Extended regimen combined oral contraception: A review of evolving concepts and acceptance by women and clinicians

Oral manifestations in women using hormonal contraceptive methods: a systematic review

OBJECTIVES

To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.

MATERIALS AND METHODS

This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.

RESULTS

Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.

CONCLUSIONS

Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.

CLINICAL RELEVANCE

The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.

Sexual health and contraception in the menopause journey

Women may experience changes in sexuality across menopause, because at this step in life hormone deficiency interacts with several determinants in a bio-psycho-social perspective. Healthcare providers should inform women about menopause impact on sexuality and be proactive during consultation in disclosing sexual concerns that would require a targeted assessment. Sexual symptoms become more frequent as women age, but they do not always translate into sexual dysfunction diagnosis, for which distress is required. It is important to recognize conditions that may increase the risk of dysfunctional response to menopause challenges in order to promote sexual longevity through counselling and specific management. In this review, we report key elements for a comprehensive assessment of sexual health around menopause, with a focus on genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD), representing well identified clinical conditions affecting sexuality at midlife and beyond. We also address the issue of contraception across the menopausal transition, highlighting risks and benefits, and possible implications on sexual function.

Fatigue Resistance Is Altered during the High-Hormone Phase of Eumenorrheic Females but Not Oral Contraceptive Users

PURPOSE

This study aimed to examine the effect of ovarian hormones and their synthetic equivalents on substrate utilization and fatigue resistance during a race-specific cycling protocol.

METHODS

Seventeen well-trained female cyclists (nine eumenorrheic females, eight oral contraceptive users) completed two experimental trials, in a randomized order, in their low- (follicular/sugar pill) and high-hormone (luteal/active pill) phases. Each 91-min trial consisted of a 45-min moderate-intensity component (submaximal cycling, or SMC) followed by 6 min of high-intensity (HIT) and then a fatigue resistance test (FRT): 6 × 1-min all-out efforts with 1-min active recovery. Meals, comprising carbohydrate (CHO) intake of 8 g·kg -1 body mass, were standardized 24-h pretrial. An electrolyte-only solution was provided ad libitum during each trial.

RESULTS

In eumenorrheic females, a large reduction in average power during FRT was observed in the luteal phase (277 ± 31 vs 287 ± 33 W; P = 0.032). Greater CHO ox (~ 4%, P = 0.020) during SMC and ventilatory inefficiencies during SMC and HIT (~7%, P < 0.001) were also observed in the luteal phase. In contraceptive users, despite some phasal changes in cardiorespiratory and metabolic data in SMC (~6% higher blood glucose and ~2% higher minute ventilation in active pill phase), none of the performance parameters in the FRT were different.

CONCLUSIONS

Fatigue resistance was compromised only in high-hormone phase of the menstrual cycle, with eumenorrheic females likely susceptible because of increased CHO utilization during SMC. Hormone-induced ventilatory inefficiencies may also have increased metabolic demand. These findings emphasize the need to maintain CHO availability for power production, particularly in high-hormone phases.

Women's attitudes about combined hormonal contraception (CHC) - induced menstrual bleeding changes - influence of personality traits in an Italian clinical sample

OBJECTIVES

We investigated the attitudes to change the frequency of menstrual bleeding by using combined hormonal contraception (CHC). Personality characteristics were also explored.

METHODS

We conducted a cross-sectional study in two university hospitals in northern Italy. Current, past and never CHC users (n = 545; age 18-44 years) completed a self-administered semi-structured questionnaire and the Ten-Item Personality Inventory (TIPI).

RESULTS

Forty-five percent of responders (n = 301) would prefer to change their bleeding frequency by using CHC. A flexible regimen was the preferred choice (n = 80; 33%) followed by extended regimens to bleed every 3 months (n = 54; 22%) or to never bleed (n = 43; 18%). The main positive reasons were to avoid dysmenorrhea (43%) and have more freedom in sexual (36%) and active (35%) life, whereas the main reason for a negative attitude was 'menstrual rhythm is natural' (59%). Age had a significant influence on women's willingness to change menstrual frequency by using CHC [>39 years (57%), 30-39 years (31%) and <30 years (46%)] (χ²: 9.1; p = 0.01). Never users significantly reported a more negative attitude (71%) in comparison with past (51%) and current users (49%) (χ²: 18.7; p = 0.001). Personality traits played a role, with higher scores of openness (p = 0.005) and extraversion (p = 0.001) in women with a positive attitude.

CONCLUSIONS

Almost half of our study sample reported a preference for changing their menstrual pattern by using CHC. Flexibility was the preferred choice across age and use of CHC. Personality characteristics (openness and extroversion) might influence attitudes toward CHC-induced menstrual bleeding changes.

"Do you want a period?" Launching and evaluating a brief contraceptive decision-making educational intervention

OBJECTIVE

Do you want a period? empowers people who menstruate to better understand their reproductive health and contraceptive choices through informed patient-centered contraceptive decision-making.

METHODS

Researchers partnered with the WISE (Women in the South-East) Telehealth Network to design, implement and evaluate the Do you want a period? brief educational intervention. Participants completed a longitudinal research study, including a web-based survey at baseline and a mobile-optimized text-based survey up to 6 weeks following baseline.

RESULTS

Do you want a period? was believable (93%, n = 79), informative (89%, n = 76), and helpful (85%, n = 72). Participants who reported that the intervention was helpful were significantly more likely to be satisfied with the usefulness of information provided (OR 5.61 [95% CI 1.65-19.12]), the overall quality of services (OR 3.39 [95% CI 1.04-11.08)], and obtaining necessary medical care (OR 2.40 [95% CI 1.08-5.33)]. At longitudinal follow-up, participants who received contraceptive services reported high acceptability of intervention (4.51 (±0.53) out of 5).

CONCLUSIONS

Do you want a period? envisions a new dialogue between women and clinicians, family, and friends. This brief educational intervention supports people who menstruate to determine if a safe and effective tailored contraceptive regimen is right for them.

Long-acting Parenteral Drug Delivery Systems for the Treatment of Chronic Diseases

The management of chronic conditions often requires patients to take daily medication for an extended duration. However, the need for daily dosing can lead to nonadherence to the therapy, which can result in the recurrence of the disease. Long-acting parenteral drug delivery systems have the potential to improve the treatment of chronic conditions. These systems use various technologies, such as oil-based injectables, PLGA-based microspheres, and in situ forming gel-based depots, to deliver different types of drugs. The use of long-acting parenteral formulations for the treatment of chronic infections such as HIV/AIDS and tuberculosis is a recent development in the field. Researchers are also exploring the use of long-acting parenteral formulations for the treatment of malaria, with the aim of reducing dosing frequency and improving adherence to treatment. This review discusses various aspects of long-acting formulation development, including the impact of the physicochemical properties of the drug, the type of long-acting formulation, and the route of administration. The clinical significance of long-acting formulations and recent advances in the field, such as long-acting nanoformulations and long-acting products currently in clinical trials, have also been highlighted.

Drospirenone 4 mg in a 24 + 4 regimen in women with contraindications to oestrogen use for contraception: bleeding patterns according to previous menstrual characteristics

PURPOSE

A new POP consisting of 4 mg drospirenone (DRSP) for 24 days with a 4-day hormone-free interval was developed to improve bleeding predictability during POP use. The aim of this study was to evaluate the effect on bleeding patterns during use of this oral contraceptive (OC) in comparison with previous menstrual cycles before the start of OC use.

METHODS

This is a pilot, prospective trial. A diary was used to collect information about daily bleeding and pelvic pain before and during treatment. During OC use, women were categorised as having (1) unscheduled bleeding or spotting days (UB), (2) scheduled bleeding or spotting days (SB) and (3) absence of bleeding/spotting (AB). SF-36 and FSFI questionnaires were used to quantify health-related quality of life and the quality of sexual life in sexually active participants.

RESULTS

Eighteen out of twenty-five (72%) women completed the entire follow-up. Women with UB (44.4%) were older at inclusion (p < 0.001) and had higher BMIs (p = 0.02) than those with AB (22.2%) or SB (33.4%). Women recorded a significant reduction of menstrual flow intensity during OC use (p < 0.0001). Those with UB also experienced a significant reduction of menstrual pain intensity (p = 0.006). Women with SB during OC use had a longer baseline cycle than those who reported UB during OC use (p = 0.008). Satisfaction with this OC was very high (8.4 ± 2.2 points) with no modification in SF-36 and FSFI values.

CONCLUSION

A DRSP-only pill is a good OC option for women with contraindications to oestrogen use. Features of the menstrual cycle before the start of OC use may be used to predict associated changes in bleeding patterns.

Menstrual Suppression in Gender Minority Youth

The purpose of this case series was to evaluate menstrual suppression in sex assigned at birth female adolescents identifying as male or gender non-conforming. A retrospective chart review of four gender minority youth (GMY), age 14-17, was performed for gender identity history, type and success of menstrual suppression, method satisfaction, side effects and improvement in menstrual distress. Menstrual suppression was successful in three patients, one patient discontinued use due to side effects that caused an increase in gender dysphoria. Menstrual distress and bleeding pattern improved in the majority of GMY in this series but side effects, as well as contraindications, may limit their use. In conclusion, menstrual dysphoria can be life-threatening for GMY and it is important that clinicians consider menstrual suppression in GMY with menstrual dysphoria. This series emphasizes the importance of individualized treatment plans.

Meta-Analysis of the Efficacy and Safety of Tranexamic Acid in Spinal Surgery

Objective. The safety and effectiveness of topical tranexamic acid in spinal surgery has not yet been reached, and further research is needed to confirm it. This study is aimed at detecting the effectiveness and safety on the tranexamic acid in spinal surgery. Methods. The Cochrane Library, PubMed, Embase, CNKI, and other databases were searched. The search time was from 2016 to 2019. All randomized controlled trials comparing the topical tranexamic acid group and the control group were collected. The experimental group used topical application. Tranexamic acid was used to treat bleeding after spinal surgery. The control group was no tranexamic acid or isotonic saline. The total bleeding, blood transfusion rate, and the occurrence of deep vein thrombosis were compared between the two groups. Rev Man 5.2.0 software was used for meta-analysis. Results. A total of 8 randomized controlled trials were included, including 884 patients. Meta-analysis results showed that the total bleeding volume of the tranexamic acid group was lower than that of the control group, and the difference was statistically significant weighted mean difference ( $\left(\text{WMD}\right)=–360.27\text{mL}$ , 95% confidence interval (CI) (–412.68, –307.87) mL, $P<0.00001$ ). The blood transfusion rate in the tranexamic acid group was lower than that in the control group (odds ratio $\left(\text{OR}\right)=0.22$ , 95% CI (0.14, 0.33), $P<0.00001$ ). There was no significant difference in the incidence of deep vein thrombosis between the two groups: $\text{OR}=1.48$ , 95% CI (0.41, 5.34), $P=0.55$ . Conclusion. Tranexamic acid can significantly reduce perioperative total blood loss, intraoperative blood loss, and blood transfusion rate during spinal surgery but has no significant effect on blood transfusion and thrombosis.

Perimenstrual Asthma in Adolescents: A Shared Condition in Pediatric and Gynecological Endocrinology

Asthma is a frequent medical condition in adolescence. The worsening of the most common symptoms perimenstrually is defined as perimenstrual asthma (PMA). The cause of PMA remains unclear, but a role for hormonal milieu is plausible. Data on PMA in adolescents are limited, and its management is not fully established. We aimed to discuss the PMA phenomenon in young females from pathophysiology to preventive strategies, focusing on the relationship with the hormonal pattern. The fluctuation of estrogens at ovulation and before menstruation and the progesterone secretion during the luteal phase and its subsequent withdrawal seem to be the culprits, because the deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle. Conventional asthma therapies are not always effective for PMA. Preventive strategies may include innovative hormonal contraception. Even a possible beneficial effect of other hormonal treatments, including estrogens, progestogens, and androgens, as well as leukotriene receptor antagonists and explorative approach using microbial-directed therapy, is considered. The underlying mechanisms, through which sex-hormone fluctuations influence asthma symptoms, represent a challenge in the clinical management of such a distressing condition. Further studies focused on young females are mandatory to promote adolescent health.

Missed opportunities in contraceptive counselling: findings from a European survey-based study with simulated patient consultation

PURPOSE

Available evidence highlights unmet needs in contraceptive counselling practices. This study aimed to understand current practises and clinician behaviour across Europe.

METHODS

A novel, online approach was used to simulate contraceptive counselling discussions based on three, predefined patient types with a hidden need: poor compliance (patient X), headaches (Y) or desire for a hormone-free option (Z). Clinicians were asked to provide guidance about a contraceptive method for their randomly assigned patient at two time points: (1) after a simulated discussion, (2) after seeing a full patient profile. Descriptive statistical analyses included evaluation of the clinicians' counselling approach and a change in contraceptive recommendation thereof.

RESULTS

Out of 661 clinicians from 10 participating European countries, including obstetricians/gynaecologists, midwives and general practitioners, most failed to uncover patient X and Y's hidden needs (78.8% and 70.5%, respectively), whereas, 63.4% of clinicians uncovered patient Z's hidden need. Clinicians who uncovered their patients' hidden needs asked significantly more questions than those who did not (range of mean, 5.1-7.8 vs 1.5-2.2 respectively). Clinicians were more likely to recommend a change of prescription after seeing the full patient profile than after the simulated discussion (increase in prescription change, range: 12.3-30.2%), indicating that clinicians rely on patients speaking up proactively about any concerns.

CONCLUSIONS

Insufficient existing counselling practices result in missed opportunities for shared decision-making and discussion. Clinicians and contraceptive counselling services should empower women by introducing more in-depth contraceptive counselling, incorporating clear, open-ended questions, to improve patient adherence and enhance reproductive planning.

Female Military Officers Report a Desire for Menstrual Suppression During Military Training

INTRODUCTION

Service women face female-specific challenges that present physiological and logistical burdens and may impact readiness. The stress of training can change menstrual patterns and symptoms, and limited access to hygienic, private facilities can hinder menstrual management. Therefore, suppressing menses with continuous hormonal contraception may be of interest.

MATERIALS AND METHODS

The 9-item "Military Women's Attitudes Toward Menstrual Suppression." questionnaire was administered to female officers upon entry (baseline) and graduation (post) from a 6-month secondary training course. Respondents rated their attitudes about menstruation and the stress of training, the desire for menstrual suppression, and the logistical burden of menstruation on a 1 (strongly agree) through 5 (strongly disagree) scale. Wilcoxon Signed Rank Tests determined changes in the distribution of responses from baseline to post.

RESULTS

Female officers (n = 108) completed baseline and post questionnaires (age 25.2 ± 0.3 years). At baseline, the majority disagreed/strongly disagreed that the stress of training "makes periods worse than usual" (n = 77, 71%), "increases menstrual symptoms and bleeding" (n = 77, 71%), or "magnifies premenstrual syndrome" (PMS; n = 69, 64%). Although 50% (n = 54) agreed/strongly agreed that "stopping periods while women are training is a good idea," 37% (n = 40) disagreed/strongly disagreed. The majority agreed/strongly agreed that menstrual suppression would prevent "the worry about menstrual supplies" (n = 75, 70%) and "the inconvenience of having a period during training" (n = 69, 64%). Many agreed/strongly agreed that it is difficult to deal with periods during training because "there is no privacy" (n = 52, 48%), "the inability to find adequate facilities" (n = 70, 65%), and "the lack of opportunity to use adequate facilities" (n = 52, 48%). Opinions remained largely consistent from baseline to post.

CONCLUSIONS

The desire for menstrual suppression among service women during training is high. Military health care providers should be prepared to counsel service women about strategies to manage menstruation, including the efficacy of continuous hormonal contraception for menstrual suppression. Future studies investigating benefits or risks of continuous hormonal contraception for menstrual suppression in service women should inform the clinical recommendations.

Real world utilization of 91 day extended levonorgestrel-containing combined oral contraceptives in Europe: a multinational database study

OBJECTIVE

As part of the risk management plan in Europe, this study was conducted to characterize drug utilization patterns of Seasonique, a 91 day extended levonorgestrel-containing combined oral contraceptive (COC_LNG).

METHODS

A retrospective observational study was conducted in France, Italy and Belgium using electronic medical record databases obtained from general practitioners (GPs) in all participating countries and gynecologists in France from 2015 to 2018. The study population included women receiving ≥1 prescription of 91 day COC_LNG during the study period. Prescribing patterns of 91 day COC_LNG were examined including: (1) treatment duration; (2) indication; (3) use of combined oral contraceptive (COC) before 91 day COC_LNG initiation; and (4) switch from and to combined hormonal contraceptives (CHCs) or other contraceptives.

RESULTS

Totals of 235, 220, 207 and 659 women using 91 day COC_LNG were identified in French, Italian and Belgian GP, and French gynecologist databases, respectively. Across databases, 46-76% of women were prescribed a single 91 day COC_LNG prescription and median treatment duration ranged from 3 to 6 months. The most common indication was contraception (42-81%), followed by menstrual migraines (2-14%). Use of COC during the 6 months prior to 91 day COC_LNG initiation was 14% across GP databases, but was lower (8%) in the French gynecologist database. The frequency of switching from 91 day COC_LNG to CHCs or other contraceptives was generally low (5-12%), with the highest proportion being among patients of French gynecologists.

CONCLUSIONS

Findings indicate that 91 day COC_LNG was prescribed for relatively short durations and predominantly as indicated for contraception. Most results were comparable across all participating countries. KEY POINTSFindings from this drug utilization study in European databases across general practitioners and French gynecologists confirmed that 91 day extended levonorgestrel-containing combined oral contraceptive (COC_LNG) was prescribed for relatively short durations (median 3-6 months); predominantly for the intended indication of contraception.Combined oral contraceptive use during the 6 months prior to 91 day COC_LNG initiation, and switching from 91 day COC_LNG to combined hormonal contraceptives or other contraceptives, were generally low (14% or less).These findings were mostly consistent across participating countries.

Contraception for Women With Psychiatric Disorders

OBJECTIVE

Mental health care for women includes decision support to prepare for major life events, including preconception planning for treatment during pregnancy and the postpartum period. The authors discuss contraceptive choices and their effectiveness, side effects, and impact on psychiatric symptoms. The Centers for Disease Control and Prevention's recommendations, Medical Eligibility Criteria for Contraceptive Use, provided the structure for review of contraceptive choices.

METHODS

A search of PsycINFO, PubMed, Embase, and Scopus was conducted for publications on the management of contraception for women with mental illness. Publications were selected if they included, based on the authors' consensus, data supporting evidence-based care important for psychiatrists who treat women desiring contraceptives.

RESULTS

The majority of women choose combined oral contraceptives. Although long-acting reversible contraceptives (implants, intrauterine devices) are associated with low failure rates, favorable safety profiles, rapid return to fertility after removal, and few contraindications, they are chosen by only 14% of women. All methods are acceptable for women with depression, although medical comorbidities may dictate a specific type. The impact of hormonal contraceptives on the risk for depression is controversial; however, clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers. Although interactions between psychotropic drugs and contraceptives are rare, clozapine, anticonvulsants, and St. John's Wort are exceptions.

CONCLUSIONS

Proactive management of mental illness, contraception, and pregnancy improves a woman's capacity to function and optimizes her mental and reproductive health.

Hormonal contraceptives and the risk of ischemic stroke in women with migraine: a new international consensus

The paper is devoted to the safe use of hormonal contraception in women with migraine, an urgent interdisciplinary problem daily faced by gynecologists, neurologists, and specialists in headache diagnosis and treatment. It gives information on the prevalence of migraine, the risk of ischemic stroke and other cardiovascular disorders in women with different types of migraine, including those receiving contraception and hormone replacement therapy. The paper presents the main provisions of the new interdisciplinary consensus «Hormonal contraceptives and the risk of ischemic stroke in women who have migraine», which are recommended to be taken into account by specialists of any profile when prescribing hormonal therapy to women with migraine in order to avoid cardiovascular events.

Bleeding patterns with the 19.5 mg LNG-IUS, with special focus on the first year of use: implications for counselling

Objective: The aim of the study was to provide an additional, detailed description of early bleeding patterns with the 19.5 mg levonorgestrel-releasing intrauterine system (LNG-IUS). Methods: We conducted a pooled analysis of the bleeding diaries of participants in a previously reported phase II randomised controlled study (n = 741) and a phase III study (n = 2904), with 2-year extension phase (n = 707), of the 19.5 mg LNG-IUS. Main outcome measures were the median number of bleeding and/or spotting days per 30-day reference period for 12 months and the influence of the previous contraceptive method and levonorgestrel dose on bleeding patterns. Results: The pooled analysis comprised 1697 women. There was a progressive decline in the number of bleeding and/or spotting days from month 1: the proportion of women with ≤4 bleeding and/or spotting days per month increased from 6.2% in month 1 to 15.8% in month 2, 26.0% in month 3, 39.3% in month 6 and 54.1% in month 12. The median number of bleeding and/or spotting days in month 1 was lowest in women who had previously been using an LNG-IUS. Conclusion: Analysis of bleeding diaries using 30-day reference periods provides detailed insight into bleeding changes in the first months following placement of the 19.5 mg LNG-IUS. This insight may prove useful when counselling women about contraceptive choice and method continuation.

Hormonal Contraceptives and Mood: Review of the Literature and Implications for Future Research

PURPOSE OF REVIEW

We examine recent studies that investigate the effects of hormonal contraception on mood in different populations of women, including women in the general population and women with diagnosed psychiatric and gynecologic disorders. We address the mechanisms of several types of hormonal contraceptives and assess how these may affect mood and gynecologic disorders.

RECENT FINDINGS

The effects of hormonal contraceptives seem to be most relevant in selected subsets of women, as they may promote improved mental health in particular psychiatric disorders such as PMDD. Currently, there is no consistent evidence for negative effects of most hormonal contraceptives in the general population. Even though some studies reveal that certain individuals appear susceptible to negative mood effects from some forms of hormonal contraceptives, more research is needed to better identify these susceptible individuals.

Effect of Oral Contraceptives on Soft Tissue Injury Risk, Soft Tissue Laxity, and Muscle Strength: A Systematic Review of the Literature

BACKGROUND

Female patients are more likely than male patients to experience various musculoskeletal (MSK) injuries. Because MSK tissues are sensitive to the female hormones relaxin, estrogen, and progesterone, studies have examined whether hormonal contraceptives, which change female hormone levels, can alter the female MSK injury risk. These studies have reached contradictory conclusions, leaving unclear the influence of hormonal contraception on female MSK injury risk.

HYPOTHESIS

Hormonal contraceptives act to decrease female soft tissue injury risk and soft tissue laxity.

STUDY DESIGN

Systematic review; Level of evidence, 3.

METHODS

Reviewers searched for clinically relevant studies evaluating the relationship between hormonal contraceptive use and soft tissue injuries, soft tissue laxity, muscle injuries, and muscle strength in the PubMed, Cochrane, Scopus, CINAHL, and Embase databases. Studies meeting inclusion criteria were scored by 2 independent researchers for risk of bias, imprecision, inconsistency, and indirectness with a template designed using the British Medical Journal Clinical Evidence GRADE (Grades of Recommendation Assessment, Development and Evaluation) scoring system and GRADEPro guidelines. Scores were uploaded into the GRADEPro scoring system software, which calculated each study's final GRADE score (very low, low, moderate, or high quality).

RESULTS

A total of 29 studies met inclusion criteria. Of the 7 studies evaluating oral contraceptive (OC) use and soft tissue injury risk, only 2 received a high quality-of-evidence score; all other studies received a very low score. The high-quality studies concluded that OC use decreases anterior cruciate ligament (ACL) injury risk. Only 1 of the 10 studies evaluating OC use and soft tissue laxity was found to have a high quality of evidence; this study determined that OC use decreases ACL laxity.

CONCLUSION

Higher quality studies suggest that OCs decrease a female patient's risk of ACL injuries and ACL laxity. The strength of these findings, however, is weak. Female patients are up to 8 times more likely to tear their ACLs than male patients. OCs may serve a therapeutic role in decreasing the sex disparity in ACL injury rates.

Use of Short Acting Reversible Contraception in Adolescents: The Pill, Patch, Ring and Emergency Contraception

Long acting reversible contraception (LARC) is the recommend form of birth control for adolescents by both the American Academy of Pediatrics and the American Congress of Obstetrics and Gynecology, but the majority of adolescents continue to use short acting reversible contraception (SARC) such as the oral contraceptive pill, vaginal ring, and transdermal patch. For this reason, it is important for medical providers to be familiar with how to prescribe and manage SARC in adolescents, paying particular attention to which patients are eligible to use them, which benefits the methods have outside of contraception, what side effects to be aware of, and special considerations for adolescents. Many adolescents will choose not to use any form of hormonal contraception-thus having a knowledge about and comfort with use of emergency contraception is of equal importance.

Using the RE-AIM Model of Health Promotion to Implement a Military Women's Health Promotion Program for Austere Settings

The health concerns for military women who serve in austere environments include feminine hygiene, risk of infection, and limited knowledge of gynecologic conditions, symptoms, and prevention. The purpose of this study is to evaluate the effectiveness of the Women's Health Promotion Program (WHPP) for Austere Environments that was implemented in the military community setting of a large operational military unit on a southeastern U.S. military base. The WHPP is a pilot-tested program designed to educate women to recognize and prepare for environments that require alteration of feminine hygiene behaviors, with the goal of maintaining genitourinary health. Evaluation of the WHPP was designed according to the RE-AIM framework, which measures the Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance of a health promotion program. The WHPP was offered to 49 military units (none of which declined) and presented to 443 military women in those units. One year after the implementation of the WHPP, the rates of urinary tract infections, vaginal candidiasis infections, and menstrual disorders decreased among the units that participated in the WHPP. These findings lay the foundation for an Army-wide adoption of this WHPP that could enhance readiness in military women.

Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature

Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method—about two times more frequently—among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13–2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method.

Male perception about the inconveniences associated with monthly bleeding for their partner - an international survey

OBJECTIVE

To assess men's perceptions about monthly bleeding and associated inconveniences for their partner, as well as men's attitudes regarding the desired menstruation frequency for their partner and knowledge about hormonal contraceptives.

METHODS

A 15 min quantitative online survey was conducted among 5044 men aged 18-45 years, who had been in a relationship for more than 6 months, across 13 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, The Netherlands, Poland, Portugal, Spain and Switzerland). Responses were compared to those obtained in a similar study among European women.

RESULTS

Most men perceived that their partner considered her menstrual flow as moderate, lasting an average of 5.2 d, slightly longer than previously reported by women. Almost all men reported that their partners experience menstruation-related symptoms. However, prevalence of mood-related symptoms was perceived to be more frequent and physical symptoms less frequent, relative to women's self-reported symptoms. Given the option, 71% of men would choose longer intervals between their partner's periods. Maintaining the couple's sex life, social life and relationship quality were key factors cited in their preference. Overall, 42% of respondents stated that women taking hormonal contraceptives needed to have monthly periods.

CONCLUSIONS

Men's perception regarding their partner's periods was generally consistent with that previously reported by women. Most men would prefer less frequent bleeding episodes for their partners. Although, the present data suggest that couples are discussing periods, knowledge about contraception could be improved. Health care professionals should intensify counselling to better inform both partners about their contraceptive options.

Real-world experience of women using extended-cycle vs monthly-cycle combined oral contraception in the United States: the National Health and Wellness Survey

BACKGROUND

The real-world experience of women receiving extended-cycle combined oral contraception (COC) versus monthly-cycle COC has not been reported.

METHODS

Data were from the United States 2013 National Health and Wellness Survey. Eligible women (18-50 years old, premenopausal, without hysterectomy) currently using extended-cycle COC (3 months between periods) were compared with women using monthly-cycle COC. Treatment satisfaction (1 "extremely dissatisfied" to 7 "extremely satisfied"), adherence (8-item Morisky Medication Adherence Scale©), menstrual cycle-related symptoms, health-related quality of life (HRQOL) and health state utilities (Medical Outcomes Short Form Survey-36v2®), depression (9-item Patient Health Questionnaire), sleep difficulties, Work Productivity and Activity Impairment-General Health, and healthcare resource use were assessed using one-way analyses of variance, chi-square tests, and generalized linear models (adjusted for covariates).

RESULTS

Participants included 260 (6.7%) women using extended-cycle and 3616 (93.3%) using monthly-cycle COC. Women using extended-cycle COC reported significantly higher treatment satisfaction (P = 0.001) and adherence (P = 0.04) and reduced heavy menstrual bleeding (P = 0.029). A non-significant tendency toward reduced menstrual pain (39.5% versus 47.3%) and menstrual cycle-related symptoms (40.0% versus 48.7%) was found in women using extended-cycle versus monthly-cycle COC. Significantly more women using extended-cycle COC reported health-related diagnoses, indicating preferential prescription for extended-cycle COC among women reporting more health problems. Consistent with this poorer health, more women using extended-cycle COC reported fatigue, headache, and activity impairment (P values < 0.05). There were no other significant differences between groups.

CONCLUSIONS

This real-world observational study supports extended-cycle COC as a valuable treatment option with high satisfaction, high adherence, and reduced heavy menstrual bleeding.

Counselling to include tailored use of combined oral contraception in clinical practice: an evaluation

BACKGROUND

Combined oral contraception (COC, 'the pill') remains the most prescribed method of contraception in the UK. Although a variety of regimens for taking monophasic COC are held to be clinically safe, women are not routinely counselled about these choices and there is a lack of evidence on how to provide this information to women.

AIM

To assess the usefulness and feasibility of including tailored use of monophasic COC within routine COC counselling in a sexual and reproductive health (SRH) service using a structured format.

METHOD

Using a structured format, healthcare professionals (HCPs) counselled new and established COC users attending an SRH service about standard and tailored ways of taking the pill. Questionnaires were used to survey both the HCPs and patients immediately after the initial consultation, and then the patients again 8 weeks later.

RESULTS

Nearly all patients (98%, n=95) felt it was helpful to be informed of the different ways of using monophasic COC by the HCP, without giving too much information at one time (96%, n=108). The HCPs were confident of their COC counselling (99%, n=110) and did not think the consultations took significantly longer (88%, n=98).

CONCLUSION

This study demonstrates that information on different pill taking regimens is useful and acceptable to patients, and can improve contraceptive pill user choice. It is also feasible for HCPs to perform COC counselling to include tailored pill use during routine consultations in a clinical setting.

Cycle control with an extended-regimen oral contraceptive combining levonorgestrel and ethinyl estradiol that includes continuous low-dose ethinyl estradiol instead of the traditional hormone-free interval

PURPOSE

To evaluate scheduled and unscheduled bleeding and spotting over 1 year of treatment with 91-day extended-regimen combined oral contraception (COC) providing continuous low-dose ethinyl estradiol (EE) in place of the traditional 7-day hormone-free interval (HFI).

PATIENTS AND METHODS

This post hoc analysis of a multicenter, open-label, 1-year, Phase 3 study of extended-regimen COC with 30 µg EE/150 µg levonorgestrel (LNG) for 84 days and EE 10 µg for 7 days included 799 sexually active, adult women who completed at least one 91-day cycle of therapy. Subjects recorded bleeding and spotting episodes daily using electronic diaries. Logistic regression analyses are reported as ORs with 95% CIs.

RESULTS

There was a 10% increase (OR =1.102; 95% CI: 1.006-1.206) in the likelihood of reporting no scheduled bleeding for each additional 91-day cycle completed. From the third 91-day cycle, more than one fifth of women reported no scheduled bleeding (third cycle =23% [121/533]; fourth cycle =22% [97/446]). Among women who reported no scheduled bleeding at Cycle 1 (136/758 [18%]), ≥45% showed sustained lack of scheduled bleeding in later cycles. There were increases of 53% (OR =1.531; 95% CI: 1.393-1.683) and 31% (OR =1.307; 95% CI: 1.205-1.418) in the likelihood of reporting 0 to ≤6 days vs >6 days of unscheduled bleeding and spotting, respectively, for each additional 91-day cycle. By Cycle 2, more than 80% of women reported no unscheduled bleeding or ≤6 days of unscheduled bleeding during each 91-day cycle.

CONCLUSION

Improved cycle control with decreased bleeding over time was shown during extended-regimen COC with 30 µg EE/150 µg LNG for 84 days and continuous low-dose EE instead of the traditional 7-day HFI. Women considering this regimen should be informed that those who complete at least one 91-day COC cycle will likely experience less bleeding/spotting in future cycles.

Comparative, open-label prospective study on the quality of life and sexual function of women affected by endometriosis-associated pelvic pain on 2 mg dienogest/30 µg ethinyl estradiol continuous or 21/7 regimen oral contraceptive

PURPOSE

To evaluate the effects of a continuous regimen combined oral contraceptive (COC) containing 2 mg dienogest and 30 µg ethinyl estradiol (DNG/EE) compared to a 21/7 regimen on the quality of life (QoL) and sexual function in women affected by endometriosis-associated pelvic pain.

METHODS

Sixty-three women constituted the Study group treated with DNG/EE COC continuous regimen; 33 women were given DNG/EE COC in a 21/7 regimen. To define the endometriosis-associated pelvic pain, the Visual Analogic Scale was used. The Short Form-36, Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) were used to assess QoL, sexual function and sexual distress, respectively. The study included two follow-ups.

RESULTS

At 3 and 6 months of treatment there was an improvement in pain of the Study group (p < 0.001). The Control group underwent pain improvement at the second follow-up (p < 0.05). At the first and the second follow-ups, the Study group reported QoL improvements in all categories (p < 0.001). The Control group reported QoL improvements in all categories at the second follow-up (p < 0.05). At the first and the second follow-ups of the Study group, the FSFI total score had risen (p < 0.001), and the FSDS score had dropped (p < 0.001). An improvement of the FSFI score and a reduction of the FSDS score of the Control group was observed at the second follow-up (p < 0.001), but not at the first follow-up (p = NS).

CONCLUSIONS

Women on DNG/EE COC continuous regimen reported a reduction of endometriosis-associated pelvic pain and there was an improvement of their sexual activity and their QoL that was better than the DNG/EE 21/7 conventional regimen.

Medically induced amenorrhea in female astronauts

Medically induced amenorrhea can be achieved through alterations in the normal regulatory hormones via the adoption of a therapeutic agent, which prevents menstrual flow. Spaceflight-related advantages for medically induced amenorrhea differ according to the time point in the astronaut's training schedule. Pregnancy is contraindicated for many pre-flight training activities as well as spaceflight, therefore effective contraception is essential. In addition, the practicalities of menstruating during pre-flight training or spaceflight can be challenging. During long-duration missions, female astronauts have often continuously taken the combined oral contraceptive pill to induce amenorrhea. Long-acting reversible contraceptives (LARCs) are safe and reliable methods used to medically induce amenorrhea terrestrially but as of yet, not extensively used by female astronauts. If LARCs were used, daily compliance with an oral pill is not required and no upmass or trash would need disposal. Military studies have shown that high proportions of female personnel desire amenorrhea during deployment; better education has been recommended at recruitment to improve uptake and autonomous decision-making. Astronauts are exposed to similar austere conditions as military personnel and parallels can be drawn with these results. Offering female astronauts up-to-date, evidence-based, comprehensive education, in view of the environment in which they work, would empower them to make informed decisions regarding menstrual suppression while respecting their autonomy.