Oral Contraceptive Users Research Articles

To each their own: The different mechanisms underlying the effect of sex hormones on visuospatial and verbal abilities

As they easily access the brain, sex hormones are associated with cognitive functions such as visuospatial and verbal abilities. As oral contraceptive (OC) users, naturally cycling women (NC women; not using OC), and men exhibit distinct sex hormone profiles, between-group differences in visuospatial and verbal performance have been observed. To date, the mechanisms underlying these differences remain unknown. Acute levels of sex hormones are thought to have either a fostering or impairing effect on performance on these tasks (e.g., acute levels of testosterone and estradiol enhance and impair visuospatial skills, respectively). Moreover, preliminary results suggest a positive correlation between the duration of OC use and visuospatial performance. Thus, the objective of this study was to investigate the temporality of the effects of sex hormones on cognition (i.e., through rapid mechanisms, long-term mechanisms, or both). To do so, 201 healthy participants (70 OC, 86 NC, and 45 men) completed tests measuring their visuospatial and verbal fluency abilities. Analyses revealed that men outperformed both groups of women and that OC users outperformed NC women on the visuospatial task. Estradiol levels in men were associated with lower performance, whereas testosterone levels in OC users were related to better performance. Regarding verbal fluency, we found no between-group differences in performance or correlations with acute hormone levels. Interestingly, longer OC use was associated with better verbal fluency in OC users. In sum, acute hormone concentrations appear to modulate visuospatial performance, whereas long-term hormonal changes (i.e., OC use over years) seem to modulate verbal fluency abilities.

The Association Between Progestin Generation in Hormonal Contraceptives and Sociosexuality

Hormones are important for regulating women’s sexuality. Many women take hormonal contraceptives (HCs) which add synthetic hormones to women’s endocrine systems and disrupt the links between gonadal hormones and sexuality. Further, there are different types of HCs which may act differently. Whereas past research has combined all women using different types of HCs into a single comparison group, the present research explores how different methods of administration and different progestin generations may differentially affect women’s sociosexuality(SOI). 1024 female participants from 3 samples reported SOI using the revised sociosexuality inventory, HC status, method of administration, length of use, brand, and cycle information in an online survey. Results indicate that compared to women who were not using HCs, women who were using HCs containing 1st, 2nd, and 3rd generation progestins reported more unrestricted SOI attitudes. However only 2nd and 3rd generation progestin users had more unrestricted SOI attitudes than women not on HCs in the pre-luteal phases of their cycle (when sexual interest is naturally heightened). Lastly, evidence suggests that women return to ovulatory cycles after a year of using the hormonal IUD. We tested for time effects between pill using groups and IUD using groups and found an interaction such that longer duration of use on the IUD was associated with more unrestricted SOl attitudes, while oral contraceptive users did not differ in SOI independent of time using the method. Results highlight the need to understand the psychobiological processes affected by different variations of HCs.

Effect of Combined Oral Contraceptive on Lipid Profile Level and Cardiovascular Risk

Background: Combined oral contraceptive pills are an effective and widely used method for contraception. Combined oral contraceptives have been shown to alter lipid profiles among various population groups with different patterns of dyslipidemia and cardiovascular risk. Objectives: The study aimed at determining the lipid profile pattern and cardiovascular risk among combined oral contraceptive users. Methods: This cross-sectional analytical study was conducted in the Department of Physiology, Rajshahi Medical College, from January 2018 to December. 2018. The study group was made of 100 women. (mean age 24.1 ± 5 years), who took combined oral contraceptive pills (30 mg ethinyl estradiol, 150 mg Levonorgestrel) for a period ranging from 1-60 months, while 100 age-matched women with regular mentruation with no history of hormonal use within the last six months before the investigation were used as controls. Fasting blood samples from all study subjects were collected and analyzed for lipid profile [ Total cholesterol (TC), High-Density Lipoprotein- cholesterol (HDL-c), Low-Density Lipoprotein- cholesterol (LDL-c) and Triglyceride (TG)] using standard calorimetric Techniques. Results: Combined oral contraceptive use was associated with increased levels of total cholesterol (p ≤ 0.001), Low-density lipoprotein cholesterol (p ≤ 0.001), triglyceride (p ≤ 0.001), as well as decreased high-density lipoprotein cholesterol (HDL-c) (p = .408) in comparison to controls. Conclusion: Combined oral contraceptive use is associated with alteration in lipid profile, particularly increases total cholesterol triglyceride, LDL and decreased HDL-c. These changes carry a potential risk in the development of cardiovascular disease. Evaluating the most effective and safest contraceptive methods is important to avoid the potential risk of developing cardiovascular disease.

Cost-effectiveness of the dual prevention pill for contraception and HIV pre-exposure prophylaxis.

Women in sub-Saharan Africa (SSA) experience the world's highest rates of both HIV infection and unintended pregnancy. The Dual Prevention Pill (DPP) is a novel multipurpose prevention technology (MPT) that co-formulates HIV pre-exposure prophylaxis (PrEP) and combined hormonal oral contraception into a single daily pill. As a dual indication product, the DPP may be preferred by women facing these overlapping health risks. However, most SSA countries face severe healthcare resource constraints. Research is needed to assess whether, in what populations, and in what use cases the DPP would be cost-effective. We augmented an agent-based SSA HIV model with maternal health parameters including unintended pregnancy, abortion, and maternal mortality. Based on a previous market analysis, we assumed a primary DPP user population of current oral contraceptive users ages 25-49, and alternative user populations in different risk groups (age 15-24, sex workers, HIV-serodiscordant couples) and baseline product use profiles (unmet need for contraception, oral PrEP use, condom use). In three geographies (western Kenya, Zimbabwe, South Africa), we estimated HIV infections averted, pregnancies averted, disability-adjusted life-years (DALYs) averted, and the incremental cost-effectiveness ratio (ICER) over a 30-year time horizon, assuming equivalent adherence to the DPP as to oral contraceptives, higher adherence, or lower adherence. The DPP is likely to be a cost-effective alternative to oral PrEP among users in need of contraception. Among women not already using PrEP, the DPP is likely to be cost-saving in sex workers and serodiscordant couples. The DPP is unlikely to be cost-effective in oral contraceptive users in the general population. Switching from oral contraception to the DPP could be net harmful in some settings and populations if it were to substantially reduces adherence to oral contraception. Results were robust to a range of time horizons or discount rates. The DPP has the potential to be cost-effective and cost-saving in populations at substantial HIV risk. Outcomes are sensitive to adherence, implying that effective counseling and decision-making tools for users considering the DPP will be essential. More research is needed to understand real-life adherence patterns and ensure health benefits achieved from contraception alone are not lost.

Influence of sex hormones status and type of training on regional bone mineral density in exercising females

ABSTRACT The primary objective of this study was to examine the influence of hormonal ovarian profile and training characteristics on spine, pelvis, and total body bone mineral density (BMD) in a group of well-trained females. Forty-two eumenorrheic females, twenty-eight monophasic oral contraceptive (OC) users and thirteen postmenopausal females participated in this study. Body composition was measured by total body dual-energy X-ray absorptiometry (DXA) to determine BMD of the areas of interest. Endurance-trained premenopausal females showed lower spine BMD compared to resistance-trained premenopausal females (1.03 ± 0.1 vs. 1.09 ± 0.09 g/cm2; p = 0.025). Postmenopausal females reported lower BMD level in comparison to eumenorrheic females in pelvis (1.079 ± 0.082 vs 1.19 ± 0.115 g/cm2; p = 0.005), spine (0.969 ± 0.097 vs 1.069 ± 0.109 g/cm2; p = 0.012) and total (1.122 ± 0.08 vs 1.193 ± 0.077 g/cm2; p = 0.018) and OC users whose duration of OC use was less than 5 years (OC < 5) in pelvis (1.235 ± 0.068 g/cm2; p < 0.001) and spine (1.062 ± 0.069 g/cm2; p = 0.018). In addition, lower BMD values were found in OC users who had been using OC for more than 5 years (OC ≥ 5) than eumenorrheic females in pelvis (1.078 ± 0.086 g/cm2; p = 0.029) and spine (0.966 ± 0.08 g/cm2; p = 0.05). Likewise, OC ≥ 5 showed lower values than and OC < 5 in pelvis (p = 0.004) and spine (p = 0.047). We observed a lower spine BMD value in premenopausal endurance-trained females compared to premenopausal resistance-trained females. Moreover, this research observed that prolonged use of OCs may reduce bone mass acquisition in the spine and pelvis, even in well-trained females. Finally, postmenopausal showed lower BMD despite being exercising women. Trial registration: ClinicalTrials.gov identifier: NCT04458662. Highlights Ovarian hormonal profile should be considered when assessing BMD in female athletes. The duration of oral contraceptive use influences spine and pelvis regional BMD in exercising females. Postmenopausal women show lower BMD when compared to premenopausal females despite being exercising females.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

Evaluation of Different Biochemical and Hematological Parameters in Different Body Mass Index of Age Groups of Combined Oral Contraceptive Users

Evaluation of Different Biochemical and Hematological Parameters in Different Body Mass Index of Age Groups of Combined Oral Contraceptive Users

Fasting blood glucose, blood pressure and body mass index among combined oral contraceptive users in Chencha town Southern Ethiopia, 2019.

The use of contraceptives has become prevalent among women in Ethiopia. Oral contraceptive use has been suggested to trigger changes in glucose metabolism, energy expenditure, blood pressure, and body weight, among various populations and ethnic groups. To elucidate the pattern of fasting blood glucose, blood pressure, and body mass index among combined oral contraceptive pills users compared to controls. An institution-based cross-sectional study design was employed. A total of 110 healthy women using combined oral contraceptive pills were recruited as cases. Another 110 healthy age and sex-matched women not using any hormonal contraceptives were recruited as controls. A study was conducted between October 2018 and January 2019. Data obtained was entered and analyzed using IBM SPSS version 23 software packages. One-way ANOVA was used to identify the variation of variables in relation to the duration of use of the drug. The P-value of < 0.05 at the 95% confidence level was statistically significant. Fasting blood glucose level among oral contraceptive users (88.55 ± 7.89 mg/dl) was higher than fasting blood glucose level among oral contraceptive non-users (86.00 ± 9.85 mg/dl) with a p-value of 0.025. The mean arterial pressure of oral contraceptive users (88.2 ± 8.48 mmHg) was relatively higher than their counterparts (86.0 ± 6.74 mmHg), with a p-value of 0.04. Comparatively the body weight and body mass index among oral contraceptive users were 2.5% and 3.9% higher than non-users with a p-value of 0.03 and 0.003, respectively(5). Utilization of oral contraceptive pills for prolonged period of time seemed to be a significant predictive factor for higher mean arterial pressure and body mass index with p < 0.001and p < 0.05 respectively. Use of combined oral contraceptives was associated with higher fasting blood glucose (+2.9%), mean arterial pressure (+2.5%), and body mass index (3.9%) compared to controls.

Investigating cardiovascular risk in premenopausal women on oral contraceptives: Systematic review with meta-analysis.

The use of oral contraceptives (OCs) is associated with an increased risk of cardiovascular events such as arterial and venous thrombosis (VTE). Cardiovascular diseases (CVDs) are the leading cause of death worldwide, with low- and middle-income nations accounting for over three-quarter of CVD deaths. The aim of this systematic review is to provide a comprehensive synthesis of the available evidence on the link between OC use and CVD risk in premenopausal women and to further assess the role of geographic disparities in the reported prevalence of CVD risk in women on OCs. A comprehensive search of databases such as MEDLINE, Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition was conducted, right from the inception to the present, by using the EBSCOhost search engine. The Cochrane Central Register of Clinical trials (CENTRAL) was also searched to augment relevant sources of information. OpenGrey, which is a repository of information providing open access to bibliographical references, was searched and the reference list of the selected studies was also scanned. The potential risk of bias of the included studies was assessed using the modified Downs and Black checklist. Data analysis was performed using the Review Manager (RevMan) version 5.3. We included 25 studies that comprised 3,245 participants, of which 1,605 (49.5%) are OC users, while 1,640 (50.5%) are non-OC users. A total of 15 studies were included for meta-analysis, and the overall pooled estimates suggested a significant increase in the traditional cardiovascular risk variables [standardized mean difference (SMD) = 0.73, (0.46, 0.99) (Z = 5.41, p < 0.001)] and little to no difference in endothelial activation among OC users when compared with non-OC users [SMD = -0.11, (-0.81, 0.60) (Z = 0.30, p = 0.76)]. Europe [SMD = 0.03, (-0.21, 0.27), (Z = 0.25 p = 0.88)] had the least effect size, while North America had the highest effect size [SMD = 1.86, (-0.31, 4.04), (Z = 1.68 p = 0.09)] for CVD risk in OC users when compared with non-OC users. The use of OCs suggests a significant increase in the prevalence of traditional cardiovascular risk variables with little to no difference in the risk of endothelial dysfunction when compared with non-OC users, and the magnitude of CVD risks varies across different geographical regions. This systematic review was registered in the international prospective register of systematic reviews (PROSPERO) under the registration number: CRD42020216169.

High risk oral contraceptive hormones do not directly enhance endothelial cell procoagulant activity in vitro.

Oral contraceptive (OC) use increases venous thromboembolism risk 2-5-fold. Procoagulant changes can be detected in plasma from OC users even without thrombosis, but cellular mechanisms that provoke thrombosis have not been identified. Endothelial cell (EC) dysfunction is thought to initiate venous thromboembolism. It is unknown whether OC hormones provoke aberrant procoagulant activity in ECs. Characterize the effect of high-risk OC hormones (ethinyl estradiol [EE] and drospirenone) on EC procoagulant activity and the potential interplay with nuclear estrogen receptors ERα and ERβ and inflammatory processes. Human umbilical vein and dermal microvascular ECs (HUVEC and HDMVEC, respectively) were treated with EE and/or drospirenone. Genes encoding the estrogen receptors ERα and ERβ (ESR1 and ESR2, respectively) were overexpressed in HUVEC and HDMVEC via lentiviral vectors. EC gene expression was assessed by RT-qPCR. The ability of ECs to support thrombin generation and fibrin formation was measured by calibrated automated thrombography and spectrophotometry, respectively. Neither EE nor drospirenone, alone or together, changed expression of genes encoding anti- or procoagulant proteins (TFPI, THBD, F3), integrins (ITGAV, ITGB3), or fibrinolytic mediators (SERPINE1, PLAT). EE and/or drospirenone did not increase EC-supported thrombin generation or fibrin formation, either. Our analyses indicated a subset of individuals express ESR1 and ESR2 transcripts in human aortic ECs. However, overexpression of ESR1 and/or ESR2 in HUVEC and HDMVEC did not facilitate the ability of OC-treated ECs to support procoagulant activity, even in the presence of a pro-inflammatory stimulus. The OC hormones EE and drospirenone do not directly enhance thrombin generation potential of primary ECs in vitro.

Polycystic Ovary Syndrome: A Comprehensive Review of Pathogenesis, Management, and Drug Regimen

PCOS Polycystic ovary syndrome is an ailment that is associated with the endocrine system of the body that usually affects the females of Reproductive age. In addition to this it is also known as an Infertility disorder. It has significantly affected a wide range of female population all around the Globe. Furthermore, PCOS is a multifactorial complex disease with ample number of side effects for instance Acne, Obesity, Insulin resistance, Infertility, Cardiovascular disorders as well as various other health disorders. Subsequently, in this modern contemporary era PCOS is a globally concerned emerging issue that needs to be resolved in the near future. Additionally various Therapeutic actions are used in order to eradicate this ailment for example the usage of Oral Contraceptives, regular changes in routine lifestyle habits, drugs like metformin, surgical methods, Laparoscopic ovarian drilling, etc… However, these modes of elucidation of the disease come with additional adverse effects and certain complicated health conditions. PCOS is directly or indirectly associated with not only the disorders of the reproductive system but also the, metabolic disorders such as Glucose intolerance, Dyslipidemia, Diabetes Mellitus, Hypertension etc. The PCOS: - Polycystic Ovary syndrome usually is known to also manifest the menstrual Dysfunction and hormones mal function in the suffering females.

Type-specific HPV incidence and clinical spectrum of lesions induced by high-risk oncogenic HPV types among study participants in Eastern Uganda

Different studies show that high-risk HPV genotypes are the main etiological agents for cervical cancer development and cancer-related deaths in women worldwide. In Uganda, cervical malignancies due to human papillomavirus (HPV) are predominant among sexually active women. However, data on the incidence and clinical spectrum of lesions associated with high-risk HPV infection is inadequate. The current study was aimed to determine incidence and clinical spectrum of lesions induced by high-risk oncogenic HPV types among study participants in Eastern Uganda. We piloted a prospective follow-up study among 1,077 women aged 15-55 years to assess the incidence and clinical spectrum of lesions associated with human papillomavirus infections (HPV). HPV Real-Time PCR using HPV High-Risk Screen Real-TM Quant 2x kit (Sacace, Biotechnologies, Italy) was used for genotyping high-risk HPV types. Four hundred and sixteen (416) of 1,077 (38.6%) women were monitored for an average time of 18 months (inter-quartile range 9.6-26.6). Forty-three (43) women had incident HPV infections during 214 person-years of follow-up reflecting an incidence rate of 20.1 per 100 person-years. Incident HPV infections were marginally associated with HIV positivity (RR = 3.0, 95% CI: 0.8 - 8.2) and usage of oral contraceptives (RR=2.6, 95% CI: 1.4 - 2.8) but not with the age of study subjects, or number sexual partners. Clearance for high-risk HPV infections was frequently ranging between 37.5% and 100.0% for high-risk types. Only 41.3% of women cleared all their infections. Clearance was associated with HIV negativity (Adjusted clearance = 0.3, 95% CI: 0.2 - 0.8) but not with age at study entry or oral contraceptive usage. Incident HPV infections and clearance of HPV type-specific infections were common among study participants. We also found a high prevalence of high-risk HPV types in cervical lesions, which reveals an association between cervical lesions and high-risk HPV types.

Patterns of use of emergency and oral contraceptives from an online service in the United Kingdom during the COVID-19 pandemic: A quantitative study of routinely collected data

ObjectivesOur study aimed to describe users of a free online contraception service, compare online emergency contraceptive pill (ECP) users with online oral contraceptive (OC) users, and describe patterns of use of online ECP and OC over time, including transition from ECP to more effective forms of contraception. Study designAnalysis of routinely collected, anonymized data from a large, publicly funded, online contraceptive service in the United Kingdom from April 1, 2019 to October 31, 2021. ResultsThe online service provided 77,447 prescriptions during the study period. About 84% for OC and 16% for ECP, of which 89% were ulipristal acetate. ECP users were younger, lived in more deprived areas, and were less likely to be of white ethnicity than OC users. About 53% ordered OC only, but 37% ordered both ECP and OC. Among those prescribed both OC and ECP (n = 1306), 40% had one method as dominant, 25% appeared to move from one method to the other (11% ECP to OC, 14% OC to ECP), and 35% continued to use both methods. ConclusionsOnline services are accessible to diverse young populations. While the majority of users order OC only, our study suggests that where there is free, online access to both OC and ECP, and those ordering ECP are always offered free OC, transition to more effective ongoing forms of contraception is uncommon. Further research is needed to understand whether online access to ECP increases its attractiveness and reduces likelihood of transition to OC. ImplicationsThis study demonstrates that free, online contraceptive services are accessible to ethnically and socioeconomically diverse users. It identifies a subgroup of contraceptive users who combine use of OC and ECPs over time, and suggests that improved access to ECP may alter contraceptive choices.

Pharmacoepidemiological Analysis of Oral Contraceptive Use in Adolescents in a German Longitudinal Cohort Study.

To assess the use of oral contraceptives (OC) in adolescents, using data from a longitudinal, population-based pediatric cohort study (LIFE Child). We also investigated associations between OC use and socioeconomic status (SES), and associations between OC use and potential adverse drug reactions such as effects on blood pressure. We included 609 female participants of the LIFE Child cohort, aged ≥13 to <21 years, who visited the study center between 2012 and 2019. Data collection compromised drug use in the past 14 days, SES, and anthropometric data such as blood pressure. An analysis of covariance was used to detect potential associations between participants' blood pressure and OC. Multivariate binary logistic regression was used to obtain odds ratios (aOR) adjusted for age and 95% confidence intervals (95% CI). The prevalence of OC use was 25.8%. OC intake was less common in participants with a high SES (aOR 0.30, 95% CI 0.15, 0.62). The mean age at OC initiation did not change between 2012 and 2019. We observed an increased use of second-generation OC (2013: 17.9%, 2019: 48.5%; p = 0.013) and a decreased use of fourth-generation OC (2013: 71.8%, 2019: 45.5%; p = 0.027). We found a higher systolic (mean: 111.74 mmHg, p < 0.001) and diastolic (69.15 mmHg, p = 0.004) blood pressure in OC users compared to non-users (systolic: 108.60 mmHg; diastolic: 67.24 mmHg). Every fourth adolescent took an OC. The share of second-generation OC increased during the study period. OC intake was associated with low SES. OC users had a slightly higher blood pressure than non-users.

Menopausal hormone therapy, oral contraceptives and risk of chronic low back pain: the HUNT Study

BackgroundThere are indications that use of menopausal hormone therapy (MHT) and oral contraceptives (OC) increases the risk of low back pain (LBP), with higher oestrogen levels involved in the underlying mechanisms. The purpose of the present study was to investigate associations between use of systemic MHT or OC and risk of chronic LBP in a large population-based data set.MethodsData were obtained from two surveys in the Trøndelag Health Study in Norway, HUNT2 (1995–1997) and HUNT3 (2006–2008). A cross-sectional study of association between use of systemic MHT and prevalence of chronic LBP comprised 12,974 women aged 40–69 years in HUNT2, with 4007 women reporting chronic LBP. A cohort study involving MHT comprised 6007 women without chronic LBP at baseline in HUNT2, and after 11 years 1245 women reported chronic LBP at follow-up in HUNT3. The cross-sectional study of association with use of OC included 23,593 women aged 20–69 years in HUNT2, with 6085 women reporting chronic LBP. The corresponding cohort study included 10,586 women without chronic LBP at baseline in HUNT2, of whom 2084 women reported chronic LBP in HUNT3. Risk of chronic LBP was examined in both study designs in generalised linear models with adjustment for potential confounders.ResultsIn the cohort study, current users of systemic MHT at baseline showed a greater risk of chronic LBP (relative risk (RR) 1.30; 95% CI: 1.14–1.49; compared with never users). The risk increased according to duration of MHT use (P for linear trend = 0.003). Known users of systemic MHT based exclusively on oestrogen experienced the highest risk (RR 1.49; 95% CI: 1.16–1.91), but an increased risk was also seen among known users of oestrogen-progestin combination MHT (RR 1.35; 95% CI: 1.16–1.57). A slight increase in risk of chronic LBP was found in the cohort study among former users of OC (RR 1.17; 95% CI: 1.06–1.30; compared with never users).ConclusionsLong-lasting use of systemic MHT, in particular therapy based on oestrogen only, is associated with greater risk of chronic LBP. Having been a user of OC most likely entails a minor increase in risk.

Effect of Oral Contraception on Screening Tests for Primary Aldosteronism: A 10-Year Longitudinal Study.

Primary aldosteronism (PA) and oral contraception (OC) can both cause hypertension in young women. However, the effect of OC on the screening test for PA, the aldosterone to renin ratio (ARR), is not clear. We evaluated the impact of OC on the screening test for PA. In this retrospective cohort study, we analyzed data from the female offspring (Gen2) of women enrolled in the Raine Study, a population-based birth cohort, who had blood pressure (BP) measurements, blood samples, and information about OC use at age 17 years (N = 484) and/or age 27 years (N = 486). Aldosterone concentration was significantly higher in OC users than nonusers at 17 years (median 486 pmol/L vs 347 pmol/L, P < 0.001). Renin concentration was significantly lower in OC users at both 17 years (13.4 mU/L vs 20.6 mU/L) and 27 years (9.2 mU/L vs 11.8 mU/L), hence the ARR was significantly higher in OC users compared to nonusers at both 17 years (31.5 vs 18.3) and 27 years (27.3 vs 21.1). The proportion of participants with ARR > 70 pmol/mU (current threshold for PA detection) was significantly higher in OC users at both 17 years (12.6% vs 2.1%) and 27 years (6.4% vs 0.4%); however, they had comparable BP to those with ARR < 70. OC use at any age abolished the relationship between ARR and BP that is observed in nonusers. OC can increase the ARR and cause a false positive PA screening result. Until more reliable criteria for PA screening in OC users are established, alternative contraception should be considered during screening.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception.

Mental rotation, episodic memory, and executive control: Possible effects of biological sex and oral contraceptive use

Oral contraceptives (OCs) are one of the most common forms of hormonal birth control. A small literature suggests that OC use may affect visuospatial ability, episodic memory, and executive control. However, previous studies have been criticized for small sample sizes and the use of different, single cognitive tests. We investigated the degree to which biological sex and OC use might affect individual mental rotation, episodic memory, and executive control in a large sample of healthy, young adults (N = 155, including 52 OC users, 53 naturally cycling females, and 50 males) tested individually over videoconference. To measure cognition, we used a set of neuropsychological tasks inspired by Glisky and colleagues’ two-factor episodic memory and executive control battery, from which two composite scores (based on principal component analysis) were derived for each participant. Our pre-registered analysis revealed a clear female advantage in episodic memory, independent of OC use. In an exploratory analysis, gist memory was elevated in OC users. Interestingly, we found no significant sex-related differences nor effects of OC use on mental rotation or executive control. Duration of OC use was also not related to any of our cognitive measures. These results suggest that the use of combined, monophasic OCs does not lead to many significant changes in cognition in young adults, although young females overall may have better episodic memory than young males. Additional studies, including longitudinal designs and looking in more detail at the menstrual cycle and OC use history, will further clarify the effects of different types of OCs and their duration of use on different aspects of cognition.

Oral contraceptive use and menstrual cycle influence acute cerebrovascular response to standing.

To determine if the menstrual cycle and oral contraceptives (OC) influence responses to acute orthostatic stress and if these factors are clinically relevant to the diagnosis of initial orthostatic hypotension (iOH). Young, healthy women were recruited, including OC users (n=12) and non-users (NOC; n=9). Women were tested during the low hormone (LH; placebo pills; days 2-5 natural cycle) and high hormone (HH; active dose; days 18-24 natural cycle) menstrual phases. Changes in mean arterial pressure, cardiac output, heart rate, the 30:15 heart rate ratio and cerebrovascular resistance indices within 30s of standing were examined. There were no effects of OC or menstrual cycle on hemodynamic responses during standing (all p>0.05). In the LH phase, OC users had a greater fall in mean middle cerebral artery blood velocity (MCAV) compared to NOC (p<0.05). However, this was reversed in the HH phase, where OC users had a reduced fall in mean MCAV (p<0.05). Interestingly, 8 women (OC and NOC) had drops in systolic/diastolic blood pressure meeting the criteria for iOH, and 7 of those 8 women displayed this drop in a single phase of the menstrual cycle. Our results indicate that chronic versus acute OC use (i.e., long-term use observed via LH phase versus short-term use observed via HH phase) have opposing effects on cerebral blood velocity during standing. Further, our results highlight that multiple assessments across the cycle may be necessary to accurately diagnose iOH, as most women met the diagnostic criteria during a single menstrual phase.

Population-based cohort study of oral contraceptive use and risk of depression.

Research on the effect of oral contraceptive (OC) use on the risk of depression shows inconsistent findings, especially in adult OC users. One possible reason for this inconsistency is the omission of women who discontinue OCs due to adverse mood effects, leading to healthy user bias. To address this issue, we aim to estimate the risk of depression that is associated with the initiation of OCs as well as the effect of OC use on lifetime risk of depression. This is a population-based cohort study based on data from 264,557 women from the UK Biobank. Incidence of depression was addressed via interviews, inpatient hospital or primary care data. The hazard ratio (HR) between OC use and incident depression was estimated by multivariable Cox regression with OC use as a time-varying exposure. To validate causality, we examined familial confounding in 7,354 sibling pairs. We observed that the first 2 years of OC use were associated with a higher rate of depression compared to never users (HR=1.71, 95% confidence interval [CI]: 1.55-1.88). Although the risk was not as pronounced beyond the first 2 years, ever OC use was still associated with an increased lifetime risk of depression (HR=1.05, 95% CI: 1.01-1.09). Previous OC use were associated with a higher rate of depression compared to never users, with adolescent OC users driving the increased hazard (HR=1.18, 95% CI: 1.12-1.25). No significant association were observed among adult OC users who had previously used OCs (HR=1.00, 95% CI: 0.95-1.04). Notably, the sibling analysis provided further evidence for a causal effect of OC use on the risk of depression. Our findings suggest that the use of OCs, particularly during the first 2 years, increases the risk of depression. Additionally, OC use during adolescence might increase the risk of depression later in life. Our results are consistent with a causal relationship between OC use and depression, as supported by the sibling analysis. This study highlights the importance of considering the healthy user bias as well as family-level confounding in studies of OC use and mental health outcomes. Physicians and patients should be aware of this potential risk when considering OCs, and individualized risk-benefit assessments should be conducted.