Trends and Factors Associated with Oral Contraceptive Use among Korean Women

Cardiometabolic Aspects of Congenital Adrenal Hyperplasia

Treatment of classic congenital adrenal hyperplasia (CAH) is directed at replacing deficient hormones and reducing androgen excess. However, even in the era of early diagnosis and lifelong hormonal substitution, the presence of CAH is still associated with numerous complications and also with increased mortality. The aim of this article was to create an authoritative and balanced review concerning cardiometabolic risk in patients with CAH. The authors searched all major databases and scanned reference lists of all potentially eligible articles to find relevant articles. The risk was compared with that in other forms of adrenal insufficiency. The reviewed articles, most of which were published recently, provided conflicting results, which can be partially explained by differences in the inclusion criteria and treatment, small sample sizes, and gene-environment interactions. However, many studies showed that the presence of CAH is associated with an increased risk of weight gain, worsening of insulin sensitivity, high blood pressure, endothelial dysfunction, early atherosclerotic changes in the vascular wall, and left ventricular diastolic dysfunction. These complications were more consistently reported in patients with classic than nonclassic CAH and were in part related to hormonal and functional abnormalities associated with this disorder and/or to the impact of overtreatment and undertreatment. An analysis of available studies suggests that individuals with classic CAH are at increased cardiometabolic risk. Excess cardiovascular and metabolic morbidity is likely multifactorial, related to glucocorticoid overtreatment, imperfect adrenal hormone replacement therapy, androgen excess, and adrenomedullary failure. Cardiometabolic effects of new therapeutic approaches require future targeted studies.

Comparison of resumption of ovulation after cessation of oral contraceptives and medroxyprogesterone acetate in women with polycystic ovary syndrome

OBJECTIVE

Both oral contraceptive pills (OCPs) and cyclic medroxyprogesterone acetate (MPA) are widely used to control menstrual abnormalities in women with polycystic ovary syndrome (PCOS). We aimed to evaluate the chance of ovulation resumption after cessation of OCPs and MPA in women with PCOS.

METHODS

A retrospective study was conducted of women with PCOS who were treated with OCPs or cyclic MPA from September 2015 to March 2019. After cessation of medication, ovulation was assessed using basal body temperature and/or measurement of serum progesterone. The odds ratio for ovulation resumption was assessed with multivariable logistic regression. Additionally, doubly robust analysis was performed with inverse-probability-weighted analysis and regression adjustment based on the covariate balancing propensity score to adjust for the effect of covariates on the treatment assignment.

RESULTS

Among 272 women with PCOS, 136 were prescribed OCPs and 136 were prescribed cyclic MPA. Ovulation resumed in 18.4% of women (n = 25) after cessation of MPA and in 24.3% of women (n = 33) after cessation of OCPs. The odds of ovulation resumption in MPA users were comparable with those in OCP users (adjusted odds ratio (aOR) 1.00, 95% confidence interval (CI) 0.89-1.12). After multiple imputation due to missing values, the results did not change substantially (aOR 0.99, 95% CI 0.89-1.10).

CONCLUSIONS

Among women with PCOS, MPA users have a similar chance of ovulation resumption as OCP users after cessation of medication. Cyclic MPA can be a good alternative to OCPs in women for whom OCPs are contraindicated or who decline to take OCPs.

Contrasting income-based inequalities in incidence and mortality of breast cancer in Korea, 2006-2015

OBJECTIVES

Breast cancer incidence and mortality rates in Korea are increasing. This study analyzed income-based inequalities in the incidence and mortality of women breast cancer from 2006 to 2015, using national data that covered all Korean women.

METHODS

We used the National Health Information Database from 2006 to 2015. For women aged 20 and older, the age-standardized incidence and mortality rates of breast cancer per 100,000 by income quintile per year were calculated using the direct method. The rate ratio and rate difference (RD) of the age-standardized incidence and mortality rates of breast cancer per 100,000 between the top and bottom income quintiles were calculated as relative and absolute measures for inequalities.

RESULTS

When comparing 2006 and 2015, both the incidence and mortality rates of breast cancer increased. The lowest income quintile experienced higher mortality rates despite having lower incidence rates. In 2015, the income-based RD in incidence and mortality rates between the highest and lowest income quintiles (Q1-Q5) was -19.9 (95% confidence interval [CI], -24.3 to -15.5) and 4.4 (95% CI, 2.9 to 5.8), respectively. Throughout this period, there was no statistically significant trend in income-based disparities in breast cancer incidence and mortality. The age-specific contributions to the absolute magnitude of inequality (RD) in incidence and mortality were more pronounced among middle-aged women than among older women.

CONCLUSIONS

This study found that breast cancer in Korea exhibited pro-rich inequalities in mortality despite pro-poor inequalities in incidence. More equitable policies for screening and treatment of breast cancer are needed.

Global, regional, and national burdens of HIV/AIDS acquired through sexual transmission 1990-2019: an observational study

Background Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019. Methods Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC). Results Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0-811.3) deaths, 33.0million (28.7-39.9) YLLs, 3.4million (2.4-4.6) YLDs, and 36.4million (32.2-43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82-21.75), South Asia (9.00, 3.94-14.30), and Eastern Europe (7.09, 6.35-7.84). Conclusions HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally.

The impact of natural menstrual cycle and oral contraceptive pill phase on substrate oxidation during rest and acute submaximal aerobic exercise

Previous research has identified sex differences in substrate oxidation during submaximal aerobic exercise including a lower respiratory exchange ratio (RER) in females compared with males. These differences may be related to differences in sex hormones. Our purpose was to examine the impact of the natural menstrual cycle (NAT) and second- and third-generation oral contraceptive pill (OCP2 and OCP3) cycle phases on substrate oxidation during rest and submaximal aerobic exercise. Fifty female participants (18 NAT, 17 OCP2, and 15 OCP3) performed two experimental trials that coincided with the low (i.e., nonactive pill/early follicular) and the high hormone (i.e., active pill/midluteal) phase of their cycle. RER and carbohydrate and lipid oxidation rates were determined from gas exchange measurements performed during 10 min of supine rest, 5 min of seated rest, and two 8-min bouts of submaximal cycling exercise at ∼40% and ∼65% of peak oxygen uptake (V̇o2peak). For all groups, there were no differences in RER between the low and high hormone phases during supine rest (0.73 ± 0.05 vs. 0.74 ± 0.05), seated rest (0.72 ± 0.04 vs. 0.72 ± 0.04), exercise at 40% (0.77 ± 0.04 vs. 0.78 ± 0.04), and 65% V̇o2peak (0.85 ± 0.04 vs. 0.86 ± 0.03; P > 0.19 for all). Similarly, carbohydrate and lipid oxidation rates remained largely unchanged across phases during both rest and exercise, apart from higher carbohydrate oxidation in NAT vs. OCP2 at 40% V̇o2peak (P = 0.019) and 65% V̇o2peak (P = 0.001). NAT and OCPs do not appear to largely influence substrate oxidation at rest and during acute submaximal aerobic exercise.NEW & NOTEWORTHY This study was the first to examine the influence of NAT and two generations of OCPs on substrate oxidation during rest and acute submaximal aerobic exercise. We reported no differences across cycle phases or groups on RER, and minimal impact on carbohydrate or lipid oxidation apart from an increase in carbohydrate oxidation in NAT compared with OCP2 during exercise. Based on these findings, NAT/OCP phase controls may not be necessary in studies investigating substrate oxidation.

Reproductive experiences and factors influencing contraceptive use among female head-porters in Ghana: A cross-sectional study

Background and Aims

Female head-porters are a cohort of women who have migrated from their rural communities into commercial cities in search of better economic opportunities. These young women are vulnerable to untoward reproductive experiences. The study assesses the reproductive experiences of women and the factors influencing contraceptive use among them.

Methods

A cross-sectional study was conducted from January to May 2021 in the Kumasi Metropolis (n = 280). The study included 280 female head-porters within the reproductive age of 15-49 years. Convenience sampling and consecutive recruitment were used to obtain the needed sample size. All statistical significance was declared at a p-value of <0.05.

Results

Forty-two percent of respondents had a history of contraceptive use (all modern or artificial contraception). The study found gravidity (p < 0.0001), parity (p < 0.0001), number of sexual partners post-migration (p = 0.008), and age of first sex (p = 0.033) to be associated with contraceptive use among female head-porters.

Conclusion

Fourteen percent had experienced sexual exploitation post-migration, the first sexual encounter of one-third of participants were nonconsensual, 19% had sex at or before 16 years, and 72% were aware of contraception. Reproductive experiences such as gravidity and sexual debut (age at first sex) have a significant influence on the use of contraception.