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Experimental Physiology Apr 2022What is the central question of this study? Are there differences in blood pressure, arterial stiffness and indices of pressure waveforms between young oral...
NEW FINDINGS
What is the central question of this study? Are there differences in blood pressure, arterial stiffness and indices of pressure waveforms between young oral contraceptive pill-using and naturally menstruating women during lower and higher hormone phases of their cycles? What is the main finding and its importance? Blood pressure, arterial stiffness and indices of pressure waveforms are influenced similarly by exogenous and endogenous hormones. However, lower levels of exogenous hormones moderately increase blood pressure among oral contraceptive pill-using women.
ABSTRACT
Elevations in blood pressure (BP) are understood as having a bidirectional relationship with stiffening of central and peripheral arteries. Arterial stiffness is mitigated by oestrogen, which aides in arterial vasorelaxation. To evaluate whether BP, stiffness, and pressure waveforms were different between young healthy naturally menstruating (non-OCP) and oral contraceptive pill (OCP)-using women, we measured brachial and aortic BPs, carotid-to-femoral pulse wave velocity, carotid β-stiffness, elastic modulus, central augmentation index and augmentation index normalized to a heart rate of 75 bpm, and forward and backward pressure waveforms in 22 women (22 (1) years, OCP: n = 12). To assess phasic differences, women were studied during the early follicular (≤5 days of menstruation onset) and early luteal (4 (2) days post-ovulation) phases of non-OCP and compared to the placebo pill (≤5 days of onset) and active pill (≤5 days of highest-dose active pill) phases of OCP. During the lower hormone phases, OCP users had significantly higher brachial systolic blood pressure (SBP) (119.3 (8.3) vs. 110.2 (8.3) mmHg, P = 0.02) and aortic SBP (104.10 (7.44) vs. 96.80 (6.39) mmHg, P = 0.03) as compared to non-OCP users; however, during the higher hormone phases, there were no differences in measures of brachial or aortic BP, arterial stiffness, or indices of BP waveforms between OCP and non-OCP users (P ≥ 0.05). In conclusion, exogenous and endogenous hormones have similar influences on BP and arterial stiffness; however, lower levels of exogenous hormones augment both central and peripheral BPs.
Topics: Blood Pressure; Brachial Artery; Contraceptives, Oral; Estrogens; Female; Humans; Menstrual Cycle; Menstruation; Pulse Wave Analysis; Vascular Stiffness
PubMed: 35199392
DOI: 10.1113/EP090151 -
International Journal of Molecular... Dec 2020Polycystic ovary syndrome (PCOS) is characterized by elevated androgen production and subclinical changes in cardiovascular and metabolic risk markers. Total... (Review)
Review
Polycystic ovary syndrome (PCOS) is characterized by elevated androgen production and subclinical changes in cardiovascular and metabolic risk markers. Total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin appear to increase specifically in PCOS compared with fertile women. PCOS also confers an increased risk of cardiometabolic disease in later life. Novel biomarkers such as serum's cholesterol efflux capacity and blood-derived macrophage activation profile may assist in more accurately defining the cardiometabolic risk profile in these women. Aldosterone antagonists, androgen receptor antagonists, 5α-reductase inhibitors, and synthetic progestogens are used to reduce hyperandrogenism. Because increased insulin secretion enhances ovarian androgen production, short-term treatment with metformin and other hypoglycemic agents results in significant weight loss, favorable metabolic changes, and testosterone reduction. The naturally occurring inositols display insulin-sensitizing effects and may be also used in this context because of their safety profile. Combined oral contraceptives represent the drug of choice for correction of androgen-related symptoms. Overall, PCOS management remains focused on specific targets including assessment and treatment of cardiometabolic risk, according to disease phenotypes. While new options are adding to established therapeutic approaches, a sometimes difficult balance between efficacy and safety of available medications has to be found in individual women.
Topics: Adult; Androgen Antagonists; Biomarkers; Cardiovascular Diseases; Chemoprevention; Contraceptives, Oral; Disease Susceptibility; Female; Humans; Outcome Assessment, Health Care; Polycystic Ovary Syndrome; Risk Assessment; Risk Factors
PubMed: 33334002
DOI: 10.3390/ijms21249554 -
Maturitas Sep 2020Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogenous clinical manifestations. The evidence indicates that PCOS is associated with long-term... (Review)
Review
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogenous clinical manifestations. The evidence indicates that PCOS is associated with long-term health risks including type 2 diabetes, metabolic syndrome, obstructive sleep apnea, endometrial cancer, and mood disorders. Although cardiometabolic risk factors are more common among women with PCOS, currently there is no strong evidence for increased cardiovascular morbidity and mortality in these patients. The effect of menopausal transition on the long-term health consequences of PCOS is mostly uncertain. The PCOS phenotype improves with aging in affected women. Accordingly, the differences in the cardiometabolic risk profiles of PCOS patients and of the general population seem to disappear after menopause. However, it is not clear whether this phenotype amelioration is associated with changes in other long-term health risks after the menopause. There are also gaps in our knowledge about the impact of long-term use of oral contraceptives on the prevalence of PCOS-related comorbidities. This review summarizes the current knowledge regarding the long-term health consequences of PCOS and their clinical implications in peri- and postmenopause, and highlights areas for future research.
Topics: Aging; Contraceptives, Oral; Female; Humans; Menopause; Phenotype; Polycystic Ovary Syndrome
PubMed: 32747035
DOI: 10.1016/j.maturitas.2020.05.013 -
Journal of Assisted Reproduction and... Jun 2020Assisted reproductive technologies (ART) represent commonly utilized management strategies for infertility with multifactorial causes (including genetically predisposed... (Review)
Review
Assisted reproductive technologies (ART) represent commonly utilized management strategies for infertility with multifactorial causes (including genetically predisposed diseases). Amongst ART, in vitro fertilization (IVF) is the most popular. IVF treatment may predispose the mother to increased risks and complications during pregnancy, and there may be adverse fetal outcomes. Hormonal therapies, including oral contraceptives, may impair glucose and lipid metabolism, and promote insulin resistance and inflammation. IVF treatment involves administration of reproductive hormones, similar in composition but in much higher doses than those used for oral contraception. The provision of IVF reproductive hormones to mice associates with glucose intolerance. In addition, the physiological and hormonal changes of pregnancy can trigger an inflammatory response, and metabolic and endocrine changes. There is controversy regarding the potential effects of IVF hormonal therapies in the promotion of diabetogenic and inflammatory states, additional to those that occur during pregnancy, and which may therefore predispose women with IVF-conceived pregnancies to adverse obstetric outcomes compared with women with spontaneously conceived pregnancies. This review summarizes the limited published evidence regarding the effect of IVF-based fertility therapies on glucose homeostasis, insulin resistance, cardio-metabolic profile, and markers of inflammation.
Topics: Animals; Contraceptives, Oral; Female; Fertilization in Vitro; Glucose Intolerance; Hormones; Humans; Inflammation; Mice; Pregnancy; Pregnancy Outcome
PubMed: 32215823
DOI: 10.1007/s10815-020-01756-z -
The European Journal of Contraception &... Apr 2023This study aimed to assess the experience and satisfaction with contraceptives and use of Combined Oral Contraceptives (COC) by women and compare their perceptions with...
PURPOSE
This study aimed to assess the experience and satisfaction with contraceptives and use of Combined Oral Contraceptives (COC) by women and compare their perceptions with those of gynaecologists.
METHODS
This was a multicentre survey study conducted in Portugal, during April and May, 2021 with women using contraceptives and gynaecologists. Online quantitative questionnaires were carried out.
RESULTS
A total of 1508 women and 100 gynaecologists were included. Cycle control was the pill non-contraceptive benefit most valued by gynaecologists and women. For gynaecologists, the main pill concern was the risk of thromboembolic events, but they believed that weight gain was the main concern for their patients. The pill was the most used contraceptive (70%) and women were largely (92%) satisfied. The pill was associated with health risks for 85% of users, mainly thrombosis (83%), weight gain (47%), and cancer (37%). The attributes of the pill most valued by women are contraceptive efficacy (82%), followed by low risk of thromboembolic events (68%), good cycle control (60%), non-interference with libido and mood (59%) and weight (53%).
CONCLUSION
Most women use contraceptive pills and are generally satisfied with their contraceptive. Cycle control was the most valued non-contraceptive benefit for gynaecologists and women, agreeing with physicians' beliefs about women. On the other hand, contrary to physicians' beliefs, that women's main concern is weight gain, women are mainly concerned with risks associated with contraceptives. Thromboembolic events are women's and gynaecologists most valued risk. Finally, this study indicates the need for physicians to better understand what COC users really fear.
Topics: Humans; Female; Male; Contraception; Contraceptives, Oral, Combined; Contraceptive Devices; Weight Gain; Perception
PubMed: 36971323
DOI: 10.1080/13625187.2023.2185482 -
Contraception Dec 2023This study aimed to compare contraceptive efficacy and safety of drospirenone 4 mg in a 24/4-day regimen in nonobese and obese users and describe pharmacokinetics... (Comparative Study)
Comparative Study
OBJECTIVES
This study aimed to compare contraceptive efficacy and safety of drospirenone 4 mg in a 24/4-day regimen in nonobese and obese users and describe pharmacokinetics according to bodyweight.
STUDY DESIGN
We analyzed data from three drospirenone 4 mg trials (2 European and 1 United States) to report outcomes in nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m) users. We used data from the US trial to calculate the Pearl Index (pregnancies per 100 woman-years) in nonbreastfeeding participants aged ≤35 years at enrollment for confirmed pregnancies. We assessed safety outcomes from all trials based on reported treatment-emergent adverse events. We evaluated pharmacokinetics by bodyweight in the US trial.
RESULTS
The three trials combined comprised 2152 nonobese and 425 obese participants, including 590 nonobese and 325 obese participants in the US trial. Eight nonobese and four obese participants had confirmed pregnancies in the US trial, resulting in Pearl Indices of 3.0 (95% CI: 1.3-5.8) and 2.9 (95% CI: 0.8-7.3), respectively. Two-hundred forty-four (11.3%) nonobese and 39 (9.2%) obese participants discontinued due to a treatment-emergent adverse event. The pharmacokinetic analysis included 814 participants with a median weight of 73 (interquartile range 61-89) kg and median plasma drospirenone exposure (AUC) of 661.3 (interquartile range 522-828) ng∙h/mL. Changing bodyweight from the median to the fifth percentile (51 kg) or 95th percentile (118 kg) changed drospirenone exposure (AUC) by 22.2% and -23.6%, respectively.
CONCLUSIONS
Drospirenone 4 mg demonstrated similar contraceptive efficacy for both nonobese and obese users despite a difference in exposure based on bodyweight.
IMPLICATIONS
Our limited comparison between obese and nonobese users of drospirenone-only oral contraception demonstrated no evidence that efficacy or discontinuation for adverse events differs between groups. Serum drospirenone levels vary by bodyweight and may correlate with bleeding outcomes.
Topics: Female; Humans; Pregnancy; Contraception; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Estrogens; Obesity
PubMed: 37544572
DOI: 10.1016/j.contraception.2023.110136 -
Nederlands Tijdschrift Voor Geneeskunde Dec 2020Our view on causes of venous thrombosis changed drastically by the discovery of Factor V Leiden, since unlike other genetic causes of hereditary thrombophilia its...
Our view on causes of venous thrombosis changed drastically by the discovery of Factor V Leiden, since unlike other genetic causes of hereditary thrombophilia its prevalence is several percent. It led to major research activities, and the insight that thrombosis is a multicausal disease, invariably the result of an interplay of genetic and environmental factors. Another consequence was a hype of testing of thrombosis patients, and women before starting oral contraceptives. Factor V Leiden became the most performed diagnisticgenetic test worldwide. However, there was no medical rationale for this massive testing. In young women the absolute risk of thrombosis is so low, that enormous numbers of women would need to be tested to prevent one thrombotic event. And tests after a first event in patients were nearly always useless, since Factor V Leiden does not affect the risk of recurrence. It took decennia before the hype faded.
Topics: Adult; Contraceptives, Oral; Factor V; Female; Humans; Recurrence; Risk Factors; Thrombophilia; Venous Thrombosis
PubMed: 33332045
DOI: No ID Found -
Zhonghua Yi Shi Za Zhi (Beijing, China... Mar 2021The creation of oral contraceptives goes back 60 years. It has gone through a long and complex process from the discovery of sex hormones to their development into drugs...
The creation of oral contraceptives goes back 60 years. It has gone through a long and complex process from the discovery of sex hormones to their development into drugs to market. A correct understanding of the developmental history of oral contraceptives is of great importance for human reproduction. Gregory G Pincus successfully synthesized the first oral contraceptive Enovid based on research by Carl Djerassi, this was approved for marketing by the US Federal Drug Administration (FDA) in May 1960. However, due to the severe side effects of Enovid, the safer and more effective second generation oral contraceptives - Levonorgestrel and the third generation oral contraceptives - Pregnene are widely used and continue to be used to this day. The introduction of oral contraceptives not only dampened the explosive growth of the world's population, but also improved the social status of women, and catalyzed the sexual liberation movement.
Topics: Contraceptives, Oral; Female; Humans; Levonorgestrel
PubMed: 34098701
DOI: 10.3760/cma.j.cn112155-20200902-00136 -
The Journal of Sexual Medicine Nov 2019Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives... (Review)
Review
INTRODUCTION
Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial.
AIM
To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine.
METHODS
A comprehensive review of the literature was performed.
MAIN OUTCOME MEASURE
Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options).
RESULTS
Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed.
CLINICAL IMPLICATIONS
There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up.
STRENGTHS & LIMITATIONS
All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice.
CONCLUSION
The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms. Both S, Lew-Starowicz M, Luria M, et al. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1681-1695.
Topics: Contraceptives, Oral, Hormonal; Female; Hormonal Contraception; Humans; Orgasm; Personal Satisfaction; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Partners; Sexuality
PubMed: 31521571
DOI: 10.1016/j.jsxm.2019.08.005 -
Journal of Pediatric and Adolescent... Jun 2020
Topics: Adolescent; Contraceptives, Oral, Hormonal; Female; Humans; Norethindrone; Uterine Hemorrhage
PubMed: 32169401
DOI: 10.1016/j.jpag.2020.02.002