Reversible Hormonal Contraception Research Articles

Use of etonogestrel subcutaneous implant in Sardinia, Italy: women’s compliance and satisfaction

Purpose of the article The main aim of the study was to analyze the population of women who used etonogestrel implant, the reason that led them to this type of contraception, and the degree of compliance with it. Materials and methods: We carried out a retrospective study on women who had etonogestrel subcutaneous implant placed (n°47) over a 6-year period (2015–2021). We submitted the women a series of questions by telephone questionnaire (range 10–72 months after placements, mean 40 months) that investigated the comorbidities and side effects related to etonogestrel implant. Materials and methods We carried out a retrospective study on women who had etonogestrel subcutaneous implant placed (n°47) over a 6-year period (2015–2021). We submitted the women a series of questions by telephone questionnaire (range 10–72 months after placements, mean 40 months) that investigated the comorbidities and side effects related to etonogestrel implant. Results The average age of placement of etonogestrel implant was 33.8 ± 3.45 years. As regards level of education, 16/47 (34%) of the women had a university degree, 21/47 (44%) had a high school diploma and 10/47 (21%) had a secondary school diploma. The 12/47 (25%) of the women were, at the time of the counselling, unemployed and only 8% did not use in the past contraceptive methods other than etonogestrel implant. The 92% of women choose etonogestrel implant because it offered safe, comfortable and long-lasting contraception. Among the main side effects evaluated, we reported spotting in 24 out of 47 (51%), headache in 4 out of 47 (8.5%). The 85% of the women recommended etonogestrel implant to their friends as a contraceptive method, with an approval rating for the implant, expressed a rating from 1 to 10 with the mean that was 7.79, the median 8. Conclusions Our results are of interest because they derive from a region of Italy in which the Long acting reversible contraception (LARC) is strongly underused. Etonogestrel implant was a safe and effective, long-acting, reversible hormonal contraception (LARC) and majority of women recommended the etonogestrel implant to their friends as a contraceptive method.

SAT463 Hormonal Contraceptive Use and Hypothyroidism Risk

Abstract Disclosure: S. Gloe: None. T.B. Carroll: Consulting Fee; Self; Corcept Therapeutics. Research Investigator; Self; Corcept Therapeutics, Novartis Pharmaceuticals. Introduction: Thyroid dysfunction is one of the most common endocrine disorders, with an estimated 4.3% of the US affected by subclinical hypothyroidism and 0.3% affected by overt hypothyroidism. Chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the US and is estimated to affect 5-10x more women than men. Given this higher incidence in women, it is possible that hormonal difference or hormonal medications may play a role in thyroid dysfunction. Nearly 15% of women aged 15-49 use oral contraceptive pills (OCP) and 10.4% use other long-acting reversible hormonal contraceptives. A recent study showed a 25% increased prevalence of hypothyroidism in women with prior OCP use and in women with more than 10 years of OCP use the risk of developing hypothyroidism was nearly 4 times as high. Methods: Using the TriNetX database, four distinct groups of women aged 18-45 were identified using data from 1/1/2010 -1/1/2020. The four groups were EPC (n=5849), POC (n=5052), IUD (n=1000), and controls without prior hormonal contraception use (n = 6677). Demographic data, date of diagnosis of hypothyroidism, alcohol use, tobacco use, and BMI was obtained for each subject. Exclusion criteria included thyroidectomy (partial or total), lack of sufficient medication data, and a hypothyroidism diagnosis prior to or within 90 days of the first contraceptive medication order. A logistic model was then created accounting for known risk factors for the development of hypothyroidism (race/ethnicity, alcohol use, smoking, and BMI).Results: Initial comparison of treatment groups to controls demonstrated an no difference in risk of developing hypothyroidism for the EPC group (OR=1.18, p=0.2), but the POC and IUD groups had decreased risk of hypothyroidism (OR=0.39, p=<0.001 and OR=0.45, p=0.029, respectively). Using the logistic model, all groups demonstrated a decreased risk of hypothyroidism as compared to the control group (EPC: OR=0.3, p=<0.001, POC: OR=0.14, p=<0.001, IUD: OR=0.12, p=<0.001). Additionally, individuals identifying as Black/African Americans were less likely to develop hypothyroidism when compared to white/Caucasian subjects (OR=0.25, p=<0.001). Finally, BMI showed a fairly weak but significant association with development of hypothyroidism (OR=1.04, p=< 0.0001). Conclusion: Contrary to prior research, our data suggests a potential protective effect against the development of hypothyroidism for EPC, POC, and IUD use. The data also confirms prior studies showing a lower incidence of hypothyroidism in individuals who identify as Black/African American and perhaps those with lower BMI. Presentation Date: Saturday, June 17, 2023

Assessment of contraceptive curricula in US pharmacy programs

IntroductionPharmacists prescribe contraception in some states following expansions in scope of practice. Adequate education on contraception in pharmacy curricula is crucial to effectively deliver these services. MethodsA 26-item survey assessing contraception curricula regarding was administered by email to instructors and administrators at 139 pharmacy schools in the United States. The survey assessed teaching methods, hours taught, topic content, and opinion of adequacy of contraceptive education provided by the program. ResultsThe survey achieved a response rate of 40% (n = 56). All programs that responded offer emergency contraception and hormonal contraception content, 96% offer non-hormonal over-the-counter contraception content, and 91% offer long-acting reversible hormonal contraception content. Average number of hours taught were as follows: non-hormonal over-the-counter contraception 2.0 hours, emergency contraception 0.9 hours, hormonal contraception 3.0 hours, long-acting reversible hormonal contraception 0.8 hours, and non-reversible hormonal contraception 0.5 hours. Patient cases were most used to supplement didactic content in all topics. Standardized patient interviews were used less frequently for both hormonal contraception (25%) and emergency contraception (7%). About 68% of programs agreed or strongly agreed that the contraceptive education provided by the program was adequate. A majority (70%) indicated interest in a standardized contraceptive curriculum. ConclusionsContraceptive education is broadly covered in didactic curricula within pharmacy education. Further assessment and development of curricula standards may be warranted to assess quality and adequacy of contraceptive education in pharmacy.

Benefits of reversible contraception.

Long-acting reversible contraception—intrauterine devices and contraceptive implants—offers the highest protection against unintended pregnancies. In addition, the use of reversible hormonal contraception has added health benefits for women in both the short and the long term. This review will give an overview of the benefits of reversible contraception as well as an evidence-based recommendation on how it should be used to benefit women the most.

AMH/MIS as a contraceptive that protects the ovarian reserve during chemotherapy

The ovarian reserve represents the stock of quiescent primordial follicles in the ovary which is gradually depleted during a woman's reproductive lifespan, resulting in menopause. Müllerian inhibiting substance (MIS) (or anti-Müllerian hormone/AMH), which is produced by granulosa cells of growing follicles, has been proposed as a negative regulator of primordial follicle activation. Here we show that long-term parenteral administration of superphysiological doses of MIS, using either an adeno-associated virus serotype 9 (AAV9) gene therapy vector or recombinant protein, resulted in a complete arrest of folliculogenesis in mice. The ovaries of MIS-treated mice were smaller than those in controls and did not contain growing follicles but retained a normal ovarian reserve. When mice treated with AAV9/MIS were paired with male breeders, they exhibited complete and permanent contraception for their entire reproductive lifespan, disrupted vaginal cycling, and hypergonadotropic hypogonadism. However, when ovaries from AAV9-MIS-treated mice were transplanted orthotopically into normal recipient mice, or when treatment with the protein was discontinued, folliculogenesis resumed, suggesting reversibility. One of the important causes of primary ovarian insufficiency is chemotherapy-induced primordial follicle depletion, which has been proposed to be mediated in part by increased activation. To test the hypothesis that MIS could prevent chemotherapy-induced overactivation, mice were given carboplatin, doxorubicin, or cyclophosphamide and were cotreated with AAV9-MIS, recombinant MIS protein, or vehicle controls. We found significantly more primordial follicles in MIS-treated animals than in controls. Thus treatment with MIS may provide a method of contraception with the unique characteristic of blocking primordial follicle activation that could be exploited to prevent the primary ovarian insufficiency often associated with chemotherapy.

Long-acting reversible hormonal contraception

Long-acting reversible hormonal contraceptives are effective methods of birth control that provide contraception for an extended period without requiring user action. Long-acting reversible hormonal contraceptives include progesterone only injectables, subdermal implants and the levonorgestrel intrauterine system. These methods have several advantages over other reversible contraceptive methods. More importantly, once in place, they require minimal maintenance and their duration of action ranges from 8 weeks to 5 years. Despite the advantages of long-acting reversible hormonal contraceptive methods, they are infrequently used in South Africa. Short-acting methods, specifically oral contraceptives and condoms, are by far the most commonly used reversible methods. A shift from the use of short-acting methods to long-acting reversible contraceptive methods could help reduce the high rates of unintended pregnancies in South Africa. In this review of long-acting reversible hormonal contraceptive methods, we discuss the long-acting progesterone injectables, the etonogestrel implant and the levonorgestrel intrauterine system available in South Africa, the side effects of each of these preparations and the non-contraceptive benefits. It is imperative that health professionals and educators inform women of reproductive age about the benefits, risks, and common side effects of long-acting reversible hormonal contraception to improve consideration and recognition of these methods.

Long-acting hormonal contraception.

Today, a new category of fertility-regulating agents has been created: long-acting, reversible hormonal contraceptives; they minimize compliance, while maximize effectiveness. They comprise subdermal implants and intrauterine devices. Other long-acting agents exist, such as Depo Provera and Noristerat. Use of Depo Provera and Noristerat carries great effectiveness, good clinical safety and usefulness in developing countries. They cause no significant increase in breast cancer risk, but they may carry an increased risk of HIV. Subcutaneous delivery systems have two common features: prolongation of effect is obtained by a drug reservoir and for most of their duration of action they provide a continuous, sustained release of the active hormone. Finally, the intrauterine system Mirena represents both a very effective contraceptive and a specific treatment for menorrhagia.

106 VASORELAXATION IN ORAL CONTRACEPTIVE-INDUCED HIGH BLOOD PRESSURE IN FEMALE RATS

Background: Oral contraceptive (OC) pills are the most common form of reversible hormonal contraception used by an estimated 100 million women worldwide. While the evidence for increased risk of venous events in OC users is well established, the association between OC use and arterial vascular complications has not been well defined. This study was designed to investigate the vascular reactivity in OC-induced high blood pressure by assessing the relaxation response of isolated aortic rings to acetylcholine, potassium and magnesium in Sprague-Dawley female rats. Methods: Female rats were given (p.o.) vehicle or OC (10.0 μg norgestrel/1.0 μg ethinyl estradiol) with free access to rat chow and water daily for 10 weeks. Results: The results indicate OC treatment led to significant increase (p < 0.001) in the arterial blood pressure and decrease in glucose tolerance in the rats. The maximum contractile response of the aortic rings to noradrenaline and higk-K+ in the OC-treated rats was not significantly different from that in the vehicle-treated rats. Acetylcholine, potassium and magnesium caused relaxation of the noradrenaline pre-contracted aortic rings, and the relaxation responses in the rings of OC treated rats were not significantly different from the rings from vehicle-treated rats. However, magnesium-induced relaxation response of the K+ pre-contracted rings from OC-treated rats were significantly attenuated when compared with those from the vehicle-treated rats. Conclusion: The results of this study indicate that estrogen-progestogen OC-induced high blood pressure is associated with altered glucose tolerance, magnesium-induced relaxation (probably via altered voltage-dependent calcium channels), preserved acetylcholine- and potassium-induced vasorelaxation.

Relative Cost Effectiveness of Depo-Provera??, Implanon??, and Mirena?? in Reversible Long-Term Hormonal Contraception in the UK

To estimate the relative cost effectiveness for women aged > or =30 years, starting long-term hormonal contraception with either levonorgestrel intrauterine system (Mirena), etonogestrel subdermal implant (Implanon) or medroxyprogesterone acetate injection (Depo-Provera). This was a modelling study, performed from the perspective of the UK NHS, of contraceptive services supplied by a general practitioner. STUDY PARTICIPANTS AND INTERVENTIONS: A dataset was created from the General Practice Research database (GPRD) comprising 16 835 women aged > or =30 years who received levonorgestrel intrauterine system (n = 6080), etonogestrel subdermal implant (n = 277) or medroxyprogesterone acetate injection (n = 10 478) for their long-term contraception between 1997 and 2002. Contraception-related healthcare resource utilisation values and contraception continuation rates were obtained from the GPRD. The incidence of pregnancy associated with each contraceptive was obtained from the published literature. By combining the GPRD dataset with published clinical outcomes, a decision model was constructed. This was used to estimate the expected annualised direct healthcare costs and consequences of the provision of each type of contraception per woman-year in pounds sterling (pound) at 2002/03 prices. Our model suggests that starting long-term contraception with levonorgestrel intrauterine system or etonogestrel subdermal implant instead of medroxyprogesterone acetate injection is a dominant strategy from the UK NHS perspective. In contrast, starting long-term contraception with etonogestrel subdermal implant instead of levonorgestrel intrauterine system is likely to be the least cost-effective option, since it would lead to an additional cost for each additional avoided pregnancy (pound 21,000). Long-acting reversible hormonal contraception has the benefit of being extremely effective (>99%), and not reliant on patient compliance nor dependent on correct usage. The relative cost effectiveness of using any one contraceptive should be considered in the light of the additional clinical benefits it may confer, user acceptability, QOL, past medical history and the estimated cost of an unintended pregnancy. Choice of contraception is essential to meet diverse user needs and preferences that may change with the user's stage of life. Only by offering choice will the maximum number of women be protected and therefore the greatest savings to the health service be gained.

A review of androgen-progestin regimens for male contraception.

It has been 40 years since the administration of steroids to women to prevent pregnancy was approved in many countries and finally the development of reversible hormonal contraceptives for men seems to be within reach. Surveys performed in recent years suggest that men are willing to share the responsibility of family planning. Worldwide about 30% of the couples that use contraception use a male method in spite of the evident shortcomings of currently available contraceptives for men. In 1994 at the International Conference on Population and Development active involvement of men in family planning was given a high priority in the women agenda. (excerpt)