scholarly journals Association between contemporary hormonal contraception and ovarian cancer in women of reproductive age in Denmark: prospective, nationwide cohort study

BMJ ◽  
2018 ◽  
pp. k3609 ◽  
Author(s):  
Lisa Iversen ◽  
Shona Fielding ◽  
Øjvind Lidegaard ◽  
Lina S Mørch ◽  
Charlotte W Skovlund ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Relative Risk ◽  
Hormonal Contraception ◽  
Reproductive Age ◽  
Hormonal Contraceptives ◽  
Ovarian Cancer Risk ◽  
Women Of Reproductive Age ◽  
Ovarian Cancers ◽  
Study Population ◽  
Combined Hormonal Contraceptives

AbstractObjectivesTo 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.DesignProspective, nationwide cohort study.SettingDenmark, 1995-2014.ParticipantsAll 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 measuresPoisson 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.ResultsDuring 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.ConclusionsUse 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.

Progestogen-only pills: which progestogen would be ideal

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Christian Egarter
Keyword(s):  
Myocardial Infarction ◽  
Animal Studies ◽  
Reproductive Age ◽  
Hormonal Contraceptives ◽  
Women Of Reproductive Age ◽  
Thromboembolic Risk ◽  
Future Studies ◽  
Risk Increase ◽  
Increased Risk ◽  
Combined Hormonal Contraceptives

AbstractCompared with nonuse, combined hormonal contraceptives containing estrogen and a progestogen are associated with a roughly 2- to 3-fold increased risk of venous and a 2-fold increased risk of arterial thromboembolism, including stroke and acute myocardial infarction. These events are, however, overall rare among women of reproductive age. Historically, progestin-only pills were not thought to be linked with any thromboembolic risk increase. Therefore, these preparations may be valuable options in women who are ineligible to take combined hormonal contraceptives. Until recently, only progestogens with partial androgenic activities were available. As demonstrated in animal studies, more modern progestogens such as drospirenone with its anti-mineralocorticoid effects may be associated with even more favorable aspects, which have to be clinically demonstrated, however, in future studies.

scholarly journals The use of emergency hormonal contraception in South Africa: current and future perspectives

2019 ◽  
Vol 61 (2) ◽  
pp. 46-48 ◽  
Author(s):  
N. Dahan-Farkas ◽  
M. Vally
Keyword(s):  
South Africa ◽  
Side Effects ◽  
Hormonal Contraception ◽  
Reproductive Age ◽  
Hormonal Contraceptives ◽  
Unprotected Intercourse ◽  
Future Perspectives ◽  
Women Of Reproductive Age ◽  
Unplanned Pregnancies ◽  
Emergency Contraceptive

Emergency hormonal contraceptives play an important role in preventing unplanned pregnancies in South Africa. In this review, we discuss the levonorgestrel emergency contraceptive, the combined estrogen and progestin regimen (also known as the Yuzpe method) and the use of Ulipristal acetate. The levonorgestrel and the combined estrogen, progestin regimen are available in South Africa. The specific mechanisms of action of each of these emergency hormonal contraceptives will be discussed as well as their efficacy, the side effects associated with each of these preparations and the drug interactions. Levonorgestrel can be used as a single dose (1.5 mg) instead of two doses (0.75 mg) 12 hours apart. Levonorgestrel is very effective, with fewer adverse effects than the combined estrogen and progestogen administration. Levonorgestrel and the Yuzpe method have demonstrated good efficacy when utilised within 72 hours after unprotected intercourse or contraceptive failure. These emergency hormonal contraceptives should not be used as regular contraception. It is essential that all health professionals and educators inform women of reproductive age about the risks and common side effects of emergency hormonal contraceptives.

scholarly journals Relationship between hormonal contraceptives and sleep among women of reproductive age: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e045819
Author(s):  
Jinhui Ma ◽  
Megan Cheng ◽  
Lehana Thabane ◽  
Caihong Ma ◽  
Ning Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Research Question ◽  
Risk Of Bias ◽  
Reproductive Age ◽  
Hormonal Contraceptives ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Women Of Reproductive Age

IntroductionThe aetiology of sleep disruptions is unknown, but hormonal fluctuations during the menstrual cycle, pregnancy and menopause have been shown to potentially affect how well a woman sleeps. The aim of this systematic review was to investigate whether hormonal contraceptives are associated with a decreased quality of sleep and increased sleep duration in women of reproductive age.MethodsThis review will analyse data from randomised controlled trials or non-randomised comparative studies investigating the association between hormonal contraceptives and sleep outcomes among women of reproductive age. Reviews addressing the same research question with similar eligibility criteria will be included. A literature search will be performed using the MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases from inception to 7 March 2021. The Cochrane Collaboration’s Risk of Bias for Randomised Trials V.2.0 and The Risk of Bias for Non-randomised Studies of Interventions tool will be used to assess risk of bias for each outcome in eligible studies. Two reviewers will independently assess eligibility of studies and risk of bias and extract the data. All extracted data will be presented in tables and narrative form. For sleep measures investigated by two or more studies with low heterogeneity, we will conduct random-effects meta-analysis to estimate the magnitude of the overall effect of hormonal contraceptives. If studies included in this systematic review form a connected network, a network meta-analysis will be conducted to estimate the comparative effect of different contraceptives. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to summarise the quality of evidence. Our protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015 guidelines.Ethics and disseminationEthics approval is not required as data were sourced from previously reported studies. The findings of this review will be published in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration numberCRD42020199958.

Combined hormonal contraception and risk of venous thromboembolism within the first year following pregnancy

2014 ◽  
Vol 112 (07) ◽  
pp. 73-78 ◽  
Author(s):  
Thomas Bergholt ◽  
Anne Nielsen ◽  
Michael J. Paidas ◽  
Ellen Christine L. Løkkegaard ◽  
Jesper Petersen
Keyword(s):  
Venous Thromboembolism ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
First Year ◽  
The Difference ◽  
Combined Hormonal Contraception ◽  
One Year ◽  
First Time ◽  
Combined Hormonal Contraceptives

SummaryEstimating the risk of venous thromboembolism (VTE) associated with combined hormonal contraceptives following early terminated pregnancies or birth, a Danish nationwide retrospective cohort observing a one-year follow-up was defined using three unique registries. All Danish women with confirmed pregnancies aged 15–49 during the period of 1995–2009 were included. The main outcomes were relative and absolute risks of first time venous thromboembolism in users as well as non-users of combined hormonal contraceptives. In 985,569 person-years, 598 venous thromboembolisms were recorded. After early terminated pregnancies and births, respectively, 113 and 485 events occurred in 212,552 and 773,017 person-years. After early terminated pregnancies, the crude VTE incidence ratios were similar, and the numbers needed to harm were equal between groups that did or did not use combined hormonal contraceptives throughout the follow-up year. After childbirth, individuals that used combined hormonal contraceptives were more likely than non-users to experience VTE depicted by crude incidence ratios; however, the difference was only significant after 14 weeks. This implied that the numbers needed to harm were lower for those that used compared to those that did not use combined oral contraceptives in the initial 14 weeks postpartum. In conclusion, the use of combined hormonal contraceptives after early terminated pregnancies was not detrimental, but during the puerperal period, they should be used with caution.

Oncological issues of hormonal contraception and hormone replacement therapy

2021 ◽  
Vol 50 (4) ◽  
pp. 83-89
Author(s):  
A. F. Urmancheeva ◽  
G. F. Kutusheva
Keyword(s):  
Replacement Therapy ◽  
Hormone Replacement ◽  
Hormonal Contraception ◽  
Epidemiological Studies ◽  
Hormonal Contraceptives ◽  
Ovarian Cancer Risk ◽  
Considerable Decrease ◽  
Female Population ◽  
Clinical Investigations ◽  
Oncologic Patients

The article gives critical analysis of numerous epidemiological studies touching upon the problems of carcinogenesis while using hormonal contraception and hormonal replacement therapy and also the expediency of HRT as to oncologic patients after radical treatment.The materials presented testify to relative carcinogenous safety of hormonal contraceptives as to the majority of tumors and even considerable decrease of endometrial and ovarian cancer risk; but some investigations point to the increase о f breast cancer in case о f prolonged application о f hormonal preparations.The results оf the analysis show that HR Tmay be recommended among female population providing active screening, especially of mammary glands and endometrium. Besides that, hormonal preparations are not excluded for rehabilitation of some oncologic patients underthorough monitoring. Yet, there exists burning necessity of continuing cooperated scientific and clinical investigations forfurther studying oncologic aspects of hormonal contraception and HRT.

scholarly journals Genetic Predisposition to Breast and Ovarian Cancers: How Many and Which Genes to Test?

2020 ◽  
Vol 21 (3) ◽  
pp. 1128 ◽  
Author(s):  
Davide Angeli ◽  
Samanta Salvi ◽  
Gianluca Tedaldi
Keyword(s):  
Ovarian Cancer ◽  
Genetic Predisposition ◽  
Genetic Disorders ◽  
Molecular Techniques ◽  
Ovarian Cancer Risk ◽  
Brca1 And Brca2 ◽  
New Genes ◽  
Ovarian Cancers ◽  
Genes Encoding ◽  
Predisposition Genes

Breast and ovarian cancers are some of the most common tumors in females, and the genetic predisposition is emerging as one of the key risk factors in the development of these two malignancies. BRCA1 and BRCA2 are the best-known genes associated with hereditary breast and ovarian cancer. However, recent advances in molecular techniques, Next-Generation Sequencing in particular, have led to the identification of many new genes involved in the predisposition to breast and/or ovarian cancer, with different penetrance estimates. TP53, PTEN, STK11, and CDH1 have been identified as high penetrance genes for the risk of breast/ovarian cancers. Besides them, PALB2, BRIP1, ATM, CHEK2, BARD1, NBN, NF1, RAD51C, RAD51D and mismatch repair genes have been recognized as moderate and low penetrance genes, along with other genes encoding proteins involved in the same pathways, possibly associated with breast/ovarian cancer risk. In this review, we summarize the past and more recent findings in the field of cancer predisposition genes, with insights into the role of the encoded proteins and the associated genetic disorders. Furthermore, we discuss the possible clinical utility of genetic testing in terms of prevention protocols and therapeutic approaches.

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