Contraceptive Risk Research Articles

Contraception Update: Extended Use of Long Acting Methods, Hormonal Contraception Risks, and Over the Counter Access.

The clinical update serves as a brief review of recently published, high-impact, and potentially practice changing journal articles summarized for our readers. Topics include menopause, sexual dysfunction, breast health, contraception, osteoporosis, and cardiovascular disease. For this clinical update, we reviewed both reproductive and general medical journals for clinically relevant publications related to the use of contraceptive methods. We have chosen to highlight articles examining the extended use of highly effective (long-acting) methods, complications of implants, risks associated with oral combined hormonal contraceptives, and the availability of over the counter contraception.

ACUTE PULMONARY EMBOLISM FOLLOWING TWO DOSES OF INTRAVENOUS CONJUGATED ESTROGEN

SESSION TITLE: Medical Student/Resident Pharmacotherapeutics SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Estrogens can increase the synthesis of several clotting factors and increase platelet aggregation.Intravenous estrogen therapy is used to manage uterine bleeding in hospitalized patients.The intravenous route is preferred for a more rapid response.Venous thromboembolism (VTE) is a potentially life-threatening consequence of estrogen therapy.This report describes a case of acute pulmonary embolism following two doses of intravenous conjugated estrogen in a female with no identifiable risk factors for VTE CASE PRESENTATION: 41 year old G3 P3 003 female presented with recurrent heavy vaginal bleed associated with clots and fatigue.Three weeks prior to this, she was admitted with weakness, fatigue, vaginal bleed was found to have a hemoglobin of 3.5g/dl, received 4 units of packed red blood cells.Transvaginal ultrasound at the time revealed a fibroid in the lower uterine segment and she was discharged with oral iron supplementation with her hemoglobin at discharge being 8.7g/dl. She was then referred for surgical management of the bleed. During the current admission for recurrent vaginal bleeding, hemoglobin was 9.8/dl. Physical examination revealed a prolapsed fibroid encompassing the cervical os. She received a one dose of 25mg of intravenous Premarin (conjugated estradiol).The same afternoon while receiving the second dose, she experienced severe chest pain and shortness of breath with desaturation, with an oxygen saturation of 79%. A Computed tomography angiography showed filling defects in the right lateral and posterior lower lobe segmental pulmonary artery embolus. She was started on a heparin drip and eventually underwent uterine artery embolization, which helped control her presenting symptoms. The intravenous Premarin was discontinued and she was transferred to the Intensive care unit.She was discharged on Rivaroxaban for 6 months. Given the fact that she was ambulatory and had no other risk factors for thromboembolic disease, Premarin was the presumed cause of her pulmonary embolus. DISCUSSION: Given that our patient is a young female with no comorbidities who was ambulatory, non-obese and a non-smoker with no family history of thrombophilia developed a pulmonary embolus during her inpatient stay, we would attribute the most likely cause of the event to be the dose of premarin that she received. Use of the Naranjo probability scale indicated a possible relationship between IV estrogen and development of pulmonary embolism in this patient.(1) CONCLUSIONS: The causal effect of dose of estrogen and the risk of thromboembolism has been previously established in those using oral contraceptives.(2) It has been determined that there is a direct correlation with dose and incidence of VTE and has been found to be the highest within the first three months of use. It would be of interest to analyze the risk of thromboembolic events with minimal estrogen exposure such as in our patient. Reference #1: Naranjo CA et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239245. Reference #2: van Hylckama Vlieg A et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type. BMJ 2009 Aug 13 DISCLOSURES: No relevant relationships by Nikhil Jagan, source=Web Response No relevant relationships by Mridula Krishnan, source=Web Response No relevant relationships by Mark Malesker, source=Web Response No relevant relationships by Michael Sanley, source=Web Response

Oral contraceptive use and cutaneous melanoma risk: A French prospective cohort study

Introduction Evidence suggests that cutaneous melanoma, the most lethal form of skin cancer, may be influenced by sex hormones. Oral hormones are the leading contraception method in industrialized countries and represent a significant source of exogenous hormone use. Several studies reported a positive association between oral contraceptive (OC) use and melanoma risk. However, findings were conflicting and data from large prospective studies are lacking. Our aim was to explore the associations between OC use and melanoma risk in women. Methods E3 N is a prospective cohort of 98,995 French women aged 40–65 years at inclusion in 1990. Use of oral hormones for contraception was collected through a self-administered questionnaire at baseline, and detailed information on lifetime use of OCs was then recorded every 2–3 years from 1992. We computed hazard ratios (HRs) and 95% Confidence Intervals (CIs) using Cox regression models adjusted for age, birth cohort, pigmentary traits, residential UV exposure in county of birth and at inclusion, and family history of skin cancer. We stratified the results according to melanoma site and histological type using competing-risk models. To examine potential confounding by sun exposure, we used data from E3N-SunExp, a nested case-control study in which a specific questionnaire on lifetime residential and recreational UV exposures was sent to all incident skin cancer cases and 3 controls per case (matched on age, county of birth, education, and length of follow-up in the cohort) in 2008. Analyses in the sub-cohort were performed through logistic regression modelling. Results Between 1992 and 2008, 539 melanoma cases were ascertained among 79,365 women. In age-adjusted models, there was a modest association between ever use of OCs and melanoma risk (HR = 1.18, 95% CI = 0.98–1.42), which was reduced after full adjustment (HR = 1.14, 95% CI = 0.95–1.38). The association was stronger in long-term users (HR = 1.33, 95% CI = 1.00–1.75 for a duration of use of at least 10 years, compared with never use of OCs). Among ever users, there was an inverse association with age at first use (Ptrend = 0.01), consistent with longer durations of OC use in women with a younger age at first use. However, we found no evidence of an association with age at last use or time since last use. When exploring different formulations, the association between ever use of OCs and melanoma risk was restricted to OCs containing high doses of estrogen (≥ 50 μg of ethinyl estradiol) (HR = 1.26, CI = 1.03–1.53). In subtype- and site-specific analyses, ever use of OCs appeared positively associated with all types and sites of melanoma, except the trunk, although no heterogeneity was detected across subtypes (Phomogeneity = 0.54) or sites (Phomogeneity = 0.23). In the E3N-SunExp population, associations between OC use and melanoma risk were not substantially modified after adjustment for residential or recreational UV exposure. However, while we found no association between OC use and sun exposure, we observed that OC use was positively associated with sunscreen use (Ptrend = 0.04 from no protection to increasing SPF) and tanning bed use (odds ratio = 1.14, 95% CI = 1.01–1.29 for ever vs. never use), even after adjusting for age and year of birth. Conclusions Overall, our findings do not support a strong association between OC use and melanoma risk. OC users were more likely to use sunscreen and tanning beds, suggesting a specific profile of OC users regarding their attitude towards tanning. Therefore, we cannot exclude that the observed relation between OC use and melanoma risk, which has been debated in the literature for almost 40 years, could relate to particular sun exposure behaviors in users. Further research, including social and behavioral description of OC users, is thus critical to increase our understanding of the risk profile of women diagnosed with melanoma, and to question the hypothesis of a hormonal influence on melanoma risk.

The action of estrogens and progestogens in the young female breast.

Evidence from different sources sustains a pro-oncogenic role of hormones, estrogens and progestogens, on the breast. The issue is of interest for young women, who are exposed to the hormonal changes imposed by the ovarian cycle and, often, take hormones with contraceptive purposes. Experimental and clinical studies show that both estrogens and progesterone are involved in mammary development during puberty and lactation, the changes being observed across mammalian species, including humans. Estrogen receptors, and more particularly the alpha isoform, participate in molecular processes of stem cells differentiation and epithelial proliferation through paracrine actions implicating growth factors. Progesterone also contributes through paracrine mechanisms involving one member of the tumor necrosis factor (TNF) family, the receptor activator of nuclear factor κB ligand (RANKL) and its receptor (RANK). Epidemiological studies have found that the length of the exposure to endogenous hormones, as determined by an early menarche or a late menopause, is a risk factor for breast cancer. Additional evidence has derived from studies with compounds modulating the estrogen or the progesterone receptors. Selective estrogen receptor modulators (SERM), like tamoxifen, have been shown to decrease the risk of breast cancer in both pre- and post-menopausal women. Aromatase inhibitors, which drastically reduce the levels of circulating estrogens, have reproduced the findings. The selective progesterone receptor modulators (SPRM) have been less investigated and issues concerning safety have arisen. These observations have interest for young women. High-risk women may consider the use of SERMs, for example, to reduce their risk. Much more common is the case of women who take hormones for contraception. The goal of the present article is twofold: i) to summarize the actual knowledge of the mechanisms implicating estrogens and progestogens on the risk for breast cancer and ii) to provide rationality for the debate about potential cancer risk of hormonal contraceptives, frequently used by premenopausal women.

Contraceptive Care of Obese Women.

In the United States, 27% of reproductive-aged women are overweight, and 35% are obese. Until recently, contraceptive research excluded women greater than 130% of their ideal body weight. Gaps in data limit evidence-based decision making for effective contraceptive counseling and management in this rapidly growing population. The aims of this summary are to review the benefits, adverse effects, and risk factors associated with contraceptive methods in obese women, with special attention to effectiveness, and provide contraceptive management and counseling recommendations for best clinical practice. We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on contraceptive counseling and management in obese women in the United States. We reviewed the body of evidence with special attention to studies published since recent Cochrane and systematic reviews on this topic. Contraceptive use is safer than pregnancy, especially for obese women who have increased pregnancy risks. Baseline health is compromised by obesity, but contraceptive risks remain low. Long-acting, reversible contraceptive methods offer superior effectiveness, minimal risk, and numerous noncontraceptive benefits across body mass index groups. No substantial evidence supports ineffectiveness of any method in obese women except oral emergency contraception and the patch. Pharmacokinetic changes of obesity associated with other oral methods do not seem to result in clinically significant declines in effectiveness. Future contraceptive efficacy studies should include obese women to better discuss their contraceptive needs. This review is beneficial for all providers caring for reproductive-aged women wanting to avoid unintended pregnancy.

The Neurology of Immune-Mediated Disorders in Women.

Many neuroinflammatory disorders have a predilection for women; even if there is no female predominance, neuroinflammatory conditions in women pose a management challenge for several reasons. Disease activity of these conditions may change during pregnancy and commonly increases in the postpartum period. Uncontrolled disease activity may affect pregnancy outcomes. Moreover, immunomodulating agents that are used to suppress the disease activity may have a negative impact on fertility, pregnancy, and fetal outcomes, and on infants who are breastfed. Adverse effects of immunosuppressants extend beyond the reproductive issues and may include bone loss, increased risk of cancers, and infectious complications. The successful management of women with these disorders requires that not only practitioners understand and recognize the adverse effects of immunosuppressants, but also seek to prevent adverse outcomes through counseling about contraceptive choices, safety monitoring, risk surveillance, and other strategies.

Hormonal contraceptive use and risk for mood and anxiety disorders – Evidence from two large epidemiological datasets

Hormonal contraceptive use and risk for mood and anxiety disorders – Evidence from two large epidemiological datasets

Abstract 4276: Oral contraceptive use and breast cancer risk: a cohort study of BRCA1 and BRCA2 mutation carriers

Abstract Background: BRCA1 and BRCA2 mutation carriers are at high risk of breast and ovarian cancer. Oral contraceptive preparations (OCPs) may reduce ovarian cancer risk, but its effect on breast cancer risk remains unclear. Methods: Combined data from three cohorts of 5705 BRCA1 and 3521 BRCA2 mutation carriers (IBCCS, BCFR and kConFab) were analyzed using age-dependent Cox regression models stratified for study and birth cohort. We conducted the first prospective analyses on this topic. Our additional main retrospective analyses were left-censored 5 years preceding date of baseline questionnaire to control for survival bias. The full-cohort retrospective analyses, without left-censoring, was performed to compare results with the literature. Prospective analyses were considered most valid, while retrospective analyses were most powerful. Results: For BRCA1 mutation carriers we found no association between ever OCP use and risk of breast cancer in the prospective analyses (HR=1.08, 95% CI 0.75-1.56), but 23% and 27% increased risks for ever OCP use in the left-censored and full retrospective analyses, respectively. Retrospectively, an increasing trend for longer duration of use, especially before first full-term pregnancy (FFTP) was found (left-censored analyses: &lt5 years HR 1.05 (95%CI 0.84-1.33), 5-9.9 years HR 1.15 (95%CI 0.92-1.44), &gt10 years HR 1.41 (95%CI 1.10-1.813), p-trend=0.001 for duration of use before FFTP). For BRCA2 mutation carriers we found a positive association between ever OCP use and risk of breast cancer prospectively (HR=1.75, 95% CI 1.03-2.97), but retrospectively findings were inconsistent (HR=1.06, 95% CI 0.85-1.33 and HR=1.52, 95% CI 1.28-1.81 for the left-censored and full analyses, respectively). Conclusion: For BRCA1 mutation carriers the discrepancy between results of prospective and retrospective analyses may be explained by time since last OCP use before FFTP. Thus, a temporal increased risk of breast cancer following longer duration of OCP use before FFTP cannot be ruled out. The discordant findings between prospective and retrospective analyses for BRCA2 carriers could not be explained. Because of the lack of scientific clarity it is too early to give an unequivocal advice on OCP use with respect to breast cancer risk to BRCA1 and BRCA2 mutation carriers. Citation Format: Lieske H. Schrijver, Hakan Olsson, Antonis Antoniou, Roger Milne, Kelly Phillips, Nadine Andrieu, Douglas Easton, David Goldgar, Christoph Engel, Karin Kast, Marie-Jose Blom, Thea Mooij, John Hopper, Floor Van Leeuwen, Mary-Beth Terry, Matti Rookus, IBCCS, kConFab, BCFR. Oral contraceptive use and breast cancer risk: a cohort study of BRCA1 and BRCA2 mutation carriers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4276. doi:10.1158/1538-7445.AM2017-4276

What are the risks of oral contraceptives in females with migraines?

What are the risks of oral contraceptives in females with migraines?

Treatment of hyperandrogenism in women with ethinylestradiol and cyproteroneacetate

In recent years, there has been an important and intensive controversy regarding the thromboembolic risk of hormonal contraceptives containing ethinylestradiol combined with certain progestogens li...

Abstract A27: Timing of pregnancies and oral contraceptive use and risk of ovarian cancer

Abstract Background: Parity and use of oral contraceptive (OC) are associated with reduced risk of ovarian cancer. However, it is not clear whether these exposures have similar risk effects during different periods of life. In a large consortial analysis, we seek to evaluate the risk reductions associated with pregnancy and with OC use in different periods during the lifetime of a woman. Methods: We combined data from 17 population-based case-control studies of ovarian cancer that are part of the Ovarian Cancer Association Consortium (OCAC). Odds ratios (ORs) and 95% confidence intervals (CI) for associations between age of pregnancies and duration of OC use were estimated in individual studies using logistic regression and combined using random effects meta-analysis. Analyses were adjusted for age, duration of OC use, number of pregnancies, and race (Caucasian, Black, Asian and other). Studies that matched on ethnicity were additionally adjusted for Hispanic ethnicity (yes/no). All tests were two-sided and P-values less than 0.05 were considered statistically significant. Results: The analysis included 15,033 ovarian cancer cases and 25,312 controls. The median age for cases was 57 (interquantile range: 50-65) and 56 for controls (interquantile range: 48-64). Approximately 83.4% of cases and 88.5% of controls reported at least one pregnancy and 55.4% of cases and 61.7% of controls reported OCs use for at least one month. On average, each pregnancy was associated with a 17% reduced risk of ovarian cancer (OR=0.83, 95% CI: 0.8-0.85) while each year of OC use was associated with a 6% reduced risk (OR=0.94, CI 0.92-0.95). Among women who reported having at least one pregnancy, older age at last pregnancy was associated with lower risk of ovarian cancer (P<0.0001). Specifically, compared to women whose last pregnancy was before the age of 25, women who had their last pregnancy between the ages of 25-30 had a 15% reduced risk of ovarian cancer (OR=0.85, 95% CI: 0.78-0.93), women who had their last pregnancy between the ages of 30-35 had a 18% reduced risk of ovarian cancer (OR=0.82, 95% CI: 0.74-0.90) and women who had their last pregnancy after the age of 35 had a 21% reduced risk of ovarian cancer (OR=0.79, 95% CI: 0.70-0.90). Similar findings were observed when analyses were stratified by increasing number of pregnancies. With respect to OC use, compared to women who reported the age at last used before the age of 25, those who reported the age at last use to be between the ages of 25-30 had a 15% lower risk of ovarian cancer (OR=0.85, 95% CI: 0.73-0.98) and those who reported the age of last use was after the age of 30 had a 18% reduced risk of ovarian cancer (OR=0.82, 95% CI: 0.66-1.03 for age at last used between 30-35; OR=0.82, 95% CI: 0.63-1.07 for age at last older than 35), but the trend was not significant. Conclusions: In summary, older age at last pregnancy was significantly associated with reduced risk of ovarian cancer. There was a suggestion that older age at last used of OCs was associated with lower risk of ovarian cancer. These findings suggest that use of OCs to later ages in life can reduce ovarian cancer risk. A joint evaluation of life periods with pregnancies and OC use and ovarian cancer risk is under way. Citation Format: Clara Bodelon, Harvey Risch, Francesmary Modugno, Penelope Webb, Celeste Leigh Pearce, Malcolm Pike, Nicolas Wentzensen. Timing of pregnancies and oral contraceptive use and risk of ovarian cancer. [abstract]. In: Proceedings of the AACR Special Conference: Improving Cancer Risk Prediction for Prevention and Early Detection; Nov 16-19, 2016; Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(5 Suppl):Abstract nr A27.

Hormonal Contraceptive Exposure and Risk Factors for Meningioma in Soetomo Hospital 2012–2016

Hormonal Contraceptive Exposure and Risk Factors for Meningioma in Soetomo Hospital 2012–2016

Contraceptive use and risk perceptions for STI and unintended pregnancy among adolescent females in San Diego County at the US-Mexico Border

Contraceptive use and risk perceptions for STI and unintended pregnancy among adolescent females in San Diego County at the US-Mexico Border

Pregnancy is more dangerous than the pill: A critical analysis of professional responses to the Yaz/Yasmin controversy

The fourth and most recent generation of hormones used in oral contraceptives has stirred a significant amount of debate regarding the safety of these compounds. Drospirenone, a new type of synthetic hormone used in popular oral contraceptives Yaz and Yasmin, has been found by epidemiologists to increase the risk of blood clots when compared to the previous generations of pills. North American regulatory bodies have investigated the health risks of drospirenone and concluded that the increased risks do not require pulling the new contraceptive technology off the market. Instead, the FDA and Health Canada along with several medical associations have actively managed the Yaz/Yasmin controversy through official statements and press releases between 2010 and 2014. This study provides an analysis of these documents and how risk information about drospirenone-containing pills has been presented to the public. The analysis addresses a gap in our knowledge about cultural factors that impact contraceptive risk assessment. Prevalent risk models used by professionals are highlighted and examined through the use of critical discourse analysis methods. More specifically, this paper highlights the main strategies used to put drospirenone risks into perspective and classify it as safe. I argue that while risks related to pregnancy and the postpartum period are overly-emphasized, other risks are downplayed through a selection process underscored by normative beliefs about women's bodies and sexuality. Future research needs to address consumer perspectives and bridge the gap between lay and scientific risk/benefit assessment of oral contraceptives.

HORMONAL CONTRACEPTION AND THE RISK OF HIV ACQUISITION

AbstractIntroduction:More than 100 million women worldwide use hormonal contraceptive, including using DMPA ororal contraceptive. There is particular concern about a putative link between hormonalcontraception and HIV infection. The aim of this review article was to evaluate the associationbetween hormonal contraception use and risk of HIV infectionMethods:We were retrieved through a systematic search of electronic databases such as PubMed, ScienceDirect, Elsevier, BMJ, JAMA by utilizing keywords HIV prevention, hormonal contraception,women's` health, risk factors and human immunodeficiency virus (HIV). This search conducted forrelevant literature published between 1989 and 2013.Finding:An estimated 40 million people live with human immunodeficiency virus (HIV) globally. Most HIVinfected human are of reproductive age 15–49 years. Approximately 45% of women usinghormonal contraceptions. Long term used of Progestin-only Injectable such as DMPA and NETEN,may cause thinning of cervico-vaginal mucosa, it may lead to abrasions that facilitate access ofHIV to CD4+ target cells in submucosal tissue and increased simian immunodeficiency virusacquisition. Although the clinical significance of this thinning remains uncertain.Conclusions:The data do not support an association between use of oral contraceptives and increased risk ofHIV acquisition. Nonetheless, family planning services are an important venue for HIV preventionactivitiesKeywords:Hormonal Contraception, HIV, Risk Factors, Women Health

Non-hormonal and hormonal intrauterine contraception: survey of patients’ perceptions in four Latin American countries

ABSTRACTObjectives: This study sought to understand women’s perceived barriers to the use of hormonal and non-hormonal intrauterine contraception in Latin America. Methods: We developed an online survey for women in Argentina, Brazil, Colombia and Mexico who were seeking contraception. The questions aimed at evaluating patient awareness of negative stories and statements, as well as perceived barriers to the copper intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNG-IUS). Results: The survey was mailed to 2300 women. A total of 1953 responses were received from Argentina (n = 465), Brazil (n = 380), Colombia (n = 613) and Mexico (n = 495). More women reported having heard negative stories about the copper IUD than about the LNG-IUS. More women believed that the copper IUD, rather than the LNG-IUS, was suitable only for those who had already had children. More women believed that weight gain (14.3% vs. 38.2%; p < 0.001), mood swings (14.1% vs. 38.7%; p < 0.001) and infertility (16.3% vs. 19.9%; p = 0.016) were possible side effects of the LNG-IUS. By contrast, more women believed that abortion (36% vs. 22.7%; p < 0.001), pelvic infections (42.1% vs. 15.7%; p < 0.001) and ectopic pregnancy (43.5% vs 23.5%; p < 0.001) were side effects more associated with the copper IUD. More believed the copper IUD was associated with less pain during placement and removal compared with the LNG-IUS (42.8% vs. 31.2%; p < 0.001). The perception of increased risk of contracting a sexual transmitted disease did not differ between the methods (IUD vs. LNG-IUS, 21.7% vs. 20.3%; p = 0.388). Conclusions: Respondents to a web-based survey in four Latin American countries have misperceptions regarding the adverse effects and risks of intrauterine contraception, which may hamper the use of these safe and efficient contraceptive methods. Education about the true risks and benefits involved is fundamental to improving patient acceptance and compliance as well as reducing unplanned pregnancies and unsafe abortions.

Genetic polymorphisms of insulin-like growth factor 1 and insulin-like growth factor binding protein 3, xenoestrogen, phytoestrogen, and premenopausal breast cancer.

Previous studies suggest a combined effect of insulin-like growth factor 1 (igf-1) and igf binding protein 3 (igfbp-3) gene polymorphisms, xenoestrogen, and phytoestrogen on the igf-1 signalling pathway and serum concentrations in the igf system, which are associated with premenopausal breast cancer (bca) risk. Between 2010 and 2012, our study recruited 140 premenopausal bca patients and 160 community-based premenopausal control subjects. Participants were surveyed about oral contraceptive (oc) use, dietary habits, and other bca risk factors. TaqMan assays were used to determine igf-1 rs1520220 and igfbp-3 rs2854744 genotypes. Daily intakes of energy-adjusted soy isoflavones (easis) were calculated by the residual method. Multivariate logistic regression was applied to estimate the adjusted odds ratios (ors) and 95% confidence intervals (cis) of the igf-1 rs1520220 and igfbp-3 rs2854744 genotypes, oc use, and intake of easis. Stratified analyses were performed to detect the gene-environment combined effect, and multivariate logistic regression was used to estimate interaction coefficients (iors) by the multiplicative model, with 95% cis. The delta method was used to calculate interaction coefficients by the additive model [relative excess risk of interaction (reri), attributable proportions of interaction (apis)] and 95% cis. The igf-1 and igfbp-3 genotypes, oc use, and easis were not found to be associated with bca risk (p > 0.05). Stratified analysis showed that the risk of bca was markedly increased in women carrying the igfbp-3C allele and using ocs compared with women either carrying the igfbp-3C allele or using ocs (or: 3.02; 95% ci: 1.04 to 8.79). The interaction coefficients ior, reri, and api were 4.89 (95% ci: 1.09 to 21.90), 2.42 (95% ci: -0.76 to 5.61), and 0.80 (95% ci: 0.46 to 1.67) respectively. The igfbp-3 rs2854744 polymorphism and oc use might synergistically increase premenopausal bca risk.

"Hormone bomb": risks of emergency contraception from the perspective of pharmacy attendants in Rio de Janeiro, Brazil

This study focused on views towards emergency contraception among pharmacy attendants in Greater Metropolitan Rio de Janeiro, Brazil. The empirical material came from a socio-anthropological study with 20 semi-structured interviews of pharmacy attendants of both sexes (8 females and 12 males). The interviews showed negative views of emergency contraception, emphasizing its potential health risks. Interviews considered emergency contraception a "hormone bomb" that can harm the female reproductive organs and other organ systems. The pharmacy attendants highlighted the risks of "uncontrolled" or "indiscriminate" use, especially by adolescents and young women. Since they considered it "dangerous" to women's bodies, they assigned the responsibility for orientation and counseling on use of the method to gynecologists rather than to pharmacists. The article discusses the need to expand the public debate on emergency contraception in Brazil to include pharmacists and pharmacy attendants, in addition to health professionals in general and teachers.

Contraceptive care after gestational diabetes: considerations for clinical practice

Gestational diabetes mellitus complicates 6–7% of pregnancies in the USA and increases affected women's risk of developing Type 2 diabetes. Women with diabetes or other medical problems require special attention for reproductive health issues. Women with prediabetes and diabetes are special populations when considering pregnancy risks, postpartum contraception and lifelong health risks. Contraceptive methods differ in composition, mechanisms of action, effectiveness, side-effect profiles, noncontraceptive benefits and safety with specific medical conditions. Hormonal contraceptives do not negatively affect glucose or lipid metabolism in healthy users. While most contraceptives are believed safe in women with gestational diabetes, additional research is necessary to evaluate for glycemic effects. The current review describes clinical considerations for contraceptive care in women with gestational diabetes.

Abstract A52: Oral contraceptive use and risk of colorectal polyps in a colonoscopy based study in western Washington state

Abstract Background: Most colorectal cancers arise from polyp precursor lesions, including advanced adenomas and a subset of serrated polyps, termed sessile serrated polyps. Growing literature on oral contraceptives (OC) use and risk of colorectal cancer suggests an inverse association. However, very little is known about the role of OC in the development of colorectal polyps. We investigated the relationship between OC use and the risk of subsets of colorectal polyps in a colonoscopy based study in western Washington State. Methods: Study participants were 20-79 year-old women enrollees at Group Health, an integrated health care system in Seattle, Washington who underwent a colonscopy for any indication from 1998-2007. Study eligible participants completed a structured interview to collect risk factor information, including reproductive history and exogenous hormone use. OC use was categorized according to ever use, recency of use, and duration of use. Participants were diagnosed as having adenomas (n=298), serrated polyps (n=336), both types of polyps (n= 105) or as polyp-free controls (n=615) on the basis of a standardized pathology review. Multivariable polytomous logistic regression was used to compare case groups with polyp-free controls and other case groups; odds ratios (OR) and 95% confidence intervals were estimated adjusted for age, race, educational status, body mass index, smoking, alcohol intake, anti-inflammatory drug use, use of postmenopausal hormones, parity and age at first birth. Results: Ever use of OC was not associated with risk for adenomas (adjusted OR 0.82, 95% CI 0.57-1.20) or serrated polyps (adjusted OR 0.93, 95% CI 0.64-1.36) while the risk for synchronous presence of both types of polyps was elevated (adjusted OR 1.43, 95% CI 0.77-2.67) (p=0.39 for the three polyp subtypes). Strength of association did not vary significantly between adenomas and serrated polyps for duration of use (p=0.43) and time since last use (p=0.75). Additionally, the associations did not differ significantly by age, lesion severity (advanced vs. nonadvanced for adenomas, sessile serrated vs. hyperplastic for serrated polyps), or location (right vs left) for either adenomas or serrated polyps. Conclusions: We observed no strong evidence that adenomas or serrated polyps were associated with ever use of OC pills. Although the majority of studies suggest a reversible effect of exogenous postmenopausal hormones on colorectal neoplasia, we did not find any association between time since last use of OC pills and development of either types of polyps. Further larger studies are needed to better understand the mechanistic processes through which oral contraceptives may be associated with the development of adenomas and serrated polyps. Citation Format: Sheetal Hardikar, Andrea N. Burnett-Hartman, Polly A. Newcomb. Oral contraceptive use and risk of colorectal polyps in a colonoscopy based study in western Washington state. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A52.