Risks of venous thromboembolic complications in related to combined oral contraceptives

Hormonal contraception is the most popular and effective reversible method for preventing unwanted pregnancy exerting multiple prophylactic and therapeutic effect along with contraceptive activity. The main adverse coupled to combined oral contraceptives (COCs) is its impact on the hemostasis and increased risk of venous thromboembolic complications. A great evolutionary path has been travelled after beginning application of hormonal contraception to reduce dose of its estrogen component and improving quality of gestagen component. Nevertheless, thrombotic complications related to COCs use still remain a pressing issue not only due to disease severity and high mortality rate from pulmonary embolism (PE), but also due to the difficulties in its timely diagnostics. Here we describe a clinical case of a 19-year-old patient suffering from vena cava inferior thrombosis complicated by PE after using COCs.

Analysis of contraceptive behavior of female athletes of reproductive age

The article presents the materials of a large-scale study devoted to the study of the contraceptive behavior of female athletes of reproductive age, representing different sports. It has been established that the most commonly used types of contraception, in all age categories, are: interrupted intercourse, spermicides, barrier contraception (male condoms), hormonal patches. The most rarely used are hormonal contraception (single-phase and three-phase combined oral contraceptives) and intrauterine contraception. It has been established that the choice of a particular type of contraception among athletes is determined by such leading factors as sexual activity, frequency of sexual contacts, the number of sexual partners, the presence or absence of a family and marriage.

Hubungan antara Penggunaan Kontrasepsi Hormonal dengan Kejadian Hipertensi pada Wanita Usia Subur di Indonesia (Analisis Data Indonesian Family Life Survey 5)

Background: The incidence of hypertension in women is 36.9%, allegedly related to hormonal changes triggered by the use of hormonal contraceptives. This study aims to analyze the relationship between the use of hormonal contraception on the incidence of hypertension in women of childbearing age. Methods: This cross-sectional study used IFLS 2014 data and involved 7,097 participants who were selected using multistage random sampling technique. The research variables included age, education, work status, physical activity, stress, use and length of time being a hormonal family planning acceptor, work status, blood pressure and obesity. Data analysis was carried out descriptively and analytically using logistic regression. Results: The incidence of hypertension reached 27.2%, and the multivariate analysis showed the significant correlation with age and duration of hormonal contraceptive use (p=0.000; PR=2.809; 95%-CI=2.516-3.136 and p=0.000; PR=1.002; 95% -CI=1.001-1.003). Conclusion: The incidence of hypertension in hormonal contraceptive users is related to age and period of use. Hormonal family planning acceptors need to regularly control blood pressure with age to monitor the incidence of hypertension.

Oncological issues of hormonal contraception and hormone replacement therapy

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.

Hormonal contraception for women with type 1 diabetes

The investigation demonstrates the influence ofperoral combined contraceptives and preparations containing only progestagens on carbohydrate and lipid exchange and haemostatic system. The factors, which exert influence upon metabolic indices in women with type I insular diabetes, are estimated. The correlation between the intake of combined and containing only progestagens contraceptive preparations and the risk of tromboembolism is revealed. The indications and contraindications are defined for the prescription of peroral contraceptives in women with type I insular diabetes.

The results of immunohistochemical study of signaling pathways’ markers of proliferation in uterine leiomyoma in women using hormonal contraception.

Objective. To elucidate the influence of various components of hormonal contraception in women with uterine leiomyoma (UL) on the key molecular and cellular mechanisms of its proliferation. Methods. Antigen Ki-67, estrogen receptors (ER) and progesterone receptors (PR) were determined by immunohistochemical methods in 230 samples of UL preparations obtained during myomectomy. Depending on the composition of the components of hormonal contraceptives that women used for 12 months before the operation, 8 study groups were created: Group I - control, without the use of any hormonal contraception; Group II - the use of COCs containing 20 μg of ethinylestradiol and 0.075 mg of gestaden; Group III - COCs (30 μg ethinylestradiol and 0.075 mg gestaden) Group IV - COCs (30 μg ethinylestradiol and 0.15 mg desogestrel) Group V - COCs (30 μg ethinyl estradiol and 0.15 mg levonorgestrel) Group VI - COCs (30 μg ethinyl estradiol and 2 mg dienogest) Group VII - COCs (30 μg ethinylestradiol and 3 mg drospirenone) Group VIII - (intrauterine levonorgestrel releasing system (IUD-LNG). Results. In UL samples from group I, an increase of Ki-67 positive cells in 3.4 times was observed (3.1 ± 0.03%; p <0.04) in comparison with intact myometrium (IM) (0.9 ± 0.06%), which is evidence of a higher cell proliferation in the UL, a 3.1-fold increase in the H-index of ER expression - 39.4 ± 4.3 (p <0.05) versus 12.9 ± 1.6 in the group with IM I and in 2.6 times of PR expression - 21.1 ± 1.7 (p <0.05) compared to IM - 8.2 ± 1.4, which may indicate a greater sensitivity of UL to sex hormones and their promoter role in UL proliferation. Expression of Ki-67 in UL samples in women taking COCs, which included dienogest (1.8 ± 0.03%, p <0.05) - group VI and desogestrel (1.9 ± 0.03%, p <0.05) - group IV, was, 42.0% and 38.8% respectively, what ois less than in group I UL, which can be regarded as the cytoprotective effect of the progestogen component of COC on the mitotic activity of UL cells. A positive trend in the expression of Ki-67 persisted when women used COCs containing gestodene (2.1 ± 0.02%; p <0.05) - group III and levonorgestrel (2.2 ± 0.04%, p <0.05) - group V, in which the expression of Ki-67 was shown by a smaller number of PM cells, respectively, by 32.3% and 25.8% than in group I PM, and also to a lesser extent - in group VIII (COC with droperidone), where the mean value of Ki-67 expression in LM samples was 2.6 ± 0.02% and was 16.9% less than in LM group I. An increase in the dose of ethinyl estradiol in COCs from 20 μg (group II) to 30 μg (group III) did not significantly affect the expression of Ki-67, therefore, the content of estrogens in modern low-dose COCs does not contribute to an increase in proliferation in the LM, and the non-contraceptive antiproliferative effect is associated exclusively with biological and the pharmacological properties of individual gestagens in the composition of COCs. It was proved that the studied COCs did not significantly affect the expression of ER and PGR. There was no significant difference in the expression of the Ki-67 marker (2.9 ± 0.04%, p <0.05) in UL cells in women using LNG-IUD for contraception, compared with group I. Conclusion. The results of the study have shown that when choosing a drug for hormonal contraception in women with UL, preference should be given to combined hormonal drugs that contain progestogens with the most pronounced antiproliferative properties (dienogest, desogestrel and levonorgestrel).

Hormonal Contraceptive Use Related to Menopausal Age

The change in the pattern and timing of menopause is an exciting and exploratory phenomenon that requires more detailed research to be carried out using hormonal contraception. This study was aimed to explore the relationship between hormonal contraceptive use and menopausal age. This study used a cross-sectional design. The study was conducted at Royal Prima General Hospital Medan from May to August 2021. A total of 68 research subjects participated in this study with the following inclusion criteria: menopausal women, aged 50-60 years, using hormonal contraceptives (pills, injections, implants), able to remember history previous contraceptive use. This study uses primary data obtained directly from guided interviews with respondents. Participants were dominated by ≥ 55 years old women with 57 people (83.81%), 62 Muslims (91.2%), menarche age >13 years as many as 28 people (41.2%). The number of children 2-4 were 32 people (47.1%) with an average menopause age of 51.93 and the smallest for 1 was 8 people (11.8%) with an average menopause age of 50.37. There were 49 users of hormonal contraception (72.1%) and 48 people (70.6%). In conclusion, we found that the use of hormonal contraceptives is significantly related to menopausal age.

Immobility due to COVID-19 confinement, use of contraceptives and presence of the G20210A mutation. Validity of the Virchow triad for the presentation of Deep Venous Thrombosis and Pulmonary Thromboembolism.

Venous thromboembolic disease is a complex and multifactorial pathology, the result of the interaction of both genetic and environmental factors. The Virchow triad, first described in 1859, is still valid to explain the pathogenesis of thrombosis, where three main factors are reflected: a) hypercoagulable state; b) impaired blood flow; c) endothelial injury. The outbreak of a new COVID-19 pandemic has led to drastic confinement measures, with the consequent syndrome of immobility, as occurred in Spain between the months of March to June 2020. Pregnancy and hormonal contraception have proven to be an environmental factor predisposing to venous thrombosis. The presence of genetic factors, such as the mutation of the prothrombin gene G20210A, has been shown to be a risk factor for the presentation of venous thrombosis. We present the case of a 23-year-old non-smoking woman, a heterozygous carrier of a prothrombin gene mutation G20210A (hypercoagulability), who after confinement due to COVID-19 (impaired blood flow due to immobility) and use of hormonal patch contraceptives (endothelial abnormality), triggered deep vein thrombosis (DVT) / pulmonary thromboembolism (PE) that required hospital admission; and who, after rapid withdrawal of anticoagulant treatment, presented a second and a third episode of DVT. We highlight the usefulness of evaluating risk factors in G20210A heterozygous patients and the proper management of anticoagulation to avoid recurrences in patients susceptible to DVT / PE.