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The New England Journal of Medicine Nov 2023
Topics: Female; Humans; Contraceptives, Oral, Hormonal; Migraine Disorders; Migraine with Aura; Menstrual Cycle
PubMed: 38048194
DOI: 10.1056/NEJMclde2303811 -
Contraception Oct 2020To assess the impact of Oregon's policy that allows pharmacist prescription of the pill and patch on contraceptive receipt for Medicaid-insured women.
OBJECTIVE
To assess the impact of Oregon's policy that allows pharmacist prescription of the pill and patch on contraceptive receipt for Medicaid-insured women.
STUDY DESIGN
We conducted a difference-in-differences analysis using Oregon Medicaid claims data to compare changes in receipt of all contraceptive services and receipt of the pill or patch for Medicaid-enrolled women (n = 436,258) before and after policy implementation in areas with and without participating pharmacists. We then described filled prescriptions for the contraceptive pill and patch by type of prescribing provider before and after implementation of the policy. We also compared past contraceptive use for women receiving prescriptions from pharmacists and non-pharmacists.
RESULTS
We found no significant policy effects on receipt of all contraceptive services or on receipt of the pill or patch. More than 98% of prescriptions filled for the pill and patch in the first two years of policy implementation were prescribed by a non-pharmacist provider. Women receiving contraceptive pill and patch prescriptions from pharmacists and non-pharmacists were equally likely to be continuing contraceptive users.
CONCLUSION
We identified no increase in receipt of contraceptive services among Medicaid-insured women in the two years following the implementation of a pharmacy access policy. Additional research is needed to investigate other possible benefits of the policy, such as satisfaction, convenience, cost and equity.
IMPLICATIONS
We identified no effect of allowing pharmacist prescription of the contraceptive pill and patch on increasing utilization of contraceptive services for Medicaid-insured women in Oregon. Impacts on access to contraceptive services and unintended pregnancy may emerge in subsequent years as availability of and demand for pharmacist-prescribed hormonal contraception increases.
Topics: Adolescent; Adult; Community Pharmacy Services; Contraceptives, Oral, Hormonal; Drug Prescriptions; Family Planning Services; Female; Health Services Accessibility; Hormonal Contraception; Humans; Medicaid; Oregon; Pharmacists; Pregnancy; United States; Young Adult
PubMed: 32652093
DOI: 10.1016/j.contraception.2020.07.001 -
Aerospace Medicine and Human Performance Jan 2024A recent finding of a deep venous thrombosis during spaceflight has prompted the need to clarify mechanisms and risks of venous thromboembolism (VTE). In turn,... (Review)
Review
A recent finding of a deep venous thrombosis during spaceflight has prompted the need to clarify mechanisms and risks of venous thromboembolism (VTE). In turn, mitigation countermeasures, diagnostic modalities, and treatment options must be explored. The objective of this review was to synthesize current evidence on VTE in spaceflight. A literature review was performed from inception to April 2023 pertaining to VTE in the context of spaceflight or ground-based analogs with human participants. PubMed was searched for papers written in English using the terms "spaceflight" or "weightlessness" and "thrombotic" or "embolism" or "thromboembolism" in "venous" or "veins". Papers using cellular or animal models were excluded. There were 63 papers captured; 7 original scientific studies, 3 narrative reviews, 2 systematic reviews, and 3 commentaries discussed VTE in spaceflight. Reference lists were screened. Important themes included: altered venous hemodynamics, increased fibrinogen and coagulation markers, hypoalbuminemia, and immune dysfunction. Additional risk factors may be seen in women, such as the use of oral contraceptives. Venous stasis and decreased shear stress secondary to fluid shifts may induce inflammatory changes in the venous system, resulting in endothelial damage and upregulation of the coagulation cascade. Additionally, women in space are subject to physiological factors increasing their VTE risk, such as the use of oral contraceptives, inducing increased blood viscosity and hypoalbuminemia. Efforts should also be placed in optimizing sensitivity and specificity of imaging markers, payload, and training ability, notably the use of vector flow imaging, and improving point-of-testing biomarkers, such as albumin and p-selectin.
Topics: Animals; Humans; Female; Venous Thromboembolism; Hypoalbuminemia; Contraceptives, Oral; Thrombosis; Space Flight
PubMed: 38158572
DOI: 10.3357/AMHP.6290.2024 -
BMC Women's Health May 2023We aimed to explore the clinical and metabolic characteristics in polycystic ovary syndrome (PCOS) patients with different endometrial lesions.
BACKGROUND
We aimed to explore the clinical and metabolic characteristics in polycystic ovary syndrome (PCOS) patients with different endometrial lesions.
METHODS
234 PCOS patients who underwent hysteroscopy and endometrial biopsy were categorized into four groups: (1) normal endometrium (control group, n = 98), (2) endometrial polyp (EP group, n = 92), (3) endometrial hyperplasia (EH group, n = 33), (4) endometrial cancer (EC group, n = 11). Serum sex hormone levels, 75 g oral glucose tolerance test, insulin release test, fasting plasma lipid, complete blood count and coagulation parameters were measured and analyzed.
RESULTS
Body mass index and triglyceride level of the EH group were higher while average menstrual cycle length was longer in comparison with the control and EP group. Sex hormone-binding globulin (SHBG) and high density lipoprotein were lower in the EH group than that in the control group. 36% of the patients in the EH group suggested obesity, higher than the other three groups. Using multivariant regression analysis, patients with free androgen index > 5 had higher risk of EH (OR 5.70; 95% CI 1.05-31.01), while metformin appeared to be a protective factor for EH (OR 0.12; 95% CI 0.02-0.80). Metformin and hormones (oral contraceptives or progestogen) were shown to be protective factors for EP (OR 0.09; 95% CI 0.02-0.42; OR 0.10; 95% CI 0.02-0.56). Hormones therapy appeared to be a protective factor for EC (OR 0.05; 95% CI 0.01-0.39).
CONCLUSION
Obesity, prolonged menstrual cycle, decreased SHBG, and dyslipidemia are risk factors for EH in patients with PCOS. Oral contraceptives, progestogen and metformin are recommended for prevention and treatment of endometrial lesions in PCOS patients.
Topics: Female; Humans; Polycystic Ovary Syndrome; Progestins; Metformin; Obesity; Gonadal Steroid Hormones; Contraceptives, Oral
PubMed: 37149578
DOI: 10.1186/s12905-023-02339-7 -
Journal of Strength and Conditioning... Mar 2023Redinger, AL and Baker, BS. Oral contraceptives and female rowers' skeletal health. J Strength Cond Res 37(3): 669-677, 2023-Previous studies suggest that women using...
Redinger, AL and Baker, BS. Oral contraceptives and female rowers' skeletal health. J Strength Cond Res 37(3): 669-677, 2023-Previous studies suggest that women using oral contraceptives (OC) experience fewer skeletal benefits from exercise compared with non-OC users. These findings may be especially important for athletes competing in weight-supported sports with a high prevalence of low bone mineral density and fracture, such as rowing. The purpose of this study was to examine skeletal health and bone injuries in collegiate female rowers. Forty-nine National Collegiate Athletic Association Division I female rowers completed general health, menstrual history, and bone physical activity questionnaire (BPAQ) surveys. Dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) scans were used to assess bone content, density, and geometry. Contraceptive (OC users n = 14, non-OC users n = 35) and self-reported stress fracture (SFx n = 11, None n = 38) groups were analyzed using analysis of covariance and independent t -tests. Additionally, effect sizes ( d ) were calculated and significance was set at p ≤ 0.05. Oral contraceptive users had reduced lumbar spine areal bone mineral density after adjustment for Total BPAQ ( d = 0.58; p = 0.041) compared with non-OC users, but all other total body and site-specific DXA measures of bone mineral content and density were similar between contraceptive and injury groups. When comparing bone geometry of the 4, 38, and 66% tibiae using pQCT, no significant differences were found after adjustment for either contraceptive or injury group (all p > 0.060). Our findings suggest that OC usage was not associated with reduced skeletal health in competitive female rowers as evidenced by all Z-scores being above -2.0 and similar bone indices of mineralized content, density, geometry, and estimated strength between the groups.
Topics: Female; Humans; Contraceptives, Oral; Bone Density; Absorptiometry, Photon; Lumbar Vertebrae; Tibia
PubMed: 36165993
DOI: 10.1519/JSC.0000000000004308 -
PloS One 2024Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial...
BACKGROUND
Women living in high-quality healthcare systems are more likely to use oral contraceptives at some point in their lives. Research findings have sparked controversial discussions about contraception in the scientific community and the media, potentially leading to higher rates of method discontinuation. Understanding the underlying motives for method discontinuation is crucial for reproductive health equity and future programming interventions. To address this question, this study aims to explore women's experiences of oral contraceptive use and discontinuation on YouTube.
METHODS
A concurrent explanatory mixed-methods design was used to conduct content analysis of German YouTube videos. The information from 175 videos of 158 individuals was extracted through quantitative descriptive content analysis. Twenty-one individuals were included in the qualitative content analysis.
FINDINGS
The body was a recurring theme in the pill biographies. Women described, for example, bodily sensations as reasons for taking and stopping the pill. They also described positive and negative side effects while taking the pill and after stopping. The most common side effects of taking the pill mentioned by YouTubers were mood swings (76/158), weight gain (45/158), headaches (33/158), and depressed mood (45/158). The symptoms after discontinuation reported most were facial skin impurities (108/158), decreased mood swings (47/158), hair loss (42/158), and weight loss (36/158). Overall, women overwhelmingly rated their discontinuation experience as positive (87/91).
CONCLUSIONS
The study identified key symptoms of oral contraceptive initiation and discontinuation by portraying the experiences of female YouTubers, adding valuable insights to the understanding of method initiation and discontinuation. Further research is needed to explore women's personal experiences with method discontinuation beyond the YouTube platform.
Topics: Humans; Female; Contraceptives, Oral; Adult; Social Media; Young Adult; Video Recording; Adolescent; Contraception Behavior; Middle Aged
PubMed: 38787833
DOI: 10.1371/journal.pone.0302316 -
Danish Medical Journal May 2021Hormonal contraception (HC) celebrates its 60th anniversary this year. Thanks to thousands of scientific studies on these products, we now have solid knowledge about the...
INTRODUCTION
Hormonal contraception (HC) celebrates its 60th anniversary this year. Thanks to thousands of scientific studies on these products, we now have solid knowledge about the short- and long-term effects and also the adverse effects of different contraceptive types. The aim of this study was to analyse trends in the use of different types of HC through the latest decade in different age groups of Danish women and to study reasons for any changes.
METHODS
Individual-level HC sale statistics were provided from the National Registry of Medicinal Products. All statistics were stated as defined daily doses per 1,000 women per day. Absolute numbers and distributions among users were calculated.
RESULTS
The overall use of HC was stable in women from 15 to 25 years, decreased among women aged 25-34 years and increased among women aged 35 years or more. On average, an increase from 35% to 39% was recorded. Across all age groups, the use of second-generation combined oral contraceptives (COC) has almost completely replaced the use of third- and fourth-generation pills, and from the age of 20 years of age, the use of COC has decreased contrasting a steep increase in use of the hormone-intrauterine device (IUD). The magnitude of this shift increased with increasing age.
CONCLUSIONS
Whereas the overall use of hormonal contraception has increased over the latest decade from 35% to 39% among all women aged 15-49 years, hormone-IUDs have increasingly replaced COCs so that they are now dominating among women aged 30 years or more. These changes are expected to have decreased venous thrombosis and menorrhagic complaints in young women substantially.
FUNDING
Expenses were covered by Department of Gynaecology, Rigshospitalet.
TRIAL REGISTRATION
The Danish Data Protection Agency (R. no. 2015-41-4481).
Topics: Adult; Contraceptives, Oral, Combined; Denmark; Female; Humans; Venous Thrombosis; Young Adult
PubMed: 34060463
DOI: No ID Found -
Drug and Therapeutics Bulletin Oct 2021
Topics: Contraceptives, Oral, Combined; Desogestrel; Female; Humans
PubMed: 34426511
DOI: 10.1136/dtb.2021.000049 -
European Journal of Sport Science May 2022The aim of this review is to discuss sexual dimorphism of energy metabolism, and to describe the impact of women's hormonal status on substrate oxidation during... (Review)
Review
The aim of this review is to discuss sexual dimorphism of energy metabolism, and to describe the impact of women's hormonal status on substrate oxidation during exercise. Many evidences indicate that sex steroids play a pivotal role in the sex-related differences of body composition and energy substrate storage. Compared with men, women rely more on fat and less on carbohydrates at the same relative exercise intensity. Scientific data suggest that 17-β oestradiol is a key hormone for the regulation of body composition and substrate metabolism. However, in women, measurements with stable isotopic tracers did not highlight any difference in whole-body substrate oxidation rates between the follicular and luteal phases of the menstrual cycle during endurance exercise. The remaining discrepancies about the effect of menstrual cycle-related hormone fluctuations on substrate oxidation could be partly explained by the exercise intensity, which is an important regulator of substrate oxidation. Due to their specific nature and concentration, the synthetic ovarian hormones contained in oral contraceptives also influence substrate metabolism during endurance exercise. However, more studies are needed to confirm that oral contraceptives increase lipolytic activity during endurance exercise without any substantial (or detectable) effect on substrate utilization. Pregnancy and menopause also modify body composition and substrate utilization during exercise through specific hormonal fluctuations. This review highlights that the hormonal status is likely to affect substrate oxidation during exercise in women emphasizing the need to take it into consideration to optimize their health and performance.
Topics: Contraceptives, Oral; Energy Metabolism; Exercise; Female; Humans; Male; Menstrual Cycle; Progesterone; Sex Characteristics
PubMed: 34134602
DOI: 10.1080/17461391.2021.1943713 -
Journal of Assisted Reproduction and... May 2023
Topics: Humans; Female; Progestins; Reproductive Health; Contraceptives, Oral, Hormonal
PubMed: 37256529
DOI: 10.1007/s10815-023-02840-w