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1.
J Obstet Gynecol Neonatal Nurs ; 53(5): 464-476, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39153740

RESUMO

In July 2023, the U.S. Food and Drug Administration approved Opill (norgestrel 0.075 mg), a progestin-only tablet to prevent pregnancy to be used without a prescription. Although progestin-only birth control pills were approved in 1973, it has taken 50 years for the first oral contraceptive pills to be sold over the counter. In this column, I review the evidence on the barriers to access oral contraceptive pills, the efficacy, preferences and support of a nonprescription progestin-only pill, the cost, and policy implications for health insurance coverage. I conclude with recommendations from professional organizations on over-the-counter access to hormonal contraception.


Assuntos
Medicamentos sem Prescrição , Humanos , Feminino , Estados Unidos , United States Food and Drug Administration , Anticoncepcionais Orais/administração & dosagem , Acessibilidade aos Serviços de Saúde , Aprovação de Drogas , Gravidez
2.
BMC Pregnancy Childbirth ; 24(1): 533, 2024 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-39138569

RESUMO

BACKGROUND: There are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI. METHOD: This retrospective cohort study was initiated in 2016-2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses. RESULT: Sixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9% vs. 40.4%, P = 0.008). There was a greater chance of CV events in women with OCP usage (OR = 3.546, P = 0.038) and a lower chance of CV events in women with greater age at menarche (OR = 0.630, P = 0.009) and longer breastfeeding duration (OR = 0.798, P = 0.041) according to multiple backward logistic regression models. CONCLUSION: Based on this study, OCP consumption is a risk factor, while older age at menarche and longer duration of breastfeeding are protective factors for cardiovascular outcomes in women after STEMI.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Feminino , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Irã (Geográfico)/epidemiologia , Fatores de Risco , Anticoncepcionais Orais/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , História Reprodutiva , Diabetes Mellitus/epidemiologia , Aleitamento Materno/estatística & dados numéricos
3.
J Adolesc Health ; 75(3): 479-486, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39001754

RESUMO

PURPOSE: Oral contraception is one of the most popular contraceptive methods both in adults and adolescents. However, the effects of oral contraception on lipids in adolescents are not well studied. METHODS: Lipid profiles were measured and contraceptive use was assessed in 14- to 19-year-old female participants of the prospective population-based Early Vascular Ageing-Tyrol Study between 2015 and 2018, twice on average 22 months apart. RESULTS: For this analysis, data from 828 young women with a median age of 17.0 years were available. Of them, 317 (38%) used oral contraceptives (OCs). OC users had a slightly higher systolic and diastolic blood pressure and larger changes over time and were more likely to use cigarettes than nonusers. Total cholesterol (179.6 vs. 162.4 mg/dL), low-density lipoprotein-cholesterol (106.4 vs. 94.6 mg/dL), and triglycerides (104.0 vs. 67.0 mg/dL) were significantly higher in OC users after multivariable adjustment in linear regression models. No difference in high-density lipoprotein-cholesterol between the two groups was found. In 558 females, follow-up data were available. Those who initiated OC use had on average 15.4 mg/dL higher low-density lipoprotein-cholesterol and 36.2 mg/dL higher triglyceride level changes between baseline and follow-up than never users. Duration of OC use did not show a significant association with lipid levels and changes. DISCUSSION: We showed an independent association between OC use and blood lipids as well as lipid trajectories over time in a large cohort of healthy adolescents. These changes are especially relevant to consider in adolescents with other risk factors for dyslipidemia or other cardiovascular risk factors.


Assuntos
Anticoncepcionais Orais , Humanos , Adolescente , Feminino , Anticoncepcionais Orais/administração & dosagem , Estudos Prospectivos , Adulto Jovem , Lipídeos/sangue , Triglicerídeos/sangue , Pressão Sanguínea/efeitos dos fármacos , LDL-Colesterol/sangue , Colesterol/sangue
4.
Clin Transl Gastroenterol ; 15(8): e00748, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38994837

RESUMO

INTRODUCTION: An association between female sex hormones and inflammatory bowel disease (IBD) has been reported in epidemiological studies. However, a solid causal relationship has not been established. Therefore, we performed a 2-sample Mendelian randomization (MR) study to explore the causal association between genetically predicted female sex hormone exposure, especially estrogen, and IBD. METHODS: Genetic variants for female sex hormone exposure (ovulatory function, reproductive function, oral contraceptive pills, and hormone replacement therapy) were obtained from genome-wide association studies. Summary statistics for IBD were derived from the International Inflammatory Bowel Disease Genetics Consortium. We applied inverse variance weighted (IVW), MR-Egger, and weighted median (WM) methods in this MR study. Heterogeneity, horizontal pleiotropy, and sensitivity analyses were conducted to confirm the accuracy and robustness of our results. RESULTS: Our study found that genetically predicted age at menarche was associated with an increased risk of Crohn's disease (odds ratio [OR] IVW 1.235, 95% confidence interval [CI] 1.028-1.484, P = 0.024), genetically predicted age of the last used hormone replacement therapy was associated with an increased risk of ulcerative colitis (OR WM 1.636, 95% CI 1.011-2.648, P = 0.045), and genetically predicted number of live births was related to a decreased risk of Crohn's disease (OR IVW 0.583, 95% CI 0.373-0.912, P = 0.018). DISCUSSION: This study provided evidence for a link between female sex hormone exposure, especially estrogen, and IBD. Further investigations are needed to explore the causal effect of estrogen on IBD activity and the underlying mechanism of estrogen in IBD.


Assuntos
Colite Ulcerativa , Doença de Crohn , Estudo de Associação Genômica Ampla , Menarca , Análise da Randomização Mendeliana , Humanos , Feminino , Menarca/genética , Colite Ulcerativa/genética , Colite Ulcerativa/epidemiologia , Doença de Crohn/genética , Doença de Crohn/epidemiologia , Estrogênios , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Hormônios Esteroides Gonadais
5.
Calcif Tissue Int ; 115(4): 382-392, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39066926

RESUMO

To explore how sex hormone fluctuations may affect bone metabolism, this study aimed to examine P1NP and ß-CTX-1 concentrations across the menstrual and oral contraceptive (OC) cycle phases in response to running. 17ß-oestradiol, progesterone, P1NP and ß-CTX-1 were analysed pre- and post-exercise in eight eumenorrheic females in the early-follicular, late-follicular, and mid-luteal phases, while 8 OC users were evaluated during the withdrawal and active pill-taking phases. The running protocol consisted of 8 × 3min treadmill runs at 85% of maximal aerobic speed. 17ß-oestradiol concentrations (pg·ml-1) were lower in early-follicular (47.22 ± 39.75) compared to late-follicular (304.95 ± 235.85;p = < 0.001) and mid-luteal phase (165.56 ± 80.6;p = 0.003) and higher in withdrawal (46.51 ± 44.09) compared to active pill-taking phase (10.88 ± 11.24;p < 0.001). Progesterone (ng·ml-1) was higher in mid-luteal (13.214 ± 4.926) compared to early-follicular (0.521 ± 0.365; p < 0.001) and late-follicular phase (1.677 ± 2.586;p < 0.001). In eumenorrheic females, P1NP concentrations (ng·ml-1) were higher in late-follicular (69.97 ± 17.84) compared to early-follicular (60.96 ± 16.64;p = 0.006;) and mid-luteal phase (59.122 ± 11.77;p = 0.002). ß-CTX-1 concentrations (ng·ml-1) were lower in mid-luteal (0.376 ± 0.098) compared to late-follicular (0.496 ± 0.166; p = 0.001) and early-follicular phase (0.452 ± 0.148; p = 0.039). OC users showed higher post-exercise P1NP concentrations in withdrawal phase (61.75 ± 8.32) compared to post-exercise in active pill-taking phase (45.45 ± 6;p < 0.001). Comparing hormonal profiles, post-exercise P1NP concentrations were higher in early-follicular (66.91 ± 16.26;p < 0.001), late-follicular (80.66 ± 16.35;p < 0.001) and mid-luteal phases (64.57 ± 9.68;p = 0.002) to active pill-taking phase. These findings underscore the importance of studying exercising females with different ovarian hormone profiles, as changes in sex hormone concentrations affect bone metabolism in response to running, showing a higher post-exercise P1NP concentrations in all menstrual cycle phases compared with active pill-taking phase of the OC cycle.


Assuntos
Biomarcadores , Anticoncepcionais Orais , Ciclo Menstrual , Corrida , Humanos , Feminino , Ciclo Menstrual/fisiologia , Corrida/fisiologia , Adulto , Anticoncepcionais Orais/administração & dosagem , Adulto Jovem , Biomarcadores/sangue , Biomarcadores/análise , Progesterona/sangue , Estradiol/sangue , Remodelação Óssea/fisiologia , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/metabolismo , Osso e Ossos/efeitos dos fármacos
6.
Front Endocrinol (Lausanne) ; 15: 1354214, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38948525

RESUMO

Background: Polycystic ovary syndrome (PCOS) is both a common endocrine syndrome and a metabolic disorder that results in harm to the reproductive system and whole-body metabolism. This study aimed to investigate differences in the serum metabolic profiles of patients with PCOS compared with healthy controls, in addition to investigating the effects of compound oral contraceptive (COC) treatment in patients with PCOS. Materials and methods: 50 patients with PCOS and 50 sex-matched healthy controls were recruited. Patients with PCOS received three cycles of self-administered COC treatment. Clinical characteristics were recorded, and the laboratory biochemical data were detected. We utilized ultra-performance liquid chromatography-high-resolution mass spectrometry to study the serum metabolic changes between patients with PCOS, patients with PCOS following COC treatment, and healthy controls. Result: Patients with PCOS who received COC treatment showed significant improvements in serum sex hormone levels, a reduction in luteinising hormone levels, and a significant reduction in the levels of biologically active free testosterone in the blood. Differential metabolite correlation analysis revealed differences between PCOS and healthy control groups in N-tetradecanamide, hexadecanamide, 10E,12Z-octadecadienoic acid, and 13-HOTrE(r); after 3 months of COC treatment, there were significant differences in benzoic acid, organic acid, and phenolamides. Using gas chromatography-mass spectrometry to analyse blood serum in each group, the characteristic changes in PCOS were metabolic disorders of amino acids, carbohydrates, and purines, with significant changes in the levels of total cholesterol, uric acid, phenylalanine, aspartic acid, and glutamate. Conclusion: Following COC treatment, improvements in sex hormone levels, endocrine factor levels, and metabolic levels were better than in the group of PCOS patients receiving no COC treatment, indicating that COC treatment for PCOS could effectively regulate the levels of sex hormones, endocrine factors, and serum metabolic profiles.


Assuntos
Metabolômica , Síndrome do Ovário Policístico , Humanos , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/tratamento farmacológico , Síndrome do Ovário Policístico/metabolismo , Feminino , Metabolômica/métodos , Adulto , Adulto Jovem , Estudos de Casos e Controles , Metaboloma/efeitos dos fármacos , Testosterona/sangue , Anticoncepcionais Orais/uso terapêutico , Anticoncepcionais Orais Combinados/uso terapêutico , Biomarcadores/sangue
7.
Sci Rep ; 14(1): 16365, 2024 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-39013992

RESUMO

This study aimed to evaluate the effects of oral contraceptive (OC) use, khat chewing, and their combined effect on telomerase level and tumor suppressor genes, p53 and p21 in breast cancer (BC) patients and normal volunteers. 140 Yemeni women aged 25-40 years old enrolled, 60 newly diagnosed pretreated BC patients, and 80 control subjects. Venous blood (5 ml) was collected and the results showed BC patients to have significantly raised levels of telomerase, p53, and p21 compared to the control group. The use of OCs significantly raised telomerase in control group with no effect in BC patients; whereas p53 and p21 were significantly increased in BC patients. On the other hand, khat chewing significantly increased p53 in controls and BC patients, whereas p21 was significantly raised in BC patients. The combined use of OCs and khat chewing significantly increased telomerase and p53 in control group, and significantly increased p53 and p21 in BC patients. Telomerase was shown to be a risk factor (OR 4.4) for BC, and the use of OCs was a high-risk factor for increasing telomerase (OR 27.8) in normal subjects. In contrast, khat chewing was shown to be protective (OR 0.142), and the combined use of OCs and khat chewing decreased the risk factor of telomerase from OR 27.8 to 2.1.


Assuntos
Neoplasias da Mama , Catha , Inibidor de Quinase Dependente de Ciclina p21 , Telomerase , Proteína Supressora de Tumor p53 , Humanos , Feminino , Telomerase/genética , Telomerase/metabolismo , Neoplasias da Mama/genética , Adulto , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo , Inibidor de Quinase Dependente de Ciclina p21/genética , Inibidor de Quinase Dependente de Ciclina p21/metabolismo , Anticoncepcionais Orais/efeitos adversos , Estudos de Casos e Controles
8.
Physiol Rep ; 12(13): e16144, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38991985

RESUMO

Previous research has demonstrated that oral contraceptive (OC) users have enhanced cardiorespiratory responses to arm metaboreflex activation (i.e., postexercise circulatory occlusion, PECO) and attenuated pressor responses to leg passive movement (PM) compared to non-OC users (NOC). We investigated the cardiorespiratory responses to arm or leg metaboreflex and mechanoreflex activation in 32 women (OC, n = 16; NOC, n = 16) performing four trials: 40% handgrip or 80% plantarflexion followed by PECO and arm or leg PM. OC and NOC increased mean arterial pressure (MAP) similarly during handgrip, plantarflexion and arm/leg PECO compared to baseline. Despite increased ventilation (VE) during exercise, none of the women exhibited higher VE during arm or leg PECO. OC and NOC similarly increased MAP and VE during arm or leg PM compared to baseline. Therefore, OC and NOC were similar across pressor and ventilatory responses to arm or leg metaboreflex and mechanoreflex activation. However, some differences due to OC may have been masked by disparities in muscle strength. Since women increase VE during exercise, we suggest that while women do not display a ventilatory response to metaboreflex activation (perhaps due to not reaching a theoretical metabolite threshold to stimulate VE), the mechanoreflex may drive VE during exercise in women.


Assuntos
Anticoncepcionais Orais , Exercício Físico , Reflexo , Humanos , Feminino , Exercício Físico/fisiologia , Adulto , Anticoncepcionais Orais/farmacologia , Força da Mão , Perna (Membro)/fisiologia , Pressão Sanguínea/fisiologia , Braço/fisiologia , Adulto Jovem
9.
Mult Scler ; 30(9): 1221-1226, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38877717

RESUMO

BACKGROUND: Conflicting data exist around oral contraceptive exposure and subsequent multiple sclerosis (MS). OBJECTIVE: To use routinely collected primary healthcare data to explore the potential association between oral contraceptive exposure and subsequent MS in females at population level. METHODS: We performed a nested case-control study using electronic primary care data, with complete electronic ascertainment from 1990. Logistic regression was used to evaluate associations between contraceptive exposure and MS, without and with adjusting for age, ethnicity and deprivation. RESULTS: A total of 4455 females were included: 891 cases and 3564 controls. No association was seen between oral contraceptive exposure and subsequent MS, or between any contraceptive, combined oral contraceptive pill (COCP) or progesterone-only pill (POP) use 0-2, 2-5 or >5 years prior to MS. Conclusions: In the largest population-based study to date, we find no evidence of an association between oral contraceptive exposure and subsequent MS diagnosis.


Assuntos
Anticoncepcionais Orais , Esclerose Múltipla , Atenção Primária à Saúde , Humanos , Feminino , Estudos de Casos e Controles , Adulto , Esclerose Múltipla/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Anticoncepcionais Orais/efeitos adversos , Adulto Jovem , Adolescente
10.
PLoS One ; 19(6): e0305085, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38857242

RESUMO

INTRODUCTION: The prevention of unintended pregnancy is a public health issue affecting women worldwide. In Australia, women are required to get a prescription to obtain the oral contraceptive pill (OCP), which may limit access and be a barrier to its initiation and continuing use. Changing the availability of the OCP from prescription-only to over-the-counter (OTC) is one solution, however, to ensure success policymakers need to understand women's preferences. Telehealth services also might serve as an alternative to obtain prescriptions and increase accessibility to OCPs. This study aims to explore the preferences for OTC OCPs among Australian women, and whether the expansion of telehealth impacted women's preferences. METHODS: A mixed methods approach was used to explore women's preferences regarding access to the OCP. Focus group discussions (FGDs) were conducted to organically identify the preferences followed by an empirical ranking exercise. Three FGDs in two phases were conducted, pre and post-expansion of telehealth in Australia due to the COVID-19 pandemic. Convenience sampling was employed. The technique of constant comparison was used for thematic analysis where transcripts were analysed iteratively, and codes were allowed to emerge during the process to give the best chance for the attributes to develop from the data. RESULTS: Thematic analysis revealed that women perceived OTC availability of OCPs as a mechanism to increase the accessibility of contraception by reducing cost, travel time, waiting time, and increasing opening hours. They also believed that it would increase adherence to OCPs. However, some potential safety concerns and logistical issues were raised, including pharmacist training, access to patient's medical history, the ability to discuss other health issues or undertake opportunistic health screening, adherence to checklists, and privacy in the pharmacy environment. Following the expansion of telehealth, accessibility issues such as opening hours, travel time, and location of the facility were considered less important. CONCLUSIONS: The participants expressed their support for reclassifying OCPs to OTC, particularly for repeat prescriptions, as it would save valuable resources and time. However, some safety and logistical issues were raised. Women indicated they would balance these concerns with the benefits when deciding to use OTC OCPs. This could be explored using a discrete choice experiment. The expansion of telehealth was perceived to reduce barriers to accessing OCPs. The findings are likely to be informative for policymakers deciding whether to reclassify OCPs to OTC, and the concerns of women that need addressing to ensure the success of any policy change.


Assuntos
Anticoncepcionais Orais , Medicamentos sem Prescrição , Humanos , Feminino , Austrália , Medicamentos sem Prescrição/provisão & distribuição , Anticoncepcionais Orais/provisão & distribuição , Adulto , Telemedicina , COVID-19/epidemiologia , COVID-19/prevenção & controle , Adulto Jovem , Acessibilidade aos Serviços de Saúde , Grupos Focais , SARS-CoV-2 , Preferência do Paciente/estatística & dados numéricos , Gravidez , Pessoa de Meia-Idade , Adolescente
11.
Reprod Health ; 21(1): 93, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38943120

RESUMO

BACKGROUND: Access to an on-demand pericoital oral contraceptive pill - used to prevent pregnancy within a defined window around sexual intercourse - could offer women more reproductive agency. A contraceptive with this indication is not currently available in any market. This review aims to understand international user appeal for an on-demand pericoital oral contraceptive pill. METHODS: Systematic scoping review, comprising 30 peer-reviewed papers published between 2014-2023. RESULTS: Data from 30 papers reporting on research from 16 countries across five World Health Organisation regions suggests widespread user appeal for on-demand oral contraceptive pills that can be used peri- or post-coitally, especially among women who are younger, more educated or who have less frequent sex. Women of varying age, wealth, employment or relationship status, and with different prior experience of using modern contraceptives, were also interested. Women identified clear rationale for use and preference of these types of product: close alignment with women's sexual lives that comprised unplanned, spontaneous or occasional sex; perceived convenience and effectiveness; discreet use of pills to negotiate contextual circumstances that constrained their reproductive agency. Factors inhibiting use included knowledge barriers and attitudes of service providers, a lack of knowledge and misinformation among end-users, women's dislike of menstrual side effects and myths related to the effects of hormone content on future fertility. CONCLUSIONS: Introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency. Priorities for future research include: broadening the geographical scope of evidence to include SE Asia and the Pacific, and international rural and peri-urban settings; documenting the perspectives of adolescents and unmarried young people; identifying opportunities for innovation in the supply channels to enhance appropriate, affordable access to on-demand oral contraceptives; and unpacking how to bring new pericoital contraceptives to the market in a variety of international settings.


Access to an oral contraceptive pill that is used as needed to prevent pregnancy and taken within a defined window around sexual intercourse (i.e. an on-demand pericoital oral contraceptive pill) could offer women more reproductive agency. Though not currently available in any market, our analysis from this review of international literature reveals widespread appeal among women for using this type of contraceptive product. Clear rationale supporting use and preference included: (1) closer alignment with women's sexual lives that comprised desired but unplanned, spontaneous or occasional sex than other contraceptives; (2) perceived convenience and effectiveness, offering benefits over other modern contraceptives; and (3) women feeling able to overcome social values and beliefs that constrained their reproductive agency. There were also barriers to use of this type of product, including knowledge gaps and attitudes of service providers, a lack of knowledge and misinformation among end-users, women's dislike of the side effects, and myths and misconceptions about the impact of the hormone content in pills on future fertility. Introduction of an on-demand pericoital oral contraceptive pill could expand contraceptive choice for diverse women experiencing unmet need for modern contraception and constrained sexual and reproductive agency. Priorities for future research include: broadening the geographical scope of evidence to include SE Asia and the Pacific, and rural and peri-urban settings; documenting the perspectives of adolescents and unmarried young people; identifying opportunities for innovation in the supply channels to enhance appropriate, affordable access to this type of contraceptive; and unpacking how to bring this new contraceptive to the market in a variety of international settings.


Assuntos
Anticoncepcionais Orais , Humanos , Feminino , Anticoncepcionais Orais/administração & dosagem , Comportamento Contraceptivo/estatística & dados numéricos , Coito , Conhecimentos, Atitudes e Prática em Saúde , Gravidez , Comportamento Sexual , Aceitação pelo Paciente de Cuidados de Saúde , Anticoncepção/métodos
12.
Medicina (Kaunas) ; 60(6)2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38929576

RESUMO

Background and Objectives: Oral contraceptives (OCs) are usually used to treat endometriosis; however, the evidence is inconsistent about whether OC use in the past, when given to asymptomatic women, is protective against the development of future disease. We aimed to assess the relationship between the use of OCs and the likelihood of discovering endometriosis, considering the length of time under OCs during their fertile age. Materials and Methods: This was a monocentric retrospective cohort study in a tertiary-care University Hospital (Department of Human Reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Slovenia) carried out from January 2012 to December 2022. Reproductive-aged women scheduled for laparoscopic surgery for primary infertility and subsequent histopathological diagnosis of endometriosis were compared to women without an endometriosis diagnosis. They were classified based on the ratio of years of OC use to fertile years in four subgroups: never, <25%, between 25 and 50%, and >50. Results: In total, 1923 women (390 with and 1533 without endometriosis) were included. Previous OC use was higher in those with endometriosis than controls (72.31% vs. 58.64%; p = 0.001). Overall, previous OC usage was not related to histopathological diagnosis of endometriosis (aOR 1.06 [95% CI 0.87-1.29]). Women who used OCs for less than 25% of their fertile age had reduced risk of rASRM stage III endometriosis (aOR 0.50 [95% CI 0.26-0.95]; p = 0.036) or superficial implants (aOR 0.88 [95% CI 0.58-0.95]; p = 0.040). No significant results were retrieved for other rASRM stages. Using OCs for <25%, between 25 and 50%, or >50% of fertile age did not increase the risk of developing superficial endometriosis, endometriomas, or DIE. Conclusions: When OCs are used at least once, histological diagnoses of endometriosis are not increased. A protective effect of OCs when used for less than 25% of fertile age on superficial implants may be present. Prospective research is needed to corroborate the findings due to constraints related to the study's limitations.


Assuntos
Anticoncepcionais Orais , Endometriose , Humanos , Endometriose/complicações , Feminino , Estudos Retrospectivos , Adulto , Anticoncepcionais Orais/uso terapêutico , Infertilidade Feminina/etiologia , Infertilidade Feminina/prevenção & controle , Eslovênia/epidemiologia , Fatores de Risco , Estudos de Coortes , Fatores de Tempo
13.
Curr Opin Anaesthesiol ; 37(4): 338-343, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38841921

RESUMO

PURPOSE OF REVIEW: This review article explores the evidence regarding sugammadex (MSD Australia) and its potential interaction with hormonal contraceptives. The impact of recent clinical trials and review articles is examined. RECENT FINDINGS: Recent clinical data suggest that the interaction between sugammadex and estrogen and progesterone concentrations may not be clinically significant and may confer some protection against ovulation. There are no clinical trials reporting interactions between sugammadex and the exogenous hormonal compounds found in oral contraceptive pills. The method of contraception is an important consideration, as sugammadex theoretically affects oral and nonoral, and combined versus single agent methods differently. Two large retrospective database studies have reported two cases of pregnancy postoperatively in patients on hormonal contraceptives whose anesthetic included sugammadex. SUMMARY: Strong clinical evidence to support or refute claims of a significant impact of sugammadex on contraceptive efficacy in women on contraception is lacking. The existing evidence does not suggest a basis for concern regarding the impact of sugammadex on contraception in the perioperative setting.


Assuntos
Interações Medicamentosas , Sugammadex , gama-Ciclodextrinas , Humanos , Sugammadex/efeitos adversos , Sugammadex/administração & dosagem , Feminino , gama-Ciclodextrinas/efeitos adversos , gama-Ciclodextrinas/administração & dosagem , Anticoncepcionais Orais/efeitos adversos , Gravidez
14.
Psychoneuroendocrinology ; 167: 107111, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38943719

RESUMO

Recent research has increasingly acknowledged the impact of oral contraceptives on affective behavior and stress responses; however, the underlying mechanisms are still not well understood. Studies have previously shown that steroid hormones modulate automatic approach and avoidance behavior. Here, we thus investigated the effects of oral contraceptives on approach and avoidance behavior and whether these effects are modulated by stress. The study comprised 130 female participants, half of whom were using oral contraceptives, while the other half were not using any hormonal contraception (NC). The participants completed the Approach Avoidance Task (AAT), which measures automatic approach and avoidance behavior to socio-affective signals. The AAT was run once before and once after a stress manipulation using the Socially Evaluated Cold Pressor Test. OC users showed absent avoidance behavior to social threat signals and a stress-induced increase in approach behavior to positive social signals. The latter was found in particular in women taking androgenic acting OC, demonstrating that different OC preparations need to be taken into account in research on OC effects. However, OC and NC group did not differ in their cortisol stress response. Overall, the results suggest that OC usage impacts on approach and avoidance behavior to social signals, which might also contribute to the development of affective side effects.


Assuntos
Aprendizagem da Esquiva , Anticoncepcionais Orais , Hidrocortisona , Estresse Psicológico , Humanos , Feminino , Estresse Psicológico/psicologia , Estresse Psicológico/metabolismo , Adulto , Aprendizagem da Esquiva/efeitos dos fármacos , Aprendizagem da Esquiva/fisiologia , Anticoncepcionais Orais/farmacologia , Hidrocortisona/metabolismo , Hidrocortisona/análise , Adulto Jovem , Saliva/química , Adolescente , Afeto/efeitos dos fármacos , Afeto/fisiologia , Comportamento Social
15.
JAMA Netw Open ; 7(6): e2418620, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38922616

RESUMO

Importance: The US Supreme Court Dobbs v Jackson Women's Health Organization decision allowed states to strengthen restrictions on abortion access, triggering the closure of family planning clinics and leading to confusion about the legality of emergency contraceptives (ECs). Objectives: To evaluate the association between the Dobbs decision and fills for oral and emergency contraceptives in states that enacted the most restrictive abortion policies after Dobbs. Design, Setting, and Participants: This cohort study used data on contraceptive fills for women of reproductive age (15-49 years) in the US from IQVIA's National Prescription Audit PayerTrak and data from the Guttmacher Institute were used to categorize changes in abortion restrictions in each state. A difference-in-differences analysis compared changes in monthly fill rates for daily oral contraceptive pills (OCPs) and ECs in states that became most restrictive (implemented a full abortion ban after Dobbs) and comparison states (kept a medium level of abortion restrictions after Dobbs) before (March 2021 to November 2021) and after (July 2022 to October 2023) the Dobbs decision. Exposure: State-level abortion restrictions. Main Outcomes and Measures: Monthly fills of OCPs and ECs per 100 000 women of reproductive age. Results: Between March 2021 and October 2023, 142.8 million prescriptions for OCPs and 904 269 prescriptions for ECs were dispensed at US retail pharmacies. Before Dobbs, trends in monthly fill rates were similar for OCPs and ECs between the most restrictive and comparison states. After the Dobbs decision, states that became the most restrictive experienced an additional 4.1% decline in OCP fills with 285.9 fewer fills per 100 000 (95% CI, -495.8 to -6.8; P = .04). In contrast to OCPs, fills for ECs increased during the first year after Dobbs (July 2022 to June 2023) in both groups of states. However, 1 year after Dobbs (July 2023 to October 2023), the most restrictive states experienced an additional 65% decrease in emergency contraceptive fills with 13.2 fewer fills per 100 000 (95% CI, -27.2 to -4.1; P = .01). Conclusions and Relevance: In this cohort study of prescriptions filled at US pharmacies, the Dobbs decision was associated with declines in oral contraceptives, particularly ECs, in states enacting the most restrictive abortion policies. Given the important role of OCPs and ECs in preventing pregnancy and the need for abortion, efforts to improve access may be needed, especially in states where legal abortion is no longer an option.


Assuntos
Anticoncepcionais Pós-Coito , Decisões da Suprema Corte , Humanos , Feminino , Estados Unidos , Adulto , Adolescente , Adulto Jovem , Anticoncepcionais Pós-Coito/uso terapêutico , Pessoa de Meia-Idade , Anticoncepcionais Orais/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Estudos de Coortes , Gravidez , Anticoncepção Pós-Coito/estatística & dados numéricos
16.
Expert Opin Pharmacother ; 25(9): 1137-1143, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38904185

RESUMO

INTRODUCTION: This Special Report aims to highlight the importance of tailored therapies in women with Polycystic Ovary Syndrome (PCOS), avoiding prescribing generalized or unsuitable therapies based on oral contraceptive pills (OCPs). AREAS COVERED: This article discusses the benefits and risks of OCP-based therapy, highlighting the possible undesirable effects, especially in those patients exhibiting risk factors as women with PCOS, and the importance of carefully evaluated tailored therapeutic approaches. Literature searches were performed with the use of PubMed, Google Scholar, and Web of Science between January and February 2024. EXPERT OPINION: Considering the recent re-analysis of PCOS Rotterdam Criteria by the Expert Group on Inositol in Basic and Clinical Research, and on PCOS (EGOI-PCOS), the traditional Rotterdam phenotypes can be reclassified to achieve more efficacious therapy choices. Using personalized therapies that consider the specific clinical characteristics of the patient allows to improve the management of the syndrome, thus avoiding the generalized use of OCPs, which risk treating only symptoms of PCOS rather than the underlying cause. In cases when contraceptive purpose is desired, patients may benefit from combined therapy with diet or insulin-sensitizer agents, as inositol, to rebalance the metabolic profile, thus reducing the risk of developing future complications.


Assuntos
Anticoncepcionais Orais , Síndrome do Ovário Policístico , Humanos , Síndrome do Ovário Policístico/tratamento farmacológico , Feminino , Anticoncepcionais Orais/uso terapêutico , Anticoncepcionais Orais/efeitos adversos , Anticoncepcionais Orais/administração & dosagem , Fatores de Risco , Medicina de Precisão , Inositol/administração & dosagem , Inositol/uso terapêutico
17.
JAMA Dermatol ; 160(7): 732-735, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38809548

RESUMO

Importance: Frontal fibrosing alopecia (FFA) is an increasingly prevalent form of follicular lichen planus, causing irreversible hair loss predominantly in postmenopausal individuals. An earlier genome-wide meta-analysis of female FFA identified risk loci in genes implicated in self-antigen presentation and T-cell homeostasis, including HLA-B*07:02, ST3GAL1, and SEMA4B. However, CYP1B1, which is important for hormone metabolism, was also implicated with the substitution of serine for asparagine at position 453 (c.1358A>G, p.Asn453Ser) exhibiting a protective effect against FFA. Increasing understanding of genetic and environmental variables and their interactions will improve understanding of disease pathogenesis and has the potential to inform risk mitigation strategies. Objective: To investigate whether oral contraceptive pill (OCP) use modulates the protective effect of the common missense variant in CYP1B1 (c.1358A>G, p.Asn453Ser) on FFA risk. Design, Setting, and Participants: This gene-environment interaction study using a case-control design enrolled female patients with FFA from UK-based dermatology clinics. The patients were matched with unrelated age- and ancestry-matched female control individuals derived from UK Biobank in a 1:66 ratio, determined by the first 4 principal components from genome-wide genotypes. Data were collected from July 2015 to September 2017, and analyzed from October 2022 to December 2023. Main Outcome and Measure: The main outcomes were the modulatory effect of OCP use on the contribution of the CYP1B1 missense variant to female FFA risk and a formal gene-environment interaction test evaluated by a logistic regression model with a multiplicative interaction term, under the assumptions of an additive genetic model interaction term, under the assumptions of an additive genetic model. Results: Of the 489 female patients with FFA, the mean (SD) age was 65.8 (9.7) years, and 370 (75.7%) had a history of OCP use. Of the 34 254 age- and ancestry-matched control individuals, the mean (SD) age was 65.0 (8.4) years, and previous OCP use was reported in 31 177 (91.0%). An association between female FFA and the CYP1B1 risk allele was observed in individuals who reported OCP use (odds ratio, 1.90 [95% CI, 1.50-2.40]; P = 8.41 × 10-8) but not in those with no documented exposure to OCPs (odds ratio, 1.16 [95% CI, 0.82-1.64]; P = .39). A full gene-environment interaction model demonstrated a significant additive statistical interaction between c.1358A, p.453Asn, and history of OCP use on FFA risk (OR for interaction, 1.63 [95% CI, 1.07-2.46]; P = .02). Conclusions and Relevance: This gene-environment interaction analysis suggests that the protective effect of the CYP1B1 missense variant on FFA risk might be mediated by exposure to OCPs. The allele that encodes an asparagine at position 453 of CYP1B1 was associated with increased odds of FFA only in participants with OCP history.


Assuntos
Alopecia , Citocromo P-450 CYP1B1 , Interação Gene-Ambiente , Humanos , Feminino , Citocromo P-450 CYP1B1/genética , Citocromo P-450 CYP1B1/metabolismo , Alopecia/genética , Pessoa de Meia-Idade , Estudos de Casos e Controles , Anticoncepcionais Orais/efeitos adversos , Anticoncepcionais Orais/administração & dosagem , Idoso , Adulto , Predisposição Genética para Doença , Líquen Plano/genética , Mutação de Sentido Incorreto , Reino Unido/epidemiologia
20.
Am J Epidemiol ; 193(9): 1242-1252, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-38775277

RESUMO

Limited estimates exist on risk factors for epithelial ovarian cancer (EOC) in Asian, Hispanic, and Native Hawaiian/Pacific Islander women. Participants in this study included 1734 Asian (n = 785 case and 949 control participants), 266 Native Hawaiian/Pacific Islander (n = 99 case and 167 control participants), 1149 Hispanic (n = 505 case and 644 control participants), and 24 189 White (n = 9981 case and 14 208 control participants) from 11 studies in the Ovarian Cancer Association Consortium. Logistic regression models estimated odds ratios (ORs) and 95% CIs for risk associations by race and ethnicity. Heterogeneity in EOC risk associations by race and ethnicity (P ≤ .02) was observed for oral contraceptive (OC) use, parity, tubal ligation, and smoking. We observed inverse associations with EOC risk for OC use and parity across all groups; associations were strongest in Native Hawaiian/Pacific Islander and Asian women. The inverse association for tubal ligation with risk was most pronounced for Native Hawaiian/Pacific Islander participants (odds ratio (OR) = 0.25; 95% CI, 0.13-0.48) compared with Asian and White participants (OR = 0.68 [95% CI, 0.51-0.90] and OR = 0.78 [95% CI, 0.73-0.85], respectively). Differences in EOC risk factor associations were observed across racial and ethnic groups, which could be due, in part, to varying prevalence of EOC histotypes. Inclusion of greater diversity in future studies is essential to inform prevention strategies. This article is part of a Special Collection on Gynecological Cancers.


Assuntos
Carcinoma Epitelial do Ovário , Havaiano Nativo ou Outro Ilhéu do Pacífico , Neoplasias Ovarianas , Humanos , Feminino , Neoplasias Ovarianas/etnologia , Neoplasias Ovarianas/epidemiologia , Pessoa de Meia-Idade , Carcinoma Epitelial do Ovário/etnologia , Carcinoma Epitelial do Ovário/epidemiologia , Fatores de Risco , Adulto , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Estudos de Casos e Controles , Idoso , Esterilização Tubária/estatística & dados numéricos , Paridade , Asiático/estatística & dados numéricos , População Branca/estatística & dados numéricos , Hispânico ou Latino/estatística & dados numéricos , Estados Unidos/epidemiologia , Anticoncepcionais Orais/efeitos adversos , Modelos Logísticos , Fumar/etnologia , Fumar/epidemiologia , Neoplasias Epiteliais e Glandulares/etnologia , Neoplasias Epiteliais e Glandulares/epidemiologia , Etnicidade/estatística & dados numéricos , Razão de Chances
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