Oral Contraceptive Pill Users Research Articles

Comparison of resumption of ovulation after cessation of oral contraceptives and medroxyprogesterone acetate in women with polycystic ovary syndrome

Objective Both oral contraceptive pills (OCPs) and cyclic medroxyprogesterone acetate (MPA) are widely used to control menstrual abnormalities in women with polycystic ovary syndrome (PCOS). We aimed to evaluate the chance of ovulation resumption after cessation of OCPs and MPA in women with PCOS. Methods A retrospective study was conducted of women with PCOS who were treated with OCPs or cyclic MPA from September 2015 to March 2019. After cessation of medication, ovulation was assessed using basal body temperature and/or measurement of serum progesterone. The odds ratio for ovulation resumption was assessed with multivariable logistic regression. Additionally, doubly robust analysis was performed with inverse-probability-weighted analysis and regression adjustment based on the covariate balancing propensity score to adjust for the effect of covariates on the treatment assignment. Results Among 272 women with PCOS, 136 were prescribed OCPs and 136 were prescribed cyclic MPA. Ovulation resumed in 18.4% of women (n = 25) after cessation of MPA and in 24.3% of women (n = 33) after cessation of OCPs. The odds of ovulation resumption in MPA users were comparable with those in OCP users (adjusted odds ratio (aOR) 1.00, 95% confidence interval (CI) 0.89–1.12). After multiple imputation due to missing values, the results did not change substantially (aOR 0.99, 95% CI 0.89–1.10). Conclusions Among women with PCOS, MPA users have a similar chance of ovulation resumption as OCP users after cessation of medication. Cyclic MPA can be a good alternative to OCPs in women for whom OCPs are contraindicated or who decline to take OCPs.

Knowledge of non-contraceptive benefits of and willingness to consider taking oral contraceptive pills among a low-risk female population: a cross-sectional study

Background In addition to its widely-appreciated contraceptive applications, the oral contraceptive pill (OCP) conveys both oncological and non-oncological benefits. Oncological benefits include a decreased risk of endometrial, ovarian, and colorectal cancer. Non-oncological benefits include reducing androgenic effects and alleviating menstruation-related problems. This study aimed to ascertain knowledge levels of non-contraceptive benefits and risks of OCP use among participants without contraindications to OCPs. This study also assessed factors associated with participants being more likely to consider taking OCPs. Methods 263 women aged 21 to 40 years old with no contraindications for OCP usage participated in this study. An anonymous questionnaire collected sociodemographic information and assessed participants’ knowledge of the non-contraceptive benefits and risks associated with OCP use. Multivariate linear regression was used to assess factors associated with knowledge levels. Multivariate logistic regression was used to investigate factors associated with being more likely to consider taking OCPs among women who did not presently take them. Results Multivariate logistic regression revealed that participants who were more knowledgeable overall about the non-contraceptive benefits of OCPs were more likely to consider taking OCPs (coefficient = 0.184, p-value = 0.00). Knowledge of both oncological and non-oncological benefits of OCP use was relatively poor, especially among older women. Current OCP users were found to be more knowledgeable about their benefits. Conclusions As women with greater knowledge of non-contraceptive benefits of OCPs are more likely to consider taking them, knowledge gaps regarding OCPs should be filled, so that more women may reap the non-contraceptive benefits of OCPs.

Thrombotic and Vascular Complications of Oral Contraceptives.

The oral contraceptive pill is the most commonly used form of reversible contraception, as it has significantly grown in popularity in recent years. The 2 types of oral contraceptive pills are combination oral contraceptives, which contain estrogen and progesterone, and progestin-only pills. Both have failure rates of approximately 7.2-9% with typical use and are safe for most patients. However, several thrombotic and vascular complications have been found to be associated with the usage of oral contraceptive pills, most notably being an increase in blood pressure and thrombosis. Although these complications do not typically affect young, healthy females, they merit concern for patients with a history of hypertension or thrombosis or patients with preexisting risk factors for these conditions. Overall, progestin-only pills are the safer option regarding these complications. Additionally, a complete summary of the medical eligibility criteria for contraceptive use has been created and is regularly updated by the Centers for Disease Control and Prevention. This chart summarizes the recommendations for contraception use by patients with a variety of preexisting conditions or risk factors.

The Symptoms Experienced by Naturally Menstruating Women and Oral Contraceptive Pill Users and Their Perceived Effects on Exercise Performance and Recovery Time Posttraining

This study examined the type, frequency, and severity of symptoms experienced by naturally menstruating women and combined, monophasic, oral contraceptive pill users and their perceived effects on exercise performance and recovery time posttraining. Forty-two recreationally active women; 21 naturally menstruating and 21 combined, monophasic, oral contraceptive pill users participated in the study. Data were collected using two approaches: (a) an online 54-part retrospective survey and (b) a daily questionnaire. “Total number of symptoms,” “symptom index score,” “average symptom severity,” and “symptom index × severity score” were calculated from the retrospective data set. Real-time symptom data (i.e., “symptom frequency per phase” and “phase symptom frequency × severity score”) were calculated across predefined cycle phases from the daily questionnaire. The retrospective survey showed that symptoms were commonly reported by recreationally active women, but there were no differences in symptomology between the groups (p > .113). The daily questionnaire showed both groups experienced a greater frequency and severity of symptoms while bleeding (p ≤ .001), which was associated with perceived reductions in exercise performance (odds ratio = 1.04–1.07) and a perceived longer recovery time posttraining (odds ratio = 1.03–1.04). The results from this study show that cycle-related symptoms were commonly reported by a group of recreationally active women, with no difference in symptomology between naturally menstruating women and combined, monophasic, oral contraceptive pill users. The magnitude of symptoms was greater while bleeding, which was associated with a perceived reduction in exercise performance and a longer recovery time posttraining.

Correlation of Forced Vital Capacity and Peak Expiratory Flow Rate with Serum Estrogen and Progesterone Levels in Combined Oral Contraceptive Pill (COCP) User

Background: Combined oral contraceptive pill (COCP) is the most commonly used contraceptive method in Bangladesh. This COCP has some effects on different organs including the lungs. So, there may be a relationship between forced vital capacity (FVC) and peak expiratory flow rate (PEFR) with serum estrogen and progesterone levels in combined oral contraceptive pill (COCP) users.
 Objective: To observe the relationship between FVC and PEFR with serum estrogen and progesterone levels in combined oral contraceptive pill users (COCP-U).
 Methodology: This cross-sectional study was carried out in the Department of Physiology, Sir Salimullah Medical College (SSMC), Dhaka between July 2017 and June 2018. A total of 30 apparently healthy young women, age ranged 20 to 30 years were included in this study, who were combined oral contraceptive pill users (COCP-U) for at least 6 months. Another 30 age and BMI matched combined oral contraceptive pill nonusers (COCP-NU) were also taken as control for comparison. FVC and PEFR of all the subjects were measured by using Digital Auto Spirometer (MINATO AS-507). Moreover, their serum estrogen and progesterone levels were done to observe their levels and also to observe the relationship between them if present. Statistical analysis was done by Independent t-test and Pearson’s Correlation Coefficient test.
 Result: Spirometric parameters like FVC and PEFR were significantly higher in COCP-U women than those of nonuser women. Moreover, the mean serum estrogen and progesterone levels were also significantly higher in COCP users in comparison to those of non-users. Here, FVC showed positive and PEFR showed negative correlation with serum estrogen level and FVC showed negative, PEFR showed positive correlation with serum progesterone level in COCP users, though the relationships were statistically non-significant. 
 Conclusion: The positive correlation of FVC and PEFR with serum estrogen and progesterone indicates, that improvement of pulmonary function occurs in COCP-U due to its estrogen and progesterone contents, which may be by increasing the strength of the muscles along with decreased airway resistance.
 J Shaheed Suhrawardy Med Coll 2022; 14(1): 37-42

Association of oral contraceptive pill use and depression among US women

BackgroundThe link between oral contraceptive pill (OCP) and depression is still unclear. This work analyses the prevalence and correlates of major depression in US women using OCP. MethodsThis study used the National Health and Nutrition Examination Survey (NHANES) 2005–2012 data to provide the prevalence and correlates of major depression in women using OCP. Major depression was defined as a score of ≥10 using the Patient Health Questionnaire-9 (PHQ-9). ResultsA total of 6239 women aged 18–55 years were included in the present analysis. Current OCP users had a lower prevalence of major depression (4.6 %; 95 % CI, 3.2 to 6.6) compared to former users of OCP (11.4 %; 95 % CI, 10.1 to 12.9) and never users of OCP (10 %; 95 % CI, 8.3 to 12.1). Current users of OCP were significantly less likely to report major depression compared to former users of OCP (OR 0.59; 95CI%, 0.39 to 0.90) after adjusting for potential confounders. The prevalence of major depression was higher in women who were: black or Hispanic, widowed/divorced/separated, those with a low and middle income, current smokers, current users of antidepressants, and with history of cancer and thyroid problems. LimitationsThis is a cross-sectional study. ConclusionThe prevalence of major depression among women using OCP may be lower than in former users of OCP, however, the burden of depression remains high. Further research with longitudinal follow-up for depression in women using OCP is needed to understand real world effect of the OCP on depression.

Health Effects of Oral Contraceptives on Periodontal Disease and Gingivitis: A Cross-Sectional Questionnaire-Based Study Among Saudi Women in Jeddah.

Sex hormones strongly influence the health and ailment of the oral cavity. For instance, a woman's oral health is influenced by her menstrual cycle, menopause, pregnancy, and usage of oral contraceptives. The use of various therapeutic medication results in intraoral alterations. Oral contraceptive pills (OCPs) are among the drugs that produce intraoral alterations. The study's objective was to evaluate attitudes and oral health conditions of Saudi women's utilizing OCPs in Jeddah, Saudi Arabia. A cross-sectional questionnaire-based study was conducted among Saudi women in Jeddah, Saudi Arabia. The self-administered questionnaire was made and sent to women to evaluate the attitude and oral health condition of women utilizing OCPs. The women using OCPs were asked to self-administer 17 questions to evaluate attitudes and oral health conditions. The questionnaire had multiple-choice questions and was consisted of four sections. The number of participants who used contraceptives was 125 (35.9%) women; of them, only 94 (75.2%) used oral contraceptives. The duration of using oral contraceptives mainly was 1-5 years (39.4%), then > 5 years (34.0%), and <1 year (26.6%). Of the 94 women, 34 (36.2%) had gingival diseases, 23 (24.5%) treated their gums; and 13 (13.8%) cleaned their gums at a dental clinic regularly. Times of teeth brushing per day were one time in 32 women (34%), twice in 47 women (50.0%), and three times in 15 (16.0%). Of the 94 women, 4 (4.3%) were smoking, 24 (25.5%) took medication other than OCPs, and 16 (17.02%) had chronic diseases. Common oral complications noticed by participants were gum bleeding after brushing (51.6%), dental caries (25.5%), and oral ulcers (10.6%). Females on OCPs had a high rate of gingival bleeding, dental caries, and oral ulcers. OCPs users had poor periodontal and gingival health. Establishing an oral hygiene program was necessary to treat gingival and periodontal inflammation that exacerbated by OCPs.

577 Risk Factors Associated with the Reported Scores on Symptoms Severity and Functional Limitations Scales of the Boston Carpal Tunnel Questionnaire: A Cross-Sectional Study

Abstract Aim We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations on the BCTQ. Method This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; Risk factors included: Rheumatoid Arthritis (RA), Diabetes Mellitus (DM), hypothyroidism, number of pregnancies, usage of Oral Contraceptive Pills (OCPs), use of smartphones and keyboards. A P-value of &amp;lt; 0.05 was considered statistically significant. Results Most participants were in their thirties (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only. Conclusions Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs and smartphone use have all been found statistically affect the outcome of the BCTQ in this study. Clinical confirmation of CTS diagnosis is required in future studies to make sure that these symptoms and functional limitations are associated with CTS pathology itself rather than other risk factors pathologies for proper targeted treatment plans and outcomes.

Fertility return after hormonal contraceptive discontinuation and associated factors among women attended Family Guidance Association of Ethiopia Dessie model clinic, Northeast Ethiopia: A cross-sectional study.

Women who use hormonal contraception face delayed return of fertility upon discontinuation. There was limited evidence of fertility return after hormonal contraceptive discontinuation in the study area. Hence this study assessed fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending Family Guidance Association Ethiopia (FGAE) Dessie model clinic, Northeast Ethiopia, 2019. A cross-sectional study was conducted on 423 samples selected by using systematic random sampling. Data were collected by face-to-face interview using a pretested and structured questionnaire and reviewing client records. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. Both bi-variable and multivariable binary logistic regressions were used to identify predictors of delayed fertility return. Adjusted odds ratio (AOR) along with a 95% Confidence Interval (CI) was used to measure the strength and the direction of the association and statistical significance was declared at a P-value less than 0.05. The proportion of fertility return among currently pregnant women after discontinuation of any hormonal contraceptive methods was 88.6% (95% CI; (85.6%-92%)). The proportion of fertility return among Depo-Provera, implant, Intrauterine Contraceptive Device (IUCD), and Oral Contraceptive Pill (OCP) users was 75%, 99.1%, 100%, and 97.8% respectively. Age, (AOR = 5.37, (95% CI; (1.48, 13.6)) and using Depo-Provera (AOR = 4.82, 95% CI; (1.89, 14.2)) had a significant association with delayed fertility return. The proportion of fertility return among women after discontinuation of any hormonal contraceptive methods was high. Age and using Depo-Provera had a positive association with delayed fertility return. This study recommends a contraceptive counseling approach that addresses concerns about delay in the return of fertility after hormonal contraceptive discontinuation to avoid confusion among family planning users.

Does chronic oral contraceptive use detrimentally affect C-reactive protein or iron status for endurance-trained women?

Chronic use of the oral contraceptive pill (OCP) is reported to increase C-reactive protein (CRP) levels and increase the risk of cardiovascular disease in premenopausal females. A secondary analysis of data from two research studies in eumenorrheic (n = 8) and OCP (n = 8) female athletes. Basal CRP and iron parameters were included in the analysis. Sample collection occurred following a standardized exercise and nutritional control for 24 h. Eumenorrheic females were tested in the early-follicular and mid-luteal phases, and the OCP users were tested in quasi-follicular and quasi-luteal phases (both active pill periods). A main effect for group (p < 0.01) indicated that average CRP concentration was higher in OCP users compared with eumenorrheic females, regardless of the day of measurement within the cycle. Results demonstrate a degree of iron parameters moderation throughout the menstrual cycle that is influenced by basal CRP levels; however, no linear relationship with CRP, serum iron, and ferritin was observed. Basal CRP values were consistently higher in the OCP group despite participants being in a rested state. These results may indicate a potential risk of cardiovascular disease in prolonged users of the OCP when compared to eumenorrheic female athletes.

Abortifacient activity of &lt;em&gt;Aegle marmelos&lt;/em&gt; and &lt;em&gt;Laurus nobilis&lt;/em&gt; leaf extracts

Rapid elevation of population in India is the one of the major problems, which directly influence the economy of country and may lead to poverty. Government implemented number of family planning programs through the various surgical operations (tubectomy and laproscopy) and oral contraceptives. Usage of oral contraceptive pills may lead serious complications, and may induce congenital abnormalities. The primary goal of this research is to assess the abortifacient activity in rat models of two historically used medicinal plants, Laurus nobilis L. and Aegle marmelos (L.) Corr. Restructure the paragraph as the study included 18 female wistar rats (150-200 g) and six male wistar rats (male wistar rats were used only for copulation). Female rats in proestrous phase were isolated and allowed to mate with males of proven fertility using the mass mating technique in a 3:1 ratio for an overnight. Control animals received an equivalent volume of the dosing vehicle (1% tween 80) orally. Aqueous extract of Laurus nobilis (AQLN) leaves and Ethanolic Extract of Aegle Marmelos leaves (EEAM) at doses of 175 mg/kg and 250 mg/ kg of were orally administrated daily for 10 days from day 0 of pregnancy to day 9. On day 20th of pregnancy, all the animals were sacrificed under euthanasia and the uterine horns were isolated, later they were examined for number of abortifacient sites and deformities of fetuses. The number of live fetuses in animals treated with EEAM at two doses was substantially lower in Group-4 at 175mg/kg (2.63 + 0.36) and Group-5 at 250mg/kg (1.87 + 0.40) compared to the vehicle control group (p 0.05, p 0.01). The survival ratio decreased considerably from 52.2% to 28.8% as the dose increased. Similarly, the abortion rate was higher in group 5 compared to Group-4. AQLN demonstrated to have 100% abortifacient efficacy at 250mg/kg, while EEAM has 83.3%.

Risk factors associated with the reported scores on the symptoms severity and functional limitations scales of the Boston Carpal Tunnel Questionnaire: a cross-sectional study.

This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; risk factors included RA, DM, hypothyroidism, number of pregnancies, usage of oral contraceptive pills (OCPs), use of smartphones and keyboards. A P value of less than 0.05 was considered statistically significant. Most participants were in their 30s (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only. Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs, and smartphone use have all been found to statistically affect the outcome of the BCTQ in this study. Therefore, clinical confirmation of the CTS diagnosis is required in future studies to ensure that these symptoms and functional limitations are associated with the CTS pathology rather than other risk factors and pathologies for proper targeted treatment plans and outcomes.

Exploring technology-based interventions to improve oral contraceptive pill adherence: a cross-sectional survey

Purpose To assess the resources that oral contraceptive pill (OCP) users currently use and wish to use after missing pills. Materials and Methods People 18–44 years old with a OCP prescription were emailed a cross-sectional survey to assess how they obtain information about managing missed pills, what information they would prefer to access, and whether they would use additional information if it were available. We performed a logistic regression and a dominance analysis to compare independent predictors of desire for a technological resource at the time of missed pills. Results We received 166 completed surveys. Nearly half of participants (47%, n = 76, 95% CI 39.0–54.4%) did not seek information about managing their missed pills. When missing a pill, more patients preferred non-technology-based information (57.1%, n = 93, 95% CI 49.3–64.5%) over technology-based information (43%, n = 70, 95% CI 35.5–50.7%). Most reported they would appreciate more information at the time of missed pills (76%, n = 124, 95% CI 68.9–82.0%). The strongest predictors for desire for technology-based information were: current use of technology, lower parity, white race, and higher educational attainment. Conclusions This study indicates that most OCP users would utilise additional information at the time of a missed pill if they had access to it and that they desire information in varying formats.

Examination of Blood Urea, State of Reactive Oxygen Species and Antioxidants Associated with Oral Contraceptive Pills Among Female Athletes

Blood urea, reactive oxygen species, and antioxidants are interconnected biochemical parameters. In case of any adverse effects of any agents, it directly affects the body's physiological activities. Objective: To examine blood urea, the state of reactive oxygen species and antioxidants associated with oral contraceptive pills (OCP) among female athletes. Methods: Participants of the study were randomly selected as participants of the study. The users of OCP were placed in the Experimental Group (EG), and the nonuser of OCP was put in (CG). Each group was comprised of twenty-five subjects. 5 ml blood was collected from all the subjects. Each subject was marked with a different identification code. The blood urea level was measured through the blood urea nitrogen (BUN) test. The balancing state of reactive oxygen species and antioxidants was measured through FRAP Assay. Results collected through both BUN and FRAP were calculated through the statistical package for social sciences (SPSS, version 26). Results: The mean and standard deviation of EG in term of blood urea was 29.23 ±7.89; df was 82, t-score was -.822, P- value was .413. A significant difference in term of FRAP between CG and EG was found, such as the mean and SD of CG were 137.95±.20.87, means and SD of EG was 110.54±.39.22, the t score was 3.23, and the P value was .002. Conclusions: Results show that OCP significantly impacts blood urea and causes an imbalance in both reactive oxygen species and antioxidants among users.

P078Use of direct-to-consumer telemedicine companies for contraception among young adults

<h3>Objectives</h3> A growing number of direct-to-consumer telemedicine companies, such as Nurx and Pandia Health, offer contraception without a traditional office visit, but little data exist describing their use among a general population. This study examines the prevalence and determinants of using telemedicine companies for contraception in a sample of sexually active young adults. <h3>Methods</h3> We collected survey data from May 2020 to May 2022 from individuals at risk of pregnancy aged 18–28 recruited at 29 community colleges in California and Texas (n=1,620 participants; 6,270 person-periods). We used multivariable mixed-effects logistic regression models with random effects for site and individual to assess whether participants used telemedicine companies for contraception by sociodemographic characteristics, state of residence, and oral contraceptive pill (OCP) use. <h3>Results</h3> Participants reported using a telemedicine company for contraception in 412 of 6,270 observations (6.6%). Participants were more likely to report using a telemedicine company if they were Asian/Pacific Islander (adjusted OR (aOR), 4.15; CI, 1.90–9.06) compared to Hispanic respondents; were Texas residents (aOR, 3.20; CI, 1.79–5.73) vs. California residents; and if they were OCP users (aOR, 6.35; CI, 4.25–9.48). We found no differences by health insurance status. Among telemedicine company users, almost all (91%) were very satisfied or satisfied with their experience and almost all (96%) reported that ordering contraception online was very convenient or convenient. <h3>Conclusions</h3> While relatively few young people used telemedicine companies for contraception, use varied by race/ethnicity and state of residence. Those who chose this alternative to traditional clinic visits reported high satisfaction levels.

P064Depression after 12-month use of oral or intrauterine contraception

<h3>Objectives</h3> To evaluate whether levonorgestrel intrauterine devices (LNG-IUD) or oral contraceptive pills (OCPs) users are more likely to have a positive depression screen after 12 months of use compared to copper IUD users. <h3>Methods</h3> We conducted a secondary analysis of the Contraceptive CHOICE Project of LNG-IUD, OCP, and copper IUD users. Participants completed the Center for Epidemiologic Studies Depression Scale (CESD-10) at baseline and at 12 months. We examined differences in participant characteristics, depression/anxiety history, and CESD-10 scores between method groups using chi-square test, and used Poisson regression to assess factors associated with a positive depression screen (CESD-10 score ≥10) at 12 months. <h3>Results</h3> At enrollment, 5,217 initiated an IUD or OCPs. At 12 months, 3,882 participants were still using their method and were included in this analysis. LNG-IUD users were more likely to have a positive depression screen at baseline, followed by copper IUD and OCP users (22.1% vs. 20.1% vs. 17.1%, p=0.04). After adjusting for positive depression screen at baseline, history of depression or anxiety, and parity, LNG-IUD and OCP users were no more likely to have a positive depression screen at 12 months compared with copper IUD users (Rradj 1.02; 95% CI, 0.87–1.18; Rradj 0.93, 0.72–1.19, respectively). The proportion of patients discontinuing their method prior to 12 months due to worsening mood did not differ between method groups (range, 2.2–4.9%; p=0.31). <h3>Conclusions</h3> Among individuals using contraception for 12 months, those initiating a LNG-IUD or OCPs were no more likely to screen positive for depression at 12 months compared to copper IUD users.

Contraceptives and cancer risks in BRCA1/2 pathogenic variant carriers: a systematic review and meta-analysis.

Increasing numbers of BReast CAncer (BRCA) 1 or 2 pathogenic variant (PV) carriers, who have an inherited predisposition to breast and ovarian cancer, are being identified. Among these women, data regarding the effects of contraception on cancer risks are unclear and various guidelines provide various recommendations. We aim to optimize counselling regarding contraception for BRCA1/2-PV carriers. Therefore, we performed a systematic review and meta-analysis. We investigated the risk ratio for developing breast cancer or ovarian cancer in BRCA1/2-PV carriers who have used any form of contraception versus non-users. Second, we analysed breast and ovarian cancer risk among BRCA1/2-PV carriers as influenced by the duration of contraceptive use and by the time since last use. In addition, we provide an overview of all relevant international guidelines regarding contraceptive use for BRCA1/2-PV carriers. A systematic search in the Medline database and Cochrane library identified studies describing breast and/or ovarian cancer risk in BRCA1/2-PV carriers as modified by contraception until June 2021. The search included medical subject headings, keywords and synonyms related to BRCA and contraceptives (any kind). PRISMA guidance was followed. Risk Of Bias In Non-randomized Studies of Interventions and Grading of Recommendations, Assessment, Development and Evaluations assessments were performed. Random-effects meta-analyses were used to estimate pooled effects for breast and ovarian cancer risk separately. Subgroup analyses were conducted for BRCA1 versus BRCA2 and for the various contraceptive methods. Results of the breast cancer risk with oral contraceptive pill (OCP) analysis depended on the outcome measure. Meta-analyses of seven studies with 7525 women revealed a hazard ratio (HR) of 1.55 (95% CI: 1.36-1.76) and of four studies including 9106 women resulted in an odds ratio (OR) of 1.06 (95% CI: 0.90-1.25), heterogeneity (I2) 0% and 52%, respectively. Breast cancer risk was still increased in ever-users compared with never-users >10 years after last OCP use. In contrast, ovarian cancer risk was decreased among OCP users: HR 0.62 (95% CI: 0.52-0.74) based on two studies including 10981 women (I2: 0%), and OR 0.49 (95% CI: 0.38-0.63) based on eight studies including 10390 women (I2: 64%). The protective effect vanished after cessation of use. Tubal ligation also protects against ovarian cancer: one study including 3319 women (I2: 0%): HR: 0.44 (95% CI: 0.26-0.74) and three studies with 7691 women (I2: 44%): OR: 0.74 (95% CI: 0.53-1.03). Data regarding other contraceptives were unavailable. No differences were observed between BRCA1 and BRCA2-PV carriers. The quality of evidence was either low or very low. The OCP potentially increases breast cancer risk, while ovarian cancer risk decreases with either the OCP and tubal ligation in BRCA1/2-PV carriers. Counselling of BRCA1/2-PV carriers should be personalized; the genetic and non-genetic factors (like prior risk-reducing surgeries, prior breast cancer and age) and patients' preferences (reversibility, ease of use, reliability and effect on menstrual cycle) should be balanced. To further optimize counselling for high-risk women, future research should focus on other (commonly used) contraceptive methods and cancer risks in this specific population, and on the potential impact of changing formulations over time.

Do E2 and P4 contribute to the explained variance in core temperature response for trained women during exertional heat stress when metabolic rates are very high?

PurposeWomen remain underrepresented in the exercise thermoregulation literature despite their participation in leisure-time and occupational physical activity in heat-stressful environments continuing to increase. Here, we determined the relative contribution of the primary ovarian hormones (estrogen [E2] and progesterone [P4]) alongside other morphological (e.g., body mass), physiological (e.g., sweat rates), functional (e.g., aerobic fitness) and environmental (e.g., vapor pressure) factors in explaining the individual variation in core temperature responses for trained women working at very high metabolic rates, specifically peak core temperature (Tpeak) and work output (mean power output).MethodsThirty-six trained women (32 ± 9 year, 53 ± 9 ml·kg−1·min−1), distinguished by intra-participant (early follicular and mid-luteal phases) or inter-participant (ovulatory vs. anovulatory vs. oral contraceptive pill user) differences in their endogenous E2 and P4 concentrations, completed a self-paced 30-min cycling work trial in warm–dry (2.2 ± 0.2 kPa, 34.1 ± 0.2 °C, 41.4 ± 3.4% RH) and/or warm–humid (3.4 ± 0.1 kPa, 30.2 ± 1.2 °C, 79.8 ± 3.7% RH) conditions that yielded 115 separate trials. Stepwise linear regression was used to explain the variance of the dependent variables.ResultsModels were able to account for 60% of the variance in Tpeak (overline{R }2: 41% core temperature at the start of work trial, overline{R }2: 15% power output, overline{R }2: 4% [E2]) and 44% of the variance in mean power output (overline{R }2: 35% peak aerobic power, overline{R }2: 9% perceived exertion).ConclusionE2 contributes a small amount toward the core temperature response in trained women, whereby starting core temperature and peak aerobic power explain the greatest variance in Tpeak and work output, respectively.

Risk of Venous Thromboembolism: The Prothrombin-G20210A Mutation and Combined Oral Contraceptives

The risk of venous thromboembolism in oral contraceptive pill users becomes dramatically increased in patients with inherited thrombophilias. The often undiscovered prothrombotic genetic conditions pose a potentially deadly threat to its generally young demographic. When thrombosis is discovered in oral contraceptive pill users with a strong family history of related events, it becomes essential to screen for prothrombotic genetic conditions and further mitigate any associated modifiable risk factors. Here we present a case of pulmonary embolism requiring cardiopulmonary resuscitation in 30-year-old female found to have a Prothrombin G20210A on oral contraceptive pills. The emergent management of the critical case, as well as the subsequent evaluation for prothrombotic conditions and the role of potential screening is discussed.

Association of Use of the Oral Contraceptive Pill (OCP) with the Expression Pattern of Different Molecular Subtypes of Breast Cancer

Background: Triple-negative breast carcinoma (TNBC) is a breast cancer subtype associated with high mortality and inadequate therapeutic options when compared to non-TNBC. Clinical data indirectly suggests where Oral Contraceptive Pill (OCP) usage is high, the prevalence of Estrogen Receptor+ (ER+) breast cancer is high, and the prevalence of TNBC is low. This has lead to our hypothesis that OCP use may increase the risk of ER+ breast cancer, and OCP use may reduce the risk of TNBC. We aimed to compare the prevalence and association of subtypes of breast cancer in OCP users with that of non-users among women 30 to 60 years of age. Methods: This hospital-based observational study of three-year duration included 155 subjects of primary invasive breast cancer who got admitted to our institution. The data was obtained for ER, PR, HER2 status, clinical classification, and data in relation to demographic factors, reproductive history, and history of OCP use. 155 subjects were divided into two groups. Group-1 included 48 patients with a history of OCP use, and group-2 included 107 patients who have not used OCP. Data was analysed using SPSS-20. Results: A significant increase in the prevalence of molecular subtypes ER+, Progesterone Receptor+ (PR+) and Luminal B breast cancer in OCP users was observed compared to non-users. There was a significant decrease in the age at the time of admission in ER+ cancer in OCP users (45.3 years) compared to non-users (52.2years). While age at the time of admission of Basal (TNBC) cancer patients in OCP users (53.1 years) was higher when compared to non-users (45.4years). Upon logistic regression, the likelihood of ER+, PR+ and Luminal B in OCP users was 11%,10% and 13% less, respectively, with 1 year of higher age and the likelihood of TNBC in OCP users was 18% more and 8% less in non-users. Conclusion: OCP use may be associated with increased prevalence of ER+, PR+ and Luminal B breast cancer. On the contrary, OCP use may be associated with a delay in the progression of the TNBC.