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O'Leary TJ, Izard RM, Tang JCY, Fraser WD, Greeves JP. Hormonal contraceptive use is associated with altered bone structural and metabolic responses to military training in women: An observational cohort study. Bone 2024; 181:117012. [PMID: 38216077 DOI: 10.1016/j.bone.2024.117012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
Military training increases tibial density and size. Female sex hormones may influence the adaption of bone to loading, but it is unknown if women using different hormonal contraceptives adapt similarly to military training. One hundred and sixteen women (57 women not using hormonal contraceptives [non-users], 38 combined oral contraceptive pill [COCP] users, 21 depot medroxyprogesterone acetate [DMPA] users) completed this study. Tibial volumetric bone mineral density (vBMD) and geometry were measured by peripheral quantitative computed tomography (4 %, 14 %, 38 %, and 66 % sites) at the start (week 1) and end (week 14) of British Army basic training. Circulating markers of bone and calcium metabolism were measured at weeks 1, 2, 4, 6, 10, and 14. Training increased trabecular vBMD at the 4 % site, periosteal perimeter at the 14 % and 66 % sites, and total area, cortical area, cortical thickness, and bone strength at all sites (0.1 to 1.6 %, p ≤ 0.009), with no differences between hormonal contraceptive groups (p ≥ 0.127). Trabecular vBMD increased at the 14 % site in non-users (0.8 %, p = 0.005), but not in COCP or DMPA users (p ≥ 0.205). Periosteal perimeter increased at the 38 % site in COCP (0.4 %, p < 0.001) and DMPA (0.5 %, p < 0.001) users, but not in non-users (p = 0.058). Training had no effect on periosteal perimeter at the 4 % site or cortical vBMD or endosteal perimeter at any site (p ≥ 0.168). βCTX decreased and PINP increased during training with no difference between hormonal contraceptive groups. Training increased iPTH in non-users, but not COCP or DMPA users. Hormonal contraceptives may exert site-specific effects on the mechanobiology of bone, with higher endogenous oestradiol promoting trabecularisation and inhibiting periosteal expansion in non-users compared with hormonal contraceptive users.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army HQ, Andover, UK; Division of Surgery and Interventional Science, UCL, London, UK
| | | | - Jonathan C Y Tang
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Biochemistry, Departments of Laboratory Medicine and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
| | - William D Fraser
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Biochemistry, Departments of Laboratory Medicine and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, UK; Division of Surgery and Interventional Science, UCL, London, UK; Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK.
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Fattore L, Pisanu A, Concas L, Casula C, Siddi C, Pisu MG, Serra M, Concas A, Porcu P. Behavioral characterization of co-exposure to cannabinoids and hormonal contraceptives in female rats. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110890. [PMID: 37926338 DOI: 10.1016/j.pnpbp.2023.110890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
Hormonal contraceptives are among the most widely used drugs by young healthy women to block ovulation and avoid pregnancy. They reduce the ovarian secretion of estradiol and progesterone, hormones that also modulate neuronal plasticity, cognitive functions, emotions and mood. Cannabis is the most commonly used illicit drug worldwide and its use is increasing among young women, many of which regularly take the "pill". Despite evidence of a bidirectional interaction between the endocannabinoid system and gonadal hormones, only very few studies have examined the consequences of cannabis consumption in young females under hormonal contraceptives treatment. To fill this gap, this study evaluated the behavioral effects of co-exposure to chronic 1) hormonal contraceptives, i.e., ethinyl estradiol (EE) plus levonorgestrel (LNG), one of the synthetic estrogen-progestin combinations of hormonal contraceptives, and 2) cannabinoid receptor agonist, i.e., WIN 55,212-2 (WIN), on motor activity, emotional state and cognitive functions in young adult female rats (8-11/experimental group). Hormonal and cannabinoid treatment started at post-natal day (PND) 52 and 56, respectively, while behavioral testing occurred between PND 84-95. The results show that chronic EE-LNG treatment, at doses (0.020 and 0.060 mg/rat, respectively) known to drastically reduce plasma progesterone levels, and the contextual exposure to WIN, at a dose (12.5 μg/kg/infusion) known to be rewarding in the rat, alters the hormonal milieu but does not cause further changes in locomotor activity compared to EE-LNG or WIN alone, and does not modify anxiety-like state (as measured by the elevated plus maze and the marble burying tests) and cognitive abilities (as measured by the novel object recognition and the prepulse inhibition tests) in young adult female rats. Although exposure to EE-LNG and WIN tends to increase the duration of immobility and to reduce the time spent swimming in the forced swimming test, there was not a significant additive effect suggestive of a depressive-like state. These findings allow deepening the current knowledge on the interaction between cannabinoid agonists and hormonal contraceptives and suggest that low, rewarding doses of cannabinoids do not significantly alter the motor and cognitive skills and do not induce anxiety or depressive-like states in females that use hormonal contraceptives.
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Affiliation(s)
- Liana Fattore
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | - Augusta Pisanu
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | - Luca Concas
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | - Claudia Casula
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | - Carlotta Siddi
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy
| | | | - Mariangela Serra
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Alessandra Concas
- Department of Life and Environment Sciences, Section of Neuroscience and Anthropology, University of Cagliari, Cagliari, Italy
| | - Patrizia Porcu
- Neuroscience Institute, National Research Council of Italy (CNR), Cagliari, Italy.
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Rovera A, Anderson P. Influence of gender and combined estrogen-progestin oral contraceptive on parotid saliva flow rate, pH, and electrolytes concentration. Clin Exp Dent Res 2024; 10:e800. [PMID: 37933471 PMCID: PMC10860451 DOI: 10.1002/cre2.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVES Endocrinal variations within an individual impact the electrolyte composition, pH, and flow-rate (FR) of saliva. The aim of this study was to evaluate the gender-specific differences and the effect of combined estrogen-progestin oral contraceptives (COCs) on FR, pH, and electrolyte concentrations in the parotid saliva (PS) of a group of healthy adults. MATERIAL AND METHODS Stimulated PS was collected from 20 healthy adults using a Lashley cup; 11 males, 8 females, and 1 female undertaking combined contraceptive therapy (levonorgestrel/ethinyloestradiol 0.1 mg + 0.02 mg). FR and pH were recorded for each saliva sample. Electrolytes concentrations (Na+ , Ca2+ , K+ , Mg2+ ) were measured using inductively coupled plasma optical emission spectrometer (ICP-OES). Statistical analysis was performed, and the significance level was set at p < .05. RESULTS PS FR varied from 0.13 to 0.42 mL/min in females not taking any medication and from 0.08 to 0.5 mL/min in males not taking any medication. PS pH of females and males not taking any medication ranged from 6.23 to 7.50 and from 6.15 to 7.55. PS pH and FR of the female taking COCs were 6.5 and 0.1 mL/min. PS pH, FR, and electrolytes concentrations (Ca2+ , Na+ , K+ , Mg2+ ) were not statistically significantly different between females and males not taking any medication. PS concentrations of Ca2+ and Na+ were significantly higher in the females taking COCs than in the females not taking any medication. Whereas, concentrations of K+ and Mg2+ did not differ significantly between the females taking COCs and the females not taking any medication. CONCLUSIONS There are no significant gender-specific differences in PS flow rate, pH, and electrolyte concentrations of Na+ , Ca2+ , Mg2+ , and K+ . Combined hormonal oral contraceptive has a significant effect on PS flow rate, pH, Ca2+ , and Na+ concentrations. Whereas the PS concentration of K+ and Mg2+ are not influenced by COCs. These results warrant further investigation.
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Affiliation(s)
- Angela Rovera
- Dental Physical Sciences Unit, Centre for Oral Bioengineering, Institute of DentistryQueen Mary University of LondonLondonUK
| | - Paul Anderson
- Dental Physical Sciences Unit, Centre for Oral Bioengineering, Institute of DentistryQueen Mary University of LondonLondonUK
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Özcan Ö, den Elzen WPJ, Hillebrand JJ, den Heijer M, van Loendersloot LL, Fischer J, Hamer H, de Jonge R, Heijboer AC. The effect of hormonal contraceptive therapy on clinical laboratory parameters: a literature review. Clin Chem Lab Med 2024; 62:18-40. [PMID: 37419659 DOI: 10.1515/cclm-2023-0384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023]
Abstract
Hormonal contraceptives (HC) are widely used among women in reproductive ages. In this review, the effects of HCs on 91 routine chemistry tests, metabolic tests, and tests for liver function, hemostatic system, renal function, hormones, vitamins and minerals were evaluated. Test parameters were differently affected by the dosage, duration, composition of HCs and route of administration. Most studies concerned the effects of combined oral contraceptives (COC) on the metabolic, hemostatic and (sex) steroids test results. Although the majority of the effects were minor, a major increase was seen in angiotensinogen levels (90-375 %) and the concentrations of the binding proteins (SHBG [∼200 %], CBG [∼100 %], TBG [∼90 %], VDBP [∼30 %], and IGFBPs [∼40 %]). Also, there were significant changes in levels of their bound molecules (testosterone, T3, T4, cortisol, vitamin D, IGF1 and GH). Data about the effects of all kinds of HCs on all test results are limited and sometimes inconclusive due to the large variety in HC, administration routes and dosages. Still, it can be concluded that HC use in women mainly stimulates the liver production of binding proteins. All biochemical test results of women using HC should be assessed carefully and unexpected test results should be further evaluated for both methodological and pre-analytical reasons. As HCs change over time, future studies are needed to learn more about the effects of other types, routes and combinations of HCs on clinical chemistry tests.
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Affiliation(s)
- Ömer Özcan
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Wendy P J den Elzen
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jacquelien J Hillebrand
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Martin den Heijer
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Laura L van Loendersloot
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johan Fischer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Henrike Hamer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert de Jonge
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Department of Laboratory Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
- Department of Laboratory Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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Begum RF, Mohan S. Pharmacological investigation of vitamin E with combined oral contraceptives on INHBA gene against PCOS that intricate through melatonin PKC pathway. Syst Biol Reprod Med 2023; 69:450-464. [PMID: 37962399 DOI: 10.1080/19396368.2023.2276082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
The most prevalent endocrine and metabolic condition in women of reproductive age are polycystic ovary syndrome (PCOS) with significant risk factors such as circadian rhythm and melatonin disruption. The aim of this study is to assess the effect of vitamin E in combination with a combined oral contraceptive (COC) on continuous light-induced PCOS using hormonal measures, oxidative stress (OS) indicators, and the inhibin beta-A (INHBA) gene, which targets the melatonin protein kinase C (PKC) pathway. An in silico technique anticipated INHBA's binding affinity for vitamin E and COC. For the in vivo investigation (IAEC/240/2021), female SD rats were divided into six groups and subjected to a 16-week induction period, followed by a 2-month test drug treatment with drospirenone (DRSP) as a standard. Serum testosterone, FSH, melatonin, and OS were calculated as hormonal markers. The expression of the INHBA gene was studied to see if it could be linked to the circadian rhythm and OS via the melatonin PKC pathway. According to the in silico study, vitamin E and DRSP had higher binding energy for the INHBA (-8.6 kcal/mol and -8.4 kcal/mol, respectively). When compared to the control group, in vivo results showed a substantial decrease in testosterone levels (p = .05), as well as changes in FSH (p = .78) and melatonin (p = .13). IHNBA gene expression has also dramatically increased, stimulating FSH production in the pituitary gland. Vitamin E and COC concomitantly are beneficial against PCOS because it modulates OS, which in turn influences circadian rhythm and the melatonin PKC pathway.
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Affiliation(s)
- Rukaiah Fatma Begum
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, India
| | - Sumithra Mohan
- Department of Pharmacology, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, India
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Battipaglia C, Feliciello L, Genazzani AD, Facchinetti F, Grandi G. Combined oral contraceptive with estetrol plus drospirenone: from pharmacokinetics to clinical applications. Expert Opin Drug Metab Toxicol 2023; 19:871-879. [PMID: 37942662 DOI: 10.1080/17425255.2023.2279752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Drospirenone/estetrol (DRSP/E4) is a combined oral contraceptive (COC) recently approved in several countries. It is composed of 15 mg of E4, a natural estrogen produced by human fetal liver throughout pregnancy, and 3 mg of DRSP, the first synthetic progestin used in oral contraception derived from 17-α-spirolactone. E4 and DRSP synergistically prevent pregnancy by inhibiting ovulation. E4 differs from 17-β-estradiol or ethinylestradiol because it represents a native estrogen with selective action in tissues (NEST), therefore it displays both agonist and antagonist estrogenic effects in different tissues. AREAS COVERED In this paper, we reviewed the scientific literature published in English prior to April 2023 and gathered information on the pharmacodynamics and pharmacokinetics of DRSP, E4 and their combination for contraception. We also proposed possible clinical applications based on the characteristics of the components of this COC. EXPERT OPINION E4/DRSP-based COC has shown high tolerability, safety and satisfaction and may represent a viable choice in young girls in need of oral contraception and pill users who suffer from high cholesterol, breast tenderness or water retention. Moreover, this new COC shows higher scheduled bleeding rate compared to other pills containing natural estrogens. All the data are reassuring, permitting long-term use.
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Affiliation(s)
- Christian Battipaglia
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Lia Feliciello
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Alessandro D Genazzani
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
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Brouillard A, Davignon LM, Turcotte AM, Marin MF. Morphologic alterations of the fear circuitry: the role of sex hormones and oral contraceptives. Front Endocrinol (Lausanne) 2023; 14:1228504. [PMID: 38027091 PMCID: PMC10661904 DOI: 10.3389/fendo.2023.1228504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background Endogenous sex hormones and oral contraceptives (OCs) have been shown to influence key regions implicated in fear processing. While OC use has been found to impact brain morphology, methodological challenges remain to be addressed, such as avoiding selection bias between OC users and non-users, as well as examining potential lasting effects of OC intake. Objective We investigated the current and lasting effects of OC use, as well as the interplay between the current hormonal milieu and history of hormonal contraception use on structural correlates of the fear circuitry. We also examined the role of endogenous and exogenous sex hormones within this network. Methods We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41). Salivary endogenous sex hormones and current users' salivary ethinyl estradiol (EE) were assessed using liquid chromatography - tandem mass spectrometry. Using structural magnetic resonance imaging, we extracted surface-based gray matter volumes (GMVs) and cortical thickness (CT) for regions of interest of the fear circuitry. Exploratory whole-brain analyses were conducted with surface-based and voxel-based morphometry methods. Results Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users. While associations with endogenous sex hormones remain unclear, we showed that EE dosage in current users had a greater influence on brain anatomy compared to salivary EE levels and progestin androgenicity, with lower doses being associated with smaller cortical GMVs. Discussion Our results highlight a sex difference for the dorsal anterior cingulate cortex GMV (a fear-promoting region), as well as a reduced CT of the ventromedial prefrontal cortex (a fear-inhibiting region) specific to current OC use. Precisely, this finding was driven by lower EE doses. These findings may represent structural vulnerabilities to anxiety and stress-related disorders. We showed little evidence of durable anatomical effects, suggesting that OC intake can (reversibly) affect fear-related brain morphology.
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Affiliation(s)
- Alexandra Brouillard
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | - Lisa-Marie Davignon
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
| | | | - Marie-France Marin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, QC, Canada
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Maher EE, White AM, Craig A, Khatri S, Kendrick PT, Matocha ME, Bondy EO, Pallem N, Breakfield G, Botkins M, Sweatt O, Griffin WC, Kaplan B, Weafer JJ, Beckmann JS, Gipson CD. Synthetic contraceptive hormones occlude the ability of nicotine to reduce ethanol consumption in ovary-intact female rats. Drug Alcohol Depend 2023; 252:110983. [PMID: 37778097 DOI: 10.1016/j.drugalcdep.2023.110983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
Rates of tobacco and alcohol use in women are rising, and women are more vulnerable than men to escalating tobacco and alcohol use. Many women use hormonal birth control, with the oral contraceptive pill being the most prevalent. Oral contraceptives contain both a progestin (synthetic progesterone) and a synthetic estrogen (ethinyl estradiol; EE) and are contraindicated for women over 35 years who smoke. Despite this, no studies have examined how synthetic contraceptive hormones impact this pattern of polysubstance use in females. To address this critical gap in the field, we treated ovary-intact female rats with either sesame oil (vehicle), the progestin levonorgestrel (LEVO; contained in formulations such as Alesse®), or the combination of EE+LEVO in addition to either undergoing single (nicotine or saline) or polydrug (nicotine and ethanol; EtOH) self-administration (SA) in a sequential use model. Rats preferred EtOH over water following extended EtOH drinking experience as well as after nicotine or saline SA experience, and rats undergoing only nicotine SA (water controls) consumed more nicotine as compared to rats co-using EtOH and nicotine. Importantly, this effect was occluded in groups treated with contraceptive hormones. In the sequential use group, both LEVO alone and the EE+LEVO combination occluded the ability of nicotine to decrease EtOH consumption. Interestingly, demand experiments suggest an economic substitute effect between nicotine and EtOH. Together, we show that chronic synthetic hormone exposure impacts nicotine and EtOH sequential use, demonstrating the crucial need to understand how chronic use of different contraceptive formulations alter patterns of polydrug use in women.
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Affiliation(s)
- Erin E Maher
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Ashley M White
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Ashley Craig
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Shailesh Khatri
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Percell T Kendrick
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Mary E Matocha
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Emma O Bondy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Nikhil Pallem
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Grace Breakfield
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Madison Botkins
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Olivia Sweatt
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - William C Griffin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brent Kaplan
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA
| | - Jessica J Weafer
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Joshua S Beckmann
- Department of Psychology, University of Kentucky, Lexington, KY, USA.
| | - Cassandra D Gipson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA.
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Jensen A, Thériault K, Yilmaz E, Pon E, Davidson PSR. Mental rotation, episodic memory, and executive control: Possible effects of biological sex and oral contraceptive use. Neurobiol Learn Mem 2023; 198:107720. [PMID: 36621560 DOI: 10.1016/j.nlm.2023.107720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
Oral contraceptives (OCs) are one of the most common forms of hormonal birth control. A small literature suggests that OC use may affect visuospatial ability, episodic memory, and executive control. However, previous studies have been criticized for small sample sizes and the use of different, single cognitive tests. We investigated the degree to which biological sex and OC use might affect individual mental rotation, episodic memory, and executive control in a large sample of healthy, young adults (N = 155, including 52 OC users, 53 naturally cycling females, and 50 males) tested individually over videoconference. To measure cognition, we used a set of neuropsychological tasks inspired by Glisky and colleagues' two-factor episodic memory and executive control battery, from which two composite scores (based on principal component analysis) were derived for each participant. Our pre-registered analysis revealed a clear female advantage in episodic memory, independent of OC use. In an exploratory analysis, gist memory was elevated in OC users. Interestingly, we found no significant sex-related differences nor effects of OC use on mental rotation or executive control. Duration of OC use was also not related to any of our cognitive measures. These results suggest that the use of combined, monophasic OCs does not lead to many significant changes in cognition in young adults, although young females overall may have better episodic memory than young males. Additional studies, including longitudinal designs and looking in more detail at the menstrual cycle and OC use history, will further clarify the effects of different types of OCs and their duration of use on different aspects of cognition.
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Affiliation(s)
- Adelaide Jensen
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada.
| | - Kim Thériault
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada
| | - Ece Yilmaz
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada
| | - Ethan Pon
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada
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Hampson E. Oral contraceptives in the central nervous system: Basic pharmacology, methodological considerations, and current state of the field. Front Neuroendocrinol 2023; 68:101040. [PMID: 36243109 DOI: 10.1016/j.yfrne.2022.101040] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Millions of women around the world use combined oral contraceptives (OCs), yet surprisingly little is known about their central nervous system (CNS) effects. This article provides a short overview of the basic pharmacology of OCs, emphasizing features that may be relevant to understanding their effects in the CNS. Historical and recent findings from studies of cognitive function, mood, and negative affect (depressive changes under OC use) are then reviewed. We also present data from an archival dataset from our own laboratory in which we explore dysphoric changes in women using four generations of contraceptive progestins. Current data in the field are consistent with a modest effect of OC use on CNS variables, but conclusions based on current findings must be made very cautiously because of multiple methodological issues in many published studies to date, and inconsistencies in the findings. Directions for future research over the next 10 years are suggested. (150 words).
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Affiliation(s)
- Elizabeth Hampson
- Department of Psychology, University of Western Ontario, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
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11
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Fortuna M, Soares SM, Pompermaier A, Freddo N, Nardi J, Mozzato MT, Varela ACC, Costa VC, Siqueira L, Menegasso AS, da Costa Maffi V, Barcellos LJG. Exposure to levonorgestrel-based birth control pill in early life and its persistent effects in zebrafish. Environ Toxicol Pharmacol 2022; 96:104006. [PMID: 36328330 DOI: 10.1016/j.etap.2022.104006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/01/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
The consumption of progestins has increased considerably in recent decades, as has their disposal into the environment. These substances can negatively affect the reproduction, physiology, and behavior of non-target organisms, such as fish. We aimed to evaluate the effects of exposure to environmentally relevant concentrations of levonorgestrel-control birth based (1.3, 13.3, 133, and 1330 ng/L) on the development and behavior of zebrafish (Danio rerio) in terms of mortality, hatching, spontaneous movement, and larval and adult behavioral tests. Exposure caused anxiogenic-like behavior in larvae, which persisted in adults, as demonstrated by the light-dark test. In contrast, it caused anxiolytic-like behavior in the novel tank test. There was a high mortality rate at all tested concentrations and increases in the hormone cortisol at 13.3 ng/L that affected the sex ratio. These changes may lead to an ecological imbalance, emphasizing the risk of early exposure to progestins in the environment.
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Affiliation(s)
- Milena Fortuna
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Suelen Mendonça Soares
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Aline Pompermaier
- Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Natália Freddo
- Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Jéssica Nardi
- Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Mateus Timbola Mozzato
- Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Amanda Carolina Cole Varela
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Vitória Cadore Costa
- Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Lisiane Siqueira
- Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Aloma Santin Menegasso
- Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Victoria da Costa Maffi
- Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Leonardo José Gil Barcellos
- Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil; Programa de Pós-graduação em Bioexperimentação, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil; Curso de Medicina Veterinária, Universidade de Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.
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Haverinen A, Luiro K, Kangasniemi MH, Piltonen TT, Hustad S, Heikinheimo O, Tapanainen JS. Estradiol Valerate vs Ethinylestradiol in Combined Oral Contraceptives: Effects on the Pituitary-Ovarian Axis. J Clin Endocrinol Metab 2022; 107:e3008-e3017. [PMID: 35279718 DOI: 10.1210/clinem/dgac150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT Limited studies have compared the effects of combined oral contraceptives (COCs) containing natural estrogens and synthetic ethinylestradiol (EE) on reproductive hormones. OBJECTIVE To compare estradiol valerate (EV) + dienogest (DNG), EE + DNG, and DNG alone (active control) on levels of follicle stimulating hormone (FSH), luteinizing hormone, anti-Müllerian hormone (AMH), ovarian steroids, sex hormone binding globulin (SHBG), and the free androgen index (FAI). METHODS This spin-off study from a randomized trial enrolled 59 healthy, 18 to 35-year-old ovulatory women, outpatients at Helsinki and Oulu University Hospitals, Finland, who were randomized to EV 2 mg + DNG 2-3 mg (n = 20); EE 0.03 mg + DNG 2 mg (n = 20); and DNG 2 mg (n = 19) for 9 weeks. Blood samples were drawn at baseline, and at 5 and 9 weeks. Age and BMI were comparable between groups; 3 women discontinued. RESULTS EV + DNG suppressed FSH by -27% (-51% to -3%) (median [95% CI]) vs EE + DNG, -64% (-78 to -51), P = 0.04, but AMH levels decreased similarly by -9% (-18 to -0.1) vs -13% (-28 to 0.2), P = 0.38, respectively. EV + DNG increased SHBG levels by 56% (30% to 82%) and EE + DNG by 385% (313% to 423%), P < 0.001. Total testosterone decreased by 16% (-27% to -5%) in the EV + DNG group but it did not decrease in the EE + DNG group, whereas the FAI decreased by -39% (-54% to -25%) vs -72% (-78% to -67%), P < 0.001. DNG alone did not induce changes in any of these parameters. CONCLUSION Compared with EE + DNG, treatment with EV + DNG resulted in milder pituitary downregulation and reduced induction of hepatic SHBG synthesis-potentially carrying more beneficial health effects.
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Affiliation(s)
- Annina Haverinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland
| | - Kaisu Luiro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland
| | - Marika H Kangasniemi
- Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, PO Box 5000, 90014 Oulu, Finland
| | - Terhi T Piltonen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital and Medical Research Centre PEDEGO Research Unit, PO Box 5000, 90014 Oulu, Finland
| | - Steinar Hustad
- Department of Clinical Science and Core Facility for Metabolomics, University of Bergen, NO-5020 Bergen, Norway
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland
| | - Juha S Tapanainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, PO Box 140, 00029 Helsinki, Finland
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Chen KX, Worley S, Foster H, Edasery D, Roknsharifi S, Ifrah C, Lipton ML. Oral contraceptive use is associated with smaller hypothalamic and pituitary gland volumes in healthy women: A structural MRI study. PLoS One 2021; 16:e0249482. [PMID: 33882080 PMCID: PMC8059834 DOI: 10.1371/journal.pone.0249482] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/18/2021] [Indexed: 11/19/2022] Open
Abstract
The effects of hormonal contraceptives on structural features of the hypothalamus and pituitary are incompletely understood. One prior study reported microstructural changes in the hypothalamus with oral contraceptive pill (OCP) use. However, effects on hypothalamic volume have not been reported. One prior study reported volumetric changes in the pituitary. However, this study was limited by including participants evaluated for neurological symptoms. We sought to determine if OCP use is associated with alteration of hypothalamic or pituitary volume. High-resolution 3T MRI was performed for a prospective cohort of 50 healthy women from 2016 to 2018, which comprised 21 OCP users (age, 19-29) and 29 naturally cycling women (age, 18-36). Participants were excluded if they were pregnant or had significant medical conditions including neurological, psychiatric, and endocrine disorders. After confirming reliability of the image analysis techniques, 5 raters independently performed manual segmentation of the hypothalamus and semi-automated intensity threshold-based segmentation of the pituitary using ITK-SNAP. Total intracranial volume was estimated using FreeSurfer. A general linear model tested the association of OCP use with hypothalamic and pituitary volumes. Hypothalamic (B = -81.2 ± 24.9, p = 0.002) and pituitary (B = -81.2 ± 38.7, p = 0.04) volumes in OCP users were smaller than in naturally cycling women. These findings may be related to interference with known trophic effects of sex hormones and suggest a structural correlate of central OCP effects.
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Affiliation(s)
- Ke Xun Chen
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
| | - Sandie Worley
- Department of Neurology, New York University School of Medicine, New York, NY, United States of America
| | - Henry Foster
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
| | - David Edasery
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
| | - Shima Roknsharifi
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
| | - Chloe Ifrah
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
| | - Michael L. Lipton
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
- Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine and Montefiore Health, Bronx, NY, United States of America
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Olufunto BO, Anoka NA, Olufunmilayo OM, Lawrence OA. Insulin resistance and depressed cardiac G6PD activity induced by glucocorticoid exposure during pregnancy are attenuated by maternal estrogen-progestin therapy. Environ Toxicol Pharmacol 2020; 79:103423. [PMID: 32492534 DOI: 10.1016/j.etap.2020.103423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to investigate the effects of maternal combined oral contraceptive (COC) on dams that were exposed to late gestational glucocorticoids (GC). Twenty-four pregnant female rats were randomly allotted into 4 groups of 6 dams each. Dams received COC (combination of 1.0 μg ethinylestradiol and 5.0 μg levonorgestrel p.o.) between 3rd and 11th week after delivery with or without prior exposure to GC (dexamethasone; 0.2 mg/kg p.o.) that was administered between gestational days 14-19. Data showed that late-gestational GC exposure led to insulin resistance (IR), increased cardiac adenosine deaminase (ADA), xanthine oxidase (XO), lactate, lactate dehydrogenase (LDH), and disrupted cardiac glucose-6-phosphate dehydrogenase (G6PD)-dependent antioxidant defenses. On the other hand, maternal COC treatment in dams not exposed to gestational GC led to IR, increased cardiac XO, LDH and defective cardiac G6PD-dependent antioxidant defenses. However, maternal COC with prior gestational GC exposure led to attenuated IR, cardiac ADA, UA, LDH, and improved cardiac G6PD-dependent antioxidant defenses but worsened cardiac triglyceride (TG) accumulation when compared with dam with gestational GC exposure without maternal COC. Taken together, the findings of this study provide evidence that maternal COC treatment improves late gestational GC-programmed effects. This is however accompanied with enhanced cardiac TG accumulation.
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Affiliation(s)
- Badmus O Olufunto
- HOPE Cardiometabolic Research Team and Department of Physiology, College of Health Sciences, University of Ilorin, Nigeria; Department of Public Health, Kwara State University, Malete, Nigeria
| | - Njan A Anoka
- Department of Pharmacology and Therapeutics, College of Health Sciences, University of Ilorin, Nigeria
| | - Ologe M Olufunmilayo
- Department of Pharmacology and Therapeutics, College of Health Sciences, University of Ilorin, Nigeria
| | - Olatunji A Lawrence
- HOPE Cardiometabolic Research Team and Department of Physiology, College of Health Sciences, University of Ilorin, Nigeria.
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15
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Swanepoel AC, Bester J, de Lange-Loots Z. Mechanical and Physical Behavior of Fibrin Clot Formation and Lysis in Combined Oral Contraceptive Users. Microsc Microanal 2020; 26:1007-1013. [PMID: 32778190 DOI: 10.1017/s1431927620024289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Combined oral contraceptives (COCs) are commonly prescribed and increase the risk of venous thromboembolism (VTE). We have previously found that two COCs, both containing drospirenone (DRSP) and ethinyl estradiol (EE), cause spontaneous fibrin formation in whole blood. The aim of this study was, therefore, to use platelet-poor plasma (PPP) from the same cohort of DRSP/EE users to determine the impact of these COCs on the fibrin component, specifically the fibrin clot viscoelasticity, turbidimetry, and biophysical traits. PPP from 25 females per test group and a control group (n = 25) were analyzed using thromboelastography (TEG), turbidimetry, and scanning electron microscopy. The results highlight abnormal fibrin clot formation, lysis, and architecture; DRSP/20EE showed the greatest effect. DRSP/EE use increased the fibrin fiber diameter and showed dense matted clots. Only when the influence of COCs on the structural properties and behavior of fibrin fibers during thrombus formation and lysis is better understood are we able to predict and prevent coagulopathies associated with these synthetic hormones. Clinical practitioners should take this into consideration for female patients that either have comorbidities, which could burden the coagulation system, or may be exposed to external factors that could increase their risk for VTE.
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Affiliation(s)
- Albe Carina Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia0007, South Africa
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom2520, South Africa
| | - Janette Bester
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia0007, South Africa
| | - Zelda de Lange-Loots
- Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, Private Bag X6001, Potchefstroom2520, South Africa
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16
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Zhao Y, Versavel M, Tidemann-Miller B, Christmann R, Naik H. Evaluation of the Potential Pharmacokinetic Interactions Between Vixotrigine and an Oral Contraceptive. Clin Drug Investig 2020; 40:737-746. [PMID: 32564301 PMCID: PMC7359159 DOI: 10.1007/s40261-020-00931-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Vixotrigine is a voltage- and use-dependent sodium channel blocker in development for neuropathic pain management. This study evaluated the effect of coadministration of vixotrigine (metabolized primarily via uridine diphosphate-glucuronosyltransferases) and an oral contraceptive containing ethinyl estradiol (uridine diphosphate-glucuronosyltransferase inducer) and levonorgestrel on the pharmacokinetics and safety of all three compounds. METHODS In this phase I, open-label, fixed-sequence, multiple-dose study, 36 healthy women received oral vixotrigine 150 mg three times daily for 6 days and once on day 7. This was followed by a washout period, days 8-11. The oral contraceptive was administered alone on days 12-25 and with vixotrigine 150 mg three times daily on days 26-32. Serial blood samples were collected for pharmacokinetic analysis. Safety was assessed. RESULTS The geometric least-squares mean ratios (90% confidence intervals) for the area under the concentration-time curve over 8 h and maximum concentration of vixotrigine co-administered with an oral contraceptive vs vixotrigine alone were 0.85 (0.82-0.89) and 0.91 (0.87-0.96), respectively. The geometric least-squares mean ratios (90% confidence interval) for area under the concentration-time curve over 24 h and maximum concentration of ethinyl estradiol with vixotrigine vs ethinyl estradiol alone were 0.94 (0.91-0.97) and 0.89 (0.84-0.94), respectively; the ratios for levonorgestrel with vixotrigine vs levonorgestrel alone were 1.06 (0.98-1.16) and 1.05 (0.98-1.13), respectively. No adverse events occurring with vixotrigine alone were deemed related to the study drug by the investigators. CONCLUSIONS Coadministration of vixotrigine and an oral contraceptive containing ethinyl estradiol and levonorgestrel had no clinically relevant effect on exposure of all three compounds. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT03324685 (registered 25 October, 2017).
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Affiliation(s)
- Yuan Zhao
- Clinical Pharmacology and Pharmacometrics, Biogen, 225 Binney Street, Cambridge, MA, 02142, USA
| | | | | | - Romy Christmann
- Global Safety Regulatory Sciences, Biogen, Cambridge, MA, USA
| | - Himanshu Naik
- Clinical Pharmacology and Pharmacometrics, Biogen, 225 Binney Street, Cambridge, MA, 02142, USA.
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Sharma R, Smith SA, Boukina N, Dordari A, Mistry A, Taylor BC, Felix N, Cameron A, Fang Z, Smith A, Ismail N. Use of the birth control pill affects stress reactivity and brain structure and function. Horm Behav 2020; 124:104783. [PMID: 32533958 DOI: 10.1016/j.yhbeh.2020.104783] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
Millions of women worldwide use oral contraceptives (i.e., birth control pill; OCs), often starting during puberty/adolescence; however, it is unknown how OC use during this critical period of development affects the brain, especially with regard to emotional working memory. Here, we examined stress reactivity, and brain structure and function in OC users using the Trier Social Stress Test and structural and functional magnetic resonance imaging (MRI). Our results show that OC use during puberty/adolescence gives rise to a blunted stress response and alters brain activation during working memory processing. OC use, in general, is also linked to increased prefrontal brain activation during working memory processing for negatively arousing stimuli. OC use is also related to significant structural changes in brain regions implicated in memory and emotional processing. Together, these findings highlight that OC use induces changes to brain structure and function and alters stress reactivity. These findings may provide a mechanistic insight for the increased vulnerability to mood-related mental illness in women after OC use.
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Affiliation(s)
- Rupali Sharma
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Samantha A Smith
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Nadia Boukina
- Brain Imaging Group (BIG) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Aisa Dordari
- School of Integrated Science, Faculty of Science, Carleton University, Canada
| | - Alana Mistry
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | | | - Nereah Felix
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Andrew Cameron
- Brain Imaging Group (BIG) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Zhuo Fang
- Brain Imaging Group (BIG) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada
| | - Andra Smith
- Brain Imaging Group (BIG) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada; University of Ottawa Brain and Mind Research Institute, Canada
| | - Nafissa Ismail
- Neuroimmunology, Stress and Endocrinology (NISE) Lab, School of Psychology, Faculty of Social Science, University of Ottawa, Canada; University of Ottawa Brain and Mind Research Institute, Canada.
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Almstedt HC, Cook MM, Bramble LF, Dabir DV, LaBrie JW. Oral contraceptive use, bone mineral density, and bone turnover markers over 12 months in college-aged females. J Bone Miner Metab 2020; 38:544-554. [PMID: 31983034 DOI: 10.1007/s00774-019-01081-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/24/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The purpose of this study was to compare bone mineral density (BMD) and bone turnover markers between combined oral contraceptive (COC) and non-COC users over 12 months. MATERIALS AND METHODS COC users (n = 34, age = 19.2 ± 0.5) and non-COC users (n = 28, age = 19.3 ± 0.6) provided serum at baseline, 6 months, and 12 months. C-terminal telopepetides (CTX) and pro-collagen type 1 N-terminal propeptides (P1NP) were determined using ELISA. BMD was measured at the three time points using dual-energy x-ray absorptiometry (DXA). RESULTS COC users had greater CTX than non-COC users at baseline (18.6 ± 8.2 vs. 13.8 ± 5.3 ng/mL, P = 0.021) and 6 months (20.4 ± 10.3 vs. 14.2 ± 8.5 ng/mL, P = 0.018). Controlling for lean mass, groups were similar in BMD. Over 12 months, non-COC users maintained BMD at the spine, while the COC users declined 2.2% in lateral spine BMD (0.773 ± 0.014 to 0.756 ± 0.014 g/cm2, P = 0.03) and 0.7% in anterior-posterior spine BMD (1.005 ± 0.015 to 0.998 ± 0.015 g/cm2, P = 0.069). Non-COC users increased in BMD of the whole body over 12 months (P < 0.001) while COC users had no change. Women who began COCs within 4 years after menarche had lower BMD at the hip and whole body. Women taking very low dose COCs (20 mcg ethinyl estradiol, EE) significantly declined in CTX, P1NP, and lateral spine BMD in comparison to participants using low dose COCs (30/35 mcg EE). CONCLUSION College-aged women who did not use COCs increased BMD of the whole body, while COC users had elevated bone turnover, declines in spinal BMD, and lack of bone acquisition of the whole body over 12 months. Young females who initiate COC use early after menarche may experience skeletal detriments.
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Affiliation(s)
- Hawley C Almstedt
- Human Performance Laboratory, Department of Health and Human Sciences, Loyola Marymount University, 1 LMU Drive MS 8888, Los Angeles, CA, 90045, USA.
| | - Makenzie M Cook
- Human Performance Laboratory, Department of Health and Human Sciences, Loyola Marymount University, 1 LMU Drive MS 8888, Los Angeles, CA, 90045, USA
| | - Lily F Bramble
- Human Performance Laboratory, Department of Health and Human Sciences, Loyola Marymount University, 1 LMU Drive MS 8888, Los Angeles, CA, 90045, USA
| | - Deepa V Dabir
- Department of Biology, Loyola Marymount University, 1 LMU Drive MS 8888, Los Angeles, CA, 90045, USA
| | - Joseph W LaBrie
- HeadsUp Laboratory, Department of Psychology, Loyola Marymount University, 1 LMU Drive Suite 4700, Los Angeles, CA, 90045, USA
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Wallner C, Rausch A, Drysch M, Dadras M, Wagner JM, Becerikli M, Lehnhardt M, Behr B. Regulatory aspects of myogenic factors GDF-8 and Follistatin on the intake of combined oral contraceptives. Gynecol Endocrinol 2020; 36:406-412. [PMID: 31526145 DOI: 10.1080/09513590.2019.1666816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Combined oral contraceptives are one of the most prescribed drugs in the western world. While there is little evidence regarding effects of estrogen or gestagens on muscle metabolism, androgens are well-known for their anabolic characteristics. In this study, we seeked to investigate potential correlations of the myokines GDF-8, IGF-1 and Follistatin with female sexual hormones and likewise possible interactions with combined oral contraceptives (Dienogest and Ethyl Estradiol) intake. We obtained serum samples of young healthy women to measure hormone correlations. Furthermore, we simulated combined oral contraceptive blood circulating hormone concentrations to identify myogenic effects on HSkM in vitro. GDF-8, IGF-1 and Follistatin showed concentration correlations (p = .005) in overall patients' serum, while Follistatin as a promyogenic protein additionally showed a positive correlation with testosterone and estradiol (p < .05). Lower GDF-8 levels were also linked to a higher BMI (p = .009). Upon combined oral contraceptives (COC) intake, patients showed decreased GDF-8 (p = .006) but increased Follistatin (p = .0001) concentrations compared to patients without COC intake. In vitro, addition of Ethyl Estradiol and Dienogest to HSkM cells revealed a pro-myogenic, proliferative, chemosensitized pattern. Our data support a pro-myogenic effect of combined oral contraceptives.
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Affiliation(s)
- Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Annesophie Rausch
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Marius Drysch
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Johannes Maximilian Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Mustafa Becerikli
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
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20
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Abstract
Purpose Concentrations of sex steroid hormones-estrogens, progesterone, and testosterone-have been associated with premenstrual and menstrual vocal symptoms. However, the extent to which these symptoms may be reflected on acoustical features of the voice is still debated. This study investigates variations in fundamental frequency (f o) and related parameters in connected speech across phases of the menstrual cycle and during the use of a combined oral contraceptive pill (OCP). Method Electrolaryngographic recordings were made, and blood samples were collected at three different phases of the menstrual cycle-menstrual, follicular, and luteal-for placebo and OCP use. These two conditions were blindly and randomly allocated in the study. Speaking f o (SFF), SFF standard deviation, SFF rate of change, SFF slope, maximum and minimum f o, and f o range were extracted for nine healthy females while reading a phrase from the Rainbow Passage. Concentrations of sex hormones were analyzed in serum. Nonparametric statistical tests were carried out to assess differences between phases and conditions. Results SFF, its standard deviation, and maximum f o were significantly different between phases of the menstrual cycle for placebo use only. Menstrual phase showed the lowest values. Maximum and minimum f o were significantly different between placebo and OCP use for menstrual and follicular phases, respectively. Conclusions Fluctuations in sex steroid hormones across the menstrual cycle alter f o in speech more than a particular hormonal concentration. OCP use seems to have a stabilizing effect on the voice relative to f o and related parameters in speech.
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Affiliation(s)
- Filipa M B Lã
- Faculty of Education, Department of Didactics, School Organization and Special Didactics, National Distance Education University, Madrid, Spain
| | - Nuria Polo
- Faculty of Philology, Department of Spanish Language and General Linguistics, National Distance Education University, Madrid, Spain
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21
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Abstract
Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2 processes that may predispose to fragility fractures in later life. The relative importance of bone acquisition during growth versus bone loss during adulthood for fracture risk has been explored by examining the variability of areal bone mineral density (BMD) (aBMD) values in relation to age. Bone mass acquired at the end of the growth period appears to be more important than bone loss occurring during adult life. The major physiological effect of estrogen is the inhibition of bone resorption. When estrogen transcription possesses binds to the receptors, various genes are activated, and a variety modified. Interleukin 6 (IL-6) stimulates bone resorption, and estrogen blocks osteoblast synthesis of IL-6. Estrogen may also antagonize the IL-6 receptors. Additionally, estrogen inhibits bone resorption by inducing small but cumulative changes in multiple estrogen-dependent regulatory factors including TNF-α and the OPG/RANKL/RANK system. Review on existing data including information about new estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen receptors than the C21 progestins. This article reviews the effect of estrogens and progestogens on bone and presents new data of the currently approved drospirenone-only pill. The use of progestin-only contraceptives leading to an estradiol level between 30 and 50 pg/ml does not seem to lead to an accelerate bone loss.
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Affiliation(s)
- P. Hadji
- Frankfurter Center of Bone Health, Goethestr. 23, 60313 Frankfurt/Main, Germany
- Philipps University of Marburg, Marburg, Germany
| | - E. Colli
- Exeltis HealthCare Madrid, C/ Manuel Pombo Angulo 28, 4th Floor, 28050 Madrid, Spain
| | - P.-A. Regidor
- Exeltis Europe, Adalperostr. 84, 85737 Ismaning, Germany
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22
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Zgliczynska M, Szymusik I, Sierocinska A, Bajaka A, Rowniak M, Sochacki-Wojcicka N, Wielgos M, Kosinska-Kaczynska K. Contraceptive Behaviors in Polish Women Aged 18-35-a Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:E2723. [PMID: 31366184 PMCID: PMC6695758 DOI: 10.3390/ijerph16152723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 12/17/2022]
Abstract
The aim was to evaluate contraceptive behaviors, and factors affecting them, in the population of Polish-speaking women. A cross-sectional study was performed on 6763 women, current contraceptive users, aged 18 to 35. An anonymous and voluntary questionnaire written in Polish, containing 33 questions, was distributed online from January to February 2017. The Internet and doctors were the most popular sources of information about contraception (82% and 73%, respectively). Upon choosing contraception, women paid the most attention to its efficacy (85%) and its impact on health (59%). The most common methods were combined oral contraceptives (38%) and condoms (24%). In total, 51% had chosen hormonal contraception, of which 68% experienced side effects. The most frequent were decreased libido (39%) and weight gain (22%). Factors associated with the usage of hormonal or non-hormonal contraception were: education, relationship status, parenthood, number of sexual partners, frequency of intercourses, sources of information about contraception, and factors considered most important when choosing a contraceptive method. The choice between short-acting and long-acting reversible contraception was influenced by age, relationship status, parenthood, smoking, sources of information about contraception, and factors considered most important when choosing a contraceptive method. Wide access to contraception, high-quality education, and counselling should become priorities in family planning healthcare.
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Affiliation(s)
- Magdalena Zgliczynska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Iwona Szymusik
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland.
| | - Aleksandra Sierocinska
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Armand Bajaka
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Martyna Rowniak
- Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Nicole Sochacki-Wojcicka
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Miroslaw Wielgos
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
| | - Katarzyna Kosinska-Kaczynska
- st Department of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicz Square 1/3, P.O. Box 02-015 Warsaw, Poland
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23
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Emmerson O, Bester J, Lindeque BG, Swanepoel AC. The Impact of Two Combined Oral Contraceptives Containing Ethinyl Estradiol and Drospirenone on Whole Blood Clot Viscoelasticity and the Biophysical and Biochemical Characteristics of Erythrocytes. Microsc Microanal 2018; 24:713-728. [PMID: 30588913 DOI: 10.1017/s1431927618015453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Venous thrombosis is associated with combined oral contraceptive (COC) use. We investigated the impact of two ethinyl estradiol (EE) and drospirenone (DRSP) containing COCs (3 mg DRSP/20 µg EE and 3 µg DRSP/30 µg EE) on the viscoelasticity of whole blood clots along with the biophysical and biochemical characteristics of erythrocytes. Thromboelastography (TEG) analysis showed a tendency toward a hypercoagulable state in the COCs groups that was more pronounced with higher EE concentrations. Light microscopy and scanning electron microscopy (SEM) showed rouleaux formation of erythrocytes and alterations to the erythrocyte shape for both COC groups, which was attributed to membrane damage. SEM analysis showed spontaneous activation of fibrin and platelets in the COC groups, along with interactions between erythrocytes and platelets and/or fibrin. Confocal microscopy confirmed compromised membrane integrity in the COC groups compared to controls. Global thrombosis test analysis showed increased platelet activation and low thrombolysis in both COC groups when compared to controls. In conclusion, DRSP/EE formulations impact erythrocytes' biophysical and biochemical properties to cause a shift in hemostasis to a prothrombotic state. Although these effects are mostly subclinical the long-term effects and risks involved with the use of these hormones should be considered carefully for each individual.
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Affiliation(s)
- Odette Emmerson
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Janette Bester
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Barend G Lindeque
- 2Department of Obstetrics and Gynaecology,School of Medicine, Faculty of Health Sciences,University of Pretoria,P.O. Box 667,Pretoria 0001,South Africa
| | - Albe C Swanepoel
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
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24
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Iversen L, Fielding S, Lidegaard Ø, Mørch LS, Skovlund CW, Hannaford PC. Association between contemporary hormonal contraception and ovarian cancer in women of reproductive age in Denmark: prospective, nationwide cohort study. BMJ 2018; 362:k3609. [PMID: 30257920 PMCID: PMC6283376 DOI: 10.1136/bmj.k3609] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To investigate the association between contemporary combined hormonal contraceptives (including progestogen types in combined preparations and all progestogen-only products) and overall and specific types of ovarian cancer. DESIGN Prospective, nationwide cohort study. SETTING Denmark, 1995-2014. PARTICIPANTS All women aged 15-49 years during 1995-2014 were eligible. Women were excluded if they immigrated after 1995, had cancer (except non-melanoma skin cancer), had venous thrombosis, or were treated for infertility before entry (final study population included 1 879 227 women). Women were categorised as never users (no record of being dispensed hormonal contraception), current or recent users (≤1 year after stopping use), or former users (>1 year after stopping use) of different hormonal contraceptives. MAIN OUTCOME MEASURES Poisson regression was used to calculate relative risk of ovarian cancer among users of any contemporary combined hormonal contraceptives and by progestogen type in combined preparations and all progestogen-only products, including non-oral preparations. Separate analyses examined women followed up to their first contraception type switch and those with full contraceptive histories. Duration, time since last use, and tumour histology were examined and the population prevented fraction were calculated. RESULTS During 21.4 million person years, 1249 incident ovarian cancers occurred. Among ever users of hormonal contraception, 478 ovarian cancers were recorded over 13 344 531 person years. Never users had 771 ovarian cancers during 8 150 250 person years. Compared with never users, reduced risks of ovarian cancer occurred with current or recent use and former use of any hormonal contraception (relative risk 0.58 (95% confidence interval 0.49 to 0.68) and 0.77 (0.66 to 0.91), respectively). Relative risks among current or recent users decreased with increasing duration (from 0.82 (0.59 to 1.12) with ≤1 year use to 0.26 (0.16 to 0.43) with >10 years' use; P<0.001 for trend). Similar results were achieved among women followed up to their first switch in contraceptive type. Little evidence of major differences in risk estimates by tumour type or progestogen content of combined oral contraceptives was seen. Use of progestogen-only products were not associated with ovarian cancer risk. Among ever users of hormonal contraception, the reduction in the age standardised absolute rate of ovarian cancer was 3.2 per 100 000 person years. Based on the relative risk for the never use versus ever use categories of hormonal contraception (0.66), the population prevented fraction was estimated to be 21%-that is, use of hormonal contraception prevented 21% of ovarian cancers in the study population. CONCLUSIONS Use of contemporary combined hormonal contraceptives is associated with a reduction in ovarian cancer risk in women of reproductive age-an effect related to duration of use, which diminishes after stopping use. These data suggest no protective effect from progestogen-only products.
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Affiliation(s)
- Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Øjvind Lidegaard
- Rigshospitalet, Juliane Marie Centre, Department of Gynaecology, University of Copenhagen, Denmark
| | - Lina S Mørch
- Rigshospitalet, Juliane Marie Centre, Department of Gynaecology, University of Copenhagen, Denmark
| | - Charlotte W Skovlund
- Rigshospitalet, Juliane Marie Centre, Department of Gynaecology, University of Copenhagen, Denmark
| | - Philip C Hannaford
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
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25
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Abstract
Oral contraceptive pill (OC) is one of the most popular form of contraception. Despite both behavioral and neuroimaging evidence of its significant impact on female brain and cognitive functions, much remains to be discovered regarding OCs targets in the brain and mechanisms of action. In the present study mental rotation performance was compared between women using anti-androgenic oral contraceptives (n = 35), naturally cycling (NC) women (n = 33) and men (n = 29). On average, OC users were less accurate than NC women and men. Men performed the task more accurately than NC women, but the difference reached significance only in the highest angular disparity condition (150 deg). The response time was positively related with progesterone level while accuracy was negatively related with 17ß-estradiol level, in NC, but not OC women. The comparison of slope and intercept values (parameters relating response time to angular disparity) revealed the main result of present study: OC users exhibited significantly lower slope compared to men and NC women, but there were no differences in intercept between groups. These results suggest that OC users instead of using rotation in mind strategy implemented some alternative method(s). We conclude that lower performance accuracy of OC users could be related to a less efficient performance strategy.
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Affiliation(s)
- Ramune Griksiene
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania.
| | - Rasa Monciunskaite
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Aurina Arnatkeviciute
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Osvaldas Ruksenas
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
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26
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Eisenlohr-Moul TA, Girdler SS, Johnson JL, Schmidt PJ, Rubinow DR. Treatment of premenstrual dysphoria with continuous versus intermittent dosing of oral contraceptives: Results of a three-arm randomized controlled trial. Depress Anxiety 2017; 34:908-917. [PMID: 28715852 PMCID: PMC5629109 DOI: 10.1002/da.22673] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although traditionally dosed combined oral contraceptives (COCs) (21 days of active pills, 7 days of inactive pills) have not been demonstrated as superior to placebo for the treatment of premenstrual dysphoria (PMD), some randomized controlled trials (RCTs) indicate that oral contraceptives administered with a shortened or eliminated hormone-free interval are superior to placebo. However, results of such trials are mixed, and no existing studies have directly compared continuous and intermittent dosing schedules of the same oral contraceptive. The present study compared placebo, intermittent dosing of oral contraceptives, and continuous dosing of contraceptives for the treatment of PMD. METHODS Fifty-five women with prospectively confirmed PMD completed a three-arm, RCT in which they were randomized to 3 months of placebo (n = 22), intermittent drospirenone/ethinyl estradiol dosed on a 21-7 schedule (n = 17), or continuous drospirenone/estradiol (n = 16) following a baseline assessment month. RESULTS All three groups demonstrated similar, robust reductions in premenstrual symptoms over time. A marked placebo response was observed. CONCLUSIONS The study fails to replicate a uniquely beneficial effect of continuous COC on PMD. Additional work is needed to understand the psychosocial context bolstering the placebo response in women with PMD.
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Affiliation(s)
- Tory A. Eisenlohr-Moul
- Corresponding Author; Present address: University of North Carolina at Chapel Hill, 2218 Nelson Highway, Suite 3, Chapel Hill, NC 27517. . Phone: 859-317-0503
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27
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Duhita MR, Schutz Y, Montani JP, Dulloo AG, Miles-Chan JL. Oral Contraceptive Pill Alters Acute Dietary Protein-Induced Thermogenesis in Young Women. Obesity (Silver Spring) 2017; 25:1482-1485. [PMID: 28712125 DOI: 10.1002/oby.21919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/30/2017] [Accepted: 06/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There is much interest in the role of dietary protein for weight control. However, there remains a need to characterize individual determinants of the thermogenic effects of protein. This study aimed to investigate the influence of menstrual cycle phase and the combined, monophasic oral contraceptive pill on the thermogenic response to a standardized high-protein (HP) versus normal-protein (NP) meal. METHODS Following an overnight fast, resting energy expenditure (EE) was measured in 16 healthy young women (8 taking and 8 not taking the pill) and 8 men for 30 minutes pre ingestion and 3 hours post ingestion of a NP (11%) or HP (24%) meal. RESULTS There was no effect of menstrual phase or contraceptive pill use on fasting EE or NP response. However, HP increased EE significantly more than NP in women not taking the oral contraceptive pill and in men, but not in women taking the pill. CONCLUSIONS This study shows an absence of the greater thermic effect of HP versus NP in women taking the oral contraceptive pill and has important implications regarding the effectiveness of HP for body weight regulation in women. With current obesity treatment/prevention strategies remaining largely ineffective, understanding the relationship between oral contraceptive pill use and protein-induced thermogenesis may enable the successful recalibration of existing dietary recommendations.
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Affiliation(s)
| | - Yves Schutz
- Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland
| | - Jean-Pierre Montani
- Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland
| | - Abdul G Dulloo
- Department of Medicine/Physiology, University of Fribourg, Fribourg, Switzerland
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28
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Armbruster D, Kirschbaum C, Strobel A. The not-so-bitter pill: Effects of combined oral contraceptives on peripheral physiological indicators of emotional reactivity. Horm Behav 2017; 94:97-105. [PMID: 28676251 DOI: 10.1016/j.yhbeh.2017.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023]
Abstract
Combined oral contraceptives (COC) are used by millions of women worldwide. Although findings are not entirely consistent, COC have been found to impact on brain function and, thus, to modulate affective processes. Here, we investigated electro-physiological responses to emotional stimuli in free cycling women in both the early follicular and late luteal phase as well as in COC users. Skin conductance response (SCR), startle reflex, corrugator and zygomaticus activity were assessed. COC users showed reduced overall startle magnitude and SCR amplitude, but heightened overall zygomaticus activity, although effect sizes were small. Thus, COC users displayed reduced physiological reactions indicating negative affect and enhanced physiological responses signifying positive affect. In free cycling women, endogenous 17β-estradiol levels were associated with fear potentiated startle in both cycle phases as well as with SCR and zygomaticus activity during the follicular phase. Testosterone was associated with corrugator and zygomaticus activity during the luteal phase, while progesterone levels correlated with corrugator activity in the follicular phase. To the contrary, in COC users, endogenous hormones were not associated with electro-physiological measures. The results further underscore the importance of considering COC use in psychophysiological studies on emotional processing.
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Affiliation(s)
- Diana Armbruster
- Personality and Individual Differences, Institute of Psychology I, Technische Universität Dresden, Dresden, Germany.
| | - Clemens Kirschbaum
- Biological Psychology, Institute of Psychology I, Technische Universität Dresden, Dresden, Germany
| | - Alexander Strobel
- Personality and Individual Differences, Institute of Psychology I, Technische Universität Dresden, Dresden, Germany
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29
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Olatunji LA, Olaniyi KS, Usman TO, Abolarinwa BA, Achile CJ, Kim IK. Combined oral contraceptive and nitric oxide synthesis inhibition synergistically causes cardiac hypertrophy and exacerbates insulin resistance in female rats. Environ Toxicol Pharmacol 2017; 52:54-61. [PMID: 28376377 DOI: 10.1016/j.etap.2017.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/18/2017] [Accepted: 03/18/2017] [Indexed: 06/07/2023]
Abstract
Combined oral contraceptive (COC) use or inhibition of nitric oxide (NO) synthesis has been shown to cause hypertension and insulin resistance. However, the concomitant effects of COC and NO deficiency on the heart and glucose regulation are not well known. We therefore hypothesized that COC treatment during NO deficiency would lead to the development of cardiac hypertrophy that is associated with aggravated glucose deregulation, pro-inflammatory and pro-fibrotic biomarkers. Eight-week-old female Wistar rats were randomly allotted into control, NO deficient (NG-nitro-l-arginine methyl ester: L-NAME; 20.0mg/kg b.w.), COC-treated (1.0μg ethinylestradiol+5.0μg levonorgestrel, p.o) and L-NAME+COC-treated groups. The animals were treated daily for 6 weeks. Systolic blood pressure was estimated by tail-cuff plethysmography, insulin resistance (IR) and β-cell function were estimated by homeostatic model of assessment (HOMA-IR and HOMA-β). Pro-inflammatory (C-reactive protein; CRP and uric acid) and pro-fibrotic (plasminogen activator inhibitor-1; PAI-1) biomarkers were estimated in the plasma. Cardiac histological examination was also done. Results show that COC or L-NAME treatments led to increased blood pressure, HOMA-IR, impaired β-cell function, PAI-1, CRP and uric acid, without significant effect on cardiac mass. L-NAME+COC-treated group had significantly higher blood pressure, HOMA-IR, impaired β-cell function, PAI-1, CRP and cardiac mass than COC- or L-NAME-treated groups. Histological examination validated that COC use during NO deficiency causes cardiac hypertrophy. The present study demonstrates that COC treatment and NO deficiency synergistically causes cardiac hypertrophy that is associated with aggravated glucose deregulation, atherogenic dyslipidemia, pro-inflammatory and pro-fibrotic markers.
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Affiliation(s)
- Lawrence A Olatunji
- Cardiovascular Research Laboratory, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria.
| | - Kehinde S Olaniyi
- Cardiovascular Research Laboratory, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Taofeek O Usman
- Cardiovascular Research Laboratory, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria; Cardiovascular Unit, Department of Physiology, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Bilikis A Abolarinwa
- Cardiovascular Research Laboratory, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Caleb J Achile
- Cardiovascular Research Laboratory, Department of Physiology, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - In-Kyeom Kim
- Department of Pharmacology & Cardiovascular Research Institute, Kyungpook National University School of Medicine, Daegu 700-842, Republic of Korea
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30
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Kyvernitakis I, Kostev K, Nassour T, Thomasius F, Hadji P. The impact of depot medroxyprogesterone acetate on fracture risk: a case-control study from the UK. Osteoporos Int 2017; 28:291-297. [PMID: 27461017 DOI: 10.1007/s00198-016-3714-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED There has been concerning about women receiving depot medroxyprogesterone acetate (DMPA) contraception because of the prolonged hypoestrogenemic state regarding the potential negative effects on bone health. This study showed that DMPA exposure is associated with increased fracture risk and that fracture risk increases with longer DMPA exposure. INTRODUCTION DMPA has been associated with impaired bone mineral acquisition during adolescence and accelerated bone loss in later life. We performed this large population-based study to assess the association between use of DMPA or combined oral contraceptives and the incident risk of fracture. METHODS We identified 4189 women between 20 and 44 years of age with a first-time fracture diagnosis, matched them with 4189 random controls using the Disease Analyzer database and investigated the relation with DMPA exposure. RESULTS Overall, 11 % of the fracture cases and 7.7 % of the controls had DMPA use recorded. The adjusted OR for developing a fracture in patients with current use of DMPA compared to non-users was 0.97 (95 % CI 0.51-1.86), 2.41 (95 % CI 1.42-4.08), and 1.46 (95 % CI 0.96-2.23) for 1-2, 3-9, and ≥10 prescriptions, respectively. The adjusted OR for developing a fracture in patients with past use of DMPA compared to non-users was 0.96 (95 % CI 0.73-1.26), 1.14 (95 % CI 0.86-1.51), and 1.55 (95 % CI 1.07-2.27) for 1-2, 3-9, and ≥10 prescriptions, respectively. The highest fracture risk was identified in young patients less than 30 years with longer DMPA exposure (≥10 prescriptions; OR 3.04, 95 % CI 1.36-6.81), as well as in patients in the late reproductive years with past use of DMPA (OR 1.72, 95 % CI 1.13-2.63). CONCLUSIONS Our results indicate that DMPA exposure is associated with increased fracture risk and may have negative effects on bone metabolism, resulting in impaired bone mineral acquisition during adolescence and accelerated bone loss in adult life.
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Affiliation(s)
- I Kyvernitakis
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Goethe-University of Frankfurt, Nibelungenallee 37-41, 60318, Frankfurt am Main, Germany.
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany.
| | - K Kostev
- IMS HEALTH GmbH & Co. OHG, Epidemiology, Real World Evidence Solutions, Darmstädter Landstraße 108, 60598, Frankfurt, Germany
| | - T Nassour
- Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - F Thomasius
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
| | - P Hadji
- Department of Bone Oncology, Gyn. Endocrinology and Reproductive Medicine, Nordwest Hospital, Goethe-University of Frankfurt, Frankfurt a.M., Germany
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Abstract
Combined oral contraceptives (COCs), colloquially referred to as "the pill," have been regarded as a medical breakthrough, as they have improved the lives of countless women, from simplifying family planning to the treatment of acne, endometriosis, polycystic ovarian syndrome, and dysmenorrhea. Unfortunately, COC usage has been associated with an increased occurrence of venous thrombosis and therefore a systemic hypercoagulable state in susceptible females. Here we discuss the health risks of COC usage and use viscoelastic and morphological techniques to investigate the effect of different COC constituents on clot formation, particularly fibrin network packaging and whole blood viscoelasticity. Viscoelastic properties of whole blood showed gender-specific changes while morphological alterations were person-specific, regardless of gender. Using scanning electron microscopy and thromboelastography provides great insight regarding fibrin packaging and the development of a hypercoagulable state in high-risk individuals. We proposed a three-step approach where (1) an individual's coagulation profile baseline is determined, after which (2) the "ideal" combination of constituents is prescribed, and (3) the coagulation profile of the individual is monitored to assess possible risk of thrombosis. Only in following such an individualized patient-oriented approach will we be able to avoid the many health issues due to COC usage in susceptible females.
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Affiliation(s)
- Albe C Swanepoel
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
| | - Amcois Visagie
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
| | - Etheresia Pretorius
- Department of Physiology,School of Medicine, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Pretoria, Arcadia0007,South Africa
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Inoue K, Kelly M, Bateson D, Rutherford A, Stewart M, Richters J. Contraceptive choices and sexual health of Japanese women living in Australia: A brief report from a qualitative study. Aust Fam Physician 2016; 45:523-527. [PMID: 27610438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is a lack of research focused specifically on the contraceptive and sexual health practices of Japanese women living in Australia. OBJECTIVE This paper reports findings from a cohort of migrant Japanese women who participated in a study of Australian women's understanding and experience of contraceptives. METHODS In-depth, open-ended interviews were conducted between August 2012 and June 2013 in New South Wales. Audio-recorded interviews of seven Japanese women were transcribed verbatim and analysed thematically. RESULTS The four prominent themes were the condom and withdrawal methods, varying attitudes to contraceptive practices, discussing contraception and sexual issues with general practitioners (GPs), and the unspoken topic of sexually transmissible infections (STIs). DISCUSSION Japanese migrants tend to choose the condom and withdrawal methods, which they perceive to be 'standard practice' in Japan. A greater understanding by Australian GPs of Japanese women's attitudes to contraception and sexual health issues could enhance the sexual health of Japanese women.
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Angelova M, Kovachev E, Miteva K, Atanasova Z. [New Low-Dose Oral Contraceptive with 28 Midiana.]. Akush Ginekol (Sofiia) 2016; 55:16-18. [PMID: 29370501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As a representative of the low dose generation of oral contraceptives, Midiana 28 provides minimal intake of estrogens for the female organism in the presence of a new generation getation component- Drospierenone. Midiana has an excellent contraceptive effect - the control group of women showed no cases of impregnation during the intake, Pearl index =0.00. It also exercises a good control over the menstrual cycle with low frequency of intementrual bleeding /17%/ Midiana 28 shows a very good tolerability with minimal, detected, rapidly transient side effects.
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Peters K, Gordon N, Ricciotti N, Hsieh J, Howard B, Weiss H. Hemostatic effects of two desogestrel-containing combined oral contraceptive regimens: a multinational, multicenter, randomized, open-label study. CLIN EXP OBSTET GYN 2016; 43:334-340. [PMID: 27328486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE OF INVESTIGATION To compare the effects of desogestrel (DSG) 150 mcg/ethinyl estradiol (EE) 20 mcg for 21 days followed by either seven days of EE ten mcg (21/7-active) or no treatment (DSG/EE+no Tx) on hemostatic markers. MATERIALS AND METHODS This was a randomized, multicenter, open-label study that enrolled healthy premenopausal women. Non-inferiority of 21/7-active to DSG/EE+no Tx was determined if the upper limit of the two-sided 95% CI of the mean treatment difference in prothrombin fragment 1+2 (F1+2) over 24 weeks between groups was < 130 pmol/L. RESULTS 246 subjects (n = 125, 21/7-active; n = 121, DSG/EE+no Tx) comprised the primary analysis. Mean F1+2 levels increased in both 21/7-active and DSG/EE+no Tx regimens (least square [LS] mean changes +45 pmol/L and +56.8 pmol/L, respectively). LS mean treatment difference was -11.8 pmol/L (95% CI: -54.8, 31.2). CONCLUSION The effect of adding EE ten mcg to the seven-day hormone-free interval of DSG/EE on F1+2 levels was non-inferior to traditional DSG/EE.
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Namli Kalem M, Hizli D, Kamalak Z, Kösüs A, Kösüs N, Turhan N, Kafali H. Effect of combined oral contraceptive use on serum 25-hydroxy vitamin D levels and ultrasound parameters in patients with polycystic ovary syndrome. Gynecol Endocrinol 2016; 32:281-4. [PMID: 26654523 DOI: 10.3109/09513590.2015.1113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate if there is an effect of combined oral contraceptive (COC) use on serum 25-hydroxy vitamin D [25(OH)D] levels in patients with polycystic ovary syndrome (PCOS). METHODS PCOS was defined by the 2003 Rotterdam criteria. All patients with PCOS were treated with a COC containing 0.035 mg ethinylestradiol and 2 mg cyproterone acetate for 6 months. Serum 25(OH)D levels, HOMA-IR, ovarian volume and antral follicule count were measured before and after the treatment. RESULTS The median 25(OH)D levels were 9.40 (range 4.40-24.50) μg/l and 7.00 (5.00-13.50) μg/l before and after COC use, respectively. Serum 25(OH)D levels decreased after the treatment; however, the difference was not statistically significant (p = 0.055). CONCLUSION This study seems to be the first prospective trial revealing the effect of COC use on serum 25(OH)D levels in women with PCOS. Although the decrease in serum 25(OH)D levels in patients with PCOS with the use of COC alone, did not reach to statistically significance level after 6 months treatment with COC.
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Affiliation(s)
- Müberra Namli Kalem
- a Department of Obstetrics & Gynecology , Turgut Ozal University School of Medicine , Ankara , Turkey
| | - Deniz Hizli
- a Department of Obstetrics & Gynecology , Turgut Ozal University School of Medicine , Ankara , Turkey
| | - Zeynep Kamalak
- b Department of Obstetrics and Gynecology , Erzurum Nene Hatun Hospital , Erzurum , Turkey
| | - Aydin Kösüs
- a Department of Obstetrics & Gynecology , Turgut Ozal University School of Medicine , Ankara , Turkey
| | - Nermin Kösüs
- a Department of Obstetrics & Gynecology , Turgut Ozal University School of Medicine , Ankara , Turkey
| | - Nilgün Turhan
- c Department of Obstetrics & Gynecology , Mugla University School of Medicine , Mugla , Turkey , and
| | - Hasan Kafali
- d Department of Obstetrics and Gynecology , Gazi University School of Medicine , Ankara , Turkey
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Abstract
BACKGROUND Postpartum contraception improves the health of mothers and children by lengthening birth intervals. For lactating women, contraception choices are limited by concerns about hormonal effects on milk quality and quantity and passage of hormones to the infant. Ideally, the contraceptive chosen should not interfere with lactation or infant growth. Timing of contraception initiation is also important. Immediately postpartum, most women have contact with a health professional, but many do not return for follow-up contraceptive counseling. However, immediate initiation of hormonal methods may disrupt the onset of milk production. OBJECTIVES To determine the effects of hormonal contraceptives on lactation and infant growth SEARCH METHODS We searched for eligible trials until 2 March 2015. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, POPLINE, Web of Science, LILACS, ClinicalTrials.gov, and ICTRP. We also examined review articles and contacted investigators. SELECTION CRITERIA We sought randomized controlled trials in any language that compared hormonal contraception versus another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception includes combined or progestin-only oral contraceptives, injectable contraceptives, implants, and intrauterine devices.Trials had to have one of our primary outcomes: breast milk quantity or biochemical composition; lactation initiation, maintenance, or duration; infant growth; or timing of contraception initiation and effect on lactation. Secondary outcomes included contraceptive efficacy while breastfeeding and birth interval. DATA COLLECTION AND ANALYSIS For continuous variables, we calculated the mean difference (MD) with 95% confidence interval (CI). For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio (OR) with 95% CI. Due to differing interventions and outcome measures, we did not aggregate the data in a meta-analysis. MAIN RESULTS In 2014, we added seven trials for a new total of 11. Five reports were published before 1985 and six from 2005 to 2014. They included 1482 women. Four trials examined combined oral contraceptives (COCs), and three studied a levonorgestrel-releasing intrauterine system (LNG-IUS). We found two trials of progestin-only pills (POPs) and two of the etonogestrel-releasing implant. Older studies often lacked quantified results. Most trials did not report significant differences between the study arms in breastfeeding duration, breast milk composition, or infant growth. Exceptions were seen mainly in older studies with limited information.For breastfeeding duration, two of eight trials indicated a negative effect on lactation. A COC study reported a negative effect on lactation duration compared to placebo but did not quantify results. Another trial showed a lower percentage of the LNG-IUS group breastfeeding at 75 days versus the nonhormonal IUD group (reported P < 0.05) but no significant difference at one year.For breast milk volume, two older studies indicated lower volume for the COC group versus the placebo group. One trial did not quantify results. The other showed lower means (mL) for the COC group, e.g. at 16 weeks (MD -24.00, 95% CI -34.53 to -13.47) and at 24 weeks (MD -24.90, 95% CI -36.01 to -13.79). Another four trials did not report any significant difference between the study groups in milk volume or composition with two POPs, a COC, or the etonogestrel implant.Seven trials studied infant growth; one showed greater weight gain (grams) for the etonogestrel implant versus no method for six weeks (MD 426.00, 95% CI 58.94 to 793.06) but less compared with depot medroxyprogesterone acetate (DMPA) from 6 to 12 weeks (MD -271.00, 95% CI -355.10 to -186.90). The others studied POPs, COCs versus POPs, or an LNG-IUS. AUTHORS' CONCLUSIONS Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Alison M Stuebe
- University of North Carolina School of MedicineDepartment of Obstetrics and Gynecology3010 Old Clinic BuildingCB 7516Chapel HillNorth CarolinaUSA27599
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Sarah T Truitt
- Alaska Native Medical CenterDepartment of Obstetrics and Gynecology4320 Diplomacy DriveAnchorageAlaskaUSA
| | - Maria F Gallo
- The Ohio State UniversityDivision of EpidemiologyColumbusOhioUSA
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Macut D, Božić Antić I, Nestorov J, Topalović V, Bjekić Macut J, Panidis D, Kastratović Kotlica B, Papadakis E, Matić G, Vojnović Milutinović D. The influence of combined oral contraceptives containing drospirenone on hypothalamic-pituitary-adrenocortical axis activity and glucocorticoid receptor expression and function in women with polycystic ovary syndrome. Hormones (Athens) 2015; 14:109-17. [PMID: 25402380 DOI: 10.14310/horm.2002.1526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Most women with PCOS have increased adrenal androgen production, enhanced peripheral metabolism of cortisol and elevation in urinary excretion of its metabolites. Increased cortisol clearance in PCOS is followed by a compensatory overdrive of the hypothalamic-pituitary-adrenocortical (HPA) axis. We hypothesized that oral contraceptives containing ethinylestradiol and drospirenone (EE-DRSP) could modulate glucocorticoid receptor (GR) expression and function and thus affect HPA axis activity in PCOS patients. DESIGN We analyzed 12 women with PCOS (age 24.17±4.88 years; body mass index 22.05±3.97 kg/m²) treated for 12 months with EE-DRSP and 20 BMI matched controls. In all subjects testosterone, dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG), cortisol (basal and after dexamethasone), concentrations of GR protein, phospo-GR211 protein, number of GR per cell (B(max) and its equilibrium dissociation constant (K(D)) were measured. RESULTS Before treatment, increased concentrations of testosterone and DHEAS (p<0.001, respectively), unaltered basal cortisol and an increased sensitivity (p<0.05) of the HPA axis to dexamethasone were observed in PCOS women in comparison to controls. After treatment, testosterone (p<0.01), DHEAS (p<0.05) and cortisol suppression after dexamethasone (p<0.01) were decreased in PCOS women. There were no changes in GR protein concentration, GR phosphorylation nor in the receptor functional parameters B(max) and K(D) in women with PCOS before and after the therapy, and in comparison to controls. CONCLUSIONS Prolonged treatment with EE-DRSP in PCOS women decreased serum androgens and increased cortisol in the presence of decreased sensitivity of the HPA axis and did not exert changes in GR expression and function.
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Giribela CRG, Consolim-Colombo FM, Nisenbaum MG, Moraes TLD, Giribela AHG, Baracat EC, Melo NRD. Effects of a combined oral contraceptive containing 20 mcg of ethinylestradiol and 3 mg of drospirenone on the blood pressure, renin-angiotensin-aldosterone system, insulin resistance, and androgenic profile of healthy young women. Gynecol Endocrinol 2015; 31:912-5. [PMID: 26172927 DOI: 10.3109/09513590.2015.1062860] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Combined oral contraceptives (COCs) may increase the risk for cardiovascular disease depending on the ethynyl estradiol (EE) dose and the androgenicity of the progestogens. Our objective was to evaluate the impact of a COC containing 20 mcg EE + 3 mg drospirenone on blood pressure (BP), renin-angiotensin-aldosterone system, insulin resistance, and androgenic profile of healthy young women. Eighty-one healthy young women aged 30 ± 1 years (case group, n = 49, received COC; control group, n = 32, used no COC) were assessed twice, before and after the 6-month study. Statistical analysis employed the paired t-tests and expressed the data in mean and standard deviation. Results were as follows: no changes in BP or in BMI; a significant increase in aldosterone, plasma renin activity, triglycerides, and total cholesterol levels, but a non-significant increase in HDL and no significant changes in LDL levels (these parameters remained within normal ranges); a significant increase in the HOMA-IR index and a significant decrease in dehydroepiandrosterone sulfate (SDHEA), androstenedione, total testosterone, and free testosterone levels; no significant variations in the control group parameters. An oral contraceptive combination of a low EE dose and an anti-androgenic progestogen does not negatively influence the risk factors for a cardiovascular disease.
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Affiliation(s)
- Cassiana Rosa Galvão Giribela
- a Gynecology and Obstetrics Department , Clinics Hospital, University of São Paulo Medical School , São Paulo , Brazil and
| | | | - Marcelo Gil Nisenbaum
- a Gynecology and Obstetrics Department , Clinics Hospital, University of São Paulo Medical School , São Paulo , Brazil and
| | - Tercio Lemos de Moraes
- b Hypertension Unit , Heart Institute (InCor), University of São Paulo Medical School , São Paulo , Brazil
| | - Aricia Helena Galvão Giribela
- a Gynecology and Obstetrics Department , Clinics Hospital, University of São Paulo Medical School , São Paulo , Brazil and
| | - Edmund Chada Baracat
- a Gynecology and Obstetrics Department , Clinics Hospital, University of São Paulo Medical School , São Paulo , Brazil and
| | - Nilson Roberto de Melo
- a Gynecology and Obstetrics Department , Clinics Hospital, University of São Paulo Medical School , São Paulo , Brazil and
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Elaut E, Buysse A, De Sutter P, Gerris J, De Cuypere G, T'Sjoen G. Cycle-Related Changes in Mood, Sexual Desire, and Sexual Activity in Oral Contraception-Using and Nonhormonal-Contraception-Using Couples. J Sex Res 2014; 53:125-136. [PMID: 25420716 DOI: 10.1080/00224499.2014.976780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Findings on women's sexuality across the menstrual cycle are inconsistent. One relatively consistent finding is a midcycle and premenstrual peak in sexual desire in freely cycling women. Results on the cycle-related effects on sexual behavior are less clear. Large proportions of reproductive-aged women use combined oral contraception (COC), but studies on potential cycle-related shifts in sexual desire and behavior are sparse. A prospective diary study assessed sexual desire, sexual behavior, and mood in 89 heterosexual couples. Women were using one of four contraceptive methods: (1) nonhormonal contraception, (2) low-dose COC containing 20 mcg ethinylestradiol and 75 mcg gestoden or desogestrel, (3) COC containing 35 mcg ethinylestradiol and 2 mg cyproteronacetate, and (4) COC containing 30 mcg ethinylestradiol and 3 mg drospirenone. No cycle effects of sexual desire were established in the COC group, but frequency of sexual intercourse declined in the last days of active pill taking. These results were similar in both female and male partners. Negative affect did not covary with sexual desire.
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Affiliation(s)
- Els Elaut
- a Centre for Sexology and Gender Problems , Ghent University Hospital
| | - Ann Buysse
- b Department of Experimental-Clinical and Health Psychology , Ghent University
| | - Petra De Sutter
- c Department of Reproductive Medicine, Obstetrics, and Gynaecology , Ghent University Hospital
| | - Jan Gerris
- c Department of Reproductive Medicine, Obstetrics, and Gynaecology , Ghent University Hospital
| | - Griet De Cuypere
- a Centre for Sexology and Gender Problems , Ghent University Hospital
| | - Guy T'Sjoen
- a Centre for Sexology and Gender Problems , Ghent University Hospital
- d Department of Endocrinology , Ghent University Hospital
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Helvaci N, Yildiz BO. Oral contraceptives in polycystic ovary syndrome. MINERVA ENDOCRINOL 2014; 39:175-187. [PMID: 25003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age and combined oral contraceptives (OCs) are often the first-line treatment of the syndrome by improving hyperandrogenism and regulating menstrual cycles. Oral contraceptives have some cardiovascular and metabolic effects that varies among different formulations depending upon the dose and type of the both estrogen and progestin components. These cardiometabolic effects of OCs raise some concerns about their long-term use in PCOS, but available data suggest that the benefits outweigh the risks. More studies are needed to clarify the safety of long-term use of OCs in PCOS.
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Affiliation(s)
- N Helvaci
- Division of Endocrinology and Metabolism Department of Internal Medicine Hacettepe University School of Medicine Hacettepe, Ankara, Turkey -
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Nappi RE, Paoletti AM, Volpe A, Chiovato L, Howard B, Weiss H, Ricciotti N. Multinational, multicentre, randomised, open-label study evaluating the impact of a 91-day extended regimen combined oral contraceptive, compared with two 28-day traditional combined oral contraceptives, on haemostatic parameters in healthy women. EUR J CONTRACEP REPR 2014; 19:285-94. [PMID: 24923685 PMCID: PMC4134112 DOI: 10.3109/13625187.2014.918596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the impact of a 91-day extended regimen combined oral contraceptive (150 μg levonorgestrel [LNG]/30 μg ethinylestradiol [EE] for 84 days, followed by 10 μg EE for seven days [Treatment 1]) compared with two traditional 21/7 regimens (21 days 150 μg LNG/30 μg EE [Treatment 2] or 150 μg desogestrel [DSG]/30 μg EE [Treatment 3], both with seven days' hormone free), on several coagulation factors and thrombin formation markers. METHODS Randomised, open-label, parallel-group comparative study involving healthy women (18-40 years). The primary endpoint was change from baseline in prothrombin fragment 1 + 2 (F1 + 2) levels over six months. RESULTS A total of 187 subjects were included in the primary analysis. In all groups, mean F1 + 2 values were elevated after six months of treatment. Changes were comparable between Treatments 1 and 2 (least squares mean change: 170 pmol/L and 158 pmol/L, respectively) but noticeably larger after Treatment 3 (least squares mean change: 592 pmol/L). The haemostatic effects of Treatment 1 were comparable to those of Treatment 2 and noninferior to those of Treatment 3 (lower limit of 95% confidence interval [- 18.3 pmol/L] > - 130 pmol/L). CONCLUSIONS The LNG/EE regimens had similar effects on F1 + 2. Noninferiority was demonstrated between extended regimen LNG/EE and DSG/EE.
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Affiliation(s)
- Rossella E. Nappi
- *Research Center for Reproductive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Anna Maria Paoletti
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
| | | | - Luca Chiovato
- Department of Internal Medicine and Endocrinology, IRCCS Maugeri Foundation, University of Pavia, Italy
| | | | - Herman Weiss
- ˆTeva Global Medical Affairs, Petach Tikva, Israel
| | - Nancy Ricciotti
- Teva Branded Pharmaceutical Products, R&D, Inc., Frazer, PA, USA
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Gestodene Study Group 322. The safety and contraceptive efficacy of a 24-day low-dose oral contraceptive regimen containing gestodene 60 µg and ethinylestradiol 15 µg. EUR J CONTRACEP REPR 2014; 4:9-15. [PMID: 14677620 DOI: 10.3109/13625189909085265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The safety and contraceptive efficacy of a new 24-day regimen of an oral contraceptive combination containing gestodene (GTD) 60 microg and ethinylestradiol (EE) 15 microg was evaluated in an open-label, multicenter study. METHODS Adult women received GTD 60 microg/EE 15 microg from day 1 to 24 and 4 days of placebo during a 28-day cycle for either 13 or 19 cycles. RESULTS Of the 1515 subjects enrolled, 1496 were included in the intent-to-treat analysis. A total of three pregnancies were reported during the 18 194 treatment cycles of the study, yielding a Pearl index of 0.21. Life-table analysis, based on 16 954 cycles, gave an accidental pregnancy rate of 0.0033. The most frequent adverse events were headache (reported in 35% of subjects), absence of bleeding (16%), flu-like syndrome (15%), pharyngitis (15%) and abdominal pain (15%). The most frequent reasons for withdrawal from the study were metrorrhagia, flu syndrome and absence of bleeding. Analyses of withdrawal and intermenstrual bleeding and spotting indicated acceptable cycle control. CONCLUSIONS The 24-day GTD 60 microg/EE 15 microg regimen appears to be a well-tolerated and effective method for low-dose oral contraception. The current formulation offers an ultra-low steroidal dosage combined with a reduced pill-free interval to improve contraceptive efficacy.
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MESH Headings
- Adult
- Contraceptives, Oral/adverse effects
- Contraceptives, Oral/pharmacology
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/pharmacology
- Contraceptives, Oral, Synthetic/administration & dosage
- Contraceptives, Oral, Synthetic/adverse effects
- Drug Administration Schedule
- Estrogens/adverse effects
- Estrogens/pharmacology
- Ethinyl Estradiol/adverse effects
- Ethinyl Estradiol/pharmacology
- Female
- Humans
- Menstrual Cycle/drug effects
- Norpregnenes/adverse effects
- Norpregnenes/pharmacology
- Pregnancy
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Gestodene Study Group 324. Cycle control, safety and efficacy of a 24-day regimen of gestodene 60 µg/ ethinylestradiol 15 µg and a 21-day regimen of desogestrel 150 µg/ethinylestradiol 20 µg. EUR J CONTRACEP REPR 2014; 4:17-25. [PMID: 14677621 DOI: 10.3109/13625189909085266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This multicenter, open-label study was conducted to compare the cycle control, efficacy and safety of a 24-day regimen of a new ultra-low-dose oral contraceptive containing gestodene (GTD) 60 microg/ethinylestradiol (EE) 15 microg and a 21-day regimen of desogestrel (DSG) 150 microg/EE 20 microg. METHODS Healthy women at least 18 years of age who had had regular menstrual cycles for the prior 3 months were randomly assigned to treatment for six cycles. RESULTS Data from 1074 women were included in the analyses. Overall, 65% of cycles were normal with GTD/EE and 78% with DSG/EE. The overall incidence of breakthrough bleeding and/or spotting was 29% with GTD/EE and 20% with DSG/EE, with absence of bleeding occurring in 6% of cycles in the GTD/EE group and 1% of cycles in the DSG/EE group. The GTD/EE group had a significantly shorter length of bleeding episodes (4 vs. 5 days, p < 0.001), a significantly lower intensity of bleeding (p < 0.01) and a significantly shorter time for onset of withdrawal bleeding than the DSG/EE group (p < 0.001). Safety profiles for the two treatment groups were similar. Significantly more subjects in the DSG/ EE group withdrew because of breast pain (p = 0.03) and nausea or vomiting (p = 0.05). One pregnancy occurred in each treatment group. CONCLUSIONS The 24-day regimen of GTD 60 microg/EE 15 microg provided good efficacy, acceptable cycle control and a favorable safety profile compared with DSG/EE. This ultra-low-dose formulation offers unique advantages in efficacy and safety for oral contraception.
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Oosterbaan HP. An open-label study of the effects of a 24-day regimen of gestodene 60 µg/ethinylestradiol 15 µg on endometrial histological findings in healthy women. EUR J CONTRACEP REPR 2014; 4 Suppl 2:3-8. [PMID: 14677619 DOI: 10.3109/13625189909085264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This open-label, non-comparative study was conducted at a single center to evaluate the effects on the endometrium of a 24-day regimen of a combined oral contraceptive containing gestodene (GTD) 60 microg and ethinylestradiol (EE) 15 microg. METHODS Healthy parous women who were > or = 18 years old and had had regular menstrual cycles for the prior 3 months were randomly assigned to one of two groups. Subjects in group A underwent endometrial biopsies during the late luteal phase of the pretreatment cycle and between days 15 and 24 of cycle 6. Subjects in group B had biopsies between days 15 and 24 of cycle 3 and during the late luteal phase of the post-treatment cycle. GTD 60 microg/EE 15 microg was taken for the first 24 days of a 28-day cycle, followed by placebo pills for 4 days, for a total of six cycles. RESULTS Data from 27 women were included in the analyses. Eleven of the 13 evaluable baseline biopsies were classified as secretory. Three of nine subjects with evaluable biopsies at cycle 3 and four of nine subjects with evaluable biopsies at cycle 6 had an atrophic endometrium. Post-treatment biopsies showed a typical secretory endometrium in seven of 11 subjects with evaluable biopsies. CONCLUSIONS The results of this study show that the 24-day regimen of GTD 60 microg/EE 15 microg produced effective endometrial suppression.
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MESH Headings
- Adult
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/adverse effects
- Contraceptives, Oral, Combined/pharmacology
- Contraceptives, Oral, Synthetic/administration & dosage
- Contraceptives, Oral, Synthetic/adverse effects
- Contraceptives, Oral, Synthetic/pharmacology
- Drug Administration Schedule
- Endometrium/drug effects
- Estrogens/administration & dosage
- Estrogens/adverse effects
- Estrogens/pharmacology
- Ethinyl Estradiol/administration & dosage
- Ethinyl Estradiol/adverse effects
- Ethinyl Estradiol/pharmacology
- Female
- Humans
- Menstrual Cycle/drug effects
- Norpregnenes/administration & dosage
- Norpregnenes/adverse effects
- Norpregnenes/pharmacology
- Time Factors
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Affiliation(s)
- H P Oosterbaan
- Bosch Medicentrum, Groot Ziekengasthuis, Den Bosch, The Netherlands
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Abstract
BACKGROUND Many hormonal contraceptives have been associated with changes in carbohydrate metabolism. Alterations may include decreased glucose tolerance and increased insulin resistance, which are risk factors for Type 2 diabetes mellitus and cardiovascular disease. These issues have been raised primarily with contraceptives containing estrogen. OBJECTIVES To evaluate the effect of hormonal contraceptives on carbohydrate metabolism in healthy women and those at risk for diabetes due to overweight. SEARCH METHODS In April 2014, we searched the computerized databases MEDLINE, POPLINE, CENTRAL, and LILACS for studies of hormonal contraceptives and carbohydrate metabolism. We also searched for clinical trials in ClinicalTrials.gov and ICTRP. The initial search also included EMBASE. SELECTION CRITERIA All randomized controlled trials were considered if they examined carbohydrate metabolism in women without diabetes who used hormonal contraceptives for contraception. Comparisons could be a placebo, a non-hormonal contraceptive, or another hormonal contraceptive that differed in drug, dosage, or regimen. Interventions included at least three cycles. Outcomes included glucose and insulin measures. DATA COLLECTION AND ANALYSIS We assessed all titles and abstracts identified during the literature searches. The data were extracted and entered into RevMan. We wrote to researchers for missing data. For continuous variables, the mean difference (MD) was computed with 95% confidence interval (CI) using a fixed-effect model. For dichotomous outcomes, the Peto odds ratio with 95% CI was calculated. MAIN RESULTS We found 31 trials that met the inclusion criteria. No new trials were eligible in 2014. Twenty-one trials compared combined oral contraceptives (COCs); others examined different COC regimens, progestin-only pills, injectables, a vaginal ring, and implants. None included a placebo. Of 34 comparisons, eight had any notable difference between the study groups in an outcome.Twelve trials studied desogestrel-containing COCs, and the few differences from levonorgestrel COCs were inconsistent. A meta-analysis of two studies showed the desogestrel group had a higher mean fasting glucose (MD 0.20; 95% CI 0.00 to 0.41). Where data could not be combined, single studies showed lower mean fasting glucose (MD -0.40; 95% CI -0.72 to -0.08) and higher means for two-hour glucose response (MD 1.08; 95% CI 0.45 to 1.71) and insulin area under the curve (AUC) (MD 20.30; 95% CI 4.24 to 36.36).Three trials examined the etonogestrel vaginal ring and one examined an etonogestrel implant. One trial showed the ring group had lower mean AUC insulin than the levonorgestrel-COC group (MD -204.51; 95% CI -389.64 to -19.38).Of eight trials of norethisterone preparations, five compared COCs and three compared injectables. In a COC trial, a norethisterone group had smaller mean change in glucose two-hour response than a levonorgestrel-COC group (MD -0.30; 95% CI -0.54 to -0.06). In an injectable study, a group using depot medroxyprogesterone acetate had higher means than the group using norethisterone enanthate for fasting glucose (MD 10.05; 95% CI 3.16 to 16.94), glucose two-hour response (MD 17.00; 95% CI 5.67 to 28.33), and fasting insulin (MD 3.40; 95% CI 2.07 to 4.73).Among five recent trials, two examined newer COCs with different estrogen types. One showed the group with nomegestrel acetate plus 17β-estradiol had lower means than the levonorgestrel group for incremental AUC glucose (MD -1.43; 95% CI -2.55 to -0.31) and glycosylated hemoglobin (HbA1c) (MD -0.10; 95% CI -0.18 to -0.02). Two trials compared extended versus conventional (cyclic) regimens. With a dienogest COC, an extended-use group had greater mean change in AUC glucose (MD 82.00; 95% CI 10.72 to 153.28). In a small trial using two levonorgestrel COCs, the lower-dose group showed smaller mean change in fasting glucose (MD -3.00; 95% CI -5.89 to -0.11), but the obese and normal weight women did not differ significantly. AUTHORS' CONCLUSIONS Current evidence suggests no major differences in carbohydrate metabolism between different hormonal contraceptives in women without diabetes. We cannot make strong statements due to having few studies that compared the same types of contraceptives. Many trials had small numbers of participants and some had large losses. Many of the earlier studies had limited reporting of methods.We still know very little about women at risk for metabolic problems due to being overweight. More than half of the trials had weight restrictions as inclusion criteria. Only one small trial stratified the groups by body mass index (obese versus normal).
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Affiliation(s)
- Laureen M Lopez
- FHI 360Global Health Research359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - David A Grimes
- University of North CarolinaDept. of Obstetrics and GynecologyChapel HillNorth CarolinaUSA
| | - Kenneth F Schulz
- FHI 360 and UNC School of MedicineQuantitative Sciences359 Blackwell Street, Suite 200Suite 200DurhamNorth CarolinaUSA27701
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Bermejo A, Iglesias C, Ruiz-Alonso M, Blesa D, Simón C, Pellicer A, García-Velasco J. The impact of using the combined oral contraceptive pill for cycle scheduling on gene expression related to endometrial receptivity. Hum Reprod 2014; 29:1271-8. [PMID: 24706003 DOI: 10.1093/humrep/deu065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alfonso Bermejo
- Instituto Valenciano de Infertilidad, Av. Del Talgo 68 (28023), Madrid, Spain
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Heijboer AC, Zimmerman Y, de Boer T, Coelingh Bennink H, Blankenstein MA. Peculiar observations in measuring testosterone in women treated with oral contraceptives supplemented with dehydroepiandrosterone (DHEA). Clin Chim Acta 2014; 430:92-5. [PMID: 24406275 DOI: 10.1016/j.cca.2013.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 12/24/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022]
Abstract
Total testosterone is considered to be decreased during the use of combined oral contraceptives. There is, however, considerable concern about the quality of testosterone assays, especially at low levels. We aimed to confirm testosterone levels measured by direct radioimmunoassay in a recent clinical trial with a state-of-the-art LC-MSMS method. Surplus specimens with known testosterone levels collected during the study (Clinical Trial Registration number ISRCTN06414473) were reanalyzed with an LC-MSMS method. This method was compared to another LC-MSMS method that had shown to concur excellently to a reference method. Follow-up experiments were designed to explain the results. In contrast to our expectation, LC-MSMS measurements did not corroborate the data obtained by radioimmunoassay. Subsequent experiments showed that this could be attributed to a strong dependency of the radioimmunoassay on SHBG. Testosterone results (n = 198) obtained by direct radioimmunoassay showed a negative correlation to SHBG levels (r = -0.676; p<0.001). By contrast, testosterone results obtained by LC-MSMS were not related to SHBG (r = 0.100; NS). In conclusion, our results indicate that total testosterone measurements during oral contraceptive use are unreliable when performed with assays sensitive to the SHBG concentration. The discrepancy with the literature can most likely be explained by the sensitivity of the immunoassay used to SHBG. Given the sharp increase in SHBG during the use of many oral contraceptives, total testosterone may not decrease, whereas its bioavailability, estimated by free testosterone levels, will be diminished. Studies aiming at restoration of testosterone homeostasis during oral contraception need to take this into account.
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Affiliation(s)
- Annemieke C Heijboer
- Department of Clinical Chemistry, VU University Medical Center Amsterdam, The Netherlands.
| | | | | | | | - Marinus A Blankenstein
- Department of Clinical Chemistry, VU University Medical Center Amsterdam, The Netherlands
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Ferrari S, Piacenti I, Napolitano A, Cagnacci A. [Pharmacological, metabolic and clinical aspects of new oral contraceptive associations containing natural estrogens]. Minerva Ginecol 2014; 66:91-102. [PMID: 24569408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Introduction of new compounds containing natural estrogens represented a major development in the field of hormonal contraception. Micronized estradiol (E2) and its estere valerate (EV), is more easily metabolized by the liver than ethynylestradiol (EE). This causes minimal metabolic impact, but the weak estrogenic activity needs not be antagonized by androgenic progestin and requires progestin capable to stabilize the endometrium. Dienogest (DNG), an antiandrogenic progestin with a short half-life, is associated with estradiol valerate (EV) in a quadriphasic fashion. In comparison to EE/levonorgestrel (LNG), EV/DNG is more neutral on metabolism and coagulation. Furthermore, it does not seem to negatively affect the cardiovascular system and breast. Cycle control is optimal with a higher prevalence of amenorrhea and reduction of menstrual flow. For this reason EV/DNG can be tehrapeutic for heavy menstrual bleedings. Nomegestrol acetate (NOMAc), an anti-andogen progestin with a long half-life is combined in monophasic regimen with micronized E2. E2/NOMAc is more neutral than EE/LNG on metabolism and more neutral than EE/DRSP on coagulation. NOMAc reduces peripheral tissue estrogen formation, and this may be beneficial for the breast. The two formulations exert a high contraceptive efficacy similar to the ones containing EE, but with less estrogen-related side-effects. The additional benefits due to DNG and NOMAc need to be further explored.
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MESH Headings
- Animals
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Agents, Female/pharmacology
- Contraceptives, Oral/administration & dosage
- Contraceptives, Oral/pharmacokinetics
- Contraceptives, Oral/pharmacology
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/pharmacokinetics
- Contraceptives, Oral, Combined/pharmacology
- Drug Design
- Estrogens/administration & dosage
- Estrogens/pharmacokinetics
- Estrogens/pharmacology
- Female
- Humans
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Affiliation(s)
- S Ferrari
- Unità Ginecologia e Ostetricia, Dipartimento di Scienze Mediche e Chirurgiche dell'Adulto e del Bambino, Azienda Ospedaliero Universitaria di Modena, Modena, Italia
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Clark PM. Defining the scope of Casey and Salzman's application of the rule of double effect to the therapeutic and prophylactic uses of combined oral contraceptives. Am J Bioeth 2014; 14:35-38. [PMID: 24978408 DOI: 10.1080/15265161.2014.922369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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50
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Lucke J. The prophylactic effects of intentional contraception. Am J Bioeth 2014; 14:38-39. [PMID: 24978409 DOI: 10.1080/15265161.2014.918207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jayne Lucke
- a LaTrobe University and University of Queensland
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