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Ragazini CS, Bahamondes MV, Prandini TRR, Brito MB, Amaral E, Bahamondes L, Duarte G, Quintana SM, Ferriani RA, Vieira CS. Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy. EUR J CONTRACEP REPR 2016; 21:285-9. [PMID: 27227739 DOI: 10.1080/13625187.2016.1177718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens. METHODS Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC + efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar. RESULTS Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p = 0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p = 0.01). The proportions of women with frequent and prolonged bleeding were similar (p > 0.05) in the three groups. CONCLUSIONS The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.
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Affiliation(s)
- Conrado S Ragazini
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Maria Valeria Bahamondes
- b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil
| | - Tatiana R Rocha Prandini
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | | | - Eliana Amaral
- b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil
| | - Luis Bahamondes
- b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil
| | - Geraldo Duarte
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Silvana Maria Quintana
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Rui Alberto Ferriani
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Carolina Sales Vieira
- a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
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Dinh A, Sriprasert I, Williams AR, Archer DF. A review of the endometrial histologic effects of progestins and progesterone receptor modulators in reproductive age women. Contraception 2015; 91:360-7. [DOI: 10.1016/j.contraception.2015.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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Madhra M, Fraser IS, Munro MG, Critchley HOD. Abnormal uterine bleeding: advantages of formal classification to patients, clinicians and researchers. Acta Obstet Gynecol Scand 2014; 93:619-25. [DOI: 10.1111/aogs.12390] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/02/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Mayank Madhra
- MRC Centre for Reproductive Health; University of Edinburgh; Queen's Medical Research Institute; Edinburgh UK
| | - Ian S. Fraser
- Department of Obstetrics and Gynaecology; Queen Elizabeth II Research Institute for Mothers and Infants; University of Sydney; Sydney New South Wales Australia
| | - Malcolm G. Munro
- Department of Obstetrics and Gynecology; David Geffen School of Medicine; University of California; Los Angeles California USA
- Gynecologic Services; Kaiser Permanente Los Angeles Medical Center; Los Angeles California USA
| | - Hilary O. D. Critchley
- MRC Centre for Reproductive Health; University of Edinburgh; Queen's Medical Research Institute; Edinburgh UK
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