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Frontiers in Neuroendocrinology Oct 2022Incidents of strokes are increased in young women relative to young men, suggesting that oral contraceptive (OC) use is one of the causes of stroke among young women.... (Review)
Review
Incidents of strokes are increased in young women relative to young men, suggesting that oral contraceptive (OC) use is one of the causes of stroke among young women. Long-term exposures to the varying combinations of estrogen and progestogen found in OCs affect blood clotting, lipid and lipoprotein metabolism, endothelial function, and de novo synthesis of neurosteroids, especially brain-derived 17β-estradiol. The latter is essential for neuroprotection, memory, sexual differentiation, synaptic transmission, and behavior. Deleterious effects of OCs may be exacerbated due to comorbidities like polycystic ovary syndrome, sickle cell anemia, COVID-19, exposures to endocrine disrupting chemicals, and conventional or electronic cigarette smoking. The goal of the current review is to revisit the available literature regarding the impact of OC use on stroke, to explain possible underlying mechanisms, and to identify gaps in our understanding to promote future research to reduce and cure stroke in OC users.
Topics: Male; Female; Humans; Contraceptives, Oral; Friends; Electronic Nicotine Delivery Systems; COVID-19; Stroke
PubMed: 35870646
DOI: 10.1016/j.yfrne.2022.101016 -
Revista Brasileira de Ginecologia E... Apr 2022
Topics: Contraceptives, Oral; Female; Humans; Progestins
PubMed: 35623623
DOI: 10.1055/s-0042-1748754 -
The Medical Clinics of North America May 2015Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism,... (Review)
Review
Oral contraception (OC) remains a popular noninvasive, readily reversible approach for pregnancy prevention and, largely off label, for control of acne, hirsutism, dysmenorrhea, irregular menstruation, menorrhagia, and other menstrual-related symptoms. Many OC formulations exist, with generics offering lower cost and comparable efficacy. Certain medical conditions, including hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE), present contraindications. Blood pressure measurement is the only physical examination or testing needed before prescription. Although no OC is clearly superior to others, OCs containing the second-generation progestin levonorgestrel have been associated with lower VTE risk than those containing other progestins.
Topics: Contraceptives, Oral, Hormonal; Eligibility Determination; Female; Humans; Pregnancy; Risk Factors
PubMed: 25841596
DOI: 10.1016/j.mcna.2015.01.004 -
The European Journal of Contraception &... Feb 2017
Topics: Contraception; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Depression; Female; Humans
PubMed: 28155568
DOI: 10.1080/13625187.2016.1269163 -
Contraception Mar 2023To synthesize published literature on POP effectiveness and efficacy. (Review)
Review
OBJECTIVES
To synthesize published literature on POP effectiveness and efficacy.
STUDY DESIGN
We searched PubMed Central, PubMed, and the Cochrane library through March 07, 2022. We included articles written in English reporting a Pearl Index or life table rate for pregnancy. We excluded articles only assessing formulations that: were never marketed globally, are only sold in combination with estrogen, are currently sold only for noncontraceptive purposes, or were not given to participants continuously. Four researchers independently extracted data and two analyzed data using Excel and R.
RESULTS
We included 54 studies. Among studies at low or moderate risk of bias, the median Pearl Index rate (the failure rate during typical use) was 1.63 (range 0.00-14.20, IQR 4.03) and the median method failure Pearl Index rate (the failure rate during perfect use) was 0.97 (range 0.40-6.50, IQR 0.68). Excluding the newer formulations, Desogestrel and Drospirenone, which are closer to combined oral contraceptives in that they prevent pregnancy by inhibiting ovulation, the median Pearl Index rate is 2.00 (range 0.00-14.12, IQR 2.5) and the median method failure Pearl Index rate is 1.05 (range 0.00-10.90, IQR 1.38).
CONCLUSIONS
Among studies at low or moderate risk of bias, the median Pearl Index rate during typical POP use was much lower than currently estimated (7.00), while the median perfect use rate was similar to current estimates.
IMPLICATIONS
Future research should investigate the possibility that POPs may be much more effective during typical use than currently believed.
Topics: Pregnancy; Female; Humans; Desogestrel; Progestins; Contraceptives, Oral, Combined; Estrogens; Ovulation
PubMed: 36535414
DOI: 10.1016/j.contraception.2022.109925 -
Hormone Molecular Biology and Clinical... Nov 2018Combined hormonal contraception containing estrogen and progestogen and postmenopausal hormone therapy with estrogen ± progestogen are reported risk factors for venous... (Review)
Review
Combined hormonal contraception containing estrogen and progestogen and postmenopausal hormone therapy with estrogen ± progestogen are reported risk factors for venous thrombosis. The thrombotic risk varies by estrogen dose and type of progestogen. Estrogen combined with "newer generation" progestogens in combined oral contraceptives may have higher thrombotic risk than estrogen combined with older generation progestogens. Among postmenopausal women thrombotic risk also varies by type of hormone and mode of delivery. Although the risk of thrombosis with the different hormonal compounds is uncertain, it has definitely been attributed to the pharmacological effect of the hormones on hemostasis. Animal and cell culture studies have demonstrated the pharmacodynamics of progestogens with respect to hemostasis. Extrapolation from these studies to clinical conditions and further to clinical end points such as cardiovascular disease is, however, controversial. Few clinical studies have focused on the effect of progestogen only therapy on the hemostatic system in vivo. Most of the current knowledge regarding the in vivo effect of progestogens on hemostasis is obtained from studies with combined contraceptives. These results obviously reflect the combined influence of both estrogen and progestogen on hemostasis, and extrapolation to progestogen-only conditions is challenging. This paper discusses the pharmacodynamics of progestogens in relation to the hemostatic system, addressing results obtained in animal and cell culture studies and in clinical studies employing progestogen-only and combined oral contraceptives. The compiled results suggest that the major effect of progestogens on hemostasis is related to alterations in platelet function and the tissue factor pathway of coagulation. More studies focusing on these topics are warranted.
Topics: Animals; Contraceptives, Oral; Hemostasis; Hormone Replacement Therapy; Humans; Progestins
PubMed: 30447140
DOI: 10.1515/hmbci-2018-0041 -
JAMA Network Open Sep 2023Hormonal contraception has been linked to mood symptoms and the ability to recognize emotions after short periods of treatment, whereas the mental health of users of...
IMPORTANCE
Hormonal contraception has been linked to mood symptoms and the ability to recognize emotions after short periods of treatment, whereas the mental health of users of long-term hormonal contraceptives has had limited investigation.
OBJECTIVE
To evaluate whether short-term hormonal withdrawal, which users of combined oral contraceptives (COCs) undergo once a month (pill pause), was associated with altered mood and emotional recognition in long-term users of COCs.
DESIGN, SETTING, AND PARTICIPANTS
This case-control study included a community sample of individuals assigned female sex at birth who identified as women and used COC for 6 months or longer. The control group included women with natural menstrual cycles who otherwise fulfilled the same inclusion criteria. The study was conducted between April 2021 and June 2022 in Salzburg, Austria.
EXPOSURE
COC users and women with natural menstrual cycles were tested twice within a month, once during their active pill phase or luteal phase and once during their pill pause or menses.
MAIN OUTCOMES AND MEASURES
Negative affect, anxiety, and mental health problems were assessed during each session. The percentage increase in mental health symptoms was calculated during the pill pause compared with that during the active intake phase in COC users. How this change compared with mood fluctuations along the menstrual cycle in women with natural menstrual cycles was assessed.
RESULTS
A total of 181 women aged 18 to 35 years (mean [SD] age, 22.7 [3.5] years) were included in the analysis (61 women with androgenic COC use, 59 with antiandrogenic COC use, 60 women with a menstrual cycle not taking COCs). COC users showed a 12.67% increase in negative affect (95% CI, 6.94%-18.39%), 7.42% increase in anxiety (95% CI, 3.43%-11.40%), and 23.61% increase in mental health symptoms (95% CI, 16.49%-30.73%; P < .001) during the pill pause compared with the active intake phase. The effect size of this change did not differ depending on progestin type (negative affect: F1,117 = 0.30, P = .59; state anxiety: F1,117 = 2.15, P = .15; mental health: F1,117 = .16, P = .69) or ethinylestradiol dose (negative affect: F1,57 = .99, P = .32; state anxiety: F1,57 = 2.30, P = .13; mental health: F1,57 = .14, P = .71) was comparable with mood changes along the menstrual cycle in women with natural cycles (negative affect: F2,175 = 0.13, P = .87; state anxiety: F2,175 = 0.14, P = .32; mental health: F2,175 = 0.65, P = .52). Mood worsening during the pill pause was more pronounced in women with higher baseline depression scores (negative affect increase of 17.95% [95% CI, 7.80%-28.10%] in COC users with higher trait depression [BDI >8]). Emotion recognition performance did not differ between active pill phase and pill pause.
CONCLUSIONS AND RELEVANCE
In this case-control study of long-term COC users, withdrawal from contraceptive steroids during the pill pause was associated with adverse mental health symptoms similar to those experienced by women during menses with withdrawal from endogenous steroids. These results question the use of the pill pause from a mental health perspective. Long-term COC users may benefit more from the mood-stabilizing effects of COCs in cases of continuous intake.
Topics: Infant, Newborn; Female; Humans; Young Adult; Adult; Mental Health; Case-Control Studies; Contraceptives, Oral, Combined; Contraception; Hormones
PubMed: 37755829
DOI: 10.1001/jamanetworkopen.2023.35957 -
Nursing Standard (Royal College of... May 2015Essential facts Oral contraception remains the most popular method of birth control for a majority of women in the UK. According to a 2012/13 report by the Health and...
Essential facts Oral contraception remains the most popular method of birth control for a majority of women in the UK. According to a 2012/13 report by the Health and Social Care Information Centre, it was chosen by 47% of women attending NHS community contraceptive clinics in England. An Office of National Statistics survey of 2008/09 shows that of the three quarters of UK women aged up to 49 using contraception, a third were prescribed the contraceptive pill. Of these, 6% used progestogen-only pills, also known as the mini-pill or POP.
Topics: Contraceptives, Oral, Hormonal; Female; Humans; Progesterone Congeners
PubMed: 26015115
DOI: 10.7748/ns.29.39.17.s19 -
FP Essentials Nov 2017The oral contraceptive pill (OCP) is the most commonly used form of reversible contraception. The two types of OCPs are combination oral contraceptives (COCs), which... (Review)
Review
The oral contraceptive pill (OCP) is the most commonly used form of reversible contraception. The two types of OCPs are combination oral contraceptives (COCs), which contain estrogen and progesterone, and progestin-only pills (POPs). Both have failure rates of approximately 7.2% to 9% with typical use, and are safe for most patients. Because estrogen-containing contraceptives can increase the risk of venous thromboembolism, patients with conditions associated with a risk of cardiovascular events should not use COCs. Blood pressure level should be assessed before initiation of oral contraceptives. Noncontraceptive benefits of oral contraceptives include reduced risk of ovarian and endometrial cancers, more favorable bleeding patterns, and improvement in menstruation-related symptoms such as acne, migraine headaches, and premenstrual dysphoric disorder. OCPs can be initiated any time the physician can be reasonably certain that the patient is not pregnant. Extended cycle regimens may be preferred by some patients. After assessing need, physicians should present all methods that can be used safely using a tiered effectiveness approach. High-quality contraceptive counseling includes working collaboratively with patients to find the most effective and acceptable method for them and helping to identify factors that may assist in or hinder their ability to use the method correctly over time.
Topics: Contraceptives, Oral; Drug Interactions; Family Planning Services; Family Practice; Female; Humans
PubMed: 29172411
DOI: No ID Found -
Best Practice & Research. Clinical... Aug 2018The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with... (Review)
Review
The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD). A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE). This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.
Topics: Adenomyosis; Contraceptives, Oral; Cytoreduction Surgical Procedures; Endometrial Ablation Techniques; Female; Fertility Preservation; High-Intensity Focused Ultrasound Ablation; Humans; Hysteroscopy; Intrauterine Devices; Minimally Invasive Surgical Procedures; Uterine Artery Embolization
PubMed: 29555380
DOI: 10.1016/j.bpobgyn.2018.01.016