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Cleveland Clinic Journal of Medicine Aug 2017Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this... (Review)
Review
Combined hormonal contraceptives are contraindicated in women who have migraine with aura, in whom these drugs can increase the risk of ischemic stroke. However, this contraindication is based on data from the 1960s and 1970s, when oral contraceptives contained much higher doses of estrogen. Stroke risk is not significantly increased with today's preparations, many of which contain less than 30 μg of ethinyl estradiol. Further, in continuous regimens, ultra-low-dose formulations--those that contain less than 20 μg of ethinyl estradiol--may help prevent menstrual migraine and reduce the frequency of aura.
Topics: Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Female; Humans; Migraine Disorders; Migraine with Aura; Stroke
PubMed: 28806162
DOI: 10.3949/ccjm.84a.16033 -
Acta Obstetricia Et Gynecologica... Dec 2019Approximately 100 million women currently use combined oral contraceptives. Combined oral contraceptives use is associated with increased risk of venous thromboembolic...
INTRODUCTION
Approximately 100 million women currently use combined oral contraceptives. Combined oral contraceptives use is associated with increased risk of venous thromboembolic events and cardiovascular disease. Progestin-only pills do not increase the risk of venous thromboembolic events, stroke and myocardial infarction but are associated with a poor cycle control. A novel estrogen-free pill containing only drospirenone (DRSP) was developed to improve bleeding pattern, tolerability and acceptance without increasing venous thromboembolic events risks in contraception.
MATERIAL AND METHODS
Two prospective, multicenter Phase III studies in healthy women aged 18-45 years were performed to demonstrate the efficacy and safety of a drospirenone-only pill in a regimen of 24 days of 4 mg of drospirenone tablets followed by 4 days of placebo. A total of 1571 women (14 329 exposure cycles) were analyzed: 713 patients in the 13-cycle study 1 with 7638 exposure cycles and 858 patients in the 9-cycle study 2 with 6691 exposure cycles. The primary endpoint was the overall Pearl index, calculated for each study separately, and for both pooled. As main secondary efficacy endpoint, the "method failure Pearl index" including all pregnancies during "perfect medication cycles" was evaluated. EudraCT registration numbers: 2010-021787-15 & 2011-002396-42.
RESULTS
Calculations on pooled studies 1 and 2 with 1571 patients gave an overall Pearl index (based on 14 329 cycles) of 0.7258 (95% CI 0.3133 to 1.4301). No single case of deep vein thrombosis or pulmonary embolism and only one case of hyperkalemia were reported. Additional information such as laboratory parameters, body mass index, bodyweight, heart rate and blood pressure showed no statistically significant changes due to the treatment.
CONCLUSIONS
This is the first report of a new drospirenone-only oral contraceptive providing clinical efficacy similar to combined oral contraceptives, with a good safety profile, and favorable cycle control.
Topics: Adult; Androstenes; Contraceptives, Oral; Female; Humans; Hyperkalemia; Metrorrhagia; Pregnancy; Pregnancy Rate; Prospective Studies; Pulmonary Embolism; Treatment Failure; Venous Thrombosis; Young Adult
PubMed: 31321765
DOI: 10.1111/aogs.13688 -
Acta Obstetricia Et Gynecologica... Feb 2013To describe the effects and side-effects of the continuous use of oral contraceptives. (Review)
Review
OBJECTIVE
To describe the effects and side-effects of the continuous use of oral contraceptives.
DESIGN
A review of articles concerning oral contraceptives taken continuously or in cycles with hormones taken for more than 21 days per cycle.
METHODS
We searched publications in PubMed and Embase. Randomized controlled trials were selected if possible, otherwise case-control studies or cohort studies with controls were chosen. A level of evidence as described by the Centre for Evidence Based Medicine (Oxford University, Oxford, UK) was assigned to all selected studies.
MAIN OUTCOME MEASURES
Clinical and paraclinical effects and side-effects of oral contraceptives administered continuously.
RESULTS
The studies suggest that the endometrium is inactive during continuous use of oral contraceptives and the risk of endometrial hyperplasia is not increased. Numbers of bleeding days are halved with continuous use; however, spotting and irregular bleeding are more often seen in the beginning of use, decreasing with time. Hemostatic parameters and serum lipid and carbohydrate profiles in continuous and conventional users do not differ. Menstrual cycle-related symptoms are relieved better by continuous treatment. After surgery for endometriosis, the effect of continuously used oral contraceptives on the risk of recurrence of pain has been found to be less than that of gonadotropin-releasing hormone (GnRH) analogues, but better than the rate seen during conventional cyclic use.
CONCLUSION
Oral contraceptives taken continuously or in long cycles seem to offer benefits with regard to menstrual symptoms and the recurrence of symptoms related to endometriosis. Long-term studies, comprising large groups of women, are lacking.
Topics: Blood Pressure; Body Weight; Bone Density; Contraceptives, Oral; Endometriosis; Endometrium; Female; Humans; Menstruation; Pelvic Pain; Secondary Prevention; Venous Thromboembolism
PubMed: 23083413
DOI: 10.1111/aogs.12036 -
The Journal of Family Planning and... Jan 2003To review the literature on the most recent progestogens to be developed, to provide clinical comparisons with older progestogens and to look at the potential of... (Comparative Study)
Comparative Study Review
OBJECTIVE
To review the literature on the most recent progestogens to be developed, to provide clinical comparisons with older progestogens and to look at the potential of products not yet marketed.
DATA SOURCES
Searches of Medline and Popline together with requests for bibliographies from the Population Council, Wyeth-Ayerst Research and Schering Health Care.
STUDY SELECTION
Information from technical papers was used to ascertain the metabolic characteristics and receptor binding affinities of the compounds. Previous reviews were scrutinised in order to make comparisons with older compounds. Any available trials were examined to ascertain efficacy, bleeding patterns and tolerability, more weight being given to comparative trials.
DISCUSSION
Five progestogens have been developed in the last decade. They are all devoid of androgenic activity; some have antiandrogenic activity. Combined oral contraceptive (COC) pills containing dienogest and drospirenone are already marketed. Nomegestrol and nestorone have been extensively studied as subdermal implants.
CONCLUSIONS
Newer progestogens used in combination with oestrogen behave very similarly to existing products. Progestogen-only products using new progestogens have potential for significantly better tolerability due to their lack of androgenic activity.
Topics: Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Drug Therapy, Combination; Drugs, Investigational; Female; Humans; Progestins; United Kingdom
PubMed: 12626173
DOI: 10.1783/147118903101197188 -
British Medical Journal (Clinical... Aug 1985
Topics: Contraceptives, Oral; Contraceptives, Oral, Hormonal; Female; Humans; Postoperative Complications; Surgical Procedures, Operative; Thrombophlebitis
PubMed: 3928026
DOI: 10.1136/bmj.291.6494.498 -
Journal of Affective Disorders Jan 2024The link between oral contraceptive pill (OCP) and depression is still unclear. This work analyses the prevalence and correlates of major depression in US women using...
BACKGROUND
The link between oral contraceptive pill (OCP) and depression is still unclear. This work analyses the prevalence and correlates of major depression in US women using OCP.
METHODS
This study used the National Health and Nutrition Examination Survey (NHANES) 2005-2012 data to provide the prevalence and correlates of major depression in women using OCP. Major depression was defined as a score of ≥10 using the Patient Health Questionnaire-9 (PHQ-9).
RESULTS
A total of 6239 women aged 18-55 years were included in the present analysis. Current OCP users had a lower prevalence of major depression (4.6 %; 95 % CI, 3.2 to 6.6) compared to former users of OCP (11.4 %; 95 % CI, 10.1 to 12.9) and never users of OCP (10 %; 95 % CI, 8.3 to 12.1). Current users of OCP were significantly less likely to report major depression compared to former users of OCP (OR 0.59; 95CI%, 0.39 to 0.90) after adjusting for potential confounders. The prevalence of major depression was higher in women who were: black or Hispanic, widowed/divorced/separated, those with a low and middle income, current smokers, current users of antidepressants, and with history of cancer and thyroid problems.
LIMITATIONS
This is a cross-sectional study.
CONCLUSION
The prevalence of major depression among women using OCP may be lower than in former users of OCP, however, the burden of depression remains high. Further research with longitudinal follow-up for depression in women using OCP is needed to understand real world effect of the OCP on depression.
Topics: Humans; Female; Contraceptives, Oral; Nutrition Surveys; Depression; Cross-Sectional Studies; Depressive Disorder, Major
PubMed: 37832730
DOI: 10.1016/j.jad.2023.10.041 -
Blood Transfusion = Trasfusione Del... Jan 2024The main drawback of oral contraceptives (OC) and hormone replacement therapy (HRT) is an increased risk of venous and, to a lesser extent, arterial thrombosis. (Review)
Review
BACKGROUND
The main drawback of oral contraceptives (OC) and hormone replacement therapy (HRT) is an increased risk of venous and, to a lesser extent, arterial thrombosis.
MATERIALS AND METHODS
This narrative, case-based review describes the effect of available estrogens and progestogens on the hemostatic system and their potential impact on the risk of thrombosis. Clinical cases are used to illustrate different options for prescribing OC and HRT in the real-word. The aim is to offer discussion topics that could be helpful to guide the choice of different hormonal treatments over a woman's lifetime and in the presence of risk factors.
RESULTS
We describe physio-pathological changes occurring during the administration of hormonal therapies. Furthermore, we analyze the risk of venous and arterial thrombosis associated with different products, routes of administration and additional risk factors. New hormonal preparations, such as estradiol combined with dienogest, as well as non-oral hormonal therapies, are suggested to decrease thrombotic risk significantly.
DISCUSSION
The availability of many products and different routes of administration allow most women to safely use contraception, as well as HRT. We encourage careful counselling instead of inflexible or fearful behavior, as expanding options and choices will allow women to make the best decisions for their health.
Topics: Female; Humans; Thrombosis; Contraceptives, Oral; Risk Factors; Hemostasis; Hormones; Contraceptives, Oral, Hormonal
PubMed: 37235737
DOI: 10.2450/BloodTransfus.535 -
British Medical Journal (Clinical... Nov 1983
Topics: Adult; Breast Neoplasms; Contraceptives, Oral; Female; Humans; Time Factors; Uterine Cervical Neoplasms
PubMed: 6416430
DOI: 10.1136/bmj.287.6403.1397 -
Gaceta Medica de Mexico 2015
Topics: Contraceptives, Oral; Female; History, 20th Century; History, 21st Century; Humans
PubMed: 25739477
DOI: No ID Found -
Journal of the National Cancer Institute Apr 2022
Topics: Contraceptives, Oral; Female; Genes, BRCA1; Genes, BRCA2; Humans; Neoplasms
PubMed: 35048983
DOI: 10.1093/jnci/djac006