication, including combined oral contraceptives (COCs) or dienogest, on operative findings in ovarian endometrioma surgery. A single-center, retrospective study. Department of Gynecology, Samsung Medical Center, Republic of Korea. Among patients who underwent ovarian endometrioma surgery for the first time at Samsung Medical Center between January 2020 and July 2023, those who started hormonal medication at another institution before their initial visit to our center, those with a waiting period of less than three months until the surgery date, and those with an endometrioma size of less than 4cm at the initial visit were excluded. A total 140 remaining patients were included in the study. The patients were divided into two groups: the group that received preoperative hormonal medication (COCs or dienogest) and the group that did not receive medication. To evaluate the impacts of preoperative hormonal medication on ovarian endometrioma patients, the operative findings were compared between the groups. Of the140 patients, 65 were in the no-medication group and 75 were in the medication group. Except for the median duration of follow-up and age, there were no differences in the baseline characteristics between the two groups. Operative findings were quantified using the revised American Society for Reproductive Medicine (rASRM) score. Although medication significantly reduced the size of the ovarian endometrioma, there were no significant differences in rASRM score between the two groups. However, the medication group experienced significant preoperative pain relief. Preoperative hormonal medication can reduce the size of ovarian endometriomas but does not significantly affect the overall operative findings. Nevertheless, preoperative medication is helpful in reducing pain in patients before surgery.

The relationship between hormonal contraceptives, level of anxiety and emotional awareness: pilot project.

An important part of the side effects of combined oral contraceptives (COC) usage is its psychological impact, which includes mood changes, anxiousness and depression. The psychological impacts are expected to be caused by physiological fluctuations of sex hormone levels during the menstrual cycle; this cycling is, however, suppressed in COC users. In our study, we assessed the differences in emotional awareness and anxiousness between women long term users of anti-androgenic COC (AA) and women with no COC use in their medical history (C). We also searched for intraindividual differences by comparing the results of both groups for the follicular and luteal phase of their cycle. A total of 45 women aged 18 to 22 participated in this study. The respondents were given our battery of questionnaires at the beginning of their follicular phase - this battery included two State-Trait Anxiety Inventory questionnaires (STAI-I, STAI-II), as well as a Levels of Emotional Awareness Scale (LEAS) test. The respondents were given only STAI-I in their luteal phase. We also analyzed the hormonal profile of our respondents. Our results show a significant difference in the LEAS analysis, implying the possibility of altered emotional awareness in AA group. STAI-I and STAI-II analysis did not yield any significant results, showing that anxiety levels of COC users probably do not differ from the general female population. We therefore discovered lower emotional awareness in COC using women (AA). Key words LEAS, STAI, Combined oral contraceptives, Anxiety, Hormonal profile.

ANALYSIS OF THE ASSORTMENT OF COMBINED ORAL CONTRACEPTIVES REGISTERED ON THE PHARMACEUTICAL MARKET OF UKRAINE AND ASSESSMENT OF THEIR SOCIO-ECONOMIC AVAILABILITY

Combined oral contraceptives (COCs) are a group of medications widely used by women of reproductive age worldwide that contain progestin and estrogen or progestin alone. COCs remain one of the most common contraceptive methods used by women of reproductive age, with approximately 151 million users worldwide. The aim of the work was to research the range of combined oral contraceptives (COC) registered on the pharmaceutical market of Ukraine and to assess their socio-economic availability using the example of AKS Pharmacy No. 55 (Odesa, 162/2 Kostandi St.) for the year 2023. Research materials and methods. Analytical (data from the State Register of Medicinal Products and the search system tabletki.ua) and pharmacoeconomic (estimation of economic availability based on the indicator of adequacy of solvency Ca. s) research methods were used. Results and discussion. It was established that as of May 15, 2024, 36 trade names (TN) of COC preparations of foreign production were registered in Ukraine. The lion's share of the market is represented by IV generation COCs - 60% of the total assortment. 3rd, 2nd and 1st generation COCs account for 23, 14 and 3% of TN drugs, respectively. The type of composition containing only progestin is represented by 2 TN preparations. It was noted that among 12 TN COC drugs - "Regulon No. 3*21" tablets; "Femoston 1/10 No. 56" tablets and "Rygevidon No. 63" tablets belong to the middle range (Ca. s. = 6,5-7,5 %). All the other 9 TN COCs belong to the high range (Ca. s. less than 5 %). Conclusions. The range of combined oral contraceptives registered in the pharmaceutical market of Ukraine is completely provided by imported manufacturers, and according to the results of socio-economic availability of COCs it was established that these drugs belong to the category of high and medium availability.

UPDATE ON MEDICAL TREATMENT OF ENDOMETRIOSIS: NEW DRUGS OR NEW THERAPEUTIC APPROACHES?

No conceptually new drugs for the safe and successful cure of endometriosis are likely to become available soon. Hormonal modulation of ovarian function and suppression of menstruation remain the pillars of disease control. However, existing drugs may be used following novel modalities to limit the consequences of endometriosis progression. To propose a pharmacological approach aimed at limiting the potential detrimental effects of the recent dramatic increase in postmenarcheal repetitive ovulatory menses and to define the type of hormones and the routes of administration that can be used to maximize safety and tolerability in the medical treatment of endometriosis. For this narrative review, we selected the best quality evidence, prioritizing RCTs, systematic reviews, meta-analyses, network meta-analyses, and international guidelines, preferably published in the last decade. Medical treatment of endometriosis should be included into all aspects of prevention. Very-low-dose combined oral contraceptives can be used for years to counteract the increased risk of ovarian cancer observed in patients with endometriosis. This primary prevention measure saves lives and can effectively integrate targeted risk-reducing surgery. Secondary pharmacological prevention, based on a working diagnosis of early-onset adenomyosis-endometriosis selectively in adolescents with severe dysmenorrhea and heavy menstrual bleeding, can potentially impede the development of advanced disease forms, and reduce the need for management of complications due to a delay in diagnosis and treatment. Tertiary prevention, i.e., medical therapy of established disease, is based initially on the safest available estrogen-progestogen combinations and progestogen monotherapies. Whenever possible, ethinyl estradiol and cyproterone acetate should be avoided because of thromboembolic and meningioma risks, respectively. Estradiol can be administered transdermally. Switching to GnRH agonists and antagonists should not be delayed when first-line agents fail. Two-thirds of symptomatic endometriosis patients can be managed satisfactorily for many years using, with the right modality, the existing safe, effective, and well-tolerated medications. Despite the constant plea for new drugs, this already appears to be an excellent clinical outcome, unsurpassed in managing other human chronic inflammatory diseases. Cohort studies are needed to verify whether turning off the recurrent inflammation caused by repeated ovulation and menstruation could also affect the risk of systemic conditions associated with endometriosis.

Impact of progestin type on the risk of drug interactions between combined oral contraceptives and psychotropic drugs: A pooled analysis of real-world data.

To assess the risk of contraceptive failure and adverse events (AEs) associated with the type of progestin when coadministered with psychotropic drugs within a routine clinical practice setting. A pooled analysis of four large, prospective, multinational cohort studies including women with a new prescription of combined oral contraceptives (COCs) and concomitant psychotropic drug use from 13 European countries and the United States. We determined the frequency of contraceptive failures and AEs within 6months after COC initiation by progestin type. Furthermore, we calculated crude and propensity score weighted incidence rate ratioswith corresponding 95% confidence intervalsvia Poisson regression. Covariates used for propensity score estimation included age, body mass index, smoking, medical history, history of hormonal contraceptive use, and education level. Our analysis comprised 7679 COC users reporting psychotropic drug use at baseline. The most common progestin type was drospirenone (30.0%) followed by norethisterone acetate/norethindrone acetate (20.5%), levonorgestrel (17.3%), norgestimate (11.6%), norethindrone (5.7%), nomegestrol/nomegestrol acetate (5.6%), desogestrel (4.9%), and dienogest (4.4%). Overall, 39 (0.5%) contraceptive failures and 156 (2.0%) AEs occurred within the first 6months of follow-up. Head-to-head comparison of different progestins against levonorgestrel regarding AEs showed a significantly lower risk for drospirenone (weighted incidence rate ratio 0.5, 95% confidence interval [0.3-0.9]), while no difference was observed for other progestins. Among women using psychotropic drugs, drospirenone was associated with a lower risk of AEs compared to levonorgestrel, while other progestins showed no significant differences. The number of contraceptive failures was low across progestins. Compared to levonorgestrel, drospirenone has shown a reduced risk of adverse events when coadministered with psychotropic drugs, whereas other common progestins showed no significant differences. Contraceptive failures were rare across progestins. This analysis provides valuable real-world data on potential drug interactions and may be used for future updates of evidence-based guidelines on contraception.

Lack of Clinically Meaningful Effect of Cariprazine on the Pharmacokinetics of a Combined Oral Contraceptive.

Cariprazine (CAR) is a potent dopamine receptor partial agonist antipsychotic approved by the EMA and the FDA. To address the uncertainty regarding the effectiveness of hormonal contraceptives during CAR co-administration and whether a second barrier method is necessary, a drug-drug interaction study with an oral contraceptive was conducted post-approval. The phaseI, fixed-sequence multicenter study involved two periods with 24 patients with schizophrenia, aiming to evaluate the effect of CAR on the pharmacokinetics (PK) of a combined oral contraceptive (COC) containing 30μg ethinylestradiol (EE) and 150μg levonorgestrel (LNG). In periodA, a single dose of COC alone was administered on day1. In periodB, the highest therapeutic dose of 6mg CAR was administered once daily from day4, and a second dose of COC was given concomitantly on day31. Overall, CAR had no clinically meaningful effect on the PK of the COC. The terminal half-life and the time of maximum plasma concentration of EE and LNG were not altered by CAR co-administration. The highest difference observed was a decrease of 14% in the maximum plasma concentration of EE, with only slight deviation of the 90% confidence interval (CI) of the test/reference ratio (77.09-96.81) from the generally accepted bioequivalence range of 80-125%, which is not considered clinically relevant. Confidence intervals of all other exposure measures were within the 80-125% range for both EE and LNG. According to these results, hormonal contraceptives can be considered effective during CAR treatment. Trial registration number (EudraCT) 2018-003722-80.

Venous Thromboembolism at Low Risk of Recurrence in Young Women: Stress and Violence Associated with Recurrence. An International Case-Control Study.

In young women with venous thromboembolism (VTE) related to weak transient risk factors, it remains unknown whether stress levels and intimate partner violence (IPV) are associated with recurrence. The VTE-WEAK study aims to investigate the association between perceived stress and IPV with a recurrence of VTE in women with a first episode of VTE due to combined oral contraceptives, pregnancy-puerperium, minor trauma/fracture, brief surgery, infection or brief immobility, and not using antithrombotic prophylaxis. We performed a multicenter, international, observational, retrospective study on women referred for thrombophilia screening who were subsequently monitored. Patients were aged 18 to 55 years old and free of high-risk thrombophilia. When a recurrence of VTE was suspected for the first time, the perceived stress level and IPV were evaluated using self-administrated PSS-10 and Woman Abuse Screening Tool (WAST) questionnaires. We monitored 7,754 women over 43,880 patients-years. A first suspected recurrence occurred in 4,772 women, among whom 1,316 had an objectively confirmed recurrence. The perceived stress level and an IPV situation were both independent risk factors for recurrence: moderate stress: adjusted odds ratio (aOR) 1.630 (1.415-2.468); high perceived stress: aOR 10.03 (7.528-13.36); IPV: 1.953 (1.546-2.468), p < 0.0001. The perceived level of stress and IPV are associated with a recurrence of VTE when suspected. The mechanisms and clinical consequences of a possible stress coagulopathy require investigation.

Effect of Low-Dose Hormone Therapy on Metabolic Parameters and Bone Mineral Density

OBJECTIVE: Early menopause causes several health concerns that are related directly to the deficiency of ovarian hormones, especially estrogen insufficiency. The purpose of the research was to investigate the impact of low-dose hormone therapy on metabolic parameters and bone densitometry in patients with early menopause. STUDY DESIGN: A total of 98 patients aged 38-42 years with an early-menopause and followed up were evaluated retrospectively in this cohort study. After the diagnosis of early menopause, combined oral contraceptive (COC) treatment including 3 mg Drospirenone + 0.02 mg Ethinylestradiol was recommended to the patients. After 1 year of COC treatment, metabolic, ultrasonographic, and bone densitometry measurements of patients who did and did not use COC regularly were compared. RESULTS: At the 12th-month follow-up, endometrial thickness was significantly higher in the COC group (3.8±0.4 mm) compared with the non-COC group (3.5±0.4 mm) (p&lt;0.01). At the 12th month follow-up, the estradiol value was significantly higher (16.1±1.5 pg/mL) in the COC group compared with the non-COC group (14.8±2.5 pg/mL) (p&lt;0.01). At the 12th month follow-up, the total cholesterol value was found significantly lower in the COC group (197±24.2 mg/dL) compared with the non-COC group (211±28 mg/dL) (p&lt;0.01). At the 12th month follow-up, the Z-score was found significantly higher in the COC group (0.02±0.3) compared with the non-COC group (0.2±0.3) (p&lt;0.01). CONCLUSION: Hormone replacement therapy is very important for women who enter early menopause, and adequate estrogen therapy must be taken to maintain bone density and reduce menopausal symptoms.

Thromboembolic events associated with combined oral contraceptives: a real-world study based on the FDA adverse event reporting system (FAERS) database

ABSTRACT Background The clinical characteristics and time-to-onset of thromboembolic events (TEEs) associated with combined oral contraceptives (COCs) remain unclear, our current study was committed to providing more data for risk evaluation and management of COCs treatment. Research design and methods This pharmacovigilance study was conducted in the FAERS database. We evaluated significant pharmacovigilance signals by using disproportionality analysis. The Weibull shape parameter test was used to analyze the time-to-onset of TEEs. Results A total of 25,080 adverse events were involved in this study. Overall COCs were significantly related to venous thromboembolism (VTE) events. Levonorgestrel, desogestrel, and drospirenone containing COCs were significantly associated with arterial thromboembolism (ATE) besides norethisterone containing COCs. Drospirenone containing COCs associated with TEEs had the highest reporting frequencies (n = 22868, 91.18%). The most-mentioned PT was pulmonary embolism (n = 9244, 36.86%). The median time-to-onset of all TEEs was 264 days, the median time-to-onset of VTE was 258.0 days, shorter than ATE (344.0 days). The Weibull shape parameter test results showed that all of the disproportionality signals had early failure-type features. Conclusions This study found an increased risk of TEEs treated with COCs, particularly with drospirenone. We should pay close attention to risk monitor on the treatment of early stages.

Mood lability and depression limit oral contraceptive therapy in endometriosis.

To determine the impact of oral contraceptive (OC) induced mood lability/depression on treatment maintenance in women with endometriosis. Women with endometriosis were retrospectively identified through International Classification of Diseases-10 codes and then a comprehensive electronic medical record review was conducted, identifying mood lability/depression as a reason for treatment discontinuation with the use of combined or progestin-only oral contraceptives. 2,682 women with endometriosis, between the ages of 18-45 treated in a university affiliated hospital between 2012-2024. Use of combined or progestin-only oral contraceptives in patients with endometriosis. The primary outcome was oral contraceptive discontinuation due to mood lability/depression in women with endometriosis. The secondary outcome assessed whether patients with a documented diagnosis of depression were more prone to discontinuing OC use due to mood lability. Mood lability/depression as a side effect of OC use was more common in women with endometriosis and increased the likelihood of discontinuing OCs. Overall, 44.2% of women with endometriosis and treated with OCs discontinued their use. The depression prevalence in our study cohort was 33.6%. Among those who discontinued, 33.9% attributed their discontinuation to mood lability/depression. Of those who discontinued OC use due to mood lability, 52.7% had a diagnosis of depression, a higher rate than those who discontinued OC use for other reasons or did not stop using OCs. There was no difference in OC discontinuation due to side effects comparing combination oral contraceptives to progestin-only oral contraceptives. Similarly, the type of progestin prescribed did not influence the OC discontinuation among those who experienced mood lability/depression. Women with endometriosis had an increased incidence of depression and a greater likelihood of discontinuing OCs when they experienced mood lability or depression. Mood lability played a significant role in OC discontinuation. The effect of oral contraceptive on mood lability/depression did not differ by the type of progestin. In patients with endometriosis at risk of depression, or who develop mood changes on oral contraceptives, other therapies that are typically considered second line should be considered early in the course of treatment.

Impact of energy balance on polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of repro­duc­tive age , affecting one in five women worldwide . Overweight and obesity increase the prevalence of PCOS, which together with dyslipidemia is con­si­dered to be the dominant feature in 40 to 60% of cases. Diagnostic criteria include irregular menstrua­tion, androgen excess, and/or polycystic ovaries, with long-term consequences being hyperinsu­line­mia and infertility. Many studies suggest that met­formine and oral contraceptive combinations are com­monly prescribed to alleviate reproductive com­plaints; However, for overweight and obese patients planning pregnancy, weight loss of 5 to 10% through lifestyle modification is recommended as first-line treatment .

Influence of menstrual- and hormonal contraceptive cycle on self-reported symptom severity and recovery measures across an annual season in female endurance athletes: The FENDURA project

ABSTRACT This longitudinal study investigated 1) differences in self-reported cycle-related symptom severity and recovery measures (sleep quality, readiness to train, resting heart rate) between pre-bleeding, bleeding, and non-bleeding days in athletes using/not using hormonal contraception (HC); 2) associations between symptom severity and recovery measures. Fifty-eight female endurance athletes recorded recovery measures, perceived symptom severity, and menstruation/withdrawal (bleeding) days for one year. Athletes were grouped as: intrauterine system (IUS)-, implant-, progestin-only oral contraceptive (POC)-, combined oral contraceptive (COC)- and non-HC users. All groups reported higher symptom severity during bleeding compared to pre-bleeding and non-bleeding days (both p < .001), while implant users reported less severe symptoms than IUS (p < .001) and non-HC users (p = .008). Perceived sleep quality was lower during pre-bleeding compared to bleeding days (p < .001) for all groups. However, IUS users reported higher sleep quality (p = .039) and physical readiness-to-train (p = .010) than non-HC users. Symptom severity was negatively associated with sleep quality and physical readiness-to-train (both p < .050). Pre-bleeding days and cycle-related symptom severity were found to negatively influence self-reported recovery measures in both HC- and non-HC users. Therefore, athletes and their support staff are advised to prioritize symptom management and the adjustment of recovery strategies on an individual basis throughout the athletes’ cycles.

Surrogate Indexes of Insulin Resistance Are Affected by Sex and Gender and by the Combination of Smoking and Oral Contraceptives

Surrogate Indexes of Insulin Resistance Are Affected by Sex and Gender and by the Combination of Smoking and Oral Contraceptives

Cost-effectiveness of long-acting progestogens versus the combined oral contraceptives pill for preventing recurrence of endometriosis-related pain following surgery: an economic evaluation alongside the PRE-EMPT trial

ObjectivesTo evaluate the cost-effectiveness of long-acting progestogens (LAP), including levonorgestrel-releasing intrauterine system (LNG-IUS) and depot-medroxyprogesterone acetate (DMPA), compared with the combined oral contraceptives pill (COCP) in preventing recurrence of endometriosis-related...

Management of Endometriosis-Related Pain: Comparing the Effectiveness of Hormonal Therapy, Surgical Interventions, and Complementary Therapies.

Endometriosis is a chronic, inflammatory disease characterized by the presence of endometrial-like tissue outside the uterus, affecting women of reproductive age. It is linked with debilitating pain, infertility, and a notable impact on the patient's quality of life. This review aims to highlight the effectiveness of hormonal therapy, surgical procedures, and complementary therapies in managing endometriosis-related pain, providing a comprehensive overview of current treatment options and their implications for clinical practice. The literature reveals that hormonal therapies, including combined oral contraceptives, progestins, and gonadotropin-releasing hormone(GnRH) agonists, are frequently used to manage endometriosis-related pain by suppressing ovarian function and reducing menstrual flow. Surgical interventions, such as laparoscopy and hysterectomy, offer pain relief by removing endometrial lesions but carry risks of recurrence and complications. Complementary therapies, including acupuncture, dietary modifications, and physical therapy, are increasingly recognized for their potential to minimize pain and improve patients' quality of life, though evidence of their effectiveness varies. The review highlights the need for personalized treatment plans that consider patient preferences, symptom severity, and reproductive goals. Future research should concentrate on the long-term outcomes of different therapies, the advancement of non-invasive diagnostic methods, and the identification of biomarkers for tailored treatment approaches. Clinicians are encouraged to adopt an interdisciplinary approach to endometriosis management, integrating medical, surgical, and complementary therapies to optimize patient outcomes.