Use Of Oral Hormonal Contraceptives Research Articles

Oral Hormonal Contraceptives and Cardiovascular Risks in Females.

Oral hormonal contraception (OHC) is a widely employed method in females for the prevention of unintended pregnancies, as well as for the treatment of menstrual disorders, endometriosis, and polycystic ovarian syndrome. However, it is believed that with OHCs use, some females may have higher risk of cardiovascular diseases, such as hypertension, diabetes, myocardial infarction, thrombosis, and heart failure. Although such risks are infrequently detected in healthy young females with the use of oral contraceptives, slightly elevated risks of cardiovascular diseases have been observed among reproductive-aged healthy females. However, prolonged use of OHC has also been claimed to have protective cardiac effects and may contribute to reduced risk of cardiovascular disease. In fact, the debate on whether OHC administration increases the risk of cardiovascular diseases has been ongoing with inconsistent and controversial viewpoints. Nevertheless, a great deal of work has been carried out to understand the relationship between OHC use and the occurrence of cardiovascular risk in females who use OHC for preventing the unwanted pregnancy or treatment of other disorders. Therefore, in this review we summarize the most recent available evidence regarding the association between the use of oral hormonal contraceptives and the risk for cardiovascular disease in females who are using OHC to prevent unintended pregnancy.

Abstract 071: Oral Contraceptive Use and Development of Acute Ischemic Stroke: A Population‐Based Retrospective Cohort Study

Introduction Existing evidence remains conflicting regarding the association between oral hormonal contraceptive (OCP) use and the risk of acute ischemic stroke (AIS). Large‐scale analyses and observational data evaluating this clinical question in recent years are scarce, despite widespread use of hormonal contraception in adult females of child‐bearing age. Modern OCP formulations contain lower doses of estrogen, the putative causative agent for AIS in this population, and underscores the need to re‐evaluate the risk initially demonstrated in older formulations containing higher levels of estrogen. Methods Hospitalizations for female patients aged 15‐50 were identified in the National Inpatient Sample (NIS) registry from 2015‐2020, excluding admissions associated with pregnancy or the postpartum period. The study exposure was use of OCPs and the primary endpoint was AIS, identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) coding. Propensity score (PS) adjustment by inverse probability weighting (IPW) was used to mimic the effects of randomization by balancing baseline clinical characteristics associated with stroke between OCP and non‐OCP users to reduce measured confounding. In addition to age and race/ethnicity, a battery of more than forty confounding covariates representing established risk factors for AIS in the general and young population were identified (cardiovascular disease, lifestyle risk factors, congenital abnormalities, vasculopathies, hypercoagulable states, migraine with aura, among others) and balanced between OCP and non‐OCP users. Sensitivity testing was performed by evaluating stroke incidence in a sub‐group of patients without any risk factors present and by assessing a negative control (head trauma), with which an association of OCP use would not be expected. The effect size of the association between OCPs and AIS was presented as an adjusted odds ratio (aOR) with 95% confidence interval (CI), with statistical significance evaluated at p < 0.001. Results PS adjustment by IPW to balance all available AIS risk factors between OCP users and non‐users yielded 23,253,209 hospitalizations, 11,654,398 (50.1%) of which were associated with OCP use. The incidence of AIS was significantly greater in OCP users compared to non‐OCP users (2.8% vs. 0.4%; aOR 7.50, 95% CI 7.43 to 7.58; p < 0.001). Sub‐group analysis of hospitalizations without any stroke risk factors also demonstrated a significant association of OCP use with the development of AIS (1.3% vs. 0.1%; aOR 14.84, 95% CI 13.16 to 16.72; p < 0.001) following adjustment for age and race/ethnicity. In negative control analysis, OCP use was not associated with admissions associated with head trauma (1.4% vs. 1.4%; OR 1.03, 95% CI 0.95 to 1.10; p = 0.485). Conclusion Retrospective observational data from the United States in recent years suggests an association between OCP use and AIS, independent of well‐established risk factors for stroke and despite widespread adoption of lower estrogen formulations.

Hormonal contraception and the recognition of sexual receptivity by facial expression

The possible influence of exogenous sex hormones present in hormonal contraceptives on the recognition of emotions by facial expression may interfere with interpersonal relationships. The objective of this study was to test the agreement between women with and without oral hormonal contraceptive (OC) use on the perception of sexual receptivity by facial expression, a complex social emotion. A total of 135 women participated in the study, 30 with and 105 without OC use, all older than 18 (Mean age 40.3). The volunteer participants completed an online form containing the Sexual Receptivity by Facial Expression (SRFE) scale images. The scale data were observed as means, with no significant differences between the groups. The results corroborate data from the literature regarding the interference of OC use on female emotional processing. Although without statistically significant differences, women using OC tend to agree less with the presence of sexual receptivity in facial expressions. In situations of clinical cases regarding altered female perception, the use of OC is a data to be investigated.

Misconceptions about multiple sclerosis and pregnancy in the Qassim region in 2021-2022: a cross-sectional study.

Multiple sclerosis (MS) is a disease with higher female prevalence, and the majority of patients are of childbearing age. Thus, pregnancy concerns are important for patients with MS and their families. Improving the understanding of the effects of pregnancy on the progress of MS could improve the knowledge about pregnancy-related issues in MS patients. The aim of this study is to evaluate the general knowledge of Saudi adults living in the Qassim region regarding pregnancy-related relapses in relapsing-remitting MS (RRMS) and to identify misconceptions regarding pregnancy, breastfeeding, and the use of oral hormonal contraceptives among female MS patients. A representative random cluster sample of 337 participants was used in this cross-sectional study. All participants were living in one of the following cities in the Qassim region: Buraydah, Unaizah, and Alrrass. Data collection was done between February 2022 and March 2022 using a self-administered questionnaire. The overall mean knowledge score was 7.42 (SD 4.21), with poor, moderate, and good knowledge representing 77.2%, 187%, and 4.2% of the sample, respectively. Higher knowledge scores were associated with age less than 40 years, being a student, knowing about MS, and knowing someone with MS. Other variables such as gender, educational level, and residence location did not show significant differences regarding the knowledge score. Our results demonstrate that knowledge and attitude are suboptimal among the Qassim population regarding the effects of MS on pregnant patients, pregnancy outcomes, breastfeeding, and usage of contraceptive methods, with 77.2% showing poor total knowledge scores.

Real-world effect of a potential drug-drug interaction between topiramate and oral contraceptives on unintended pregnancy outcomes

ObjectiveTo evaluate the association of concomitant topiramate and oral hormonal contraceptive use with unintended pregnancies. Study DesignWe conducted a retrospective cohort design in MarketScan Research Databases (2005−2018) on women aged 12−48 who had migraines or chronic headaches and concomitantly used topiramate and oral contraceptives. We used a cohort of patients with oral contraceptives and concomitant use of other migraine prevention therapies (propranolol, metoprolol, amitriptyline, venlafaxine, or verapamil) as a comparator. We followed patients for up to 1 year from cohort entry to assess the occurrence of unintended pregnancy (i.e., contraception failure). Pregnancy events were measured via an algorithm harnessing medical encounters information with live births, terminations, or prenatal visits. Statistical models accounted for multiple cohort entries and adjusted for measured confounders via a propensity score weighting method. ResultsWe identified 63,649 episodes of oral contraceptives+topiramateand 59,012 episodes of oral contraceptives+other maintenance therapies. The mean age was 29.2±9.0 and 29.0±9.3 years in the study cohorts. In the adjusted analysis, the contraception failure rate (95% confidence interval) was 1.3 (1.1, 1.6) per 100 person-years in the oral contraceptives+topiramate cohort and 1.3 (1.1, 1.6) in the oral contraceptives+other maintenance therapies cohort. The adjusted rate ratio and rate difference measures were 1.00 (0.80, 1.26) and 0.00 (-0.3, 0.3). ConclusionConcomitant use of low-dose topiramate and oral contraceptives among patients with migraines was not associated with a higher risk for unintended pregnancies. ImplicationsOur real-world findings confirm clinical pharmacology trials, suggesting that low-dose (≤200 mg/d) topiramate may not influence oral contraceptive effectiveness.

213-LB: Combined Oral Contraceptives Drive Inactivity and Hepatic Mitochondrial Oxidative Stress in Female Mice

Background: It is well established that compared to age-matched men, pre-menopausal women are protected against metabolic disease (obesity, diabetes, hepatic steatosis) . However, both epidemiological data on menopause and pre-clinical ovariectomy models show that disruption of estrogen signaling increases disease susceptibility. Combined oral hormonal contraceptives (OC) induce loss of normal estrogen cycling, and despite widespread use, the impact of OCs on metabolic health and disease remains poorly understood. Methods: Female C57BL/6J mice (7-8 wks old) were treated with high-fat diet (HFD; CON) or HFD + OCs (2mg estradiol/kg HFD, 200mg progestin/kg HFD; OC) for 12 wks. In each treatment group, mice either remained sedentary or had access to voluntary running wheels (VWR; n=12 per group) . Liver and skeletal muscle mitochondrial function (respiratory capacity, H2O2, coupling) were measured along with body composition, glucose tolerance, energy expenditure, and intrahepatic triglyceride. Results: OCs decreased VWR, spontaneous physical activity, and total energy expenditure. OC treated mice had lower adiposity and hepatic triglyceride compared to CON mice, with no difference in glucose tolerance. Despite similar maximal respiratory capacity, OCs induced robust increases in hepatic mitochondrial H2O2 across all respiratory states and with both fat and carbohydrate-based substrates. There were no differences in muscle mitochondrial outcomes. Conclusions: When combined with HFD, OC use lowers physical activity and energy expenditure while inducing tissue-specific effects on mitochondrial function in mice. These data provide pause for use of OCs in the context of elevated metabolic disease risk. Future work should explore whether OC-induced changes in physical activity blunts the ability of exercise to prevent or treat insulin resistance and steatosis and whether prolonged OC exposure leads to liver injury via elevated oxidative stress. Disclosure K. Fuller: None. C. S. Mccoin: None. H. Stierwalt: None. J. P. Thyfault: None. Funding AHA (20PRE35120098) , VA Merit Review Grant (1I01BX002567-01)

Adverse events related to oral hormonal contraceptive use in undergraduate pharmacy students: a cross-sectional study

We aimed to measure the prevalence of adverse events related to oral hormonal contraceptive (OHC) use and their associated factors in undergraduate pharmacy students. A cross-sectional study was conducted by using an online questionnaire for female students of the Faculty of Pharmaceutical Sciences of the University of São Paulo from July to August 2020. A descriptive analysis of the data was carried out, which was followed by determining the prevalence ratios to identify possible factors associated with adverse events resulting from OHC. A total of 269 valid responses were obtained, among which 50.2% (n = 135) of the students reported using OHC as a contraceptive method and 21.2% (n = 57) affirmed that they had at least one adverse event related to OHC use, which corresponds to 42.2% of those who had used OHC. The most common adverse event was headache (70.2%), and a period of less than one month was the most cited (49.1%). Only migraine comorbidity was associated with the occurrence of adverse events related to OHC. These findings reinforce the high incidence of adverse events among OHC users and the low rate of discontinuation due to these events. There is a need to provide more information on contraceptive methods to users, including its risks and contraindications.

Epidemiological Survey on the Perception of Adverse Effects in Women Using Contraceptive Methods in Brazil.

The present study aimed to understand patient perception of the adverse effects of contraceptives to improve health care and adherence to treatment. An online questionnaire was available for women in Brazil to respond to assess their perception of adverse effects and their relationship with contraceptive methods. Of all 536 women who responded, 346 (64.6%) reported current contraceptive use. One hundred and twenty-two (122-34.8%) women reported having already stopped using contraception because of the adverse effects. As for the contraceptive method used, the most frequent was the combined oral contraceptive (212-39.6%). When we calculated the relative risk for headache, there was a relative risk of 2.1282 (1.3425-3.3739; 95% CI), suggesting that the use of pills increases the risk of headache, as well as edema, in which a relative risk of 1.4435 (1.0177-2.0474; 95% CI) was observed. For low libido, the use of oral hormonal contraceptives was also shown to be a risk factor since its relative risk was 1.8805 (1.3527-2.6142; 95% CI). As for acne, the use of hormonal contraceptives proved to be a protective factor, with a relative risk of 0.3015 (0.1789-0.5082; 95% CI). The choice of a contraceptive method must always be individualized, and the patients must be equal participants in the process knowing the expected benefits and harms of each method and hormone, when present.

Survey of Available Information on the Risks and Contraindications of Oral Hormonal Contraceptives on Higher Education Websites

Background: Venous thromboembolism (VTE) is one of the most common cardiovascular disorders after myocardial infarction and stroke. Primary manifestations include deep vein thrombosis and pulmonary embolism, which are often preventable and often underdiagnosed. Patients with inherited thrombophilia or family history of VTE are at increased risk for VTE. Acquired VTE risk factors include the use of oral hormonal contraceptives, such as combined oral contraceptive pills (COCPs) containing estrogen and progestin. Women with a family history of VTE are advised not to take COCPs; possible alternatives include use of progestin-only contraceptive pills or non-oral contraceptive methods. Currently it is unknown if young women at college are given information regarding this potential risk when seeking oral contraceptives. Thus, higher education websites can provide a potential venue to promote awareness of this risk. In this study, we reviewed a sample of higher education websites in the US to assess availability of information on oral hormonal contraceptives and their risks for young women.Methods: US higher education institutions for this survey and categorized into 5 major types: community colleges, liberal arts institutions, private for-profit institutions, public non-profit institutions, and private non-profit institutions; 25 institutions from each category were included for analysis. The study was conducted using the Google search terms “birth control pills,” “oral contraceptive pills,” OR plus the university name. Mention of contraindications, risk factors, and blood clot warnings was noted for each website and categorized as to whether the information appeared on the institution's webpage or as a link to an external reference source. Information listed was further classified by risk factors and contraindications mentioned.Results: A total of 125 US higher education institution websites were assessed. Eighteen (14.4%) of the 125 offered information on COCP-related clotting risks. Community colleges and private, for-profit institutions had no information on birth control available either on their webpage or through an external link. Only 3 of 25 (12%) liberal arts institutions discussed clotting risk information. Five of the 25 (20%) public, nonprofit institutions surveyed provided information on their student webpages; three of these 5 offering information through their website as well as through a link to an external website. Of the private, non-profit institutions surveyed, 2 (8%) provided information through their institution's website and 4 (16%) provided information through external sources. Regarding contraindications, 2 (8%) liberal arts schools provided information on their website only, identical to the percentages seen with private and public non-profit institutions. Additionally, 4 (16%) private non-profit universities and 2 (8%) public, non-profit institutions provided information only through external sources. Two (8%) public non-profit institutions provided information both on their website and through external links. Overall, only 6 (4.8%) of the 125 institutions described family history or inherited prothrombotic blood disorder as a potential contraindication or risk factor for COCP-related clotting, all 6 of which were public or private non-profit institutions.Conclusion: The results of this study raise the question of whether higher education institutions are providing the appropriate risk and contraindication information for women considering oral contraceptives as a birth control method. This suggests that there is an opportunity for more birth control education to be provided by higher education institutions. [Display omitted] DisclosuresSarmiento: Quest Diagnostics: Current Employment. Sahud: Quest Diagnostics: Current Employment. Wong: Quest Diagnostics: Current Employment, Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company.

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.

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.

Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus

We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ≥18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (≥2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ≥3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence.

Recurrent pulmonary embolism associated with oral hormonal contraceptive use

Pulmonary embolism (PE) is a dramatic and life-threatening complication of deep vein thrombosis, and thus, its prevention, diagnosis, and treatment are of special importance. One of the more common acquired risk factor of PE is the use of oral contraceptive (OCP) medications. We report a case of PE secondary to OCP use. A 30-year-old female patient presented with PE following OCP use. Diagnosis was confirmed with computed tomography angiography and treatment was started with thrombolytics. Although appropriate treatment was initiated and offending drug was withdrawn, patient succumbed to her illness. Thus, treatment with OCPs requires careful and thorough evaluation of patient history and regular follow-up, focusing on likely complications.

Common determinants of Ca breast - a case control study in Lahore

Background Ca breast is commonest malignancy in females all over the world and 2nd leading cause of death in females. In Pakistan, it is more common in young age (incidence in 30-39 years) contrary to west (over 65years). Genetics ,use of oral hormonal contraceptives, prolonged hormonal replacement therapy, environmental hazards and parity are also considered to play an important role in causation of ca. breast .This morbidity pattern of young age in Pakistan is a real concern for the health care planners and providers. Objectives:-To know the etiological factors in the area, to formulate a public awareness programme for reduction in mortality and morbidity due to breast cancer in Pakistan Study design:-Case Control Study. Place and duration of the study: - Mayo and INMOL hospitals. Jan-June, 2005.Respondants and methods:-Pre- tested questionnaire was used to interview the cases and control groups Results:-Ca breast is significantly more in married, young age, with 3 or more children, breast feeding moth ers. Conclusion: - Early marriages environmental hazards, genetic predisposition and hormonal imbalance are the most important suspected causes. Cancer awareness and screening programme with community participation are the best feasible approaches for rectification of the situation.

Oral and injectable contraceptive use and HIV acquisition risk among women in four African countries: a secondary analysis of data from a microbicide trial

ObjectiveTo assess the effect of oral and injectable contraceptive use compared to nonhormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial. Study designThis is a prospective cohort study using data from women enrolled in HIV Prevention Trials Network protocol 035. At each quarterly visit, participants were interviewed about self-reported contraceptive use and sexual behaviors and underwent HIV testing. Cox proportional hazards regression was used to assess the effect of injectable and oral hormonal contraceptive use on HIV acquisition. ResultsThe analysis included 2830 participants, of whom 106 became HIV infected (4.07 per 100person-years). At baseline, 1546 (51%) participants reported using injectable contraceptives and 595 (21%) reported using oral contraceptives. HIV incidence among injectable, oral and nonhormonal contraceptive method users was 4.72, 2.68 and 3.83 per 100person-years, respectively. Injectable contraceptive use was associated with a nonstatistically significant increased risk of HIV acquisition [adjusted hazard ratio (aHR)=1.17; 95% confidence interval (CI) 0.70, 1.96], while oral contraceptive use was associated with a nonstatistically significant decreased risk of HIV acquisition (aHR=0.76; 95% CI 0.37,1.55). ConclusionIn this secondary analysis of randomized trial data, a marginal, but nonstatistically significant, increase in HIV risk among women using injectable hormonal contraceptives was observed. No increased HIV risk was observed among women using oral contraceptives. Our findings support the World Health Organization’s recommendation that women at high risk for acquiring HIV, including those using progestogen-only injectable contraception, should be strongly advised to always use condoms and other HIV prevention measures. ImplicationsAmong Southern African women participating in an HIV prevention trial, women using injectable hormonal contraceptives had a modest increased risk of HIV acquisition; however, this association was not statistically significant. Continued research on the relationship between widely used hormonal contraceptive methods and HIV acquisition is essential.

Tratamento minimamente invasivo do adenoma hepático em situações especiais

ABSTRACTHepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

A multivariate analysis of the factors that influence the modification of sexual desire in oral hormonal contraceptive (OC) users

Objective. This work studied the influencing factors of age, level of education, family planning awareness, relationship with partner, the age at which sexual relationships were initiated, parity, the method of contraceptive previously used, the type of contraceptive pill used and the duration of oral hormonal contraception (OC) use in relation to the modification of sexual desire in OC users. Materials and Methods. Prospective study of 760 OC users at the Family Planning Center “Marina Alta” in Alicante (Spain). A logistical regression analysis was carried out to study the relative risk of reduction in libido, taking other risk factors into account. Results. In the simple analysis, women who initiated sexual relationships between 18 and 25 years of age had a lower sexual desire in comparison with women who were sexually active before the age of 18 (OR = 2.11; CI: 1.15 - 3.91). Nulliparous women had a reduced sexual desire compared with those women that had given birth (OR = 2.32; CI: 1.41 - 3.82). An OC use of between 6 months and 1 year reduced sexual desire in comparison with a use of less than 6 months (OR = 0.24; CI: 0.09 - 0.64). In the multivariate analysis, age (OR = 1.12; CI: 1.01 - 1.21) and the use of OC within an initial 6 month to a year period (OR = 0.24; CI: 0.09 - 0.64) presented a statistically significant relationship with the modification of sexual desire. The level of education, family planning awareness, relationship with partner, the method of contraception previously used and the type of contraceptive pill prescribed showed no statistical significance with the modification of sexual desire in OC users. Conclusions. Sexual desire in OC users decreases as a woman’s age increases and in an early stage of use in the first six months after beginning OC treatment.

Erhöht die hormonale Kontrazeption das Tumorrisiko?

A non-contraceptive benefit of oral hormonal contraceptives (OC) is a diminished risk for certain benign as well as malignant tumours, such as benign breast tumours, uterine fibroids and ovarian cysts. Endometriosis itself is not positively influenced by OC, but dysmenorrhea is decreased. Modern low-dose OC do not increase the risk of liver cell adenomata or carcinomata. OC do not influence melanoma. Modern data do not suggest an increased risk for breast carcinoma in OC users. Long-term use of OC leads to a decreased risk of endometrial and colorectal carcinomata. Cervical carcinoma is not influenced directly by OC, but probably indirectly through a change in sexual behaviour. There is no increase of vulvar or vaginal carcinoma, even after long-term use of OC.

A comparative analysis of the modification of sexual desire of users of oral hormonal contraceptives and intrauterine contraceptive devices

Objective: To compare the influence of oral hormonal contraceptives (OCs) and the use of intrauterine contraceptive devices (IUDs) on the modification of sexual desire.Materials and methods:A prospective observational study of 1073 women using OCs or an IUD at the Family Planning Center 'Marina Alta' in Alicante, Spain. In order to evaluate the relative risk regarding the decrease in libidoattributed to each contraceptive method, a logistic regression analysis was undertaken which considered the factors of age adjustment, level of studies, family planning information, relationship with partner,age when sexual relationships were initiated, parity, contraceptive method previously used and the duration of use of the contraceptive method.Results: No differences in the decrease of sexualdesire were observed between the use of the OC and IUD (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.70-2.49), yet differences were noted, however, in relation to age (OR 1.05; 95% CI 1.01-1.10).Although these differences were not statistically significant, a high level of awareness regarding family planning was shown to increase sexual desire when compared to a lower level of information on thissubject (OR 0.64; 95% CI 0.41-1.01). Sexual desire was seen to decrease if the quality of the relationship with the partner was average (OR 2.24; 95% CI 1.36-3.69) or poor (OR 4.69; 95% CI 1.93-11.4). Nulliparouswomen showed a greater decrease in sexual desire in relation to women who had already given birth (OR 1.57; 95% CI 1.00-2.47). Sexual desire was greater if the contraceptive method had already been in usefor 6-12 months (OR 0.41; 95% CI 0.17-0.98).Conclusions: Sexual desire does not vary in relation to the use of OCs or IUDs, yet it does decrease with age, in nulliparous women and in those withan average or poor relationship with their partner. Furthermore, sexual desire shows an increase between the first 6 and 12 months of contraceptive treatment.