Association of 12-Month Contraceptive Supply Policy and Months of Oral Contraception Prescribed by Obstetrics and Gynecology Physicians: An Exploratory Cross-Sectional Study

Objective This study sought to determine if there was a difference in the months of oral contraception prescribed by physicians living in U.S. states with a 12-month supply policy compared to physicians in states without a policy. Methods We conducted an exploratory descriptive study using a convenience sample of Obstetrics & Gynecology resident physicians (n=275) in the United States. Standard bivariate analyses were used to compare the difference between groups. Results Few physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (p<0.05). Conclusions The majority of physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12-months of contraception, regardless of whether they lived in a state with a 12-month contraceptive supply policy. Physician education may be needed to effectively implement 12-month contraceptive supply policies.

Prevalence of anxiety and its associated factors among infertile patients after ‘two-child’ policy in Chongqing, China: a cross-sectional study

Background With the prevalence of infertility increasing every year around the world, it has seriously impacted the individual quality of family and social life. Anxiety is one of the most prevalent anxiety disorders among infertile patients. After the two-child policy, whether it affected the prevalence of anxiety is controversial. This study aimed to determine the prevalence of anxiety and its potential risk factors among Chinese infertile women after the enforcement of ‘two-child policy’. Methods This cross-sectional study included 693 infertile patients in a reproductive medical center in Chongqing, China, between February 2016 and December 2018. Data was collected by Self-filling questionnaires including basic demographic information and the Generalized Anxiety Disorder-7 (GAD-7). SPSS statistical software (IBM SPSS version 25) was used to analyse the obtained data. Descriptive analysis was used to describe basic information and anxiety scores, the chi-square test and binary logistic regression were used to analyse the relationship between anxiety and other variables. Results The prevalence of anxiety among total infertile patients was 21.8%, and its 23.5% among first-child infertile patients (FI), and 18.4% among second-child infertile patients (SI) respectively (P > 0.05). Binary logistic regression showed that patients with lower education levels were more likely to have anxiety (P < 0.01). Patients with middle salary incomes were more likely to have anxiety (OR = 1.860, 95% CI: 1.068–3.238). Oral contraception taking history (OR = 1.778, 95% CI: 1.186–2.667), and history of allergy (OR = 2.098, 95% CI: 1.219–3.612) were associated with anxiety. Conclusions Under the full liberalization of the “two-child policy”, the total prevalence of anxiety among Chinese infertile female is comparatively high. Low education levels, middle incomes, oral contraception taking and allergy history can be the related risk factors of anxiety. We promote that all infertile patients should be evaluated for the prevalence of anxiety, especially those with potential risks, and receive consultant or targeted treatment when needed.

An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

Functional Ovarian cysts: Expectant management versus Oral contraceptives

Background: Ovarian cyst is a common problem in females of reproductive age group. Objective: To compare the expectant management and use of oral contraceptives for the management of ovarian cysts. Methodology: This was a comparative study, conducted in the department of Obstetrics and Gynecology, Sheikh Zayed Medical College, Rahim Yar Khan, from January 2017 to December 2018. A total of 870 females were included through non-probability, purposive sampling. Informed verbal consent was obtained. Ultrasound was performed to measure the cyst size, site, and characteristics. The lottery method was used to divide the patients into two groups. Patients in group E received expectant treatment (placebo) and in group OC, patients were prescribed hormonal treatment with combined oral contraceptive (COCP) having ethinyl estradiol 0.03mg and levonorgestril 0.15mg. Then patients were counseled and followed up for one month. After one month, USG was performed again to measure success as cyst resolution. The collected data was analyzed into SPSS 16. Both groups were compared for success by using the chi-square test, taking p-value <0.05 as significant. Results: Mean age of females was 26.42±7.59 years. There were 488 (56%) married females while 382 (44%) were unmarried. Mean cyst size was 3.93±1.28cm. was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. Success (Cyst resolution) was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. (p=0.00). Conclusion: It was concluded that oral contraceptives are more effective and successful in the resolution of ovarian cysts as compared to expectant management.

Combined oral contraception and treatment of new coronavirus infection (COVID-19): drug interaction issues

Combined oral contraception and treatment of new coronavirus infection (COVID-19): issues of drug interaction This article examines the interaction of combined oral contraceptives with drugs recommended in the treatment of new coronavirus infection (COVID-19) at the pharmacodynamic and pharmacokinetic levels, with an assessment of the effectiveness and safety of therapy for the female body.

A Systematic Review and Meta-Analysis Examining Whether Changing Ovarian Sex Steroid Hormone Levels Influence Cerebrovascular Function

Sex differences in cerebrovascular disease rates indicate a possible role for ovarian sex steroid hormones in cerebrovascular function. To synthesise and identify knowledge gaps, a systematic review and meta-analysis was conducted to assess how ovarian sex steroid hormone changes across the lifespan affect cerebrovascular function in women. Three databases (EMBASE, MEDLINE and Web of Science) were systematically searched for studies on adult cerebrovascular function and ovarian sex steroid hormones. Forty-five studies met pre-defined inclusion criteria. Studied hormone groups included hormone replacement therapy (HRT; n = 17), pregnancy (n = 12), menstrual cycle (n = 7), menopause (n = 5), oral contraception (n = 2), and ovarian hyperstimulation (n = 2). Outcome measures included pulsatility index (PI), cerebral blood flow/velocity (CBF), resistance index (RI), cerebral autoregulation, and cerebrovascular reactivity. Meta-analysis was carried out on HRT studies. PI significantly decreased [−0.05, 95% CI: (−0.10, −0.01); p = 0.01] in post-menopausal women undergoing HRT compared to post-menopausal women who were not, though there was considerable heterogeneity (I2 = 96.8%). No effects of HRT were seen in CBF (p = 0.24) or RI (p = 0.77). This review indicates that HRT improves PI in post-menopausal women. However, there remains insufficient evidence to determine how changing ovarian sex steroid hormone levels affects cerebrovascular function in women during other hormonal phases (e.g., pregnancy, oral contraception).