Hormonal Contraceptive Users Research Articles

Positive Association Between 25-Hydroxyvitamin D and C-Reactive Protein is Confounded by Hormonal Contraceptive Use

Studies of the relationship between vitamin D and inflammation are equivocal. This may be due to unaccounted confounding. Hormonal contraceptive (HC) use is associated with elevated circulating 25-hydroxyvitamin D [25(OH)D] in Caucasians and African-Americans, but its effects on 25(OH)D in other ethnicities are unclear. HC use is associated with elevated C-reactive protein (CRP), an inflammatory biomarker. Our objectives were to assess the effect of HC use on 25(OH)D across ethnic groups, and to examine the association between HC, 25(OH)D and CRP in an ethnically diverse population of young adults. We recruited Caucasian, East Asian, and South Asian individuals (n=1,403) from Toronto, Canada. Fasting blood measures of 25(OH)D and CRP were obtained. Across ethnic groups, women HC users (n=280) had higher 25(OH)D and CRP than women HC non-users (n=695) and men (n=428) (p<0.008 and p<0.0001, respectively). Circulating 25(OH)D was positively associated with CRP in the entire population in models not accounting for HC use (β=0.010±0.003; p<0.0001). There was no association when men and women HC non-users were examined separately. Among women HC users, there was no association after accounting for hormone dose. A positive association between 25(OH)D and CRP among individuals above the median 25(OH)D (≥51.9 nmol/L) was not significant after adjustment for HC use. No association was observed among individuals below the median. HC use and 25(OH)D were positively associated across ethnic groups. We found no association between 25(OH)D and CRP when HC use was accounted for. HC use confounds the association between 25(OH)D and CRP.

Plasma vitamin D, hormonal contraceptive use, and biomarkers of cardiometabolic disease

The relationship between vitamin D and cardiometabolic disease is unclear. Hormonal contraceptive (HC) use among women is associated with elevated plasma 25‐hydroxyvitamin D [25(OH)D]. HC use is also associated with cardiometabolic disease risk. The objective was to examine whether the association between 25(OH)D and biomarkers of cardiometabolic disease differs between healthy young women HC non‐users (n=677), women HC users (n=280), and men (n=427) aged 20 – 29 years. Participants provided overnight fasting blood samples for measurement of 25(OH)D, glucose, insulin, and blood lipids. HC use was determined by questionnaire. In models adjusted for age, waist circumference, physical activity, ethnicity, and season of blood collection, vitamin D deficiency was associated with higher insulin, HOMA‐IR, and HOMA‐Beta among men and women HC non‐users, and with higher triglycerides among men only. No biomarkers were associated with 25(OH)D among women HC users. Circulating 25(OH)D concentrations are inversely associated with biomarkers of glycemic dysregulation in young adults; however, HC use among women attenuates this association. Given the widespread use of HC by women throughout the world, a better understanding of the extent to which these medications modify the relationship between vitamin D and disease‐related processes is warranted. Research support from the Advanced Foods and Materials Network.Grant Funding Source: Advanced Foods and Materials Network

Restless legs syndrome in combined hormonal contraception users

The goal of the study was to estimate the prevalence of restless legs syndrome (RLS) among women of childbearing age taking combined hormonal or combined oral contraception (CHC). A survey that included demographic information, contraceptive use history, the four criteria necessary for RLS diagnosis and an International RLS study group severity scale was distributed to 145 women taking CHC and 169 matched control women not on CHC. A high prevalence of moderate to severe RLS of 20.7% was found. A significant correlation between CHC use and RLS was not found (p = 0.53). RLS severity was not significantly associated with CHC use either (p = 0.2127). Women with RLS were significantly heavier compared with those without RLS (p = 0.0015). RLS severity weakly correlated with body mass index (R = 0.26, p = 0.044). Hormonal contraceptive therapy does not increase the risk of developing RLS symptoms.

Can a meta-analysis that included articles with high heterogeneity appropriately evaluate the risk of venous thromboembolism in users of combined hormonal contraceptives containing drospirenone or desogestrel? A reply to Rosa et al.

Concerns about the appropriateness of high heterogeneity in the meta-analysis evaluating the risk of venous thromboembolism in users of combined hormonal contraceptives are discussed in this reply to a critical response of the original study. The response claimed that some of the study’s meta-analyses were compromised by the high heterogeneity which affected two studies one pertaining to drospirenone and the other one to desogestrel. The authors acknowledge previously pointed out methodological flaws in the cohort studies. Finally taking into account the discussed limitations the authors consider that observational studies will not add relevant information and only well-designed prospective studies will help to better understand the real risks of hormonal contraception.

Can a meta-analysis that included articles with high heterogeneity appropriately evaluate the risk of venous thromboembolism in users of combined hormonal contraceptives containing drospirenone or desogestrel?

The authors suggest that the authors of the systematic review reassess the meta-analyses which demonstrated high diversities. The reanalysis of the cohort studies comparing venous thromboembolism (VTE) risk in users of combined oral contraceptives (COCs) containing desogestrel with that of women taking a COC containing levonorgestrel brought no substantial change to light with regard to the aforementioned author’s findings. On the contrary when reassessing the cohort studies comparing users of COCs containing drospirenone with women taking a COC containing levonorgestrel unlike the review authors they found no significant difference in VTE risk between these two groups. The authors’ meta-analysis of nested case control studies did show a higher VTE risk associated with the use of drosperinone-containing pills. Future studies of higher quality and longer duration are needed to determine whether the risk of VTE associated with the use of COCs containing drosperinone is greater than with those containing levonorgestrel.

Combined hormonal contraceptives and the risk of venous and arterial thromboembolism and cardiovascular death: misuse of automated databases

BackgroundIn December 2011, the US Food and Drug Administration (FDA) convened a public Advisory Committee meeting to review evidence from a study commissioned by the agency. An analysis of findings...

Effect of hormonal contraceptive methods on HIV disease progression

Systematically assess from the literature whether women living with HIV who use hormonal contraception are at increased risk of HIV-disease progression compared with those who do not use hormonal contraception. We searched PUBMED and EMBASE for articles published in peer-reviewed journals through December 15, 2011 for evidence relevant to all hormonal contraceptive methods and HIV-disease progression. Twelve reports of 11 studies met inclusion criteria. One randomized controlled trial (RCT) found increased risk for the composite outcome of a reduced CD4 cell count or death among hormonal contraceptive users when compared with copper intrauterine device (IUD) users. Ten cohort studies reported no increased risk for HIV disease progression (as measured by mortality, time to a CD4 cell count below 200, time to initiation of antiretroviral therapy, an increase in HIV-RNA viral load, or a decrease in CD4 count) among women who used hormonal contraception compared with those who did not. The preponderance of evidence indicates that HIV-positive women can use hormonal contraceptive methods without concerns related to HIV-disease progression. Cohort studies consistently found no association between hormonal contraceptive use and HIV-disease progression compared with nonuse of hormonal contraceptives. One RCT found that hormonal contraceptive use was associated with increased risk of HIV-disease progression when compared with IUD use, but this study had important methodological shortcomings. Prevention of unintended pregnancy among women living with HIV remains a public health priority to safeguard women's and infants' health and to prevent vertical transmission of HIV.

Plasma 25-Hydroxyvitamin D, Hormonal Contraceptive Use, and the Plasma Proteome in Caucasian, East Asian, and South Asian Young Adults

Vitamin D affects gene expression, but its downstream effects on the proteome are unclear. Hormonal contraceptives (HC), which affect vitamin D metabolism and have widespread effects on the plasma proteome, may confound the association between vitamin D and the proteome. We determined whether HC use modified the association between 25-hydroxyvitamin D (25D) and a panel of 54 high-abundance plasma proteins. Cross-sectional analyses were conducted in healthy, nonsmoking female HC users (n = 216), female HC nonusers (n = 502), and men (n = 301) from Toronto, Canada. Plasma 25D was measured by HPLC-MS/MS, and proteins were measured by LC-multiple-reaction-monitoring (MRM)-MS. The 54 proteins clustered into four distinct proteomic profiles. A positive association was observed between Profile 1, containing positive acute phase proteins, and 25D. In female HC users, a J-shaped association existed between Profile 1 and 25D, but no associations existed in female HC nonusers and men. Twelve proteins were individually associated with 25D in female HC users, but only two were associated with 25D in female HC nonusers and no associations were observed in men. After accounting for hormone dose, only three proteins were associated with 25D. In summary, HC use is an important confounder of the association between circulating 25D and numerous plasma proteins.

Hormonal Contraceptive Continuation and Switching in South Africa

Investigating the association between hormonal contraception and HIV is challenging due to high discontinuation rates among users. This secondary analysis of 262 South African adolescent new users of hormonal contraception found continuation rates after 1 year for depot medroxyprogesterone acetate, norethisterone enanthate, or combined oral contraceptives of 40.4%, 64.4%, and 64.6%, respectively. Implications for studies evaluating the association between injectable hormonal contraceptive use and HIV are discussed.

Contraceptive failures in overweight and obese combined hormonal contraceptive users.

To estimate weather contraceptive failure rates among combined oral contraceptive pill (OCP), patch, and vaginal ring users was associated with increasing body mass index (BMI). Females enrolled in a large contraceptive study offering the reversible method of their choice at no cost were followed-up for 2-3 years. We compared the failure rates (pregnancy) among users of the OCP, transdermal patch, and contraceptive vaginal ring stratified by BMI. Among the 7,486 participants available for this analysis, 1,523 chose OCPs, patch, or ring at enrollment. Of the 334 unintended pregnancies, 128 were found to be a result of OCP, patch, or ring failure. Three-year failure rates were not different across BMI categories (BMI less than 25 8.44%, 95% confidence interval [CI] 6.1-11.5; BMI 25-30 11.03%, 95% CI 7.5-16.0; BMI more than 30 8.92%, 95% confidence interval 7.6-11.5). Increasing parity (hazard ratio [HR] 3.06, CI 1.31-7.18) and history of a previous unintended pregnancy (HR 2.82, CI 1.63-4.87), but not BMI, were significant risk factors for unintended pregnancy. Overweight and obese females do not appear to be at increased risk for contraceptive failure when using the OCP, patch, or vaginal ring.

Suppressed response to hormonal contraceptives in women of Khairpur, Sindh, Pakistan

Objective: Contraception has gained gradual popularity in many parts of the developing world including Pakistan. Despite this increase in acceptance, the birth rate remains high. Failure of contraception has been reported in the literature, which made us aim to conduct this study. The efficiency of hormonal contraceptives in the study area was assessed and this is the first report from Pakistan. Methods: A total of 200 women (aged 20-30 and 31-40 years; n = 100 each) with minimum consistent use of hormonal contraceptives in the form of pills (Combined oral contraceptives) for 12 months were enrolled in this study. Blood samples were collected from women of each age group and corresponding control groups (n = 100) from local hospitals and reproductive health service center. Serum levels of the fertility hormones viz leutinizing and follicle stimulating hormones were measured through ELISA technique. Results: Our data revealed that over all in the both age groups, 72% women had normal, 16% increased and 12% showed decreased levels of leutinizing hormone (p > 0.05) and 67% women showed normal, 33% showed decreased and no increased levels were found for follicle stimulating hormone (p > 0.05). No age-wise significant difference in response was observed among both the age groups tested. Conclusion: Statistically insignificant difference in serum leutinizing hormone and follicle stimulating hormone seen among both the age groups of hormonal contraceptive users and control group indicates less effective hormonal contraception response in the study area.

Venous Thrombosis in Users of Non-Oral Hormonal Contraception: Follow-Up Study, Denmark 2001-10

Conclusion: Women who use transdermal patches or vaginal rings for contraception have approximately a six to seven times increased risk of venous thromboembolism (VTE) compared to women who do not use hormonal contraception. Summary: It is well known oral contraceptive agents increase the risk of VTE. There are, however, little to no data regarding the effects of methods other than pills to deliver hormonal contraceptive agents. Such methods include transdermal patches, subcutaneous implants, and vaginal rings. The authors used a historic national registry in a cohort study design to assess absolute and relative risk of VTE in Danish women using nonoral hormonal contraception. This national registry-based cohort study used four national registries from Denmark. All Danish nonpregnant women aged 15 to 49 years (n = 1,626,158), who were free of previous VTE or cancer, were followed up from 2001 to 2010. The main outcome measures were incidence rates of VTE in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception. Relative risk of venous thrombosis was compared with nonusers of hormonal contraception, and rate ratios of venous thrombosis in current users of nonoral products were compared with the standard reference of an oral contraceptive with levonorgestrel and estrogen (30-40 μg). A diagnosis of VTE was considered confirmed if there was at least 4 weeks of anticoagulation therapy after the initial VTE diagnosis. There were 5,287 first ever VTE events recorded within 9,429,128 women-years of observation. Of these VTE events, 3,434 were confirmed. The rate of confirmed VTE events was 2.1/10,000 years in nonusers of hormonal contraception. After adjustment for age, calendar year, and education, the relative risks and 95% confidence interval (95% CI) of confirmed VTE in users of transdermal combined contraceptive patches and vaginal ring compared with nonusers of hormonal contraception were 7.9 (3.5-17.7) and 6.5 (7.4-8.9), respectively. Corresponding incidence events per 10,000 exposure-years were 9.7 and 7.8 events. The relative risk (95% CI) was increased in women who used subcutaneous implants (1.4 [0.6-3.4]) but not in those who use the levonorgestrel intrauterine system (0.6 [0.4-0.8]). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk (95% CI) of VTE was 2.3 (1.0-5.2) in users of transdermal patches and 1.9 (1.3-2.7) in users of the vaginal ring. Comment: In the last paragraph of the discussion portion of this article the authors succinctly point out the implications of their study, “if the incidence rate of venous thrombosis in women using combined oral contraceptives containing levonorgestrel is 6 per 10,000 exposure years, that of the vaginal ring is 11 per 10,000 exposure years, and that of the transdermal patch is 14 per 10,000 exposure years, then 2000 women using the vaginal ring, and 1250 using the transdermal patch should shift to combined oral contraceptives with levonorgestrel to prevent 1 event of VTE in one year. A risk of 10 per 10,000 years implies a risk of VTE more than 1% over a 10 year user period. Therefore, women are generally advised to use combined oral contraceptives with levonorgestrel or norgestimate, rather than to use transdermal patches or vaginal rings.”

Longer Duration of Hormonal Contraceptive Use Predicts Better Cognitive Outcomes Later in Life

The cognitive effects of postmenopausal hormone therapy (HT) have been studied extensively, but little is known about the relationship between premenopausal hormone use and cognition. Hormonal contraceptive use vs. nonuse may be a potential factor influencing cognitive processes in midlife. The aim of this study is to explore the effect of modification of hormone milieu through use of hormonal contraception in premenopausal women and midlife cognitive function. Subjects were 261 cognitively normal women, aged 40-65 (mean μ=52), enrolled in the Wisconsin Registry for Alzheimer's Prevention. All women completed the Women's Health History Questionnaire and a self-report health history questionnaire and were administered a battery of neuropsychologic tests. Cognitive results were analyzed using summary scores for the domains of Verbal Ability, Visuo-spatial Ability, Working Memory, Verbal Learning & Memory, and Speed & Flexibility derived using a confirmatory factor analysis. Hormonal contraceptive ever users performed significantly better than never users in the domains of Visuo-spatial Ability (μ=0.75, 95% confidence interval [CI] 0.23-1.28, p=0.005) and Speed & Flexibility (μ=0.52, 95% CI -0.16-1.04, p=0.007), with duration-dependent increases in performance, especially in ever users with ≥ 15 years of use. These data provide preliminary evidence that hormonal contraceptive use may influence cognitive outcomes, even years after use is discontinued. Hormonal contraceptive users scored better in domains of Visuo-spatial Ability and Speed & Flexibility than never users, with a duration-dependent trend. Further research is needed to explore the use of hormonal contraceptives to prevent or delay cognitive decline and to clarify the physiologic basis of this phenomenon.

Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception

It remains controversial whether anti-Müllerian hormone (AMH) concentration is influenced by hormonal contraception. This study quantified the effect of hormonal contraception on both endocrine and sonographic ovarian reserve markers in 228 users and 504 non-users of hormonal contraception. On day 2–5 of the menstrual cycle or during withdrawal bleeding, blood sampling and transvaginal sonography was performed. After adjusting for age, ovarian reserve parameters were lower among users than among non-users of hormonal contraception: serum AMH concentration by 29.8% (95% CI 19.9 to 38.5%), antral follicle count (AFC) by 30.4% (95% CI 23.6 to 36.7%) and ovarian volume by 42.2% (95% CI 37.8 to 46.3%). AFC in all follicle size categories (small, 2–4mm; intermediate, 5–7mm; large, 8–10mm) was lower in users than in non-users of hormonal contraception. A negatively linear association was observed between duration of hormonal-contraception use and ovarian reserve parameters. No dose–response relation was found between the dose of ethinyloestradiol and AMH or AFC. This study indicates that ovarian reserve markers are lower in women using sex steroids for contraception. Thus, AMH concentration and AFC may not retain their accuracy as predictors of ovarian reserve in women using hormonal contraception.Serum anti-Müllerian hormone (AMH) concentration is an indirect marker of the number of small follicles in the ovary and thereby the ovarian reserve. The AMH concentration is now widely used as one of the markers of the ovarian reserve in ovarian hormonal stimulation regimens. Hence the AMH concentration in a patient is used to decide the dose of the ovarian hormonal stimulation prior to IVF treatment. In some infertile patients, hormonal contraception is used prior to ovarian hormonal stimulation and therefore it is important to clarify whether serum AMH concentration is influenced by the use of sex steroids. The aim of this study was to quantify the potential effect of hormonal contraception on the ovarian function by hormonal analyses and ovarian ultrasound examination. Examinations were performed in the early phase of the menstrual cycle or the hormone-free interval of hormonal contraception. We compared the AMH concentration, the antral follicle count (AFC) and the ovarian volume in 228 users versus 504 non-users of hormonal contraception. Users of hormonal contraception had 29.8% lower AMH concentration, 30.4% lower AFC and 42.2% lower ovarian volume than non-users. These findings were more pronounced with increasing duration of hormonal contraception. No dose–response relation was found between the dose of ethinylestradiol and the impact on serum AMH and AFC. The study indicates that ovarian reserve markers are lower in women using sex steroids for contraception. Thus, serum AMH concentration and AFC may not retain their accuracy as predictors of the ovarian reserve in women using hormonal contraception.

Novel Effects of Hormonal Contraceptive Use on the Plasma Proteome

BackgroundHormonal contraceptive (HC) use may increase cardiometabolic risk; however, the effect of HC on emerging cardiometabolic and other disease risk factors is not clear.ObjectivesTo determine the association between HC use and plasma proteins involved in established and emerging disease risk pathways.MethodConcentrations of 54 high-abundance plasma proteins were measured simultaneously by LC-MRM/MS in 783 women from the Toronto Nutrigenomics and Health Study. C-reactive protein (CRP) was measured separately. ANCOVA was used to test differences in protein concentrations between users and non-users, and among HC users depending on total hormone dose. Linear regression was used to test the association between duration (years) of HC use and plasma protein concentrations. Principal components analysis (PCA) was used to identify plasma proteomic profiles in users and non-users.ResultsAfter Bonferroni correction, 19 proteins involved in inflammation, innate immunity, coagulation and blood pressure regulation were significantly different between users and non-users (P<0.0009). These differences were replicated across three distinct ethnocultural groups. Traditional markers of glucose and lipid metabolism were also significantly higher among HC users. Neither hormone dose nor duration of use affected protein concentrations. PCA identified 4 distinct proteomic profiles in users and 3 in non-users.ConclusionHC use was associated with different concentrations of plasma proteins along various disease-related pathways, and these differences were present across different ethnicities. Aside from the known effect of HC on traditional biomarkers of cardiometabolic risk, HC use also affects numerous proteins that may be biomarkers of dysregulation in inflammation, coagulation and blood pressure.

Investigation of vaginal microbiota in sexually active women using hormonal contraceptives in Pakistan

BackgroundPrevious studies report association of contraceptives with moderate increase in urinary tract infection among sexually active premenopausal women. The aim of our study was to find out whether the use of hormonal contraceptives has any effect on microbiota of the vagina in the contraceptives users in Khairpur Sindh Pakistan.MethodsA prospective study in woman population of Khairpur Sindh Pakistan aged 20–30 years and 31–40 years, using Hormonal contraceptives was carried out. High vaginal swab samples (n = 100) were collected from the test populations as well as control group (n = 100) and investigated for vaginal microbial flora using standard microbiological and biochemical techniques.ResultsVaginal swabs culturing from hormonal contraceptives users in the age group 20–30 years showed statistically insignificant Candida sp (10% samples), and statistically significant (p < 0.05) Staphylococcus saprophyticus. (18% samples), Streptococcus agalactiae (23% samples), Escherichia coli (28% samples) and Lactobacillus fermentum (32% samples). In the age group 31–40 years, statistically significant percentage of samples (p < 0.05) showed Lactobacillus fermentum (28%), Candida sp (24%), and E. coli, (24%) where statistically insignificant samples showed Staphylococcus saprophyticus (13%) and Streptococcus agalactiae (11%).ConclusionsThe use of hormonal contraceptives alters the normal microbiota of vagina in women according to the age. Lactobacillus fermentum appeared as the predominant species followed by E. coli among the age group of 20–30 years and, Lactobacillus fermentum, Candida sp and E. coli as predominant among women of age group 31–40 years when compared to corresponding control groups. An inverse relationship between E. coli and Lactobacillus fermentum was observed in the women aged 20–30 years.

Women's attitudes towards monthly bleeding: Results of a global population-based survey

Objective Monthly bleeding can be uncomfortable and inconvenient. Fifty years after the introduction of the pill, one wonders whether women still want to bleed every month.Methods Cross-national online survey of women aged 15–49 years (N = 4039) who were currently using, had used or would consider using a hormonal contraceptive. The survey was conducted in eight countries across Europe, North America and Latin America to assess attitudes towards monthly bleeding.Results Almost one-third of women reported that bleeding had a severe negative impact on their daily life, particularly with respect to sexual life and sports activities. Approximately 60% of women would, at least sometimes, like to postpone their bleeding and 50% wished they had the flexibility to determine when their menstrual bleeding starts. Overall, 34% of women would change the frequency of their bleeding to once every two or three months.Conclusions Past, current or future users of hormonal contraception reported that bleeding has a severe negative impact on daily life. Given the choice, most women surveyed would reduce the frequency of their bleeding.

Use of hormonal contraceptives and risk of HIV-1 transmission

Coital frequency could be the real reason for Heffron and colleagues' findings1Heffron R Donnell D Rees H et al.Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study.Lancet Infect Dis. 2012; 12: 19-26Summary Full Text Full Text PDF PubMed Scopus (342) Google Scholar that hormonal contraception increases risk of HIV acquisition. Although the investigators examined and dismissed the possibility that more sexual activity in hormonal contraceptive users than non-users was to blame, the veracity of self-reports about sex has always been questionable. Could women not using contraception or using only condoms have the same level of sexual activity as those using hormonal contraception? Women are probably likely to choose effective birth control, such as hormonal contraception, when the risks of unintended pregnancy are high. When sexual activity is sporadic or absent, risk of HIV acquisition is low, as is motivation to use hormonal contraception. Nevertheless, non-users might have overstated their sexual activity because of study requirements for participation. However, in the final relative risk analysis, hormonal contraception could be falsely implicated for the noted increase in risk of HIV acquisition. Misreported condom use is the other possible confounder. The investigators concluded that condom use did not skew the findings; however, self-reports of this topic are notoriously inaccurate2Minnis AM Steiner MJ Gallo MF et al.Biomarker validation of reports of recent sexual activity: results of a randomized controlled study in Zimbabwe.Am J Epidemiol. 2009; 170: 918-924Crossref PubMed Scopus (133) Google Scholar and can substantially affect research. Reported condom use was balanced at roughly 91%. If those using hormonal contraception overstated condom use to avoid a lecture about safe sex, non-use of condoms combined with high sexual activity would put them at significant risk of HIV acquisition. Consequently, the raw data show that the comparison groups were equally protected by condoms, which could falsely leave hormonal contraception as the risk factor for HIV acquisition. Marginal structural models cannot salvage the truth from potentially biased data. In summary, the results of this and similar studies are built on shaky ground; far more evidence exists that self-reported coital frequency and condom use are poor scientific variables. However, at the margins these factors can be easily obscured, thus distorting the risk estimates for a primary exposure. In the published report, only 13 women on hormonal contraception seroconverted. Epidemiology often fails to prove causation. New approaches are needed to answer the important question of whether hormonal contraception increases risk of HIV acquisition.3Morrison CN Nanda K Hormonal contraception and HIV: an unanswered question.Lancet Infect Dis. 2012; 12: 2-3Summary Full Text Full Text PDF PubMed Scopus (42) Google Scholar I have served on a scientific advisory board for Bayer HealthCare. Use of hormonal contraceptives and risk of HIV-1 transmission – Authors' replyWe acknowledge the limitations of self-reported sexual behaviour; however, findings from several supplementary analyses suggest that incomplete statistical control for sexual behaviour does not explain our findings. First, self-reported unprotected sex was strongly associated with HIV-1 risk in our multivariate models (adjusted hazard ratio [HR] 2·82, 95% CI 1·62–4·92; p=0·0002 for HIV-1 acquisition in women and 2·57, 1·38–4·77; p=0·003 for HIV-1 transmission from women to men). Second, unprotected sex strongly correlated with increased pregnancy incidence1 and self-reported condom use was associated with an 80% reduction in per-contact risk,2 which is consistent with widely accepted estimates of condom effectiveness. Full-Text PDF

Sex hormone‐binding globulin as a marker for the thrombotic risk of hormonal contraceptives

It takes many years to obtain reliable values for the risk of venous thrombosis of hormonal contraceptive users from clinical data. Measurement of activated protein C (APC) resistance via thrombin generation is a validated test for determining the thrombogenicity of hormonal contraceptives. Sex hormone-binding globulin (SHBG) might serve as a marker for the risk of venous thrombosis, and can be easily and rapidly measured in routine laboratories. To determine whether SHBG is a useful marker for the thrombotic risk of hormonal contraceptive users by comparing plasma SHBG levels with normalized APC sensitivity ratio (nAPCsr) values and thrombosis risks reported in the recent literature. We conducted an observational study in 262 users of different contraceptives, and measured nAPCsr and SHBG levels. Users of contraceptives with a higher risk of causing venous thrombosis, i.e. combined hormonal contraceptives containing desogestrel, cyproterone acetate or drospirenone, and the transdermal patch, had higher SHBG levels than users of combined hormonal contraceptives containing levonorgestrel, which carry a lower thrombosis risk. Users of the patch had the highest SHBG levels, with a mean difference of 246 nmol L(-1) (95% confidence interval 179-349) from that in users of levonorgestrel-containing combined hormonal contraceptives. SHBG levels were positively associated with both the nAPCsr and the risks of venous thrombosis reported in the recent literature. SHBG is a useful marker with which to estimate the thrombotic safety of a preparation.

Prevalence of menstrual pain in young women: what is dysmenorrhea?

ObjectivesThis study aimed to determine the frequency of dysmenorrhea, as identified by different definitions, in a population of young women, and to investigate factors associated with this complaint.Materials and methodsA final group of 408 young women completed a self-assessment questionnaire. This was a cross-sectional analytical study.ResultsMenstrual pain was reported by 84.1% of women, with 43.1% reporting that pain occurred during every period, and 41% reporting that pain occurred during some periods. Women with menstrual pain had an earlier menarche (P = 0.0002) and a longer menstrual flow (P = 0.006), and this group was characterized as having a higher prevalence of smokers (P = 0.031) and a lower prevalence of hormonal contraception users (P = 0.015). Pain intensity was correlated (r = 0.302, P < 0.0001) positively with menstrual flow length (CR = 0.336), history of abortions (CR = 3.640), and gynecological pathologies (CR = 0.948), and negatively with age at menarche (CR = −0.225), use of hormonal contraception (CR = −0.787), and history of gynecological surgery (CR = −2.115). Considering the parameters of menstrual pain, a need for medication, and inability to function normally (absenteeism from study or social activities) alone or together, the prevalence of dysmenorrhea is 84.1% when considering only menstrual pain, 55.2% when considering the association between menstrual pain and need for medication, 31.9% when considering the association between menstrual pain and absenteeism, and 25.3% when considering the association between menstrual pain, need for medication, and absenteeism (P < 0.0001). The probability of having more severe dysmenorrhea is directly related to pain intensity as measured by a visual analog scale, but does not coincide with it.ConclusionMenstrual pain is a very common problem, but the need for medication and the inability to function normally occurs less frequently. Nevertheless, at least one in four women experiences distressing menstrual pain characterized by a need for medication and absenteeism from study or social activities.