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PubMed1999

Hemostatic responses to maximal exercise in oral contraceptive users.

OBJECTIVE: This study examined the effect of exercise on markers of fibrinolysis and coagulation in users and nonusers of oral contraceptives. STUDY DESIGN: Fourteen oral contraceptive users and 14 nonusers performed a maximal exercise test on a cycle ergometer. Blood samples were collected before and immediately after the completion of the test. A repeated-measures analysis of variance was used for statistical analysis with values considered significant at P =.05. RESULTS: Acute maximal exercise resulted in significant increases in tissue plasminogen activator activity in both groups. There was a trend toward a smaller increase in tissue plasminogen activator activity in oral contraceptive users, but the difference between groups was not statistically significant. Plasminogen activator inhibitor 1 activity was reduced with exercise in both groups but with a significantly greater decrease observed in the nonusers (P <.0001). Prothrombin fragment 1+2 was significantly higher (P <.0001) in the oral contraceptive group but did not change with exercise. Epinephrine levels before and after exercise were similar between the 2 groups, but postexercise norepinephrine concentrations were significantly lower (P =.026) in the oral contraceptive users. CONCLUSION: These data suggest that oral contraceptive use blunts the fibrinolytic response to exercise. This, together with increased coagulation activation in oral contraceptive users, may alter the hemostatic balance during exercise.

Adult↗
PubMed2001

The relationship between use of oral contraceptives and myocardial infarction in young women with fatal outcome, compared to those who survive: results from the MICA case-control study.

To examine the relationship between use of oral contraceptives and the risk of dying from myocardial infarction, we made a comparison of deceased patients and live patients (women aged less than 45) identified for the Myocardial Infarction Causality case-control study, using data obtained from general practice medical notes. There were 422 live patients and 110 deceased patients of women with a myocardial infarction with data available. The adjusted odds ratio for exposure to second generation oral contraceptives and risk of death within 28 days of a myocardial infarction compared with no oral contraceptive use was raised (2.88, 95% confidence interval 1.22-6.77), and this effect was not seen for other types of oral contraceptives including third generation oral contraceptive formulations. In absolute terms, between 47,000 and 71,000 women would have to be exposed to a second generation pill for one year to result in one extra death from myocardial infarction, and this risk applies mainly to smokers. The results suggest a slightly increased relative risk of death among those having a myocardial infarction associated with exposure to second generation oral contraceptives, but this represents a small absolute risk. Further work is required before any change in contraceptive practice should be advocated.

Adult↗
PubMed1998

Contraceptive technology and family planning services.

A large variety of modern contraceptives is now available, including several means to administer hormonal contraception, highly effective long-term methods and simple sterilization techniques. Methods under research include immuno-contraceptives for women and men, hormonal methods for men, new approaches to female hormonal contraception and improved barrier methods. Modern contraceptives are effective and safe for most women, and some methods have beneficial health effects other than prevention of pregnancy. However, underlying health conditions may decrease the safety of a given method. The appropriate use of the technology available requires screening for biomedical conditions and counseling that enables the selection of methods according to the life style of women and couples. Contraceptive methods have had a considerable positive impact on maternal and infant health and on population growth, but unwanted pregnancies and unsafe abortion still occur in large numbers. This shows the need to improve access to and quality of family planning services including the availability of contraceptives, sensitive providers trained in technical matters and communication skills, and communication between the community, the providers and the managers.

Chile↗
PubMed1999

Contraceptive use by female physicians in the United States.

OBJECTIVE: Little is known about female physicians' personal contraceptive use, and such usage could influence their prescribing patterns. METHODS: We used data from the Women Physicians' Health Study, a large (n = 4501) national study, administered in 1993-1994, on characteristics of female physicians in the United States. RESULTS: These female physicians (ages 30-44 years) were more likely to use contraception than women in the general population (ages 15-44 years); this was true even when the physicians were compared with only other women of high socioeconomic status and when stratified by ethnicity, age, and number of children. Physicians were also more likely to use intrauterine devices, diaphragms, or condoms, and less likely to use female or male sterilization than were other women. Younger female physicians were especially unlikely to use permanent methods, particularly when compared with their age-matched counterparts in the general population. One fifth of contracepting physicians used more than one type of contraceptive; the most frequently used combination was spermicide with a barrier method. CONCLUSION: Female physicians contracept differently than do women in the general population, in ways consistent with delaying and reducing total fertility. Physicians' personal characteristics have been shown to influence their patient counseling practices, including their contraception-related attitudes and practices. Although female physicians' clinical advice might differ from their personal practices, as women physicians become more prevalent, their contraceptive choices could influence those of their patients.

Adult↗
PubMed2002

Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study.

BACKGROUND: Use of oral contraceptives could increase risk of cervical cancer; however the effect of human papillomavirus (HPV), the main cause of cervical cancer, is not usually taken into account. We aimed to assess how use of oral contraceptives affected risk of cervical cancer in women who tested positive for HPV DNA. METHODS: We pooled data from eight case-control studies of patients with histologically confirmed invasive cervical carcinoma (ICC) and from two studies of patients with carcinoma in situ (ISC). Information about use of oral contraceptives was obtained from personal interviews. Effects were estimated as odds ratios, with logistic-regression models adjusted for possible confounders. FINDINGS: 1465 of 1561 (94%) patients with ICC, 211 of 292 (72%) with ISC, and 255 of 1916 (13%) controls were positive for HPV DNA. Compared with never-users, patients who had used oral contraceptives for fewer than 5 years did not have increased risk of cervical cancer (odds ratio 0.73; 95% CI 0.52-1.03). The odds ratio for use of oral contraceptives was 2.82 (95% CI 1.46-5.42) for 5-9 years, and 4.03 (2.09-8.02) for use for 10 years or longer, and these risks did not vary by time since first or last use. INTERPRETATION: Long-term use of oral contraceptives could be a cofactor that increases risk of cervical carcinoma by up to four-fold in women who are positive for cervical HPV DNA. In the absence of worldwide information about HPV status, extra effort should be made to include long-term users of oral contraceptives in cervical screening programmes.

Age of Onset↗
PubMed2003

Cervical cancer and use of hormonal contraceptives: a systematic review.

BACKGROUND: Human papillomavirus (HPV) is believed to be the most important cause of cervical cancer. Recent studies suggest that long duration use of oral contraceptives increases the risk of cervical cancer in HPV positive women. METHODS: Results from published studies were combined to examine the relationship between invasive and in situ cervical cancer and duration and recency of use of hormonal contraceptives, with particular attention to HPV infection. FINDINGS: 28 eligible studies were identified, together including 12531 women with cervical cancer. Compared with never users of oral contraceptives, the relative risks of cervical cancer increased with increasing duration of use: for durations of approximately less than 5 years, 5-9 years, and 10 or more years, respectively, the summary relative risks were 1.1 (95% CI 1.1-1.2), 1.6 (1.4-1.7), and 2.2 (1.9-2.4) for all women; and 0.9 (0.7-1.2), 1.3 (1.0-1.9), and 2.5 (1.6-3.9) for HPV positive women. The results were broadly similar for invasive and in situ cervical cancers, for squamous cell and adenocarcinoma, and in studies that adjusted for HPV status, number of sexual partners, cervical screening, smoking, or use of barrier contraceptives. The limited available data suggest that the relative risk of cervical cancer may decrease after use of oral contraceptives ceases. However, study designs varied and there was some heterogeneity between study results. INTERPRETATION: Although long duration use of hormonal contraceptives is associated with an increased risk of cervical cancer, the public health implications of these findings depend largely on the extent to which the observed associations remain long after use of hormonal contraceptives has ceased, and this cannot be evaluated properly from published data.

Case-Control Studies↗
PubMed1996

Contraception for the older woman.

Contraception presents particular problems for women over the age of 40. Although fertility is declining and the risk of pregnancy may be small, the consequences of an unplanned pregnancy may be socially devastating and medically ill-advised. Menstrual dysfunction and psychosexual difficulties increase with age and may exacerbate the side-effects of some methods of contraception. The long-term risks of combined hormonal contraception, particularly cardiovascular disease, become more pertinent to women whose natural risk of disease increases with age. Patterns of sexual activity and contraceptive use change with age. The advantages and disadvantages of currently available methods of contraception are difficult to quantify, and the choice of method is very much a matter for individual concern. The increasing prevalence of HRT may complicate matters for some women who are unsure for how long to continue using contraception. Contraceptives of the future may be designed to improve the reproductive health of all women, particularly those approaching the menopause.

Adult↗
PubMed2006

Blood blockages and scolding nurses: barriers to adolescent contraceptive use in South Africa.

A third of adolescent girls in South Africa become pregnant before the age of 20, despite contraception being free and mostly accessible. This qualitative study was undertaken in Limpopo Province in 1997 on the barriers to adolescent girls accessing clinic services for contraception. Thirty-five in-depth interviews and five group discussions were conducted with girls aged 14-20, and interviews with nursing staff at 14 clinics. Many of the girls described pressure from male partners and family members to have a baby or prove their fertility. Other barriers to sustained contraceptive use included medically inaccurate notions about how conception occurs and fears about the effects of contraception on fertility and menstruation, which were not taken seriously by nurses. Nurses' attempts to stigmatise teenage sexuality, their scolding and harsh treatment of adolescent girls, and their unwillingness to acknowledge adolescents' experiences as contraceptive users, undermined the effective use of contraception by girls. Youth need better information on reproductive physiology and sexual health, and detailed information on contraception. Tools to enhance the accuracy and availability of knowledge in the clinic setting have a role, but need to be introduced along with initiatives to ensure that services are adolescent-friendly and do not stigmatise adolescent sexual activity.

Adolescent↗
PubMed1998

Emergency postcoital contraception.

Of the estimated 3.5 million unintended pregnancies that occur each year in the United States, some 1.7 million are thought to be the result of contraceptive failure. The extremely high numbers of unintended pregnancies not only in the United States but also worldwide indicates that emergency contraception remains an important but underused method of pregnancy prevention. Emergency postcoital contraception via mechanical or pharmacological means inhibits fertilization and/or implantation from unprotected sexual intercourse. Although emergency contraception has been used primarily in victims of sexual assault, it offers a low-cost, highly effective method to reduce the incidence of unintended pregnancy. Emergency contraception decreases the costs and emotional and physical risks to women who have had unprotected intercourse. Emergency contraception also increases the latitude women have to make reproductive decisions by offering an alternative to abortion and childbearing. The heart of the problem with emergency contraception is not the failure rate or side effects of specific methods but the fact that so few women and adolescents who have had unprotected intercourse know the option exists, and their providers may be reluctant to prescribe the method.

Adolescent↗
PubMed1998

Emergency contraception: the user profile.

UNLABELLED: Emergency contraception (EC) has recently become available, accepted and widely used in Sweden but little is known about the characteristics and background factors of women requesting EC. METHODS: During a four-month period, consecutive women (n = 762) visiting family planning clinics to request emergency contraception filled out a questionnaire about their current need for EC. RESULTS: The user of emergency contraception was typically a nulligravid young woman (83%) but 13% had a previous history of at least one induced abortion and 41% had given birth in the past. One out of four had used EC before, and of these 20% more than once. Condom breakage was the major reason for the current need for EC but as many as 37% had not discussed the need for contraception prior to intercourse. Friends were the most important source of knowledge about EC. CONCLUSION: Women requesting emergency contraception could be anyone and emergency contraception is used to compensate for contraceptive failure in order to prevent unwanted pregnancies.

Adolescent↗
PubMed1999

Factors affecting contraceptive use and behavior in Kocaeli, Turkey.

This study aimed to investigate contraceptive use and its determinants in Kocaeli, Turkey. A questionnaire was applied to 922 randomly selected sexually active women of reproductive age, in order to extract information concerning contraceptive use and sociodemographic factors affecting behavior and contraceptive use. Knowledge of at least one method was nearly universal. Intrauterine devices and withdrawal were the most commonly used methods. Illiterate women and housewives had less knowledge about some modern methods. The number of children (p < 0.001), nuclear type family (p < 0.05), and approval of family planning (p < 0.001) were the factors most predictive of contraceptive use. Husbands were involved in family planning via discussing family size (79.4%) and method (85.5%) 38.2% of males participated actively by using withdrawal or condom. Increasing the literacy of both male and female partners significantly increased both contraceptive use and the participation of husbands in family planning descision making. In conclusion, increasing the education level of couples and the status of women would result in increased contraceptive use in the future. Since the contraceptive behavior of women is influenced by their husbands' attitudes, family planning programs should be focused on the needs of both partners.

Adolescent↗
PubMed2003

Oral contraceptives and the risk of ductal breast carcinoma in situ.

UNLABELLED: Recent evidence suggests that oral contraceptive use is associated with little to no increased risk of invasive breast carcinoma. No study has examined the relationship between oral contraceptive use and the risk of non-invasive breast carcinoma, that is, breast carcinoma in situ. OBJECTIVE: To define the role of oral contraceptive use in the development of breast carcinoma in situ. METHODS: The data are 875 ductal carcinoma in situ (DCIS) cases diagnosed among residents of the state of Connecticut from September 15, 1994 to March 14, 1998 and between the age of 20 and 79 years as well as 999 control subjects. Controls are female Connecticut residents collected via random-digit-dial and frequency matched to the cases by 5-year age intervals. Telephone interviews were used to collect information on risk factors and cancer screening history. Logistic regression was used to provide maximum likelihood estimates of the odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: The risk of being diagnosed with DCIS for women who had ever used oral contraceptives was not increased relative to women who had never used them (OR: 1.0, 95% CI: 0.8, 1.2). The risk did not significantly increase with duration of oral contraceptive use, nor with duration of high estrogen use, time since last use, progestin or estrogen type, or age at first use. Furthermore, the association between oral contraceptive use and DCIS risk did not vary by the presence of a family history of breast cancer or by menopausal status. CONCLUSIONS: In these data, no evidence was found for an increased risk of ductal carcinoma in situ associated with the use of oral contraceptives.

Adult↗
PubMed2002

Clinical risk factors for venous thromboembolus in users of the combined oral contraceptive pill.

AIMS: To estimate the risk of venous thromboembolism among women prescribed the oral contraceptive pill who have acute clinical conditions such as lower limb fractures, compared with women with idiopathic venous thromboembolism. METHODS: A nested case-control analysis using the General Practice Research Database, January 1993 to December 1999 was carried out. The participants were women aged 15-39 years, prescribed third generation oral contraceptives (gestodene and desogestrel) or oral contraceptives containing levonorgestrel. The main outcome measures were odds ratios as a measure of the relative risk estimate for venous thromboembolism in women with clinical conditions that predispose to VTE. RESULTS: The adjusted relative risk estimate for venous thromboembolism among patients with the acute clinical conditions, compared with those without such illness, and adjusted for oral contraceptive use, was 17 (95% CI 6.5, 46). CONCLUSIONS: This paper documents the strong independent association between certain acute clinical conditions and venous thromboembolism in women prescribed oral contraceptives. Failure to accurately identify and exclude such patients from a study of the effect of oral contraceptives on the risk of venous thromboembolism would result in an underestimate of the risk of venous thromboembolism associated with oral contraceptives.

Adolescent↗
PubMed2004

Effects of oral contraceptives on circulating osteoprotegerin and soluble RANK ligand serum levels in healthy young women.

OBJECTIVE: Osteoprotegerin (OPG) represents a secreted cytokine which regulates bone mass by blocking receptor activator of nuclear factor-kappaB ligand (RANKL), the principal regulator of osteoclast function. In vitro, OPG production is upregulated by oestrogens in osteoblastic lineage cells, a mechanism that has been discussed as a protective paracrine mechanism of oestrogens on the skeleton. To define the effects of oestrogens on the RANKL/OPG system in vivo, we evaluated OPG and both free and total soluble RANKL (sRANKL) serum levels in healthy young women with or without oral contraceptives. DESIGN AND PATIENTS: Serum levels of OPG and sRANKL were prospectively assessed in a cohort of healthy young women with (n = 30) or without (n = 25) combined oestrogen-progestin-based oral contraceptives. MEASUREMENTS: OPG, total and free sRANKL serum levels were determined by enzyme-linked immunosorbent assays (ELISA). RESULTS: In women using oral contraceptives, OPG serum levels were significantly higher (2.71 +/- 1.42 pmol/l) compared to nonusers (1.35 +/- 1.02 pmol/l; P = 0.0003), whereas free (P = 0.55) and total (P = 0.24) sRANKL serum levels did not differ between both groups. This resulted in an increased OPG/free sRANKL ratio (P = 0.02) in women on oral contraceptives. During the ovarian cycle, OPG (P = 0.22) and free sRANKL (P = 0.99) serum levels remained unchanged in women without oral contraceptives (n = 19), while total sRANKL levels were higher in the follicular than in the luteal phase (P = 0.02). CONCLUSIONS: Intake of oral contraceptives is associated with increased OPG serum levels, but not sRANKL levels, resulting in a higher OPG/sRANKL ratio. This may contribute to the positive effects of oral contraceptives on the skeleton.

Adult↗
PubMed2001

Effect of second and third generation oral contraceptives on lipid metabolism in the absence or presence of the factor V Leiden mutation.

OBJECTIVES: The effect of a second and third generation oral contraceptive and of the progestagens used in these pills on lipid metabolism was studied in the absence or presence of the factor V Leiden mutation. DESIGN: A single centre, double blind randomized trial. SETTING: University Medical Centre. SUBJECTS: A total of 51 women without and 35 women with the factor V Leiden mutation. INTERVENTIONS: A second generation (30 microg ethinylestradiol/150 microg levonorgestrel) or a third generation (30 microg ethinylestradiol/l 50 microg desogestrel) oral contraceptive. After two cycles of use and a wash-out period of two cycles, the participants received the corresponding progestagen-only preparation containing 150 microg levonorgestrel or 150 microg desogestrel. MAIN OUTCOME MEASURES: Mean difference in changes between the treatment groups on total cholesterol, HDL, LDL, triglycerides and total/HDL cholesterol ratio. RESULTS: Compared with levonorgestrel, desogestrel-containing oral contraceptives caused in women without the factor V Leiden mutation significant changes in HDL (0.43; 95% confidence interval [CI] 0.25-0.61), LDL (-0.55; 95% CI -0.90 to -0.20), triglycerides (0.19; 95% CI 0.06-0.32) and total/ HDL cholesterol ratio (-0.87; 95% CI -1.21 to -0.53). When the progestagen-only preparations were used, differential changes were found for HDL (0.16; 95% CI 0.03-0.29), LDL (-0.31; 95% CI - 0.56 to -0.05) and total/HDL cholesterol ratio (-0.55; 95% CI -0.84 to -0.26). Desogestrel-only caused changes opposite to those of desogestrel-containing oral contraceptives. For cholesterol and triglycerides, this effect was also found for levonorgestrel-only in comparison with levonorgestrel-combined oral contraceptives. Levonorgestrel appeared to induce the effect on HDL. Almost all results were similar for women with the factor V Leiden mutation. CONCLUSION: It appears that desogestrel counteracts the effects of oestrogens to a lesser extent than levonorgestrel. Desogestrel-containing oral contraceptives have therefore a more favourable influence on cholesterol metabolism in comparison with levonorgestrel-containing oral contraceptives.

Adolescent↗
PubMed2000

Oral contraceptives and stroke.

Since 1962, more than 25 studies have been devoted to the relationship between oral contraceptives and stroke. They are all case-control or cohort epidemiological studies and thus contain the difficulties and biases that are inherent in these types of studies. The following conclusions can be drawn from these studies: High oestrogen content (> or = 50 microg) increases the risk of stroke, all stroke subtypes, and stroke death. Low oestrogen content (<50 microg) carries a very low or no risk of stroke. There are no data on progestogen only oral contraceptives. Stroke risk is greatly increased if associated risk factors are present, in particular hypertension, cigarette smoking and migraine. Oral contraceptives, even at low doses, significantly increase the risk of cerebral venous thrombosis, which is further enhanced if congenital thrombophilia is present. The attributable risk of stroke in young women using oral contraceptives is about 1 per 200000 woman-years. The contraceptive and non-contraceptive benefits of low dose oral contraceptives vastly outweigh their risks provided that other risk factors are absent or well controlled.

Brain Ischemia↗
PubMed2003

Interaction between oral contraceptive use and coagulation factor levels in deep venous thrombosis.

Deep venous thrombosis is a multicausal disease, i.e. more than one risk factor needs to be present to cause the disease. Oral contraceptive use increases the risk of venous thrombosis but since not all women using oral contraceptives develop thrombosis, the presence of additional risk factors in patients is likely. The aim of this study was to assess the joint effect of oral contraceptive use and the levels of procoagulant factors (F)(FII, FV, FVII, FVIII, FIX, FX, FXI, FXII, FXIII and fibrinogen). Data of premenopausal women were re-analyzed in the Leiden Thrombophilia Study. The highest relative risks were observed for the combination of oral contraceptive use and high levels (>90th percentile) of FII (Odds Ratio [OR]OC+FII 10.1; 95% confidence interval [CI] 3.5-29.0), FV (OROC+FV 12.6; 95% CI 3.8-41.5), and FXI (OROC+FXI 11.9; 95% CI 3.6-39.2) and low levels (< 10th percentile) of FXII (OROC+FXII 12.3; 95% CI 2.4-63.0). No interaction was observed between oral contraceptive use and high levels of the other coagulation factors, i.e. the joint effect of these risk factors did not exceed the sum of the separate effects. The results of this study indicate that the risk for the joint effects of oral contraceptive use and coagulation factor levels are minor compared with the joint effect of oral contraceptive use and the FV Leiden mutation (RR > 30).

Adolescent↗
PubMed2001

The next step for emergency contraception: over-the-counter availability.

Emergency contraception to prevent pregnancy after episodes of unprotected sexual intercourse has existed since ancient times. Modern medicine began to use hormonal methods in the 1960s, and today emergency contraception is used regularly in many countries. In the United States, providers do not routinely prescribe it, nor do they adequately inform their patients that it is available. This occurs even though sufficient information exists on the safety and efficacy of this method. Because the effectiveness of emergency contraceptive pills relies heavily on prompt administration, better access for patients is essential. Recently, proponents of emergency contraception have attempted to better inform the public of this resource. In addition, two oral contraceptive products are now available and marketed specifically for emergency contraception. The purpose of this article is to discuss the safety and efficacy of emergency contraceptive pills and the potential for them to become available without a prescription.

Contraceptives, Postcoital↗