Oral Hormonal Contraceptives Research Articles

The impact of oral contraceptive use on breast cancer risk: State of the art and future perspectives in the era of 4P medicine.

Breast cancer is the most commonly occurring cancer in women, the second most frequent cancer overall, and it causes the greatest number of cancer-related deaths among women. The significant increased concern of breast cancer worldwide may be attributed to the prolonged life expectancy and the adoption of the western lifestyle with its related risks factors. A woman's risk for breast cancer is linked to her reproductive history and with her lifetime hormonal exposure. Among the known risk factors for breast cancer, several studies investigated the possible role of the assumption of hormonal "pills" in both breast cancer incidence and development. Nevertheless, data about the association between the assumption of oral contraceptives and breast cancer incidence are still controversial and not conclusive. Given the public health importance of breast cancer and the popularity of hormonal "pills" as contraceptive, the impact of oral contraceptive use on breast cancer risk assumes relevance from both a clinical and a social point of view. Therefore, in this review we wanted to illustrate this issue by addressing the following major themes: a) the role of sex steroid hormones in female breast development and carcinogenesis; b) the clinical impact of hormonal oral contraception according to the state of the art literature; c) the actual scientific debate and future perspectives.

Evidências dos efeitos adversos no uso de anticoncepcionais hormonais orais em mulheres: uma revisão integrativa

Objetivo: Identificar na literatura as evidências científicas sobre os eventos adversos, oriundos do uso de anticoncepcional hormonal oral por mulheres. Método: Revisão integrativa de literatura, tendo como fonte de pesquisa as bases de dados Periódico da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, da Biblioteca Virtual em Saúde, PUBMED e Google Acadêmico, usando os descritores de busca “anticoncepcionais orais” AND “eventos adversos”. Com essa busca foram encontradas inicialmente 202 publicações. Após realizar seleção foram incluídos 17 artigos científicos na revisão. Os textos foram submetidos a análise de conteúdo semântica. Resultados: Foram levantadas três categorias: o uso de anticoncepcionais orais: aspectos clínicos e teóricos; associação entre o uso de anticoncepcionais orais e os eventos trombóticos; relação entre o uso de anticoncepcionais orais, neoplasias e doenças cardiovasculares. Conclusão: Contribuirá para que enfermeiros orientem as mulheres na escolha do método de anticoncepção, levando em consideração as possíveis complicações decorrentes do uso prolongado dos anticoncepcionais orais hormonais composto de estrogênio.Descritores: Anticoncepcionais Orais; Saúde Reprodutiva; Saúde Sexual; Saúde da Mulher.Evidence of adverse effects on oral hormonal contraceptive use in women: integrative reviewObjective: To identify in the literature the scientific evidence on adverse events arising from the use of oral hormonal contraceptives in women. Method: Integrative literature review, using the databases of the Virtual Health Library and the Journal of the Coordination for the Improvement of Higher Education Personnel as a research source, using the search keywords “oral contraceptives” AND “adverse events”. With this search, 202 publications were initially found, after making a selection, 17 scientific articles were included in the review. The texts were submitted to semantic content analysis. Results: Three categories were raised: the use of oral contraceptives: clinical and theoretical aspects; association between the use of oral contraceptives and thrombotic events; relationship between the use of oral contraceptives, neoplasms and cardiovascular diseases. Conclusion: It will help nurses to guide women in choosing the contraceptive method, taking into account the possible complications resulting from the prolonged use of hormonal oral contraceptives composed of estrogen.Descriptors: Oral Contraceptives; Reproductive Health; Sexual Health; Women's Health.Evidencia de efectos adversos sobre el uso de anticonceptivos hormonales orales en mujeres: revisión integradoraObjetivo: Identificar en la literatura la evidencia científica sobre eventos adversos derivados del uso de anticonceptivos hormonales orales en mujeres. Método: Revisión integral de la literatura, utilizando las bases de datos de la Biblioteca Virtual de Salud y la Revista de Coordinación para la Mejora del Personal de Educación Superior como fuente de investigación, utilizando las palabras clave de búsqueda "anticonceptivos orales" Y "eventos adversos". Con esta búsqueda, inicialmente se encontraron 202 publicaciones, luego de hacer una selección, se incluyeron 17 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon tres categorías: el uso de anticonceptivos orales: aspectos clínicos y teóricos; asociación entre el uso de anticonceptivos orales y eventos trombóticos; relación entre el uso de anticonceptivos orales, neoplasias y enfermedades cardiovasculares. Conclusión: Ayudará a las enfermeras a guiar a las mujeres a elegir el método anticonceptivo, teniendo en cuenta las posibles complicaciones derivadas del uso prolongado de anticonceptivos orales hormonales compuestos de estrógenos.Descriptores: Anticonceptivos Orales; Salud Reproductiva; Salud Sexual; Salud de la Mujer.

Comparison of Serum Lipid Profiles of Women with or Without Hormonal Contraceptives Users at a Tertiary Care Hospital in Dhaka City

Background: Both oral and injectable hormonal contraceptives are the most popular type of birth control measures used in Bangladesh.
 Objective: The purpose for the present study was to see the effects of hormonal contraceptives on serum lipid profiles.
 Methodology: This was case-control study which was carried out in the Department of Obstetrics & Gynaecology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2004 to December 2005 for eighteen (18) months. Women of reproductive age group who had given the history of taking low-dose OCP containing 30 meg EE plus 150 meg LNG were included as case group and women who were presented without the history of hormonal contraceptives use were included as control group. Blood was collected from each woman in fasting state and serum was sent for estimation of serum lipids profiles like serum triglycerides, total cholesterol, LDL and HDL.
 Result: The study included 40 women (control) who were not using OCP and 40 women (case) who were using OCP for more than one year. Comparison of age between control (31.75±4.85 years) and case (30.43±5.44 years) groups showed no significant difference (p>0.05). No significant difference with raised cholesterol levels (207.50±3.54 and 254.71± 45.54 mg/dl) was reported. Comparison of normal (136.16±39.46 and 154.05±35.33 mg/dl) and raised (229.00±24.52 and 246.32±35.98 mg/dl) triglyceride levels between control and case groups did not statistically significant. Comparison of normal and raised HDL levels did not show statistically any significant difference in control (32.07±3.02 mg/dL) and case (32.48±1.76 mg/dL) groups. Mean (±SD) of normal and raised levels of LDL was significantly high in case group. Normal LDL level was 82.71±26.82 and 111.05±15.40 mg/dl and raised LDL level was 138.55±3.03 and 188.82±40.37 mg/dL.
 Conclusion: In conclusion use of low-dose OCP containing 30 meg EE plus 150 meg LNG significantly increases serum cholesterol, serum triglyceride and LDL-cholesterol levels but not HDL-cholesterol.
 Journal of Science Foundation, January 2020;18(1):19-24

Contraceptive discontinuities in the use of oral and injectable hormonal contraceptives, and male condoms

The study aimed to estimate the total contraceptive discontinuity rates in the use of oral and injectable hormonal contraceptives, and male condoms and dropout rates due to switches to more effective and less effective methods. Data on 2,051 women, users of primary healthcare services in three Brazilian state capitals, were collected using the contraceptive calendar. The results showed that 24.5% of users of oral hormonal contraceptives, 33.5% of users of injectables, and 39% of users of male condoms had discontinued the respective method after 12 months of use, independently of the reason, and that the rates varied little between the capitals but did depend on the method. The main reason for discontinuing use of the contraceptive method was the desire to become pregnant (20.8%). Conception while using the method was reported by 20% of the women, a proportion that reached 25.7% in users of male condoms. After 12 months with the method, the dropout rate for reasons related to the contraceptive method was 11.4% in users of injectables; 15.9% of users of male condoms switched to a more effective method; and 16.3% of users of injectables switched to a less effective method. Contraceptive discontinuity rates were high and varied according to the contraceptive method.

Knowledge and attitudes about oral hormonal contraception among students from selected universities

Knowledge and attitudes about oral hormonal contraception among students from selected universities

Meta-Analysis the Effect of Oral and Injection Contraceptives on Breast Cancer

Background: Oral contraceptives and injec­tions are the main risk factors for breast cancer. The content of the hormones estrogen and progesterone in oral contraceptives and proges­tin in injection contraceptives can affect uncontrolled growth of breast tissue, leading to breast cancer. This study aims to analyze the magnitude of the effect of oral contraceptives and injection on the incidence of breast cancer by means of a meta-analysis study. Subjects and Method: This was a systematic review and meta-analysis conducted with PRISMA flow diagrams. Search for articles through journal databases includes: PubMed, Science Direct, and Google Scholar by selecting articles published in 2010-2020. The keywords used were Women Aged 15-80 Years AND Contraceptive Pills OR Birth control injec­ti­ons AND Breast Cancer. The inclusion crite­ria were full text articles with observational study design, articles in English, and multi­variate analysis used with adjusted odds ratios. Articles that meet the requirements are ana­lyzed using the Revman 5.3 application. Results: A meta-analysis of 15 observational studies showed that oral contraceptives had a 1.30 times risk of developing breast cancer compared with women using non-hormonal contraceptives (aOR= 1.30; 95% CI= 1.13 to 1.50; p= 0.0002). A meta-analysis of 6 obser­vational studies showed injectable contracep­tives had a 1.37 times risk of developing breast cancer compared to using non-hormonal contraceptives (aOR= 1.37; 95% CI= 1.09 to 1.71; p= 0.006). Conclusion: Oral hormonal contraceptives and injections have a weak effect on the inci­dence of breast cancer. Keywords: injection contraception, oral contraception, breast cancer, meta-analysis Correspondence: Dilma’aarij Riski Agustia. Masters Program in Public Health. Universitas Sebelas Maret, Jl.Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: dilmarij@gmail.com. Mobile: 082230100871. Journal of Maternal and Child Health (2021), 06(02): 238-249 https://doi.org/10.26911/thejmch.2021.06.02.11

Efeitos Colaterais a longo prazo associados ao uso de Anticoncepcionais Hormonais Orais

Oral hormonal contraceptives are effective contraceptive methods that prevent unwanted pregnancies from occurring. They are classified according to a hormonal composition as combinations and mini pills and not different from the other drugs, these also have associated effects. Thus, the objective of this research was to outline the effects related to the continuous and long-term use of oral hormonal contraceptives. This is an Integrative Review carried out based on articles published between the years 2015 and 2021, in the databases MEDLINE, BDENF, LILACS and Google Scholar. Among the results found, it was shown that oral contraceptive hormones can cause greater damage to health, such as thrombosis, increased blood pressure, cardiovascular problems, neoplasms, especially with long-term use. It is concluded that it is necessary that health professionals, especially pharmacists, and visual women on alert, regarding the effects triggered by the prolonged use of the oral hormonal method and the aggravations of these when associated with modifiable and non-modifiable risk predispositions. Relevant to women's health.

The knowledge of young women about breast cancer

Abstract Introduction. Breast cancer is the most common malignant neoplasm among women in Poland. Many factors, both non-modifiable and modifiable, are involved in the development of this cancer, so it is important that women know the risk factors and the principles of cancer prevention. Numerous studies show that the knowledge of women in this area is small. Aim. Determining the state of knowledge about breast cancer of young women in Poland, comparing the analysis of social awareness on this subject with previous research, and identifying the most important preventive measures in this area. Material and methods. An anonymous questionnaire survey was conducted in electronic form among women aged 16-25 from all over Poland. The study was carried out using a proprietary questionnaire (Google form) completed online. The questionnaire contained closed questions verifying the knowledge of the topic under study and a certificate. The following computer programs were used for statistical analysis of data: Statistica and Microsoft Excel. Results. Less than a third of women knows the typical age at which breast cancer develops and is aware of the relationship between the use of oral hormonal contraceptives and the development of this cancer. Few of the respondents are able to correctly identify the risk factors for breast cancer, practically every tenth respondent knows the principles of breast cancer prevention, and nearly one third of them correctly indicated its symptoms. Conclusions. There are gaps in the knowledge of young women about breast cancer that need to be filled. Education in the field of breast self-examination and risk factors for breast cancer development is a priority, which in the future may contribute to increasing the detection of breast changes and reducing the number of breast cancer cases.

The knowledge of young women about cervical cancer

Abstract Introduction. Women in Poland suffer from and die of cervical cancer more often than women from other European countries. The reason for this phenomenon is the fact that women in Poland are reluctant to perform Pap smear tests. Reluctance to undergo a Pap smear is due to low awareness of its course. Numerous studies show that women do not know much about the course of illness, risk factors and prevention of cervical cancer. In its prevention, health behaviors are important from the moment of sexual initiation, so it is important that young women have sufficient knowledge about it. Aim. Determining the state of knowledge of the respondents, comparing social awareness to previous research and proposing new preventive solutions. Material and methods. An anonymous questionnaire survey was conducted in electronic form among women aged 16-25 from all over Poland. The study was conducted using a proprietary questionnaire (Google form) completed online. The questionnaire contained closed questions verifying the knowledge of the topic under study and personal information. The following computer programs were used for statistical analysis of data: Statistica and Microsoft Excel. Results. Almost half of the surveyed women believes that the use of oral hormonal contraception does not increase the risk of developing cervical cancer. One in ten women does not know about the existence of an HPV vaccine. Nearly one third of the respondents do not see a gynecologist at all. Nearly two-thirds of women do not perform a Pap smear. Conclusions. The surveyed women have some knowledge concerning cervical prophylaxis, but they rarely use it in practice. However, the knowledge of women about the symptoms and risk factors of cervical cancer is small. Too few women know about the existence of a cervical cancer prevention program in Poland.

The Effect of Oral Contraceptive Hormones on Anterior Cruciate Ligament Strength

Females are up to eight times more likely to injure their anterior cruciate ligaments (ACLs) than males. While anatomical and biomechanical factors likely contribute to this disparity, hormonal differences have also been found to predispose women to ACL injury. The ACL’s strength is affected by various female hormones such as relaxing and estrogen. Oral contraceptives (OCs) can directly alter these hormone levels, however no study to date has done a comprehensive comparison of differing contraceptive regimens on ACL strength. Untreated rats were compared to rats treated with one of the five following clinically-used OCs: Norethindrone only, Norethindrone plus Ethinyl Estradiol, Etynodiol Diacetate plus Ethinyl Estradiol, Norgestimate plus Ethinyl Estradiol, and Drospirenone plus Ethinyl Estradiol. Doses were scaled from human doses to account for differences in bioavailability and body weight, and OCs were administered daily via oral gavage for four rat estrous cycles (20 days). 42 rats were then sacrificed (6 rats/group), and ACL specimens underwent biomechanical testing and were preloaded to 1N and then preconditioned for 10 cycles at a rate of 0.25mm/s. Strength (MPa) and stiffness (N/mm) were assessed. ACL strength (MPa) was calculated by normalizing maximum load before failure (N) by ACL cross sectional area (mm2). ACL specimens were also isolated for quantitative real-time polymerase chain reaction analysis to assess collagen and matrix metalloproteinase (MMP) expression. Readings from the left and right ACLs for each rat were averaged. Data was then analyzed with One-Way ANOVA and post hoc Bonferroni and Holm multiple comparison statistical calculations. The average strength of ACLs from rats treated with Norethindrone only (42.1 ± 1.4 MPa), Drospirenone plus Ethinyl Estradiol (41.5 ± 1.9 MPa), Etynodiol Diacetate plus Ethinyl Estradiol (41.0 ± 3.3 MPa), and Norethindrone plus Ethinyl Estradiol (38.7 ± 3.0 MPa) was significantly increased when compared to untreated rats (29.1 ± 4.9 MPa) (p = 0.001, p = 0.004, p = 0.004 and p = 0.037 respectively). There was no significant difference with Norgestimate plus Ethinyl Estradiol (34.9 ± 1.4 MPa) OCs. ACL strength directly correlated with each formulation’s ratio of progestin to estrogen potency. The order from strongest to weakest ACLs as well as highest to lowest progesterone to estrogen ratios was Norethindrone only, Drospirenone plus Ethinyl Estradiol, Etynodiol Diacetate plus Ethinyl Estradiol, Norethindrone plus Ethinyl Estradiol, and then Norgestimate plus Ethinyl Estradiol. The higher ratio formulation (Drospirenone plus Ethinyl Estradiol) also increased the expression of type I collagen by 8.1 ± 2.7-fold (p = 0.02) and decreased MMP1 by 0.06 ± 0.04-fold (p = 0.04) when compared to untreated rats. The low progestin-to-estrogen (Norgestimate plus Ethinyl Estradiol) ratio formulation only increased type I collagen expression 4.7 ± 0.6-fold (p = 0.26) and decreased MMP1 expression only 0.38 ± 0.13-fold (p = 0.25). Oral contraceptives act to influence ACL strength differently depending on their formulation, likely by increasing type I collagen and decreasing MMP1 expression. Norethindrone only, Drospirenone plus Ethinyl Estradiol, Etynodiol Diacetate plus Ethinyl Estradiol, and Norethindrone plus Ethinyl Estradiol formulations increased ACL strength when compared to Norgestimate plus Ethinyl Estradiol and untreated rat ACLs. Formulations with no estrogen, like Norethindrone only, or formulations with a higher progestin to estrogen ratio, such as Drospirenone plus Ethinyl Estradiol or Etynodiol Diacetate plus Ethinyl Estradiol, may be more protective for the ACL than formulations with low progestin to estrogen ratios, such as Norgestimate plus Ethinyl Estradiol.

Impact of menstrual cycle phase and oral contraceptives on sleep and overnight memory consolidation.

Sleep spindles benefit declarative memory consolidation and are considered to be a biological marker for general cognitive abilities. However, the impact of sexual hormones and hormonal oral contraceptives (OCs) on these relationships are less clear. Thus, we here investigated the influence of endogenous progesterone levels of naturally cycling women and women using OCs on nocturnal sleep and overnight memory consolidation. Nineteen healthy women using OCs (MAge = 21.4, SD = 2.1 years) were compared to 43 healthy women with a natural menstrual cycle (follicular phase: n = 16, MAge = 21.4, SD = 3.1 years; luteal phase: n = 27, MAge = 22.5, SD = 3.6 years). Sleep spindle density and salivary progesterone were measured during an adaptation and an experimental night. A word pair association task preceding the experimental night followed by two recalls (pre‐sleep and post‐sleep) was performed to test declarative memory performance. We found that memory performance improved overnight in all women. Interestingly, women using OCs (characterized by a low endogenous progesterone level but with very potent synthetic progestins) and naturally cycling women during the luteal phase (characterized by a high endogenous progesterone level) had a higher fast sleep spindle density compared to naturally cycling women during the follicular phase (characterized by a low endogenous progesterone level). Furthermore, we observed a positive correlation between endogenous progesterone level and fast spindle density in women during the luteal phase. Results suggest that the use of OCs and the menstrual cycle phase affects sleep spindles and therefore should be considered in further studies investigating sleep spindles and cognitive performance.

Hormonal contraception agents for planned use: a comparative analysis of clinico-pharmacological and economic characteristics and consumption

Aim. To analyze and compare the assortment, affordability and consumer demand for hormonal contraceptives for planned use: oral hormonal contraceptives (OHC) of the combined contraceptive releasing-systems (CCRS) and hormonal contraceptives of prolonged action (HCPA) presented at the pharmaceutical market in 2018.Materials and methods. The analysis of the assortment, economic affordability by the solvency adequacy index (Са.s.) and consumer demand by the number of OHC, CCRS, and HCPA packages sold according to the data of the “Morion” analytical system for 2018 was performed.Results. OHC was represented by 40 trade names (TN), among them 35 TN were estrogens and gestagens in fixed combinations; gestagens and estrogens for sequential use were 3 TN; gestagens – 2 TN. CCRS and HCPA – 2 TN. The range of solvency adequacy index was: for OHC – 1.49-5.02 %; CCRS – 5.32-6.38 %; HCPA – 0.45-0.72 %. The number of packages sold was (in thousands): for OHC – 1879.4, among them 1708.1 – for estrogens and gestagens in fixed combinations; 156.7 – for gestagens and estrogens for sequential use; 14.6 – for gestagens; for CCRS – 27.3; for HCPA – 31.9.Conclusions. At the pharmaceutical market of Ukraine, OHC are represented by the largest assortment compared to CCRS and HCPA and are in high demand. The most affordable hormonal contraceptives for planned use in Ukraine are CCRS. The most economical and affordable contraceptives are in high demand.

Herbal Remedies for Birth Control: An Alternative to Synthetic Hormonal Contraceptives

Background: Both women and men wish to have control over when to become parents. Birth control or contraception methods basically entail different types of mechanisms to avoid pregnancy. Making choices about birth control methods is not easy since there are many types of fertility control techniques available to avoid pregnancy. Objective: Several health problems are associated with females or males on the prominent use of oral contraceptives/pills. To reduce the side effects of these pills, nature provides us with several medicinal plants that act as good birth control pills. So this review aims to focus on the database provided in the literature to use these medicinal plants to avoid or control the severe health problems which directly or indirectly affect the health of the individual. Methods: All significant databases were collected via electronic search using PubMed, Scopus, Web of Science and Science direct and were compiled. Results: Several common options include family planning through abstinence, hormonal methods like oral contraceptives, barrier methods, etc. Apart from this, some people who do not want to have children may opt for permanent sterilization, but these methods or pills, when taken orally, change the hormonal balance of the individual, which leads to the other disorders. Thus, this present review concludes the knowledgeable erudition on the natural plants acting as antifertility agents. Conclusion: This review article is mainly focused on the natural birth control methods to combat pregnancy and also emphasize on various medicinal active plants being used to avoid fertility.

Type of Dysmenorrhea, Menstrual Characteristics and Symptoms in Nursing Students in Southern Spain.

Dysmenorrhea is a form of chronic pain associated with menstruation that affects a high percentage of young people. This study sought to determine the prevalence of primary and secondary dysmenorrhea among female nursing students in southern Spain and to compare their menstrual characteristics and symptoms. A cross-sectional observational study was conducted using a self-report questionnaire that included sociodemographic variables, menstrual characteristics and related symptoms. Descriptive bivariate analysis and binary logistic regression were performed in which the dependent variable was secondary dysmenorrhea. The prevalence of dysmenorrhea was 73.8% (of which 63.3% had primary dysmenorrhea and 10.5% had secondary dysmenorrhea), and was more likely in women with longer periods, heavier bleeding and those not using oral hormonal contraception (OCP). Secondary dysmenorrhea was 31.75, (confidence interval (CI)95% = 4.44–238.59; p < 0.01) times more likely among those with menstrual headache, 8.37 (CI95% = 2.35–19.80; p < 0.01), times greater among those suffering nausea during menstruation, 6.60 (CI95% = 1.42–30.67; p < 0.01), times greater among those suffering from menstrual vomiting, it was also 1.17 (CI95% = 1.08–1.26; p < 0.01) times more likely for each day that the period was prolonged and 6.63 (CI95% = 1.47–30.01; p = 0.014) times more likely in women with a heavy menstrual flow. These findings may help guide professionals towards the prescription of additional tests in certain cases in which secondary dysmenorrhea is suspected.

Abstract 5760: Trends in oral contraceptive and intrauterine device use among reproductive aged women in the US from 1999-2017

Abstract Importance: Since the 1960s, an increase in the use of oral contraceptives (OC) and other hormonal contraceptives has mirrored a decreased incidence of ovarian and endometrial cancers in the US. With improved access and increased contraceptive options over time, it is important to follow trends of use and consider how changing patterns can affect gynecologic cancer risks. Objective: To evaluate trends in OC use and intrauterine device (IUD) use among reproductive aged women in the US. Methods: Nationally representative data from the National Health and Nutrition Examination Survey (NHANES, N=19,216) and the National Survey for Family Growth (NSFG, N=26,262) were used to determine current OC and IUD use among reproductive aged women in the US. Women with prior hysterectomy, bilateral oophorectomy or that were post-menopausal were excluded due to ineligibility for standard OCs. Adjusted logistic regression and unadjusted Joinpoint models (to determine inflection points) were used to evaluated trends in contraceptive use between 1999-2017. We used questionnaire data from continuous NHANES and NSFG cycles from 1999/2000 to 2015/16 and 2006/08 to 2015/17, respectively. Within each survey, temporal trends in OC use were assessed overall and by race, age, gravidity, education and BMI. OC formulation/generation were determined from current prescriptions in NHANES. Trends in IUD use were evaluated in NSFG. Results: Since 1999, self-reported OC use overall decreased annually by 3% in NHANES [OR 0.97 (95%CI 0.96, 0.99) P=0.001] and 4% in NSFG [0.96 (0.94, 0.97) P&amp;lt;0.001]. Annual percent change estimates from unadjusted joinpoint regression also suggested consistent decreases over time. Proportion of OC use by generation of progestin across all cycles was stable with an average of 42.3% 3rd generation, 31.3% 1st, 17.0% 2nd, and 9.5% 4th (the latter was limited to cycles from 2003/04 to 2015/16). Decreases in OC use over time did not vary by categories of race, age, education or BMI. However, trends in OC use varied significantly by gravidity in NHANES (Phet=0.05). OC use for nulligravid women was stable over time, while reported OC use decreased 4% annually in gravid women [OR 0.96 (0.94-0.98) P&amp;lt;0.001]. IUD use increased by 14% each year [OR 1.14 (1.11, 1.17) P&amp;lt;0.001]; 76.5% of users reported hormonal IUD use in the 2015/17 cycle. The largest uptake of IUD use (32% increase per year [OR 1.32 (1.21, 1.43) P&amp;lt;0.001]) occurred among nulligravid women, which was historically, a contraindication for IUD use. Conclusions: IUD use is increasing at a rate faster than that of the decreasing rate of OC use. There is some suggestion that like OC use, IUD use also reduces ovarian and endometrial cancer risks, although associations with hormonal IUDs are less clear. As such, the changing landscape of contraceptive practices in the US may alter future trends in ovarian and endometrial cancers and thus requires further surveillance. Citation Format: Lauren A. King, Kara A. Michels, Barry I. Graubard, Britton Trabert. Trends in oral contraceptive and intrauterine device use among reproductive aged women in the US from 1999-2017 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5760.

Counterpoint: Investigators should not control for menstrual cycle phase when performing studies of vascular control that include women.

Observed sex differences in the epidemiology of cardiovascular disease incidence and the efficacy of clinical intervention strategies, coupled with recent mandates from the National Institutes of Health (NIH), and its international counterparts to consider sex as a biological variable in all preclinical and clinical work (15), have led to increased enrollment of women in human physiology studies of vascular function with the goal of improving external validity and clinical applicability of the findings. However, standard practice in these studies is to test women during the early follicular phase (~days 1-5) of the menstrual cycle, during which estrogen and progesterone concentrations are lowest, and either exclude or limit testing of women who use hormonal contraceptives to the placebo phase. This approach seeks to control for, or limit, differences in circulating hormone concentrations between men and women and is based on the dogmatic theory that cyclic changes in estrogen and progesterone concentrations lead to greater variability in study outcomes and uninterpretable datasets. Contrary to this common approach, we propose that limiting testing of women to this single phase 1) decreases external validity of the findings, 2) obfuscates potential physiological differences contributable to differences in sex hormone concentrations between men and women, and 3) is, in many instances, contradicted by literature that demonstrates limited or no variability in vascular measurements across the menstrual cycle.

Contraceptive vaginal ring reduces lamotrigine levels

ObjectiveThe objective of the study was to describe the effect of the vaginal ring and transdermal patch on lamotrigine serum levels in women with epilepsy. BackgroundPrevious studies demonstrate that oral hormonal contraceptives containing synthetic estrogen increase lamotrigine clearance through induction of glucuronidation. This leads to variable lamotrigine serum concentrations throughout monthly cycles in women who are on combined oral contraceptives (COCs). The effects of estrogen-containing nonoral hormonal contraceptive methods, including the vaginal ring and transdermal patch, on lamotrigine pharmacokinetics are not well described. MethodsRetrospective chart review was performed to identify serum lamotrigine levels drawn from women with epilepsy while on the active phase of vaginal ring or transdermal patch and while off contraception. Wilcoxon signed-rank tests for paired data were used to compare the difference in dose-corrected lamotrigine concentration in plasma between values while on hormonal contraception to those while off contraception in patients using a vaginal ring. ResultsSix patients were using the vaginal ring, and one patient was using the transdermal patch. Lamotrigine dose-corrected concentrations were decreased during the active phase of the vaginal ring compared with concentrations during the period off contraception (p = .04). There was one patient without a decrease in concentration, but the other five patients on the vaginal ring had a decrease in dose-corrected lamotrigine concentration ranging from 36 to 70% while on the vaginal ring. Similarly, one patient using the transdermal patch had a decrease of 37% in dose-corrected lamotrigine concentration while on the patch. ConclusionsThe findings support that the vaginal ring contraceptive method decreases lamotrigine concentrations during the active phase of treatment. This has important implications for contraceptive counseling and maintaining therapeutic levels in women of childbearing age with epilepsy.

An interdisciplinary approach to the problem of gallstone disease in women: a view of a gynecologist

The article presents the modern view on pathogenetic mechanisms of the cholelithiasis development in women, illustrated by clinical observations. Gender-associated risk factors for cholelithiasis are pregnancy and childbirth, female sex hormones administration and polycystic ovary syndrome. The gallstone disease risk factors in women taking hormonal oral contraceptives and menopausal hormone therapy are hereditary predisposition, impaired lipid, carbohydrate metabolism and functional gallbladder disorders. Patients at high risk of developing cholelithiasis are recommended to perform a gallbladder ultrasound examination before and during hormonal therapy. The ursodeoxycholic acid treatment is safe, effective and compatible with female sex hormone administration in patients with detected biliary sludge.

Effects of oral contraceptives on thyroid function and vice versa.

Thyroid gland dysfunction represents an epidemiologically relevant disease in the female gender, where treatment with oral contraceptives (OCs) is frequently prescribed. Although OCs are able to impact the thyroid gland function, scanty data have been released on this matter so far. The aim of this article was to review how hormonal OCs, including estrogen- or progesterone-only containing medications, interact with the hepatic production of thyroid-binding globulin (TBG) and, consequently, their effects on serum levels of thyroxine (T4) and triiodothyronine (T3). We also reviewed the effect of Levo-T4 (LT4) administration in women taking OCs and how they influence the thyroid function in both euthyroid women and in those receiving LT4. The estrogenic component of the pills is capable of increasing various liver proteins, such as TBG, sex hormone-binding protein (SHBG) and coagulation factors. On the other hand, the role of progestogens is to modulate estrogen-dependent effects mainly through their anti-androgenic action. In fact, a reduction in the effects of androgens is useful to keep the thromboembolic and cardiovascular risks low, whereas OCs increase it especially in women with subclinical hypothyroidism or in those treated with LT4. Accordingly, subclinical hypothyroidism is known to be associated with a higher mean platelet volume than normal and this increases cardiovascular risk due to platelet hyperactivity caused by incomplete thrombocytopoietic maturation.

Screening and Prevention for High-Grade Serous Carcinoma of the Ovary Based on Carcinogenesis-Fallopian Tube- and Ovarian-Derived Tumors and Incessant Retrograde Bleeding.

High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian carcinoma. Many HGSCs are now believed to originate in the fallopian tube epithelium; ovarian surface epithelium is another possible origin. Thus, current screening methods, i.e., ultrasonography and serum CA-125 measurements, have a limitation in their early detection. Recently, circulating biomarkers, such as tumor DNA, autoantibody, and microRNA, have been investigated to detect HGSCs. As cancer cells in the fallopian tube flow into the endometrial cavity, the detection of exfoliated cells, tumor DNA, and proteome from samples obtained from the endometrial cavity or the cervix may be useful. The risk of ovarian serous carcinoma is affected by the use of oral contraceptive and menopausal hormone therapy (MHT). MHT regimens causing endometrial bleeding increase serous carcinoma risk, hence, incessant retrograde bleeding from the endometrial cavity into the Douglas pouch appears to play an important role in high-grade serous carcinogenesis. In this review, we provide an overview of current and novel screening methods and prevention approaches for ovarian and fallopian tube HGSC.