Oral Contraceptive Pills Group Research Articles

Pretreatment with oral contraceptive pills in women with PCOS scheduled for IVF: a randomized clinical trial

Abstract STUDY QUESTION What is the effect of pretreatment with oral contraceptive pills (OCPs) on oocyte and embryo quality and pregnancy rates in women with polycystic ovary syndrome (PCOS) scheduled for IVF/ICSI cycles? SUMMARY ANSWER In women with PCOS who underwent a first or second IVF/ICSI cycle with a GnRH antagonist protocol and were randomized to start ovarian stimulation immediately, the quality of cleavage-stage embryos was non-inferior to pretreatment with OCP. WHAT IS KNOWN ALREADY PCOS in Asian populations is characterized by high levels of circulating LH in the early follicular phase. Previous studies indicated that inappropriately high LH levels might affect oocyte maturation and fertilization rates, and impaired embryo quality, consequently resulting in higher rates of impaired pregnancy and miscarriage in women with PCOS. OCPs are frequently used as pretreatment to lower LH levels in PCOS patients. STUDY DESIGN, SIZE, DURATION We performed a randomized controlled trial. After informed consent, women diagnosed with PCOS scheduled for their first or second IVF/ICSI cycle with a GnRH antagonist protocol were randomized to receive OCPs (OCP group) or start ovarian stimulation immediately, regardless of the day of the menstrual cycle (non-OCP group). Using a non-inferiority hypothesis, the sample size was calculated at 242 women. The study lasted from 7 February 2018 to 31 August 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 242 infertility patients with PCOS undergoing the first or second cycle of IVF or ICSI were enrolled and randomized into two groups. In the OCP group, recombinant FSH was started on Day 7 of the washout period after pretreatment with OCP. In the non-OCP group, recombinant FSH was started immediately regardless of the day of the menstrual cycle. All participants received standardized GnRH antagonist ovarian stimulation. The freeze-all strategy was applied to all participants. The primary outcome was the number of good-quality embryos on Day 3 after insemination. Secondary outcomes included the rates of blastocyst formation, implantation, clinical pregnancy, and live birth from the first frozen/warmed embryo transfer cycles and cumulative live birth rates. MAIN RESULTS AND THE ROLE OF CHANCE We randomized 242 women to receive OCP (n = 121) or start immediately with ovarian stimulation (n = 121). The number of good-quality embryos on Day 3 in the OCP group was non-inferior to the non-OCP group (OCP group versus non-OCP group, 6.58 ± 4.93 versus 7.18 ± 4.39, AD −0.61, 95% CI: −1.86 to 0.65, P = 0.34). The rates of blastocyst formation (55.4% versus 52.9%, relative risk (RR) 1.11, 95% CI: 0.96 to 1.28, P = 0.17), implantation (63.0% versus 65.5%, RR 0.90, 95% CI: 0.53 to 1.53, P = 0.79), clinical pregnancy (67.9% versus 68.8%, RR 0.96, 95% CI: 0.54 to 1.71, P = 1.0), and live birth rate (52.8% versus 55.1%, RR 0.92, 95% CI: 0.53 to 1.56, P = 0.79) of the first frozen/warmed embryo transfer cycles were all comparable between the OCP and non-OCP group, respectively. Cumulative live birth rates were also similar in the OCP and non-OCP groups (78.3% versus 83.5%, respectively RR 0.71, 95% CI: 0.36 to 1.42, P = 0.39). LIMITATIONS, REASONS FOR CAUTION Only patients with PCOS in Southern China were recruited. Therefore, caution is necessary when generalizing our results to all such patients with PCOS. Also, since a freeze-only strategy was used, the results of this study are only applicable when infertile women with PCOS undergo the freeze-only method. The obvious treatment difference between the two groups meant that the study was designed as an open-label study for women and doctors. The study had a randomized controlled design that minimized bias. WIDER IMPLICATIONS OF THE FINDINGS Pretreatment with OCPs to lower LH levels in patients with PCOS before ovarian stimulation in IVF or ICSI cycles may not improve the quality of cleavage-stage embryos. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Key Research and Development Program of China (No. 2023YFC2705503). This study was supported in part by the Investigator-Initiated Studies Program (grant from MSD and Organon). BWM reports consultancy, travel support, and research funding from Merck. He reports consultancy from Organon and Norgine, and also reports holding stock from ObsEva. No conflicts of interest are declared for the other authors. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (No. chiCTR1800014822). URL: https://www.chictr.org.cn/showproj.html?proj=25280 TRIAL REGISTRATION DATE 7 February 2018. DATE OF FIRST PATIENT’S ENROLLMENT 22 February 2018.

The use of combined hormonal contraceptive for in-vitro fertilization cycle priming is not associated with decreased pregnancy rate in frozen embryo transfer cycles: a cohort study.

The objectives of this study are to evaluate the cycle outcomes from IVF treatment preceded by oral contraceptive pills (OCP) priming compared to estradiol pretreatment and to determine if there is a role for OCP priming for those undergoing frozen embryo transfers. The study took place at a university-affiliated fertility center in Canada. The study included in-vitro fertilization (IVF) antagonist cycles from Jan 2016 to Jun 2019. Those with protocol deviation or treatment cancellation were excluded. There were 2237 cycles by 1958 patients; 27% of cycles utilized OCP priming. The average age in the OCP group was 34 years old compared to 36.5 in the estradiol group (P<0.01). AMH was reported in 43% of patients and was 3.7ng/mL in the OCP group versus 2.2 ng/mL in the estradiol group (P<0.01). The number of oocytes (15.2 vs. 12.5) and number of blastocysts (4.6 vs. 3.3) were higher in the OCP group (P all <0.01). After adjusting for age and AMH with linear regression for the 978 cycles with recorded AMH (24% with OCP prime), a significantly higher number of oocytes (13.8 vs. 11.9, P=0.002) was still noted in the OCP group. There were 866 euploid embryo transfer cycles (28% with OCP prime). There were no significant differences in implantation (77% vs. 76%) or ongoing pregnancy rates (56% vs. 54%) between those who had a frozen embryo transfer after OCP primed compared to estradiol primed stimulation cycles (P all >0.6). There were no differences in pregnancy outcomes from euploid frozen blastocyst transfers after OCP primed antagonist cycles compared to estradiol pretreatment. In fact, the use of OCP pretreatment was associated with increased oocyte yield, keeping in mind demographic differences with the OCP pretreatment group being younger with higher anti-Müllerian hormone and a higher prevalence of PCOS. Thus, OCP priming should still be considered in specific populations, such as those with oligo-ovulation or adequate ovarian reserve.

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.

Effect of oral contraceptive pills on the retinal microvascular structure: An optical coherence tomography angiography study

BackgroundTo investigate the effect of oral contraceptive pills (OCPs) on foveal avascular zone (FAZ), peripapillary capillary plexus, and superficial and deep capillary plexus (SCP and DCP) measurements. MethodsThis cross-sectionally designed study included 32 healthy female participants using OCPs (3 mg drospirenone and 0.03 mg ethinylestradiol) for at least one year for contraception and 32 healthy controls that did not use any drugs. All subjects were evaluated using optical coherence tomography angiography (OCTA). Using OCTA, the measurements of SCP, DCP, radial peripapillary capillary (RPC) vessel density; FAZ area and perimeter; acircularity index (AI); and foveal density (FD) were undertaken. Each participant's measurements were taken while they were in the follicular phase of their menstrual cycles (day 3). ResultsAge and body mass index did not significantly differ between the groups (p = 0.56 and p = 0.15, respectively). The DCP vessel densities in all the regions were lower in the OCP group (p<0.05 for all). The vessel densities of SCP and RPC, FAZ area and perimeter, AI, and FD were similar between the two groups (p>0.05 for all). ConclusionWe determined that the DCP vessel density was reduced in women using this drug. OCPs can cause changes in retinal microvascular structures. Therefore, OCTA can be used in the follow-up of healthy women using OCP.

Oral contraceptive pill (OCP) treatment alters the gene expression of intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) in polycystic ovary syndrome (PCOS) women compared to drug-naive PCOS women

BackgroundPolycystic ovary syndrome (PCOS) presents clinical symptoms of menstrual abnormalities, excessive hair growth (hirsutism), scalp hair loss, acne and infertility. Metabolic abnormalities such as obesity, insulin resistance, glucose intolerance and cardiovascular problems constitute an essential part of PCOS, all of which can have significant long-term health consequences. Low-grade chronic inflammation demonstrated by persistent moderately elevated serum levels of inflammatory and coagulatory markers plays a critical role in the pathogenesis of PCOS. Oral contraceptive pills (OCPs) constitute the mainstay of pharmacologic therapy for women with PCOS to regularize cyclicity and ameliorate androgen excess. On the other hand, OCP use is associated with various venous thromboembolic and proinflammatory events in the general population. PCOS women always carriers the increased lifetime risk of these events. The studies on the effect of OCPs on inflammatory, coagulation and metabolic parameters in PCOS are less robust. Therefore in this study, we investigated and compared the messenger RNA (mRNA) expression profiles of genes implicated in inflammatory and coagulation pathways between drug-naive and OCP-treated PCOS women. The selected genes include intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1). Furthermore, the correlation between the selected markers and various metabolic indices in the OCP group has also been explored.MethodThe relative amounts of ICAM-1, TNF-α, MCP-1 and PAI-1 mRNA in peripheral blood mononuclear cells from 25 drug-naive PCOS subjects (controls) and 25 PCOS subjects who received OCPs containing 0.03 mg-ethinyl-estradiol and 0.15 mg-levonorgestrel for at least six months (cases) were estimated using real-time qPCR. The statistical interpretation was conducted using SPSS version 20.0 (SPSS, Inc, Chicago, IL), Epi Info version 2002 (Disease Control and Prevention Centres, Atlanta, GA) and GraphPad Prism 5 (GraphPad Software, La Jolla, CA) software.ResultSix months of OCP therapy enhanced the expression of inflammatory genes viz ICAM-1, TNF-α and MCP-1 mRNA in PCOS women by 2.54, 2.05 and 1.74 folds, respectively, in this study. However, PAI-1 mRNA in the OCP group showed no significant increase. Furthermore, in cases, ICAM-1 mRNA expression positively correlated with body mass index (BMI) (p = 0.01), fasting insulin (p = 0.01), insulin 2 h p = 0.02), glucose 2 h (p = 0.01) and triglycerides (p = 0.01). TNF-α mRNA expression positively correlated with fasting insulin (p = 0.0007). MCP-1 mRNA expression positively correlated with (BMI) (p = 0.002).ConclusionOCPs helped reduce clinical hyperandrogenism and regularise menstrual cycles in women with PCOS. However, OCP use was associated with increased fold expression of inflammatory markers which positively correlated with metabolic abnormalities.

Effects of oral contraceptives plus orlistat in patients with polycystic ovary syndrome and overweight/obesity: A meta-analysis.

This meta-analysis was conducted to compare the effect and safety of oral contraceptive pills (OCP) plus orlistat with OCP alone in clinical, hormonal, and lipid metabolism outcomes in patients with polycystic ovary syndrome (PCOS) and overweight/obesity. Pubmed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and SinoMed were systematically reviewed. A random-effects or fixed-effects model was used to pool the estimate. Eight studies were included in this meta-analysis. Significant reductions in BMI, WHR, and waist circumference were observed in combination group as compared with OCP alone group. Regarding the hormonal outcome, T, SHBG, FAI, LH, DHEAS, FSH, and E2 levels were significantly improved in combination group compared with OCP alone group. However, the TT and FT did not change significantly between the two groups. Regarding the lipid metabolism outcomes, TC, LDL-C, and TG levels were reduced and HDL-C level was increased in the combination group. Regarding the insulin metabolism outcomes, FINS and HOMA-IR levels were reduced in combination group than in OCP group. The ovulation rate, pregnancy rate, and overall effective rate were significantly higher in combination group than in OCP alone group. Fewer complications were observed in the combination group than in OCP group, and the difference between them was significant. This combination treatment of OCP and orlistat was more effective than OCP alone in reducing the weight, hormonal, lipid, and insulin metabolism profiles, as well as improving the ovulation rate, pregnancy rate, and overall effective rate, as compared with OCP alone.

Comparison between Outcome of Assisted Reproductive Technique (Art) Cycles with and Without OCP Pretreatment in Infertile Women: A Randomized Clinical Trial

The objective of this randomized clinical trial was to assess the effect of pretreatment with oral contraceptive pill (OCP) on assisted reproductive technique outcomes in patient’s candidate for assisted reproductive technique (ART). In a randomized clinical trial University-based infertility center, Tehran, Iran. 160 infertile patient who are candidate for IVF, randomly divided into two groups: 80 patients in OCP pretreatment group and 80 patients in non-OCP pretreatment group. The IVF protocol in all patients was standard long GnRH agonist (long protocol). The oocyte number, embryo formation, fertility rate, gonadotropin dose, ovarian cyst formation and cancelled cycles were evaluated. Oocytes number per patient in OCP group was 13.87 and in non-OCP group was 15.22, pregnancy rate in OCP group was 44.7% and in non-OCP was 31.2%, the abortion rate in OCP group was 10.5% and in non-OCP was 3.1%, that there was no significant difference between two groups, embryo formation in two groups was similar. ovarian cyst in OCP group was 2.6% and in non-OCP was 12.5% (P&lt; 0.05) so the cancelled cycles due to ovarian cyst in OCP group was less than non-OCP group. Based on our data, OCP pretreatment have no effect on oocyte number, embryo formation, pregnancy rate and abortion, but this pretreatment can decrease the cyst formation so decrease the cancelled cycles in OCP pretreatment.

Metformin decreases miR-122, miR-223 and miR-29a in women with polycystic ovary syndrome.

Metformin is associated with increased insulin sensitivity, whereas oral contraceptive pills (OCP) could increase the risk for type 2 diabetes (T2D) in women with polycystic ovary syndrome (PCOS). Certain miRNAs might serve as biomarkers for the risk of T2D. The aim of this study was to investigate changes in circulating miRNA levels during treatment with metformin and OCP in women with PCOS. Sixty-five women with PCOS according to Rotterdam criteria were randomized to metformin (2 g/day), metformin + OCP (150 mg desogestrel + 30 µg ethinylestradiol) or OCP alone for 12 months. Serum miRNA analysis was performed with individual RT-qPCR or Taqman low density array cards of 22 selected miRNAs previously related to PCOS, glucose and/or lipid metabolism. miR-122 and miR-29a levels were decreased after treatment with metformin compared with metformin + OCP and OCP group: miR-122: log2 difference −0.7 (P = 0.01) and −0.7 (P = 0.02), miR-29a: log2 difference −0.5 (P = 0.01) and −0.4 (P = 0.04), while miR-223 levels were decreased in the metformin + OCP group after treatment: log2 difference −0.5 (P = 0.02). During the treatment period, a significant weight loss was observed in the metformin group compared with the OCP group. In the OCP group, miRNA levels were unchanged during the treatment period. Levels of circulating miRNAs associated with lipid and glucose metabolism decreased during metformin treatment. Changes in miRNA levels in the metformin group could be explained by the simultaneous weight loss in the same group. These results support the notion that metformin treatment alone may be superior for metabolic health compared with OCP.

Analysis of Intrinsic and Extrinsic Coagulation Pathway Factors in OCP Treated PCOS Women.

Human polycystic ovary syndrome (PCOS)-a cluster of diseases displays various symptoms associated with endocrine and gynecological disorders in childbearing women. Oral contraceptive pills (OCP) being a drug of choice minimizes symptoms and complications associated with the disorder. But, the controversial data available in literature regarding use of OCPs compels us to setup a study design regarding effect of OCP treatment in PCOS subjects and the possible outcomes specifically regarding coagulation pathways. Two PCOS study groups have been selected according to Rotterdam Criteria: one with OCP treatment (n = 50) and other without any drug treatment i.e., drug naive (n = 50). Anthropometry, Biochemistry, Hormones, Insulin and various clotting factors like Factor XI, Factor V, tPA, TAT-III and D-dimer were analyzed in both groups. The results showed worsening of IR, Metabolic parameters and coagulopathy in OCP group comparative to drug naive group indicating adverse effects of the OCP treatment which puts these women at risk for number of future clinical implications especially Cardiovascular and metabolic complications.

Effect of short-term use of oral contraceptive pills on intraocular pressure

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age. &#x0D; Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21. &#x0D; Results: &#x0D; Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000).&#x0D; Conclusion:&#x0D; OCP significantly increase IOP even when used for short time period.

Central Corneal Thickness in Females Using Oral Contraceptive Pills

Purpose: To compare the central corneal thickness in females using oral contraceptive pills (OCP) with age matched controls.&#x0D; Study Design: Descriptive Observational study.&#x0D; Place and Duration of Study: Department of ophthalmology, University of Lahore teaching hospital, from August 2018 to December 2018.&#x0D; Material and Methods: Fifty-one females who used OCP within last one year and 38 age-matched controls were included in this study after approval from the ethical review board. Females with any systemic disease, pregnancy and lactating mothers were excluded from the study. Females with ocular diseases, like trachoma, cataract, keratitis, uveitis, corneal dystrophies, Keratoglobus, Keratoconus, ocular trauma, and high refractive errors were also excluded. Each subject underwent full ocular examination including best-corrected visual acuity using Snellen acuity chart and Bio-microscopic examination of anterior segment and the fundus. Central corneal thickness (CCT) was measured with ultrasonic pachymeter and the intraocular pressure was measured with noncontact tonometer at the time of examination. The data was collected by self-designed proforma and analyzed by using SPSS version 20.&#x0D; Results: Mean age of the females using OCP was 31.4 ± 6.8 years and mean age of age-matched controls was 32.9 ± 5.5 years (p = 0.38). Mean Central corneal thickness values were higher in OCP group when compared to controls (541.8 ± 31.39μm and 518.7 ± 36.7 μm, respectively). P value was 0.004, which was statistically significant. The mean IOP value was 14.5 ± 2.6 mm Hg in OCP group and 14.4 ± 2.8 mm Hg in the control group (P = 0.86), which was not statistically significant.&#x0D; Conclusion: Central corneal thickness values are significantly higher in patients using OCP.

The effect of oral contraceptive pills on the macula, the retinal nerve fiber layer, the ganglion cell layer and the choroidal thickness

BackgrounTo evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL), and the choroidal thickness (CT).MethodsIn this prospective observational cross-sectional study, 60 eyes of 30 healthy women taking monophasic OCP (0.03 mg ethinylestradiol and 0.15 mg levonorgestrel) for contraception for at least 1 year were compared with 60 eyes of a control group of 30 healthy women who were not taking any OCP. Spectral-Domain Optical Coherence Tomography (SD-OCT) was used to evaluate the macula, the RNFL, the GCL, and the CT. Measurements were taken in the follicular phase (day 3) of the last menstrual cycle in all women. The body mass index (BMI) scores of all participants were also recorded.ResultsNo disparity in terms of age and BMI between both groups was observed (p = 0.444, p = 0.074, respectively). All the macular parameters measurements were considerably lower in the OCP group compared to the control group (p < 0.001). Also, the RNFL thickness, the GCL thickness, and the CT were all significantly thinner in the OCP group (p < 0.001).ConclusionsThe use of OCP can cause significant changes in the retina and choroid thickness over 1 year period. The women who are using OCP for a longer duration could have some eye problems. OCT should be routinely done for follow up. Further long term studies are required, using different preparations of OCP. It is important to find out when this thickness alterations can be clinically significant or symptomatic and if these changes are reversible or not.

Effects of low-dose contraceptive pills on the risk factors of cardiovascular diseases among 15-35-year-old women: A retrospective cohort.

BackgroundCardiovascular diseases could be preventable; as a result, understanding the risk factors was regarded as the major priority for healthcare providers.ObjectiveThe main objective of this research was to achieve a deeper insight into the effect of long-term use of low-dose oral contraceptive pills (OCP) on the risk factors of cardiovascular diseases.Materials and MethodsThis research was a retrospective cohort conducted (historical and prospectively) conducted on 100 women with normal menstrual cycles aged 15 to 35 yr, who were referred to the healthcare centers in Yazd, Iran. The participants were categorized into two groups: The OCP group was consuming the pills for 0-3, 4-23, and 24-36 months, and the non-OCP group. Participants were followed up for a minimum of 3 months and a maximum of six months.ResultsThe highest level of low-density lipoprotein (LDL), homocysteine, cholesterol, triglyceride levels, and systolic blood pressure was observed in the OCP group in the duration of 24 to 36 months. The Tukey's test demonstrated that there were comprehensible differences in the LDL (p = 0.01), cholesterol (p = 0.01), triglyceride (p 0.001), and homocysteine levels (p 0.001), also systolic blood pressure (p = 0.04).ConclusionIt was realized that the long-term consumption of low-dose OCP can augment the incidence of some risk factors (systolic blood pressure, homocysteine levels, cholesterol, LDL-c, and triglyceride) and lead to developing cardiovascular diseases amongst the healthy women.

Evaluation of the Macula, Retinal Nerve Fiber Layer and Choroid Thickness in Women Using Oral Contraceptive Pills

AbstractBackground: Oral Contraceptive Pills (OCP) have some risks and side effects with regard to several organs, one of which is the eye. Estrogen & progesterone receptors have been shown to be present in various eye structures, such as the choroid, retina, conjunctiva, cornea, Meibomian glands, and lens.Aim of Study: The purpose of this study is to assess the macula, Retinal Nerve Fiber Layer (RNFL), and choroid thickness, in addition to evaluation of macular Ganglion Cell Complex (GCC) by using spectral-domain OCT system (3D OCT-2000 FA; Topcon Crop., Tokyo, Japan) in 20 women using Oral Contraceptive Pills (OCP) for more than one year and to compare them with 20 healthy reproductive age women volunteers.Patients and Methods: This is cross sectional study in-cluded 20 women using oral contraceptive pills in comparison to 20 normal females between April 2018 till July 2018 at Giza memorial Institute of Ophthalmic Research. Optical Coherence Tomography (OCT) is used to evaluate the posterior ocular segments, and measurements have been taken in the follicular phase (day 3) of the cycle in all women.Results: The mean age of the OCP group was 31.7±3.76 years and the mean age of the control group was 31.3±5.031 years. Both groups are homogenous in terms of age (p=0.7773). Most of the macular layer thickness and the foveal center are significantly thinner in OCP group. The macular volume is thinner in OCP study group. Retinal nerve fiber layers are thicker in OCP study group a part from Superior RNFL which is thinner in OCP study group, while temporal RNFL zone is with no significant changes. Choroid thickness values, is thicker in OCP study group. Ganglion cell complex is with no significant difference.Conclusion: We found that women who had received combined oral contraceptive pills more than one year have changes in posterior ocular segment.

Oral Contraceptives Provide Protection against Anterior Cruciate Ligament Tears: A National Database Study of 165,748 Female Patients

Objectives: ACL tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to query a large nationwide database to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears. We hypothesized that females taking OCPs would exhibit ACL tears at lower rates than a matched population of patients not taking OCPs. Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15-49. Female experiencing an ACL tear and undergoing surgery (CPT 29888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Patients were matched by age and Charlson comorbidity score. Chi-squared testing was used to assess for significant differences in the rate of ACL tears for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years. Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There were a total of 569 (0.69%) ACL tears in the non-OCP group and 465 (0.56%) in the OCP group (p&lt;0.001). In the non-OCP group, patients aged 15-19 accounted for 29.35% of all ACL tears, whereas, in the OCP group, this same age group only accounted for 13.33% of ACL tears. Among all age groups, the odds ratios for experiencing an ACL tear while on OCP was 0.82 (χ2=0.001, 95% CI 0.72-0.92) (Figure 1) compared to not using OCP. This protective effect was driven primarily by the 15-19 age group (odds ratio 0.37 (χ2&lt;0.001, 95% CI 0.27-0.50)). Conclusion: This investigation utilizing a large national database found that usage of OCPs was associated with an 18% decrease in the risk of ACL tear when compared to a matched population of patients with ACL tears not taking OCPs. These findings were in line with smaller studies which demonstrated similar results. Additionally, it was shown that OCPs were most protective in the 15-19 year old age group, with a 63% reduction in tears in this group. Ongoing randomized trials in patients without ACL tear could help to demonstrate further clinical evidence for OCP usage as a way to modify risk factors for ACL tear. While clinical evidence is limited, there should be strong consideration for OCP usage in elite high school and college aged athletes, especially those who are at risk of ACL tear.

Effect of Short-term Use of Oral Contraceptive Pills on Intraocular Pressure

Purpose: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age. Study Design: Observational case control study. Place and Duration of Study: The study was conducted at Arif memorial teaching hospital and Allied hospital Faisalabad from October 2017 to March 2018. Material and Methods: There were 100 female subjects, who were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. We compared the intra ocular pressures between the two groups by using Student t test. Results: Average age was 29.16 in group A and 27.74 years in group B. Average duration of using OCP was 14.9 months. Mean IOP in right eye was 13.08 � 1.41 mm of Hg and 13.34 � 1.27 mm of Hg in left eye in Group A. While, mean IOP in right eye was 11.72 � 1.35 mm of Hg and in left eye was 11.92 � 1.3 mm of Hg in controls. Significant difference was noted between the IOP of OCP group and controls. (p = 0.000). Conclusion: OCP significantly increases IOP even when used for short time period. Key words: Oral contraceptive pills, Intra-ocular pressure, Glaucoma.

Daily fluctuations in ocular surface symptoms during the normal menstrual cycle and with the use of oral contraceptives

PurposeWomen are more prone to ocular surface symptoms and circulating estrogen levels have been implicated. Fluctuations in estrogen during the menstrual cycle may influence ocular symptoms but existing research is incomplete and conflicting, partly due to paucity of validated questionnaires to assess daily ocular symptoms. This study aimed to evaluate daily fluctuations in ocular symptoms across a complete menstrual cycle and to compare symptoms in normally menstruating women and women using the combined oral contraceptive pill (OCP). MethodsTo do this, a short online tool to assess daily symptoms was developed. 36 normally menstruating women and 36 women using the combined OCP were recruited. A two-item questionnaire, the Instant Ocular Symptoms Survey (IOSS) was developed and administered on a smartphone platform every day for 40 days. Linear mixed model analysis was used to examine differences in symptom scores over time and between groups. ResultsThe IOSS was found to be effective for measuring instantaneous symptoms, exhibiting good diagnostic abilities and repeatability. (AUC ± SE = 0.80 ± 0.07 and ICC = 0.75). Daily ocular symptoms showed a cyclic fluctuation across the cycle (p = 0.004) and highest symptoms were recorded on day 2 of the cycle when estrogen levels are lowest. Symptom scores were significantly higher in the OCP group (p = 0.02). ConclusionsEffects of menstrual phase and OCP use should be considered in the interpretation of ocular symptoms in clinical practice. These findings enhance the current understandings of ocular surface and systemic pain during menstrual cycle.

The Effect of Hormonal Contraception on Cervicovaginal Mucosal End Points Associated with HIV Acquisition.

Reproductive age women may choose to concurrently use topical antiretrovirals and hormonal contraceptives (HCs) to simultaneously prevent HIV-1 infection and unintended/mistimed pregnancy. There are conflicting data on the effect of HCs on mucosal susceptibility to HIV-1. The objective of this study was to evaluate cervicovaginal (CV) mucosal data from healthy women before and after initiation of either oral contraceptive pills (OCPs) or depot medroxyprogesterone acetate (DMPA) injection. CONRAD A10-114 was a prospective, open-label, parallel cohort study. We enrolled 74 women and 62 completed the visits (32 and 30 who selected OCPs and DMPA, respectively). Participants provided CV lavage, vaginal biopsies, and CV swabs at baseline in the luteal phase and then ∼6 weeks after initiating HCs. After contraceptive initiation, there were significant increases in vaginal immune cell density among both DMPA and OCP users. Changes for OCP users were concentrated in the subepithelial lamina propria, whereas for DMPA users, they were distributed throughout the vaginal tissue, including the epithelium (CD45+, CD3+, CD4+, and CD1a+). Contraceptive use altered concentrations of soluble CV inflammatory and immune mediators, with significant reductions in some proinflammatory cytokines and secretory leukoprotease inhibitor. Compared with baseline, p24 antigen production after ex vivo HIV-1 infection of vaginal biopsies doubled after DMPA use, but all p-values were >.05. HIV-1 replication was significantly higher in DMPA-exposed tissues compared with those from the OCP group at the end of the tissue culture (p = .01). Although not statistically significant, median in vitro inhibition of HIV-1 by CV fluid (innate antiviral activity), was reduced by ∼50% with HCs (p > .21). Exposure to exogenous contraceptive hormones significantly increased vaginal immune cells and reduced CV proinflammatory cytokines and antimicrobial peptides. DMPA users showed higher susceptibility to HIV-1 ex vivo infection.

Oral contraceptives provide protection against anterior cruciate ligament tears: a national database study of 165,748 female patients

ABSTRACTObjective: Anterior cruciate ligament (ACL) tears are more prevalent in females than males. One of the factors responsible for this may be the variation in levels of estrogen and progesterone. The purpose of this study was to determine the potentially protective effects of oral contraceptive pills (OCPs) on ACL tears.Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for all OCP users amongst females aged 15–49. Female experiencing an ACL tear and undergoing surgery (CPT 29,888) were compared to a control group of females undergoing surgery for an ACL tear, but not on OCPs. Chi-squared testing was used to assess for significant differences in the rate of ACL reconstruction for the OCP and non-OCP users, according to age groups broken down into age intervals of 5 years.Results: There were a total 82,874 patients in both the OCP and non-OCP groups. There was a total of 569 (0.69%) ACL reconstructions in the non-OCP group and 465 (0.56%) in the OCP group (p < 0.001). In the non-OCP group, patients aged 15–19 accounted for 29.35% of all ACL reconstructions, whereas, in the OCP group, this same age group only accounted for 13.33%. Among all age groups, the odds ratios for experiencing an ACL reconstruction while on OCP was 0.82 (χ2 = 0.001, 95% CI 0.72–0.92) compared to not using OCP. This protective effect was driven primarily by the 15–19 age group (odds ratio 0.37 (χ2 < 0.001, 95% CI 0.27–0.50)). The number need to treat for OCP usage in the 15–19 age group was six patients.Conclusions: OCPs have a protective effect on ACL tear, especially in the 15–19 age group, which exhibited a 63% reduction in the rate of tear. Consideration should be given to prescribing OCPs to younger athletes, after careful assessment of the risks of these commonly prescribed medications.Level of evidence: III

Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience.

ObjectiveTo evaluate the effectiveness of oral contraceptive pill (OCP) as therapy for endometrial hyperplasia (EH) without atypia in reproductive-aged women compared with oral progestin.MethodsA retrospective cohort study was carried out in our reproductive center. Consecutive patients diagnosed with infertility and non-atypical EH identified through electronic database who met inclusion criteria (n=309). Patients were assigned to two treatment groups: OCP (n=216) and oral progestin (n=93); clinical and reproductive outcomes were recorded.ResultsReversal of EH to normal endometrium, clinical pregnancy, live birth and miscarriage rate. Women in OCP group were younger, had higher prevalence of Polycystic Ovary Syndrome and other uterine pathology and longer duration of infertility than women in progestin group. Reversal of EH was observed in 93.52% women on OCP and in 86.02% women on progestin (p=0.032; adjusted odds ratio [aOR]= 2.35; 95% confidence interval [CI]=1.06-5.21) after the initial course of treatment for 2 to 6 months. Cyclic OCP (n=184) resulted in better response to treatment compared to continuous OCP (n=32) (95.11% vs. 84.38%; p=0.039; aOR =3.60; 95% CI =1.12-11.55). Clinical pregnancy rate in OCP group was marginally higher than progestin group (87/208, 41.83% vs. 27/90, 30.00%; p=0.054). Miscarriage (25.29% vs. 29.63%; p=0.654) and live birth rate (31.25% vs. 21.11%; p=0.074) were comparable between the groups.ConclusionFor the first time we demonstrate that OCP is an effective therapy for non-atypical EH and is associated with higher remission rate compared with oral progestin. Reproductive outcomes are reassuring and comparable between the two groups.