Contracepção em situações especiais / Contraception in special situations

A decisão de escolha do método contraceptivo em situações clínicas especiais é desafiadora tanto para médicos quanto para pacientes. Em parte, isso se deve às contraindicações reais que alguns contraceptivos apresentam. Porém, há uma estreita relação com a falta de conhecimento e medo de muitos profissionais em prescrever métodos que, na realidade, são seguros. A má escolha do método contraceptivo para pacientes portadoras de condições específicas pode levar a diversos desfechos ruins, como piora da condição de base, ocorrência de eventos adversos indesejáveis e preveníveis e ocorrência de gravidez de alto risco indesejada. Dessa forma, foi realizada uma revisão na literatura com o objetivo de auxiliar profissionais médicos na decisão contraceptiva de pacientes portadoras de doenças reumatológicas e musculoesqueléticas, epilepsia, esclerose múltipla, transtornos alimentares, anemia falciforme e obesidade, e que já foram submetidas a cirurgia bariátrica.(AU)

The decision to choose the contraceptive method in special clinical situations is challenging for both physicians and patients. In part, this is due to the real contraindications that some contraceptives present. However, there is a close relationship with the lack of knowledge and fear of many professionals in prescribing methods that are actually safe. The poor choice of contraceptive method in patients with specific conditions can lead to several bad outcomes, such as worsening of the baseline condition, occurrence of undesirable and preventable adverse events and occurrence of an unwanted high-risk pregnancy. Thus, a literature review was carried out in order to assist medical professionals in the contraceptive decision of patients with rheumatological and musculoskeletal diseases, epilepsy, multiple sclerosis, eating disorders, sickle cell anemia, obesity and who have already undergone bariatric surgery.(AU)

Contracepção pós-parto e pós-abortamento: um compilado das evidências atuais / Postpartum and post-abortion contraception: a compilation of current evidences

Idealmente, a contracepção deve ser iniciada o mais precocemente possível após o parto ou após o abortamento, permitindo que as mulheres sejam protegidas contra uma gravidez não programada subsequente. O objetivo desta revisão é discutir a contracepção no pós-parto e pós-aborto, por meio da análise de ensaios clínicos e metanálises, além das principais diretrizes internacionais, com ênfase nas indicações e contraindicações, tempo de início do uso dos métodos contraceptivos e possíveis complicações. Nesta revisão não sistemática, são discutidos os principais métodos contraceptivos: dispositivos intrauterinos, métodos somente de progestagênios, métodos hormonais combinados, métodos de barreira, método de amenorreia lactacional e esterilização. O aconselhamento contraceptivo pós-parto deve começar durante o pré-natal e, em pacientes após abortamento, durante a internação hospitalar. Todas as mulheres devem ter acesso a informações claras sobre cada método contraceptivo, e o processo de tomada de decisão deve ser compartilhado com o médico assistente. Idealmente, métodos de contracepção reversíveis de longa duração devem ser priorizados em relação aos outros. Em conjunto, todas as evidências demonstram que o melhor método para cada paciente é aquele que combine altas taxas de segurança com o desejo da paciente de iniciá-lo e mantê-lo pelo tempo que desejar.

Contraception should ideally be started as early as possible after childbirth or abortion to allow women to be protected against a subsequent unplanned pregnancy. The aim of this review is to discuss postpartum and postabortion contraception, through the analysis of clinical trials and meta-analyses, in addition to the main international guidelines, with emphasis on indications and contraindications, time to start contraceptive method and possible complications. In this review, the main contraceptive methods are discussed: intrauterine devices, progestin-only methods, combined hormonal methods, barrier methods, lactational amenorrhea method and sterilization. Postpartum contraceptive counseling should start during prenatal care and during hospital stay in post-abortion patients. All women should have access to clear information about each contraceptive method and the decision-making process must be shared. Ideally, long acting reversible contraception methods should be prioritized over others. Taken together, all the evidence shows that the best method for each patient is the one that combines high safety rates with the patient's desire to start and maintain it for as long as she wants.

Body weight changes and duration of estrogen exposure modulate the evolution of hepatocellular adenomas after contraception discontinuation.

BACKGROUND AND AIMS: The natural history of hepatocellular adenomas (HCAs) remains to be better described, especially in nonresected patients. We aim to identify the predictive factors of HCA evolution after estrogen-based contraception discontinuation. APPROACH AND RESULTS: We retrospectively included patients with a histological diagnosis of HCA from three centers. Clinical, radiological, and pathological data were collected to identify predictive factors of radiological evolution per Response Evaluation Criteria in Solid Tumors, version 1.1, and occurrence of complications (bleeding, malignant transformation). We built a score using variables that modulate estrogen levels: body mass index and duration of estrogen-based contraception. An external cohort was used to validate this score. 183 patients were included in the cohort, including 161 women (89%) using estrogen-based contraception for a median of 12 years. Thirty percent of patients had at least one HNF1A -inactivated HCA, 45.5% at least one inflammatory HCA, and 11% at least one HCA with activation of ß-catenin (bHCA). Twenty-one symptomatic bleedings (11%) and eleven malignant transformations (6%) occurred. Ages < 37 years old ( p = 0.004) and HCA > 5 cm at imaging were independently associated with symptomatic bleeding ( p = 0.003), whereas a bHCA was associated with malignant transformation ( p < 0.001). After a median follow-up of 5 years, radiological regression was observed in 31%, stabilization in 47%, and progression in 22% of patients. Weight loss was associated with regression ( p < 0.0001) and weight gain with progression ( p = 0.02). The estrogen exposure score predicted radiological regression (odds ratio, 2.33; confidence interval 95%, 1.29-4.19; p = 0.005) with a linear relationship between the rate of estrogen exposure and the probability of regression. This result was confirmed in an external cohort of 72 female patients ( p = 0.003). CONCLUSION: Weight variation is strongly associated with radiological evolution after oral contraception discontinuation. A score of estrogen exposure, easily assessable in clinical practice at diagnosis, predicts regression of HCA.

Estrogen-Eluting Ring for Contraception and Possible Issues of Severe Pulmonary Emboli.

BACKGROUND This case report demonstrates the relationship of an estrogen-eluting vaginal ring and thrombosis. There have been multiple reports in the literature demonstrating this scenario, but it is normally found that the patient is taking the medication orally. In this unique report we present the case of a patient with an acute severe pulmonary embolus while using an estrogen-eluting vaginal ring, with no other significant risk factors. CASE REPORT A 27-year-old African American woman who came to the Emergency Department due to new shortness of breath and tachycardia. She was discovered to have a pulmonary embolus found on CTA pulmonary. On further questioning, the patient noted using an estrogen-eluting ring for contraception. CONCLUSIONS We postulate that her use of this estrogen-eluting ring likely played a large part in her developing a pulmonary embolus, as this patient had little to no risk of developing a pulmonary embolism.

[An update in intrauterine contraception]. / Nouveautés en contraception intra-utérine.

Intrauterine devices (IUD) are the oldest of the modern contraceptives. There are currently two types of IUDs: copper IUD (Cu-IUD) and levonorgestrel IUD (LNG-IUD). Both offer high contraceptive effectiveness. Although they have been used for decades, the literature still brings its share of new information on IUDs: impact on oncological risk, non-contraceptive benefits, rare adverse effects, and impact on women's well-being. In addition, Cu-DIU is recognized as the most effective emergency contraceptive and can be inserted up to 5-7 days after the at-risk sexual intercourse. Research is now looking at the effectiveness of LNG-IUD in emergency contraception. Finally, new IUD concepts are also being evaluated: they should allow a reduction in the rate of expulsion, intermenstrual and heavy menstrual bleeding, an increase in comfort and in IUDs duration of use. This article makes an update on the latest developments in terms of intrauterine contraceptives.

Le dispositif intra-utérin (DIU) est le plus ancien des contraceptifs modernes. On distingue les DIU au cuivre (Cu-DIU) et les DIU au lévonorgestrel (LNG-DIU). Ils offrent une haute efficacité contraceptive. Bien qu'ils soient utilisés depuis des décennies, la littérature apporte encore aujourd'hui son lot de nouvelles informations sur les DIU: impact sur le risque oncologique, bénéfices non contraceptifs, effets indésirables rares et impact sur le bien-être des femmes. Par ailleurs, le Cu-DIU est reconnu comme étant le contraceptif d'urgence le plus efficace, pouvant être inséré jusqu'à 5-7 jours après le rapport à risque. La recherche se penche maintenant sur l'efficacité du LNG-DIU en contraception d'urgence. Enfin, de nouveaux concepts de DIU sont aussi à l'étude : ils devraient permettre une réduction du taux d'expulsion, une diminution des méno- et métrorragies, une augmentation du confort et une plus longue durée d'utilisation. Cet article fait le point sur les dernières nouveautés en termes de contraceptifs intra-utérins.

Exogenous Hormones and Breast Cancer Risk: Contraception, Menopausal Hormone Therapy, and Breast Cancer Survivors.

The use of exogenous estrogen and progesterone/progestin medications spans the reproductive and postreproductive lives of millions of women providing control over pregnancy timing, management of premenopausal and postmenopausal symptoms, and prevention of disease, including endometrial and ovarian cancer. These same hormones can also increase the risk of breast cancer in some settings and their use in breast cancer survivors may increase the risk of breast cancer recurrence. Given both the benefits and risks of these exogenous hormones, a detailed understanding of the available scientific evidence is imperative to help counsel individuals in their use across various settings.

Surgical contraception of free-ranging female capybaras: Description and comparison of open and minimally invasive techniques.

OBJECTIVE: To develop, describe, and evaluate 2 surgical techniques for contraception of free-ranging female capybaras. STUDY DESIGN: Prospective study. ANIMALS: Cadaveric (n = 3) and free-ranging female capybaras (n = 21). METHODS: Preliminary studies of surgical anatomy were performed on 3 capybara cadavers. Two different techniques for partial salpingectomy were evaluated in free-ranging female capybaras: bilateral minilaparotomy (LTG; n = 11) or bilateral laparoscopy (LCG; n = 10). Data concerning body weight, tubal ligation time, total surgical time, incision size, and intraoperative and postoperative complications were analyzed, as well as the clinical status and incisional healing 1 week postoperatively. RESULTS: Body weight (P = .214), ligation time of the left uterine tube (P = .901), and total surgical time (P = .473) were similar between the experimental groups. The ligation time of the right uterine tube was shorter in the LCG group (P = .0463). In the LTG, no differences were observed between the sides regarding the incision size (P = .478). No major intraoperative or postoperative complications occurred in either group. One LCG procedure had to be converted to LTG due to technical issues. All skin incisions healed without complication. CONCLUSION: Both procedures showed similar and satisfactory outcomes. CLINICAL SIGNIFICANCE: The proposed techniques may be a suitable alternative to conventional laparotomy for contraception of female capybaras, especially under field conditions.

Association between contraceptive use and risk of lower urinary tract infection (LUTI): A case-control study.

AIM: The aim of this study was to analyze the association between widely used contraceptive methods and the manifestation of lower urinary tract infections (LUTI) in patients treated in gynecological practices in Germany. MATERIALS AND METHODS: This study was based on IQVIA Disease Analyzer database and includes a total of 133,638 females aged between 16 and 50 years who received an initial diagnosis of LUTI including cystitis (ICD-10: N39.0, N30.0) between January 2011 and December 2020 (index date). 1 : 1 matching of LUTI cases to non-LUTI controls was used to investigate the association between predefined criteria and LUTI. A greedy nearest neighbor propensity score method was used to balance cases and controls with respect to age, pregnancy, visit frequency during the observation period, and comorbidities including cancer, diabetes mellitus, and urolithiasis. Univariate logistic regression models were used to assess the association between contraceptive prescriptions and LUTI. RESULTS: The general use of any contraceptive method was negatively associated with subsequent LUTI. Injectable contraceptives and pills were negatively associated with LUTI manifestation. There was a significant negative association between monophasic preparations containing < 50 µg estrogen, triphasic preparations, and progestogen-only preparations and LUTI. By contrast, we found a significant positive association between emergency contraceptives and LUTI. CONCLUSION: The general application of birth control methods as well as the use of injectable contraceptives and oral contraceptives were negatively associated with LUTI manifestation. In contrast to other birth control methods, the intake of emergency contraception was positively associated with a manifestation of LUTI.

Which Hormones and Contraception for Women with APS? Exogenous Hormone Use in Women with APS.

PURPOSE OF REVIEW: Use of exogenous estrogen carries significant risk for patients with prothrombotic disorders including those with antiphospholipid antibody (aPL) and antiphospholipid syndrome (APS). This review summarizes current knowledge of contraceptive and other hormone therapies for aPL-positive and APS women and highlights knowledge gaps to guide future research. RECENT FINDINGS: Studies support very low risk for most progestin-only contraceptives in patients with increased thrombotic risk, but suggest increased VTE risk with depot-medroxyprogesterone acetate. Highest efficacy contraceptives are intrauterine devices and subdermal implants, and these are recommended for women with aPL/APS. Progestin-only pills are effective and low risk. Perimenopausal symptoms may be treated with nonhormone therapies in aPL/APS patients: vasomotor symptoms can improve with nonhormonal medications and cognitive behavioral therapy, and genitourinary symptoms often improve with intravaginal estrogen that has limited systemic absorption.

Pharmacokinetics, metabolism and serum concentrations of progestins used in contraception.

Many different forms of hormonal contraception are used by millions of women worldwide. These contraceptives differ in the dose and type of synthetic progestogenic compound (progestin) used, as well as the route of administration and whether or not they contain estrogenic compounds. There is an increasing awareness that different forms of contraception and different progestins have different side-effect profiles, in particular their cardiovascular effects, effects on reproductive cancers and susceptibility to infectious diseases. There is a need to develop new methods to suit different needs and with minimal risks, especially in under-resourced areas. This requires a better understanding of the pharmacokinetics, metabolism, serum and tissue concentrations of progestins used in contraception as well as the biological activities of progestins and their metabolites via steroid receptors. Here we review the current knowledge on these topics and identify the research gaps. We show that there is a paucity of research on most of these topics for most progestins. We find that major impediments to clear conclusions on these topics include a lack of standardized methodologies, comparisons between non-parallel clinical studies and variability of data on serum concentrations between and within studies. The latter is most likely due, at least in part, to differences in intrinsic characteristics of participants. The review highlights the importance of insight on these topics in order to provide the best contraceptive options to women with minimal risks.

Hormonal Contraceptives and Dermatology.

Hormones play a significant role in normal skin physiology and many dermatologic conditions. As contraceptives and hormonal therapies continue to advance and increase in popularity, it is important for dermatologists to understand their mechanisms and dermatologic effects given the intricate interplay between hormones and the skin. This article reviews the dermatologic effects, both adverse and beneficial, of combined oral contraceptives (COCs), hormonal intrauterine devices (IUDs), implants, injections, and vaginal rings. Overall, the literature suggests that progesterone-only methods, such as implants and hormonal IUDs, tend to trigger or worsen many conditions, including acne, hirsutism, alopecia, and even rosacea. Therefore, it is worthwhile to obtain detailed medication and contraceptive histories on patients with these conditions. There is sufficient evidence that hormonal contraceptives, particularly COCs and vaginal rings, may effectively treat acne and hirsutism. While there are less data to support the role of hormonal contraceptives in other dermatologic disorders, they demonstrate potential in improving androgenetic alopecia and hidradenitis suppurativa.

A influência do sobrepeso/ obesidade sobre o uso do levonorgestrel como método contraceptivo de emergência / The influence of overweight/obesity over the use of levonorgestrel as an emergency contraceptive method

A contracepção de emergência tem como objetivo prevenir uma gravidez indesejada após uma relação sexual desprotegida, falha do método contraceptivo regular ou agressão sexual. Dentre os métodos disponíveis atualmente, destaca-se a pílula hormonal de levonorgestrel (LNG) como uma das principais estratégias utilizadas, tendo em vista o perfil de segurança desse fármaco e a facilidade de acesso e utilização dele. No entanto, embora o efeito de tal molécula seja satisfatório, pesquisas sugerem que altos índices de massa corporal implicam uma redução da eficácia contraceptiva da pílula de LNG. Nesse sentido, esse estudo visa evidenciar, mediante revisão de literatura, a relação entre esse fármaco e sua competência em mulheres com sobrepeso ou obesidade, bem como expor quais medidas devem ser tomadas para evitar a gravidez indesejada nessas pacientes. Embora existam divergências, foi observado que a maior parte dos estudos indica que a composição corporal das pacientes pode influenciar na eficácia contraceptiva da molécula de LNG, de forma sinérgica ou não com outros fatores, especialmente quando considerado o IMC > 25 kg/m² ou peso > 75 kg, uma vez que o risco de gravidez pode aumentar de 1,5 até 4,4 vezes quando comparado aos padrões de normalidade, com tendência de crescimento em relação aos parâmetros de sobrepeso/obesidade.(AU)

The main goal of the emergency contraceptive is to prevent a non-planned pregnancy after the sexual relationship without condom, after the fail of the usual contraceptive or the sexual assault. Among all the currently available methods, the hormonal pill of levonorgestrel (LNG) has its importance as one of the most used strategies, due of its safety, easy access and use. However, in spite of the fact that this molecule has a good effect, some researches suggest that a high level of the body mass reduces the efficacy of the contraceptive pill of LNG. In this context, this study objective is to clarify, by using literature review, the relation between this drug and its competence in overweight/obese women, as well to expose which other options could be taken to avoid a non-planned pregnancy in those patients. Despite of the fact that there are divergences, the most part of the studies shows that patient's body composition can influence on the contraceptive effectiveness of the LNG molecule, sinergically or not to other factors, especially when the IMC > 25 kg/m² or the body weight > 75 kg, once the pregnancy risk can be raised from 1,5 to 4,4 times when compared to regular standards, with growth tendency when related to overweigh/obesity parameters.(AU)

Relationship between contraceptive methods and human papillomavirus positivity.

PURPOSE: Understanding the effect of contraceptive use on high-risk human papillomavirus (HPV) positivity may provide information that is valuable to women in contraceptive decision-making. This study includes women aged 30-65 years who admitted to Family Planing outpatient clinic and have hrHPVDNA positivity. METHODS: We included a total of 801 women. All participants underwent national cervical cancer screening using HPV screening test conducted by the Cancer Control Department of the Ministry of Health. They completed a questionnaire on demographic information and potential risk factors. RESULTS: The HPV DNA positivity rate among all participants was 8.4%. The two most common HPV genotypes were HPV16 and HPV51. Meanwhile, hrHPV infection was associated with age, marital status, smoking status, and contraceptive method. CONCLUSION: HPV is the most common cause of sexually transmitted diseases. Understanding about the reproductive and demographic characteristics affecting HPV persistence is crucial. The effect of contraceptive methods on HPV positivity is important information that is necessary to be relayed to women by healthcare professionals.

[Stratification of cardiovascular risk in women: Optimize the medical care]. / Stratification du risque cardiovasculaire de la femme : optimiser les prises en charge.

Cardiovascular diseases are become the primary cause of death in women. The cardiovascular risk of the woman has unknown specificities and remains underestimated. At equal age, women have more cardio vascular risk factors than men. All these specificities must be taken into account for an optimized evaluation of cardiovascular risk and for improvement of CV management in women. Some traditional risk factors are more deleterious in women such as hypertension, tobacco, diabetes or psycho-social stress and they are less well controlled compared to men. Women are also exposed to hormonal risk factors (contraception, pregnancy and menopause) or to emergent risk situations (migraine with aura, endometriosis, polycystic ovary syndrome, auto-immune diseases…). Conversely, lifestyle measures (regular physical activity, no smoking, healthy diet, stress management) are extremely effective in primary and secondary prevention in women. Predicting the risk of cardiovascular events in women is difficult because the classic risk scores (SCORE, Framingham…) do not take into account hormonal CV specificities and underestimate the women CV risk. Until then, only the specific women AHA stratification of CVR allowed for appropriate care for them. Recently, at the initiative of the French Society of hypertension, a consensus of experts proposed a stratification of CVR adapted to French women, to help practitioners in their care, especially for the two hormonal periods as contraception and menopause.

Oral contraceptive and breast cancer: do benefits outweigh the risks? A case - control study from Jordan.

BACKGROUND: Oral contraceptives (OCs) use has been linked to increased risk of breast cancer (BC) in several reports from the world. Limited number of similar studies have been conducted in the Middle Eastern female population. This study aimed to explore any possible correlation between the contemporary and duration of OCs use among Jordanian women and the risk of breast cancer. METHODS: A case control study was conducted in 450 Jordanian women (225 as cases and 225 as controls), aged 18 to 65. Chi-square test was used to study the association between risk of breast cancer and different factors. Mann Whitney-U test was employed to evaluate the relation between time-dependent risk factor and breast cancer. RESULTS: Our results indicated that regular use of OCs exhibited association with increased risk of breast cancer (OR = 2.25, 95% CI 1.34-2.79; p = 0.002), while the duration of OCs use was not associated with the increased risk of breast cancer (p > 0.05). In addition, other factors demonstrated significant association with the increased risk of breast cancer such as age at puberty, age at menopause, previous pregnancies, menopausal status, and family history of cancer. CONCLUSIONS: regular use of OCs may be associated with increased risk of breast cancer in Jordanian women. A larger sample size in multi-center setting study is required to confirm this finding among the Jordanian female population.

Contraception in cancer survivors - an expert review Part I. Breast and gynaecological cancers.

Objective: The efficacy of treatment for many cancers has increased dramatically in recent decades and there are a growing number of cancer survivors who need effective contraception. In this paper, a group of experts from the European Society of Contraception set out to define the most frequent cancers in women and summarise the guidelines, reviews and studies that provide information and guidance on contraception for each cancer. Methods: Epidemiological studies were analysed to determine the frequency of cancers in women of reproductive age. A narrative review was performed for each cancer, collecting data about the treatment of the disease, its impact on fertility, and the efficacy, health risks, possible benefits and contraindications of the contraceptive methods available. The recommendations were then summarised. Results: Owing to a large amount of information, the results are presented in two parts. Part 1 includes contraception after breast and gynaecological cancers. Part 2 summarises the findings and recommendations regarding contraception in women with skin, gastrointestinal, haematological and endocrine cancers.

Induced Abortion, Birth Control Methods, and Breast Cancer Risk: A Case-Control Study in China.

BACKGROUND: The association between induced abortion and birth control methods (including oral contraceptives and intrauterine devices) and breast cancer may vary among countries, due to the different usage and frequency of birth control methods and induced abortion among countries. A better understanding of this association may help in determining safer birth control methods for Chinese women. METHODS: A case-control study was conducted with a total of 794 cases and 805 controls. Standardized questionnaires were used to collect information on demographic characteristics, exposure to induced abortion, birth control methods, and other risk factors for breast cancer. Multivariate logistic regression was conducted to explore the association between birth control methods and breast cancer. RESULTS: Multivariate logistic regression analyses showed that having a history of medical abortions, ≥3 surgical abortions, or both medical and surgical abortions was associated with an increased risk of breast cancer in post-menopausal women (odds ratio [OR] 2.48; 95% confidence interval [CI], 1.14-5.40). Pre-menopausal women who had used intra-uterine devices (IUDs) for more than 20 years tended to have a lower breast cancer risk than other age-matched pre-menopausal women (OR 0.41; 95% CI, 0.25-0.68). Both pre-menopausal and post-menopausal women who had <20 years exposure to IUDs and those who had used two or more birth control methods (with the exception of women who used IUDs for more than 20 years) tended to have much higher breast cancer risk. CONCLUSION: The relationship between induced abortion and birth control methods and breast cancer was complex, though being exposed to induced abortion and two or more birth control methods in one's lifetime appeared to be risk factors for breast cancer in Chinese women.

A utilização de contraceptivos hormonais por adolescentes e potenciais riscos para a saúde / The use of hormonal contraceptives by adolescents and potential health risks

Reunir informações referentes aos riscos do uso de contraceptivos hormonais por adolescentes. Revisão integrativa da literatura científica dos últimos 10 anos. Incluídos os estudos sobre uso de anticoncepcional por adolescentes e os riscos associados. Estratégia de busca baseou-se na combinação dos descritores "adolescente", "saúde do adolescente", "anticoncepção", "fatores de risco" e "efeitos adversos" e seus respectivos mesh terms resultando em 73 artigos. Aplicando-se critérios de exclusão, restaram 22 artigos que foram analisados e agrupados em quadros. A literatura nacional e internacional menciona os métodos contraceptivos hormonais como seguros para uso por adolescentes porém ressaltam riscos cardiovasculares, alterações em gestações futuras e prejuízos ao sistema osteomuscular observados nas amostras estudadas, entre outros. A utilização de contracepção hormonal em adolescentes necessita de atenção e manejo cuidadoso para avaliação dos riscos e benefícios. Mais estudos abordando essa temática devem ser realizados para melhor esclarecimento sobre o assunto. (AU)

To gather information related to the risks of the use of hormonal contraceptives by teenagers. An integrative review of the scientific literature of the past 10 years. Studies investigating the use of contraceptives by teenagers and the associated risks were included. Search strategy was based on the combination of descriptors "teen", "teen health", "contraception", "risk factors" and "adverse effects" and their respective mesh terms, resulting in 73 articles. After exclusion criteria were applied, 22 articles remained to be analyzed, and their data were grouped into charts. The national and international literatures consider hormonal contraceptive methods to be safe for use by teenagers, but mention cardiovascular risks, changes in future pregnancies and damages to the musculoskeletal system, among others, as potential complications observed in the samples. The use of hormonal contraception in adolescents requires attention and careful management to assess risks and benefits. Further studies should be conducted to clarify this topic. (AU)

[Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]. / Contraception : Recommandations pour la Pratique Clinique du CNGOF (texte court).

The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.

Human papilloma virus genotype distribution and risk factor analysis amongst reproductive-age women in urban Gambia.

PURPOSE: Cervical cancer is the most frequently diagnosed female cancer in The Gambia, representing approximately 30 % of cases. In 2014, the quadrivalent human papilloma virus (HPV) vaccine was introduced, which offers protection against HPV genotypes 6, 11, 16 and 18. To evaluate the potential effectiveness of this vaccine, genotype distribution and risk factor analysis were assessed. METHODOLOGY: Endocervical samples (n=232) were collected from women aged 20-49 years residing in urban Gambia. A questionnaire was administered to capture socio-demographic and cervical cancer risk factors. HPV detection and genotyping was performed by PCR amplification of the L1 major capsid gene and analysis of sequenced PCR products.Results/Key findings. The prevalence of HPV was 12 % (28/232), and the high-risk (HR) genotype HPV 52 (5/28) was the most prevalent genotype. HR-HPV sequences had high identity (≥90 %) to isolates which originated from America, Europe and Asia but not from Africa. Half (14/28) of participants were co-infected with Ureaplasma urealyticum/parvum, which increases the risk of progression to cervical cancer. Female genital mutilation and the use of hormone contraception for >5 years were identified as potential risk factors for HPV infection. Ethnicity-associated differences were also noted; participants of the Fula ethnic group had a higher prevalence of HR-HPV infection (31.3 %) compared to the Mandinka (18.8 %) and Wollof (12.5 %) groups. CONCLUSION: These data may have a significant public health impact as the HPV quadrivalent vaccine may be of limited value if the circulating non-HPV 16/18 HR-genotypes are responsible for cytological abnormalities of the cervix.