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Norwood J, Jenkins CA, Bhatta M, Turner M, Bian A, Nelson J, Ransby I, Hughes D, Koethe JR, Sterling TR, Shepherd BE, Castilho JL. Hormonal Contraception and Risk of Cardiometabolic Disease in Women with HIV. J Womens Health (Larchmt) 2024; 33:966-974. [PMID: 38484324 PMCID: PMC11302212 DOI: 10.1089/jwh.2023.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Objective: We sought to determine the association of hormonal contraception (HC) and cardiometabolic outcomes among women with human immunodeficiency virus (HIV). Methods: We included women with HIV aged 18-45 years in clinical care in the Southeastern United States between 1998 and 2018. Oral and injectable HC use was captured from medication records. Our outcomes included incident cardiovascular/thrombotic disease (CVD) (atherosclerosis, hypertension, cerebrovascular disease, thrombosis, and heart failure) and incident metabolic disorders (diabetes, dyslipidemia, obesity, and non-alcoholic steatohepatitis). We excluded women with prevalent conditions. We used multivariable marginal structural models to examine time-varying current and cumulative HC use and cardiometabolic outcomes in separate analyses, adjusting for age, race, smoking, time-varying comorbidities, CD4 cell count, HIV RNA, and antiretroviral use. Women with HC exposure were compared with women without HC exposure. Results: Among the 710 women included, 201 women (28%) used HC. CVD analyses included 603 women without prevalent CVD and 93 incident events; metabolic analyses included 365 women without prevalent metabolic disease and 150 incident events. Current and cumulative oral HC use was associated with increased odds of CVD, though this was not statistically significant (adjusted odds ratio [aOR] = 2.08, [95% confidence interval (CI): 0.80-5.43] and aOR = 1.24 [95% CI: 0.96-1.60] per year of use, respectively). Oral HC was not associated with risk of incident metabolic disorders. Depot medroxyprogesterone acetate (DMPA) was not associated with risk of incident CVD. Current and cumulative DMPA use was significantly associated with decreased odds of incident metabolic disorders (aOR = 0.48 [95% CI: 0.23, 1.00] and aOR = 0.65 [95% CI: 0.42-1.00] per year of use, respectively). Conclusion: Our results suggest that cardiovascular risk should be considered when selecting contraception for women with HIV.
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Affiliation(s)
- Jamison Norwood
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manasa Bhatta
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Megan Turner
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey Nelson
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Imani Ransby
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dana Hughes
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John R. Koethe
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy R. Sterling
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica L. Castilho
- Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Shaheen K, Kamel HH, Mostafa Mohammed E, Hashim Mohammed A, Ahmed Sileem S, Fouad M, Shehata Sayd Z, ElHodiby ME. Clomiphene citrate as a new modality in management of vaginal bleeding with depomedroxyprogesterone acetate (DMPA): A randomized controlled trial. Steroids 2024; 206:109425. [PMID: 38636732 DOI: 10.1016/j.steroids.2024.109425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Depo-medroxyprogesterone acetate (DMPA) functions as a contraceptive method by inhibiting the secretion of gonadotropins, which prevents follicular maturation and ovulation, as well as thinning of the endometrium leading to unscheduled vaginal bleeding and subsequent discontinuation of DMPA. Our study aimed to evaluate the efficacy and safety of clomiphene citrate (CC) in stopping bleeding among DMPA users. MATERIALS AND METHODS We randomly assigned 200 DMPA users using a computer-generated random numbers table in a 1:1 ratio to one of two groups; the study group, which received CC at a dose of 50 mg twice daily for five days (n = 100), and the control group, which received a placebo for five days (n = 100). Our primary outcome measure was the onset and duration of bleeding cessation. Secondary outcomes included endometrial thickness, recurrence of vaginal bleeding, and any reported side effects associated with CC use. RESULTS Clomiphene citrate significantly resulted in early cessation of vaginal bleeding in 83 % of the patients, which continued for three months of follow-up. In addition, the recurrence of vaginal bleeding was significantly reduced in the CC group compared to the control group (11 % vs. 67 %; p < 0.001). Endometrial thickness was significantly greater in the CC group than in the control group (p < 0.001). Breast tenderness was more frequently reported in the study group, with no difference in dyspareunia between the two groups. CONCLUSIONS Clomiphene citrate is effective in controlling bleeding among DMPA users. Further studies are encouraged to confirm our findings.
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Affiliation(s)
- Kareem Shaheen
- Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Hany H Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Enas Mostafa Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Hashim Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
| | - Sileem Ahmed Sileem
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mahmoud Fouad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Zainab Shehata Sayd
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Assiut, Egypt
| | - Mohamed E ElHodiby
- Department of Obstetrics and Gynecology, Faculty of Medicine, Misr University for Science and Technology, Giza, Egypt
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