The combined oral contraceptive pill

The combined oral contraceptive pill (COCP) has been a popular choice of contraception since it was first introduced in 1961. There are numerous varieties of COCP and tailored regimes allow patients more choice and opportunities to adapt contraception to suit individual needs. The pandemic has made it more difficult for patients to access long-acting reversible contraception support and many have been using interim methods of contraception, including the COCP. In this article we explore which pill to prescribe, developments in tailored regimes, guidance about changing pills when side effects arise, health risks and benefits, as well as best practice for remote assessments and prescribing.

Frekuensi Hubungan Seksual dan KB Pil Kombinasi terhadap Terjadinya Erosi Portio pada Wanita Pasangan Usia Subur

Portio erosion is a wound or inflammation of the cervix (portio). Inflammation can be caused by hormonal changes, during pregnancy, contraceptive pill use, installation and removal of IUDs, and lack of personal hygien. This erosion can bleed easily and cause bleeding or metrorrhagia. This study aims to determine the relationship between the frequency of sexual relations and the use of the combined oral contraceptive pill to erosion of portion in reproductive women. This research is an analytic study with a cross sectional design with accidental sampling. Data collection was carried out using interviews and direct observation. Data analysis by a cross tabulation with Spearman Rank test through SPSS software. The results obtained are severe portio erosion covering more than 2/3 of the total cervical area of ​​8 women (53%) based on the frequency of sexual intercourse, and mild portio erosion covers less than 1/3 of the total cervical area of ​​10 women (67%) based on the combined oral contraceptive pill. The study concludes that the frequency of sexual intercourse affected the incidence of portio erosion. The use of the combined oral contraceptive pill has affected the incidence of portio erosion in the POSKESDES Binor Paiton Probolinggo. The results of this study are input for women of childbearing age who are sexually active and use combined pill contraceptives to be more aware of the health of their reproductive organs by routinely performing an IVA or Pap smear at least once a year.

Acute Nonatherosclerotic Coronary Thromboembolism Presenting with an Inferior STEMI in a Patient on Oral Contraception

Background. Direct coronary embolism in the setting of oral contraceptive pill (OCP) use is a rare adverse effect. It is known for OCP to increase the risk of thrombosis; however, leading to an inferior ST elevated myocardial infarction (STEMI) due to an acute occlusive embolism is a rare entity. Coronary embolism occurs in about 3% of patients with acute coronary syndrome. Case Report. We present a case of a young 41-year-old female with a past medical history significant for dysfunctional uterine bleeding on oral contraceptive pills, who presented to the hospital with chest pain. Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. The patient was taken emergently to the cardiac catheterization lab. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations. Conclusion. Coronary embolism is rare and often not considered in the differential of acute coronary syndrome. It is of utmost importance for clinicians to keep a wide differential of nonatherosclerotic causes of STEMI especially when the patient is young, without significant cardiac risk factors.

Norethisterone-induced cholestasis: A case report

Case presentation: This case report concerns a 49-year-old woman who developed norethisterone drug -induced cholestasis, a progestin contraceptive, which is quite rare complication generally observed with estrogenic component of combined oral contraceptive pill.

Early detection of pancreatic ductal adenocarcinomas with an ensemble learning model based on a panel of protein serum biomarkers

Earlier detection of pancreatic ductal adenocarcinoma (PDAC) is key to improving patient outcomes, as it is mostly detected at advanced stages which are associated with poor survival. Developing non-invasive blood tests for early detection would be an important breakthrough. The primary objective of the work presented here was to use a unique dataset, that is both large and prospectively collected, to quantify a set of 96 cancer-associated proteins and construct multi-marker models with the capacity to accurately predict PDAC years before diagnosis. The data is part of a nested case control study within UK Collaborative Trial of Ovarian Cancer Screening and is comprised of 219 samples, collected from a total of 143 post-menopausal women who were diagnosed with pancreatic cancer within 70 months after sample collection, and 248 matched non-cancer controls. We developed a stacked ensemble modelling technique to achieve robustness in predictions and, therefore, improve performance in newly collected datasets. With a pool of 10 base-learners and a Bayesian averaging meta-learner, we can predict PDAC status with an AUC of 0.91 (95% CI 0.75 - 1.0), sensitivity of 92% (95% CI 0.54 - 1.0) at 90% specificity, up to 1 year to diagnosis, and at an AUC of 0.85 (95% CI 0.74 - 0.93) up to 2 years to diagnosis (sensitivity of 61%, 95 % CI 0.17 - 0.83, at 90% specificity). These models also use clinical covariates such as hormone replacement therapy use (at randomization), oral contraceptive pill use (ever) and diabetes and outperform biomarker combinations cited in the literature.

Treatment of endometriosis: a review with comparison of 8 guidelines

Background Endometriosis, the presence of endometrial-like tissue outside the uterus, is a common clinical entity between women of reproductive age, with a prevalence of about 10%. Due to the variety of endometriosis-associated symptoms, a great variety of treatments have been implemented. The aim of this review is to give an overview on therapeutical approaches of eight national and international widely used guidelines. Methods Six national (College National des Gynecologues et Obstetriciens Francais, National German Guideline (S2k), Society of Obstetricians and Gynaecologists of Canada, American College of Obstetricians (ACOG) and Gynecologists, American Society for Reproductive Medicine (ASRM) and National Institute for Health and Care (NICE) and two international (World Endometriosis Society, European Society of Human Reproduction and Embryology) guidelines are included in this review. Conclusion All the above-mentioned guidelines agree that the combined oral contraceptive pill, progestogens are therapies recommended for endometriosis associated pain. Concerning infertility, there is no clear consensus about surgical treatment. Discrepancies are also found on recommendation of the second- and third-line treatments.

Demographic information and risk factors of stroke patients younger than 65 years old

Objective: The main objective of this study is to evaluate the prevalence of risk factors for and demographics of patients younger than 65 years old with stroke. Methods: This retrospective cross-sectional study took into consideration all patients younger than 65 years old who were admitted to the emergency department from 2016 to 2018. Some significant criteria such as age, sex, type of stroke, stroke risk factors, and modified Ranking Scale (mRS) were extracted from patients’ medical records. Based on their age, these patients were divided into three groups: younger than 35 years old (Group A), between 35-50 years old (Group B), and older than 50 years old (Group C). Data analysis was carried out using IBM® SPSS® Statistics 20.0 software. Results: A total of 392 patients with stroke were included in this study. Groups A, B, and C included 31, 124, and 237 patients, respectively. Among them, 313 patients (79.84%) were admitted to the hospital in cold seasons, while 73 patients (18.6%) had no symptoms related to stroke at the time of admission. The most common adjustable risk factor among the patients was hypertension (HTN) with a frequency of 230 (58.7%). Of note, the frequency of HTN, diabetes, atrial fibrillation (AF), oral contraceptive pill (OCP) consumption, and coronary artery disease (CAD) in patients was significantly different among these three groups. Conclusion: According to the findings of the present study, the prevalence rate of stroke probably varies for male and female (gender) in the studied groups, which is significantly correlated with age. Among the adjustable risk factors for stroke, HTN, diabetes, AF, OCP consumption, and CAD are significantly correlated with the age.

Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study

Background Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don’t use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women, with and without chronic disease, and investigated factors which influenced contraceptive use over time. Methods Using data from 15,244 young women from the Australian Longitudinal Study on Women’s Health (born 1989-95), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease. Results Differences in contraceptive use over time were found for women with cardiac disease, those with autoinflammatory diseases. Compared to women without chronic disease using the pill alone, women with cardiac disease had double the odds of using ‘other’ low efficacy contraception and condoms (OR=2.2, 95% CI: 1.34-3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR=1.39, 95% CI: 1.03-1.89). Women with autoinflammatory disease had increased odds of using LARC and condoms (OR=1.58, 95% CI: 1.04-2.41), using ‘other’ low efficacy contraception and condoms (OR=1.69, 95% CI: 1.11-2.57), and using combined oral contraceptive pill and condom use (OR=1.38, 95% CI: 1.09-1.75), compared to women without chronic disease using the pill. There was little evidence to suggest that contraceptive patterns differed for women with asthma or diabetes from women without chronic disease. Conclusion The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between healthcare providers and women with chronic disease to improve young women’s contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.