Oral Contraceptive Pills Treatment Research Articles

The symptomatic cesarean scar defect with oral contraceptive pills treatment following evacuation of a cesarean scar pregnancy

The symptomatic cesarean scar defect with oral contraceptive pills treatment following evacuation of a cesarean scar pregnancy

PROLONGED DURATION OF ORAL CONTRACEPTIVE USE IMMEDIATELY PRIOR TO IVF STIMULATION DECREASES BLASTULATION RATE IN GNRH ANTAGONIST CYCLES

Oral contraceptive pills (OCP) are widely used to aid in follicle synchronization and cycle scheduling. Studies remain conflicted regarding the impact of OCP pretreatment on cycle outcomes, with some showing no impact on outcomes, and others showing changes in live birth rate.1-2 It is unclear whether the durations of OCP use impacts these discrepant findings. The objective of this study is to determine whether duration of OCP pretreatment impacts controlled ovarian stimulation cycle outcomes. This retrospective cohort study included patients who underwent antagonist cycles with OCP pretreatment from 2016-2021. OCP pretreatment was used within 5 days prior to administered gonadotropins. The association between duration of OCP use with ratio of mature oocytes to eggs retrieved (MII ratio), fertilization rate, and blastulation rate was assessed. Spearman correlation coefficient was used to assess the relationship between baseline demographics and cycle characteristics with OCP duration, and multiple linear regression was used to control for confounders. To determine the most sensitive and specific cut-point for OCP treatment duration that was predictive of blastulation rates (<50% vs. ≥50%), a receiver operator curve (ROC) was generated and Youden Index (YI) was used to determine the most predictive threshold. A total of 2126 cycles were identified, with a range of 1-281 days of pretreatment OCP use. Correlation analysis revealed that age, BMI, AMH, days of stimulation, and total gonadotropin dosage were not associated with duration of OCP use. Duration of OCP use was correlated with lower basal antral follicle count (BAFC): r(1561) = -.09, p=.002. OCP duration was not associated with number of eggs retrieved or mature oocytes retrieved. Controlling for age and BAFC, duration of OCP use was not associated with MII ratio or fertilization rate. Blastulation rate decreased significantly with longer duration of pretreatment OCP use (β=-0.002 ± 0.001, p=0.01). The ROC generated YI demonstrated that more than 17 days of OCP pretreatment was a predictor for blastulation rates <50%. Prolonged pretreatment OCP use did not impact ovarian response, but was correlated with lower blastulation rates.

The Role of Oral Contraceptive Pills in Hidradenitis Suppurativa: A Cohort Study.

There is a need to establish the role of antiandrogens as an alternative or concomitant therapy for hidradenitis suppurativa (HS). Thus, the objectives of this study are (1) to assess the effectiveness of oral contraceptive pills (OCPs) at week 12 in HS women, and (2) to describe the clinical profile of patients receiving oral contraceptive pills (OCPs). A prospective observational study was designed. This study included 100 participants, 50 women with HS who started OCPs for the first time at our HS Clinic and 50 participants without OCP treatment. The main outcome of interest was the percentage of reduction in total abscess and inflammatory nodule (AN) count at week 12. Thirty-three women received combined OCPs and 17 non-combined OCP. HS patients with OCPs treatment were younger (31.7 vs. 40.9 years, p < 0.001), thinner (28.62 vs. 33.35 kg/m2), and have a higher number of areas affected (2.32 vs. 1.38, p = 0.02) than those without OCPs. After 12-weeks of treatment, it was observed that the percentage of AN reduction was higher in HS women receiving OCP than in patients without OCP (53.9% vs. 38.42%, p = 0.049). It was observed that OCP prescription (β = 3.79, p = 0.034) and concomitant therapy (β = 3.91, p = 0.037) were independently associated with a higher % AN when controlling for disease duration, concomitant therapy, and treatment with/without OCP (R2 = 0.67). The factors potentially associated with the percentage AN reduction at week 12 in HS women treated with OCPs were disease duration (β = −1.327, p = 0.052), concomitant therapy (β = 11.04, p = 0.079), and HS worsening with the menstrual cycle (β = 10.55, p = 0.087). In conclusion, OCPs might be effective for improving AN count in women with HS. Women whose HS worsens in relation to the menstrual cycle and have a shorter disease may benefit more from the therapeutic effect of OCPs.

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 oral contraceptives treatment on quality of life of Korean women with polycystic ovary syndrome

Objectives: Oral contraceptive pills (OCP) may improve quality of life in women with polycystic ovary syndrome (PCOS). However, data on the effect of OCP on the quality of life of women with PCOS are scarce. The objective of this study was to assess the effect of OCP on the quality of life of Korean women with PCOS. Materials and Methods: This prospective observational study enrolled 32 women with PCOS who were 19- to 30-years-old. All women were prescribed OCP after the diagnosis of PCOS. A survey was carried out using 36-item Short Form Health Survey (SF-36) and PCOS-specific health-related quality of life questionnaire (PCOSQ) at the moment of PCOS diagnosis and at six months later after the OCP treatment. Results: In SF-36, scores for all subscales except body pain increased without statistical significance. In PCOSQ, emotions, infertility, and menstrual problem scores were significant different between the two survey points (emotion score: 40.6 ± 3.4 vs. 42.9 &#x00B1; 3.0, p vs. 23.0 &#x00B1; 1.0, p = 0.033; menstrual problem score: 21.2 &#x00B1; 1.2 vs. 23.3 &#x00B1; 1.1, p Conclusions: OCP treatment improved the quality of life of Korean women with PCOS.

A comparison of two different oral contraceptives in patients with severe primary dysmenorrhoea

Pain relief of two different oral contraceptive pills (OCPs) in severe primary dysmenorrhoea (PD) was compared. Sixty-six nulliparous patients with severe PD requiring contraception were evaluated. Group 1 comprised 33 healthy controls. Patients with severe PD were divided into two groups. Patients in Group 2 were administered oestradiol valerate/dienogest and patients in Group 3 were administered ethinylestradiol/drospirenone. Doppler indices of both uterine arteries (left and right) including systolic/diastolicrates (S/D), pulsatility index (PI) and resistance index (RI) were measured, and a visual analogue scale (VAS) was applied to patients before treatment. VAS scores and Doppler indices were repeated after 3 months of OCP treatment and the changes in values were compared. The demographic and clinical characteristics of the patients were similar. The mean value of RI was significantly lower after therapy in Groups 2 and 3 in the right and left uterine arteries (p = .001 and p = .039, respectively). The clinical trial number was NCT03124524.Impact StatementWhat is already known on this subject: OCPs are the most appropriate treatment option for PD. There is no clear data about OCP containing dienogest for treatment in PD. Dienogest has been reported to be highly effective in the treatment of endometriosis and is also recommended as first-line therapy for pelvic pain-associated endometriosis.What the results of this study add: In this study, although there was no superiority in pain relief between the treatment groups, lower VAS scores and lower RI values of uterine arteries were seen after treatment. Both OCPs relieve pain in severe PD. There was no serious adverse effect in the patients.What the implications are of these findings for clinical practice and/or further research: Estradiol valerate/dienogest, which is a routinely prescribed drug for heavy menstrual bleeding in women who desire oral contraception, is as effective as ethinylestradiol/drospirenone in pain relief.

Oral contraceptive pills as an option for non-surgical management of retained products of conception – a preliminary study

Many Patients with persistent retained products of conception prefers to avoid surgical interventions, such as a dilatation and curettage (D&C) that might pose an additional future risk to their already compromised fertility or obstetric performance. The aim of this study was to the possibility of induced withdrawal bleeding following oral contraceptive administration as a non-surgical treatment for patients with persistent retained products of conception (RPOC). A retrospective study of patients presenting with retained products of conception (RPOC) after failed expectant management or after treatment with PGE1 was performed. Twelve women presenting with RPOC at ≤8 weeks gestation with minimal to mild vaginal bleeding and no signs of infection were treated with oral contraceptive pill (OCP) containing 0.03 mg ethinylestradiol and 0.15 mg of desogestrel for 3 weeks. Out of the 12 patients treated, nine women (75%) successfully expelled the RPOC after completing the three-week course of OCPs. The three cases (25%) that did not resolve following OCP treatment had pregnancy products with positive blood flow on Doppler examination. We conclude that OCPs may be a useful medical treatment option for persisting RPOC in selected patients with absence blood flow on Doppler examination wishing to avoid surgical intervention.

Metformin or Oral Contraceptives for Adolescents With Polycystic Ovarian Syndrome: A Meta-analysis.

Polycystic ovarian syndrome (PCOS) is a common disease. There is limited evidence to support various treatment choices. This leads to variable treatment practices. To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the use of metformin versus oral contraceptive pills (OCPs) for the treatment of PCOS in adolescents aged 11 to 19 years. We performed literature searches through Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials, and gray literature resources, up to January 29, 2015. Two reviewers screened titles and abstracts of identified citations, assessed full text eligibility, and extracted information from eligible trials. Four RCTs met the inclusion and exclusion criteria. The reviewed evidence came from 170 patients. Overall, OCP treatment resulted in modest improvement in menstrual cycle frequency (weighted mean difference [WMD] = 0.27, P < .01, 95% confidence interval [CI] -0.33 to -0.21) and mild reduction of acne scores (WMD = 0.3, P = .02, 95% CI 0.05 to 0.55). While metformin resulted in greater BMI reduction (WMD = -4.02, P < .01, 95% CI -5.23 to -2.81) it was associated with decreased dysglycemia prevalence (risk ratio: 0.41, P = .02, 95% CI 0.19 to 0.86) and improved total cholesterol and low-density lipoprotein levels. Metformin and OCPs were similar in terms of impact on hirsutism. Current evidence is derived from very low to low quality evidence. Therefore, treatment choice should be guided by patient values and preferences while balancing potential side effects. Future high quality RCTs are needed to address several questions for the treatment of adolescents with PCOS.

Effects of Oral Contraceptive Pills on Mood: Lessons Learned from Longitudinal Studies

Oral Contraceptive Pills (OCP) are widely used by women of reproductive age and their use is increasing overtime. Yet, while OCPs have been shown to ameliorate mood symptoms in some women, mood changes are also commonly reported as side effects. The objective of this systematic literature review was to determine the effects of OCP on mood symptoms among healthy women using OCPs for contraception. We included prospective, longitudinal studies with clear comparison groups of either baseline versus post OCP use or case-control studies comparing women with or without OCP treatment. Despite the considerable variability in operational definitions of depression or negative affect, the majority of studies demonstrated no effect of OCP on depressive symptoms when compared with control or baseline data. While studies of manic symptoms were not available, irritability and mood swings related to the premenstrual phase were assessed. Results are equivocal with half the studies showing improvement in symptoms with OCP and half showing no difference. Overall, studies lacked standardized assessment tools and often relied on symptom checklists. Future research would benefit from the development and validation of a convenient tool for the assessment of mood symptoms across the menstrual cycle.

Oral contraceptive pills in the management of clomiphene resistant anovulation

Introduction: We tried to evaluate the effectiveness of 2 months oral contraceptive pill (OCP) pretreatment for clomiphene citrate (CC) resistant cases followed by repeat clomiphene citrate treatment. Material and Methods: In this study of 100 patients, 30 met the criteria of clomiphen citrate resistant anovulation . Before starting OCPs day 3 hormone profile assayed. All 30patients were given 2 months of continuous OCPs for hypothalamic –pituitary-ovarian axis suppression. After withdrawal bleeding, their day 3 hormonal profile assayed and clomiphene citrate was given from day 3-day7. Follicular growth monitored by sonography from day 12 till max size (>20mm) reached. 10,000 IU Hcg given to those patients who failed to show spontaneous rupture. Ovulation was confirmed by S. Progesterone assay on day 21. Pregnancy confirmed by S. Beta hCG level and 7 weeks amenorrhoea. Result: A total number of 30 patients completed 75 treatment cycles. 23 of them achieved ovulation. There were significant changes observed in hormonal profile in response to OCP treatment. 17 beta estradiol levels decreased to 58%, 63% reduction noted in LH level, androgen decreased by 56%. FSH level also decreased but not so significantly. 23 patients ovulated out of 30 patients (76.6%) which resulted in high ovulatory cycle 55/75 (73.2%) and Cumulative pregnancy rate 60% (18/30). Conclusion: This study showed the excellent ovulation and pregnancy rate following OCP suppression. This mode of treatment is a cheaper alternative to GnRH therapy for poor anovulatory women.

Pretreatment with oral contraceptive pills to identify poor responders that may benefit from rLH supplementation during GnRH-antagonist treatment for IVF: A pilot perspective study proposal.

Controlled ovarian stimulation, using a gonadotrophin-releasing hormone (GnRH) antagonist protocol, is a potential treatment option for women with a low response to other fertility treatments as it appears to be at least as effective as GnRH agonists (long protocol). However, previous studies have indicated that the administration of GnRH antagonist may cause an excessive reduction in endogenous luteinizing hormone (LH) levels. The use of recombinant LH (rLH) supplementation during ovarian stimulation is controversial. The present article proposes a future study focused on women aged ≥40 years old, with the aim of identifying patients who are poor responders to GnRH-antagonist treatment that may benefit from rLH supplementation. We hypothesize that patients with suppressed hypothalamic-pituitary-axis activity may benefit from rLH supplementation, as GnRH-antagonist administration has the potential to induce a marked reduction in LH levels in such patients compared with that in patients that exhibit a regular recovery following the administration of oral contraceptive pills (OCPs). Furthermore, patients with hyper-responsive hypothalamic-pituitary-axis activity may be affected by ‘low-gonadotropin-responsiveness’, similar to that observed in patients with any mutation in the follicle-stimulating hormone (FSH) receptor, who are known to benefit from rLH supplementation. The proposed pilot study would include 120 women who are predicted to be poor responders to GnRH-antagonist treatment. All subjects will be allocated at random (using 2:1 computerized randomization) into two study groups: Group A (OCP-treated) and group B (control). For all patients, the serum values of FSH, LH and 17β estradiol (E2) will be detected on day 3 of the menstrual cycle preceding OCP treatment (baseline) and at day 4 following OCP treatment. The Δ-variation from baseline levels for all markers, the FSH/LH ratio and the E2/FSH ratio will be determined. Δ-variation from the baseline of the FSH and LH values will be used to further categorize group A patients into subgroups A1–4, based on respective quartile numbers (Q1–4). Patients admitted to each of the four subgroups A1–4, based on their FSH quartile, will be selected at random to receive rLH supplementation (ratio, 1:1) during ovarian stimulation. If the resulting data are able to identify women that may benefit from rLH supplementation during ovarian stimulation, a large part of inconclusive evidence regarding rLH supplementation will be clarified. If patients supplemented with rLH (according to abnormal recovery of hypothalamic-pituitary-axis activity after OCP treatment) exhibit an improved ovarian response during in vitro fertilization (IVF) and subsequent pregnancy rate, the pre-IVF OCP test could be adopted as a useful tool for improving the success rate of assisted reproductive technologies in poorly-responding patients.

Metformin improves endothelial function and carotid intima media thickness in patients with PCOS

Objective: Oral contraceptive pills (OCP) are widely used for treating women with polycystic ovary syndrome (PCOS). Metformin has beneficial effects on insulin resistance and endothelial functions. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl estradiol (EE) alone or in combination with metformin on the flow-mediated vasodilatation (FMD) and carotid intima media thickness (CIMT) in women with PCOS.Methods: Fifty women with PCOS (mean age 23 ± 5) were randomized to oral treatment of OCP alone (n = 25) or an OCP combination with metformin (n = 25) for 6 months. FMD from the brachial artery and CIMT were calculated. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months' treatment, echocardiographic measurements and laboratory tests were also obtained.Results: After 6 months' treatment we observed a small decrease in FMD in the OCP group (14.9 ± 9.4 versus 14.4 ± 9.9, p = 0.801) and a slight increase in the combination group (14.5 ± 9.1 versus 15.0 ± 8.0, p = 0.715) but neither of them reached significance. CIMT increased in the OCP group (0.048 ± 0.011 to 0.050 ± 0.010 cm, p = 0.433) and decreased slightly in the combination group (0.049 ± 0.012, 0.048 ± 0.011 cm, p = 0.833).Conclusion: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.

The effects of treatment with drospirenone/ethinyl oestradiol alone or in combination with metformin on elastic properties of aorta in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a heterogeneous clinical condition. Oral contraceptive pills (OCPs) have conventionally been the mainstay of treatment for the amelioration of hyperandrogenism and regulation of menstrual cycles in women with PCOS. Metformin has beneficial effects on insulin resistance and endothelial functions. To our knowledge, the effect of metformin/OCP combination treatment on aortic stiffness has not been studied so far. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl oestradiol (E/E) alone or in combination with metformin on the elastic properties of the aorta in women with PCOS. Thirty-seven women with PCOS were enrolled in the study. The first treatment arm, which was treated with OCP alone, was described as the OCP group (19 patients, mean age: 23·2 ± 5·4); the other treatment arm, which was treated with OCP and metformin, was described as the combination group (18 patients, mean age: 23·0 ± 4·5). The elastic parameters of the aorta namely 'aortic strain', 'aortic distensibility', 'aortic diameter alteration' and 'aortic stiffness index' were calculated by the appropriate formulae. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months of treatment, echocardiographic measurements and laboratory tests were also obtained. After 6 months of treatment, significant weight loss and decrease in body mass index (BMI) were observed in the combination group (75·3 ± 13·3 kg to 72·3 ± 13·5 kg and 31·7 ± 7·3 kg/m² vs 30·4 ± 7·3 kg/m², P = 0·001 and P = 0·001, respectively). Conversely in the OCP group, BMI and weight were not significantly different after 6 months of treatment (68·8 ± 18·3 kg to 71·6 ± 21·2 kg and 26·4 ± 6·2 kg/m² to 27·4 ± 6·9 kg/m², P = 0·159 and P = 0·149, respectively). In addition, there were no significant differences in aortic strain, distensibility (7·7 ± 4·2 to 7·8 ± 3·6 and 7·2 ± 4·1 to 7·7 ± 3·6, P = 0·926 and P = 0·593, respectively) and stiffness index in the OCP group (8·8 ± 7·4 to 8·2 ± 6·7, P = 0·772). However, in the combination group, the adjusted values of the aortic stiffness index decreased significantly at the 6 months' follow-up (10·0 ± 1·5 to 6·7 ± 0·3, P = 0·021) and aortic distensibility and strain increased but not significantly (7·0 ± 4·3 to 9·3 ± 3·3 and 6·8 ± 3·9 to 9·4 ± 3·5, P = 0·163 and P = 0·071, respectively) at the 6 months' follow-up. We demonstrated an improvement in the elastic parameters of the aorta by adding metformin to OCP treatment. We suggest that metformin plus OCP treatment may decrease cardiovascular disease risk in women with PCOS.

Does the degree of hypothalamic-pituitary-ovarian recovery after oral contraceptive pills affect outcomes of IVF/ICSI cycles receiving GnRH-antagonist adjuvant therapy in women over 35 years of age?

To evaluate if the degree of recovery of serum gonadotropins after oral contraceptive pills (OCP) pretreatment has an impact on ovarian response in GnRH-antagonist IVF cycles in women of advanced maternal age. In this retrospective cohort study, we included 98 women 35-42years undergoing their first IVF cycle receiving gonadotropins and a fixed GnRH-antagonist adjuvant protocol. Data analysis was carried out according to changes in serum FSH, LH and estradiol (E(2)) levels (basal and post-OCP) divided in quartiles, and also according to absolute levels. The main outcomes were peak serum E(2), number of mature oocytes retrieved, length of stimulation, and amount of gonadotropins used. By quartile analysis, patients with the highest levels of serum gonadotropins suppression and also patients with gonadotropin rebound needed larger amounts of LH during the treatment. On the other hand, women with absolute suppression of FSH/LH had increased length of stimulation. The results of this study provide data that assist in clinical management. Gonadotropin serum levels after OCP treatment provide information for optimization of supplementation with LH in GnRH-antagonist cycles in women over age 35.

17-hydroxysteroid dehydrogenase type 5 gene polymorphism (-71A/G HSD17B5 SNP) and treatment with oral contraceptive pills in PCOS women without metabolic comorbidities

We studied (1) the effects of oral contraceptive pills (OCPs) on hirsutism, hormonal and metabolic variables in 49 polycystic ovary syndrome patients without metabolic comorbidities and (2) the effect of 17-hydroxysteroid dehydrogenase type 5 gene polymorphism (-71A/G HSD17B5 SNP) on the response to OCP treatment. Mean age was 21.9 ± 6.5 years. Patients received monophasic OCP (20 μg ethinyl estradiol plus 75 μg gestodene), 21/28 days per cycle, during 6 months; 32 patients with severe hirsutism also received spironolactone 100 mg. The frequencies of HSD17B5 genotypes were: AA = 0.49 (55.1%), AG = 0.42 (30.6%) and GG = 0.09 (14.3%). After 6 months, body mass index and waist circumference remained unchanged regardless of the presence of allele G. A slight reduction (p < 0.05) was noted in systolic blood pressure (p < 0.05) and luteinizing hormone levels, whereas a slight increase (p < 0.05) was noted in lipids. Total testosterone and hirsutism score declined, while sex hormone binding globulin increased after OCP treatment (p < 0.05). None of these changes were associated with genotype. Insulin and homeostasis model assessment remained unchanged after treatment and did not vary according to the presence of allele G. OCP seems to ameliorate androgenic symptoms without compromising metabolic parameters. The -71A/G SNP of HSD17B5 gene did not contribute to the improvements observed.

A combined approach to patients with repeated IVF failures

In an attempt to evaluate the appropriate approach in patients with repeated IVF failures, we compared the stimulation characteristics of 19 cycles. This includes the combination of diagnostic hysteroscopy and endometrial sampling during oral contraceptive pill treatment, which precedes the ultrashort GnRH-ag/GnRH-ant protocol to the patients' previous failed IVF attempt. Patients undergoing the combined approach achieved an improved outcome with reasonable implantation and clinical pregnancy rates (25 and 42%, respectively).

Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom-recurrence after conservative surgery for endometriosis

Endometriosis recurrence after conservative surgery is not infrequent. Variable regimens of hormonal therapy have been proposed as adjuvant post-operative measures for prophylaxis against recurrence. Among these, the combined oral contraceptive pills (OCP), represents a valuable option in terms of safety and tolerability for long-term use. The objective of this review is to evaluate the effect of post-operative use of OCP in preventing symptom recurrence, and/or anatomical relapse of endometriosis. A systematic search of Medline identified seven studies evaluating post-operative OCP treatment on prevention of endometriosis recurrence. A reduction in anatomical relapse rate was observed when oral contraceptive therapy was administered for more than 1 year after conservative surgery. Post-operative use of OCP was associated with a reduction in frequency and intensity of dysmenorrhoea recurrence. No association was found between OCP therapy and dyspareunia prevention, although the effect of OCP on chronic pelvic pain was conflicting. Long-term OCP therapy can be a reliable adjuvant post-operative measure to prevent or reduce frequency/severity of recurrent dysmenorrhoea and anatomical relapse of endometriosis. Since both continuous and cyclic OCP administration regimens seem to have comparable effects, the choice of regimen can be modulated according to patient preferences. The protective effect seems to be related to the duration of treatment.

Long-term oral contraceptive treatment, metabolic syndrome and measures of cardiovascular risk in pre-menopausal women: National Health and Nutrition Examination Survey 1999–2004

Aim. Differences in subclinical cardiometabolic measures were examined as a function of oral contraceptive pills (OCP) treatment duration to compare never-treated women with four OCP-treatment groups (<1, 1–5, 5–10 and >10 years).Methods. The NHANES (1999–2004) database was used to evaluate 2089 healthy, pre-menopausal women, aged 18–55 years, with or without OCP history, no other hormonal treatment or history of systemic conditions. Outcome measures included body mass, central obesity, blood pressure, glycemia, insulinemia, lipid profile and inflammation. Analyses evaluated differences in prevalence of Metabolic Syndrome (MetS), constituent MetS and other clinical risk criteria, as well as outcome magnitudes. Analyses controlled for demographic and health-related variables, and study-eligible conditions.Results. Relative to other groups, women with >10 years OCP-use, and to some extent those with 5–10 years treatment, displayed no differences in prevalence of MetS and most risk criteria. Further analysis showed that, relative to women treated for <5 years, those with more prolonged OCP treatment displayed lower body mass and fasting glycemia with higher HDL-c levels, but more elevated LDL-c and total cholesterol.Conclusions. The findings of both beneficial and detrimental subclinical cardiometabolic differences with more long-term OCP-treatment reinforces the need to monitor changes in these factors within the context of the treated patient's risk-benefit profile. However, because the magnitude of these differences was small, relative to normative ranges, it may be concluded that OCPs, as used in recent decades, are unlikely to markedly affect cardiometabolic risk.

Oral contraceptive pill pretreatment in ovarian stimulation with GnRH antagonists for IVF: a systematic review and meta-analysis

To assess the impact of oral contraceptive pill (OCP) pretreatment in ovarian stimulation for in vitro fertilization (IVF) using gonadotropin releasing hormone (GnRH) antagonists. Systematic review and meta-analysis of randomized controlled trials (RTC). University IVF center. Infertile patients (n = 847), treated in four trials. Systematic literature search (MEDLINE, EMBASE, CENTRAL COCHRANE, conference proceedings, reference lists) for randomized trials on OCP treatment before stimulation with gonadotropins and GnRH antagonist for IVF. Meta-analysis of data yielding pooled odds ratios (OR) or weighted differences of the means (WMD) and 95% confidence intervals (CI). Ongoing pregnancy rate per randomized woman. Ongoing pregnancy rate per randomized woman was not found to be significantly different between patients with and those without OCP pretreatment (OR: 0.74, 95% CI: 0.53 to 1.03). Duration of gonadotropin stimulation (WMD: +1.41 days, 95% CI: +1.13 to +1.68) and gonadotropin consumption (WMD: +542 IU, 95% CI: +127 to +956) were significantly increased after OCP pretreatment. No significant differences were observed regarding the number of cumulus-oocyte complexes (COCs) and the fertilization rates. A significant difference in ongoing pregnancy rates between patients who received OCP pretreatment and those who did not is currently not present, although further studies are necessary for more solid conclusions on pregnancy likelihood to be drawn.

Effects of Simvastatin and Oral Contraceptive Agent on Polycystic Ovary Syndrome: Prospective, Randomized, Crossover Trial

There is increasing evidence that statins improve the lipid profile and also have cardioprotective effects that include an anti-inflammatory action and improved endothelial dysfunction. Preliminary findings from a 12-week trial suggest that women with polycystic ovary syndrome (PCOS) had lower total testosterone levels and a better lipid profile when given simvastatin plus an oral contraceptive pill (OCP) rather than an OCP alone. The final results of this trial, after a crossover of treatments and follow-up for 24 weeks, now are available. The 48 women entered into the study were prospectively randomized to receive simvastatin plus OCP for 12 weeks followed by OCP alone for 12 weeks longer, or OCP alone for 12 weeks and then combined treatment. Simvastatin was given orally in a daily dose of 20 mg. The OCP contained 20 μg of ethinyl estradiol and 150 μg of desogestrelpo. Total serum testosterone declined 38% after combined treatment but only by 26% with OC alone, a highly significant difference. The corresponding figures for free testosterone levels were 58% and 35%. Hirsutism decreased by about 8% with combined treatment and by less than 5% with OCP treatment; this difference also was significant. Similar effects on levels of dehydroepiandrosterone sulfate accompanied the two treatment regimens. Simvastatin therapy correlated with decreased levels of luteinizing hormone, but no changes in follicle-stimulating hormone or prolactin. Total cholesterol decreased by 7.5% with combined treatment but increased modestly on OCP alone. Both treatments were associated with increases in high-density lipoprotein cholesterol. With combined treatment, low-density lipoprotein cholesterol decreased by 20%. Triglycerides did not change with combined treatment but rose by one-fifth on OCP alone. OCP treatment led to a modest but significant negative effect on glucose metabolism. Both combined treatment and OCP correlated with a significant increase in fasting insulin. Statin therapy significantly improved markers of systemic inflammation including high-sensitivity C-reactive protein and soluble vascular cell adhesion molecule. No significant changes in body mass index were noted, and none of the subjects developed symptoms of muscle damage or biochemical evidence of liver dysfunction. These findings show that simvastatin therapy can substantially lessen clinical and endocrinological elements of PCOS and, at the same time, decrease cardiovascular risk factors.