CONTRACEPTIVES HORMONAL [keywords]
- Age-specific birth rates in women with epilepsy: a population-based study. [Journal Article]
- Brain Behav 2016 Aug; 6(8):e00492.
The aim of this study was to investigate birth rates and use of hormonal contraception in different age groups among women with epilepsy (WWE) in comparison to women without epilepsy.Demographic data and medical information on more than 25,000 pregnant women (40,000 births), representing 95% of all pregnancies in Oppland County, Norway, were registered in the Oppland Perinatal Database in the period 1989-2011. Data were analyzed with respect to epilepsy diagnoses, and 176 women with a validated epilepsy diagnosis (303 pregnancies) were identified. Age-specific birth rates in these women were estimated and compared with age-specific birth rates in women without epilepsy in the same county.In WWE over 25 years of age, birth rates were significantly lower than in those of the same age group without epilepsy. In women below 20 years of age, birth rates were similar in those with and without epilepsy. The use of hormonal contraceptives prior to pregnancy was lower among WWE under 25 years than in the corresponding age group without epilepsy.Health professionals who counsel WWE who are of fertile age should be aware of the strongly reduced birth rates in WWE over 25 years of age, and the lower rates of use of contraceptives among young WWE.
- Estradiol levels in women predict skin conductance response but not valence and expectancy ratings in conditioned fear extinction. [JOURNAL ARTICLE]
- Neurobiol Learn Mem 2016 Aug 17.
Anxiety disorders are more prevalent in women than men. One contributing factor may be the sex hormone estradiol, which is known to impact the long term recall of conditioned fear extinction, a laboratory procedure that forms the basis of exposure therapy for anxiety disorders. To date, the literature examining estradiol and fear extinction in humans has focused primarily on physiological measures of fear, such as skin conductance response (SCR) and fear potentiated startle. This is surprising, given that models of anxiety identify at least three important components: physiological symptoms, cognitive beliefs, and avoidance behavior. To help address this gap, we exposed women with naturally high (n = 20) or low estradiol (n = 19), women using hormonal contraceptives (n = 16), and a male control group (n = 18) to a fear extinction task, and measured SCR, US expectancy and CS valence ratings. During extinction recall, low estradiol was associated with greater recovery of SCR, but was not related to US expectancy or CS evaluation. Importantly, women using hormonal contraceptives showed a dissociation between SCR and cognitive beliefs: they exhibited a greater recovery of SCR during extinction recall, yet reported similar US expectancy and CS valence ratings to the other female groups. This divergence underscores the importance of assessing multiple measures of fear when examining the role of estradiol in human fear extinction, especially when considering the potential of estradiol as an enhancement for psychological treatments for anxiety disorders.
- Effects of hormonal contraception on systemic metabolism: cross-sectional and longitudinal evidence. [JOURNAL ARTICLE]
- Int J Epidemiol 2016 Aug 18.
Hormonal contraception is commonly used worldwide, but its systemic effects across lipoprotein subclasses, fatty acids, circulating metabolites and cytokines remain poorly understood.A comprehensive molecular profile (75 metabolic measures and 37 cytokines) was measured for up to 5841 women (age range 24-49 years) from three population-based cohorts. Women using combined oral contraceptive pills (COCPs) or progestin-only contraceptives (POCs) were compared with those who did not use hormonal contraception. Metabolomics profiles were reassessed for 869 women after 6 years to uncover the metabolic effects of starting, stopping and persistently using hormonal contraception.The comprehensive molecular profiling allowed multiple new findings on the metabolic associations with the use of COCPs. They were positively associated with lipoprotein subclasses, including all high-density lipoprotein (HDL) subclasses. The associations with fatty acids and amino acids were strong and variable in direction. COCP use was negatively associated with albumin and positively associated with creatinine and inflammatory markers, including glycoprotein acetyls and several growth factors and interleukins. Our findings also confirmed previous results e.g. for increased circulating triglycerides and HDL cholesterol. Starting COCPs caused similar metabolic changes to those observed cross-sectionally: the changes were maintained in consistent users and normalized in those who stopped using. In contrast, POCs were only weakly associated with metabolic and inflammatory markers. Results were consistent across all cohorts and for different COCP preparations and different types of POC delivery.Use of COCPs causes widespread metabolic and inflammatory effects. However, persistent use does not appear to accumulate the effects over time and the metabolic perturbations are reversed upon discontinuation. POCs have little effect on systemic metabolism and inflammation.
- Use pattern for contraceptive implants in Norway. [JOURNAL ARTICLE]
- Acta Obstet Gynecol Scand 2016 Aug 19.
Knowledge about global use patterns of contraceptive implants is limited. This study aims to describe implant use patterns from a user and prescriber perspective.In a cross-sectional design, we estimated the annual number of users by calculating doses sold per 1000 women-years in the Norwegian Prescription Database for the years 2006-2012. For each contraceptive method, we calculated on an annual basis a proportion of defined daily doses of all hormonal contraceptives in five years age groups. Data were analyzed in SPSS version 22, with chi-square test, t-test, and survival analysis.Sales from pharmacies for contraceptive implants more than doubled over the study years and was consistently higher in the younger age groups. The collection rate was 9.3 per 1000 women in 2012, when implant sales amounted to 2.4% of all daily doses of hormonal contraceptives sold. General practitioners and doctors with no specialty were the major prescribers to starters of contraceptive implants, whereas gynecologists prescribed nearly 12% of the volume, a higher proportion to women > 35 years of age than younger women. The cumulative proportions of continued users at 6-, 12-, 24-, and 36-months were 96.1%, 78.6%, 51.9%, and 34.9%, significantly lower for users who had doctors with no specialty as prescribers. At end of first expiration period, 21% of starters continued using implants.Implants play a minor role in the overall use of hormonal contraception in Norway. One in five starters continue as long-term users. This article is protected by copyright. All rights reserved.
- Hormonal contraceptives for contraception in overweight or obese women. [REVIEW, JOURNAL ARTICLE]
- Cochrane Database Syst Rev 2016 Aug 18.:CD008452.
Obesity has reached epidemic proportions around the world. Effectiveness of hormonal contraceptives may be related to metabolic changes in obesity or to greater body mass or body fat. Hormonal contraceptives include oral contraceptives (OCs), injectables, implants, hormonal intrauterine contraception (IUC), the transdermal patch, and the vaginal ring. Given the prevalence of overweight and obesity, the public health impact of any effect on contraceptive efficacy could be substantial.To examine the effectiveness of hormonal contraceptives in preventing pregnancy among women who are overweight or obese versus women with a lower body mass index (BMI) or weight.Until 4 August 2016, we searched for studies in PubMed (MEDLINE), CENTRAL, POPLINE, Web of Science, ClinicalTrials.gov, and ICTRP. We examined reference lists of pertinent articles to identify other studies. For the initial review, we wrote to investigators to find additional published or unpublished studies.All study designs were eligible. The study could have examined any type of hormonal contraceptive. Reports had to contain information on the specific contraceptive methods used. The primary outcome was pregnancy. Overweight or obese women must have been identified by an analysis cutoff for weight or BMI (kg/m(2)).Two authors independently extracted the data. One entered the data into RevMan and a second verified accuracy. The main comparisons were between overweight or obese women and women of lower weight or BMI. We examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale. Where available, we included life-table rates. We also used unadjusted pregnancy rates, relative risk (RR), or rate ratio when those were the only results provided. For dichotomous variables, we computed an odds ratio with 95% confidence interval (CI).With 8 studies added in this update, 17 met our inclusion criteria and had a total of 63,813 women. We focus here on 12 studies that provided high, moderate, or low quality evidence. Most did not show a higher pregnancy risk among overweight or obese women. Of five COC studies, two found BMI to be associated with pregnancy but in different directions. With an OC containing norethindrone acetate and ethinyl estradiol (EE), pregnancy risk was higher for overweight women, i.e. with BMI ≥ 25 versus those with BMI < 25 (reported relative risk 2.49, 95% CI 1.01 to 6.13). In contrast, a trial using an OC with levonorgestrel and EE reported a Pearl Index of 0 for obese women (BMI ≥ 30) versus 5.59 for nonobese women (BMI < 30). The same trial tested a transdermal patch containing levonorgestrel and EE. Within the patch group, obese women in the "treatment-compliant" subgroup had a higher reported Pearl Index than nonobese women (4.63 versus 2.15). Of five implant studies, two that examined the six-capsule levonorgestrel implant showed differences in pregnancy by weight. One study showed higher weight was associated with higher pregnancy rate in years 6 and 7 combined (reported P < 0.05). In the other, pregnancy rates differed in year 5 among the lower weight groups only (reported P < 0.01) and did not involve women weighing 70 kg or more.Analysis of data from other contraceptive methods indicated no association of pregnancy with overweight or obesity. These included depot medroxyprogesterone acetate (subcutaneous), levonorgestrel IUC, the two-rod levonorgestrel implant, and the etonogestrel implant.The evidence generally did not indicate an association between higher BMI or weight and effectiveness of hormonal contraceptives. However, we found few studies for most contraceptive methods. Studies using BMI, rather than weight alone, can provide information about whether body composition is related to contraceptive effectiveness. The contraceptive methods examined here are among the most effective when used according to the recommended regimen.We considered the overall quality of evidence to be low for the objectives of this review. More recent reports provided evidence of varying quality, while the quality was generally low for older studies. For many trials the quality would be higher for their original purpose rather than the non-randomized comparisons here. Investigators should consider adjusting for potential confounding related to BMI or contraceptive effectiveness. Newer studies included a greater proportion of overweight or obese women, which helps in examining effectiveness and side effects of hormonal contraceptives within those groups.
- The effect of a drospirenone-containing combined oral contraceptive on female sexual function: a prospective randomised study. [JOURNAL ARTICLE]
- Eur J Contracept Reprod Health Care 2016 Aug 18.:1-6.
The study investigated the effects on female sexual function of a progestogen-containing combined oral contraceptives (COCs) with an antiandrogenic profile taken in a continuous regimen.In this prospective randomised single-institution study, 80 healthy women with a monogamous partner and an active sexual life were randomised into two groups for a period of 3 months. Women in the exposed group (n = 40) took a COCs containing 30 μg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) in a 21/7 regimen. Women in the control group (n = 40) used either a barrier contraceptive method (BCM) or a natural family planning method (NFPM). Participants were asked to complete a set of validated questionnaires to assess sociodemographic variables and measure Female Sexual Function Index (FSFI).The total FSFI score (p < 0.0001), as well as the desire (p = 0.04) and arousal (p = 0.03) scores, were significantly lower in the COCs group after 3 months of hormonal contraceptive use compared with baseline. Women using BCM or NFPM showed an improvement in total FSFI score (p = 0.02). Hormonal contraception with DRSP increased the likelihood of worse sexual function in the desire (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.22, 4.98; p = 0.01) and arousal domains (OR 2.85; 95%CI 1.34, 5.93; p = 0.005) and in total FSFI score (OR 2.01; 95%CI 1.45, 2.79; p < 0.001). The results remained statistically significant even after adjustment for smoking status.The study found evidence that women taking a combined EE/DRSP COCs for 3 months may have a worsening of sexual function as measured by FSFI.
- Ovarian function during hormonal contraception assessed by endocrine and sonographic markers: a systematic review. [REVIEW, JOURNAL ARTICLE]
- Reprod Biomed Online 2016 Aug 4.
This systematic review focuses on the literature evidence for residual ovarian function during treatment with hormonal contraceptives. We reviewed all papers which assessed residual ovarian activity during hormonal contraceptive use, using endocrine markers such as serum anti-Müllerian hormone (AMH) concentrations, FSH, LH, oestradiol, progesterone and sonographic markers such as antral follicle count (AFC), ovarian volume and vascular indices. We considered every type (oestroprogestin or only progestin) and dosage of hormonal contraceptive and every mode of administration (oral, vaginal ring, implant, transdermal patch). We performed an electronic database search for papers published from 1 January 1990 until 30 November 2015 using PubMed and MEDLINE. We pre-selected 113 studies and judged 48 studies suitable for the review. Most studies showed that follicular development continues during treatment with hormonal contraceptives, and that during treatment there is a reduction in serum concentrations of FSH, LH and oestradiol, and also a reduction in endometrial thickness, ovarian volume and the number and size of antral follicles. The ovarian reserve parameters, namely AFC and ovarian volume, are lower among users than among non-users of hormonal contraception; regarding the effect of hormonal contraception on AMH, there are still controversies in the literature.
- Pregnancy is more dangerous than the pill: A critical analysis of professional responses to the Yaz/Yasmin controversy. [JOURNAL ARTICLE]
- Soc Sci Med 2016 Aug 5.:9-16.
The fourth and most recent generation of hormones used in oral contraceptives has stirred a significant amount of debate regarding the safety of these compounds. Drospirenone, a new type of synthetic hormone used in popular oral contraceptives Yaz and Yasmin, has been found by epidemiologists to increase the risk of blood clots when compared to the previous generations of pills. North American regulatory bodies have investigated the health risks of drospirenone and concluded that the increased risks do not require pulling the new contraceptive technology off the market. Instead, the FDA and Health Canada along with several medical associations have actively managed the Yaz/Yasmin controversy through official statements and press releases between 2010 and 2014. This study provides an analysis of these documents and how risk information about drospirenone-containing pills has been presented to the public. The analysis addresses a gap in our knowledge about cultural factors that impact contraceptive risk assessment. Prevalent risk models used by professionals are highlighted and examined through the use of critical discourse analysis methods. More specifically, this paper highlights the main strategies used to put drospirenone risks into perspective and classify it as safe. I argue that while risks related to pregnancy and the postpartum period are overly-emphasized, other risks are downplayed through a selection process underscored by normative beliefs about women's bodies and sexuality. Future research needs to address consumer perspectives and bridge the gap between lay and scientific risk/benefit assessment of oral contraceptives.
- Heritability of caffeine metabolism: Environmental effects masking genetic effects on CYP1A2 activity but not on NAT2. [JOURNAL ARTICLE]
- Clin Pharmacol Ther 2016 Aug 10.
Heritability of caffeine pharmacokinetics and CYP1A2 activity is controversial. Here we analyzed the pharmacokinetics of caffeine, an in vivo probe drug for CYP1A2 and arylamine N-acetyltransferase 2 (NAT2) activity, in monozygotic and dizygotic twins. In the entire group, common and unique environmental effects explained most variation in caffeine AUC. Apparently, smoking and hormonal contraceptives masked the genetic effects on CYP1A2 activity. However, when excluding smokers and users of hormonal contraceptives, 89% of caffeine AUC variation was due to genetic effects and even in the entire group, 8% of caffeine AUC variation could be explained by a CYP1A1/1A2 promotor polymorphism (rs2470893). In contrast, nearly all of the variation (99%) of NAT2 activity was explained by genetic effects. This study illustrates two very different situations in pharmacogenetics, from an almost exclusively genetic determination of NAT2 activity with no environmental modulation to only moderate genetic effects on CYP1A2 activity with strong environmental modulation. This article is protected by copyright. All rights reserved.
- [OP.LB01.08] THE ASSOCIATION BETWEEN OBESITY AND PARITY IN SURINAMESE WOMEN. [Journal Article]
- J Hypertens 2016 Sep.:e38.
An important risk factor for cardiovascular disease is obesity, which is more common in women than men. Pregnancy has frequently been cited as a contributor to overweight in women due to gestational weight gain and postpartum weight retention. Obesity prevalence is rapidly rising in urban women in Suriname. The main objective of this study was to assess whether parity is associated with obesity, as measured by body mass index (BMI).The Healthy Life in Suriname (HELISUR) study randomly selected 1,800 subjects of different ancestries living in Paramaribo. Questionnaires on demographic factors, disease history, use of medication, and women's health were collected. Height, weight, blood pressure and serum glucose and cholesterol were measured. We used multiple linear regression analysis to explore the association between obesity and parity, independent of several covariates.Of the 1,800 subjects, 1,159 participated in the physical examination, of which 728 were women (309 Asian; 299 African and 120 of mixed/other ancestry). With increasing parity, crude mean BMI raised significantly (Figure 1, panel A), with a more prominent effect in African-Surinamese compared to Asian-Surinamese women (Figure 1, panel B).(Figure is included in full-text article.)In multivariable regression analysis, BMI increased by 0.32 kg/m (95% CI 0.07 - 0.56) per child, after adjustment for age, ancestry, educational level, current breastfeeding, menopausal status, use of hormonal contraceptives, fasting serum glucose, serum total cholesterol, and systolic blood pressure. Systolic blood pressure, glucose and cholesterol increased respectively 7.36 (95% CI 5.49 - 9.23) mmHg, 0.49 (95% CI 0.29 - 0.70) and 0.18 (95% CI 0.08 - 0.28) mmol/L with each parity group. However, this association was abolished after adjustment for age.Our study demonstrated that parity is associated with a higher BMI in urban Surinamese women, even after adjustment for several covariates. The effect of parity seems to be stronger in African-Surinamese women compared to Asian-Surinamese women. The higher BMI was not accompanied by a worse metabolic profile. Preventive programs for pre- and postpartum women should focus on education about their increased risk of developing obesity.