-
The Cochrane Database of Systematic... Oct 2009Dysmenorrhoea (painful menstrual cramps) is common. Combined OCPs are recommended in the management of primary dysmenorrhoea. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dysmenorrhoea (painful menstrual cramps) is common. Combined OCPs are recommended in the management of primary dysmenorrhoea.
OBJECTIVES
To determine the effectiveness and safety of combined oral contraceptive pills for the management of primary dysmenorrhoea.
SEARCH STRATEGY
We conducted electronic searches for randomised controlled trials (RCTs) in the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials CENTRAL, CCTR, MEDLINE, EMBASE, and CINAHL (first conducted in 2001, updated on 5 November 2008).
SELECTION CRITERIA
RCTs comparing all combined OCPs with other combined OCPs, placebo, no management, or management with nonsteroidal anti-inflammatories (NSAIDs) were considered.
DATA COLLECTION AND ANALYSIS
Twenty three studies were identified and ten were included. Six compared the combined OCP with placebo and four compared different dosages of combined OCP.
MAIN RESULTS
One study of low dose oestrogen and four studies of medium dose oestrogen combined OCPs compared with placebo, for a combined total of 497 women, reported pain improvement. For the outcome of pain relief across the different OCPs the pooled OR suggested benefit with OCPs compared to placebo (7 RCTs: Peto OR 2.01 [95% CI 1.32, 3.08]).The Chi-squared test for heterogeneity showed there is significant heterogeneity with an I(2) statistic of 64% and a significant chi-square test (14.06, df=5, p=0.02). A sensitivity analysis removing the studies with inadequate allocation concealment suggested significant benefit of treatment with the pooled OR of 2.99 (95% CI 1.76, 5.07) and heterogeneity no longer statistically significant and I(2) statistic of 0%.Three studies reported adverse effects (Davis 2005; Hendrix 2002; GPRG 1968) The adverse effects were nausea, headaches and weight gain. Two studies reported if women experienced any side effect and no evidence of an effect was found (3 RCTs: OR = 1.45 (95% 0.71, 2.94). There was no evidence of statistical heterogeneity.There were no studies identified that compared combined OCP versus non steroidal anti-inflammatory drugsThere was no evidence of a difference for the pooled studies for 3rd generation pro gestagens (OR = 1.11 (95% CI 0.79 - 1.57)). For the 2nd generation versus 3rd generation the OR was 0.44 (95% CI 0.23-0.84) suggesting benefit of the 3rd generation OCP but this was for a single study (Winkler 2003).
AUTHORS' CONCLUSIONS
There is limited evidence for pain improvement with the use of the OCP (both low and medium dose oestrogen) in women with dysmenorrhoea. There is no evidence of a difference between different OCP preparations.
Topics: Contraceptives, Oral, Combined; Dysmenorrhea; Female; Humans; Randomized Controlled Trials as Topic
PubMed: 19821293
DOI: 10.1002/14651858.CD002120.pub3 -
Fertility and Sterility Jan 2002To review and compare the risk-benefit profile of triphasic oral contraceptives with that of low-dose monophasic oral contraceptives. (Comparative Study)
Comparative Study Review
OBJECTIVE
To review and compare the risk-benefit profile of triphasic oral contraceptives with that of low-dose monophasic oral contraceptives.
DESIGN
Literature on currently marketed triphasics and monophasics.
PATIENT(S)
Healthy women of reproductive age.
MAIN OUTCOME MEASURE(S)
Comparison of the rationale for development, composition, mechanism, efficacy, menstrual cycle control, side effects, health benefits, and risk-benefit profile.
RESULT(S)
All triphasics contain ethinyl estradiol (0.025-0.040 mg/d) and one of several progestins in doses (0.05-1.0 mg/d) related to their relative potencies, which are substantially lower overall (total dose) than those in monophasics. The triphasics are highly efficacious. In general, menstrual cycle control and side effects are similar in both types, but triphasics containing the newer progestins (desogestrel, gestodene, and norgestimate) have better cycle control and a reduced incidence of androgenic side effects compared with those with norethindrone or levonorgestrel. Both triphasics and monophasics have minimal effects on carbohydrate and lipid metabolism and hemostasis parameters, and therefore comparable low risks of coronary heart disease. The health benefits of triphasics and monophasics are similar and include decreased incidence of unwanted and ectopic pregnancies, ovarian cysts, endometrial and ovarian cancers, benign breast disease, and acute pelvic inflammatory disease; less menstrual blood loss and iron deficiency anemia; and lower frequency of irregular bleeding and menorrhagia.
CONCLUSION(S)
The risk-benefit profiles of both triphasics and monophasics are favorable and similar.
Topics: Contraceptives, Oral, Combined; Drug Administration Schedule; Female; Humans; Menstrual Cycle; Reproduction
PubMed: 11779584
DOI: 10.1016/s0015-0282(01)02927-2 -
Fertility and Sterility Jan 1990Figure 9 is an attempt to summate the influences of life-style on lipid parameters. Based on the work of Nikkila, it shows the source of the production of HDL and LDL,... (Review)
Review
Figure 9 is an attempt to summate the influences of life-style on lipid parameters. Based on the work of Nikkila, it shows the source of the production of HDL and LDL, the factors that can affect these lipoprotein levels, and where in the cascade of lipoprotein metabolism these factors exert influence. The source of HDL production is the liver and the intestine. At this stage, diet, exercise, hormones, genetics, drugs, and certain disease states can affect HDL levels. Lecithin-cholesterol acyl transferase (LCAT) esterifies HDL-free cholesterol in plasma, and HDL3 is formed that in turn is transformed to HDL2. At the same time, VLDL from the gut and the liver will be converted, under the influence of LPL, to HDL2 and LDL. Thus HDL2 is being formed by the breakdown of VLDL and from the transformation of HDL3 to HDL2. Insulin, exercise, alcohol, fats, drugs, and diet affect lipoprotein lipase and consequently influence levels of LDL and HDL2 indirectly. Progestogens increase and estrogens decrease hepatic endothelial lipase, thus affecting the HDL2 concentration. It is at this point that combination OCs influence HDL2. The balance between estrogen and progestogen in a given contraceptive determines the extent and direction of HDL2 concentration. A separate pathway in the liver also catabolizes HDL2 and HDL3. LDL is generated partly from catabolism of VLDL and is partly secreted from the liver. The removal of LDL is mediated by receptors in both the liver and peripheral tissues. It is here that the Brown-Goldstein theory plays a major role. If LDL receptors are present in an insufficient number or are defective, then the C will accumulate and atherosclerosis may follow. Thus two key enzymes, LCAT and LPL, control the production of HDL2 and LDL, whereas a third enzyme, hepatic endothelial lipase, catabolizes HDL2.
Topics: Cardiovascular Diseases; Contraceptives, Oral; Female; Humans; Lipid Metabolism; Risk Factors
PubMed: 2403935
DOI: 10.1016/s0015-0282(16)53208-7 -
The Journal of Family Planning and... Apr 2014Extended use of the combined oral contraceptive pill (COC), defined as taking active pills for at least 28 days, has been used in order to avoid bleeding at... (Review)
Review
BACKGROUND
Extended use of the combined oral contraceptive pill (COC), defined as taking active pills for at least 28 days, has been used in order to avoid bleeding at important times and to treat gynaecological conditions such as endometriosis. We examined the main issues involved in extended use of the COC and how it has evolved from being one of medicine's best-kept secrets to becoming more widely accepted by women and the medical community.
STUDY DESIGN
Literature review, using Medline, Embase, Pubmed, CINHAL Plus, the Cochrane Database of Systematic Reviews and the Ovid database for all relevant clinical trials, systematic reviews, meta-analyses, literature reviews, scientific papers and individual opinions between 1950 and October 2013.
RESULTS
Accumulating evidence supports various forms of extended pill use as suitable alternatives to the standard (21/7) regimen. In terms of user preference, much hinges on whether women wish to reduce the frequency or duration of scheduled bleeding on the combined pill. Available data on the safety of extended pill regimens do not give cause for concern, but longer term data should be collected.
CONCLUSIONS
Information for women considering extended COC regimens should keep pace with research findings to ensure that women and clinicians are better informed about the choices available.
Topics: Contraceptives, Oral, Combined; Drug Administration Schedule; Endometrium; Female; Humans; Medication Adherence; Menstruation; Menstruation Disturbances; Time Factors
PubMed: 24648529
DOI: 10.1136/jfprhc-2013-100600 -
Cytokine Oct 2022Investigate the impact of sex, menstrual cycle phase and oral contraceptive use on intestinal permeability and ex-vivo tumour necrosis factor alpha (TNFα) release...
The effect of sex, menstrual cycle phase and oral contraceptive use on intestinal permeability and ex-vivo monocyte TNFα release following treatment with lipopolysaccharide and hyperthermia.
PURPOSE
Investigate the impact of sex, menstrual cycle phase and oral contraceptive use on intestinal permeability and ex-vivo tumour necrosis factor alpha (TNFα) release following treatment with lipopolysaccharide (LPS) and hyperthermia.
METHODS
Twenty-seven participants (9 men, 9 eumenorrheic women (MC) and 9 women taking an oral contraceptive pill (OC)) completed three trials. Men were tested on 3 occasions over 6 weeks; MC during early-follicular, ovulation, and mid-luteal phases; OC during the pill and pill-free phase. Intestinal permeability was assessed following a 4-hour dual sugar absorption test (lactulose: rhamnose). Venous blood was collected each trial and stimulated with 100 μg·mL LPS before incubation at 37 °C and 40 °C and analysed for TNFα via ELISA.
RESULTS
L:R ratio was higher in OC than MC (+0.003, p = 0.061) and men (+0.005, p = 0.007). Men had higher TNFα responses than both MC (+53 %, p = 0.004) and OC (+61 %, p = 0.003). TNFα release was greater at 40 °C than 37 °C (+23 %, p < 0.001).
CONCLUSIONS
Men present with lower resting intestinal barrier permeability relative to women regardless of OC use and displayed greater monocyte TNFα release following whole blood treatment with LPS and hyperthermia. Oral contraceptive users had highest intestinal permeability however, neither permeability or TNFα release were impacted by the pill cycle. Although no statistical effect was seen in the menstrual cycle, intestinal permeability and TNFα release were more variable across the phases.
Topics: Contraceptives, Oral; Female; Humans; Hyperthermia, Induced; Lipopolysaccharides; Male; Menstrual Cycle; Monocytes; Permeability; Tumor Necrosis Factor-alpha
PubMed: 35944412
DOI: 10.1016/j.cyto.2022.155991 -
Australian Family Physician Jun 2009Providing contraceptive advice is a core activity in general practice. There have been numerous changes to the contraceptive options available in Australia over the past...
BACKGROUND
Providing contraceptive advice is a core activity in general practice. There have been numerous changes to the contraceptive options available in Australia over the past 10 years. It is important that general practitioners are aware of these changes so that they can advise patients appropriately.
OBJECTIVE
This article examines the changes that have occurred in contraception over the past decade and discusses the implications of these changes to clinical practice.
DISCUSSION
Up-to-date knowledge about how the combined oral contraceptive pill works is reflected in changes to packaging and formulations, with varying success. Other changes include the over-the-counter availability of emergency contraceptive pills and the new combined hormonal vaginal ring. There has been a resurgence in intrauterine device use and their insertion has Level 1 (nonprocedural) indemnity status in most medical defence organisations. Bleeding with long acting progestogen only contraception remains a problem and management options include antiprostaglandins, tranexamic acid, doxycycline, the combined oral contraceptive pill and removal of the device. Sterilisation remains an option for older men and women and newer methods are available.
Topics: Contraception; Contraception Behavior; Contraceptives, Oral, Combined; Humans
PubMed: 19521578
DOI: No ID Found -
American Journal of Public Health Oct 1985
Topics: Adolescent; Adult; Contraception; Contraceptives, Oral; Female; Humans; United States
PubMed: 4037156
DOI: 10.2105/ajph.75.10.1131 -
Thrombosis and Haemostasis Jul 1997Studies conducted in the first three decades after discovery of a link between venous thromboembolism and oral contraceptive users showed a relative risk of first... (Review)
Review
Studies conducted in the first three decades after discovery of a link between venous thromboembolism and oral contraceptive users showed a relative risk of first thrombosis during oral contraceptive use of 2.9 (95% CI 0.5-17). In recent studies in which the sub-50 micrograms ethinyl estrodiol containing pills were investigated comparing current users with non-users, the RR is 3.8 for non-fatal deep VTE and 2.7 for superficial VTE, deep VTE and pulmonary embolism (PE) together and 2.1 for fatal VT and PE together. The association is attributed to the estrogenic component and not related to duration of pill use. The risk disappears once the pill has been stopped, and it is not elevated among past users. Smoking does not appear to be risk factor for VTE; obesity and varicose veins are, at the most, weak risk factors. Since a causal relationship between OC use and VTE is tempting, clues for unraveling the mechanism were sought in the hemostatic system. Studies of the coagulation system found changes in the activation of coagulation and fibrinolytic compartments, but within the normal range. An epidemiologic study showed that the risk of VTE among women using OCs is 30-fold increased by the presence of a mutation of factor V, called Factor V Leiden (5% prevalence in the Caucasian population). Selective screening for the mutated factor V should be limited to women with a personal or family history of VTE. Four epidemiologic studies showed a two-fold increase in risk of VTE with the use of OCs containing third-generation progestins (gestodene and desogestrel), relative to second-generations products (levonorgestrel). Biases cannot devaluate the conclusion that the increased risk of VTE in especially first-time and younger users of third-generation OCs is highly likely. The clinical consequence is therefore that second-generation OCs are the first choice in prescription to first-time users.
Topics: Blood Coagulation; Case-Control Studies; Contraceptives, Oral; Female; Humans; Progestins; Reproducibility of Results; Risk Factors; Thromboembolism; Veins
PubMed: 9198174
DOI: No ID Found -
British Medical Journal (Clinical... Dec 1983
Topics: Adult; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Female; Humans; Progesterone Congeners; Uterine Cervical Neoplasms
PubMed: 6416597
DOI: No ID Found -
Journal of Neuroscience Research Jan 2017Oral contraceptive (OC) users typically show a blunted or no cortisol response to psychosocial stress. Although most OC regimens include both an inactive (dummy) and...
Oral contraceptive (OC) users typically show a blunted or no cortisol response to psychosocial stress. Although most OC regimens include both an inactive (dummy) and active pill phase, studies have not systematically investigated cortisol responses during these pill phases. Further, high levels of cortisol following a stressor diminish retrieval of emotional material, but the effects of stress on memory among OC users are poorly understood. We examined the effects of a psychosocial stressor, the Trier Social Stress Test, vs. a control condition on cortisol responsivity and emotional memory retrieval in women tested either during their active (n = 18) or inactive pill phase (n = 21). In secondary analyses, we quantitatively compared OC users with normally cycling women and showed a significant lack of cortisol response during both active and inactive pill phase. Emotional recall did not differ between active and inactive pill phases. Stress differentially diminished recall of negative words compared with positive or neutral words, but cortisol levels were unrelated to memory performance. These findings indicate that OC users have distinct cortisol and memory responses to stress that are similar between the active and inactive pill phases. © 2016 Wiley Periodicals, Inc.
Topics: Adult; Analysis of Variance; Association Learning; Contraceptives, Oral; Emotions; Female; Gonadal Steroid Hormones; Humans; Hydrocortisone; Memory; Neuropsychological Tests; Psychiatric Status Rating Scales; Saliva; Stress, Psychological; Young Adult
PubMed: 27870412
DOI: 10.1002/jnr.23904