Subdermal Implants Research Articles

Counseling Women About Sexual Health Effects of Contraceptives.

Background: Choosing a contraceptive method is a pivotal decision for patients, whereas health care professionals (HCPs) face challenges in providing suitable recommendations. Adverse sexual effects often lead to dissatisfaction and discontinuation of contraceptives, underscoring the importance of thorough counseling and shared decision making between HCPs and patients. Objective: This article aims to investigate the relationship between contraceptive methods and female sexual function through a comprehensive review of available literature, emphasizing the importance of considering sexual health in contraceptive prescription and management. Methods: A systematic analysis of existing literature, incorporating studies utilizing validated sexual health questionnaires, was conducted to elucidate the intricate interplay between contraceptives and female sexual function. Results: The review encompasses various contraceptive methods, including combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, subdermal contraceptive implants, hormonal intrauterine devices, permanent sterilization, and barrier methods. Insights gleaned from the analysis shed light on the impact of these methods on female sexual health. Conclusion: Comprehensive understanding of the effects of contraceptives on female sexual function is crucial for both HCPs and patients. By integrating sexual health considerations into contraceptive surveillance, compliance can be improved, contraceptive efficacy optimized, and the risk of unwanted pregnancies minimized. This review underscores the significance of tailored counseling and shared decision making in contraceptive management, particularly for cisgender women.

Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice

Background In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited. Aim The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation. Design and setting Retrospective cohort study utilising data from a Dutch primary care research network. Methods We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions. Results We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation. Conclusion The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.

Contraception options during pubertal transition: Risks, benefits and considerations.

The age of puberty and sexual maturation has been decreasing, highlighting the importance of providing appropriate contraception to girls and adolescents. However, challenges remain, including legal implications and understanding the effects of hormonal methods on pubertal development. This article aims to equip general practitioners with theknowledge of options, as well as their use and limitations, in young people seeking contraception. No one-size-fits-all approach exists for adolescent contraception. Long-acting reversible contraceptives offer superior contraceptive efficacy, with subdermal implants being the most acceptable regarding the insertion procedure. Condoms should be recommended for protection against sexually transmissible infections. Bone health and mood disorders should be considered when prescribing hormonal contraceptives. Despite the lack of robust evidence regarding harm caused by contraception in adolescents, preventing unintended pregnancies should take precedence, with theoretical risks guiding tailored options for individuals.

Effect of Levonorgestrel Implant on Lactation and Infant Growth: A Review

Background: Family Planning is a way to regulate the number of children born and the spacing of pregnancies through information, education, and the use of contraceptives. Postpartum contraception is important to obtain an optimal interpregnancy interval. Postpartum contraception should be initiated early; one of which is Long-Acting Reversible Contraception (LARC). Levonorgestrel can be used to prevent pregnancy because it interferes with ovulation, implantation, and fertilization. Objectives: This study aimed to assess the efficacy and effects of using levonorgestrel implants on breastfeeding and infant growth. Methods: Primary data were in the form of research papers obtained from ScienceDirect, PubMed, and Google Scholar published from the period 2010-2018. The keywords for the searches included: “levonorgestrel”, “levonorgestrel (LNG)-releasing implant”, “levonorgestrel on lactogenesis”, “levonorgestrel on infant growth”, and “levonorgestrel on breastfeeding”, which were used alone or in combination. Results: The 20 selected articles were reviewed based on five identified phrases. Levonorgestrel subdermal implants were shown to be a good choice for women who wanted effective contraception. When used by breastfeeding mothers, levonorgestrel subdermal implants affected neither infant growth (0-1 year of age) nor lactation duration. Conclusions: Levonorgestrel subdermal implants can be effective long-term contraception. These implants are safe for breastfeeding mothers and do not affect infant growth.

Reasons for Early Withdrawal of Etonogestrel Subdermal Implant

Reasons for Early Withdrawal of Etonogestrel Subdermal Implant

Lyophilized Polyvinyl Alcohol and Chitosan Scaffolds Pre-Loaded with Silicon Dioxide Nanoparticles for Tissue Regeneration.

Materials with a soft tissue regenerative capacity can be produced using biopolymer scaffolds and nanomaterials, which allow injured tissue to recover without any side effects or limitations. Four formulations were prepared using polyvinyl alcohol (PVA) and chitosan (CS), with silicon dioxide nanoparticles (NPs-SiO2) incorporated using the freeze-drying method at a temperature of -50 °C. TGA and DSC showed no change in thermal degradation, with glass transition temperatures around 74 °C and 77 °C. The interactions between the hydroxyl groups of PVA and CS remained stable. Scanning electron microscopy (SEM) indicated that the incorporation of NPs-SiO2 complemented the freeze-drying process, enabling the dispersion of the components on the polymeric matrix and obtaining structures with a small pore size (between 30 and 60 μm) and large pores (between 100 and 160 μm). The antimicrobial capacity analysis of Gram-positive and Gram-negative bacteria revealed that the scaffolds inhibited around 99% of K. pneumoniae, E. cloacae, and S. aureus ATCC 55804. The subdermal implantation analysis demonstrated tissue growth and proliferation, with good biocompatibility, promoting the healing process for tissue restoration through the simultaneous degradation and formation of type I collagen fibers. All the results presented expand the boundaries in tissue engineering and regenerative medicine by highlighting the crucial role of nanoparticles in optimizing scaffold properties.

P-607 Reproductive outcomes of oocyte donors using subdermal etonogestrel implants and levonorgestrel intrauterine devices

Abstract Study question Does the use of progesterone contraceptive devices during controlled ovarian stimulation (COS) affect ovarian response in oocyte donation cycles? Summary answer Progesterone contraceptive devices during COS did not impact ovarian response, measured by oocyte retrieval and maturity rates, in oocyte donation cycles. What is known already Subdermal etonogestrel implants and levonorgestrel intrauterine devices (L-DIU) are widely used contraceptives amongst oocyte donors. While the safe and effective use of L-DIU during COS has been documented, the impact of subdermal etonogestrel implants on ovarian response is less understood. Given their distinct mechanisms of action and varying local and systemic pharmacodynamics, a comprehensive understanding of the impact of these contraceptives on ovarian response during COS will be crucial for guiding informed clinical practice. Study design, size, duration In this retrospective cohort study, we analyzed 3,452 heterologous ICSI cycles from 1,975 oocyte donors (18-35 years), performed between March 2021 and September 2023, across two centers. We identified 40 COS in donors using contraceptive devices, either a subdermal etonogestrel implant (n = 18) or L-DIU, (n = 22). These were matched with 80 COS without a device. We primarily compared ovarian response amongst the two groups. Secondary outcomes included biochemical pregnancy, clinical pregnancy and live birth rates. Participants/materials, setting, methods We applied a propensity matching score model (PsmPy package, Python), trained on 3,388 oocyte donation cycles, for matching donors with and without contraceptive devices. Matching was based on age, BMI, anti-müllerian hormone (AMH) and antral follicle count (AFC), maintaining a 1:2 ratio. Ovarian response outcomes (oocyte retrieval and maturation rates) were analyzed using Student’s t-tests, while and clinical outcomes were evaluated using Fisher’s exact test. P-values <0.05 were considered significant. Main results and the role of chance Mean age was 26.22, BMI 24.7, AMH 2.63 ng/ml and AFC 18.77. We evaluated a total of 120 COS, leading to 176 heterologous ICSI cycles. The oocyte retrieval rate (total number of cumulus-oocyte-complexes (COCs) per total number of follicles > 14mm at final follicular scan), averaged 109.64%. We observed no differences in the number of COCs retrieved from donors with and without contraceptive devices (17.5 ±7.6 and 18.5 ± 9.6, respectively). Similarly, oocyte maturation rates (total number of MII oocytes per total number of COCs), were comparable amongst the two groups (78.6% overall, 77.6% with contraception device and 79.1% without contraception device, p > 0.05). The presence of the device did not affect biochemical pregnancy (69.7% with contraceptive device, 61.1% without contraceptive device, p > 0.05), clinical pregnancy (54.6% with contraceptive device, 52.9% with contraceptive device, p > 0.05) and ongoing pregnancy (36.4% with contraceptive device, 35.3% without contraceptive device). These results were consistent regardless of the type of device used. Limitations, reasons for caution The main limitation is the retrospective nature of the study, potentially influencing causal inferences, and that both devices were analyzed as one same group. The small subset of COS with contraceptive devices may impact statistical power. Perinatal outcomes were not analyzed. Wider implications of the findings This research provides clinicians with reassurance that the use of progesterone contraceptive devices during COS does not adversely affect clinical outcomes. These findings offer valuable insights for patient counseling, affirming the safety of contraceptive methods and encouraging further research for a more comprehensive understanding in diverse populations and clinical settings. Trial registration number not applicable

Efficacy of medication abortion with concurrent initiation of progestin contraceptives: A retrospective cohort study

ObjectivesTo evaluate medication abortion (MAB) outcomes for participants receiving intramuscular depot medroxyprogesterone acetate (DMPA) injections or subdermal etonogestrel implants concurrently with mifepristone compared to those who did not in a real-world setting. Study designThis retrospective cohort study included MAB patients from one Planned Parenthood health center in St. Paul, MN, between 2017 and 2019. We abstracted electronic health records and compared sociodemographic variables, clinical information, and treatment failure rates (primary outcome) between study groups with logistic regression (generating odds ratios [OR] and 95% confidence intervals [CI]). ResultsAmong 7296 MAB participants, 224 (3.1%) received DMPA injections and 309 (4.2%) received etonogestrel implants concurrently with mifepristone; 141 (62.9%) and 200 (64.7%) completed follow-up respectively. From a random sample of 1000, 990 comparison participants met inclusion criteria; 704 (71.1%) completed follow-up. Fourteen (9.9%) DMPA participants (aOR 4.26, 95% CI 1.87–9.68, p < 0.001) and 6 (3.0%) etonogestrel implant participants (aOR 1.38, 95% CI 0.48–3.55, p = 0.522) required additional treatment to empty the uterus and/or had an ongoing pregnancy, each contrasted with 15 (2.1%) comparison patients (models adjusted for gestational duration, patient age, parity, and race). ConclusionAlthough our study is limited by high rates of loss to follow-up, our analysis suggests that concurrent administration of DMPA with mifepristone may decrease MAB efficacy, while etonogestrel implant placement does not appear to alter MAB outcomes. These findings are overall consistent with prior literature and inform post-MAB contraception counseling. ImplicationsThis retrospective cohort study reinforces prior randomized controlled trial findings that concurrent depot medroxyprogesterone acetate injection with mifepristone administration may decrease medication abortion efficacy. Conversely, concurrent etonogestrel contraceptive implant placement with mifepristone administration does not appear to decrease medication abortion efficacy. These findings inform post-abortion contraception counseling.

Promoting Reproductive Justice in the Office: LARC Removal Counseling at Time of Insertion

Purpose: While access to receiving LARC devices is increasing, it is not apparent if there is an infrastructure for providing equal access to LARC removal. The purpose of this study was to assess how patients perceive LARC counseling by providers at the time of insertion. In addition, explore the information that providers include in their LARC removal counseling at the time of insertion. Methods: The study population included participants of both patients and providers. Our patient participants included people between the ages of 18 to 50 years old who have or previously have had any form of intrauterine contraceptive device or subdermal contraceptive implant. Subjects will be recruited from the Texas Tech El Paso Obstetrics and Gynecology Clinics. The provider participants included residents, attending OB/GYNs, and nurse-midwives in the Texas Tech Health Science Center at El Paso Department of Obstetrics and Gynecology. Patients completed an anonymous survey depending on which type of device they had. If they have had both the intrauterine contraceptive device and the subdermal contraceptive implant, they were eligible to complete one survey for each device. Participants completed surveys on an iPad. Providers were surveyed once, either through paper surveys or emailed surveys. Survey responses were anonymous. Data was analyzed using SAS 9.4 software. Results: Overall, 246 participants reported having a subdermal implant (45.5%) or IUD (54.5%), majority of the participants were between the ages of 18-30 (72.8%), Hispanic (78.9%), had insurance or grant accessibility (67.5%). There were 17 providers consisting of medical residents, physicians, and nurse midwives who completed the survey. Based on provider surveys, 80.0% of providers counseled patients at 100% of visits about getting device removed. In addition, 80.0% of providers informed their patients to return to the office for device removal. About 93.3% of providers never discuss the cost of removing the device. Regarding the patient surveys, in response to the question, “How well do you understand the process of getting the device removed,” results were reported into two groups: ’extremely poorly/poorly/neutral” and “somewhat well/very well.” There was no statistically significant difference among the patients with an IUD who either poorly understood the process or understood the process as least somewhat well. For patients with a subdermal implant, 73.68% of those who poorly understood the process of removal stated that providers did not discuss the cost of removing the device versus 37% of those who understood the process well where providers did not discuss the cost of device removal (p &lt; 0.001). About 68.42% of patients with a subdermal implant who poorly understood the process of device removal stated that providers did tell them they needed to come back to the office for device removal; 94.62% of patients with a subdermal implant who understood the process of device removal well stated that providers told them to return to the office for removal (p &lt; 0.001). On whether providers discussed insurance coverage for device removal, 63.44% of patients who understood the process well states yes versus only 21.44% of patients who poorly understood the process of device removal. Conclusions: In patients with subdermal implants, a low percentage of providers discussed the cost of removal and whether or not insurance covered the cost of removal. Results implicate a need for an infrastructure to increase access for LARC removal services. However, further studies with larger patient and provider pools would be necessary for statistically significant results, particularly for IUDs.

Increasing access to LARC removal in pediatrics to support adolescent reproductive justice in the United States.

In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long-acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have. In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults. We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self-removal is a safe and accessible option, safety and efficacy data on subdermal implant self-removal is currently limited. In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self-removal options with adolescents and young adults.

The Global Impact of Diversifying PrEP Options: Results of an International Discrete Choice Experiment of Existing and Potential PrEP Strategies with Gay and Bisexual Men and Physicians.

To improve current and future use of existing (oral, injectable) and potential future (implants, douches) pre-exposure prophylaxis (PrEP) products, we must understand product preferences relative to one another, among gay and bisexual men (GBM), and physicians who prescribe PrEP. We completed an online discrete choice experiment (DCE) with separate groups of GBM and/or physicians from the United States, South Africa, Spain, and Thailand. Participants were presented information on PrEP products, including daily pills, event-driven pills (2-1-1 regimen), injections, subdermal implants (dissolvable, removable), and rectal douches. Next, they completed a choice exercise in which they were shown 10 screens, each presenting 3 of the aforementioned products at a time with 11 attributes for physicians and 10 attributes for GBM. For the attributes that were not constant, one level was shown per screen for each product. Participants selected the product they preferred most and rated their likelihood to select (GBM) or recommend (physicians) that product. Data were modeled using hierarchical Bayes estimation; resulting model coefficients were used to develop attribute importance measures and product preferences. For GBM across all countries, if all aforementioned PrEP products were on the market at the same time, over 90% of GBM would use some form of PrEP; 100% of physicians would recommend at least one of the PrEP products. There were variations in product preference by country. GBM in the United States and Thailand preferred the injection (21.7%, 22.9%, respectively), while the dissolvable implant was preferred in South Africa and Spain (19.9%, 19.8%, respectively). In the United States, South Africa, and Spain (where physician data were available), physicians were most likely to recommend the dissolvable implant (37.2%, 40.6%, 38.3%, respectively).

Parenteral platforms for tunable, long-acting administration of a highly hydrophobic antiretroviral drug

GSK2838232 (GSK8232) is a second-generation maturation inhibitor (MI) developed for the treatment of HIV with excellent broad-spectrum virological profiles. The compound has demonstrated promising clinical results as an orally administered agent. Additionally, the compound’s physical and pharmacological properties present opportunities for exploitation as long-acting parenteral formulations. Despite unique design constraints including solubility and dose of GSK8232, we report on three effective tunable drug delivery strategies: active pharmaceutical ingredient (API) suspensions, ionic liquids, and subdermal implants. Promising sustained drug release profiles were achieved in rats with each approach. Additionally, we were able to tune drug release rates through a combination of passive and active strategies, broadening applicability of these formulation approaches beyond GSK8232. Taken together, this report is an important first step to advance long-acting formulation development for critical HIV medicines that do not fit the traditional profile of suitable long-acting candidates.

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

BackgroundSuccessful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.MethodsAn implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.ResultsLandscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.ConclusionLandscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.

AB158. SOH24AB_032. A systematic review of peripheral nerve injuries associated with the insertion or removal of subdermal contraceptive implants

AB158. SOH24AB_032. A systematic review of peripheral nerve injuries associated with the insertion or removal of subdermal contraceptive implants

Utilization of modern contraceptives among female health care workers at Gulu university teaching hospitals in Northern Uganda

BackgroundThe global high rate of unintended pregnancy is a direct result of underutilization of contraceptives methods. Healthcare workers (HCWs) play a pivotal role in promoting and facilitating access to modern family planning services. By examining the extent to which healthcare providers practice what they preach, this research aimed to shed light on the prevalence and factors associated with modern contraceptive use among female HCW at two university teaching hospitals in northern Uganda.MethodsA cross-sectional survey was conducted among qualified female healthcare workers (FHCWs) at Gulu Regional Referral Hospital (GRRH) and St. Mary’s Hospital-Lacor in Gulu, Uganda. Convenient consecutive sampling was used to enroll study participants. Linear regression analysis was employed to determine factors independently associated with modern contraceptive use. P < 0.005 was considered statistically significant.ResultsWe enrolled 201 female HCWs, with a median age 31 (interquartile range: 27–38) years. Overall, 15 (7.5%, 95% Confidence Interval [CI]: 4.4 —11.1) participants utilized modern methods of family planning in the last 3 months while lifetime use was at 73.6% (n = 148, 95%CI: 67.3 — 79.4%). Most common method utilized was intra-uterine devices [IUDs] (51%, n = 76), followed by sub-dermal implants (15.4%, n = 23). Eighty-five (42.3%, n = 85) participants had desire to get pregnant. Factors independently associated with utilization of modern methods contraceptives were working at GRRH (adjusted odds ratio (aOR): 5.0, 95% CI: 1.59 — 10.0, p = 0.003), and being single (aOR: 3.3, 9%CI: 1.02 —10.57, p = 0.046).ConclusionsUtilization of modern methods of contraceptive among female HCWs in this study is lower than the Uganda national estimates for the general female population. Most utilized method is IUDs followed by sub-dermal implants. More studies are recommended to see if this finding is similar among FHCWs in other regions of Uganda and the rest of Africa while also considering Male Healthcare Workers.

Assessment of Effectiveness and Side Effects of Subdermal Implant among User Women

Abstract Background: Implanon is a progestin-only implantable contraceptive; it offers promise, long-term, with a high-efficacy contraceptive. It is one of the most effective reversible contraceptives and is of the same effectiveness to sterilization. Objective: To assess the adverse effect profile and effectiveness of subdermal implants. Materials and Methods: A prospective study involved 48 women attending for insertion of the subdermal implant on days 2–5 of their cycle. The implant was inserted subdermally under the effect of local xylocaine of the nondominant arm. Results: The commonest side effect was weight gain constituted 62.5%. At the same time, amenorrhea was reported in 31.3%. Pain at the site of insertion constitutes 14.6%. While bleeding occurred in one case, which responded to local pressure. The commonest cause of discontinuation was weight gain constituted 12.5%. Followed by disturbances in the menstrual cycle. Discontinuation rate 41.7% (20 out of 48 cases). Conclusion: Implanon is an effective long-term contraception with few adverse effects.

Abstract 1448: Investigating the effects of estrogen on the initiation of prostate cancer

Abstract Background: Prostate cancer (PCa) is responsible for ~10% of cancer-related deaths in men. Nkx3.1 is an androgen-regulated gene expressed primarily in the prostate, which encodes a tumor suppressor protein important for male reproductive development. Loss of nkx3.1 is thought to lead to prostatic intraepithelial neoplasia (PIN), the pre-invasive form of prostatic adenocarcinoma. Previous evidence suggests that estrogenic dysregulation and testosterone imbalance play a significant role in PCa initiation and progression. Objectives/Aims: We aimed to investigate how estrogen impacts the progression of PIN in the anterior prostate of mice lacking nkx3.1. Methods: To investigate the effect of long-term exposure to 17β-estradiol (E2), nkx3.1+/+ and nkx3.1−/− 12-week-old mice were given 2 mg/day of E2 over 90 days by subdermal implantation of 90-day extended-release tablets. After 90 days, the anterior prostate lobes of the mice were harvested and analyzed post-treatment for signs of pre-cancerous tissue. The immediate, early effect of E2 exposure was also investigated by the subcutaneous injection of 8- and 20-week-old mice with 0.300 mg/kg of E2. Within two hours, the anterior prostate lobes were harvested, and ~500 ng/μL of RNA was isolated from the tissues. cDNA was reverse-transcribed, in triplicate, from the RNA and the expression of c-myc, p53, estrogen receptor ERα (ESR1), and ERβ (ESR2) were assessed via qRT-PCR. Three technical replicates from three biological replicates were performed for each treatment. Results: Nkx3.1−/− mice chronically exposed to elevated E2 developed PIN following E2 treatment, while the placebo group had tissue hyperplasia. Nkx3.1+/+ mice had normal prostate tissue regardless of E2 treatment. In response to immediate exposure to E2, the prostates of 8-week-old nkx3.1+/+ mice showed reduced c-myc expression. 8-week-old nkx3.1−/− mice showed no changes in expression of any of the four genes assayed, in response to E2 as compared to the placebo treatment. In contrast, regardless of exposure to E2, c-myc, p53, and ESR2 were significantly elevated in these mice compared to the nkx3.1+/+ groups. Furthermore, c-myc and p53 expression was suppressed in 20-week-old nkx3.1−/− mice in response to E2, while ESR1 and ESR2 remained unchanged. Conclusion: Our evidence suggested that prolonged exposure of wild-type mice to E2 had no pathohistological impact on the anterior prostate tissue. In nkx3.1-deficient mice, however, E2 exposure promoted the onset of PIN, and caused immediate differential expression of estrogen-responsive genes, suggesting a role of nkx3.1 in protecting the prostate in the presence of a hormonal imbalance. Citation Format: Nash S. Denic, Ashlyn Swift-Gallant, Kenneth R. Kao. Investigating the effects of estrogen on the initiation of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1448.

Progestogen only contraception in women with congenital heart disease

Background There is little information of progestogen-only contraceptives in patients with congenital heart disease (CHD) on the long-term. Objective To evaluate the use of contraception in patients with CHD. We studied both short-acting reversible contraceptives (SARCs), oral progestin-only pills (POPs) and long-acting reversible contraceptives (LARCs): intrauterine devices (IUD-IPs) and subdermal implants both impregnated with progestogens (SI-IPs). Study design Retrospective study of all women attending the preconception clinic. Contraceptive methods were classified in three TIERs of effectiveness before and after consultation. ESC classification regarding pregnancy risk, WHOMEC classification for combined oral contraceptive safety was collected. Results Six hundred and fifty-three patients. A significant proportion of them switched from TIER 3 to TIER 2 or 1 (p < .001) after consultation. One hundred and ninety-nine patients used POPs, 53 underwent IUD-IPs implantation and 36 SI-IPs, mean duration was 58 ± 8, 59 ± 8 and 53 ± 38 months, respectively. Conclusions Because of their safety and efficacy, IUD-IPs and SI-IPs should be considered as first-line contraception in patients with CHD.

Outcomes of etonogestrel subdermal contraceptive implants: A single center cross-sectional study.

To examine the prevalence of menstrual irregularities, side effects, and discontinuation rates of etonogestrel subdermal implants (ESI) in women attending King Abdulaziz Medical City, Jeddah, Saudi Arabia. This cross-sectional was carried out based on electronic medical records and a phone-based questionnaire administered to women who underwent ESI insertion in a single tertiary care hospital in Jeddah, Saudi Arabia, between 2019 and 2022. The primary objective was the prevalence of menstrual abnormalities. The secondary study objective included the discontinuation rate, reasons for discontinuation, and ESI side effects. In total, 345 women with ESI were included in this study. The prevalence of any type of menstrual abnormalities was 88%. Other side effects included skin and mood changes, arm pain, and numbness. The discontinuation rate was 11% in the first year and 22% before the completion of 36 months. Although menstrual abnormalities are a common side effect of ESI, only 22% of users discontinued this method of contraception.

Effects of gender affirming hormone treatment in transgender individuals - a retrospective cohort study.

Gender affirming hormone treatment (GAHT) results in measurable changes to anthropomorphic, biochemical and hormonal variables that are important to patients and their health care professionals to guide treatment. This study sought to quantify changes which occur in response to initiation of GAHT. We performed a retrospective cohort study of outcomes in transgender and gender diverse (TGD) patients starting GAHT. The primary outcome was proportion of patients and time required to achieve optimal hormone levels after commencement of GAHT. Additional analyses were performed to assess whether clinical and biochemical factors were associated with likelihood of achieving target hormone levels. 345 patients were included. Among 154 transmasculine individuals, 116 (75%) achieved a testosterone level >10 nmol/L during follow-up at a median of 4-months (IQR 4-9). No clinical or biochemical factors were significantly associated with likelihood of reaching therapeutic testosterone concentrations in transmen. Among 191 transfeminine individuals, 131 (72%) achieved a testosterone level <2.0 nmol/L during follow-up at a median of 4-months (IQR 3-9). Factors associated with increased likelihood of testosterone suppression were use of subdermal estradiol implants as well as cyproterone acetate as an androgen antagonist. Changes in differing directions were observed during repeated measures of lipids, liver function, and blood count between transmasculine and transfeminine individuals, reflecting the important effects of testosterone and estradiol on biochemical tests ordered as part of routine clinical care. Most TGD patients achieve target testosterone levels within 9 months of GAHT initiation. Adverse effects of GAHT are rare, and are usually mild.